Radiation oncology is cool

one of the most impactful classes i ever took in undergrad was a course called Instrumental Analysis which was, essentially, Electrical Engineering for Chemists. i don’t remember the actual devices that we studied but i came with a lifelong appreciation for understanding the limitations of machines

It never ceases to amaze me how a piece of software as profoundly shit as Microsoft Teams continues to be used by organisations worldwide

Mom, come pick me up, the best lack all conviction and the worst are full of passionate intensity.

I'm sorry, if you're going to make a big show about how you've got a Department of WAR helmed by a Secretary of WAR and staffed by WARfighters, it's totally inane to then claim that your massive bombing of a foreign country constitutes something other than a war.

Inpatient diuresis thoughts Spironolactone is not only part of GDMT, and not only a K-spring diuretic, but also an H-sparing diuretic. Start it up front when you anticipate >10-15 pound loop diuresis to prevent not only constant potassium chasing, but also metabolic alkalosis. 1/2

my uncle runs a place in Anchorage that serves fish and chips, and he named the half portion the "Texas size" which is just an incredible troll

This recent RCT of an "AI stethoscope" claims the technology "shows promise" for diagnosing cardiovascular conditions. It does not. It is a textbook example of the risks of conducting unprincipled 'per protocol analyses'. Once again, peer review at a major medical journal has failed. 🧵 1/

New from @cidjournal.bsky.social and Mayo Clinic, a modern cohort of Legionella PNA: 344 adults with Legionella (85% L pneumophila) 1/3rd ICU, 1/8 died at 30 days Urine Ag only + test in 42.4%, but among those with +PCR/Cx, UAg+ in only 25.6% #IDSky #Legionella academic.oup.com/cid/advance-...

Our former med student, Casey Means, will finally have her nomination hearing for US Surgeon General this week. Listen to why she is a poor pick for this important role, using a deep dive into her 2024 book Good Energy as a window into her knowledge, priorities, & perspective. youtu.be/0PjFRo5o9XM

You've heard that something is going on with colon cancer. I'm working on a thing...let me know what you think!! Is it helpful? What would you do different? hankgreen.com/crc

Historian of medicine here. Yes. Yes, they did.

Most of the time things make more sense when I think of this administration by their names rather than their titles, but I think this quote captures the zeitgeist better when attributed to the Director of Health and Human Services.

Warning: PCSK9 stands for proprotein convertase subtilisin kexin 9

This is really cool. Now do Lyme-free ticks and rickettsia-free fleas pls thx www.nejm.org/doi/pdf/10.1...

A 49-year-old man with acute myeloid leukemia was evaluated for prolonged neutropenic fever. On examination, there were crackles at the lung bases. CT of the chest revealed a reversed halo sign. Read the full case details: nej.md/3MAEwuS #MedSky #Hematology #IDSky

Did a Celebrated Researcher Obscure a Baby’s Poisoning? He sure did. www.newyorker.com/magazine/202...

Why is a 20-year-old study "still under fire"? Because: - it was wrong - the lead author lied to conceal it - millions of women and infants were harmed - other death investigations were misled - when shown this, major institutions looked away www.cbc.ca/news/health/...

You can see my enthusiasm for #naturalexperiments wane over the course of this paper, even as difference-in-differences takes over medical journals. evidence.nejm.org/doi/abs/10.1...

This story is so wild and so well told. I woke my husband up gasping at the "we made it up" part.

I’ve spent 15 years challenging a flawed explanation for an infant’s death. Credit to The New Yorker for patient investigative journalism that corrected the record when institutions did not.

OMG philosophy academic publishing is cooked retractionwatch.com/2024/06/12/h...

reminder to liberally check carbon monoxide levels during snowmageddon CO levels can be measured on venous blood along with routine labs (no need for a separate arterial puncture) emcrit.org/ibcc/co/ #EMIMCC

I am one single hour into onboarding for my first clinical attending job and I've become a single issue voter to destroy the US medical billing system

i stopped taking my blood pressure pills and gained all my blood pressure back, these things don’t work

Yikes. Are these the best endpoints to be studying here?

FYI to anyone who follows my main account on Twitter/X “therealdoctort,” unfortunately the account has been hacked and the name has been changed. I’ve reached out to @X to try and regain control. Please disregard any posts or messages coming from that account until I can get it back. Thanks.

This second point (early endpoint for something expected to have late benefits) is EXACTLY what led to nonsensical claims about ventilators killing people in April 2020 in NYC, and we are STILL dealing with it. Hard not to think it was specifically chosen here to minimize the benefit of vaccines.

Friendly reminder that we call eggplant eggplant because the "normal" eggplant used to look like this

My new Substack: This week's announcements of ChatGPT Health and Utah's new system that permits AI to refill prescriptions are both interesting in their own right. But together, they usher in the "AI Doctor" era. The implications are enormous. open.substack.com/pub/robertwa...

The Norwegian Nobel Prize committee has been forced to make a statement, declaring that the prize cannot be transferred. It's hard even to comprehend how stupid this has become

1/ Hello 👋 #medtwitter #neurotwitter #neurosky #medsky #neurocritcare #FOAMEd have another brief case that I wanted to discuss with you and see if maybe you can learn something new or reinforce old knowledge!

I SET YOU ALL UP FOR AN INFLATION JOKE AND AM DISAPPOINTED IN YOUR FAILURE

A 31-year-old woman presented with 10 days of fever, sinus pressure, cough, nausea, and vomiting. Three episodes of similar symptoms, as well as night sweats, fatigue, and weight loss, had occurred in the previous 5 months. Read the full case details: nej.md/4sbcTbS #MedSky #IDSky #Immunology

posterior view of the skull pretty creepy

Bruising on the back of the hand is so common in older adults that John Mulaney used to have a joke about it in his touring set in 2024. It is not a smoking gun for a peripheral IV no matter how badly journalists want it to be.

It's not too late to get your flu shot. Flu circulates year round but more intensely during flu season. For N. hemisphere: Onset: October–November Peak: December–February (most often January) Decline: March Tail end: April–May (occasionally later) This is why we give shots until the end of February

It is very important to me that we do not tell apartment complexes that they need fast chargers for EVs. They need level 2 chargers. Not more than is used by a dryer or electric range. When you're charging overnight, you do not need crazy voltage.

Gluten free but gluing the 11th will cost you.

Rapid response www.bmj.com/content/386/... on randomization and allocation leading to eventual retraction from the @bmj.com www.bmj.com/content/391/... Intraosseous vs IV access trial #EMIMCC #EpiSky

had a dream where it was the end of the semester and i had studied very hard for all my classes. i took each final exam and finished on time. i did really well and was rewarded for my diligence with passing grades and honors. pretty nice dream. glad i had it. everyone fully clothed, too.

Whoa www.nejm.org/doi/full/10....

Did you know that from tomorrow, Qualtrics is offering synthetic panels (AI-generated participants)? Follow me down a rabbit hole I'm calling "doing science is tough and I'm so busy, can't we just make up participants?"

Do you ever wonder which patients are accessing their patient portal during their hospitalization? Turns out, not all patients use the portal equally: health disparities have been noted in inpatient portal use. Read more: https://doi.org/10.1002/jhm.70093 #VisualAbstract by Shaheen Fatima

Complex regional pain syndrome (CRPS) is characterized by substantial pain in a distal limb. Approximately 90% of cases are triggered by physical limb trauma; the condition typically commences immediately to less than 1 month after the inciting event. Learn more: nej.md/3MSMW0n #MedSky

1st, I review the resident note: it’s disorganized but OK 2nd, I review the med list. Every drug is perfectly dosed, timed, and routed. Totally optimized, tidy med list.

I give the NEJM a lot of guff about their social media posts, but this is exactly how you should share important articles.

You can do this right now: Think of a person who wrote a paper you love, whose work influenced or helped you, or has made your professional life better. Search up their email address. Shoot them a quick email of thanks. It means so, so much. This is a rough time of year, share some joy.