Adam Cifu Profile picture
20 Nov, 11 tweets, 4 min read
1/11 A little distraction for Friday. A talk I started working on 20 years ago and then gave up on. Encouraged to return to it by @OSheaLaos. Illness found in paintings. Please add your own finds!
2/11 The one that got me started on this. Rhinophyma. Actually, the picture on the Wikipedia page for the condition!
3/11 Munch is a pro at depicting psychic distress. He seems to be pretty good at the interplay between the physical and psychological too. This one of congenital syphilis might keep you up.
4/11 Just found this yesterday. Check out the Hutchinson’s teeth on the allegorical syphilis!
5/11 There are innumerable good goiters in art. Modigliani is one of my favorites.
6/11 Look at that hand. Some sort of inflammatory arthritis.
7/11 Crazy article about this one (IMAJ 3: 864-871, 2001) that tries to identify all the diseases (Pott’s, hyperostosis vertebralis, post-infectious osteomyelitis…)
8/11 Unfortunately can’t find a good reproduction of this. Many have written that the bishop has scleroderma (telangiectases, tight skin, swollen fingers).
9/11 Portrait of Michelangelo himself showing off some serious hand OA.
10/11 Should have just been called, "Derm Clinic."
11/11 Much too much to say about this. An amazing contemporary artist. Just spend the whole weekend with her website.

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More from @adamcifu

21 Oct
On the occasion of meeting the nurse with whom I will now be working, five of my most memorable experiences with nurses. Please add on.
1. With my grandmother when I was 11
2. August of my internship. Berated by a cardiologist, Dr. Marcus, for, as remember it, not being sufficiently obsequious. Despite profound sleep deprivation I held it together until a nurse hugged me and said, “don’t worry, we all know he’s a &@)$%bag.” I became a puddle.
3. September of my internship. Called into the room of an unresponsive patient. I froze. Nurse came up beside me and quietly told me everything I should do: vitals, blood glucose, EKG, blood gas…
Read 5 tweets
7 Oct
1/9 This thread is a waste of time. It will change nobody’s mind. Nobody should really care what I think—I am no expert here. But, given the response on twitter about this excellent article, I felt like I needed to articulate my thoughts.…
2/9 I have spent most of my career as an EBM proponent, hollering about the superiority of the RCT. Hell, @vinayprasad and I wrote a whole book about it. (No reason not to mix in a little shameless self-promotion).…
3/9 However, people often forget that EBM is not blind adherence to an RCT; nor is it refusal to act without an RCT. Fundamentalism in all forms is bad. EBM requires integrating clinical experience and expertise with the best available evidence from systematic research.
Read 9 tweets
5 Oct
A few more quotations from The Plague, which I continue to find strangely reassuring. These things happen and we always respond in the same way. Image
2/5 Image
3/5 Image
Read 5 tweets
14 Aug
A tweetorial in the guise of a story.
A woman is hoping to have her elderly mother visit from out of town. She and her husband are asymptomatic and have been very careful about contacts. The mother, who is driving from Maine, is well, and has had no risk contacts.
The husband suggests that he and his wife get tested to assure that it is safe for his mother-in-law to visit. Is he being thoughtful or is he trying to get out of having her visit?
It is hard to get good numbers for the test characteristics for NP, PCR test for COVID-19. But here are some numbers I have seen (bear with me, if you don't like the numbers, change them, doesn't much matter).
Sensitivity: 95%
Specificity: 85%
LR+: 6.33
LR-: 0.58
Read 8 tweets
24 Feb
As my busiest month of EBM teaching winds down, thought it was a good time for a quick tweetorial of reading RCTs (without my usual pathetic B/W slides). These are the studies we, appropriately, rely on most in medicine but they can be misleading. What would you add?
How RCTS can be misleading #1

For studies with subjective endpoints, was the control really adequate.…
How RCTS can be misleading #2

Always be cautious when surrogate endpoints are used.…
Read 9 tweets
17 Feb
Went off topic a bit during our critical appraisal course today and gave some advice about keeping up with the literature. (4 Slides)
Keeping up, slide 1
Keeping up, slide 2
Read 5 tweets

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