Discover and read the best of Twitter Threads about #medtwitter

Most recents (24)

1/
I’ve been working on my #medtwitter elevator pitch. Mostly because lately I seem to have lots of fleeting conversations about it.

And I know I’m not alone.

Here's what I find:

Some are sold but nervous.
Some are intrigued but don’t get it.

And a lot are precontemplative.
2/
I think it’s because it can seem like all #medtwitter users look the same.

Them: “I would get on Twitter but I’m not a social media person.”
Me: “Twitter is different! Even if you don’t do social media!”
Them: 😐“Nah. Can’t see it.”

*ping*

Them: ✌️🏾

Elevator ride over.
3/
But I’ve been thinking about the many different #medtwitter identities there are. Most can find a fit nestled somewhere in 1 or a few of them.

What works for each person depends on a few things:

Who you are
What you hope to get from it
What’s going on in your life

Yup.
Read 22 tweets
February Teaching Rounds - Recap

Part 1 of 2.

Because #spacedlearning is an endless journey...

Join us #medtwitter & #medstudenttwitter
Day 2 - Upper GI bleed

1. 4 common pathways to a working Dx of an overt upper GI bleed

2. 3 common diagnosis...

3. 2 KEY questions!

More here -
bit.ly/2V9pboc
Day 3 - H20 toxicity

1. Hyponatremia = excess H20 = H20 toxicity.
The is true is most, but not all cases

2. Why do we care?
When neurons swell they don't work well...

3. @jackpenner's @CPSolvers video & schema bit.ly/3b64K0T

More here - bit.ly/3bUWUri
Read 5 tweets
I had a pretty scary experience last night as a patient that I wanted to share. This story may hit home for #allergy #foodallergy #celiac friends and I hope will be enlightening for my #medtwitter #medstudenttwitter friends! 1/
So my family ordered takeout from a restaurant that I’ve eaten safely at dozens of times in the past. Unfortunately 2 bites into my food, I started to feel nauseous and my lips start tingling.

For anyone with food allergies, you know that’s the start of something bad. 2/
That uncomfortable feeling progressed into full blown anaphylaxis very quickly.

Ive made it 28 yrs, never had to use my EpiPen before & I made the huge mistake of not having it with me. I am INCREDIBLY thankful that my partner keeps one for me at all times just in case. 3/
Read 17 tweets
DOI: doi.org/10.1016/j.ijca…

Drs @SukhNijjer, @jerd10 and @RicardoPetraco. What are your views on @DavidLBrownMD fallacies of FFR?

As a budding interventional cardiologist, I like to hear all opinions and sides to the story :)
“In conclusion, FFR in isolation is of no proven clinical value in the evaluation of patients with suspected ischemia. The ESC guidelines continue to promote an outdated paradigm for the evaluation of suspected ischemia that focuses on the focal epicardial stenosis.”
The 4 fallacies

1/4 - The first fallacy is the foundational premise of FFR that ischemia caused by a focal obstructive epicardial coronary stenosis is on the direct pathway to death or MI and therefore should be a target of revascularization
Read 7 tweets
“Who is your boss?”

Physician, 2000: “My patient.”
Physician, 2010: “My employer.”
Physician, 2020: “The stakeholders.”

jamanetwork.com/journals/jama/…
Via @JAMA_current #medtwitter
#Anesthesiology is hardest hit, accounting for 33% of physicians bought out by private equity in this study. A total of 1894 physicians and climbing, 246 ➡️593➡️458➡️597 (and this data is already 4 years old).
“Private equity firms expect greater than 20% annual returns, [which] may conflict with the need for longer-term investments in practice stability, physician recruitment, quality, and safety.”
Read 15 tweets
This week, the @NBMEnow announced that the USMLE Step 1 would be moving to P/F as early as 2022. Folks far smarter than I am like @jbcarmody and @BenMazer have had a lot to say about this seismic change in US #MedEd, but I wanted to offer some other thoughts on this. 1/
For those of you unfamiliar with medical education, Step 1 is a basic sciences exam often taken after the 2nd year of med school. It’s original (and really still, primary) purpose is to serve as one of 4 licensing exams to practice medicine in the US. 2/ en.wikipedia.org/wiki/USMLE_Ste…
The issues surrounding this exam are very well documented on @jbcarmody’s blog, thesheriffofsodium.com, and aren’t worth repeating at length here. 3/
Read 23 tweets
1/ #MedTwitter, thanks for joining us last week for our case #tweetorial (bit.ly/38rGrZs)! We have more clinical reasoning practice for you today!

67F w/ HTN, HFpEF & RA (on chronic prednisone & PCP PPx) p/w 3 days of progressive dyspnea, malaise & productive cough.
2/ As you get more information, what clinical reasoning tool can you use to determine how the data you gather increases or decreases the probability of the diseases you’re considering?
3/ ANS: Likelihood ratio. LRs help us decide how much each test result increases or decreases the probability of a specific disease.

For example, her history of HF has an LR of ~5 for HF as the cause of her dyspnea, increasing the probability of a HF exacerbation by ~30%.
Read 16 tweets
Influenza THREAD🧵

Roses are red
Violets are blue
I am in quarantine
‘Cause I have the FLU.

#medtwitter #MedTwitterValentines #HealthPolicyValentines #hcldr
What is Influenza (Flu)?

✅Flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and sometimes lungs.
✅It can cause mild to severe illness, and sometimes death.
✅The best way to prevent flu is by getting a flu vaccine each year.
Flu symptoms

🌡️Often come on suddenly
🌡️Fever or feeling feverish/chills
🌡️Cough
🌡️Sore throat
🌡️Runny or stuffy nose
🌡️Muscle or body aches
🌡️Headaches
🌡️Fatigue (tiredness)
🌡️Vomiting and diarrhea is more common in children
Read 12 tweets
Thread :

I am on a search committee for leadership position at our academic hospital. Final meeting today. I am the only non-white person in the room.

I felt fear.

It’s strange to call it what it is. I had rehearsed many times what I would say about diversity and equity. 1/
I even lay awake in bed today from 5-6 AM planning out just the right words so people could hear me, understand the important, not get offended.

During meeting, I had to do silent pep talk. “If I don’t say it, who will?”

Waiting for the “right time” to interject. 2/
I said my piece. It came out (almost) as smoothly as planned.

I am still worried what people will say about my comments as they walk from the meeting.

This is what your minoritized colleagues are feeling when they discuss the taboo subjects of race and racism in medicine. 3/
Read 4 tweets
Teaching Rounds Day 11/15

Hypoxemia...

Beyond the Mechanism & Back to the Bedside

Join us, #medtwitter & #medstudenttwitter
I fondly remember learning about hypoxemia in medical school and breaking it down by mechanism

1. Low FiO2
2. Hypoventilation
3. Impaired diffusion
4. Shunt
5. V/Q mismatch - the go-to answer every time!
This was a great way to understand hypoxemia, but I haven't found myself using this approach clinically.
Read 12 tweets
1/ #MedTwitter, we have a new edition of the “Clinical Reasoning Corner” coming this week, which means it’s time for some more clinical reasoning practice!

Follow along and let us know how you’re thinking about the case!

Today’s chief complaint is fever & abdominal pain.
2/ You’re called to admit a 52F w/ cirrhosis 2/2 Hepatitis C who is p/w 3 wks of progressive abdominal distension, and 2 days of abdominal pain & fevers.

She has a fever to 38.6C, scleral icterus, a diffusely tender abdomen, and a positive fluid wave.
3/ You and your colleague wonder whether or not she has ascites and recall a number of physical exam findings associated with it.

What clinical reasoning tool can you use to determine how each exam finding impacts the probability of ascites?
Read 11 tweets
1/ Hey #medtwitter, what do you know about diagnostic odds ratios and how they are used?

It’s time for another round of #statswithCoreIM!

Let’s start by considering dichotomous test characteristics:
2/ Diagnostic Odds Ratios are different, and special, because they allow us to use one single number to describe how good a diagnostic test is.
3/ For example, let’s consider the DORs of some diagnostic tests of the flu:
😷Cough - 2.8
😷Fever - 4.5
😷Rapid flu swab ~ 15
😷Flu PCR ~ 100

(And stay tuned for another Steve & Janine podcast on the flu next Wednesday!)
Read 5 tweets
Thread : The value of 50K+ patient encounters is often marginalized by some academic elites. The voice of the community cardiologist should be a loud one on twitter, as we represent >80% of all cardiologists. 1
Perhaps we should have a C-index for how many patient encounters someone has had? Next to thier K index? Theory is one thing, application another. 2
A K index is in a way a double edged sword. True academic luminaries and trialists should have as @RayDalio writes a “Believability weighting” which is basically what the K-index is. 3
Read 18 tweets
(1/n) Delighted to share our work using #scRNAseq to explore the intersection between regeneration, development and #immune recognition in #cancer #metastasis online @NatureMedicine @sloan_kettering @WeillCornell @scell_papers @dana_peer @LabMassague
nature.com/articles/s4159…
@NatureMedicine @sloan_kettering @WeillCornell @scell_papers @dana_peer @LabMassague (2/n) human primary #lungcancer is characterized by the emergence of regenerative cell types, typically seen in response to lung injury, but showing striking lineage promiscuity (identity confused!)
@NatureMedicine @sloan_kettering @WeillCornell @scell_papers @dana_peer @LabMassague (3/n) #metastasis exhibits a continuum of more primitive stem to epithelial progenitor states – driven in large part by key embryonic and lung-specifying transcription factors, SOX2 and SOX9.
Read 11 tweets
1/ Do you mentor or are you: a learner wanting to improve exam scores? Dx the reason for low test scores in today’s #MedEdMethodsMonday!

Inspired by @thecurbsiders ep193 featuring @Missydoc0128

#MedEd #MedThread #MedEdPearl #MedTweetorial #FacDev #Medtwitter #medstudenttwitter
2/ Self-Regulated Learning Microanalytic Assessment and Training (SRL-MAT) - a tool that can identify 6 test-taking problems, described by Dr. Andrews @williamkellymd @GenesseyFlint & Dr. Dezee from @USUhealthsci in @AcadMedJournal

tiny.cc/SRLtool
3/ The tool is used between a mentor & learner in a 60-min session.

The learner 1st reads & thinks aloud while going through a vignette appropriate for their level, with the actual question and answers covered.

They then talk through a Question Review Form:
Read 9 tweets
Interpreting QTc in setting of prolonged QRS... 👏🏼👏🏼

This is an important and frequently encountered issue.

Thread.

1/
It’s common for people to avoid key first line medications and choose less ideal alternatives when the computer’s QTc reads out 490 or 510...

But when there is a LBBB, RBBB, or paced rhythm, the vast majority of the time this is not necessary. Why?

2/
We measure the QT because impaired REpolarization creates a risk for Torsades, a dangerous ventricular arrhythmia.

But if you think about it, QT interval includes both DEpolarization (QRS) and REpolarization (ST segment + TW, together referred to as the JT interval).

3/
Read 16 tweets
A New Year, New Therapies! An #IBD #medtwitter #tweetorial

As a late ring into the New Year, let’s explore Novel #IBD Agents coming to practice!

Our Aims:
1️⃣ Understand the Nomenclature
2️⃣ Revise Currently Available Drugs
3️⃣ Discuss Mechanisms & Adverse Events of Novel Agents
First, do we even know what are we treating ⁉️

Studies 🔬 within each one of these four key elements have unveiled pathways involved in #IBD pathogenesis.

Some of which are amendable for potential therapeutic intervention…
In summary...

It takes a genetically susceptible host 🧬 to be exposed to a specific environmental agent 🦠 that, through a weakened intestinal barrier ⚔️, will lead to an exaggerated Immune activation🔥, responsible for the phenotypes we see in clinical practice!
Read 25 tweets
Screening for myeloma/MGUS. Thread #medtwitter

1/ General screening of asymptomatic persons is not recommended. iStopMM is a randomized trial to determine role of screening, and also the role of more close follow up to enable early detection clinicaltrials.gov/ct2/show/NCT03… @IMFmyeloma
2/ I now recommend screening to detect high risk smoldering myeloma in persons with 2 or more first degree relatives with myeloma, & in blacks with one or more affected relative. One time screening at age 50-60, or 10 yrs before age of diagnosis of myeloma in relative @neuherman
3/ Whenever we want to look for myeloma / AL amyloidosis due to clinical suspicion, or to screen high risk individuals, the tests to do are: serum protein electrophoresis, serum immunofixation, & serum free light chain assay. @MayoMyeloma @MayoProceedings mayoclinicproceedings.org/article/S0025-…
Read 6 tweets
1/ Thread

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome #MECFS

Is it really that bad?

Trigger warnings: The studies below paint a very bleak picture

#MyalgicE #SickNotWeak #pwME #MyalgicEncephalomyelitis #ChronicIllness #MedEd #MedTwitter #SickNotWeak
2/ Full recovery from #MECFS is rare

The median recovery rate from multiple published studies is 3-7%

(just 1 paper linked below)
#MyalgicE #SickNotWeak #pwME #MyalgicEncephalomyelitis #ChronicIllness #MedEd #MedTwitter
academic.oup.com/occmed/article…
3/ ~25% of #MECFS patients are housebound or bedbound.....

....sometimes for decades!

That means no work, no vacations, no social life, lost time, lost goals, lost relationships.....

journals.sagepub.com/doi/abs/10.117…
Read 11 tweets
1/

Why is cystic fibrosis (CF) one of the most common genetic diseases? Could heterozygous carriers have a selective advantage?

The infection that CF carriers may be protected against is absolutely astounding.

#medthread #medtwitter #tweetorial
2/

Three types of supporting evidence are required to determine whether CF carriers plausibly have a selective advantage against an infectious pathogen:

💥 Historical/geographical
💥 Clinical/population
💥 Molecular

Let's examine these one by one.

ncbi.nlm.nih.gov/pmc/articles/P…
3/

💥 Historical/geographical

The first inkling that CF carriers may have a selective advantage came from observations that patients w/ cystic fibrosis rarely get tuberculosis (TB).

TB infection is so rare in CF patients that it's case-reportable.

ncbi.nlm.nih.gov/pubmed/26110137
Read 13 tweets
1/ Time Management is today's #MedEdMethodsMonday #MedThread

As junior faculty & a #GIM fellow working on a #MedEd Masters, life is often a precarious juggling act. How do you stay on track in #academics?

#Medtwitter #MedEdPearl #FOAMed
2/ Components of Time Management
Gordon & Borkan’s lit review highlights 4 principles of time management tiny.cc/MedEdTime:

1. Set goals
2. Prioritize competing responsibilities
3. Plan & organize activities
4. Minimize wasted time
3/ Set Goals
- Set short- (1-3yr) & long-term (5-10yr) goals for your career
(see tiny.cc/MedEdGoals)
- Break long-term ends goals into bite-sized means goals
- Monitor past & current activities for goal compatibility
Read 11 tweets
Teaching Rounds Day 3/15

H2O toxicity...

Say what?

Yes...
H2O toxicity.

The Story and The Schema.
Join us, #medtwitter & #medstudenttwitter
The Story...

What is H20 toxicity?
It’s when the blood has too much H2O.

What exactly is too much?
Enough that neurons swell and
don't work well.
Cool.

The symptoms of this mysterious condition?
When severe, patients can have a seizure, and other marked neurologic symptoms.

More commonly, patients have symptoms from the underlying cause, and not so much the H20 toxicity.
Read 17 tweets
This weeks #tweetorialsinpsychiatry is on the #neuropsychiatry of 'Psychosis in Parkinson's Disease'. #psychtwitter #medtwitter #psychosis #parkinsonsdisease
James Parkinson's original 1817 description of PD focussed on the motor symptoms, but it is now recognised that non-motor features are a significant feature of both PD and its treatment. Psychotic symptoms have a prevalence of 20-70% depending on disease stage.
The high prevalence rate reflects in part the broad definition of psychosis used. This encompasses both illusions and brief hallucinations with retained insight at the one end of the spectrum to delusional and more complex psychotic states at the other.
Read 18 tweets
1/2 I just ran into @VP Mike Pence at the Drake Diner in Des Moines. I confronted him about his damaging health care cuts because for me it's not about politics, it's about saving lives.

#DrakeUniversity #IowaCaucus #TrumpRallyIA #MedTwitter
@VP 2/2 When I told him he is putting my patients' lives at risk, @VP deflected and denied knowledge of the policy. He either doesn't understand, or doesn't care about the impact of this administrations' policies on patients everywhere.
@VP I'm a bit surprised by how this has taken off. I was truly just taking what so many of us are feeling and putting it out there. I'm just one of many doctors doing this work. Donate it you want to help us do more good work holding Trump accountable: secure.actblue.com/donate/pencein…
Read 4 tweets

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