CORE IM Profile picture
May 4, 2022 5 tweets 2 min read Read on X
1/ Welcome back to #StatswithCoreIM !

What would you tell this patient who inquires about lab cancer #screening test to help him “live longer”?

What types of bias can occur in determining whether a cancer screening test reduces mortality?
2/ Take a look at the bolded arrows below that illustrate that early detection doesn’t always mean better outcomes!

Length-time bias applies to slow-growing disease in which patients have a long phase without symptoms.
3/ Lead time bias applies to situations where patients are screened earlier, so they are diagnosed earlier, so they appear to live longer solely by nature of knowing they have the disease for a longer period of time.

Therefore, survival time⬆️⬆️
4/ How would you explain these biases to our patient?
5/ So now what? How can studies mitigate length and lead time bias?

Check out our bullets below ⬇️ and let us know if you have additional ways you think about mitigating these biases in studies

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More from @COREIMpodcast

Sep 11
1/ 🚨 NEW #AtTheBedside: Moral Distress Part 1: Definitions, Causes & Consequences

Time to really name, talk about, and hopefully unpack some of the hidden weight we carry in the practice of medicine ⤵️

🖥️:
Sponsor: @Pan_Financial coreimpodcast.com/2024/09/11/mor…
Image
2/ Moral distress:

When clinicians are:
☀️ Stopped from taking what they believe to be ethically appropriate actions
☀️ Forced to take actions that are ethically inappropriate based on their professional obligations

Results in a sense of complicity & wrongdoing
3/ Moral distress occurs at:

☀️Patient or family level
☀️Unit or team level
☀️System level
Read 8 tweets
Jun 5
1/ 🚨 NEW #5Pearls on HFpEF!

HFpEF is:
- Clinical syndrome of heart failure w/ EF 50%+
- ☂️ term | Heterogeneous disease 

HFpEF is NOT:
- Classic high BP, causing stiff ventricles

🖥️ :
ACP CME:
Sponsor:  coreimpodcast.com/2024/06/05/hfp…
bit.ly/CIMCME
coreimpodcast.com/Freed
Image
2/ Clinically, HFpEF is:

🫀Dyspnea on exertion
🫀PND
🫀Orthopnea
🫀Fatigue
🫀Exercise intolerance
🫀JVD
🫀Pulmonary rales
🫀LE edema
3/ On echo, HFpEF is NOT:
🫀Just diastolic dysfunction

**Diastolic dysfunction CAN be seen in HFpEF 

But, it was not observed on resting echocardiograms of ⅓ of HFpEF patients in the Paragon-HF trial ‼️
Read 7 tweets
May 13
1/ 🚨 NEW #5Pearls episode on Cardiorenal Considerations 🫀🫘

So many diuretic options, so which to choose and why?

Use the toolkit ⤵️ for all your diuresis needs!

🖥️:
CME: 
Sponsor:  bit.ly/3wx8tnB
bit.ly/CIMCME
coreimpodcast.com/Freed
Image
2/ Not all AKI in heart failure is cardiorenal syndrome!

In pure cardiorenal, expect a “bland” UA with no:
🥩 Protein
🩸 Blood
🦠 Granular or other cell casts!

**Remember, keep a broad differential for AKI
3/ You suspect volume overload in a patient…what dose of diuretic do you start with?

2.5x their home dose of diuretic (in IV form)!

IV options include:
💉 Furosemide
💉 Bumetanide

**Bumetanide drip at higher doses is associated with myalgias
Read 9 tweets
Jun 8, 2023
1/ Time for #12LeadThursday!

What’s the axis and do you notice anything about the precordial leads? Image
2/ What do you see on ECG to identify extreme axis deviation?

Negative deflection in lead I + negative deflection in aVF = extreme axis deviation Image
3/ What about the precordial leads?

Do you notice dominant R waves, S waves, or T-wave inversions? Image
Read 5 tweets
Apr 13, 2023
1/ What better way to end off a week of pacemakers and ICDs than recapping and revisiting our #12LeadThursday series!

🧵 Image
2/ Which patients get pacemakers?

Think of 2 big buckets: conduction disease and heart failure Image
3/ Let’s start with conduction disease!

Refresh your memory with this past byte - 80 y/o M with hx of CABG…what's the rhythm?
bit.ly/40cAry0
Read 15 tweets
Jan 18, 2023
1/ Atrial Fibrillation: #GrayMatters Series

What do you do with that episode of #Afib when sick or post-op in the hospital?

What type of monitoring is best?

🎧: link.chtbl.com/Afib
🗒️: bit.ly/3QPiLFt
CME: bit.ly/CIMCME
Sponsor: go.amboss.com/CoreIM-E9
2/ When do you start AC for new Afib post-op?

We hope this infographic will be handy for the many times we may be in the gray zone!

From @accpchest guidelines

A few things to consider:
🤔 Patient specific risk
🤔 Blood thinner of choice
🤔 Bleeding risk of the surgery
3/ Credit to the team that worked tirelessly on this!

Hosts: Dr. Nick Villano, @Ali_Trainor, @FreedoBaggins
Off-air producer: @ShreyaTrivediMD
Experts: @jasonmatosmd, @PoojaJagadishMD, @gregorykatz
Graphic: Josie Levey

🎧:link.chtbl.com/Afib

coreimpodcast.com/2023/01/18/dia…
Read 5 tweets

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