RCT = randomized controlled trial; MA = metaanalisis; sr = systematic review; DX = diagnosis; inc_ = incident; w_ = with; wo_ = without; pxs = patients; EX = exclusion; IN = inclusion; ↗️ = improve; ↘️ = worsen; ↑ = increase; ↓ = decrease; 𝙄𝙌𝘾 BS = 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ brief scope = year (Y), journal (J), country (C) ➖ type of study (T) ➕ number of patients/sample (N) ➕ time (t) ➖ population (P), intervention (I), comparison (C), outcome (O, OC);                p = primary; s = secondary; critILL = critically ill

General Glossary

1. A JR is an academic session where we go through some articles previously codified/labeled, for 45-60 min.
2. The articles are selected during the session based on the participants interests and backgrounds.
3. Its purpose is to understand and discuss relevant content elements applying systematized note-taking methodologies.
4. We generate discussion and recall pivotal concepts about different topics, all pertinent to our clinical practice.
5. We write down the key points of every session and publish them on our website.
6. In the following session we briefly recall the key-points from the previous JR, applying the 'reinforcing technique’.
7. Check out our calendar and see you in the DISCORD server.

January, 2025

2024 HEALIO - Eliminating these 14 risk factors may prevent nearly half of dementia cases (AAIC).pdf

Codified by ABFL

Glossary: 🧠 = brain; AAIC = Alzheimer's Association International Conference; AGA, FPG = fasting plasma glucose (alteración de glucemia en ayunas); DEM = dementia; DIA = diabetes; Per cin = waist circumference (perímetro de cintura); RECS = recommendations; srMA = systematic review and metaanalisis.

1. 14 rf, the new ones are underlined - 1/4 DEM in red:
a. ↑ 7
   - pollution
   - diabetes
   - -ol
   - -chol
   - HTA
   - Obesity
   - Smoking
      HOSPdia -ol-chol
b. ↓6 - 1/3 DEM in green
   - depression
   - hearing
   - education
   - physical inactivity
   - Social interaction
   - vision
     ➩ dep-vi-so-h = “divisó”
   c. =1
   - head
2. 57M = DEM by 2019 ➩ expected: 153M = DEM by 2050
3. 13 RECS by Lancet comission for individuals + governments
4. Triangulation framework was used in 2020 (w_12 rf) ➩ based on srMA: all except vision loss (RR =

    1.5) + LDL-chol (RR = 1.3)
       - Highest: depression (RR = 2.2)
       - Lowest: air pollution (RR = 1.1)
5. Implications: physicians + family physicians
6. 13 RECS ➩ the highlights:
       - midlife cognitively stimulating activities (GMC)
       - awareness of -ol overconsumption (AAQC)
       - ↓ air pollution exposure (AMA) ➩ quantification matters (GMC)
7. Relevant association:
       - Hearing ↓ ➩ social isolation ➩ -ol ➩ depression (AMA)
       - ↓ physical activity ➩ iiu LDL ➩ obesity

       - SM = ↑ TG + HTA + per cin + ↓ HDL + AGA or DIA (GLU>100)

⏳ TIME MANAGEMENT
01:15:53
Round: 4 10:12:50
Round: 3 58:16:30 JR
Round: 2 04:13:33 Continue
Round: 1 03:11:51 Past JR

Thursday, January 9 , 2025 at 23h30 BE ABFL, AMA, AHO, MAAT, DFM, GMC, HIBN, AAQC

⏳ TIME MANAGEMENT
01:28:34
Round: 4 01:08:07 Comment
Round: 3 21:40:72 Wrap-up
Round: 2 54:23:69 ART ➩ vasopressin
Round: 1 11:22:11 Past JR + issues

2024 ICUmmp - Rethinking Septic Shock Management Uncovering the Potential of Early Vasopressin Use to Enhance px OC (x) [r].pdf

Codified by RICH

Glossary:  🫁 = lungs; 🫀 = heart; 🩸 = coagulation; MM = mortality; NE = norepinephrine; SS = Survival; SSø = septic shock; VP = vasopressin.

1. Definitions of SSØ ➩ Evans 2021 (SSC), Singer 2016 (SEPSIS-3), SSC 2012 (Dellinger)
   - ↓ flow (persistent)
   - ↓ pressure
   - ↑ inflammation
   - LIFE-THREATENING
2. SSø ➩ does NOT respond to fluids… = despite adequate volume resuscitation.
3. SSø ➩ ↑ MB + MM ➩ in ICU
4. NE (other cathecolamines) ➩ DISADVANTAGES = 🫀 + 🫁 + 🩸 + immune + METABOLISM
5. Evans 2021 ➩ SSC ➩ POTENTIAL cut-off 0.25-0.5 ug/Kg/min to add VP (despite uncertainties on 

    TIMING)
6. 3 retrospective OBS: (Sacha 2018, 2021 + Bauer 2022)
   - PREDICTORS of VP response➩ ph + lactate
        * pH ↓ = bad condition ➩ bad OC when 0,1U ↓ in pH < 7.4
        * ↓ Lactate 🟰 worse 🆚 best 🟰 5.4 🆚 4, p<0.001
   - H+_MM ➩ NE dose + lactate
        * ↓ NE 🟰10ug/min ✔ 🆚 up to 60ug/min ✖ ➩ ↑ ↑ iH+_MM w_10ug/min (additional to 60ug/min)

           ▶ 21%
        * ↓ Lactate 🟰 2.3 mmol/L ✔ ➩ ↑ every 1mmol/L ✖ ➩ ↑ ↑ iH+_MM w_each_1mmol/L18%
7. VASOPRESSIN RESPONSE = while MAP ≥65mmHg + ↓ NE d_6h ➩ under VP

8. Perspectives + hopes + realities ➩ explanation.

Monday, January 6 , 2025 at 23h30 BE ABFL, AMA, AHO, MAAT, DFM, GMC, HIBN, AAQC

2018 CID - Renal Dosing of Antibiotics Are We Jumping the Gun (Crass) [r].pdf

Codified by ABFL

Glossary: 

🫁 = PNA = bacterial pneumonia;
ABSSI = acute bacterial skin and skin structure infections;
AKI = acute kidney injury;
CID = clinical infectious diseases;
CrCL = creatinine clearance;
cUTI = complicated urinary tract infection;
GFR = glomerular filtration rate;
ICD = International Classification of Diseases;
cIAI = complicated intraabdominal infections
REC = record

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2018, CID, USA (Michigan) ➖ retro_REC ➕ 18500 ➕ 2006-2018 ➖ P I C O:
   - P: adults w_ID (cUTI + cIAI + PNA + ABSSI)
   - I: AKI OR moderate impairment
   - C: NA
   - O: transient OR persistent
3. METHODS.
   - DEF ➠ cUTI = ≥56yo
   - 3 equations were used: Cockcroft-Gault (CrCL) + MDRD (eGFR) + CKD-EPI (eGFR)
   - IN ➠ ICD 9th and 10th (admitting, primary or present) + only 1st encounter
   - EX ➠ >1 infection type + CKD ≥S4 + incomplete or inaccurate REC + Scr <3
4. RESULTS
   - Scr 0.88 in all + ↑ “♾ 0.94 + ABSSSI 0.84” than “🫁 0.81+ 🫃🏽0.8”
   - AKI at admission = 17.5%, most common in 🫁
   - less common = ABSSSI 9.7%

   - AKI resolves in 57,2% ➩ in 48h

   - Moderate renal impairment ➩ 43-46% had ↗ ➩ GFR >50 ➩ in 48h

⏳ TIME MANAGEMENT
01:12:25
Round: 3 25:52:42 Wrap-up
Round: 2 35:47:33 Continue last JR
Round: 1 10:45:96 Past JR

Thursday, January 16, 2025 at 23h30 BE MAAT, AHO, DFM, GMC, JCAU, RICH, HIBN, AAQC

2018 CID - Renal Dosing of Antibiotics Are We Jumping the Gun (Crass) [r].pdf

Codified by ABFL

Glossary: [IS] = Israel; ♾ = kidneys = renal; 🫁 = lungs; ATB = antibiotic; CART = classification and regression tree analysis; ID = infectious disease; ID = infectious diseases; INF = infective; MOO = microorganism; TTO = treatment.

1. CRITICAL PERIOD ➩ primary driver of ID = early ATB TTO
2. Adequate ➩ doses = ATB in vitro → target pathogens = ATB in vivo (pharmacodynamics)
3. Early ➩ empirical TTO period… WHEN INF moo + susceptibility = unknown.
4. DATA:
   - Retro_cohort (SSø) ➩ 14 ICU + 10 H+ ➩ 1h delay = ↓SS (7.6%)
   - MA (S) ➩ ✖ 48h = ↑MM (1.6OR) ➩ NNT = 10
   - SingleCen_OBS (BSI) ➩ [IS] + ✖ = ↑ MM (1.6 OR)
        * intra 🫃🏽= ↑ MM (3.8OR)
        * skin = ↑ MM (3.1OR)
   - Retros_cohort (comm_acq_BSI) ➩ ✔ 48h = ↓MM (0.54 OR)
   - Pros_S (BSI_Enterococcus) ➩ ✔ 48h = ↓MM (0.21 OR)
   - Retros_singC (BSI_Enterococcus) ➩ ✖ outside CART (48.1h) = ↑MM (3x)
   - OBS_USA (BSI_S. aureus) ➩ ✔ CART (44.75h) = ↓ MM
5. ✔ pharmacodynamic = dosis + administration (although ok in vitro ↔ in vivo activity)
6. 48h = CRITICAL IMPORTANCE ➩ ↓ doses in ♾ impairment = poor

    OC (IF impairment does not persist)

⏳ TIME MANAGEMENT
01:12:56
Round: 5 06:12:25
Round: 4 08:57:76 Wrap-up
Round: 3 44:03:93 Continue w_JC
Round: 2 07:49:54 ART selection
Round: 1 05:52:77 Past JR

Monday, January 13 , 2025 at 23h30 BE ABFL, AMA, AHO, MAAT, DFM, GMC, HIBN, AAQC

2024 NEJMjw - PREVENT A New Cardiovascular Risk Calculator (JAMA).pdf

Codified by ABFL

Glossary: 

🫀 = heart; ACC/AHA = American College of Cardiology/American Heart Association; CHOL mm = Cholesterol management; JAMAim = JAMA internal medicine; MI = myocardial infarction; S† = stroke.

1. New CV risk calculator ➩ PREVENT
2. PREVENT is from AHA 🆚 past one from AHA & ACC 2013
3. Comparison:
- Much larger + more contemporary (derived from databases)
- 5 new input variables:
     * 2 mandatory: BMI + eGFR
     * 3 optionals: HbA1c + urinary albumin-creatinine ratio + zip code (social deprivation)
- No RACE
- Adds ‘CARDIOVASCULAR DISEASE' = heart failure + ASCVD (past one ONLY ASCVD)
- All published in CIRCULATION 2024
4. Comparison ↔ current PREVENT 🆚 older calculator
      - 2 studies ➩ 2024 JAMAim, JAMA, US, wo_MI or S† ➩ PREVENT (4-5%) 🆚 older (8-9%)
      - Same studies = considered ↓ adults for PRIMARY preventive STATIN
5. Decision making in primary care?

      - 2024 Editorial ➩ continue w_2018 ACC/AHA GL on CHOL mm

      - Consider the 7.5% threshold ➕ pxs preferences

      - Next version of the GL will address the LOWER RISK ESTIMATES (PREVENT)

⏳ TIME MANAGEMENT
16:56:41
Round: 4 00:00:95
Round: 3 00:46:06 Comments
Round: 2 09:17:87 Wrap-up
Round: 1 06:51:52 Selection + reading

2025 NEJMjw - Large Language Artificial Intelligence Models+Clinical Reasoning The Frontier in 2024 (NEJM + JAMA).pdf

Codified by ABFL


1. AI models demonstrated:
      - Expert-like reasoning performance
      - Human-like cognitive biases
2. LLM = GPT-4 + Gemini-1.0-Pro
3. Contextual factors are not considered by AI ➩ can't easily be captured in written clinical vignettes
4. Study ➩ 50 physicians ➩ randomized:
      - Group A. USE OF Standard DX tools
      - Groups B. USE OF Standard DX tools ➕ GPT-4
      - Results: DID NOT enhance dx performance (…+GPT-4)

      - Interpretation: LLM does not outperform humans BUT humans (physicians) need more training to

        use LLM.

Monday, January 27, 2025 at 23h30 BE AMA, AHO, MAAT, GMC, HIBN, AAQC

⏳ TIME MANAGEMENT
01:06:04
Round: 10 00:11:29 Final comments
Round: 9 05:10:62 Wrap-up
Round: 8 04:42:22 Analysis
Round: 7 04:10:13 ART 2
Round: 6 00:26:19 Final comments
Round: 5 18:30:33 Wrap-up
Round: 4 14:53:35 Analysis
Round: 3 05:38:23 Hyponatremia
Round: 2 04:50:40 ART selection
Round: 1 07:31:32 Past JR (Andrea)

2024 NEJMjw - Treating Hyponatremia, Pick Up the Pace (JAMA).pdf

Codified by ABFL

Glossary: 

♾ = kidneys = renal; 🫀 = heart; ACC = American College of Cardiology;
AHA = American Heart Association; Coh = cohort; im = internal medicine;
Mass = MAssachusetts; ODS = osmotic demyelination syndrome

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. Study 1. 🟰 2023, NEJM evidence, USA (2H+ in Mass) ➖ retros ➕ 3000 ➕ 25y ➖ P I C O:
   - P: adults, severe hyponatremia (Na < 120)
   - I: slow 🆚 fast CORRECTION (<6mEq / 24h 🆚 >10mEq / 24h)
   - C: NA
   - O: MM ➩ Result: ↑ MM in SLOW correction
   - RESULTS: slow ↔ ↑ H+_MM➕ fast ↔ shorter H+_stay & (somewhat) ↓ MM ➩ ODS = 0.2% (7 pxs, overall incidence)
3. Study 2. 🟰 2024, JAMA im, NA ➖ MA ➕ 16 coh (12k)➕ ? ➖ P I C O:
   - P: adults, severe hyponatremia
   - I: cases of ↓ Na (Na <120 OR Na < 125 w_sev_SYMP)
   - C: NA
   - O: H+_MM & MM30 ➩ Result: ↓ in FAST
   - RESULTS: Thesholds varied ➕ slow 🆚 fast CORRECTION (6 🆚 10 in 24h) ➩ ODS ≤0.5% (overall incidence)
4. RATIONALE
 - All the studies were OBSERVATIONAL ➩ risk of unmeasured confounders
 - Might NOT apply to MOST-SEVERE hyponatremia (although there is robust evidence of a fast

   correction) 

 - Several studies suggest that we should be correcting hyponatremia more rapidly.

2024 NEJMjw - PREVENT A New Cardiovascular Risk Calculator (JAMA).pdf

Codified by ABFL


1. New CV risk calculator ➩ PREVENT

2. PREVENT is from AHA 🆚 past one from AHA & ACC 2013
3. Comparison:
-  Much larger + more contemporary (derived from databases)
-  5 new input variables:
      * 2 mandatory: BMI + eGFR
      * 3 optionals: HbA1c + urinary albumin-creatinine ratio + zip code (social deprivation)
-  No RACE

-  Adds ‘CARDIOVASCULAR DISEASE' = heart failure + ASCVD (past one ONLY ASCVD)

- All published in CIRCULATION 2024

Thursday, January 23, 2025 at 23h30 BE ABFL, AMA, AHO, MAAT, HIBN, AAQC

2025 NEJMjw - Large Language Artificial Intelligence Models+Clinical Reasoning The Frontier in 2024 (NEJM + JAMA).pdf

Codified by ABFL

Glossary: AI = artificial intelligence; LLM = large language models; RA = Rheumathoid arthritis.

1. AI models demonstrated:
      - Expert-like reasoning performance
      - Human-like cognitive biases
2. LLM = GPT-4 + Gemini-1.0-Pro
3. Contextual factors are not considered by AI ➩ can't easily be captured in written clinical vignettes
4. Study ➩ 50 physicians ➩ randomized:
      - Group A. USE OF Standard DX tools
      - Groups B. USE OF Standard DX tools ➕ GPT-4
      - Results: DID NOT enhance dx performance (…+GPT-4)
      - Interpretation: LLM does not outperform humans BUT humans (physicians) need more training to use LLM.
5. 3 types of bias of AI in this study:
      - Framing effect. Decisions influenced by how information is presented ➩ recommended surgery

        EXPRESSED as SS (34% by 5y) instead of high MM (66% by 5y)
      - Primacy effect. Tendency to better remember the first piece of information they encounter than

        the information they receive later on. ➩ PE as top 3 DX (hemoptysis mentioned first) 🆚 PE as 

        top 3 DX but not iteratively (hemoptysis NOT mentioned first OR less emphasized).
      - Hindsight effect. Phenomenon that allows to convince oneself after an event that they accurately

        predicted it before it happened. ➩ soft tissue inflammation ➩ one version PX died 🆚 other

        version recovered, although GPT-4 said “irrespective of the outcome”… appropriate care has

        provided to the first case.
6. AI wo_critical lens could exacerbate decision-making errors.
7. Talk to AI, and make open questions:
     - Does this patient have rheumatoid arthritis? ✖ 🆚 Can you provide evidence against a DX of RA?

       ✔
     - What is the likely diagnosis? ✖ 🆚 What are likely diagnoses that could explain these symptoms?

       ✔

2025 HBR - The Surprising Power of Team Rituals (Zakhour) [r].pdf

Codified by HIBN


1. We could apply the team rituals in our current workplaces
2. Work rituals = collective activities that members of a team engage in regularly and to which they

    attribute meaning.
3. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
4. 2025, Cosmic Centaurs, USA ➖ survey ➕ 929 individuals (60 countries) – field study (UAE, SA, L)➕ 3y ➖ P I C O:
   - P: teams different enterprises (survey) + from advertising agency (field study)
   - I: questions + high use of rituals
   - C: NA + low use of rituals
   - O: purpose + phychological safety + interpersonal knowledge + job satisfaction ➩ work

     experiences + barriers to implementation + design and complying.
5. To design ➕ implement a successful set of rituals ➩ 5 measures:
      - Leading w_faith
      - Imbuing rituals w_meaning
      - Being religious about participation
      - Keeping the faith but adapting the practice     

      - Spreading the word6. Effective communication (AMA) – consistent application (HIBN) – start the

        habit (AAQC).

⏳ TIME MANAGEMENT
01:33:32

Round: 7 03:20:03 Comments
Round: 6 14:59:69 Wrap-up
Round: 5 29:54:11 ART 2
Round: 4 10:41:46 Wrap-up
Round: 3 23:06:63 Continue past JR
Round: 2 03:19:20 Comments
Round: 1 08:11:14 Past JR

Thursday, January 30, 2025 at 23h30 BE ABFL, AMA, AHO, GMC, JCAU, MACR, HIBN, AAQC

⏳ TIME MANAGEMENT
01:14:09

Round: 8 00:42:44 Comments
Round: 7 17:29:60 Wrap-up
Round: 6 13:57:03 ART 2
Round: 5 06:00:31 ART selection
Round: 4 00:37:48 Comments
Round: 3 16:22:15 ART 1
Round: 2 12:12:32 2nd Past JR by AHO
Round: 1 06:47:86 Past JR by AMA

2025 NEJMjw - Are SGLT-2 Inhibitors Safe and Effective in H+ pxs (DC).pdf

Codified by MAAT

Glossary:
🫀 = heart; ♾ = kidneys = renal; AKI = acute kidney injury;
DKA = diabetic ketoacidosis; DM = diabetes mellitus; INF = infection.


1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, DC, NA ➖ MA ➕ 20k ➕ ❓ ➖ P I C O:
   - P: DM pxs + HF (hospitalized)
   - I: SGLT-2 ⊖ ✔
   - C: SGLT-2 ⊖ ✖
   - O: pOC = DKA | sOCs = readmission + MM + AKI
3. EVIDENCE:
   - SGLT-2 ⊖ is IMP ➩ DM + ♾ disease + 🫀 failure
   - Little is know about risks + benefits
   - Chief concern = DKA (results from INF + ↓ oral intake)
   - Euglycemic ketoacidosis 🆚 hypergycemic ➩ former could be missed
4. RESULTS
   - 30% were DM
   - DKA = ↑ SGLT-2 receivers (non-significant) = 0.21 🆚 0.14 per 100 person-years
   - Readmission ↓ (significantly)
   - MM ↓ in 🫀failure pxs
   - ♾ injury ↓ incidence
   - OBS studies (20) DID NOT show ↑r_DKA w_SGLT-2 ⊖
5. RATIONALE
   - Caution w_INTERPRETATION (nonsignificant)
   - Results underpowered ❓

   - Risk underestimated due to IN outPXS follow-up

   - Supports SGLT-2 ⊖ use in H+ w_🫀 failure

2025 HBR - The Surprising Power of Team Rituals (Zakhour) [r].pdf

Codified by HIBN

Glossary:
m = months


1. Being religious about participation.
   - Easy 🆚 Hard ➩ selecting + designing 🆚 disciplined (communicating + organizing + engaging)
   - RITUAL is a CORE ASPECT (not optional, not extracurricular)
   - FOR teams NEW TO RITUALS ➩ no all in one, but ONE AT A TIME (sequentially) ➖ ritual owner 

     = develop: relevant communication + agendas + templates (it should be CHANGED or ROTATED

     regularly)
   - Field study ➩ 3m ➩ at departure (turnovers + strategy shifts) theaters of stopping the rituals ➩ 6m

     later, the survey showed they kept the rituals (82% high levels of observance)
2. Keeping the faith but adapting the practice..
   - A good operating system is one that adapts over time ➩ according to CONTEXT
   - 6-12m ➩ rituals should be reviewed (purpose + relevancy)
   - Cancel the RITUALS that do not serve you (add new ones ➩ needs + preferences + cultural

     context)
   - Andrea (AMA): Cultural context ➩ punctuality as a good habit despite her cultural context
   - Hans (HIBN): What the team prefers, needs and how their context influences them. Alcohol

     example
   - Frequencies should also ve REVISITED.
3. Spreading the word.
   - One committed leader IS essential
   - Preach the RITUAL value to the broader organization once it bears FRUIT
   - The help teaching + sharing + helping

   - Certainty + connection + engagement are the RESULTS

Monday, February 10, 2025 at 23h30 BE AMA, AHO, BAR, DFM, MACR, RCH, HIBN, AAQC

2025 HBR - The Surprising Power of Team Rituals (Zakhour) [r].pdf

Codified by HIBN



1. We could apply the team rituals in our current workplaces
2. Work rituals = collective activities that members of a team engage in regularly and to which they attribute meaning.
3. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
4. 2025, Cosmic Centaurs, USA ➖ survey ➕ 929 individuals (60 countries) – field study (UAE, SA, L)➕ 3y ➖ P I C O:
   - P: teams different enterprises (survey) + from advertising agency (field study)
   - I: questions + high use of rituals
   - C: NA + low use of rituals
   - O: purpose + phychological safety + interpersonal knowledge + job satisfaction ➩ work experiences + barriers to implementation + design and complying.
5. To design ➕ implement a successful set of rituals ➩ 5 measures:
     - Leading w_faith
     - Imbuing rituals w_meaning
     - Being religious about participation
     - Keeping the faith but adapting the practice
     - Spreading the word
6. Effective communication (AMA) – consistent application (HIBN) – start the habit (AAQC).
7. LEADING w_faith
     - Commitment is ESSENTIAL to start rituals.
     - In the field study, skepticism was high… then everyone started to participate (first the CEO).
     - Engagement and faith is important among the team members ➩ one member co-created a check-

       in ritual.
8. IMBUING RITUALS w_meaning
     - Not a religious connotation but meaning
     - The purpose MUST be aligned w_specific goals (WHAT) + organizational purpose (WHY)
     - 5 GOALS IN THE study: 1) strategy and planning, 2) performance management, 3) improving operations, 4) learning, and 5) team engagement and relationship-building
     - One member co-created a monthly ritual and they met to follow the PROCESS as a team (rather than PROGRESS)
     - Earlier interventions are useful
     - RETROSPECTIVE ➩ had certain points: purpose + facilitated discussions of reflections &

       suggestions + mutual commitment towards action steps.

    – No finger-pointing and defensiveness.
     - No work topics were discussed during these “TEAM TIME”
     - QUESTIONS to use: “What part of your childhood would you change if you could?” and “How do

       you like to receive negative feedback?”
9. Being religious about participation.
     - Easy 🆚 Hard ➩ selecting + designing 🆚 disciplined (communicating + organizing + engaging)

     - RITUAL is a CORE ASPECT (not optional, not extracurricular)

     - FOR teams NEW TO RITUALS ➩ no all in one, but ONE AT A TIME (sequentially) ➖ ritual owner

       = develop: relevant communication + agendas + templates (it should be CHANGED or ROTATED

       regularly)

2025 NEJMjw - Is “As-Needed” Blood Pressure Medication Really Needed in inPXS (JAMA).pdf

Codified by ABFL

Glossary: BP = blood pressure; HR = hazard ratio; JAMAim = JAMA internal medicine; MI = myocardial infarction; QX = surgical; S† = stroke; TTO = treatment = medication.


1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA im, ? ➖ RETROSPECTIVE ➕ 130k ➕ ? ➖ P I C O:
     - P: adults, 71yo ➩ hospitalized (Veteran affairs)
     - I: as-needed BP TTO
     - C: NA (“nonrecipients”)
     - O: AKI ➖ composite: MI ➕ S† ➕ MM
3. EVIDENCE:
     - Hypertension 2024 ➩ OBS studies
     - Consensus ➩ NOT to use “as-needed” BP TTO
4. METHODS.
- IN ➠ CV related admission + antiHTA TTO + SBP >140
- EX ➠ QX + ICU pxs
6. RESULTS
     - 21% received as-needed BP TTO
     - Propensity-score ➩ AKI excess (HR 1.2) ‎ =  as-needed BP TTO ➕ 💉 as-needed BP TTO =

       MORE AKI excess (HR 1.6)
     - Secondary analyses ➩ as-needed BP TTO: BP drop (1.5-fold) + composite (MI + S† + MM) 🆚 non recipients
7. RATIONALE
     - Do not treat a NUMBER
     - DO not order as-needed BP TTO
     - Do not write a BP THRESHOLD to automatically start BP TTO
8. COMMENTS
     - Careful with technology automated thresholds (AMA)

⏳ TIME MANAGEMENT
01:37:51

Round: 5 01:23:30 Comment
Round: 4 32:03:26 ART 2
Round: 3 10:22:43 Comments
Round: 2 41:58:71 ART1: Continue ART2 last JR
Round: 1 12:04:22 Past JR

Monday, February 3, 2025 at 23h30 BE ABFL, AMA, AHO, MAAT, DFM, JCAU, HIBN, AAQC

March, 2025

⏳ TIME MANAGEMENT
01:27:09

Round: 4 00:39:70 Comments
Round: 3 45:15:89 Another point
Round: 2 35:40:71 ART 1

Round: 1 05:32:84 Past JR

2025 CC - Physiology and pathophysiology of mucus + mucolytic use in CrIll pxs (Roe) [r].pdf

Codified by AMA

Glossary: [ ] = proportion, ↑r = increased risk, ⊕ = induction, ♾ = kidneys = renal, 💧 = secretion, 🔘 = cells, 🧠 = brain, 🫀 = heart, 🫁 = lungs, AARC = American Association for Respiratory Care, AM = adhesion molecules, ASL = airway surface layer, aw_ = airway, BTS = British Thoracic Society, HME = heat and moisture exchangers, HTS = hypertonic saline, MECHS = mechanisms, NIV = non-invasive ventilation, PPV = positive pressure ventilation, R = resistance..

1. Wo_Controlling humification = Dried: epithelium + mucosal layers leading to:
       - Impaired tranportation
       - ↑ aw_R
       - ↑r of opportunistic INF
2. Supplemental oxygen should be WARMED ➕ HUMIDIFIED.
3. Balance ➩ AVOID ↑ humidity ➩ overwhelm mucociliary transportation:
       - ↑ mucosal burden
       - Cause atelectasis (water droplet)
4. AARC + BTS (not in low flow + NIV) ➩ use of HUMIDIFICATION for MV pxs.
       - Active: used w_heated water reservoirs
       - Passive: used w_HME
5. Difference ↔ systems = external power OR water supply need (in the active). MECHS:
       - Active = Bubble + flow humidification + evaporation (active heating).
       - Passive = HME into ventilation circuit (membrane properties)
6. HMEs problems (although cheap and easy to install):
       - ↑ Vm (>10L/min)
       - Tº control (<32ºC)
       - ↑r of air leakage
       - ↑r of 💧 blockage
7. Traditionally used ➩ ACTIVE HUMIDIFICATION ➩ specially in:
       - prolonged MV pxs
       - Thick/large 💧burdens
8. Temperature ➩ ACTIVE (requires) 🆚 PASIVE (not requires)
9. Function ➩ lubricant 💦 + air humidification 💨 + selective permeable barrier 𝌉 (gas exchange & nutritional absorption)
10. Dysfunction in ICU (Table 1):
       - Epithelium.
            * ↑ plasia + meta plasia ➩ 🔘💧
            * Epithelial → mesenchimal TRANSFORMATION
       - Mucociliary Transport
            * Reverse of 💨 direction (regardless of PPV)
            * ↓ transit ⏱
            * ↑ [🔘 brush (periciliary layer)]
            * ↓ in cilia ➩ LENGTH
       - Immune Response
            * ⚡ dendritic 🔘
            * ⊕ 🔘 AM in 🫁 capillaries
            * ⊕ of FIBROSIS
       - Mucus composition
            * ↑ viscocity
            * ↑ DNA + proteinaceous components
            * ⊕ MUC5AC, MUC5B, MUC1
            * ↑ cleavage MUC4 and MUC16
11. In humans ➩ predominate
       - MUC5AC: ⊕ by pathogens, gases, inflammation, factors (adrenergic + cholinergic +

         neurohumoral)
       - MUC5B: constitutive
12. SAMPLING (underlined are the same):
       * Mucus sampling ➩ rheology + mass spectrometry + microbiology + ELISA + cytology. + RNA

          sequencing

       * Biopsy ➩ DNA + immunochemistry + immunofluorescence + RNA sequencing
13. TTO w_HTS, effects:
       - Direct ➩ ↑ ASL height + ↓ viscosity (ionic bonds breakage)

       - Indirect ➩ repair of ASL (↓ viscosity from ↑ H2O) ➩ DNA dissociation ➕ ⊕ proteolysis (from

         muco-proteins)

Thursday, February 27, 2025 at 23h30 BE

AMA, MAAT, DHA, HIBN, AAQC

⏳ TIME MANAGEMENT
01:52:33

Round: 8 00:37:70 Final comments
Round: 7 12:16:39 wrap - up
Round: 6 27:07:68 Comments
Round: 5 31:59:68 Exploration
Round: 4 01:40:88 Comments
Round: 3 30:13:56 ART 1
Round: 2 01:25:47 ART Selection
Round: 1 07:11:64 Past JR

2025 CC - Physiology and pathophysiology of mucus + mucolytic use in CrIll pxs (Roe) [r].pdf

Codified by AMA

Glossary:🫁 CA = lung cancer; CF = cystic fibrosis; COPD = chronic obstructive pulmonary disease; DYS = dysfunction; GL = guidelines; INF = infection; MV = mechanical ventilation; MV = mechanical ventilation.

1. Start by the same article next JR (see images, figures, tables) ➩ mucus dysfunction
2. Airways mucus ➩ lubricating ➕ humidifying
3. DYS (CI pxs) ➩ changes in production ➕ composition➕ physical properties ➕ inflammatory phenotype
4. MUCUS:
        - Water
        - Proteinas
        - Lipids
        - Carbohydrates
        - Electrolytes
5. Function ➩ lubricant 💦 + air humidification 💨 + selective permeable barrier 𝌉 (gas exchange & nutritional absorption)
6. Main diseases w_mucus DYS:
        - Asthma
        - COPD
        - CF
        - 🫁 CA
7. ICU factors lead to CHANGES IN mucus:
        - INF
        - Accumulation of inflammatory cells
        - 🫁 ↓ H2O
        - ↓ 😷 reflexes
        - ↑ O2
        - MECH stress from MV
8. Survey 2020, UK ➩ 4% uses or follows GL (83% uses it as normal practice)
9. Morphological CHANGES, epitelium from 🐽 to 👛ALV:
        - HIGH ➩ = ciliated
        - LOW ➩ cuboidal
10. CELLS
        - Secretory (submucosal) ➩ production of MUCUS ➩ 60% of gland volume (98% water, 1%

          salts, 0.3% mucin glycoproteins)
        - Ciliated (epithelial) ➩ movement of MUCUS
11. Mucin glycoproteins properties:
        - Antimicrobial
        - Immunological

        - Defensive

Monday, February 24, 2025 at 23h30 BE AAGC, AG, AMA, AHO, MAAT, IC, JQB, JV, KG, LL, PACG, VV, N,  HIBN, AAQC

2025 UPTODATE - Middle meningeal artery embolization for chronic subdural hematoma (nature).pdf

Codified by ABFL

Glossary: 

💉= IV; SJS/TEN = Stevens-Johnson syndrome/toxic epidermal necrolysis;

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, Nature, ? ➖ interventional
➕ 7 pxs ➕ ? ➖ P I C O:
   - P: adults w_SJS/TEN
   - I: JAK inhibitors (also received high-dose 💉 glucoCORTICOIDS) ➩ abrocitinib or tofacitinib)
   - C: NA
   - O: clinical improvement; sOC = adverse events
3. EVIDENCE:
   - NO TTO for SJS/TEN, just supportive care
6. RESULTS
   - All I ➩ rapid clinical ↗️
   - Re-epithelialization wo_adverse events

   - Still, further studies needed to confirm EFFICACY + OPTIMAL use.

2024 THE CONVERSATION - Can listening to music make you more productive at work (Fiveash) [r].pdf

Codified by ABFL

Glossary: 

BM = Background music;SJS/TEN = Stevens-Johnson syndrome/toxic epidermal necrolysis;

1. Listening to music ➩ ↗️ or ↘️ productivity at work
2. NO one-size-fits-all answer
3. Personalize the type of music according to everyone
4. Factors that hep us understand it:
   - Personality traits
   - What you’re doing
   - What kind of music you’re listening to
5. Arousal ➩ mental alertness, and the readiness of the brain to process new information.
6. Optimal arousal = FACILITATES = state of "flow"
7. INTROVERTS 🆚 EXTROVERTS ➩ high arousal baseline level 🆚 lower arousal baseline level ➩
8. Personality:






9. What you’re doing:
       - Complex music = music w_lyrics
       - Reading + writing at the same time as listening to COMPLEX MUSIC is DIFFICULT
       - Simple + repetitive tasks w_BM (upbeat & complex) ➩ ↗️ productivity
       - MECHS ➩ effects on motivation + attention + ⊕ 🧠 reward networks
10. Type of music: for complex tasks





11. In MEMORY ➩ calming music WORKS
12. WHAT works best will be different for everyone. Based on:
         - Personality
         - Familiarity w_music
         - Musical preferences
         - Cultural context (AMA)
13. Music should be rewarding (meaningful) ➩ attention + mood + motivation ➩ ↗️ performance (specially in simple tasks)
14. What about COMPLEX TASKS?
         - Complex tasks = a cognitively demanding task involving 📖 + ✍🏽
         - LISTEN before doing your work
15. What works for you?
         - TRY different tasks and different types of music
         - Start w_your FAVORITE music.
         - Listening to music without lyrics and with a strong beat might help you focus on the task at

           hand.
        - Use BREAKS to listen to your music.   

        - Moving along with music is suggested to ↗️ reward processing, especially in social

          situations.   

        - DANCING works.

Monday, February 17, 2025 at 23h30 BE AMA, ABFL, MAAT, JQB, HIBN, AAQC

⏳ TIME MANAGEMENT
01:26:13

Round: 7 00:42:75 Comments

Round: 6 25:32:42 Wrap-up
Round: 5 10:43:11 ART 2 ➩ -20 min
Round: 4 23:12:44 Wrap-up
Round: 3 04:53:27 ART 1
Round: 2 10:06:93 Select JR
Round: 1 11:02:46 Past JR

2024 NEJMjw - Are 7 Days of Antibiotics as Good as 14 Days for Bloodstream INF (NEJM).pdf

Codified by ABFL


1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, NEJM, ❓ ➖ mn_nonINF (BALANCE) ➕ 3.6k H+ ➕ ❓ ➖ P I C O:
    - P: adults hospitalized ➩ bloodstream INF
    - I: 7d of ATB
    - C: 14d of ATB
    - O: MM90, sOC = relapse
  3. EVIDENCE:
  - Mantra = "shorter is better”
  - Does it apply to BSI? few (underwhelming) results from small trials
  - The mantra applies to UNCOMPLICATED INF syndromes
  4. METHODS.
- RANDOM ➠ 7 🆚 14 d
  - Drug choice + route + dose ➩ discretion of CLINICIAN
- INTERV ➠
6. RESULTS
  - BSI sources:
       * Urinary tract 42%
       * 🫃🏽 or biliary tree 19%
       * 🫁 13%
  - Pathogens
       * E. Coli 44%
       * Klebsiella spp. 15%
       * Enterococcus spp. 7%
  - MM90 ➩ SIMILAR in both groups (≈15%) [idem in respecified criterion for noninferiority]
  - RElapse ➩ UNCOMMON in both (<3%)  
  7. ≈ better than ~ (verified thanks to AMA remark)
  8. Key strength = large size
  9. BALANCE should change practice ❗
10. Excluded cases MUST GUIDE our application:
         - S. Aureus BSI
         - Severe immunocompromised (↓N, 💉 immunosuppression [transpants: solid-organ OR stem

            cell])
         - Prostetic 🫀 elves
         - Vascular grafts
         - Undrained abscesses
         - Other w_prolonged TTO (endocarditis + osteomyelitis + septic arthritis)

11. OK 7d in uncomplicated BSI

⏳ TIME MANAGEMENT
01:07:13

Round: 10 01:19:87 Comments
Round: 9 14:24:20 Wrap-up
Round: 8 08:51:00 Analysis
Round: 7 03:24:94 ART 2
Round: 6 01:18:88 ART selection
Round: 5 01:18:31 Comments
Round: 4 12:46:31 Wrap-up
Round: 3 13:53:40 ART 1
Round: 2 02:30:08 Select ART
Round: 1 07:26:35 Past JR

2025 NEJMjw - Can Tracking Inflammatory Biomarkers Shorten ATB Duration in Patients s_S (JAMA).pdf

Codified by MAAT

Glossary: ♾ = kidneys = renal; ✖ = discontinuation; BSI = bloodstream infection; UC = usual care

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, JAMA, UK ➖ mc_nonINF ➕ 2,7k critILL (60yo)➕ ❓ ➖ P I C O:
   - P: adults, 41 ICU
   - I: ATB ✖ w_PCT OR ATB ✖ CRP
   - C: usual care (UC)
   - O: MM28
3. EVIDENCE:
   - Adverse events + efficacy = unknown ➩ ATB duration
4. METHODS.
- RANDOM ➠ 3 groups (2 in I and 1 in C)
- INTERV ➠ blinded allocation ➕ no bioMAR values ➕ in I groups daily automated advice (cutt-off + % baseline value) ➕ in C group (daily advice to continue)
6. RESULTS
   - PCT 🆚 UC = d_ATB ↓ 1d (11d 🆚 10d)
   - CRP 🆚 UC = NOT SHORTER (11d both)
   - MM28 ➩ slightly ↑ in both bioMAR groups (~21%) 🆚 UC (19%) ➩ w_prespecified statistical

     criteria = ATB ✖ w_PCT was NOT INFERIOR to ATB ✖ w_UC (in MM)
   - Adverse events ➩ rare + similar
7. The COST to ↓ d_ATB is debatable or controversial (just 1 day?)
8. BioMARK in isolation to guide ATB decision is NOT the best idea - is not recommended.

Thursday, February 13, 2025 at 23h30 BE AMA, ABFL, MAAT, JCAU, HIBN, AAQC

February, 2025

Thursday, March 27, 2025 at 23h30 BE AMA, BAH, HIBN, AAQC

2025 NEJMjw - C. difficile Infection w_ Reduced Fidaxomicin Antibiotic Susceptibility May Develop Among Hospitalized Pxs (CID)

Codified by ABFL

Glossary: CID = Clostridioides difficile infection.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, CID, USA (Cleveland Veterans Affairs Medical Center)➖ COHORT ➕ 122 - 108 fidaxo ➕ t ➖ P I C O:
   - P: adults w_CDI
   - I: Fidaxomicine
   - C: NA
   - O: pOC = Susceptibility; sOC = Failure + recurrent disease
3. EVIDENCE:
   - ↓ susceptibility to fidaxomicin for CID
   - Its clinical implications are unclear
4. METHODS.
   - stool cultures for C. Difficile + susceptibility test
   - Whole-genome sequencing
6. RESULTS
   - Failure ➩ 7%
   - Recurrent disease ➩ 13%
   - 108 pxs w_fidaxomicin ➩ 6pxs (5.6%) w_↓ susceptibility
   - 4 of the 6 ➩ ↓ susceptibility only AFTER THERAPY
   - 2 of the 6 ➩ resistance (onset of disease + clinical failure)
   - RNA polymerase mutations = in all ↓ susceptibility isolates
7. RATIONALE
   - There are VARIANTS of C. difficile that ↓ susceptibility

   - Consider: vancomycin OR ↑doses of fidaxomicin (if no response to initial therapy + if subsequent recurrence)

2025 NEJMjw - Automated Blood Pressure Measurement — Without a Clinician in the Room (AJH).pdf

Codified by ABFL

Glossary: ↔ = between, AMAP = ambulatory monitoring of arterial pressure

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, AJH, USA (Boston, hypertension clinic)➖ single-center ➕ 67 - 44pxs ➕ t ➖

P I C O
   - P: out of hospital pxs
   - I: unattended BP measurement
   - C: AMAP
   - O: pOC = delay times; sOC = intervals ↔ 3 measurements
3. EVIDENCE
   - Time + space are IMP to measure BP
   - Automated devices ➩ can measure BP in ≠ INTERVALS + w_px in a quiet location = UNATTENDED BP measurement
4. METHOD
   - DELAY TIME = 3-5 min for 1st measurement after clinical left
   - INTERVALS ↔ 3 measurements (30-60sec)
   - All pxs had undergone AMAP
5. RESULTS
   - Longest ➩ 5min delay + 1min interval ➩ 67 pxs
   - Shortest ➩ 3 min delay + 30 sec intervals ➩ 44 pxs
   - 3 lectures (average) were SIMILAR
   - BOTH PROTOCOLS (short ➕ long) were CORRELATED CLOSELY w_AMAP
6. RATIONALE
   - SHORTER was as accurate as the longer in approximating to AMAP
   - “Whether this study's findings can be extrapolated to delays and intervals when multiple BP

      readings are taken directly by clinical staff is unclear.” Allan Brett

⏳ TIME MANAGEMENT
01:38:15

Round: 4 01:01:17 Comments
Round: 3 01:27:31 ART + logistics
Round: 2 01:14:93 CorrectionsRound: 1 08:27:82 Past JR

⏳ TIME MANAGEMENT
01:12:42

Round: 6 00:41:27 Comments
Round: 5 16:06:02 Wrap-up
Round: 4 11:47:36 ART 2
Round: 3 18:12:81 wrap-up
Round: 2 11:39:50 ART 1
Round: 1 14:15:93 Past JR + change of place

⏳ TIME MANAGEMENT
01:38:15

Round: 4 01:01:17 Comments
Round: 3 01:27:31 ART + logistics
Round: 2 01:14:93 Corrections
Round: 1 08:27:82 Past JR

2025 CC - Physiology and pathophysiology of mucus + mucolytic use in CrIll pxs (Roe) [r].pdf

Codified by AMA

Glossary: [ ] = proportion, ↑r = increased risk, ↓ AP = hypotension, ⊕ = induction, ♾ = kidneys/renal, ❃ = mucus, 💧 = secretion, 🔘 = cells, 🧠 = brain, 🫀 = heart, 🫁 = lungs, 🚀 = transport, 🛡 = protection, AARC = American Association for Respiratory Care, AD = advantages, AM = adhesion molecules, ARF = acute respiratory failure, ASL = airway surface layer, aw_ = airway, BTS = British Thoracic Society, DIS = disadvantages, HME = heat and moisture exchangers, HTS = hypertonic saline, MECHS = mechanisms, neb_HTS = nebulised hypertonic saline, NICE = National Institute for Health and Care Excellence, NIV = non-invasive ventilation, Par = participants, PPV = positive pressure ventilation, R = resistance.

1. Table 2. Mucus collection techniques
      - Induced/spontaneus sputum ▶ ask for spontaneous cough ➕ inhale neb_HTS (several mins) to

        loosen secretions → ⊕ cough
            * AD. No training needed ➕ ↑ ↓ aw_ + in alert pxs
            * DIS. Saliva contamination ➕ use of HTS (facilitate expectoration): uncomfortable for pxs +

              alter mucus composition
      - Endotracheal sampling ▶ only in intubated ➖ suction catheter is inserted and samples collected

        (∂ suction).
            * AD. Minimal technical skill

            * DIS. Intubation required ➕ ↑ aw_ ➕ intra/inter individual variability (content & volume)
      - Bronchoscopy/BAL ▶ bronchoscope enters the branchial tree w_saline flushes + suctioning.
            * AD. Therapeutic benefit (❃ plugging) ➕ performed regularly for ↓ aw_
            * DIS. Sedation & intubation needed ➕ personnel & equipment needed.
2. NAC/carbocisteine
      - NAC = lytics ➖ carbocisteina =regulators
      - Erdosteine = UK licensed (acute bronchitis) BUT REC by NICE. Commonly used in the NHS.
      - NAC MECHS: disrupts 2sulphide bonds (mucin polymer) ➩ substituting sulfhydryl groups FOR

        2sulphide bonds ➩ ↓ viscocity & elasticity.
      * Administration route:
            * PO. No mucolytic properties demonstrated. (other indications: antioxidant effect as glutathion

              precursor)
            * Nebulised. Preferred due to rapid local mucosal action.
            * IV.
      * SIDE EFFECTS.
            * Nebulised. Nausea, unpleasant smell, sticky residue. Hypersensitivity → anaphylactoid

              reaction (18%) leads to bronchospasm, angioedema and ↓AP. ∑ a trail nebulised is needed.
            * PO and IV not commented.
            * If previous reaction in any form, 🚫 its use.
      * APPLICATIONS.
            * Weak evidence ➩ no ↗️ in expectoration, viscocity, O2tion, MM.
            * srMA (13 RCTs + 1712 pxs ARF): 3 NAC trials w_2 ≠ routes of administration (💉 +

              nebulised) ➩ NO ↗️ (OCs: d_MV, h_LOS or mv_FD)
            * RCT, 40pxs, MV >3d ➩ I: Nebulised NAC 🆚 C: normal saline ➩ OCs: modest ↑ SO2 within

              12h (I)
            * srMA (4 studies, 355 par) ➩ no ≠ (OCs: incubation rate, O2 index, icu_LOS, h_LOS or MM)

            * ∑ studies failed to show any ↗️

Thursday, March 13, 2025 at 23h30 BE AMA, MAAT, HIBN, AAQC

Journal Reviews