June 8, 2015

Crowdsourcing: TVP

In an effort to demonstrate* the crowdsourcing potential of Twitter for EM medical education resources, I asked:

The crowd performed well and very quickly I got a number of useful responses:

Thanks everybody!

*to a skeptical resident

May 26, 2015

ACA Update: What do you want?

On June 13, I'm speaking at the Policy Prescriptions Health Policy Symposium at Baylor.

My talk is titled "The ACA: An Evidence-Based Update." To continue my new tradition of crowd-sourcing, what would you want included? What do you know that I should share? What don't you know that you want to?

April 12, 2015

Bow Transplant

Missing shoe bow

A generous donor was found

Suitable donor tissue identified

and harvested.

Donor tissue prepped

Transplant begun


The patient thanks the donor

Happy family reunited

See also Laryngectomy

April 9, 2015

Number Needed to Tweet

My recent lecture at Northwestern:

"Number Needed to Tweet:
How Social Media is Changing Medical Education"

Much thanks to Mike Gisondi & @NU_FAME for the invitation!

Want to: 

Watch the whole thing? Video

Read a summary & lots of tweets? Storify:

March 17, 2015

Keep your ProMISe

The ProMISe study was published in NEJM today -- I'm sure there will be great takes from all around. The first I saw was from Rick Body at St. Emlyn's, very nice summary indeed.

I'll leave the detailed analysis to others. My quick take, mostly based on comparing baseline characteristics of each group (Table 1), interventions in each group (Table 2), and outcomes (Table 3): ProMISe is a lot like ProCESS and ARISE.

The groups were similar, and the outcomes were similar, but most notably, the interventions were similar.

My bottom line interpretation remains the same; the keys in sepsis are:
  • early identification
  • early antibiotics
  • early aggressive resuscitation (particularly fluids)
We've gotten much better at all of those since 2001, which is (in my opinion) the main lesson from Rivers.

What ProCESS, ARISE, and ProMISe really tell us is that if you do all the things that are on a protocol, it doesn't matter whether or not you have a protocol.*

Like with ProCESS, it's a little tricky to decipher what fluids each subgroup actually got. I think Table S7 in the Supplemental Appendix is key:

*more on protocols from me, re: ProCESS

**Correction: just noticed the terminal "e" is not capitalized. Oh well.

February 10, 2015

Brussels Sprouts + Math = A Recipe for Confusion

My wife is a dietitian and a very good, healthy cook. Today she was cooking some Brussels sprouts (which I, evidently incorrectly, have been calling "brussel sprouts") and it brought up a great lesson in how hard it is to try to eat healthily in America. Rather, I just finished 26th grade and my wife went to school for this and has literally done this for a living for nearly a decade, and yet we can't figure out what we're eating.

We have a 1-pound bag of Brussels sprouts:
1 pound bag = 454 grams
According to the label, the serving size is 4 sprouts, or 84g, which contains 40 calories. There are 5 servings per container, which should be 20 sprouts in the bag for a total of 200 calories.


The label (photo) is identical to the official USDA label (image above).

My wife counted how many sprouts came in the bag, and we have 40, not the 20 the label says we should have (4 sprouts per serving x 5 servings). Which, on the one hand, is great, because, hey, who doesn't want free Brussels sprouts?

So does our bag just have really small sprouts? Or do we have a 400-calorie bag of Brussels sprouts?

4 of our sprouts in a 1-cup measuring cup
10 of our sprouts in a 1-cup measuring cup
This looks like <4 servings, probably closer to 3 with the (inedible) stems cut off

So how do we figure out the nutrition content? Do we have 10 servings of Brussels sprouts and there are 400 calories? Or, do use our measuring cup and we have 160 calories?

My point here isn't that I want bigger sprouts, or "hey look the Brussels sprouts people don't know how to do math!" But again, I just finished 26th grade and my wife went to school for this and has literally done this for a living for nearly a decade, and yet we can't figure out what we're eating.