Allan Lai أُعيد تغريده
Allan Lai
2.2K posts
Allan Lai
@RespRate16
Co-bro @ResusTonight. Urgent & primary care. Lord of the typos & bad grammar. Likes #POCUS. Hype man. Fortunate human.
Canada انضم Nisan 2018
194 يتبع567 المتابعون
Allan Lai أُعيد تغريده
JAMA, you tried so hard and almost nailed it!
The reason why the evidence gap is >14 years in clinical medicine is you are publishing breaking reviews on techniques and approaches that were all the rage… 14 years ago.
B-lines - incredibly valuable.
IVC collapsibility or IJ ultrasound alone are not the right approach. We are assessing complex physiology, not checking oil levels of cars!!
JAMA@JAMA_current
Point-of-care ultrasonography (#POCUS) is a noninvasive bedside imaging modality used to assess intravascular volume status in hospitalized or emergency department patients with possible #VolumeOverload. POCUS evaluates the inferior vena cava, internal jugular vein, and lung parenchyma with high-frequency linear, low-frequency phased-array, and low-frequency curvilinear probes.
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Docs don’t make rational decisions bc they’re also managing future regret - the ‘case’ that got away.
Ex) Best chances of stopping a penalty kick as a GK ⚽️? Stand still. Bayesian at its best.
But goalies don’t do this bc ‘not trying’ = regret.
Irrational? Yes
Natural? Yes
Brad Spellberg@BradSpellberg
Doctors are generally not good at Bayesian reasoning or diagnostic test ordering. This is well known and established. This is why we have campaigns like Choosing Wisely. Doctors tend to over test. They tend not to apply pre-test prob or think about post test prob. They react.
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@ross_prager @AnilMakam I guess if I wanted to get lost in the weeds... test characteristics and subsequent LR are derived on the population studied, which may not represent the patient one is applying the test to. I reckon how it translates to practice is we think in OR or predictive values?
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Better to use likelihood ratios
PPV and NPV only good if treating populations or your patient has the same average risk
Ross Prager@ross_prager
How can a 99% accurate medical test give you a 9% chance of having the disease if it comes back positive? 🤔 If you are in medicine this is the SINGLE most important diagnostic testing concept to know. Welcome to the difference between specificity and positive predictive value. Sensitivity & specificity are fixed test properties. These do not factor how common a disease is (prevalence) Positive Predictive Value (probability a positive test reflects having a disease) factors in prevalence and is actually more important to clinicians than sens/spec. It is harder to figure out though because we need to have a gestault for how prevalent a disease is for the EXACT patient we are seeing. If you have very low prevalence, even with a great test, most positives are false positives. This is why screening low-risk patients can result in many false positives and harm To master this, just play with the calculator yourself and you will see!!!!👇
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What is evidence-based diagnosis?
AKA Bayesian clinical reasoning
Watch my 2 minute pitch for why doctors should care
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@AnilMakam Tremendous. Would you happen to have your full lecture to share? Totally understand if not possible; just appreciate hearing you speak on the topic.
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Allan Lai أُعيد تغريده
How can a 99% accurate medical test give you a 9% chance of having the disease if it comes back positive? 🤔
If you are in medicine this is the SINGLE most important diagnostic testing concept to know.
Welcome to the difference between specificity and positive predictive value.
Sensitivity & specificity are fixed test properties.
These do not factor how common a disease is (prevalence)
Positive Predictive Value (probability a positive test reflects having a disease) factors in prevalence and is actually more important to clinicians than sens/spec.
It is harder to figure out though because we need to have a gestault for how prevalent a disease is for the EXACT patient we are seeing.
If you have very low prevalence, even with a great test, most positives are false positives.
This is why screening low-risk patients can result in many false positives and harm
To master this, just play with the calculator yourself and you will see!!!!👇
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@ross_prager @NTFabiano This is the way. We're very similar in this regard!
What's your workflow with AI like in practice, taking into account EMR/policy/blah blah?
Also hi Ross
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I have found a really collaborative approach to writing with AI.
First, I train of thought all of my ideas using Wisperflow (voice to text) into the LLM.
I then ask the LLM to structure these into themes.
I then think about it and outline what I am going to write.
I then get AI to challenge my summary and suggest improvements.
Then I write.
Then I get AI to help polish.
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@nickmmark Quite clever! How does the moderator facilitate the questions that relate to the card? For example, the blood pressure is 180/100. The learner will inevitably ask if they have symptoms. Or is it more of the learner just asks questions about what they would want to know & why?
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Awesome session of gamification in medical education.
I love this idea: student/resident picks a card and pretends they are responding to this situation. Costs nothing, you can “play” in just a few minutes, you can make cards to suite any learning objectives.
#CHEST2024
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Allan Lai أُعيد تغريده
Mentorship has been crucial for my own development. I realize not all trainees find mentors they connect with.
I want to help.
I am not sure if this will work... but I am starting a virtual mentor group for trainees (medical students or residents) from anywhere in the world.
To join, complete this form! app.youform.com/forms/zammezup
Please retweet this so all trainees see and have the chance to join! 🙏
I won't be able to accommodate everyone in this first group but I will try my best.
I might also find other mentors who are interested in leading a group if the demand is high enough.
As always, my DMs are open!
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@cliffreid thought you should know the @zeropointsurvey features prominently in an interprofessional resuscitation course myself, @robpaquinRN et al. we're spreading the gospel in Canada!
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Cory Rohlfsen@CoryRohlfsen
#MedTwitter An expert is threatened by an idea that challenges their domain of knowledge. Their identity is at risk. A practitioner is eager to pursue the bounds of their knowledge. Their identity is in the pursuit. Be a practitioner. Don’t be an expert. Medicine is humbling
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Soapbox rant of the day 😤
There is more to an Echo report than EF ‼️
I see far too many patients labelled as "HFpEF" when their reported EF is normal, despite a HOST of other more significant cardiac pathology that is driving their presentation and physiology 🤦♀️
🧵
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By being ambiguous 99% of the time, our utterances are that much more impactful the 1% of the time we do feel strongly about something.
GIF
Zaven Sargsyan@sargsyanz
Likert scale for internists. To what degree do you agree with the following statement: “xxxxxx" I disagree I don't disagree It's not unreasonable It's reasonable I agree
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Allan Lai أُعيد تغريده
EMCrit Wee - @Ross_Prager on 10 Heuristics for the New ICU Attending. We took an amazing tweetorial and made it into a podcast. Fantastic tips for Resus and Crit Care [#FOAMed]
emcrit.org/qus8
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Allan Lai أُعيد تغريده
(1/x) Here's our paper on the medico-legal risks of #pocus 🧑⚖️
A better title: How not to get sued performing POCUS. A 🧵
Teaser: You can be sued performing #pocus...
Please share to help spread best #pocus practices 🙏
theultrasoundjournal.springeropen.com/articles/10.11…
@arntfield @derwuk @NephroP @ArgaizR
#medtwitter #foamed #foamus #meded
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Use of point-of-care ultrasound in rural British Columbia.
Read a story of how #pocus went viral? Now in 90% of #ruralBC ERs, influencing care 50% of the time it's used. We need to revamp #ugme and residency with longitudinal POCUS curriculum.
cfp.ca/content/70/2/1…
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