I am prepared to vote for anybody who will stop this

It’s a special time of year, when the leaves argue with the sky and the squirrels are all fat and anxious

Please, call me Orfor.

If they were shorter they would not touch the ground

Happy There Is A Circulatory System Walking Through The Kitchen Day to all who celebrate.

Sunday running chronicles: Unseasonably warm, but still getting dark out at 4:30 PM. The smell of fallen leaves and rotting hay makes me think not all decay is bad.

🚲⚠️ Look out, CAR T, there's another transportation-named cancer treatment class in town! ⚠️🚲 First-in-human trial of bicycle-drug conjugates (BDCs) hit JCO this week. So what are they, and how are they different than antibody-drug conjugates (ADCs)? #OncSky #MedSky

Only Jason Isbell can casually drop "diphenhydramine" into a song and take nothing away from the melody or poetry

Thanks and well done

Eye-opening: shifting from likes/shares-based boosting to view-time-based boosting essentially keeps "outgroup criticism" posts constant, while replacing 1/2 of "ingroup praise" and ~all "neutral" content with "other political content". Ew.

A 20-year-old man with Graves’ disease presented to the ED with a 2-hour history of confusion. A goiter, bounding carotid pulses, and bruits over the thyroid (shown in videos) were noted on physical examination. Read the full case details: nej.md/3XcXjy2 #MedSky #EndoSky

#idboardreview 40 M presents w/ N, V, severe epigastric pain. SH:smoker, drinks 18 beers/day, monogamous with wife, bit by his dog 3d ago, dental cleaning 7d ago, recently installed air conditioning system. Bandemia, AKI. Diffuse blanching rash & mottling. Dx? #medEd #idmeded #idsky

This really hasn’t gotten enough attention this week. @wired.com #ICE www.wired.com/story/fbi-wa...

This is so fucking cool #KidneyWk

This was a great case and discussion. @pulmcrit.bsky.social your recent post also made me think of the case (where an MRI was indeed indicated, but not available for some time).

Yes, @microsoft.com Outlook, you’re absolutely right: I just typed in my username and password and then invoked my 2FA because I wanted to be logged out!

That year I still had charting to do on Halloween 😭 #MedSky

Telling the team I prefer bedside rounds

A. Josephson's neuro emergencies talk at #UCSFMHP2025: 1) In both Guillain-Barré & myasthenia, do measure lung strength 2) Short peak time to max pain: main way to tell SAH from other headaches 3) Slurred speech: main way to distinguish central vertigo 4) Empiric Rx of meningitis: include steroids

Palliative care pearls from Steve Pantilat at #UCSFMHP2025: 1) A way to frame palliative care: "To help you live as well as possible for as long as possible" 2) Prognosis: big bands ("weeks to months"). But add: "I hope you do better" and "things can happen suddenly" 3) Empathy improves outcomes

I use Claude (an AI) to scan my posts for spelling and grammar errors. On the most recent post (about the East Wing, link below), I got a really amazing addendum. www.pbump.net/o/yes-most-a...

I am really sick of reading noninferiority trials with a noninferiority margin set at 5% of *mortality*. Another way of thinking about this design:

Some disorganized thoughts about this trial will follow here.

Continents xkcd.com/3159/

Updated the IBCC chapter on pancreatitis Added fresh, new guidelines from the AGA (meh) and International Association of Pancreatology (very good) Lets talk about some updates… #1/6🧵 (chapter: emcrit.org/ibcc/pancrea...) #EMIMCC

I can't look at today's Spelling Bee without thinking "You fool of a Took!"

Are you a doctor, nurse or other frontline medical provider who has recently left your position at a VA hospital or clinic? We want to hear from you. Tell us your story 👇

"Remember that cat food you ordered and received 3 days ago?" asks Gmail's AI. "It's coming tomorrow." The fabric of reality unravels around me. I am the cat food. I arrived a thousand years ago and never.

Early feeding in post-ERCP pancreatitis 🤔PEP: We all dread it, and treating it makes us nervous. 👍Trial supporting early feeding, within 24 hours. Shorter hospital stays This already increasingly supported and accepted. ACG and other guidelines. #GIsky #Medsky #IMsky

waiting to hear back on my submission

When you see this in a question stem you can rest assured you are about to see the most jacked up chest CT of your life: "A chest radiograph is ordered that is read as normal (Figures 1 and 2)."

Uncertainty is ubiquitous in the practice of medicine. A new review characterizes clinical uncertainty and shows how teachers can guide learners to recognize, manage, and communicate uncertainty in practice. Read the full review: nej.md/43xKSQX @gdhaliwal1.bsky.social #MedSky #MedEd

How to distinguish arterial and venous pulsations. From André Mansoor m.youtube.com/watch?v=gkLA...

I've never said yes to an interview so quickly as when @ashleybelanger.bsky.social reached out to discuss a topic that – it will surprise no one to learn – I feel pretty strongly about.

Planetary Rings xkcd.com/3156/

Celiac: Beware of borderline negative TTG 311 pts with Nml IgA levels 39 borderline negative TTG Of borderline negative TTG 36% Dx'd with CD (79% in those with borderline neg TTG and +EmA) Low + and borderline - TTG frequently with dx of CD Need to follow up on these patients. #IMsky #Medsky

Large R Pleural Effusion Cirrhosis but no evid of Portal Hypertension Hx CHF (stable) Alb gradient 1.6 🔼 +Tc-99m peritoneal cavity scintigraphy Hepatic Hydrothorax can occur in absence of ascites, but also in absence of other signs of portal hypertension. Rx challenging #GIsky #IMsky #Medsky

Wow, so many great nuggets in here. Overall, not just in the non-inferiority margin, but a 0% difference in primary outcome (95CI: -7% to +7%), so really cefazolin & an anti-staph penicillin look equivalent in an RCT for Staph aureus bacteremia. More AKI with cloxacillin, unsurprising. But... (1/2)

Just updated the IBCC chapter on cholecystitis & cholangitis. These patients are often initially triaged to the ICU. Understanding these diseases can help us direct patients to interventions they need. Let’s talk about four pearls 😁 chapter: emcrit.org/ibcc/biliary... #EMIMCC

Every so often I check in on Twitter to make sure there are no errant DMs, and I get a little sad when I see great MedEd content. I have not curated my BueSky experience very well--could you all share your starter packs or suggestions of folks to follow?

I know "dihydropyridine" is a lot of syllables, and "non-dihydropyridine" is even more syllables. But they're quite different - isn't it important to specify which!?! www.jacc.org/doi/epdf/10....

Great point about considering the sens/spec of the given scan, in the given patient, at the given time. Those reported in literature are averages… but this particular scan might be better or worse. But regarding even the pooled “sensitivity of CT for cholecystitis of 94%”… Thread 🧵 1/

Interesting read. Nice to see my friend @adamrodmanmd.bsky.social – someone I really trust to be sensible with AI, def not a techbro cheerleader (perhaps the exact opposite!) Nevertheless I find passages like this very bleak. I have caught my students using AI too (but NOT on advice from medschool)

Not only is making esoteric diagnoses just a tiny part of our job, but IMHO we are collectively underappreciating how the overuse of AI in daily life erodes critical thinking more generally.

i love quick questions. you give a quick answer, the exchange is over, everyone's happy

Women don't like the vehicle.

Penn declines to sign the compact. Way to go!

Confused about all the AI deals? Let Hank Green explain it. youtu.be/Q0TpWitfxPk?...