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Sep 29 6 tweets 3 min read
1/ 🚨NEW PATIENT!🚨 66 y/o M found in his home unresponsive and hypothermic.

What abnormalities do you see in this EKG? Image
2/ Did you notice sinus bradycardia? What about intraventricular conduction delay?

Check out this slide with all 5 EKG findings! Image
3/ With these EKG findings and hypothermia, what else should you order?! Image
4/ This patient’s T4 was undetectable and TSH was 40.

What’s the diagnosis? Image
5/ Myxedema coma is right!

Let’s review:

Shoutout to @denahayes and Vorada Sakulsaengprapha for a great #12LeadThursday byte! Image
Shoutout to @DHayesMD for being the author of this awesome #12LeadThursday byte!

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More from @COREIMpodcast

Sep 15
🚨Your pager is going off!🚨 80M w h/o CAD on the inpatient medicine floor reporting burning epigastric pain after eating.

Here is his EKG:
Take a look…any notable findings on this patient’s EKG?!
The patient is given an antacid and you order a repeat EKG.

Your repeat EKG looks exactly like the patient’s baseline (based on chart review). What’s going on?!
Read 6 tweets
Aug 17
1/ What are 3 Qs you can ask yourself when looking at non-inferiority trials?

Q1) Was the trial planned i.e. pre-specified as comparing an intervention which is non-inferior to control?

WHY?

Bc changing the analysis *afterwards* introduces bias #StatswithCoreIM
2/ Q2) was the control treatment administered to the full std of care?

The trial relies on strict adherence to full standard of care for the control arm, otherwise the whole confidence interval shifts with a relative⬆️in benefit of the intervention compared to control
3/ Q3) Did investigators perform both a per protocol and intention to treat analysis?

Per protocol:
Exaggerates group difference when intervention is inferior
Less likely to result in false positive

Intention to treat:
Makes groups prognostically 🟰
Benefit of randomization
Read 9 tweets
Jun 21
1/ Let’s dive into #noninferiority trials for this edition of #StatswithCoreIM

But first, take a look at this figure for what superiority trials aim to assess: What’s better?
2/ So how are NON-inferiority trials different?

They ask if a treatment is much worse than standard of care.
3/ Let’s look at the possible outcomes of a non-inferiority trial.
✔️Superior and non-inferior
✔️Non-inferior
✔️Not non-inferior
✔️Inferior and not non-inferior
✔️Inferior and non-inferior
Read 5 tweets
May 4
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⬆️⬆️
Read 5 tweets
Mar 17
1/ Welcome back to 12-Lead Thursday #MedTwitter !

Let’s get the juices flowing with an EKG! What are the major abnormalities?
2/ Yes, those are inferolateral ST elevations!

And notice the underlying rhythm of atrial fibrillation
3/ Continuing our patient story, the patient was taken emergently to the cath lab where angiography revealed...

Normal coronary arteries!
Read 9 tweets
Mar 8
1/ First and foremost, from all of us here at @COREIMpodcast, sincerest greetings for #InternationalWomensDay!

We wanted to use this opportunity to shed light on the discussion on post-menopausal hormone therapy (HT) via highlighting the important yet controversial WHI trial Image
2/ WHI followed the Nurses' Health Study, a prospective investigation that showed HT was associated with decreased cardiovascular disease (CVD) risk Image
3/ WHI, a randomized controlled trial (RCT), was believed to mitigate the effects of confounding factors better than cohort studies. WHI, in contrast to the Nurses’ Health Study, showed that HT was associated with a slightly increased risk for CVD among other conditions ImageImage
Read 9 tweets

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