John Mandrola, MD

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John Mandrola, MD

John Mandrola, MD

@drjohnm

Heart rhythm doc, writer for @Medscape, host of This Week in Cardiology podcast, editor of Sensible Medicine. The more you see, the harder medicine gets.

Louisville, KY Katılım Mayıs 2010
2.1K Takip Edilen70.2K Takipçiler
John Mandrola, MD
John Mandrola, MD@drjohnm·
Dear @JAMA_current and @NEJM and other journals, the trend of doing "research summaries" or short videos to condense trial manuscripts is a bad idea Details matter; supplements matter; critical appraisal means going deeper into the specifics If modern-day docs are going to offer more than an LLM, we will need to learn to read deeper into studies Rely on short summaries/central figures and you are at risk for being bamboozled, like the LAAO proponents
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John Mandrola, MD
John Mandrola, MD@drjohnm·
The dynamics of why things are done (or not done) in the healthcare system are shockingly complex and involve far more than medical matters Do listen...below is the tip of the iceberg If only we had recordings of conversations before LAAO
The Doctor’s Lounge Podcast@DRsLoungePod

Medicare created the heart team requirement for TAVR for a reason. A surgical opinion was supposed to be a check on the system. It isn't working. "People let you know if they're happy or not happy that you did not sign off on someone to get a TAVR. Let me just leave it at that." And if you're a young surgeon without referrals? You need to be on that heart team. You need the aortic call. You need the cases. "If I were desperate, I probably would have done the same thing. You've got to put food on the table. You're not doing anything illegal." That's not corruption. That's a system that put a young surgeon in an impossible position — and called it a check and balance.

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John Mandrola, MD
John Mandrola, MD@drjohnm·
1989 graduate of UCONN medical school. We were pass/fail and it was bad. After scoring 2.0 (standard deviations) on my first test (biochem) which I tortured myself for, I said, that was dumb, I got a P. From then on, standard deviation goal was 0.0-0.5. Much easier. But not ideal
Ian Kingsbury@PeerReReview

Notably, Yale is one of only three medical schools that does pass-fail grading during all four years of medical school, a policy for which they are penalized in our Med School Excellence Index. Bad actors tend to do many bad things. cam.donoharmmedicine.org/medical-school…

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Andrew Flett
Andrew Flett@drflett·
1 New JAMA paper from the NHLBI HCM Registry reinforces the importance of CMR scar for arrhythmic risk prediction. In nearly 2700 patients with HCM and ~7 years’ follow-up, LGE burden was one of the strongest predictors of SCD/ventricular arrhythmic events. #WhyCMR #CardioTwitter
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Anil Makam
Anil Makam@AnilMakam·
Makes an important point here about the role of these short summaries they do this because this is how most doctors digests information if designed appropriately, an LLM should be able to read and appraise a paper and provide better peer review than most clinicians and honestly most peer reviewers and editors this is why AI will win out over the long run the status quo is replaceable - off the shelf schemas, algorithms, checklists, and consensus/guideline based medicine
John Mandrola, MD@drjohnm

Dear @JAMA_current and @NEJM and other journals, the trend of doing "research summaries" or short videos to condense trial manuscripts is a bad idea Details matter; supplements matter; critical appraisal means going deeper into the specifics If modern-day docs are going to offer more than an LLM, we will need to learn to read deeper into studies Rely on short summaries/central figures and you are at risk for being bamboozled, like the LAAO proponents

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John Mandrola, MD
John Mandrola, MD@drjohnm·
@MNOpining @JAMA_current @NEJM IMO, an abstract is so limited that no one would consider that enough. But the central figure or research summary temps readers to just look there. Imagine a research summary of CHAMPION AF--it would miss all the key aspects of how trialists misled readers
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John Mandrola, MD
John Mandrola, MD@drjohnm·
Important thoughts 👇🏻 Don’t be bamboozled by biased selections
Neil Floch MD@NeilFlochMD

As a trauma surgeon I have seen so many horror stories from elderly patients using anticoagulants such as Eloquis, Xarelto and others - I see brain bleeds, hemorrhagic stroke, retroperitoneal bleeding…. But I know that although I may see 10 of these patients every time I am on call…. There are millions of others where these medications have saved lives, prevented stroke, prevented embolization and infarcts and many other beneficial effects. As a physician any patients with a bariatric complication will contact you because you are their doctor- realize you are the front line and you see the complications- we must rely on data and studies that give a big picture that is more accurate than opinion.

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G Karthikeyan
G Karthikeyan@drkarthik2010·
Dig-RHD @JAMA_current published online jamanetwork.com/journals/jama/… Surprised and disappointed that @drjohnm did not cover the trial in his podcast #ACC26
Harriette Van Spall, MD MPH 🇨🇦@hvanspall

Arguably one of the most important RCT’s presented at #ACC26 #Digoxin is effective, cheap, & ⬇️ composite ACD or WHF in #rheumatic heart disease, which affects 54.8 million ppl in world An 18% risk reduction is HUGE for a pragmatic investigator initiated #RCT @m4ggiesimpson

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John Mandrola, MD
John Mandrola, MD@drjohnm·
I was told recently by an enthusiastic colleague that how one looks at recent CLOSURE and CHAMPION data on left atrial appendage closure is like a Rorschach test Meaning (I think) evidence appraisal is in the eye of the reviewer I disagree strongly. Evidence is evidence CLOSURE: LAAC inferior to best med Rx CHAMPION: Ischemic stroke 60% higher in LAAC vs DOAC and total bleeding similar. Not superior. 👆Simple facts. Like the sky is blue. LAAC is clearly not better than best medical therapy or DOAC—is what the evidence says
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Zen and the Art of Persuasive Writing
Zen and the Art of Persuasive Writing@Zenpersuasion·
I’m an appellate court judge. I’ve read thousands of briefs. Here’s what no one told you about persuasion and how to win. Thread.
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John Mandrola, MD
John Mandrola, MD@drjohnm·
On the surface, this seems great I love deprescribing. The problem is Goodhart’s law: when a measure becomes a target, it ceases to be a good measure If we are hung up on measures and targets, how about this: Any pt who makes it to 90 and has not had an echo or nuclear scan in the last decade garners a bonus I challenge you all
HHS Rapid Response@HHSResponse

🚨 BREAKING: @CMSGov is issuing billing guidance that allows physicians to get paid for deprescribing work for the first time.

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ALBERTO ALFIE
ALBERTO ALFIE@ALFIEEP1·
Thanks @drjohnm for highlighting my final remarks on the new PFA era on your weekly podcast “This Week in Cardiology”. It is truly an honor. open.spotify.com/episode/1EFQPd…
ALBERTO ALFIE@ALFIEEP1

After 20 yrs in EP, I’ve never seen hype like PFA. Point-by-point RF—when done properly—delivers excellent results, with no clear superiority of PFA. Are we driven by better outcomes, or by speed, simplicity, and industry momentum? Time to refocus on science over marketing.

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Venk Murthy MD PhD
Venk Murthy MD PhD@venkmurthy·
This is an important lesson for those who argue for whole body screening MRIs & unproven labs Even something as "simple" as repairing torn meniscus turns out to not be so simple! Now extend to numerous "spots" on a scan with little known beyond that... nejm.org/doi/10.1056/NE…
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John Mandrola, MD
John Mandrola, MD@drjohnm·
I’m so curious about the law and SCOTUS. As a podcaster myself, why wouldn’t I buy a book from another podcaster? @whignewtons is as good a writer as speaker
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Keşfet

@CharlesTe @JAMA_current @NEJM @drflett @MNOpining @drkarthik2010 @AndrewFoy82 @elonmusk