Nick Panos

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Nick Panos

Nick Panos

@NG_Panos

Husband, #GirlDad, #Stoic | Neuro ICU Pharmacist @RushMedical | Views my own

Katılım Eylül 2020
505 Takip Edilen319 Takipçiler
Nick Panos
Nick Panos@NG_Panos·
@DiorIzzy @ABsteward @unfarmaceutico Let me clarify…stopping isn’t difficult if you have all the objective information you need to discontinue antibiotics. This takes time, no doubt. Pharmacists pestering you everyday also helps 🙂
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Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟
Another recommendation revisited—and RCTs surprisingly ignored again: Two high-quality trials show no mortality benefit for 1-hour antibiotics in non-shock sepsis, yet the guideline continues to push it. Recommendation 17: For adults with probable or definite sepsis without shock, we “recommend” administering antimicrobial therapy immediately, ideally within 1 hr (strong recommendation, very low certainty evidence). Evidence comes from a systematic review and meta-analysis combining 42 observational studies (~191k patients) and 2 RCTs. The guideline argued the RCTs did not show mortality benefit, mostly included non-shock patients, and the median time difference between early and later antibiotics was small (~1–2 h). Based on this, they discounted the RCTs and relied on observational studies—though RCTs provide stronger causal evidence. These justifications are weak: the RCTs studied exactly the population being recommended, and small timing differences do not invalidate high-quality evidence. Surprisingly, despite new data, the guideline revisited the evidence but effectively ignored it again. @BradSpellberg @DrToddLee @PulmCrit
Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟@ABsteward

🔥Just published🔥 Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026 : Critical Care Medicine #IDXposts share.google/VN4AfbchzDiRr7…

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Nick Panos
Nick Panos@NG_Panos·
@unfarmaceutico @ABsteward Outside ICU ≠ inside ICU. Unfortunately, rapid diagnostic tests do not provide immediate results. Therefore, the practice of empiric early administration will continue until technological advances are made. I’m sure we’ll get there soon
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farmacríticx
farmacríticx@unfarmaceutico·
@NG_Panos @ABsteward Over the years, I’ve come to embrace the 48-h reassessment (ABx time-out), while keeping in mind that systemic empiricism is not harmless… In Latin America, abx resistance is wreaking havoc, and our epidemiology is truly catastrophic.
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Nick Panos
Nick Panos@NG_Panos·
@unfarmaceutico @ABsteward Agree that antibiotic overuse could be an issue, however, stopping isn’t hard. That’s been my observation, FWIW. I trust that we are all promoters of antibiotic stewardship. Are there outliers? Of course. When treating a patient in the ICU you must do it quickly.
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farmacríticx
farmacríticx@unfarmaceutico·
@NG_Panos @ABsteward Abx overuse has been driven by the “golden hour” concept (obs. data). RCTs show a more nuanced effect → recs should adapt. Starting is easy; stopping is so hard (med-legal, pending cx). Complex issue.
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Nick Panos retweetledi
Adam Grant
Adam Grant@AdamMGrant·
Only following people who agree with you is a recipe for confirmation bias and groupthink. Critical thinking depends on listening to people who question your assumptions and challenge your conclusions. Learning is the product of engaging with a range of thoughtful views.
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Nick Panos
Nick Panos@NG_Panos·
I’m sure pharmacists can help reduce times by about 30 minutes if PCCs were moved to dispensing cabinets in the ED
Nick Panos tweet media
Stephan A Mayer@stephanamayer

More evidence that door-to-needle times for emergency reversal of AC for ICH lag far behind DTN times for IV lytic therapy for AIS (median 49 vs 28 mins). Lots of room for improvement. The #CodeICH train keeps rolling, and it can't be stoppoed. Beating the clock: comparing the speed of AC reversal for ICH to thrombolysis for AIS academic.oup.com/esj/article/11…

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Nick Panos
Nick Panos@NG_Panos·
@IM_Crit_ You are a hero to critical care pharmacists everywhere because of this. Thank you
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IMCrit
IMCrit@IM_Crit_·
ICU Rounds: I don’t want to brag about myself but today I resisted the cardiology team’s request to start bumetanide drip and albumin in a patient with fluid overload #foamed #foamcc #meded #medtwitter
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Nick Panos retweetledi
Axios
Axios@axios·
Most Americans are too busy for social media, too normal for politics, too rational to tweet. They work, raise kids, coach Little League — and never post a word about any of it. This isn't a small minority. It's a monstrous, if silent, majority. axios.com/2026/03/11/ame…
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Nick Panos retweetledi
ACCP CRIT PRN
ACCP CRIT PRN@accpcritprn·
#JournalWatch Tenecteplase in stroke mimics, safe or not? This single-center retrospective study of 250 pts found ICH in 11.5% of AIS vs 0% of mimics (p=0.0021). Symptomatic rates similar between groups. Reassuring data for rapid treatment decisions. doi: 10.1002/phar.70112
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Daily Stoic
Daily Stoic@dailystoic·
The 5 Virtues of Good Leadership: 1. Courage 2. Temperance 3. Dignity 4. Humility 5. Wisdom
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Nick Panos
Nick Panos@NG_Panos·
@mcuban Retail (Independent and chain) and hospital based pharmacists are already providing these services and it’s free. Why should PBMs get reimbursed for this service? Give it to the pharmacists that are doing these things to help navigate the restrictive nature of PBMs
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Mark Cuban
Mark Cuban@mcuban·
This is your heads up about the new scams that PBMs and their related companies are pulling. It is built on the following premise "Whoever controls care decisions controls revenue." The new "Rebate GPO" from PBMs is charging PEPM or PMPM fees to employers for "clinical services" . Can someone explain to me any scenario where a Pharmacy Benefit Manager would be the best source of clinical management services like the following : (PMPM) Specialty Drug Management $10 – $100 Coordination of specialty medications, utilization review, patient monitoring Digital Health / Remote Care Programs $20 – $40 Virtual care platforms, chronic disease apps, coaching programs Care Navigation Services $5 – $15 Member guidance, provider steering, benefits assistance Medication Adherence Programs $3 – $10 Outreach programs designed to improve prescription compliance Clinical Analytics & Employer Reporting $2 – $8 Data dashboards, utilization analysis, predictive modeling Prior Authorization Administration $1 – $5 Processing and management of prior authorization requests Biosimilar Conversion Programs $5 – $20 Drug switching initiatives and manufacturer coordination Outcomes / Value-Based Contract Administration $2 – $6 Tracking clinical outcomes tied to manufacturer agreements I'll say it again. The new PBM scam is to control care decisions WHOEVER CONTROLS CARE DECISIONS CONTROLS YOUR BENEFITS BUDGET. AND IT WONT BE YOU. IT WILL BE YOUR PBM You have been warned. @RepBuddyCarter @HawleyMO @SenWarren @RubenGallego @jamestalarico @SenSchumer @RFKJr_Official @modrnhealthcr @RosenthalHealth @chrisklomp @DrOz
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Shadi Yaghi
Shadi Yaghi@ShadiYaghi2·
But data is limited & no good evidence at this time. My approach is to enroll in RCTs if available If not & clinical concern for AIS, can consider TNK if: Last dose 24-48 hr & no known renal dx & NIHSS>5 & no immediate EVT. Discussion of risks/benefit w pt/family is important
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Shadi Yaghi
Shadi Yaghi@ShadiYaghi2·
I have gotten a lot of questions about recent DOAC use now becoming a relative contraindication. Below is a threat to shed some light on this and give you my perspective. A thread 🧵 #sec-10-6-1" target="_blank" rel="nofollow noopener">ahajournals.org/doi/10.1161/ST…
Shadi Yaghi tweet media
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Nick Panos
Nick Panos@NG_Panos·
We should be investing in ourselves
Aakash Gupta@aakashgupta

The math on this project should mass-humble every AI lab on the planet. 1 cubic millimeter. One-millionth of a human brain. Harvard and Google spent 10 years mapping it. The imaging alone took 326 days. They sliced the tissue into 5,000 wafers each 30 nanometers thick, ran them through a $6 million electron microscope, then needed Google’s ML models to stitch the 3D reconstruction because no human team could process the output. The result: 57,000 cells, 150 million synapses, 230 millimeters of blood vessels, compressed into 1.4 petabytes of raw data. For context, 1.4 petabytes is roughly 1.4 million gigabytes. From a speck smaller than a grain of rice. Now scale that. The full human brain is one million times larger. Mapping the whole thing at this resolution would produce approximately 1.4 zettabytes of data. That’s roughly equal to all the data generated on Earth in a single year. The storage alone would cost an estimated $50 billion and require a 140-acre data center, which would make it the largest on the planet. And they found things textbooks don’t contain. One neuron had over 5,000 connection points. Some axons had coiled themselves into tight whorls for completely unknown reasons. Pairs of cell clusters grew in mirror images of each other. Jeff Lichtman, the Harvard lead, said there’s “a chasm between what we already know and what we need to know.” This is why the next step isn’t a human brain. It’s a mouse hippocampus, 10 cubic millimeters, over the next five years. Because even a mouse brain is 1,000x larger than what they just mapped, and the full mouse connectome is the proof of concept before anyone attempts the human one. We’re building AI systems that loosely mimic neural networks while still unable to fully read the wiring diagram of a single cubic millimeter of the thing we’re trying to imitate. The original is 1.4 petabytes per millionth of its volume. Every AI model on Earth fits in a fraction of that. The brain runs on 20 watts and fits in your skull. The data center required to merely describe one-millionth of it would span 140 acres.

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Nick Panos retweetledi
IMCrit
IMCrit@IM_Crit_·
Albumin (A) replacement therapy in septic shock In a multicenter RCT, 440 pts w septic shock were treated w A aiming to keep serum A >3.0 g/dL or w standard fluid therapy. 90-day mortality did not differ between the A group (43.3%) & controls (45.9%) jamanetwork.com/journals/jaman…
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Jimmy L. Pruitt III, PharmD, BCPS, BCCCP, BCEMP
Is med twitter/X officially cooked? I look at bluesky and other alternatives and don’t see the same community that it was here years ago despite more people online. Interesting few years
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Nick Panos
Nick Panos@NG_Panos·
@PharmD_intheED Yes. I’m not on bluesky and I’ve seen pharmacists posting more on LinkedIn a lot more over the last couple years.
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