Discover and read the best of Twitter Threads about #twdfnr

Most recents (9)

1/

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

*silence*

Me: "Sir?"
Him: "I hear you. But I need to leave."
2/
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."
3/
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
1/10
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

journalofhospitalmedicine.com/jhospmed/artic…
2/
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.

Example:

💥13%-48% of patients with acute stroke have delirium💥

journals.sagepub.com/doi/10.1111/j.…
3/
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
1/9
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.

journalofhospitalmedicine.com/jhospmed/artic…
2/
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.

ncbi.nlm.nih.gov/pubmed/26518436
3/
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.

ncbi.nlm.nih.gov/pubmed/22990018
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.
2/
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
3/
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
@BrowofJustice
Read 11 tweets
1/
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.

journalofhospitalmedicine.com/jhospmed/artic…
2/
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.
3/
Would you order suggest that this patient with stable pulmonary embolism (PE) undergo echocardiography (echo)?
Read 10 tweets
1/
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

journalofhospitalmedicine.com/jhospmed/artic…
2/
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?
3/
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.

ncbi.nlm.nih.gov/pubmed/27323235
Read 9 tweets
1/
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

journalofhospitalmedicine.com/jhospmed/artic…
2/
First, a question: how often do you use intermittent pneumatic compression (IPC) for venous thromboembolism in medical ward patients?
3/
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

ncbi.nlm.nih.gov/pubmed/23852609
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

journalofhospitalmedicine.com/jhospmed/artic…
2/
Let’s start with two questions...

First: Do you use prealbumin as a “marker” of malnutrition?
3/
Second: How did prealbumin get its name?

[GE = gel electrophoresis]
Read 10 tweets
1/
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

journalofhospitalmedicine.com/jhospmed/artic…
2/
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?
3/
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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