Tony Breu Profile picture
Jul 14, 2019 16 tweets 7 min read Read on X
1/15 What are your opinions of Tweetorials?

This thread will review the results of the survey I posted from 6/28/19-7/13/19.

Thanks to everyone who completed it (n=743). If you want to see the data for yourself, the last tweet will have a link.
2/ Demographics

Two-thirds of the respondents were doctors (41% internal medicine, 18% hospital medicine), with at least 10 other roles represented.

Nearly 80% were between 20 and 40 years old.
3/ Geography

56% of respondents were from the United States, with at least one response coming from an additional 57 other countries.

The global reach of Twitter is pretty awesome.

Interactive world map: bit.ly/2xPNvhG
Interactive US map: bit.ly/2JyReHq
4/ What is your current level of Twitter engagement?

Unsurprisingly, many respondents were heavy consumers, with 87% using Twitter at least once/day.

Fewer people RT/like others' tweets at least once/day (67%) or post themselves (20%).

surveymonkey.com/results/SM-VLR…
5/ How often do each of the following prompt you to read a tweetorial?

Two things "very often" drive respondents to read a tweetorial:
➣ Learn something new (85%)
➣ Feed curiosity (75%)

We are curious people!

surveymonkey.com/results/SM-6KW…
6/ How valuable do you find the following components of a tweetorial?

Three things were seen as "valuable" or "very valuable" to >50% of respondents:
➣ Pics/Figures (94%)
➣ Links to literature (81%)
➣ Surveys/Polls (63%)

One takeaway: cite your work!

surveymonkey.com/results/SM-WLF…
7/ How often do you read a tweetorial all the way through?

Most respondents (87%) "always" or "often" read a tweetorial all the way through.

What makes people stop? The number one answer (selected by 38% of respondents) was "it goes on too long”.
8/ What is the optimal tweetorial length?

Tweet 7 suggests that a tweetorial's length matters. What was the suggested optimal number of tweets?

12

Though most prefer 10-15 tweets per tweetorial, you can see from the figure that there is an audience for longer ones.
9/
I looked at this data and didn't see any differences based on role or age.

The only thing that seemed to matter: if you "rarely" completed a tweetorial, you were more likely to prefer a shorter one, compared with those who "always" did (10 tweets versus 14).
10/ Approximately how many times have you bookmarked or otherwise collected a tweetorial for later use?

Although 88% of respondents had read more than 5 tweetorials, few collect them. 25% had collected zero and 64% had collected 5 or fewer.

This remains an area of great need.
11/
The free text responses support the idea that one main limitation of this platform is that content can easily be "lost".

Partially in response to this survey, I'll be working with others on the @MedTweetorials project. More information to come on this in future weeks.
12/ Should tweetorials be peer reviewed?

33% responded yes. I did not ask a follow-up question about what this process might look like.

Also, there were no clear differences based on role or whether one has written a tweetorial.
13/ What is the best comparison for a tweetorial?

Nearly half (47%) see tweetorials as lectures.

Unsurprisingly, if you view a tweetorial as a form of peer-reviewed research, you're more likely to think it should be peer-reviewed (66% versus 32% for "lecture”).
14/ Have you (how many) tweetorials have you posted?

About 1 in 7 (14%) of respondents have posted a tweetorial. That’s 82 people.

59% have written 3 or fewer with 18 having written 1.

One need not make this a full-time job to be a valuable contributor!
15/15
Those are some of the key results of the survey.

If you're interested in reviewing the full set of anonymous data, you can see it here (I have left out free-text answers):

surveymonkey.com/results/SM-WBD…
Please feel free to use the results of this presentation.

If you would like to reference this tweetorial, here is a suggested citation:

Breu, AC. (@tony_breu). “What are your opinions of Tweetorials?” Twitter. 14 July 2019, 10:37 AM. .

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More from @tony_breu

Jun 20
1/11
🤔Why does chronic hepatitis C infection "require" the intermediary of cirrhosis in order to cause hepatocellular carcinoma (HCC)?

Chronic hepatitis B can "skip" this step, going directly from chronic infection to HCC.

Why the difference?
2/
To begin, let's look at how frequently HCC occurs in patients without cirrhosis.

A 2019 study of United States (US) medical centers included 5144 patients with HCC.

💡12% had no underlying cirrhosis

pubmed.ncbi.nlm.nih.gov/31475372/
3/
A 2022 study found a similar rate, with 13% of patients with HCC showing no evidence of cirrhosis.

When looking more specifically at hepatitis C (HCV) versus hepatitis B (HBV), they found varying rates:

➣ HCV: 6% of patients with HCC were non-cirrhotic
➣ HBV: 19% of patients with HCC were non-cirrhotic

pubmed.ncbi.nlm.nih.gov/34027591/Image
Read 11 tweets
Apr 9
1/12 - Mystery #1

You are seeing a patient recently diagnosed with heart failure and started on GDMT. You notice that their hemoglobin (HGB) has increased (12 → 13 g/dL) in the intervening weeks.

🤔Which medication is the likely cause of this increase in HGB?
2/12 - An Answer

Empagliflozin

💡All SGLT2 inhibitors have been associated with an increase in hematocrit/hemoglobin soon after initiation.

The average increase is 2.3% in hematocrit and 0.6 g/dL in hemoglobin.

ncbi.nlm.nih.gov/pmc/articles/P…Image
3/12 - An Initial Explanation (I)

The effect of SGLT2 inhibitors on HCT/HGB has been noted since the very first randomized control trial of dapagliflozin, published in 2010.

Initially, investigators assumed this was related to the diuretic effect of these drugs (i.e., a reduction in plasma volume led to an increase in HCT/HGB).

pubmed.ncbi.nlm.nih.gov/20609968/Image
Read 12 tweets
Feb 22
1/10
🤔Why is pulmonary embolism (PE) relatively rare in those with Factor V Leiden?

This Factor V Leiden Paradox was pointed out to me by @DrSamelsonJones after I posted about a similar difference with Behçet Syndrome.

Let's have a look.
2/
In 1993, Dahlback, Carlsson, and Svensson first described a heritable resistance to activated protein C.

A year later the same group found this to be the most common form of hereditary hypercoagulability.


ncbi.nlm.nih.gov/pmc/articles/P…
pubmed.ncbi.nlm.nih.gov/8302317/Image
Image
3/
The mutation in the Factor V gene conferring resistance to activated protein C was detailed the following year by a group in Leiden, The Netherlands.

Thus the name for the condition: Factor V Leiden.

pubmed.ncbi.nlm.nih.gov/8164741/Image
Read 10 tweets
Feb 18
1/8
🤔Why is pulmonary embolism (PE) so rare in Behçet Syndrome?

The condition is associated with a 14-fold increased risk of deep vein thrombosis (DVT) but almost none of these result in PE.

What is it about the thrombus in Behçet that makes it so unable to embolize?
2/
Numerous case series have reported a markedly increased risk of deep vein thrombosis with Behçet Syndrome.

One reported the following rates of venous thrombosis:
➣ Behçet Syndrome: 18/73 (25%)
➣ Controls: 4/146 (3%)

pubmed.ncbi.nlm.nih.gov/11426022/Image
3/
Another study of 882 patients with vascular Behçet Syndrome reported the following rates of deep vein thrombosis (DVT) and pulmonary embolism (PE):

➣ DVT: 592/882 (67%)
➣ PE: 0%!

pubmed.ncbi.nlm.nih.gov/24907156/Image
Read 9 tweets
Dec 12, 2023
1/7
🤔What is the hemodynamic response to a chronic hemoglobin of 1.5 g/dL.

A fascinating 1963 study published in @CircAHA provides some interesting answers. Let's have a look at Patient One.

ahajournals.org/doi/pdf/10.116…
Image
@CircAHA 2/
Patient One had chronic anemia with a hemoglobin 1.5 g/dL. You'll see that before receiving blood they had the following cardiac parameter:

• HR 100 (elevated)
• Cardiac index 8.9 (elevated)
• Stroke index 89 (elevated) Image
@CircAHA 3/
After transfusion to a hemoglobin of 10 g/dL, the following changes were noted:

• HR 100 (elevated but unchanged)
• Cardiac index 3.4 (decreased and now normal)
• Stroke index 34 (decreased and now normal)
Image
Image
Read 7 tweets
Dec 10, 2023
1/17
🤔Why don't we transfuse to a normal hemoglobin?

In many cases, we aim to restore values to the normal range. Potassium and other electrolytes. Even white blood cells.

But not hemoglobin.

In most situations, we accept >7g/dL, far less than normal. Why are we so tolerant? Image
2/
The principal rationale for red blood cell transfusion is to increase the O₂-carrying capacity and therefore O₂ delivery to tissues.

As hemoglobin is lowered O₂ delivery decreases, assuming all else remains unchanged.

So giving blood makes sense.
3/
Historically we did not transfuse to normal because we did not transfuse. The risks far outstripped the benefits.

There were also technical constraints and storage limitations. This meant that transfusions were reserved for acute conditions.

onlinelibrary.wiley.com/doi/pdfdirect/…
Image
Read 17 tweets

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