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Why is the routine use of neuroimaging for hospitalized patients with delirium a #TWDFNR?

This #tweetorial is a supplement to the review published in the July 2019 issue of the @JHospMedicine

journalofhospitalmedicine.com/jhospmed/artic… 2/
To understand why the routine use CT/MRI to evaluate delirium is a #TWDFNR, we must first recognize that many acute neurologic processes assessed with neuroimaging DO cause delirium.

Example:

💥13%-48% of patients with acute stroke have delirium💥

journals.sagepub.com/doi/10.1111/j.…

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Why is “HIT Testing in Low Probability Patients” a TWDFNR?

This tweetorial is a complement to the review published in the June 2019 issue of @JHospMedicine by authors Amanda Li, Lisa Hicks, and @efan75.

journalofhospitalmedicine.com/jhospmed/artic… 2/
As the authors note, the ELISA test has a sensitivity >95% when the optical density threshold is low. The high sensitivity of the ELISA may make one inclined to use it liberally to evaluate for HIT.

ncbi.nlm.nih.gov/pubmed/26518436

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Why is "Routine Echocardiography in Hemodynamically Stable Patients with Acute Pulmonary Embolism" a #TWDFNR?

This question was addressed in this month's @JHospMedicine by @PaulBerglMD et al.

Here's a thread to complement their awesome review.

journalofhospitalmedicine.com/jhospmed/artic… 2/
Let's start with a case and question. The case is taken from the review by @PaulBerglMD et al. Review it and answer the question in tweet 3.

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Why is "Prescribing Docusate for Constipation in Hospitalized Adults" a #TWDFNR?

This thread is a complement to the recently published review of the same name, appearing in February 2019 issue of @JHospMedicine

journalofhospitalmedicine.com/jhospmed/artic… 2/
Before discussing the review by Robert Fakheri and Frank Volpicelli, let's gauge current practice.

How do you currently use docusate in hospitalized adults with constipation?

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Why is the routine use of intermittent pneumatic compression for the prevention of venous thromboembolism in medical ward patients a #TWDFNR?

This thread is meant to complement the recently published article appearing in @JHospMedicine

journalofhospitalmedicine.com/jhospmed/artic… 2/
First, a question: how often do you use intermittent pneumatic compression (IPC) for venous thromboembolism in medical ward patients?

1/ Why is "Prealbumin Testing to Diagnose Malnutrition in the Hospitalized Patient" a #TWDFNR?

This #tweetorial is meant to complement the recent publication of the same name in @JHospMedicine

journalofhospitalmedicine.com/jhospmed/artic… 2/
Let’s start with two questions...

First: Do you use prealbumin as a “marker” of malnutrition?

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Why is the acute treatment of "hypertensive urgency" a #TWDFNR?

This #tweetorial is meant to complement the recent publication: "Acute Treatment of Hypertensive Urgency" in @JHospMedicine

journalofhospitalmedicine.com/jhospmed/artic… 2/
Case: A 71M with a history of HTN is hospitalized for cellulitis. On hospital day 2, the nurse pages you:

"Pt X with BP ____. Please advise". He has no symptoms or signs of end-organ damage.

What would be your threshold SBP to write for an as-needed anti-hypertensive?