Avital O'Glasser, MD FACP FHM Profile picture
Hospitalist & Associate Professor @OHSU_DHM, PreOp Clinic Medical Director @OHSUSOM, Assistant PD @OHSUIMRes, @ACPinternists #CECP member, Secretary @SPAQIedu
Jake Varney Profile picture 1 added to My Authors
9 Jun 20
1/ It’s been over two weeks since I last posted a thread about #COVID19 trends in Oregon

A lot has happened in since then—George Floyd’s murder and subsequent #BlackLivesMatter protests & active discussions

I will NOT to be tone deaf to that here

2/ instead, advocacy regarding COVID19 & #BlackLivesMatter cannot be talked about separately—and indeed the two are intimately intertwined

many have described current realities as “Two Pandemics”

@gradydoctor’s @JHospMedicine piece is one example:

3/ COVID19 has been infected and killing Black Americans at dramatically disproportionate rates for months...then came the “acute on chronic decompensation” as @gradydoctor describes ImageImage
Read 40 tweets
21 May 20
A #periopmedicine-meets-#COVID19 #tweetorial #Medthread

There has been a lot of overlap between the two areas in the last few months:
🦠appropriate PPE use
🦠pre-op covid19 screening of asymptomatic patients
🦠OR & postop ward management/re-designs

other topics have been explored, such as the safety of laparoscopic surgery v laparotomy given risk/benefit of
overall surgical risk, operative time, potential aerosolization of particles via gas suspension and pneumoperitoneum

one article:

I’ve also captured my thoughts about how we resume “elective” surgical volume as states and countries start to “reopen” in this #tweetorial

I'm not going to revisit these subjects here. But...


Read 24 tweets
7 May 20
There's been increasing discussions (on and off #medtwitter) re cancelled surgeries, financial impact on hospitals, and what "elective surgery" means

as some hospitals start to increase surgical volume and project how long it will take to catch up on the queue, some thoughts: 1/
the complexities of these decisions at the institution/health system level AND at the personal level for patients and their families only serve to highlight how complex & nuanced surgical decision making and planning can be...

brief background

why were surgeries cancelled?
🚫preserve PPE
🚫increase available ICU and hospital beds
🚫staff deployment to other services incl COVID teams
🚫decreased spread
🚫decrease patient risk post op complications (esp if they were covid + preop or acquired it postop)
Read 20 tweets
24 Apr 20
1/ I haven’t written a #periopmedicine #tweetorial in a while, but last night @etsshow tapped me on the shoulder w a request for a #Medthread re preop evals via #telehealth

The specific❓was re assuaging surgeon (& I’ll add anesthesiologist) concerns re the lack of an exam

2/ Background 1️⃣–telehealth across the board has rapidly expanded given the challenges of providing care while keeping safe distances due to #covid19

We’ve had an incredible amount of institution level support for this at @OHSUnews @OHSUSOM!

3/ Background 2️⃣–telehealth for PREOP has been a goal for years w go-live in June.


To meet the care needs in a large, rural state—many of our sicker/older patients lived very far away & w limited socioeconomic means to get to preop clinic before surgery
Read 26 tweets
6 Mar 20
A Friday #tweetorial #medthread about patient privacy on
#medtwitter #SoMe

There are many facets of patient privacy & professionalism concerns in this communal space—I’m going to focus on this through the
lens of case-based teaching

We know that #medtwitter & #SoMe enhance learning based on tenants of adult learning theory—this includes the microsimulation, mini-challenges, & active discussion of case-based learning.

However, how can we make this effective safe for our patients AND ourselves?

I want to introduce this concept—the term came to me a couple of weeks ago:


Read 25 tweets
28 Feb 20
#acgme2020 #acgmetweets why does twitter need GME, why does #GME need #medtwitter??

@RJmdphilly @michellebr00ks @gretchendiemer @MargMChapman @gradydoctor ImageImage
#ACGME2020 #ACGMEtweets what are some of the mechanisms of using #medtwitter for adult learning?
#twearls Image
Read 16 tweets
21 Jan 20
By request (incl @afedwardMD @SaraJPharmD @bethgarbitelli), a #periopmedicine #tweeetorial #MedThread about marijuana management

This is one of my longer tweetorials—there’s a lot to cover!

Also, no silly weed or "high" GIFs…my purpose here is to teach, not stereotype...

Why do we need to ask about how we can best manage marijuana use perioperatively?

❇️ use is increasing
❇️ multiorgan effects
❇️ potential for intoxication or withdrawal
❇️ interaction with anesthetic agents
❇️ risk of postop complications

What do we mean when we say “marijuana”?

the Cannabis plant (species incl sativa, indica, & ruderalis), which contains > 500 chemical compounds, 100+ of which are “cannabinoids”

Potential ”medicinal” effects:
Muscle relaxant

Photo Wiki

Read 28 tweets
14 Jan 20
@ebtapper @AtoosaRabiee @rrosenblattmd @ETSshow agree, would absolutely use in a talk if it contributed to your teaching goals
definitely "cite" the writer
one of the "perks" of using tweets in talks (ex. screengrabs) is that you can capture writer (profile) & date easily, but could also provide the hyperlink
@ebtapper @AtoosaRabiee @rrosenblattmd @ETSshow & you can cite tweets in publications, too
and just to get meta...@tony_breu himself has provided an answer to the "how"
(and the #tweetorial embedded was data from a survey he did about tweetorials)

@ebtapper @AtoosaRabiee @rrosenblattmd @ETSshow @tony_breu if you wanted to get really user friendly for folk not on twitter, you could provide linked to a @threadreaderapp unrolled thread (turns a thread into a single webpage)


Read 4 tweets
2 Jan 20
A New Year’s (+1 day) #periopmedicine #medthread #tweetorial

What do New Year’s resolutions and pre-op optimization have in common??

Let’s warm up with a quiz
What is the most common New Year’s resolution?

According to this resource, the top resolution is to exercise more

This is certainly applicable to the subject of periop optimization...
...as are other potential resolutions such as drink less, lose weight...

Read 22 tweets
20 Nov 19
Welcome back! Time for #tweetorial part 2 of #periopmedicine meets #meded
This time? #GME!
I’m going to continue to look at this through the lens of my experience practicing perioperative medicine as an #IMproud internist

Let’s start with an “origin story”.

Do you know what my first exposure to the concept and question of “is this patient of an acceptable risk to proceed to the OR?” Was?

Want to take a guess?

It was on a hepatology elective! We were consulted to inform #periop risk discussions for a young patient with cirrhosis scheduled for an open abdominal surgery (fyi, this can be high risk)
It was a lightbulb moment for me as an IM resident!
Periop wasn’t just cardiac…
Read 24 tweets
18 Nov 19
#periopmedicine #tweetorial time!
Thank you for the votes—“clinical pearl” was the clear front runner, so here we go—with a TWIST!

HOW & WHY can you utilize the periop space to clinically TEACH

That’s right, this is a #periop #meded #medthread!

This is going to be a 2-parter, because I have that much to say.
Stay tuned for #tweetorial part 2 later this week

I’m hoping to be comprehensive and apply a broad arc about #meded to #periopmedicine

Today we start with #UME (medical students), later #GME
For starters, what are your current thoughts on teaching in the #perioperative setting?
Read 24 tweets
8 Oct 19
A #periopmedicine #tweetorial/#medthread

It’s that time of year again!
Sunday football?
ERAS applications?
Girl Scout cookies?
Well, yes…but for the purposes our discussion, it’s “COLD & FLU SEASON”

What do you do if a patient scheduled for surgery has a URI?

what is the theoretical concern?
That presenting for surgery, and the anesthetic management including intubation required to facilitate it, will lead to #perioperative complications if the patient has (or has recently had) an upper respiratory tract infection.

these concerns include the risk of periop pulmonary complications:
🔘respiratory failure
🔘airway hyperreactivity (during induction or emergence) ➡️laryngo/bronchospasm
🔘deeper infection like pneumonia

does this “biologic plausibility” translate into real-world events?

Read 23 tweets
11 Sep 19
As voted upon, a #Tweeotorial #Medthread:
#perioperative medicine meets #backtobedside
so let’s talk about functional capacity and METS!

“metabolic equivalent of task”


Have you ever seen that report out on exercise equipment? Usually a number < 10?
It’s a measure of physical activity via oxygen consumption

Again, huh? #backtobedside??
Stay with me…
Recall that the 2007 and 2014 ACC/AHA perioperative guidelines both include a step in their algorithms that no additional ischemic testing is recommended for patients who can achieve > 4 METS

So...how about those METS???
Read 27 tweets
3 Sep 19
#Periopmedicine #Medthread!
Based on requests (esp @JenniferBrokaw), a long over-due #tweetorial with my advice & pearls for providing patient-centered care for the surgical patient with #ParkinsonsDisease
@JenniferBrokaw Caveats
1⃣I’m not an anesthesiologist & don’t care for pts w PD #intraoperatively
2⃣I practice outpatient #PREoperative medicine, so I am not providing inpatient postop care
3⃣There are several high yield publications/resources, & much of this is pulled from my own experience
@JenniferBrokaw Caveats out of the way, let’s chat about why understanding #periop #ParkinsonsDisease management is so foundational.
Remember how Osler said to know syphilis is to know all of internal medicine?
Yeah…PD meets #periopmedicine is potentially THAT informative.
Read 28 tweets
26 Aug 19
A Monday #Medthread:
#medtwitter colleagues—what gets your BP and HR up the most in terms of delivering “bad news”?
in my #periopmedicine world, it’s telling a patient we might need to postpone or cancel their surgery
So…a #tweetorial to share my learnings over the years
Take a step back—remember that there’s no such thing as “preop clearance”.
The value added is preoperative evaluation and risk assessment, with patient + procedure-specific optimization
Inherent to this is communicating risk and concerns for it
The overwhelming majority of patients I evaluate in preop clinic are stable/optimized at the time of my evaluation, though my assessment still adds value by empowering intraop and post-op care, as well as facilitating pre-op patient instructions and empowerment
Read 23 tweets
9 Aug 19
Friday #Medthread! I’ve been chatting lately that I should write a #tweetorial about how I’ve put my social media related/based activities on my academic/professional CV. So, without further ado... 1/x
these are excited times, & hopefully this won't be uncharted territory for too much longer as standards are set and more institutions embrace social media related activities...BUT for now...how do you show your uniqueness and innovations via #medtwitter #SoMe?? 2/x
1⃣these are my opinions (grounded in experience & many discussions)
2⃣I use the OHSU CV template (Scholarship/Service/Teaching)
3⃣employers may not be ready to embrace

PS--bonus points--name the TV show the GIF is from!! (probably not known/respected enough...)
Read 18 tweets
7 Aug 19
An anniversary #Medthread!
One year ago today, I gave my OHSU #GrandRounds about #medtwitter for academic clinicians and immediately posted its accompanying #tweetorial.
My goodness, what a year!!
Some reflections and musings 1/x
an incredible year indeed, professionally AND personally--and definitely in no small part thanks to #medtwitter and the opportunity to prepare and give this talk about #SoMe
pardon my if the argument is getting a little circular...the coffee is still kicking in... 2/x
I truly truly had no idea. In probably a poor exam of my "beginning of the academic year commitment to say 'no' more often", I told my boss that I could fill the August 7th #GrandRounds slot on only a few weeks notice.

"Don't you have a talk about twitter prepared?"... 3/x
Read 17 tweets
1 Aug 19
there 2 hours left in July 2019 on the west coast, so a belated/last minute #medthread w July-in-the-hospital thoughts in large part inspired by @ETSshow recent amazing episode w @drjenniferbest & the question--would YOU want to be a patient in the hospital in July? 1/x
@ETSshow @drjenniferbest brief background, I was born end of June in a teaching hospital, and grew up with stories that "it got different the day after you were born", so was aware that there was something "special" about July long before I considered a calling for medicine 2/x
@ETSshow @drjenniferbest back to the more recent past. Beyond being an intern, resident, attending, and patient myself in July, I have been the patient of a NICU BABY in July--a critically ill newborn in the neonatal intensive care unit 3/x
Read 9 tweets
24 Jul 19
As promised, a #tweetorial #Medthread to accompany our new publication ABOUT #medtwitter use by residency programs!
"Twelve Tips for Tweeting as a Residency Program"


@DesaisSima @PDX_Tom The piece is in the online journal @MedEdPublish, & we really appreciate the reads. Because it is open-access, I won't regurgitate the entire piece, but I will share and sprinkle additional explanations on highlights 2/x
@DesaisSima @PDX_Tom @MedEdPublish the "12 Tips" piece chronicle our journey to create @OHSUIMRes for the @OHSUSOM @OHSUNews Internal Medicine Residency Program, and the reflections, musings, advise for others thinking about a programmatic account for internal medicine and non-IM residency/fellowship programs 3/x
Read 19 tweets
15 Jul 19
Followup #Medthread #Tweetorial about #periop med management as promised!
Thank you to all who voted.
So...the answer was an MAO-I.
all the agents are ones to stop pre-op, but why was MAO-I the answer I was going for?? 1/x
First choice was Ephedra--definitely something to stop pre-op given it's sympathetic effect and risk of cardiovascular instability.
HOWEVER, Ephedra was banned by the FDA in 2/2004, so I haven't seen a patient on this in the preop setting in years 2/x
thinking about Ephedra is a good opportunity to this about herbal/nutraceutical/supplement management periop, given hypothetical or KNOWN risk of:
✅cytochrome up/down regulation
✅cardiovascular instability
✅changes to platelet/coagulation function
✅drug/drug interactions 3/x
Read 13 tweets
6 Jul 19
A quick, spontaneous Saturday #tweetorial #Medthread about periop OSA inspired by @cacace_frank's journal catch up (w my first response below). Going to make this interactive (& tag #periop hospitalists & anesthesiologists along the way)... 1/x
@cacace_frank rightfully so, #periop OSA is getting more and more attention. It, and the company it keeps (OHS, PHTN, R heart failure) are driving periop risk factors, for respiratory events (resp failure, esp with opioids on board) AND cardiac events 2/x
@cacace_frank society guidelines recommend screening for OSA pre-op (ex. STOP-BANG), but what do you do with a positive screen? recall, it only takes 3/8 points on STOP-BANG to get to "high risk". It's a patient risk/benefit AND systems-based Q re utilization of/access to sleep studies...3/x
Read 19 tweets