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.
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.
Thursday, January 18, 2024, at 23h15 BE
HIBN, VFP, AAQC
2024 NEJMjw - Toothbrushing Lowers Risk for HAP (JAMA)
1. 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ BRIEF: Y, J, C ➖ T ➕ N ➕ t ➖ PICO:
2. 2023 (Dec 18), JAMAim, ? ➖ MA of 15 RCT ➕ 2800 ➕ ? ➖ PICO:
- P: adults in iMV
- I: toothbrushing and tongue brushing with chlorhexidine or plaque- removing toothpaste – 2-4x/day
- C: chlorhexidine swabbing – 2x/day
- pOC: HAP risks + MM
- sOC: dMV + ICU LOS
3. R ➩ ↓ HAP ➩ 33% ➕ ↓ MM 19% 🟰 ↓ dMV (1.2 d) ➕ ICU LOS (1.8d)4. Toothbrushing is not always easy for patients with endotracheal tubes, but these data support the effort to incorporate regular toothbrushing. (Paul Mueller)
2023 NEJMjw - Upper Gastrointestinal Bleeding in Patients Using Aspirin for Primary Prevention of Adverse CVE (Am J Med)
1. 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ BRIEF: Y, J, C ➖ T ➕ N ➕ t ➖ PICO:
2. 2023, AJM, USA ➖ retrospective OBS ➕ 535K (≥45yo) ➕ 2016-2020 ➖ PICO:
- P: middle-aged + older pxs
- I: ASA (primary prevention)
- C: ✖︎
- O: UGI bleeding INCIDENCE
3. R1 ➩ age- and sex-adjusted UGI bleeding ➩ INCIDENCE ↗️ 7.5 - 10 per 100k
4. R2 ➩ >75yo had ↗️ INCIDENCE + highest RATES
5. R3 ➩ all pxs ↗️ incidence
6. R4 ➩ UGI bleeding ≈ HIGHER ODDS OF: H admission + endoscopy + transfusioN.
7. The worrisome trend of increasing UGI bleeding should remind us to ask patients about aspirin use for primary prevention and to discourage its use for this purpose in people who are 60 or older. (Rahul Ganatra)
8. ASPREE + ARRIVE trials SHOWED THE SAME! (NEJM 2018, LANCET 2018)
atory settings and/or pharmacological or fluidic therapy were avoided either before or during TCD examination.
⏳ TIME MANAGEMENT
01:04:25
Round: 4 05:44:59 Q&A
Round: 3 16:11:29 Article 2
Round: 2 37:19:66 Article 1
Round: 1 05:09:75 Refresh
Thursday, January 22, 2024, at 23h15 BE
HIBN, AAQC
2023 LANCET - Seeing the humanity in health [ed]
1. Restricted numeric approach (statistics, averages and generalities) is different from the other elements concerning human beings and their realities
2. Human emotions should be very much considered to understand the faces behind health research (joy, fear, pain, hope, death)
3. Lancet shows images illustrating these scenes.
4. Nigeria example: universal health coverage + 2023 Wakley Prize Essay competition (lack of access to health care)
5. We are social animals, and personal stories help us to empathise. They make us care. (LANCET)
6. Care + compassion = COMMON THEMES. It gives some examples (kid helping in an Ebola centre, volunteers, etc.)
7. Our lives, and our health, are shaped by our physical, social, biological, and political surroundings. (LANCET)
8. Confronting challenges of humanity are the foundation of health research and advocacy.
9. Images + story telling are powerful.
2024 PSYADV - What Is the Impact of Shift Work on Sleep and Sleep Disorders Risk (FP)
DIS = disorders,
1. 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ BS: Y, J, C ➖ T ➕ N ➕ t ➖ PICO:
2. 2023, Front Psychiatry, BE ➖ survey ➕ >50k responded ➩ >37.5k included ➕ ? ➖ PICO:
* P: Belgian, >18yo (60% women)
* I: HSDQ applied
* C: none
* O: prevalence of sleep disorders + factors associated
3. R ➩ Day workers = > insomnia + movement DIS.
4. R ➩ Other shifts = insomnia + hypersomnia, and circadian rhythm sleep-wake disorders
5. R ➩ Other shifts 🆚 night shifts = ↗ prevalence (sleep DIS + sleep DIS comorbidity) (p<0.01) = ‘>1/2’ 1 sleep DIS = ‘>1/4’ ≥2 sleep DIS
6. 50% early morning, night or rotating shifts 🆚 25% regular day and evening shifts 🟰 SHORT SLEEP (p<0.01)7. Evening shifts 🆚 other shifts 🟰 LONG SLEEP (p<0.01)8. Male, elder, and lower education ≈ ↑ prevalence of SHORT sleep. 9. LIMITATIONS: selection bias ➕ use of HSDQ (polysomnography) ➕ small sample size10. Regular assessment of sleep quality and quantity and screening for disordered sleep in those working shifts might be crucial to timely treat sleep disorders
⏳ TIME MANAGEMENT:
46:40:80
Round: 6 00:17:08 Comments
Round: 5 26:53:06 Article 2
Round: 4 06:08:14 Wrap up
Round: 3 22:38:02 Article 1
Round: 2 02:56:78 Past JR
Round: 1 02:58:04 Articles decision
Thursday, January 25, 2024, at 18h25 BO
HIBN, JJFM, MACR, AAQC
2023 ICUmmp - A Very Old Patient in the ICU, Much More Than an Acute Organ Dysfunction (putowski)
CI = cognitive impairment, MOF = multi-organ failure
1. Ageing + shortage of ICU beds = demand of ICU supply of resources
2. Fluids are relevant in ELDERLY, DUE TO cardiovascular changes (aging changes described in Table 1)
3. Family support is PARAMOUNT considering ABCDEF bundle to avoid DELIRIUM
4. Cognitive impairment are 40% in elderly and it is difficult to measure in the ICU (though IQCODE exists)
5. Greater cognitive decline was associated with 30-day mortality.
6. ↑ sympatechic tone is RELEVANT in elderly patients
7. VIP-1, VIP-2 and the CLUSTER analysis ➩ one-point ↗ in SOFA = ↗ MM 30
8. ETHICA ➩ elderly were RELUCTANT to accept life-sustaining TTOs
9. mini–mental state examination (MMSE) = 30-point questionnaire = used to measure CI
10. Long-term OC after ICU are strongly determined by pre-ICU functional trajectories (Ferrante et al. 2015).
11. SOFA ➩ initially SEVERITY description ➩ later CORRELATED with MM ➩ described in VIP pxs with VIP-1, 2 and COVIP studies.
12. SOFA continues to be a globally utilised universal METHOD for MOF assessment.
2023 WHO - Preventing antimicrobial resistance together (vid)
AMR = antimicrobial resistance
1. AMR SHOULD be stopped
2. AMR ➩ contributes to ±5 million deaths / year
3. AMR = MISUSE and OVERUSE of ATBs
4. World AMR awareness week:
* Clean water
* Sanitation y hygiene
* INF prevention + control in health facilities
* VAX for children, elderly + at risk
* Responsible use of ATB
5. It is a shared responsibility
6. HIBN: avoid automedication
7. MACR: avoid contaminated water
⏳ TIME MANAGEMENT
46:40:80
Round: 4 05:18:29 Comments
Round: 3 57:41:22 Article 2
Round: 2 05:01:72 Article 1Round: 1 05:30:49 Last JR
Monday, January 29, 2024, at 18h29 BO
HIBN, JJFM, MACR, AAQC
2024 ICUmmp - Scientists discover first new ATB in six decades (Nature)
1. 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ BS: Y, J, C ➖ T ➕ N ➕ t ➖ PICO:
2. 2024, NATURE, USA ➖ trial (experimental) ➕ 39k compounds of ATB + 12M human body compounds ➕ ? ➖ PICO:
- P: mice and human MODELS
- I: ZOSURABALPIN for MRSA
- C: none
- O: effectivity to reduce the population
3. R ➩ it works, both in test tubes and mice (demonstrated exceptional efficacy)
4. Blocked the PROTECTIVE MEMBRANE by the transportation of a lipopolysaccharide, to the outer cell, ✖ ➩ formation of the protective membrane ➩ cell death.
5. 21 researchers involved
6. Long way to go before its potential use in hospitals
7. A. baumanni has zosurabalpin, in Phase I (Roche), effectively treats highly drug-resistant contemporary isolates of CRAB in vitro and in mouse models of infection. ➩ CRAB = Carbapenem-resistant acinetobacter baumanni
2023 SPARK - How to start an email_ The best and worst email greetings (R+R]
1. Types of greetings, which to use and NOT to use
2. In Spanish, it is mostly “good morning” (JMCM)
3. Context and recipient are important to set the email GREETING
4. TO USE
- Hi
- Hello
- Dear
- Dear TITLE
- Greetings
- Hi there
5. NOT TO USE
- Hey!
- Yo!
- HI nickname
- To whom it may concern
- Dear Sir/Madam
- Dear JOB TITLE
- Good morning/afternoon!
- Name
- Wrong or misspelled name
- No greeting
2024 LANCET - Virological characteristics of the SARS-CoV-2 JN.1 variant (kaku) [corr]
Mlm = multinomial logistic model
1. SARS-CoV-2 BA.2.86 main lineage BEFORE JN.1
2. BA.2.86 ➩ August 2023
3. ≠ Ω XBB lineages
4. JN.1 harbours Leu455Ser + 3 mutations in non-spike proteins
5. Leu455Phe ➩ contributes to increased transmissibility + immune escape
6. EFFECTIVE REPRODUCTIVE NUMBER of JN.1 was done ➩ FR, UK, ES ➩ 25 sequences of JN.1 with BAYESIAN mlm
7. JN.1 might become the dominant lineage worldwide ➩ INDEED in Nov 2023 OVERTOOK HK.3 in FR + ES
8. Infectivity = rodent sera infected OR immunized (w_BA.2.86) ➩ NT50 against JN.1 was similar to that against BA.2.86… ∑ Leu455Ser DOES NOT affect antigenicity of BA.2.86
9. In breakthrough INF sera w_XBB.1.5 + EG.5.1 against JN.1 was ↓ than HK.3 (NT50)
10. JN.1 shows robust resistance to monovalent XBB.1.5 vaccine COMPARED with BA.2.86
11. JN.1 is one of the most immune-evading variants to date
⏳ TIME MANAGEMENT:
01:23:09
Round: 7 05:33:04 Comments
Round: 6 17:32:89 JN.1. variant
Round: 5 28:34:06 SPARK, email greetings
Round: 4 19:39:50 ICU management and practice ART
Round: 3 05:50:59 Article decision
Round: 2 00:00:02 TEST
Round: 1 05:59:12 Refresh
Thursday, February 15, 2024, at 18h55 BO
HIBN, AAQC
1. Common IF pattens:
- Daily time-restricted feeding
- OMAD plan
- 5:2 plan
2. Calorie restriction is relevant to support IF
3. Hypoglycemia should be prevented and anticipated
4. Protein intake is PARAMOUNT to apply safely IF
5. Benefits: improvement in hunger, weight loss, insulins sensitivity, blood pressure, inflammation, stress response and sleep. Reduces decision fatigue. Useful for shift workers ➩ organize meals in a consisten time frame.
6. Risks: hypoglycemia, SARCOPENIA, dehydration. AVOID PROLONGED fasting ➩ ♥️ dysrhythmias, gout, kidney stones and postural hypotension.
7. Application should be: * First, ensure protein intake * Second, ↓ carbohydrate intake * Apply IF8. Always combine nutrition (food QUALITY MATTERS) and lifestyle changes.9. The 2022 Clinical Practice Statement on Nutrition and Physical Activity by the Obesity Medicine Association would be a valuable starting place for a clinician interested in using IF with pxs.
Thursday, February 01, 2024, at 18h29 BO
HIBN, AAQC
2023 NEJM - Notable Articles of 2023 (NEJMed)
1. ARTs of interest:
- Semaglutide in pxs with HFpEF & 🐷
- Dupilumab for COPD with T2 Inflammation indicated by Eosinophil Counts
- RCT of Early Detection and TTO of Postpartum Hemorrhage
- Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression
- Inaxaplin for Proteinuric Kidney Disease in Persons with Two APOL1 Variants
- Treatment Strategy for Rifampin-Susceptible Tuberculosis
- Phase 2 Trial of Baxdrostat for TTO-Resistant HTA
- Empagliflozin in pxs with CKD
- Lecanemab in Early Alzheimer’s Disease
2. LECANEMAN in ALZHEIMER
CDR-SB = Clinical Dementia Rating–Sum of Boxes, eALZ = early Alzheimer disease, AdvEve = adverse events
- 2023, NEJM, USA ➖ ph3_mc_db_RCT ➕ >1500pxs ➕ 18m ➖ PICO:
* P = early alzheimer pxs (50-90yo) w_amyloid on PET OR CSF testing * I = lecanemab * C = placebo * pOC = change of CDR-SB at 18m * R = less reduction in I - CDR-SB = ranges from 0 to 18 ➩ ↗️ scores = GREATER impairment - Similar AdvEve in I + C ➩ most common = infusion-related reactions ➕ amyloid-related imaging abnormalities w_ edema OR effusions. - Lecanemab ↓ markers of amyloid in eALZ ➕ mod_less ↘️ on measures of cognition and function at 18m BUT was ≈ adverse events. - Study done during C19
Thursday, March 28, 2024, at 18h29 BO
HIBN, AAQC
2024 NPR - In a pandemic milestone, the NIH ends guidance on C19 TTO (Huang) [r].pdf
PhysiIDSA = Infectious Diseases Society of America, ACP = American Colleague of Physicians, GL = guidelines, Ab = antibodies
L=s, Ab = antibodies
1. NIH will end their guidance. They recommend to follow IDSA ➕ ACP
2. Last 4 years NIH has been publishing dynamically the GL
3. 50M times were visited the NIH GL
4. TURNING POINTS:
- 2020 ➩ first pandemic wave ➩ 1st GL “we don’t know what does and does not work”
- June 2020 ➩ steroids (dexamehasone)… combination with antivirals
- A year into the pandemic ➩ lab-made Ab ➩ monoclonal Abs gave so much insight into the virus itself ➩ challenged by fast-changing spike protein (new strains)
- End 2021 ➩ Molnupiravir (Merck) ➕ Paxlovid (Pfizer) ➩ warts (limitations) = molnupiravir (not SO effective), paxlovid (many interactions e.g. statins)
5. Underuse ➩ Molnupiravir 2% and Paxlovid 15% ➩ of C19 eligible pxs
6. Study 2021-2022 ➩ federal government bought PAXLOVID + MOLNUPIRAVIR ➩ then transitioned to commercial market ∑ less use. (Have likely further declined since late 2023)7. Patient dilema ➩ pxs do not BELIEVE they will get very sick (risk factors assessment)8. We need PATIENT EDUCATION ➩ how the drug work ➕ when they’re most effective 9. What’s in the pipeline? Japanese company - SHIONOGI ➩ pill course for ACUTE ➕ long COVID
Monday, April 18, 2024, at 17h15 BE
HIBN, AAQC
2024 MB - Trials of Psychological Interventions for Depression Rarely Assess Suicidality (LANCETpsy).pdf
1. Y, J, C ➖ T ➕ N ➕ t ➖ PICO:
2. 2024, Lancet PSY, NL ➖ srMA of RCTs➕468 RCT ➕ up to May 2023 ➖ PICO:
* P: RCTs
* I: studies w_depression + suicidality + psy_INT
* C: NA
* O: psy_INT were efficient?
3. R:
- aggregated analysis = suicidal ideation (SI) ➕ suicide risk (SR) = ↘️ immediately af_I (SMD, -0.31; 95% CI, -0.60 to -0.03; I2, 68%).
- I ↘️ SI + SR af_I 🆚 active control groups (SMD, -0.34; 95% CI, -0.66 to -0.02; I2, 72%) 🆚 tto as usual as the control (SMD, -0.40; 95% CI, -0.74 to -0.05; I2, 71%)
- SI alone ➩ the same ↘️ (SMD, -0.36; 95% CI, -0.70 to -0.02; I2, 70%)
- At f-up ➩ no effects (SMD, -0.49; 95% CI, -1.31 to 0.32; I2, 79%)
4. No significant effect in studies wo_
1. Direct intervention,
2. Single-item measures,
3. Continuous outcomes.
5. Assessment of suicide was rarely reported in trials of psychological interventions targeting depression. (authors)
6. ‘Monitoring and reporting of suicidal thoughts’ need ↗️ - even ‘risk of suicide’ is excluded.”
7. Limitations:
- Small sample
- Single-item suicide OC
- Combination of ≠ suicide OC
2024 PSYADV - ADHD and Loneliness Affects Mental Health in Young People (JAD).pdf
1. 2024, J. Atten. Disord, ? ➖ srMA (cross-sectional or longitudinal quantitative) ➕ 20 studies (1253 pxs) ➕ ? ➖ PICO:
- P: young adults (10-24 years) w_ADHD
- I: loneliness w_ADHD
- C: wo_ADHD
- O: prevalence of loneliness + effect of loneliness on mental health
2. Methods:
- 1 measure of LONE
- ADHD was verified via Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses and ICD
3. Results ➩
- 9/17 ↑ levels of LONE
- 4/17 no diff
- 3 wo_conduct significance test
- 1 ↓ levels of LONE
4. Meta ➩
- P = ↑ levels of LONE (Hedges g, 0.41; 95% CI, 0.25, 0.58; P <.001)
- No sig influence of SIZE despite concerns of POTENTIAL PUBLICATION BIAS (tested by moderator analysis)
5. sr ➩
- LONE ≈ mental health difficulties in P
- ⊕ LONE ≈ externalizing behavior, internalizing behaviors, depression, anxiety, and addiction
- ADHD is a sig PREDICTOR of major depressive disorder onset (confounder were controlled)
6. This review highlights that loneliness may be an important problem in ADHD and clinicians should be aware of and assess the potential for elevated loneliness in this population.
7. Limitations ➩
- Small n of studies
- Narrow focus on LONE
- Dichotomous categorization of ADHD (less severe excluded?)
Monday, April 15, 2024, at 17h15 BE
HIBN, AAQC
Is OCD Linked to a Higher Risk for Death From Natural and Unnatural Causes
1. Y, J, C ➖ T ➕ N ➕ t ➖ PICO:
2. 2024, BMJ, SE ➖ matched coacher + sibling cohort ➕ 15M (selected 61k + 34k ) ➕ Jan 1973 to Dec 2020 (48y) ➖ PICO:
* P: >6y SE people
* I: OCD dx (affected)
* C: unaffected overall and siblings
* pOC: all-cause + cause specific
3. R ➩ adjusted stratified cox proportional:
* All cause = HR, 1.82
* Natural causes = HR, 1.3
* Unnatural causes = HR, 3.3
4. Diagnosed pxs, more likely:
* SE natives
* Less educated
* Single
* Low income
* Psychiatric disorders
5. Risk factor for specific causes:
* endocrine, nutritional, and metabolic diseases;
* mental and behavioral disorders (dementia, vascular dementia, and mental and behavioral disorders alcohol related)
* nervous, circulatory, respiratory, digestive, and genitourinary systems
6. Less risk in pxs NEOPLASMS
7. Sibling cohort ➩ 8y ➕ more likely women + same as point 4 ➕ MM w_OCD 4.7 + MM wo_OCD 2.7 ➕ adjusted risks acMM 1.8, natural 1.5, unnatural 3.1.
8. Limitations ➩ selection bias due to:
* data source constraints
* underpowered estimates for specOC
* mediator effects of covariates
* lack of info on lifestyle factors * uncertainty ‘generalizability to diverse populations’ * uncertainty ‘HC settings outside of Sweden’
Trials of Psychological Interventions for Depression Rarely Assess Suicidality
1. Y, J, C ➖ T ➕ N ➕ t ➖ PICO:
2. 2024, Lancet PSY, NL ➖ srMA of RCTs➕468 RCT ➕ up to May 2023 ➖ PICO:
* P: RCTs
* I: studies w_depression + suicidality + psy_INT
* C: NA
* O: psy_INT were efficient?
… to continue…
Thursday, April 25, 2024, at 17h15 BE
HIBN, AAQC
- GPT-4 ↗️ than physicians (PSY) ➕ similarly to physician (SX & IM)
- GPT-4 ↘️ in PED & OB/GYN ➕ ↗️ than physicians
- GPT-3.5 did not pass the examination in any discipline ➕ ↘️ to physicians (5 disciplines)
- GPT-4 passed 4 of 5 (score > 65%)
6. Strengths:
- Large cohort allowing direct comparison ↔ GPT models
- Open sharing of the examinations
- ⊕ builds confidence in the technology
- ⊕ too early to integrate in clinical practice
- ⊕ good for medical education, simulations, personal assessment, and feedback
- 🔍 combination of physician + AT = ↗️ results 🆚 2 physicians 🆚 AI alone ➩ synergy matters
7. Limitations:
- Image-based question exclusion
- Linguistic ⌄ cultural biases due to translation
8. ∑ ➩ This juncture represents an opportunity to reshape physician training and capabilities in tandem with the advancements in AI.
⏳ TIME MANAGEMENT
01:32:45
Round: 3 00:18:09 Brief
Round: 2 01:29:52 continue ART
Round: 1 02:35:32 Last JR
2024 NEJMai - GPT versus Resident Physicians, A Benchmark Based on Official Board Scores (katz) [R].pdf
1. Y, J, C ➖ T ➕ N ➕ t ➖ PICO:
2. 2024, NEJMai, IS ➖ retrospective cohort ➕ 849 physicians ➕ 2022 ➖ PICO:
- P: medical specialists
- I: GPT-3.5 & GPT-4
- C: board residency examinations
- O: PERFORMANCE of physician, GPT-4, GPT-3.5
3. Importance:
- How LLM is relevant for medical education and clinical practice?
- How different version of LLM perform?
- 🔍 LLM performance with questions from simulated models (MedQA, MedMCQA, and MultiMedQA)
- 🔍 LLM evaluated in real examination settings
4. Methods:
- IN. Number of physicians ➕ scores
- EX. Questions w_images
- Translated from Hebrew to English
- Run by standard Web application (OpenAI)
- Minimize biases = ChatGPT refreshed between questions.
- Two columns (excel) question and solution (4 mulitiple options)5. Results: IM = internal medicine, SX = surgery, OB/GYN = obstetrics and gynecology, PSY = psychiatry, PED = pediatrics
Monday, April 22, 2024, at 17h15 BE
HIBN, AAQC
⏳ TIME MANAGEMENT
49:01:36
Round: 4 17:09:46 ART 2 selection
Round: 3 20:29:65 ART 1
Round: 2 09:04:00 ART selection + ART 1
Round: 1 02:18:24 Past JR
2024 NEJMai - GPT versus Resident Physicians, A Benchmark Based on Official Board Scores (katz) [R].pdf
1. Y, J, C ➖ T ➕ N ➕ t ➖ PICO:
2. 2024, NEJMai, IS ➖ cohort ➕ 849pxs ➕ 2022 ➖ PICO:
- P: medical specialists
- I: GPT-3.5 & GPT-4 - C: board residency examinations - O: PERFORMANCE3. To continue…
2024 AIH - 10 things you may have suspected about AI but didn’t know for sure till now (pearson).pdf
0. Ten points by analysts of Stanford University
1. The public is pessimistic about AI’s economic impact.
- Survey ➩ 37% AI will ↗️ job
- 32% will ↗️ job market
- 3 of 10 ONLY think it is positive for the economy (HIBN)
2. Demographic differences exist regarding AI optimism.
- Gen Z more OPTIMISTS than baby boomers
- Higher incomes + education levels = ↗️ optimists (entertainment, health, economy)
3. ChatGPT is widely known and widely used.
- Univ. Toronto ➩ 63% aware ➕ 50% of them USE it
4. AI helps medicine take significant strides forward.
- 2023 SEVERAL medial systems were launched
* EVEscape = predicts pandemics
* AlphaMissence = mutation classification
5. Highly knowledgeable medical AI has arrived.
- ↗️ MedQA benchmark = to assess AIs clinical knowledge (90% accuracy)
- Since 2019 was 3X
6. The FDA is approving more and more AI-equipped medical devices.
- 139 devices
- Since 2012 = 45x more
7. Robust and standardized evaluations for GenAI responsibility are seriously lacking.
- Lack of standardization in REPORTING
- Complicates risks & limitations comparisons
8. Researchers have discovered more complex vulnerabilities in large language models.
- Security weaknesses (adversarial prompts)
- Less ovbious strategies ➩ repeat words infinitely
9. The number of AI incidents continues to rise.
- 123 incidentes in 2023
- 20x ↗️ since 2013
- Sexually explicit deepfakes
10. ChatGPT is politically biased.
- Towards democrats in the US
- Towards Labour Party in UK
Monday, April 29, 2024, at 17h15 BE
HIBN, GIP, AAQC
2024 ICM - Noninvasive neuromonitoring in acute brain injured patients (brasil) [ED]
NIM = noninvasive monitoring, BUS = brain ultrasound, TCCD = transcranial color-duplex sonography, CBF = cerebral blood flow, ƒ-up = follow-up, PI = pulsatility index, QEEG = quantitative EEG
1. Gold standard = invasive methods
2. Clinical evaluation is the 1st step ➩ LIMITED by sedation
3. With diverse physics principles + strengths + limitations + levels of evidence ➩ NIM plays a role in ƒ-up
4. Hemodynamics
- TCCD useful in IC hemorrhage, assessment, hydrocephalus, midline shift
- Visualization of the major intracranial vessels + their blood flow velocities.
- Perfusion and pressure = PI > 1.3 + diastolic flow velocity <20 cm/s
- Slow velocities = intravascular 🩸 ↓
- Hyperdynamic blood transit = systemic (hyperemia, sepsis)⌄ central (vasospasm, stenosis)
5. Electrical activity
- EEG ➩ for comatose
- Detects seizures + treatment starting decision (and escalating)
- Structural brain damage + 🧠 dysfunction ≈ seizures
- QEEG …
6. Function
7. Mechoanical properties
8. Oxygenation
To continue…
Monday, May 6, 2024 at 17h15 BEHIBN, AAQC
2024 NN - Thought Provoking Work May Reduce Later Life Cognitive Decline (AAN - NEUROLOGY).pdf
Glossary: MCI = mild cognitive impairment, ↓r = may lower risk, RTI = routine task intensity
1. Complex, thought-provoking work ↓r MCI
2. Y, J, C ➖ T ➕ N ➕ t ➖ PICO: ➩ 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ
3. 2024, NEUROLOGY, Norway (Oslo U.) ➖ cohort (30a - 65a) ➕ 7k ➕ 2a (2017-19) ➖ PICO:
- P: people working
- I: registry-based trajectories (305 occupations) + dementia diagnosis
- C: NA
- O: correlation
4. Methods:
- Nature of tasks = routine manual, routine cognitive, non-routine analytical, and non-routine interpersonal
- Non-routine analytical tasks = activities that involve analyzing information, engaging in creative thinking and interpreting information for others.
- Non-routine interpersonal tasks = establishing and maintaining personal relationships, motivating others and coaching.
- Non-routine cognitive = public relations and computer programing.
5. Additional data. Participants were divided into 4 groups based on the degree of cognitive stimulation:
- Low RTI: Primary education teaching associate professionals (44.3%), secondary education teaching professionals (9.9%), other public service administrative professionals (5.6%), crop and animal producers (5.6%), and college, university, and higher education teaching professionals (4.2%).
- Intermediate-low RTI: Child care workers (11.1%), Nurses (10.7%), other public service administrative associate professionals (5.3%), bank associate professionals (4.4%), and other public service administrative professionals (4.4%).
- Intermediate-high RTI: Shop salespersons and other salespersons (retail) (17.6%), nursing assistants and care assistants (12.9%), personal care and related workers not elsewhere classified (7.3%), secretaries (5.5%), and caretakers (3.8%).
- High RTI: Helpers and cleaners in offices and other establishments (9.7%), mail carriers and sorting clerks (7.0%), road workers and construction workers (5.1%), paper-pulp and papermaking plant operators (3.8%), and heavy truck and lorry drivers (3.5%).
6. Results:
- Adjustments (demographic & lifestyle) STILL showed a 66% ↑r MCI in ‘least cognitively demanding jobs’.
- Participants in the highest cognitive demand jobs had ↓ MCI (27%) 🆚 lowest demand jobs (42%).
- The most common job (highest cognitive demands) = teaching. - The most common jobs (lowest cognitive demands) = mail carriers and custodians.7. HUNT4 70+ study8. CAUTION ➩ It only shows an association.
⏳ TIME MANAGEMENT
37:00:25
Round: 2 34:11:60 ART 1
Round: 1 02:48:65 Last JR
Thursday, May 2, 2024, at 17h15 BE
HIBN, RYCC, AAQC
2024 ICM - Noninvasive neuromonitoring in acute brain injured patients (brasil) [ED]
NIM = noninvasive monitoring, BUS = brain ultrasound, TCCD = transcranial color-duplex sonography, CBF = cerebral blood flow, ƒ-up = follow-up, PI = pulsatility index, QEEG = quantitative EEG
1. See past notes…
2. Electrical activity
- EEG ➩ for comatose
- Detects seizures + treatment starting decision (and escalating)
- Structural brain damage + 🧠 dysfunction ≈ seizures
- QEEG: digital signals analyzed w_mathematical algorithms (frequency bands)
- Non-convulsive status detection
- Also detects ischemia, bleeding, hydrocephalus, brain swelling or herniation and to assess sedation depth
- Malignant patterns ➩ poor OC
3. Function
- PUPILLOMETER ➩ delivers 3 sec flash of light + optimizes accuracy
- Objective, quantitative, and reliably repeatable assessment of the brainstem function
- Evaluates central reflex pathways
- NPi good prognostic tool ➩ post CA + NCC pxs ➩ ≈ ↑ ICP when abnormal (0-3)
4. Mechanical properties
- Volume matters (intracranial compliance - intracerebral compliance) to CEREBRAL blood perfusion
- B4C ➩ nanometric resolution of pulsatile elastic movement within heartbeats. Shows ICP surrogate waveforms in real time.
- P2/P1 ratio and time-to-peak ➩ assess ICC deterioration
- It has potential utilization in clinics IF ICC is compromised.
- NIM synergism = BUS + B4C = diagnostic power enhancement
- Optic nerve sheath diameter ➩ BUS ➩ if CSF pressure ↑, then >5.8mm ≈ ↑ ICP
5. Oxygenation
- NIRS ➩ rsO2 = Hb O2 saturation
- Two sensors over the frontal lobes
- Balance: DO2 ↔ VO2
- rSO2 < 50% ⌄ ↓ >10-20% from basal - Technical issues ➩ contamination by extraCRANIAL signals
6. Take-home message
- ADVANTAGES: safe, low cost, bedside, repeatable
- LIMITATIONS: accuracy, need of training.
- Cannot SUBSTITUTE invasive methods.
2024 FRONTIERS - Cake and cookies may increase Alzheimer’s risk (FRONTIER nutrition).pdf
1. UPF = ultraprocessed food
2. Linked with dementia
3. UPF ➩ frozen meals, soft drinks, cake mixes, and fast food – added sugars or fats ➕ artificial colors and flavors.4. Frontiers in Nutrition, BR ➩ UPF ≈ Alzheimer ➩ most, but one with DEMENTIA5. Caution to interpret
2024 NEJMjw - How Does Lifestyle Affect Cognition and Brain Pathology (JAMA)
RMAP = Rush Memory and Aging Project
1. Y, J, C ➖ T ➕ N ➕ t ➖ PICO:
2. 2024, JAMA NEUROLOGY, ? ➖ clinicoPATHOL cohort ➕ 586 ➕ ? ➖ PICO:
- P: postmortem brain pathology RMAP
- I: lifestyle factors
- C: NA
- O: global cognitive score
3. Healthy lifestyle score = self-reported nonsmoking status + physical activity of ≥150 minutes per week + light-to-moderate alcohol consumption + adherence to the Mediterranean-DASH y (MIND diet), cognitive activity.
4. Score = 0-5 = higher WAS healthier lifestyle5. Results: - Lifestyle ➩ higher scores were healthier - Dementia-related brain pathologies = ß-amiloid load, phosphorylated tau tangles… and other6. Patients were studied close to death, 1y between cognitive test and death7. Better global cognitive performance = ↑ lifestyle scores = ↓ ß-amyloid load (12% of ‘lifestyle - cognitive performance’ = ß-amyloid load)
⏳ TIME MANAGEMENT
56:40:95
Round: 4 21:20:74 ART 3
Round: 3 12:49:19 ART 2
Round: 2 19:27:72 ART 1
Round: 1 03:03:30 past JR
Thursday, May 16, 2024, at 17h15 BE
HIBN, AAQC
⏳ TIME MANAGEMENT
56:57:64
Round: 3 33:16:45 ART 1 and 2
Round: 2 21:50:45 ART selection
Round: 1 01:50:74 Last JR
2024 MB - Therapist Burnout Negatively Affects Patient Outcomes During Psychotherapy (JAMAno).pdf
Glossary: QOC = quality of care; ≈ ⊕ = positive association
1. Clinicians burnout affect pxs ➩ QOC, communication, medical error
2. Previous is worse in interventions that requiere HIGH LIVEL OF EMPATHY + INTERPERSONAL ENGAGEMENT = psychotherapy
3. Mental health professionals = > women, white, phychologists. (Many years of experience)
4. Patients = > men, white ➩ combat issues , childhood trauma, psych comorbidity, multiple trauma/
5. 35.2% had BURNOUT ➩ South of USA more likely to report BURNOUT (p = 0.005), pxs in the south ↑ likely to be treated by a burned out therapist 🆚 Northeast residents.
6. Pxs ↓ improvement in PTSD due to therapist’s: a. Burnout, b. Depression (past year). c. Dropped the tto. d. 3 days more between tto sessions.
7. ↑ improvement PTSD symptoms ≈ ⊕ PTSD checklist (PCL-5), retired work status, lack of stable housing.
8. Adjusted to DROPOUT ➕ SESSION TIMING = SAME positive association9. “These findings suggest that interventions to reduce therapist burnout might also result in more patients experiencing clinically meaningful improvement in PTSD symptoms from evidence-based psychotherapies” authors10. LIMITATIONS = single-item burnout measures and by not reassessing (therapist’s burnout) after C19
2024 HBR - Are You Being Emotionally Manipulated at Work (velasquez) [R+R].pdf
Glossary: QOC = quality of care; CI = cognitive impairment;
1. Continuing past JR
2. Rely on facts.
- People can amplify emotions to overshadow logical reasoning ➕ critical thinking.
- Bring your focus back to the realm of facts + evidence
- Careful with PERSUASIVE emotional narratives
- Details might seem exaggerated or inconsistent
- Ask yourself: What hard evidence supports their claim? Are there
- Inconsistencies or contradictions in their explanation?
- How to confront? a. Review project timeline, b. cross-check previous communications, c. evaluate their historical performance in similar situations
- Separate emotions from professional assessment.
3. Practice emotional detachment.
- It’s beneficial to detach emotionally to see things more clearly
- DEF. Conscious effort to manage our emotional response to a situation
- Neutral standpoint not COLD ⌄ uncaring
- Am I reacting based on the emotional content of their story, or am I maintaining focus on the actual terms and objectives of the negotiation?
- Focus solely on the objective aspects of the scenario
4. Set boundaries
- Proactively establish clear, firm boundaries.
- Which behaviors and interactions are acceptable + reasonable
- Shields manipulation + fosters transparent & respectful professional environment
- Am I being subtly coerced into overstepping my job role? - Acknowledge their situation ➩ express your boundaries - “balance my professional duties” “win-win”
2024 HBR - Are You Being Emotionally Manipulated at Work (velasquez) [R+R].pdf
Glossary: EI = emotional intelligence; CI = cognitive impairment
1. Emotional manipulation ➩ affects overall mental wellbeing + decision-making + problem-solving
2. High EI = double-edged sword ➩ compassionate leader 🆚 vulnerable target for manipulation.
3. EI can be a force for ‘good + empathetic conversations & understanding’ 🆚 ‘weaponized’ for manipulative reasons.
4. RECOGNIZING
- Strategic emotional displays.
* WHAT? From outrage TO sadness
* WHY? sway decisions, affect group dynamics OR paint themselves in a certain light.
* HOW? Dr. L delivering a heartfelt speech about px care + hospital’s mission w_the underlying motive to make doctors work longer hours SACRIFICING their well-being.
* TACTICS. Anger & aggression + guilt-tripping + dark clouds + emotional blackmail + playing the martyr
- Disguised true feelings.
* WHAT? hide their true feeling and intentions portraying themselves as trustworthy.
* WHY? To exert control
* HOW? Supports work-life balance in team meetings while doing another thing behind (closed doors)
* TACTICS. Not using words + feigned ignorance + backhanded compliments
- Subtle motivations.
* WHAT? guides individuals toward decisions NOT in their best interests
* WHY? Personal convenience
* HOW? 2 ways: a. Overwhelming workload w_impossible deadlines (pretense of pushing you to excel); b. Vague or inconsistent feedback (keeps uncertainty + impossibility to perform effectively)
* TACTICS. Striking responsibility + denying promises + gaslighting + moving goalposts + selective inattention
5. COUNTERACTING - Trust your gut - Seek external perspectives - Rely on facts - Practice emotional detachment - Set boundaries
Monday, May 13, 2024 at 17h15 BEHIBN, AAQC
Tuesday, June 11, 2024 at 17h15 BEAAQC
Glossary: ≠ = no association; yo = years old
1. Mediterranean diet = MedDiet
2. Published in Nutrients
3. Australian study
4. 294 older adults (≥60yo)
5. Associations: adherence to MedDiet ↔ severity of depression, anxiety and stress
6. Results:
- ↑ MedDiet adherence = ↓ severity of anxiety symptoms. β = −0.118
- ↑ MedDiet adherence = ↓ symptoms of stress. β = −0.151
- MedDiet adherence ≠ depressive symptoms
7. Authors recommend to apply this relatively easy lifestyle change.
Glossary: MI = myocardial infarction; pxs = patients; w_ = with
1. 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ Y, J, C ➖ T ➕ N ➕ t ➖ PICO: ➩ MINT trial
2. 2023, NEJM, C ➖ ph3, interventional ➕ 3504 pxs ➕ t ➖ PICO:
- P: pxs w_MI
- I: restrictive = cutoff 7-8g/dL
- C: liberal = cutoff <10g/dL
To continue...
Tuesday, Jun 04, 2024 at 17h15 BEHIBN, AAQC
Glossary: PA = physical activity; hf = hot flashes
1. Y, J, C ➖ T ➕ N ➕ t ➖ PICO:
2. 2024, Menopause, USA ➖ observational ➕ 188 ♀ ➕ 2019-2023 ➖ PICO:
- P: ♀ 50±5 yo
- I: PA
- C: ✖︎
- O: waking & sleeping hf
3. Methods:
- 2 groups = objective & subjective ➩ waking & sleeping hf
- Objective = sternal skin conductance
- Subjective = pressing an event marker and data logging
4. Additional deets
- Wrist-worn accelerometers = measure physical activity ➕ sleep and wake periods
- External temperatura & humidity
5. Results
- Acute physical activity increases ≈
- Objective (p<0.001)➕ subjective (p=0.03) waking hf
- Objective (p<0.01) ➕ subjective (p<0.001) sleeping hf
- Temperature ↑ was ≈
- Subjetive sleeping hf (p<0.001) - NOT objective sleeping hf - Odds of experiencing any hot NO
⏳ TIME MANAGEMENT
01:22:05
Round: 4 53:47:64 ART 2
Round: 3 26:03:76 ART 1
Round: 2 00:00:04
Round: 1 02:14:13
Tuesday, July 02, 2024 at 00h30 BE AAQC
Codified by ABFL
Glossary: FR = fluid responsiveness ; IVC = inferior vena cava; DX = diagnostic; pxs = patients ; AURC = area under the receiver operating characteristic (ROC) curve; Sen = sensitivity; Spe = specificity; d_ = during; INSeff = inspiratory effort; MV = Mechanically ventilated; srMA = systematic review and meta-analysis;
1. Reply to Ono’s comment on the ECHO to predict FR published in ICM 2024 ➩ paper’s aim = propose a pragmatic approach for intensivists.
2. Ono focuses on IVC = its respiratory variations as a poorly accurate parameter to predict FR.
3. Author justifies the factual truth
4. Study findings: Hemopred study = cohort (540 pxs), the IVC distensibility index could be measured in 78% of pxs. Its DX performance for predicting FR was low (AURC of 0.635, Sen 55%, Spe of 70%)
5. Misunderstanding clarified: Dr. Ono’s comments highlight a common misunderstanding.
- Spontaneously breathing = IVC collapses d_INSP ➩ ∑ unreliable for predicting FR due to variability in INSeff
- In MV pxs wo_spontaneous effort, the IVC dilates during tidal ventilation (as in the study)
6. Systematic Review: A referenced srMA included studies on IVC collapsibility in spontaneously breathing pxs and IVC distensibility in mechanically ventilated pxs. It found an EXTREME HETEROGENEITY, making IVC respiratory variations an unreliable predictor of FR.
7. Measurement at End-Expiration: While not a comprehensive solution, measuring IVC diameter at end-expiration can provide accurate information in 29% of pxs, especially when the IVC is either very small or dilated.
8. FR and Congestion: The association ‘FR ↔ congestion’ is noted, despite the challenge of assessing organ congestion at the bedside. The pragmatic approach suggests ➩ ✋🏽 additional fluids in congested pxs, even if FR persists.
9. Balance the benefits and risks of fluid management in critically ill pxs.
10. Future research is needed to better assess this aspect.
2024 ICM - How to use facemask noninvasive ventilation (Ferreyro) [ed].pdf
Codified by ABFL
Glossary: NIV = Noninvasive ventilation; MV = mechanical ventilation; SED = sedation; PAR = paralysis; pxs = patients; a_↑CO2 = acute hypercapnia; PS = pressure support; Vt = tidal volume; pif= peak inspiratory flow; INS = inspiratory; ESP = expiratory; DIS = diseases; dyn_↑ inflation = dynamic hyperinflation; MM = mortality; hr_ = high risk of. RR = respiratory rate; ∑ = therefore; TTO = treatment; PBW = predicted body weight; SILI = self-inflicted lung injury
1. … continues…
2. Indications:
- Post-extubation (hr_extubation failure). >65yo + 🫀 or 🫁 disease ➩ helps combining w_HFNO to ↓ re-intubation rate and ↗️ clinical outcomes ➩ particularly in OBESE. ➩ might be dangerous to use facemask NIV (Esteban et al, 2004) but recent evidence shows otherwise (Thille et al, 2021)
3. Monitoring
- Goals: assess the response to TTO + adjust ventilator settings + identify pxs that might benefit.
- RR isolated = unreliable marker of INSP effort + distress ➩ ∑ consider also other parameters
- HACOR predicts TTO failure after NIV start (1-6h)
- PaO2/FiO2<200 + Vte > 9.5 mL/kg (PBW) = ↑ INS effort = ↑ risk of SILI = facemask NIV failure = TTO failure ➩ ∑ prompt endotracheal intubation
- Persistently intense INS effort (>10–15 cm H2O) by esophageal manometry (right af_NIV initiation) = hr_NIV failure
- Noninvasive alternatives for INS effort assessment are underway.
- IF no leaks, high P0.1 (> 3–4 cmH2O) suggests “intense respiratory drive with respiratory distress”
4. Limitations
- Leaks in patient’s face and the applied mask ➩ contribute to asynchronies ➩ ↑r TTO failure
- Skin breakdown in the nasal bridge ➩ 20% pxs
- Inadequate nutrition
- NG tubes might ↑ leaks
- Gastric distention + impaired secretion clearance
- High PEEP not possible
5. ↗️ comfort & tolerance
- Interchange between oronasal + full-face masks
- Light sedation (deme ⌄ opioids )
6. Contraindications
- NOT for urgent MV indication
- Imminent 🫀 ⌄ 🫁 arrest
- Airway obstruction
- Inadequate secretion clearance
- Facial deformities
⏳ TIME MANAGEMENT
01:16:27
Round: 3 04:19:69 Last points
Round: 2 25:23:27 ART 2
Round: 1 46:44:09 Continuing last JR
Tuesday, June 25, 2024 at 17h15 BEHIBN , AAQC
2024 NEJMjw - New Editor-in-Chief for NEJM Journal Watch (NEJM).pdf
Codified by ABFL
Glossary: EiC = Editor-in-Chief
1. Consistent mission (editorial transition)
2. Dr. Raja-Elie Abduolnour
- Assistant Prof. Harvard Med School
- New EiC NEJMjw series
3. Dr. Allan Brett
- EiC NEJMjw General Medicine since 1994 ➩ continues - EiC NEJMjw series since 2016 ➩ changes4. Roles: selecting, editing, and writing the summaries
2024 MEDSCAPE - ChatGPT Accurately Defines Colonoscopy Screening Intervals (Patil) [r].pdf
Codified by ABFL
Glossary: USMSTF = US Multi-Society Task Force on Colorectal Cancer; GE = gastroenterology; GL = guidelines; pxs = patients; 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)
1. ChatGPT4 OUTPERFORMED GE practitioners + better concordance with 2020 USMSTF GL
2. Y, J, C ➖ T ➕ N ➕ t ➖ PICO 👇🏽
3. 2024, CG&H, USA➖ prospective obs ➕ 505 ➕ Jan 2024 - Apr 2023 ➖ PICO:
- P: pxs undergoing colonoscopy
- I: ChatGPT4 performance on rescreening + surveillance intervals
- C: GE practitioners
- O: overall accuracy of ChatGPT4 recommendations + alignment to USMSTF GL
4. Methods:
- Accuracy + concordance + reliability of rescreening + surveilance intervals ➩ ChatGPT4 🆚 GE practitioners (endoscopy reports)
- Data (De-identified text regarding history of present illness, age, gender, family history, colonoscopy procedure, and pathology report) was entered into ChatGPT4
5. Take-away:
- 7% had family history of colon cancer
- Follow-up recommendation in 99.2% of pxs (4 referred to Gastroenterologist)
- ‘I’ concordant with USMSTF panel in 86%
- ‘C’ concordant with 75%
- Inter-rater reliability = GOOD (ChatGPT4 & USMSTF panel) ⏤ Fleiss' kappa [κ], 0.786; P < .001
- Inter-rater reliability = FAIR (ChatGPT4 & GE practitioners) ⏤ κ, 0.543; P < .001
- ChatGPT4 incorrectly advised DELAYED SURVEILLANCE in 26 pxs
6. “After further refinement, ChatGPT4 may help in a support role for routine clinical duties, such as suggesting colonoscopy follow-up intervals for low-risk colon polyps," the authors wrote.
⏳ TIME MANAGEMENT
46:23:40
Round: 3 30:40:88 ART 2
Round: 2 08:59:51 ART 1Round: 1 06:42:99 past JR
Tuesday, June 20, 2024 at 17h15 BEAAQC
2024 NEJM - Depression — Understanding, Identifying, + Diagnosing (Anderson) [P]
Codified by JJFM
1. Depression is incredibly common.
2. The common number that you'll see is about 8 % of the U .S.
3. If you broaden that diagnosis to say people that are impacted by ‘sad mood, some level of anxiety’, the rates can run as high as 20, 25%.
4. Do we augment with another medication or do we switch to a different medication? One of the challenges for primary care docs is why if you have a patient that hasn't responded to the first two or possibly even three oral antidepressants?
5. Last few decades, has been the development of this group of specialized treatments. Electroconvulsive therapy has been around for many years. It has changed a lot.
6. It works really well for patients who have failed other treatment modalities. ➩ The newer forms of treatment are:
- Transcranomagnetic stimulation
- Ketamin
- S -Ketamine,
- Psychedelic medications like psilocybin (new)
7. Side effects ➕ risks ➩ so it needs to be balanced out and used appropriately.
8. To continue…
2024 ICM - Lactate levels in sepsis, don’t forget the mitochondria (Nedel) [corr].pdf
Codified by ABFL
Glossary: SSC = surviving sepsis campaign; ➩➩ = leads to; ≈ = linked to
1. Response to Ahlstedt paper of a post hoc analysis challenging SSC concepts of lactate and perfusion.
2. Those concepts might not fully capture the complexities under ‘lactate’
3. Mentions 20% cut-off point of CLEARANCE ➩ poorly understood mechanism
4. Fan-in & fan-out metabolic connectivity makes it controversial
5. Mitochondria = central hubs integrating cellular functions
6. Mitochondrial DYSF = structural damage
- ↓ VO2 ≈ ATP production
- ↑ adrenergic ⊕
- ➩➩ aerobic glicolysis = ↑ pro-inflammatory profile (Th17, M1 expression) ➕ ↑ expression of pro-inflammatory cytokines (TNF- alfa, IL1, IL6) ➩➩ impaired blood flow-microcirculation = prolonged CRT, SvO2 impairment, prolonged ∆ PvCO2-PaCO2
7. Hypoperfusion and mitochondrial metabolism are connected, and they can be modulated through the host immune response8. Lactate = metabolic product = biomarker = less as a therapeutic agent
Tuesday, June 27, 2024 at 17h15 BEAAQC
2024 ICM - How to use facemask noninvasive ventilation (Ferreyro) [ed].pdf
Codified by ABFL
Glossary: NIV = Noninvasive ventilation; MV = mechanical ventilation; SED = sedation; PAR = paralysis; pxs = patients; a_↑CO2 = acute hypercapnia; PS = pressure support; Vt = tidal volume; pif= peak inspiratory flow; INS = inspiratory; ESP = expiratory; DIS = diseases; dyn_↑ inflation = dynamic hyperinflation; MM = mortality; hr_ = high risk of.
1. NIV main advantage = ⊕ 🫁 support ➕ ⊖ detrimental effects of MV, SED, PAR
2. Facemask ➩ initially for a_↑CO2 🫁 failure due to COPD
3. Set-up & settings
- Bi-tube circuit or single-limb circuit
- Gas conditioning needed (except ↓ FiO2 w_turbine-driven ventilators)
- IF significant leaks, heated humidifiers are effective (heating & humidifying)
- PS mode ➩ conventionally ➩ PEEP 5-8 (more in obese)
- Overassistance risks = hyperinflation + large Vt
- Minimal PS APPROACH ➩ to obtain Vt 6-8
- INS (2L/min) & ESP (20-50% pif) triggers
- Rise time ➩ adjust for comfort ➩ ↓ obstructive DIS, NEVER at minimum value
4. Indications
- a_↑CO2 🫁 failure ➩ PS: ↘️ 🫁 muscles, ↑ Vmin, ↓ RR, ➩ ∑ limits dyn_↑ inflation
- Low PEEP (5 cmH20) counteracts intrinsic PEEP + ↓ isometric workload
- Trial of NIV ➩ under STRICT monitoring ➩ hypercapnia-induced altered consciousness secondary to COPD exacerbation (NOT asthma exacerbations)
- 🫁 FAILURE due to cardiogenic pulmonary edema ➩ facemask NIV: ↑ 🫁 volume, ↓ 🫁 shunt, ↓ RR, ↓ INS effort, ↓ right ventricular preload, ↗️ 🫀 contraction, ↓ left ventricle afterload.
- Novo acute hypoxemia 🫁failure and/or ARDS ➩ controversial ➩ facemask NIV: ↗️ O2, not ↓ endotracheal intubation in PaFi <200 (can ↑ MM) ➩ TTO failure = 30-60% ✚ intubation need after NIV = ↑r of MM ➩ HFNO + helmet NIV = promising alternatives ➩ despite CONTROVERY, facemask: ↓ ‘r_INTUBATION ⌄ MM’ (composite OC) in C19
- Surgery post 🫀 +🫃🏽= ↓ atelectasis, ↓ bacterial growth, ✋🏽translocation, limiting PO pneumonia, ↓ endotracheal intubation. - Post-extubation (hr_extubation failure)5. To continue…
⏳ TIME MANAGEMENT
01:26:18
Round: 3 10:56:79 Last points
Round: 2 01:13:08 ART + wrap-up
Round: 1 02:13:81 Past JR
Tuesday, August 20, 2024 at 00h30 BE AAQC
2024 PA - Early Cognitive Decline Reports Tied to Higher Tau Levels in the Brain (Neurology).pdf
Codified by ABFL
Glossary: AD = Alzheimer’s disease; A4 = Anti-Amyloid Treatment in Asymptomatic AD study; LEARN = Longitudinal Evaluation of Amyloid Risk and Neurodegeneration; HA = Harvard Aging Brain Study; CFI = Cognitive Function Index, PACC = Preclinical Alzheimer Cognitive Composite; PET = Flortaucipir positron emission tomography; APOE = apolipoprotein E; 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)
1. Y, J, C ➖ T + N + t ➖ PICO:
2. 2024, Neurology, USA ➖ cross-sectional + 675 (A4_LEARN_HABS_2obs) + ? ➖ PICO:
- P: cognitively impaired + at risk of AD
- I: CFI + PACC + PET
- C: NA
- O: association scores↔images
3. Results:
- APOE (44%) = Ab 44.54 centiloids ➩ self-CFI > partner-CFI
- Ab + MTL tau + NEO tau ≈ self- & partner-CFI scores
* Ab + MTL tau = equally significant when tested for independent effects
* Ab + NEO tau = NEO tau was NOT significant when tested for independent effects
- Self CFI = significant predictor of ↑ MTL tau & NEO tau
- Partner CFI = significant predictor of ↑ MTL tau & NEO tau
- PACC = predicted MTL & NEO tau
- Self- + partner-CFI + PACC = predicted MTL tau in “Ab positive” subgroup
- Partner-CFI + PACC = predicted NEO tau in “Ab positive” subgroup
- NO TRENDS in Ab (-)
4. Limitation: 90% white individuals
5. “Although this study was cross-sectional, findings suggest that among older cognitive unimpaired individuals who are at risk for AD dementia, capturing self-report and study partner report of cognitive function may be valuable for understanding the relationship between early pathophysiologic progression and the emergence of functional impairment.”
⏳ TIME MANAGEMENT
46:44:94
Round: 3 09:46:55 ART 2
Round: 2 35:45:53 ART 1
Round: 1 01:12:85 Last JR
2024 HEALIO - More severe OSA linked to premature aging in adults (ATS conference).pdf
Codified by ABFL
Glossary: OSA = obstructive sleep apnea; 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)
1. Y, J, C ➖ T + N + t ➖ PICO:
2. 2024, conference abstract, CA ➖ cross-sectional + 1254 + 2016-2019 ➖ PICO:
- P: Canadian Sleep and Circadian Network biobank subjects
- I: biomarkers = DNA methylation
- C: NA
- O: epigenetic OR biological PREDICTION
3. Takeaways
- Oxygen desaturation index was used as a marker of OSA severity.
- The link between this marker and premature aging changed based on the generation of clock used to calculate epigenetic age.
Tuesday, September 03, 2024 at 00h30 BE AAQC
Codified by HIBN
Glossary: AD = Alzheimer’s disease; A4 = Anti-Amyloid Treatment in Asymptomatic AD study; LEARN = Longitudinal Evaluation of Amyloid Risk and Neurodegeneration; HA = Harvard Aging Brain Study; CFI = Cognitive Function Index, PACC = Preclinical Alzheimer Cognitive Composite; PET = Flortaucipir positron emission tomography; APOE = apolipoprotein E; 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)
1. Eight patient/caregiver pairings on sleep patterns and agitation.
2. Individuals with mild cognitive impairment or dementia
3. School of Medicine at Oregon Health & Science University (OHSU)
4. The question “are there behaviors associated with agitation that can potentially serve as a target for treatment?”
5. Based on the MODERATE study
6. Symptoms = agitation, motor disturbance, disinhibition or irritability
7. The caregivers:
- answered a phone-delivered survey to name the behaviors
- Used CMAI-SF in the previous week
- Frequency rated as 0 (none) to 5 (daily), total agitation was the sum of the frequency of all agitated behavior (max 70)
8. The highest correlation for agitation among the 11 different models was “wake after sleep onset”
measured in minutes
9. The findings should be confirmed in a larger, more representative sample.
Codified by HIBN
Glossary: DDCH = Danish Diet, Cancer and Health cohort study; GE = gastroenterology; AF = atrial fibrillation; WHS = Women’s Health Study; PHS = Physicians Health Study; MA = metaanalisis; COSMOS = COcoa Supplement and Multivitamin Outcomes Study; CA = cancer; wo_ = without; dx = diagnosis; inc_ = incident; pxs = patients; 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)
1. Contradictory information
- DDCH = consumption <6x/w = 20% ↓r indicen AF 🆚 consumption <1m
- WHS & PHS = no association “chocolate consumption & incident AF”
- MA (5 studies) = no association
2. 2024, EJPC, USA ➖ db, pc, 2x2 fac, RCT (COSMOS)➕ >18k ➕ 5.5y (3.5y randomized tto, 2y post-intervention)➖ PICO:
- P: ♀≥65y & ♂︎≥60y
- I: cocoa extract (500 mg flavanols/day, including 80 mg (–)-epicatechin) & multivitamin supplementation (CVD and CA prevention)
- C: placebo arm
- O: composite “myocardial infarction, stroke, CVD mortality, revascularization procedures, unstable angina requiring hospitalization, peripheral artery disease, and carotid artery disease”
3. IN. Free of major CVD ➕ wo_CA dx ➕
4. EX. Irregular heart rhythms at baseline
5. Results.
- Intervention phase ➩ inc_AF = no DIFF
- Cumulative follow-up ➩ ↓ HR for inc_AF (p=0.01)
- Post-intervention phase ➩ ↓ inc_AF (p=0.009)
- I = 27% ↓ in CV death - NOT in total CV events
6. Limitation.
- AF not predefined endpoint
- AF events self-reported
- Enrolled relatively healthy individuals without a history of major clinical CVD events (volunteer bias?)
7. Rationale
- Cocoa extract of the study = flavanol and (–)-epicatechin
- Cocoa flavanols = vasodilatory, anti-inflammatory, antioxidant, antiplatelet, and angiotensin-
converting enzyme properties ➩ electrical and structural atrial remodelling
Thursday, November 21, 2024 at 00h30 BE MSMEV, ABFL, HIBN, AAQC
2024 MB - Life’s Essential 8 Maintaining a High Status Over Time May Lower Stroke Risk (Stroke).pdf
Codified by ABFL
Glossary: LE8 = Life's Essentials 8; S† = stroke; ∂ = reverse; ↗️ = increase; wo_H_S† = without history of Stroke; pxs = patients; 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).
1. Y, J, C ➖ T + N + t ➖ PICO: ➩ KAILUAN STUDY: 2024, Stroke, CH ➖ prospective cohort + >26k + 2006-2020 (14y) ➖ PICO:
- P: adults, not old (46yo), wo_H_S†
- I: LE8 calculation ➩ a. 6 surveys (2006-2016), b.medical records (2016-2020)
- C: NA
- O: Risk of STROKE
2. CH ➩ ↑ est lifetime r_S† + incidence, frequency, MM = 1990-2019
3. LE8 score = 0-100 unweighted average
4. RESULTS:
- High LE8 status = ↓ r_S†
- ↗️ LE8 even with ↓ initial levels = ↓ OR ∂ r_S†
- 5 trajectory patterns identified: low-stable(10.46%), moderate-increasing (15.00%), moderate-decreasing (22.78%), moderate-stable (38.46%), and high-stable (13.30%).
- <500 incident S† = <11% HH
- Associations were found comparing MODERATE-DECREASING 🆚 others.
- Significative ↓ r_S† ➩ high LE8 (≥80) 🆚 low LE8 (≤49)
- ↓ r_S† = faster annual growth in LE8
- Despite ↓ LE8 in moderate-increasing group 🆚 moderate-decreasing group, the ↗️ group still showed a ↓ r_S†
5. LIMITATIONS
- predominantly men - 1 specific community (LIMITS generalizability)
- unmeasured confounders (inherent in observational)
- 30% of the cohort in final analyses (excluded eldest w_ ↑ systemic inflammation + ↓ socioeconomic status).
Tuesday, November 18, 2024 at 00h30 BE RCH, BAR, DHAA, ABFL, HIBN, AAQC
2024 PSYADV - The Montreal Cognitive Assessment Reliably Screens for Cognitive Impairment (BJGP).pdf
Codified by ABFL
Glossary: AD = Alzheimer’s disease; A4 = Anti-Amyloid Treatment in Asymptomatic AD study; LEARN = Longitudinal Evaluation of Amyloid Risk and Neurodegeneration; HA = Harvard Aging Brain Study; CFI = Cognitive Function Index, PACC = Preclinical Alzheimer Cognitive Composite; PET = Flortaucipir positron emission tomography; APOE = apolipoprotein E; 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)
1. 2024, BJGP, FR ➖ quan_pros_cross-sect feasibility + 221 + Nov 2022 to April 2023 ➖ PICO:
- P: >50yo w_CI (confirmed OR suspected)
- I: MoCA
- C: ✖︎
- O: feasibility I⃣ d_<15min
2. IN: FR proficient pxs
3. Context: routine consultations in general practice.
4. Interest of the study:
- explore feasibility _MoCA for early detection of CI
- calculate the prevalence of CI
- understand the difficulties faced by GP and PXS in completing.
5. Demographics:
- 61 GP ➩ 70% office + 26% MP primary care structure + 3% health center
- 22y ➩ time in practice
6. From 51% GP (previous screening):
- 19 had performed the MMSE
- 5 the MoCA
- 4 the Dubois 5-word test,
- 3 the clock test.
7. RESULTS:
- Test completion ➩ time (mean) = 8 minutes ➕ 82% completed in 10 min ➕ 97% completed in < 15 minutes.
- 221 MoCAs performed ➩ 62% mild CI ➕ 4% moderate CI ➕ 34% normal. ➕ 0% w_severe CI
- GP impression of MoCA = positive experience (“simplicity”)
- The MoCA was preferred over the MMSE by 3 GPs
- Challenges: patient understanding ➕concentration ➕ anxiety ➕ motivation.
8. LIMITATIONS
- Insufficient data on GP’ views of the MoCA
- Timing d_busy period for GP
- Lack of focus among pxs,
- Potential investigator + functional bias.
⏳ TIME MANAGEMENT
69:47:64
Round: 2 03:05:31 Comments
Round: 1 36:42:33 Wrap-up
Round: 0 30:00:00 Article
Thursday, November 28, 2024 at 00h30 BE RCH, EMCC, BAR, OQC, RICH, HIBN, AAQC
Codified by ABFL
Glossary: CRP = high-sensitivity C-reactive protein HIT-6 = short-form Headache Impact Test-6 DASS = 21-item Depression Anxiety, and Stress Scale; BP = blood pressure; INT = intervention; 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).
1. Y, J, C ➖ T ➕ N ➕ t ➖ PICO:
2. 2024, BMC Medicine, IRAN ➖ RCT, 3blinded ➕ 72 ➕ 3months ➖PICO
- P: adults (18-55) + w_migraine
- I: vit D + probiotics
- C: placebo
- O: frequency + duration + severity + functiong + mental health + CRP
3. METHODS
- Baseline + 12w ➩ measured HIT-6 + DASS
- All OC were measured
- BP + vit D
- From the 72 participants, just 68 completed till the end
4. RESULTS
- SBP, DBP, MAP were ↓ in all
- ↗️ vit D in INT group
- Both groups ↘️ frequent, duration, severity, HIT6 from baseline
- ↔group ➩ ↘️ frequency + severity in the INT
- ↔group ➩ NO DIFF in duration + HIT-6 + CRP + mental health
5. LIMITATIONS
- LESS men
- Potential confounders
- reliance on self-reported data
Codified by RICH
Glossary: GT = glucose tolerance; GLU = glucose; NEFA = nonesterified fatty acids; OGTT = oral glucose tolerance test; 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).
1. GT more impaired in meat + snack at night 🆚 fasting at night = Timing matters
2. Y, J, C ➖ T ➕ N ➕ t ➖ PICO: ➩ 2024, Diabetología, AUSTRALIA ➖ three-arm, parallel-group cluster RCT ➕ 55 healthy participants ➕X ➖ PICO:
- P: adults 18-50yo, healthy
- I: fasting groups
- C: snack + meal groups
- O: GLU + INSULIN + NEFA + OGTT + calculated insulin+ insulinogenic indexes.
3. 20% of population works at night
4. TO CONTINUE
⏳ TIME MANAGEMENT
01:10:15
Round: 7 02:15:99 Comments
Round: 6 21:23:69 ART 2
Round: 5 01:01:54 Comments
Round: 4 12:27:01 Wrap-up
Round: 3 22:59:74 ARticle 1
Round: 2 05:32:33 ART selection
Round: 1 04:35:60 Past JR
Monday, November 25, 2024 at 00h30 BE AHO, OQC, RCH, RICH, HIBN, AAQC
Codified by MAAT
Glossary: vp = vasopressor; sed = sedation; VE = volume expansion; WHS = Women’s Health Study; PHS = Physicians Health Study; MA = metaanalisis; pxs = patients; 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).
1. Y, J, C ➖ T ➕ N ➕ t ➖ PICO: ➩ 2024, CC, FR ➖ post hoc of mc_pros➕ 205 ➕ 4y ➖ PICO:
- P: under MV, w_vp + sed
- I: VE
- C: ✖︎
- O: ΔP(v–a)CO2 and ΔScvO2 as reliable parameters to define FR
2. Measurement of CI was done by TTE ± PiCCO
3. FR = CI >15%
4. Excessive fluid therapy is associated with bad outcomes ➩ Acheampong A, Vincent JL. A positive fluid balance is an independent prognostic factor in patients with sepsis. Crit Care. 2015;19(1):251.
5. EX: cardiac arrhythmias, contraindication to PLR maneuver (↑ ICP, fracture of lower extremities), pregnancy, moribund, changes in vp + sed d_study, + risk of fluid loading-induced 🫁 edema.
6. MA ➩ 5 studies + ∆ScvO2 is reliable to indicate FR
7. RESULTS:
- to continue…..
⏳ TIME MANAGEMENT
01:55:24
Round: 3 55:42:57 paper
Round: 2 08:51:36 article
Round: 1 03:35:61 Past JR
Thursday, December 05, 2024 at 00h30 BE AHO, GMC, RCH, RICH, HIBN, AAQC
2024 NEJMjw - Indefinite β-Blocker Therapy After Myocardial Infarction (NEJM).pdf
Codified by MAAT
Glossary: RCT = Randomized Controlled Trial; MI = Miocardial infarction; QOL = quality of life; HR = Heart Failure; FEVI = Ejection fraction <40%; CV = cardiovascular; BB = B-blocker; wo_ = without; pxs = patients; 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).
1. 2024, NEJM, FR ➖ RCT_noninferiority ➕ 3700 ➕ MI to enrollment = 3y ➖ PICO: ➩
* P: adults, MI + revascularization
* I: Stopped BB
* C: Continue BB
* O: Incidence ➕ hospitalization ➕ QOL
2. EX:
- HF
- FEVI <40%
3. RESULTS:
- Incidence ➩ composite: MM + MI + St + H+ (24% 🆚 21%) “possibly inferior to continuing”
- Hospitalizations ➩ 3% points ➩ ↑ in INT (19% 🆚 17%)
- QOL ➩ similar
4. QOL is similar in both groups.
5. Another study contrasts with the current ➩ NO DIFF in CV OC (NEJM 2024)
6. Either is acceptable (both studies contrasting NEJM 2024)
7. Consider stopping ➩ side effects ± polypharmacy
8. Consider continuing ➩ wo_concerns ± blood control
2024 NEJMjw - Do Hypertension and Antihypertensive Use Affect Dementia Risk (Neurology).pdf
Codified by MAAT
Glossary: AD = Alzheimer disease; NAD = non-Alzheimer disease; DAP = dyastolic blood pressure; 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).
1. Y, J, C ➖ T ➕ N ➕ t ➖ PICO: ➩ 2024, NEUROLOGY, 14 EU, African, Asian, NA, SA, AUS ➖ international_dataset cohort ➕>31k ➕ 4y ➖ PICO:
- P: older adults (72yo, >fem), hypertensive?
- I: untreated (HTA wo_antiHTA)
- C: treated (HTA w_HTA w_antiHTA, normotensive at baseline) + control (wo_HTA or antiHTA)
- O: risk of AD and NAD dementia
2. RESULTS:
- Untreated 🆚 controls ➩ 36% ↑ risk AD
- Untreated 🆚 treated ➩ 42% ↑ risk AD
- Untreated ➕ treated (similar NAD risk) 🆚 controls ➩ ↑ risk NAD
3. Risk ➩ Race did not affect ➖ baseline BP did not affect BUT DBP
4. “A strength of this study is the inclusion of multiple races and ethnicities. However, determining a target blood pressure for treatment is still needed.”
⏳ TIME MANAGEMENT
01:22:15
Round: 4 42:40:50 ART 2 + wrap-up + comments
Round: 3 13:36:66 Wrap-up
Round: 2 21:47:05 ART selection
Round: 1 04:11:31 Last JR
Monday, December 02, 2024 at 00h30 BE AHO, OQC, RCH, RICH, HIBN, AAQC
2024 NEJMjw - Guidelines for the Primary Prevention of Stroke (Stroke).pdf
Codified by RICH
Glossary: hCVr = high cardiovascular risk; CVD = cardiovascular disease.
1. Recommendations based on evaluation + classification of COMPREHENSIVE LITERATURE SEARCH
2. FOUR big changes:
- Social determinants: education, health literacy, economic stability, healthcare access, transportation, food security, housing security, neighborhood of residence, experiences of racism, and others ➩ ENTE-HHH
- Sedendary behavior ➩ LE8
- Use of GLP-1 ➩ T2D + hCVr + CVD
- Gender - sex risk factors ➩ SCREEN history of pregnancy disorders among others + MANAGE chronic hypertension + vascular risk factors
3. LE8 = life 8 essentials ➩ I run, am hungry (lipids, sugar), I weight, under pressure, smokes, I am tired - will sleep.
4. Migraine w_ or wo_aura ➩ modify risk factors
5. Migraine w_aura ➩ better progestin-only OR nonhormal contraception
6. Transgender women + gender-diverse individuals taking estrogens for gender affirmation, evaluate and modify risk factors.
Codified by RICH
Glossary: r_ = ristk; T2D = type 2 diabetes; GLU = glucose; AUC = area under the curve; M = meal; S = snack; F = fasting
1. Previous JR
* P: adults 18-50yo,
* I: fasting (20)
* C: snack (17) + meal (18) groups
* O: GLU + INSULIN + NEFA + OGTT + calculated insulin+ insulinogenic indexes.
2. ↗️ r_obesity + T2D
3. TRE ↗️ health and GLU control
4. Study intervention was a simulation
5. Sleep time = 7-9 hours
6. RESULTS
- OGTT GLU AUC ➩ ↑ M + S 🆚 F
- Insulin AUC ➩ ↑ F 🆚 others
- NEFA ➩ ↑ only M
- Insulinogenic index ➩ ↑ F
- Sensitivity significative
- GLU Tol ➩ IMPAIRED M + S 🆚 F
7. LIMITATIONS: Analysis C-peptide
8. “Simulated night-shift work induced insulin resistance, which was not rescued by altering either meal timing or meal size" Banks
⏳ TIME MANAGEMENT
01:25:00
Round: 6 01:11:51 Comments
Round: 5 17:46:54 wrap-up
Round: 4 24:28:69 ART 2
Round: 3 13:33:89 wrap-up
Round: 2 23:24:10 ART 1
Round: 1 04:35:28 Past JR
2024 ICUmmp - Effect of PEEP on PVR in Pxs w_ ARDS (BLUE).pdf
Codified by RICH
Glossary: 🫁 = lungs; ARDS = acute respiratory distress syndrome; HDs = hemodynamics; RV = right ventricular; LV = left ventricle; ITP = intrathoracic pressure; CO = cardiac outpu; CI = cardiac indext; PL = transpulmonary pressure; PVR = 🫁 vascular resistance; FRC = functional residual capacity; PAC = 🫁 artery catheter; ECHO = ecocardiography; R/I = recruitment to inflation ratio; VEDA = ventricular end diastolic area; 𝌡 = changes;
1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS ➩ 2024, BLUE, ❓ ➖ T ➕ 23 pxs (10 🆚 13) ➕ t ➖ P I C O:
- P: adult,
- I: 10mmHg of PEEP ↑ ➩ high/low recruiters
- C: NA
- O: PVR
3. EVIDENCE
- PEEP in ARDS (pxs MV) = therapeutic dilema
- PEEP ↗ ‘gas exchange + 🫁 mechanics’ but may impair HDs.
- Main target = RV preload and afterload
- LV function is less affected.
- ↑ ITP from PEEP 🟰 ↓ venous return ➩ ↓ RV preload ➩ ↓ CO if both ventricles are preload-
dependent.
- ↑ PL may ↑ PVR ➩ further ↓ CO, potentially via a leftward septal shift.
- PEEP on PVR is complex ➩ depends on lung volume.
- 🫁 vessels are: alveolar and extra-alveolar.
- A. When ↪🫁 volume ↑ (from ↓ FRC), ↪ PVR ↓ due to the expansion of extra-alveolar vessels. ➩
recruitment
- B. When ↪ Further 🫁 distention (above FRC), ↪ compresses alveolar vessels ➩ ↑ PVR ➩
distention
- A + B 🟰 U-shaped PVR & 🫁 volume, with the nadir at FRC.
- ∑ PEEP on PVR depends if recruitment (decreasing PVR) or distension (increasing PVR).
4. METHOD
- Materials: PAC (for CI) + ECHO (for RV dimensions/function) + R/I ratio (for 🫁 recruitment) ➩
- Definitions: low recruiters (R/I < 0.5) ➕ high recruiters (R/I > 0.5)
5. RESULTS
- High recruiters🟰 = “PVR” ➕ = ” right-to-left VEDA” ➕
- Low recruiters 🟰 ↑ PVR ➕ ↑ ” right-to-left VEDA” ➕
- ↑ PEEP ➩ ↓ CI in preload responders
- RV afterload ↑ with ↑ distension d_PEEP application (due to ↑ PVR + RV enlargement)
- Low recruiters 🟰 𝌡PVR comes from “𝌡MPAP + 𝌡PAOP” (rather than ONLY CO)
- PEEP reduced CO equally in both groups
- ↑ PEEP has a LESSER IMPACT on RV afterload in ‘high recruiters’.
⏳ TIME MANAGEMENT
01:30:46
Round: 4 05:11:38 Comments
Round: 3 01:13:25 ART
Round: 2 10:05:59 ART selection
Round: 1 02:04:63 +8 min = last JR
Thursday, December 12, 2024 at 00h30 BE JCAU, ABFL, BAR, RCH, GMC, RICH, HIBN, AAQC
Monday, December 09, 2024 at 00h30 BE AHO, BAR, DFM, GMC, OQC, RICH, HIBN, AAQC
Codified by RICH
Glossary: AUD = alcohol use disorder.
1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O: ➩ 2024, JAMA Psychiatry, CH (Sweden) ➖ observational_within indiv ➕ 230k ➕ 17y + follow up 9y ➖ PICO:
- P: AUD patients (hospitalized)
- I: USE
- C: NONUSE
- O: RISK of hospitalization OF AUD
2. EVIDENCE
- GLP-1 agonists = ↓ alcohol craving ➩ BRAIN REWARD SYSTEM
- HOW GLP-1 could ↗️OC is unknown.
3. RESULTS
- Semaglutide + liraglutide ↔ ↓ r_AUD HOSPITALIZATION
- Among naltrexone, disulfiram and acamprosate ➩ JUST naltrexone ↔ ↓ r_hospitalization
- GLP-1 ➩ not ↔ EXCESS r_suicide
4. No suicide (at-risk population) DESPITE concerns of this threat
5. US FDA meds for AUD are underutilized
Codified by RICH
Glossary: VTE = venous thromboembolism; PE = pulmonary embolism; rf = risk factor; antiCOAG = Anticoagulation.
1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O: ➩ 2024, CIRCULATION, JPN ➖ ol_mc_manucSupp ➕ <180 ➕ 18m ➖ PICO:
- P: CA associated PE + low-risk PE
- I: 18m RIVAROXABAN
- C: 6m RIVAROXABAN
- O: recurrent VTE
2. EVIDENCE
- CA = well-known rf (VTE: incident + recurrent)
- It is unknown the OPTIMAL DURATION of antiCOAG in this setting
3. RESULTS
- PESI = low risk ➩ 88% inc_PE
- Study was stopped prematurely due to SLOW RECRUITMENT
- Recurrent VTE in 6% 🆚 19% (INT 🆚 C)
- Bleeding ➩ NO DIFF
- Fatal bleeding ➩ NO DIFF
4. IT WOULD be prolonged except ↑ r of BLEEDING.
⏳ TIME MANAGEMENT
01:04:02
Round: 7 01:38:95 Comments
Round: 6 23:34:89 ART 2
Round: 5 01:19:52 Comment
Round: 4 13:36:22 Wrap-up
Round: 3 09:30:71 ART 1
Round: 2 08:40:60 Selection
Round: 1 05:41:25 Past JR
2024 NEJMjw - Catching Inpatient Diagnostic Errors at Change of Shift (AIM).pdf
Codified by ABFL
Glossary: ✖ = error; ✏️ = questionnary; AIM = Annals of Internal Medicine; 🪲 = infections; 🫀 = cardiovascular; 🧠 = neurologic
1. 𝙄𝙌𝘾 BS 🟰 Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, AIM, USA ➖ single center ✏️ ➕ 36 ➕ ? ➖ P I C O:
- P: hospitalists
- I: day 2 of week service ➩ questionnaire
- C: NA
- O: diagnostic error or harm
3. EVIDENCE:
4. RESULTS
- DX ✖ = 32% ➩ 1/2 missed info
- Missed DX ➩ 🪲 27% 🫀 25%. 🧠 12%
- HARM = 17% of ✖ (<6% diagnosis changed)
- Death = 1 ✖
5. Based on this study, changing my patient's diagnoses — after a careful chart review — at the beginning of my shift could mean that an error is lurking and will trigger me to fish it out, address it, and learn from it (Raja-Elie E. Abdulnour).
⏳ TIME MANAGEMENT
01:06:12
Round: 6 01:13:73 Comments
Round: 5 07:03:44 Wrap-up
Round: 4 12:13:04 ART 1, today
Round: 3 02:43:04 Selection 2
Round: 2 33:05:92 ART 2, past JR
Round: 1 09:52:87 Past JR
Thursday, December 19, 2024 at 00h30 BE AHO, MAAT, GMC, JCAU, HIBN, AAQC
Monday, December 16, 2024 at 00h30 BE ABFL. AHO, MAAT, EAM, GMC, JCAU, OQC, RICH, HIBN, AAQC
2024 NEJMjw - How Common Are Central Line Complications (JHM).pdf
Codified by ABFL
Glossary: ➰= central line; AUS = Australia; CVAD = central venous access devices; JHM = J Hosp Med; PICCs = peripherally inserted central catheters; sec_analy_mc = secondary analysis of a multicentric
1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, JHM, AUS ➖ sec_analy_mc_RCT (Lancet 2021) ➕ 1900 ➕ ❓ ➖ P I C O:
- P: adults
- I: CVADS (tunneled 40%, nontunneled 17%)
- C: PICCs 40%
- O: failure incidence ➕ complication
3. EVIDENCE.
- Complications = infections + occlusion + dislodgment + fracture + thrombosis + pain
4. RESULTS.
- Failure ➩ 10% ➩ 1/2 were infections
- Occlusion ➩ 17%
- Dislodgment ➩ 17%
- Incidence ➩ 8/1000 PICCs➖ 8/1000 nontunneled ➖ 6/1000 tunneled
- AntiMICROBIAL (50% of the total used) nontunneled CVAD ➩ ↓ infections than tunneled
- Nonstudy H+ ➩ 7x ↑ dislodgment than Study H+
5. RATIONALE.
- Consider antiMICROBIAL for nontunneled
- Recommended FOR immunocompromised, risk of INF, >5 days
- Secure nontunneled when pxs are tranferred
Codified by RICH
Glossary: 🗣 = communication; ↓ = reduction; ↔ = association;
1. Response to Brandao Barreto et al on the paper
2. Compassion care ➕ connections ARE CRITICAL in ICU
3. They agree on the importance emotional + psychological aspects in ICU
4. The letter mentioned the limitations of having ax external facilitator, HOWEVER ICU nurses were facilitators
- 5 to 15 years of experience
- Already part of the ICU team
5. Complication of their ROLE ➩ TRANSITION of responsibilities and new activities
6. ICU physicians are not really FULLY and formally trained IN THIS AREA
7. Disagreement ➩ “ICU clinicians are adequately trained to handle the psychological burden of families”
8. Disagreement ➩ not ok to delegate RELATIONAL + EMOTIONAL support tasks ▶ CORE to practice compassionate, patient- and family-centered care.
9. Curtis ➩ missed opportunities:
- inadequate time listening
- inconsistent info across clinicians
- Meetings called only by physicians
- discomfort with emotions
10. TRIAL ➩ 3-step approach ➩ verbal + non-verbal COMMUNICATION ↔ ↓ psychological burden in families
⏳ TIME MANAGEMENT
01:02:19
Round: 5 01:28:63 Comments
Round: 4 08:57:69 ART 2
Round: 3 16:18:42 Wrap-up
Round: 2 23:59:28 ART 1
Round: 1 11:35:15 Past JR
Thuesday, December 26, 2024 at 00h30 BE AHO, MAAT, GMC, JCAU, RICH, HIBN, AAQC
2024 ICUmmp - Ventilatory Support for Asthma - An Overview of Critical Asthma mm (chiumello) [r].pdf
Codified by RICH
Glossary: 🫁 = lungs; ♀ = women; CA = critical asthma; ICU = intensive care unit; INF = infection; MV = mechanical ventilation
1. CA is an umbrella term with different definitions ➩ starting w_EXACERBATION until respiratory
failure. Needs ICU + MV
2. Asthma ➩ complex ➕ heterogeneous 🟰 lung disease marked by chronic airway inflammation
and variable respiratory symptoms (wheezing, shortness of breath, cough and chest tightness) DUE
TO:
- reversible airflow obstruction
- excessive bronchial reactivity.
3. INTENSITY + FREQUENCY ➩ triggered by: (GINA 2024)
- Allergens
- 🫁 INF
- exercise
4. USA study ➩ (Pendergraft et al. 2004).
- 10% of asthma admissions (primary diagnosis) ➩ referred to ICU ➕ 2% required intubation
- ↑ MM + ↑ H+ LOS + ↑ reADMISSIONS if [intubated + ICU]
- majority ♀
5. There are 300M asthma pxs worldwide ➩ reference from 2004 though
6. MM ➩ asthma exacerbation = 0.5 - 5% 🆚 CA = 3 - 10%
⏳ TIME MANAGEMENT
01:00:47
Round: 4 03:12:10 Comments
Round: 3 34:21:97 ART 1 5 min ago
Round: 2 13:16:19 ART choice
Round: 1 09:57:27 Past JR
