Discover and read the best of Twitter Threads about #medthread

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How frequently do you round on each labour epidural patient?

#CASAM2022 #OBAnes
This afternoon at #CASAM2022 @ammunro2 & myself will talk about the management of labour epidurals to reduce failure #LaborDoesntHaveToHurt #OBAnes

There are some QI indicators to guide our work
Great evidence informed recommendations from @ammunro2 today to manage the failed catheter for cesarean at #CASAM2022 • honoured to shared the stage with her and @CAS_OBSection Chair @ValZaph
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Join me for a #dermtwitter #tweetorial on:


#MedEd #FOAMEd #medstudenttwitter #MedTwitter

Let's start ourselves off with a question: Which one of the following conditions will lead to scarring?
The correct answer is Pyoderma Gangrenosum! This illustrates a quick first point - scarring only occurs if you damage the skin into dermis and beyond. Epidermal damage heals without scarring, which is why the first 3 don't lead to scarring!
So what exactly is a scar?

Scarring is a normal part of healing that at its root, is extra collagen laid down to repair skin injury.

However, sometimes the process gets out of hand and exuberant which leads to hypertrophic scars (pic 1) keloids (pic 2)!
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Hi #dermtwitter/#medtwitter! Our last (for now!) #tweetorial/#medthread on nails! This time it’s...


Education from @naildisorders and the @jmervak team!

@societypedsderm @PeDRAResearch #medstudenttwitter #medtwitter #meded #FOAMed
Beau’s lines (transverse ridge) and onychomadesis (nail shedding) common in kids! Often seen in a post-viral setting.

Common culprit = hand foot mouth disease!
Congenital malalignment of the great toenails – lateral deviation of the first toenails. More common than you think. Start looking at more toes and you’ll see it! Can improve with time or persist. Risk for nail thickening or ingrown nails.

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Join me for a quick #tweetorial/#medthread on:

Pearls for the #Dermatology Exam!

#MedEd #dermtwitter #medtwitter #medstudenttwitter #FOAMed

First a question - What do you think when someone asks for your help with a rash?
Regardless how you answered, I hope to teach you something today! Let's start!

"In #dermatology, we don't do an H+P, we do a P+H."

The exam is perhaps most important. You can use it to narrow down your ddx! Then, you use your history to further work toward the right dx.
"If there's scale, there probably is epidermal involvement."

Scale usually implies action in the epidermis. This doesn't rule out anything in the dermis or subcutis, but just that the pathology includes action up top.

Check out my #tweetorial on scale
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Hi #dermtwitter! Back for another #tweetorial/#medthread on nails! Today we’re learning about:

ONYCHOMYCOSIS- nail fungus!
This is THE most common nail condition- so follow along!
Education from @naildisorders
#medstudenttwitter #medtwitter #meded #FOAMed
Onychomycosis is more common in adults than kids.
Trauma, diabetes, immunosuppression, tinea pedis, psoriasis, and family history are some risk factors

Pro tip- check the feet for tinea pedis if you suspect onychomycosis!

Patients with onychomycosis present with nail discoloration (yellow to brown), onycholysis (nail separation), nail brittleness, or nail thickening.

The big toenail is most frequently affected.

Fingernail involvement without also have toenail involvement is uncommon.
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🥳 Tooting my own horn 🥳

Just got back from a 1-week road trip vacation and learned... 3 papers were published while I was away!

Here's a quick #medthread 🧵about an epic week of publishing w/friends—what we learned, and what we created!
#AcademicTwitter #patientresearchers
Have you ever been asked to peer-review a manuscript and wondered if you were "doing it right?"

You are me.

@crblease & I published a template to help organize the thoughts of newbie reviewers (including patients).…
#academictwitter #patientresearchers A step-by-step guide to peer review: a template for patients
Now that #opennotes are mandatory, will clinician documentation change?

Rahimian et al., analyzed 143,888 notes from 60 #hemonc clinicians from 2012-16, before AND after introduction of open notes.

TL;DR: Notes became longer AND easier to read.🤔…
#hemonc Open notes sounds great, but will a provider’s documentati
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3/ Clot is in a constant state of evolution. #Fibrin—> #Collagen.
Unfortunately many patients present in the subacute or late phase of #clot development which hinders many of our treatment approaches.
7️⃣days- 20% collagen

1️⃣5️⃣ days- 50% collagen

2️⃣1️⃣days- 80% (!!) collagen
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1/ Welcome to the first part of a #Tweetorial series on #VenousDisease.

🩸To begin how about we talk about the main player in the game- C.L.O.T. (and why you should care about it)

#Cardiotwitter #Irad #fellows #fellowtwitter #medthread #clot #medtwitter #clottwitter
3/ All clots ARE NOT born equally! There is a difference! Image
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🔥I am excited to share the outstanding interim results from #FLASH registry that were presented yesterday at #SIR2021!!💥

#medthread #tweetorial
1/11 Image
The treatment of #PE has been plagued by high acute mortality rates. Current risk stratification relies on #thrombolytics which carry a significant bleeding risk. #medthread #FLASH

2/11 Image
The #FlowTriever System, the first FDA-cleared mechanical thrombectomy system for #PE, is purposely designed to capture and remove large clot burden from big vessels in a single session without the need for tPA or prolonged #ICU stay. #medthread #FLASH

3/11 Image
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Words Matter. More patients are reading their notes (aka #opennotes). Clinicians wonder:

What do patients find judgmental OR offensive in their notes?

This #medthread is an overview of what we learned. Read the full paper in @JournalGIM:…

#medtwitter 1/8
Sharing notes w/patients can help w/care.

We can use #opennotes to explain, build trust, clarify & remind patients of plan.

BUT notes also offer patients a window into how clinicians view them & their conditions.

Some patients may feel offended or judged by our words. 2/8
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Thank you to Dr. @RobAnders1 for inviting me to present to Dr. Sarita Verma (@ddsv3) and @TheNOSM at one of their faculty retreats. They asked me to speak about a few things, but I will be tweeting my keynote which focuses on:

The Future of #MedEd*

*As seen by @TChanMD
As many of you know, I am here on Twitter. So I started my talk by inviting the @TheNOSM crew to engage with me online to talk more after my talk. The convo doesn't have to stop when I log off of WebEx...@Twitter is the ultimate #DigitalCorridor for those in #MedEd & #MedTwitter.
My intellectual & financial conflicts of interest pertaining to this talk are:
@PSIFoundation who gave me $ to study #SoMe for Education and Knowledge Translation.

@ALiEMteam honorarium to teach/administer for @ALiEMfac

@McMasterU for their patronge of @MacPFD

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Good afternoon and good evening…thank you all for joining us for this portion of the 2020 @SOAPHQ virtual annual meeting

What's new in #OBAnes - A comprehensive review of the most relevant articles published in 2019

#MedThread #Tweetorial #Ostheimer #SOAPAM2020
#Halifax would have been amazing - @ruthi_landau and I worked incredibly hard with our amazing management team to bring you an innovative agenda and in many ways we reimagined the way @SOAPHQ delivers an annual meeting #MedThread #Tweetorial #OBAnes #Ostheimer
Most of us have never lived through something like #COVID19 - As we embrace the new normal, remind ourselves of strategies to address our own wellness as physician leaders on the frontline - let's continue to look out for one another! #MedThread #Tweetorial #OBAnes #Ostheimer
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Dear oncology: We wrote this paper for you & it was published in @Cancer_Cell.

>10 yrs of research shows pts benefit when they read their clinical notes (#opennotes) however oncologists have been resistant to the practice.

#medthread 🧵 #MedTwitter 1/9…
- I've read every paper on #opennotes
- I've presented about open notes at @ASCO & @AACR
- I'm connected w/the cancer patient community

I noticed:
- Pts are positive about the idea of open notes
- Oncologists are nervous
#bcsm #btsm #lcsm #mmsm #ayacsm #CSSMchat
My colleagues at @myopennotes have conducted studies of pts & clinicians with survey responses in the tens of thousands, but we had never dug into the oncology-specific data... UNTIL NOW.

How do oncology clinician views differ from those of their patients? 3/9
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1/ Curriculum #Medthread about our Global Health Track & Scholars Program!

The OHSU IM Global Health Program endorses a broad definition of #GlobalHealth rooted in interdisciplinary collaboration to promote better health for all…

2/ As the program has grown over the years, one of the highlights of the program was a rotation at Scottish Livingstone Hospital in Molepolole, Botswana through our Harvard/Beth Israel Deaconess partnership

3/ Program alumnus @AdamRodmanMD (host of @BedsideRounds) was a program participant, and then completed a #GlobalHealth fellowship!

Watch him talk about his experience at Scottish Livingstone Hospital here:

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A #dermtwitter, #medtwitter, and #medstudenttwitter #tweetorial! PC: @dermnetnz. Let's kick off this #MedEd #FOAMEd #medthread with a question.

With LP, which one of the following body sites is most commonly involved?

The correct answer is wrists! LP lesions are most commonly seen on flexor wrists, trunk, medial thighs, and shins. It very rarely involves the face.

The mnemonic for the clinical appearance of LP is to remember the "Ps."
Pruritic (!!!)

You can also make out white and gray lacy streaks and puncta. This is called "Wickham Striae" which helps confirm the diagnosis (1).

Notably, LP also can go to the oropharynx, which can cause erosive lesions that are painful. Wickham Striae are easier to see in the mouth (2).
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Hello #medtwitter & #dermtwitter, time for another #dermatology #tweetorial! Let’s go back to the basics and talk about:


Hopefully this #meded/#foamed moment is helpful for all the #maskne in the #covid19 era!

Let’s start with a simple question:
What causes acne?
All of the above! Often, every one of these factors plays some role. What’s important is knowing what treatment to emphasize based on what factor seems to be the biggest influencer.

For example:
-Retinoids for cell turnover
-Ocps for hormones
-Antibiotics for bacteria!
Let’s talk exam. When I see an acne patient, I’m looking for what lesion I see most: comedones (white/blackheads), inflammatory papules, or cysts.

I’m also looking at distribution (where on the body) and the severity.

It’s critical to ask if it’s a good, typical, or bad day!
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A #medtwitter #dermtwitter #tweetorial! #MedEd #FOAMEd

This is a drug reaction that we can see on inpatients, with an exam full of pustules!

Let's start with a question - How long after drug exposure does AGEP appear?
The correct answer is 24-48 hours!

The other answers are typical time frames for other types of reactions.
Urticaria usually manifests minutes to hours after drug exposure.
Morbilliform drug eruptions occur 4-14 days after drug exposure.
DRESS occurs 2-6 weeks afterward!
Unlike DRESS and morbilliform eruptions, AGEP doesn't require repeated exposure of drug. So one single dose can definitely cause AGEP. A typical place we see this is with perioperative antibiotics!

Common culprits are Penicillins, quinolones, sulfa, antifungals, and CCBs!
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UK PM Boris Johnson has declared a “war on fat” after confronting the role his #obesity played in his harrowing encounter with #COVID.

In this #tweetorial, we’ll take a closer look at the studies sounding the alarm in the UK.

#medthread #MedTwitter…

Ho et al. (pre-print) studied 428,225 subjects in the @UK_Biobank of which 340 had confirmed #COVID.

BMI had a risk ratio (RR) of 1.24 (per 1SD). Obesity itself had a RR of 2.29.…

To put this in context: for every 4.5 point increase in BMI, the risk of hospitalization from #COVID increases by almost 25%!
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Here it is! My #tweetorial on my experience of pumping during MS3 rotations.

Read on for tips to successfully pumping as a medical student (applies to residents too!).

#medthread #medstudenttwitter #MedTwitter #mamainmedicine

My baby was born in May; took @TheUSMLE Step 1 in Aug (applied for extra break time to pump); then started rotations.

I pumped all of MS3 - you can too if it’s important to you. It helped me feel I was taking care of my baby when we were apart.

Easy? No. Worth it? Yes.

First - You do NOT need to ask for permission. Pumping is your RIGHT. Wasn't a big deal for me as an MS3.

Let your team know up front when you will need to step out to pump, and how long you will be gone (don’t underestimate your time).…
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Hey #medstudenttwitter! I just finished a virtual #familymedicine rotation, and wanted to share something I learned.

When should patients take their blood pressure pills?

#tweetorial #medthread #medtwitter @umnmedschool

Patients often ask when they should take their medications. The answer often depends on side effects, such as drowsiness (take these meds at night).

Did you know there's evidence that blood pressure medications actually WORK BETTER if taken before bed?

The results of a study of over 19,000 patients in Spain was published in October 2019. Patients were randomized to take their antihypertensives before bed or in the morning.…
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Okay #medtwitter and #dermtwitter, you knew it was only a matter of time, didn’t you?! Let’s do this #COVID19 themed #medthread:


#MedEd #FOAMEd #dermatology #dermatologia @AADskin @AADMember @Meddermsoc @dermhospitalist
First, a word of caution – this is one person’s thoughts on a new skin finding reported in a new disease that the medical community is still learning about! As such, nothing in the #tweetorial should be regarded as definite. Just wanted to share a thought process!
So, who cares? #COVID19 is devastating, at times even for the young & healthy! But it’s all respiratory, right?

Well, as we're learning, there's so much more to #SARScov2, and as a #dermatologist, this is the perfect example of how the exam helps frame possible mechanisms.
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This #medthread is for those providing critical care in pop-up ICU's right now...

💥 A primer on the ABCDEF ICU liberation bundle 💥

Take home: less delirium = lives saved

#medtwitter #weareallintensivistsrightnow
In 2013 @SCCM published the ABCDEF bundle to:

💡 Reduce ICU delirium
💡 Deliver high value care
💡 Improve short/longterm critical care outcomes

While individual components can be implemented, best practice uses the whole bundle w/ all patients.…
A = Assess, prevent, and manage pain

ICU patients are often unable to communicate pain.

The CPOT (Critical-Care Pain Observation Tool) is a validated, non-verbal assessment to ensure pain is controlled (score of >2 = pain that should be treated)
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#Obesity and #COVIDー19 have been in the headlines recently.

The link between the two is now undeniable.

Let’s take a look at WHY they are so tightly linked molecularly, physiologically, and anatomically in this #tweetorial.

#medthread #medtwitter…
We learned quite a bit about obesity and viral infection in 2009 during the #H1N1 epidemic. Obesity led to:

🔼risk of ICU admission
🔼viral shedding
🔼recovery times

But WHY?…
The story is complex, but inflammation plays a critical role.

Individuals with obesity are in a state of chronic low-grade inflammation as evidenced by altered levels of several cytokines such as TNFα, IL-6, and CRP.
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Day 3 of #DistanceMedEd for #dermtwitter and #medtwitter! We've done 2 of the 5 reaction patterns so far, so let's focus in on the....

DERMAL reaction pattern!

#MedEd #FOAMEd #tweetorial #medthread PC: @dermnetnz
As opposed to the papulosquamous reaction pattern, the dermal pattern implies the action is DEEP in the DERMIS. This means that without epidermal alteration, you shouldn't see scale!

There is of course an exception with overlying xerosis or if you have another process on top!
When you see something dermal, you have to think about what is infiltrating the skin. A few possibilities/examples:

Edema/fluid 👉 urticaria (1)
Inflammatory cells (reactive) 👉 granuloma annulare (2)
Inflammatory cells (cancer) 👉 CBCL (3)
Collagen 👉 Morphea (4)
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