Discover and read the best of Twitter Threads about #twdfnr

Most recents (9)


Him: "I need to leave."
Me: "Can we talk about it more? I'm concerned that you aren't well enough to go yet."


Me: "Sir?"
Him: "I hear you. But I need to leave."
Me: "There's
some things happening with your body that could be life threatening and--"
Him: *interrupting me* "Listen. I know I need some more tests. And I know y'all think it would be best for me to stay."

*wipes face with his hand and sighs*

Him: "I get that."
Him: "But away from this hospital? I got a WHOLE LOT going on. And you know what? That shit is life threatening, too."
Me: *listening*
Him: "'Scuse my language."
Me: "It's ok."

He sighed again. Hard. Then he started looking around his bed.

Him: "I got to go, man."
Read 18 tweets
Why is the routine use of neuroimaging for hospitalized patients with delirium a #TWDFNR?

This #tweetorial is a supplement to the review published in the July 2019 issue of the @JHospMedicine…
To understand why the routine use CT/MRI to evaluate delirium is a #TWDFNR, we must first recognize that many acute neurologic processes assessed with neuroimaging DO cause delirium.


💥13%-48% of patients with acute stroke have delirium💥…
Regarding neuroimaging in hospitalized patients with delirium, the authors of the #TWDFNR review cover four studies and note that the overall diagnostic yield is 2.7%-14.5%.

How do these values inform your interpretation of the utility of CT/MRI in this setting?
Read 10 tweets
Why is “HIT Testing in Low Probability Patients” a TWDFNR?

This tweetorial is a complement to the review published in the June 2019 issue of @JHospMedicine by authors Amanda Li, Lisa Hicks, and @efan75.…
As the authors note, the ELISA test has a sensitivity >95% when the optical density threshold is low. The high sensitivity of the ELISA may make one inclined to use it liberally to evaluate for HIT.
But, there is another way one can effectively rule-out HIT: the 4Ts score.

A 2012 meta-analysis determined that the negative predictive value of a low probability 4Ts score was 99.8%. And, it didn't matter who "performed" the scoring.
Read 9 tweets
I want to put a 🙌 out to #MedTwitter

I may not tweet a lot but I do follow and gain quite a bit so I want to share how it has changed the way I carry myself and provide care.

It’s a thread.
Patient asks the case manager when the doctor is going to see him

I spent 30 minutes updating him earlier that day 🤔

Pre-twitter: ok
Post-twitter: Sir, I’m in charge of your care, tell me a bit more about why you didn’t think I was your doctor.
#WomenInMedicine @AMarshallMD
Overhear the nurses talking about a patient who made a veiled but serious threat to them during the course of care.

Pre-twitter: I’m sorry.
Post-twitter: 😠 that’s not OK. How can I support you?

#MedTwitter #NurseTwitter
Read 11 tweets
Why is "Routine Echocardiography in Hemodynamically Stable Patients with Acute Pulmonary Embolism" a #TWDFNR?

This question was addressed in this month's @JHospMedicine by @PaulBerglMD et al.

Here's a thread to complement their awesome review.…
Let's start with a case and question. The case is taken from the review by @PaulBerglMD et al. Review it and answer the question in tweet 3.
Would you order suggest that this patient with stable pulmonary embolism (PE) undergo echocardiography (echo)?
Read 10 tweets
Why is "Prescribing Docusate for Constipation in Hospitalized Adults" a #TWDFNR?

This thread is a complement to the recently published review of the same name, appearing in February 2019 issue of @JHospMedicine…
Before discussing the review by Robert Fakheri and Frank Volpicelli, let's gauge current practice.

How do you currently use docusate in hospitalized adults with constipation?
If you use docusate, you're not alone.

One single-center study found that docusate accounted for 64% of laxative doses. The cost: $60,000/year.
Read 9 tweets
Why is the routine use of intermittent pneumatic compression for the prevention of venous thromboembolism in medical ward patients a #TWDFNR?

This thread is meant to complement the recently published article appearing in @JHospMedicine…
First, a question: how often do you use intermittent pneumatic compression (IPC) for venous thromboembolism in medical ward patients?
One reason why you might be inclined to use IPC: it has proven effectiveness in high-risk populations (e.g., surgical, trauma, stroke).

For pulmonary embolism:
RR 0.48, 95% CI [0.33-0.69]
NNT = 63
Read 6 tweets
1/ Why is "Prealbumin Testing to Diagnose Malnutrition in the Hospitalized Patient" a #TWDFNR?

This #tweetorial is meant to complement the recent publication of the same name in @JHospMedicine…
Let’s start with two questions...

First: Do you use prealbumin as a “marker” of malnutrition?
Second: How did prealbumin get its name?

[GE = gel electrophoresis]
Read 10 tweets
Why is the acute treatment of "hypertensive urgency" a #TWDFNR?

This #tweetorial is meant to complement the recent publication: "Acute Treatment of Hypertensive Urgency" in @JHospMedicine…
Case: A 71M with a history of HTN is hospitalized for cellulitis. On hospital day 2, the nurse pages you:

"Pt X with BP ____. Please advise". He has no symptoms or signs of end-organ damage.

What would be your threshold SBP to write for an as-needed anti-hypertensive?
The treatment of hypertensive urgency is based on an assumption: if we do not lower the blood pressure now, something bad (e.g. stroke, MI, aortic dissection) will occur in the next few hours.

We aren't giving IV hydralazine to prevent a stroke two years from now...
Read 15 tweets

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