Kevin Hageman

@nickd_ssc @mackinprof Tell me you don’t understand systematic reviews and meta analyses without telling me. Your take on this is just weird. Like you’d prefer findings not be confirmed and further analyzed and just do your thing? Ok.

@Factor_XII @mackinprof You’re right. It doesn’t matter. I’m doing the thing. Producing the results and doing what your “community” is realizing works on a 5-10 year lag when the process and gatekeepers catch up.

No, we knew all this and the science behind it was accumulating and people were learning. The stand just summarizes it and puts it all in one place as an evidence summary with a standard search. But thanks for your contribution Nick!

@nickd_ssc @mackinprof It’s not me - it’s “us,” the scientific community. You can have whatever opinion you want & “disagree” but it actually doesn’t matter. Now if you want to analyze the individual studies, heterogeneity, & have an actual informed discussion, I think we’d all be open to that!

@Factor_XII @mackinprof I strongly disagree that this is the highest level of evidence. What you consider evidence is different than what I do.

@nickd_ssc @mackinprof It’s called science, pal. And no science is not perfect, and sometimes not reproducible, but this is about the highest level of evidence we have. But you’re going to double down regardless.

@mackinprof You know how this works. The stand validates, not just summarizes. My point is that the validation is unnecessary and silly. And for a handful of researchers to put their names on a paper recognizing the obvious is quite silly.

@cardiojaydoc02 I probably work half to 2/3 as much 🤷🏼‍♂️

I’m not sure of any physician that works LESS as an attending than they did in training. That’s news to me. One of the myths is that you will work less when you’re done.

⭐ META-ANALYSIS: Hospital delirium --> devastating long-term outcomes 253 studies, 137,000+ pts: • 5.4x dementia risk • 2.8x institutionalisation • 2.5x mortality • 1.7x readmission ⚠️ Delirium = a serious acute problem AND a risk warning. ➡️ All pts deserve robust delirium assessment

@CMichaelGibson Stop sending pizza to doctors in the name of wellness. Stop making wellness modules for physicians Stop MOC or repeat exams Change value assessment to quality of care over RVUs Ensure everyone gets 6 weeks of vacation and days off for weekend call

@NFL_DovKleiman They don’t work.

This is awesome: NC State has fixed the guardian cap. The NFL needs to implement this immediately. Guardian caps don't need to be cringy. 🔥🔥🔥

@medrants You’ve got me beat!

@Factor_XII But you don't tell clinical stories that precede CAT scans, MRIs and ultrasound. Ever see an exploratory laparotomy? What about a Bilroth 2? Can you explain why that operation led to anemia? Remember when alpha-methyl dopa was a first line antihypertensive?

In the past 24 hours I have: Uttered the word Tamagotchi Been called Unc Stated that when I trained ARNIs weren’t a thing Stated similarly re SLGT2s Oof. I’m becoming that attending.

“What do you understand by an inappropriate procedure?” Mary (patient): “My perception is that every procedure that is done is appropriate, otherwise they would not be offered.” Patients place an extraordinary degree of trust in us, and we should never lose sight of the responsibility that comes with it.

@TobyRichardsUEL @farkomd @DrMarthaGulati @HeartOTXHeartMD @JayMathewsMD Why use this over the new PREVENT calculator?

@farkomd @DrMarthaGulati @HeartOTXHeartMD @JayMathewsMD u-prevent.com been using this for patients for almost a decade and recent adopted by the AHA. Provides an interactive risk predictor. Good evidence that these tools improve patient engagement and compliance. (Also stop doing unnecessary CTA's)

Would you recommend a statin for this coronary CTA with an LDL of 110? Otherwise healthy man in 50s? Any other info you need to make a decision? @DrMarthaGulati @HeartOTXHeartMD @JayMathewsMD

@BulwarkOnline Jesus Christ

Sen. Kaine: “Do you believe that there’s no evidence that the flu vaccine has efficacy in reducing serious injury and hospitalization?” Means: *pauses* Sen. Kaine: “This is an easy one, doctor.”

@aclong111 She’s a Provider

Maybe I’m unusual in this regard, but hearing “as a physician” from someone who didn’t complete residency and doesn’t practice clinically gets under my skin a little. Earning an MD is an accomplishment. But finishing residency and actually taking care of patients is what most people understand “physician” to mean.

@BlaneyMD @DrCasteelEM …portal colopathy and leave the -itis out which I think is appropriate from my limited knowledge of the disease process.

@BlaneyMD @DrCasteelEM No you should bash a little — people treat imaging findings in not the patient. The “Ew” was hospitalists throwing abx at this — that’s just reflexive and not thinking, the latter which has fallen out of clinical practice. I think I’m lucky in that our radiologists often call…

Many patients with cirrhosis or AH get cross-sectional imaging in the ED, with a lot of this imaging suggestive of "enteritis" or "colitis," with evidence of enteric/colonic wall thickening. Many reflexively treat with cipro/flagyl, regardless of symptoms. 🛑 ⤵️ (1/2)

“Against Medical Advice” offers no proven benefit and may increase stigma. Time to rethink AMA. 🔗: doi.org/10.12788/jhm.2… ✍️: David Alfandre, Jay Brenner, Eberechukwu Onukwugha 🖼️: #VisualAbstract by @ShaheenFatimaa #PatientCenteredCare #JHospMedicine #HealthEquity #TWDFNR

@IM_Crit_ What do you mean no one will know wth I’m talking about when I document a C3R PE

Perfect is the enemy of good. IMHO, the new PE classification is too granular to be clinically useful:

The evolution of acute pulmonary embolism classification (including the recently published 2026AHA/ACC/ACCP/ACEP/CHEST/ SCAI/SHM/SIR/SVM/SVN Guideline): #foamed #foamcc #meded #MedTwitter

If your PETH is reflective of your birth year we have a problem.

💡 One of the most important findings in delirium research in recent years, and I think it's still not widely enough known. The DECIDE study (Richardson et al, Age and Ageing 2021) followed 305 older adults from the population-based CFAS II-Newcastle cohort. They compared cognitive trajectories in three groups: hospitalised with delirium, hospitalised without delirium, and a matched group who weren't admitted to hospital at all. The hospitalised patients who didn't develop delirium had essentially the same cognitive trajectory as those who were never admitted. No significant difference. But those who developed delirium during their admission showed a 2.2-point MMSE decline at one year compared to the no-delirium group (P<0.001). Neither the number of admissions nor total length of stay were significant predictors. For years we've assumed that hospital admission itself is bad for the brain. This study suggests the real culprit is delirium. And delirium is something we can detect and, at least partly, prevent. That makes it potentially a modifiable risk factor for dementia - at least it means that we need to look into this more and explore the potential benefits of early detection and aggressive treatment aimed at protecting the brain. #medtwitter #dementia