David Goldblatt

Airway Epithelial Innate Immunity frontiersin.org/articles/10.33…

welcome to philly

Hospitals are putting hard caps on physician compensation, sometimes as low as the 75th percentile, and calling it fraud and abuse protection. Think about what that means. If earning above the 90th percentile is inherently suspicious, then 10 percent of every physician in every specialty must be breaking the law. At the 75th percentile, 25 percent of all physicians are apparently committing fraud. That logic falls apart the moment you say it out loud. Health law attorney Dennis Hursh has been reviewing these clauses for years, and he says they are showing up in the majority of physician employment contracts now. Some contracts say compensation "may be reviewed" if it exceeds the threshold. Others are blunt: under no circumstances will your total compensation exceed this number. So if you are the most productive physician in your specialty in the entire country, your pay is frozen. Every dollar you produce above that cap flows to the institution. And as Hursh puts it, the CEO's bonus is not capped. It gets worse. Most hospitals are not giving physicians clear, timely productivity data. You might be told you produced 9,500 WRVUs, but without access to the actual benchmarks, you have no idea whether you are approaching the cap. You are flying blind while working at a pace that funds someone else's compensation growth. There is also a downstream effect that hurts the entire profession. Compensation surveys from MGMA and SullivanCotter use reported salary and productivity data. When the highest producers have their pay artificially suppressed, it pulls benchmark numbers down for every physician in that specialty the following year. The cap does not just limit one doctor. It compresses pay across the board. Hursh says physicians need to review contracts for this language, demand regular and transparent productivity reports, and push for independent third-party compensation reviews when they are producing at the top of their field. The hospital should not be the one deciding whether the cap is justified. The physicians most hurt by this are exactly the ones hospitals cannot afford to lose. Listen to the full conversation on The Podcast by KevinMD. Link in the replies. Have you seen this cap in your own contract? #ThePodcastbyKevinMD

Can intensivists get ICU delirium or do I have an early onset neurodegenerative disease?

@kidney_boy Oh, platelet dysfunction is a good point. 👍

@dgoldblatt Worse gfr = sicker patient = higher complication rate Platelet dysfunction, etc

age, weight, height, platelet count, hgb, kidney size and native vs transplant kidney were used to create a risk score for major bleeding after kidney biopsy. Adding renal function, surprisingly, did not improve the model. sciencedirect.com/science/articl…

GPCR-biased Mu opioid agonist: If able to provide analgesia without respiratory depression, this could be a significant development. nature.com/articles/s4158…

Welcome to the family

@EricTopol @Nature Screams in MRI language

Nowadays closing the left atrial appendage to avoid clot embolism from atrial fibrillation requires an implant. This looks like the future. Magnets! Magnetofluids. @Nature nature.com/articles/s4158…

@kidney_boy I'm going to get some flak from the kidney world on this but I think the bigger issue is nephrology than the radiologists 😈

Poor guy died because the doctor had been fooled into the myth of contrast nephropathy. When death is on the Iine, fuck the kidneys.

@BrandonLuuMD Is there any evidence that earlier administration of stimulants shifts phase earlier?

Here’s the link to the study: frontiersin.org/journals/psych… For more comprehensive protocols on how to shift your circadian rhythm, check out my newsletter on this here: brandonluumd.substack.com/p/circadian-rh…

Circadian rhythm dysfunction is highly prevalent in ADHD Up to ~75% of patients have delayed sleep and wake timing, and shifting the clock earlier is linked to symptom improvement I just published a paper on what this means for treatment. Here’s what we found 🧵1/12

@kidney_boy Pretty sure if you were allergic to albumin, you'd be dead

This guy claims 5-10% of people suffer allergic reactions to albumin. I have never heard of this. I use albumin all the time, can't remember a single case of allergy.

Not only robust reduction, but time-course supports (although does not prove) a direct causal relationship. Full vaccine earlier in life- before first sexual contact - achieves the best result.

@sponhourm Parking the bus

Does soccer have a cultural equivalent to American football’s “establishing the run”

You asked, we answered! We excited for an episode of @CritCareTime all about ventilators basics: 🌬️ goals 🧠 concepts ⚙️ modes/settings This is mostly a foundation for beginners, but there are some great pearls for experts too. (Like why I still use SIMV sometimes...) 1/2

N-ACETYLCYSTEINE NEEDS TO GO AWAY FOR RESPIRATORY ILLNESS Mucoactive Drugs in Bronchiectasis | New England Journal of Medicine nejm.org/do/10.1056/NEJ…

An exciting milestone for AI in science: Our C2S-Scale 27B foundation model, built with @Yale and based on Gemma, generated a novel hypothesis about cancer cellular behavior, which scientists experimentally validated in living cells.  With more preclinical and clinical tests, this discovery may reveal a promising new pathway for developing therapies to fight cancer.

@RogerSeheult @IM_Crit_ openevidence.com/ask/537a756c-1… At the risk of being annoying, take a look at this from OE, which I find routinely gives phenomenal, balanced reviews. I guess there is evidence that anti-pyretics may prolong some viral illnesses, but data is generally weak. Sorry to blow up your notis.

@dgoldblatt @IM_Crit_ I asked from to gather studies. Seems pretty solid. x.com/i/grok/share/y…

Open letter to my fellow intensivists/hospitalists: Please stop treating every episode of fever in your patients unless you have a really strong reason such as neurological injury or myocardial ischemia. When I tell them to "just monitor", many ICU nurses are looking at me

@RogerSeheult @IM_Crit_ Multivariate analysis suggested that antipyretic therapy prolonged illness in subjects infected with flu A, but its use was the result of prolonged illness in those infected with S. sonnei. The precise nature of these relationships requires a prospective, RCT.

@RogerSeheult @IM_Crit_ I couldn't help myself. The last 2 papers seemed the most interesting. The Graham 1990 paper checks out, but its a bit odd that symptoms were worse. The Plaisance 2000 paper has a very comical conclusion: