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Nick Mark MD Profile picture
@nickmmark
Apr 18, 2020 • 4 tweets • 6 min read • Read on X
It was a privilege to share the (virtual) stage with an amazing panel discussion of differences between PICU and MICU care by #POPCoRNet. Thanks to @DrPhilipVerhoef @DeannaMarie208 @davidshoremd @DoctorVig @MihirAtreya @ArunK_MD @PfarrMarie @annaberry29 for arranging. #FOAMcc 1/3
We covered some important adult and pediatric ICU topics including #Pain/#Anxiety/#Delirium (PAD) treatment, #COVIDairway management, #ARDS #ventilator strategy, #proning, #vasopressors, & how to perform #ACLS while wearing PPE. I've attached some relevant OnePagers. 2/3 ImageImageImage
Very thankful to the amazing international audience who contributed great comments and discussion. Bottom line: adults are just big kids and there are some great pediatric intensivists out there who are ready care for adults with #COVID thanks to #POPCoRNetwork resources. 3/3
Here’s the link to watch the recorded webinar. ➡️

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More from @nickmmark

Nick Mark MD Profile picture
Jun 1
Well designed RCT shows patients randomized to an exercise program had substantially improved survival after adjuvant chemotherapy for colon cancer.
- 5 yr disease-free survival 80.3% vs
73.9% (HR 0.72)
- 8 yr overall survival 90.3% vs 83.2% (HR 0.63)

This is groundbreaking!
1/ Image
Some deets on the CHALLENGE trial

A 55 center trial done over 15 years (2009-2024) that randomized n=889 people with resected colon cancer after adjuvant chemotherapy to either:
- participate in a structured exercise program
- or to receive health-education materials alone

2/
The intervention was pretty comprehensive:
Personal activity consultant (PACs) - essentially trainers - got to know the participant 1:1, introduced them to the gym and came up with personalized activity goals
Regular every 2 week sessions helped participants reach the goals

3/ Image
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Read 16 tweets
Nick Mark MD Profile picture
May 18
Tragic news today about former president Biden's prostate cancer diagnosis. I wish him well.

As someone who follows presidential health reporting, I noticed something odd: unlike his predecessors, Biden's physician's never reported PSA.

How to interpret this absence? A🧵
1/ Image
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There are two possibilities:
1️⃣ Biden’s PSA was never checked
2️⃣ Biden’s PSA was checked but it wasn't reported

Strictly speaking, not checking PSA could be a medically correct option. Whether or not to test PSA is a complex question and is not the topic of this thread.

2/
Like many VIPs, presidents tend to have excessive testing that is not always strictly evidence-based.

For example, Bush 43 had an exercise treadmill test and a TB test for no apparent reason.

3/ Image
Read 13 tweets
Nick Mark MD Profile picture
May 4
In honor of #MayThe4thBeWithYou let's consider the most difficult airways in the Star Wars universe:

1. Darth Vader
Species: human
Vader presents several challenges: Vent dependent at baseline, airway burns from Mustafar, limited neck mobility.
Discuss GOC before saving him Image
2. Fodesinbeed Annodue
Species: Trog
All airways require teamwork, but intubating Fodesinbeed Annodue's two heads really will require two operators.
Consider double simultaneous awake fiberoptic intubation
Be sure to consent both heads. Image
You will never find a more wretched hive of scum & challenging airways than Mos Eisley (except maybe at Jabba's)

3.Greedo
Species: Rodian
Micrognathia, posterior airway, no nasal intubation, green skin so no pulse ox
Approach: VL + bronchoscope. Intubate quickly (shoot first) Image
Read 23 tweets
Nick Mark MD Profile picture
Mar 9
Every year, there is a predictable spike in fatal car accidents, medical errors, & heart attacks.

It’s estimated that there are thousands of excess deaths, a 1% increase in energy consumption, & billions of dollars in lost GDP.

The cause? Daylight savings transitions.

🧵

1/ Image
Earth's axis of rotation and orbital axis are not precisely aligned. The 23.5 degree difference - 'axis tilt' - gives us our seasons and a noticeable difference in day length over the course of the year.

2/
For millennia this seasonal variation was an accepted fact of life.

In 1895, George Hudson, a New Zealand entomologist, was annoyed that less afternoon light meant less time for bug collecting.

He realized that clocks could be adjusted seasonally to align with daylight.

3/ Image
Read 27 tweets
Nick Mark MD Profile picture
Feb 14
Musk is so stupid. Exhibit #10544

There aren’t thousands of 150 year olds getting paid social security. There are null values in a database he doesn’t understand how to read… Image
When unidentified people get admitted to the hospital the default DOB is 1/1/1900. The EHR shows their age as 125 yo.

But *almost* everyone is smart enough to understand this is just a result of missing data… Image
Nice summary here debunking Elon’s “duplicate SSNs” claim.

thedatageneralist.com/elon-musk-does…
Read 4 tweets
Nick Mark MD Profile picture
Feb 8
Important point re indirects:

Unlike other Trump moves, this is arguably GOOD news for researchers!

If the NIH budget is unchanged (a big if), this allocates more money to researchers; if you go from an indirect of 75% to 15% it means you can fund 3 grants instead of 2.
Some context:

Between 1947 and 1965, indirect rates ranged from 8% to 25% of total direct costs. In 1965, Congress removed most caps. Since then indirects have steadily risen.

2/
A lot of indirects go to thing like depreciation of facilities not paying salaries of support staff.

This accounting can be a little misleading.

If donors build a new $400m building, the institution can depreciate it & “lose” $20m/year over 20 years. Indirects pay this.

3/
Read 4 tweets

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