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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!)
4/ What’s the point? A DOR is useful to compare tests to each other - for example, in a meta-analysis.

However, when interpreting your patient’s test results, you must consider the test result, the test’s properties and the local disease prevalence.
5/ Or, as @AdamRodmanMD might say: test characteristics matter, as we need to know them.

Check out all the graphics for this post and all our other posts on our website: coreimpodcast.com/2020/02/11/dia…

Happy learning!

/fin
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More from @COREIMpodcast see all

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CORE IM
@COREIMpodcast
Wish you’d paid more attention to your #radiology lectures in med school? Don’t worry, we’ve got you, #medtwitter. Announcing #readingroom, a new feature where we break down common rads findings into learning bites.

Let’s start with a good ol’ CXR: what’s your read?

1/6
It’s a hemithorax opacification! Now let’s level up and ask what your ddx is for such a finding.

2/6
Pleural effusion and atelectasis are most likely. What else is on your ddx, though - and what other CXR findings help you tier your ddx?

Moving on to a CT ... what’s that purple arrow pointing to?
3/6
Read 6 tweets
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CORE IM
@COREIMpodcast
Well hello there, #medtwitter! In this morning’s #meded byte, we’re myth-busting the physical exam with a post from our #staysharp series.

Our question for today:
Are bowel auscultations worth the gurgle?

1/8 Image
Let’s bring it back to fundamentals.

In med school, we learn that the pitch of a bowel sound is meant to shift our differential. For instance, low-pitched sounds might make you favor a diagnosis of ileus.

(As an aside, can anyone spell borborygmi right on the 1st try?)

2/8 Image
Here’s the catch: bowel sounds aren’t terribly reliable!

The test characteristics of auscultation say it all. Our review of the available literature indicated that bowel sounds have low sensitivity and PPVs for diagnosis things like ileus.

3/8 Image
Read 8 tweets
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CORE IM
@COREIMpodcast
1/ Today is day 2 of our #pride series focusing on #lgbtq+ health, and we’re going to spend today reviewing some important terms. #MedTwitter
2/ Let’s start with what we will affectionately call the alphabet soup. “LGBT” is likely familiar to many, but what people say after the T varies from person to person both in form and meaning.
3/ Terms one might see after LGBT include:
❤️Q: queer, and/or questioning (one’s sexuality, gender identity, etc.)
🧡I: intersex
💚A: asexual, agender and/or ally
💙+: meant to include any and all other identities not already included in the previous letters.
Read 10 tweets

Related threads

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Christopher Jackson
@ChrisDJacksonMD
Hey #medtwitter! I am giving a go at my first #MedEd #Tweetorial! I want to review my top 10 trials of 2019 inspired by my talk @UTHSC_Medicine on 2019 GIM updates. Thanks to @cjchiu for the inspiration and encouragement to do this!
1) POC CRP to Guide Antibiotic Treatment for COPD trial:
- RCT of 636 patients with GOLD stage II COPD seen at 86 clinics for AECOPD
- 20.4% absolute difference in self-reported abx use with no difference in COPD-related health at 4 weeks
- Maybe a CRP a day keeps the abx away
POC CRP to Guide Antibiotic Treatment Limitations:
- May not be generalizable to patients with more advanced COPD
- Bias reporting by patients
- Not all places have POC CRP available
- Read more here: nejm.org/doi/full/10.10…
Read 24 tweets
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Gabrielle Mayer
@gabmayer
Hey #medtwitter and #medstudenttwitter! A while ago, I gave a #dermatology presentation on the intersection of derm and #trans health.

I learned a lot. So here's a #medthread on some of the takeaways I found most valuable.

1/10
Let's start with our transfeminine pts.

Derm can provide a number of facial feminization procedures (FFP): e.g. botox, soft-tissue augmentation.

These FFPs can be more affordable/less invasive than feminizing surgeries such as forehead or mandibular contouring.

2/10
Note: tho traditionally considered "cosmetic", these interventions have MATERIAL psychosocial benefits – studies show that facial feminization has a demonstrated positive impact on QoL + mental health outcomes.

3/10

ncbi.nlm.nih.gov/pubmed/26818277

ncbi.nlm.nih.gov/pubmed/20461468
Read 10 tweets
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Steven Chen
@DrStevenTChen
Hey #medtwitter, can you help me?

I’m leading a session today for the Ohio #derm association/@AADskin career launch Bootcamp on...

THE POWER OF TWITTER!

Could you help RT & like to help me prove the reach of this platform!
Thank you!
#dermtwitter #dermatology #dermatologia
@medpedshosp @tony_breu @aoglasser @AdamRodmanMD @WrayCharles @ETSshow @AdeAdamson @HarkerDavid @RoxanaDaneshjou @SBowersMD @DxRxEdu @sargsyanz @AADmember @SuzanneOlbricht @ebtapper @OgunyemiMD @DrGaellon @GIMaPreceptor
@AADskin Thanks to all! This is what we ended up with the presentation. Appreciate all of #medtwitter's help!
Read 3 tweets
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Tyler Black, MD
@tylerblack32
So hey #medtwitter, I know that Invega and Zyprexa and Saphris are new sexy drugs, but for bipolar disorder, have you considered lithium? Yeah, I know, that drug rep WAS pretty hot... but... this medication deserves a rep.

LITHIUM MEGATHREAD!!

#somepsych #psychtwitter #MedEd
I'm nowhere near sexy enough to be hired by a Pharma company, but allow me to be that rep.

(This is particularly targeted at my American psychiatric colleagues, who for whatever reason seem quite enthralled with every new medication that comes down the pipeline)
The last decade has brought out SO MUCH EVIDENCE for Lithium (Li+) in bipolar disorder (BD). Many old ideas about Li+ have changed, and our knowledge has just gotten so much stronger.
Read 27 tweets
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ClinicalProblemSolvers
@CPSolvers
1/#Medtwitter friends, we are thrilled to share a #tweetorial courtesy of @StephenieLe11 and inspired by @DrDanRestrepo's episode on intrarenal AKI #FOAMed
clinicalproblemsolving.com/2019/03/21/epi…
2/30M presented with MSSA native tricuspid valve endocarditis and lower extremity edema was found to have AKI. What are the renal manifestations of endocarditis?
3/There are numerous causes of AKI in patients with endocarditis. Let us know if you think of others!
Read 11 tweets
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Adam Rodman
@AdamRodmanMD
Hey #medtwitter, it’s time for another #histmed #FOAMed Tweetorial! I’m giving a couple of lectures this fall, and in the spirit of #FOAM I’m going to (try my best) to do a Tweetorial for each, so anyone can benefit/watch me flounder/vehemently disagree with me.
So thank you to @BostonChiefs, and let's talk about semiotics and the development of the physical exam!
First, an opinion poll. Do you think that the physical exam as it is practiced today is useful for care of our patients? When I poll people, I’ve noticed dramatic response differential between training levels.
Read 47 tweets

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