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grepmeded's profile
GrepMed
GrepMed
GrepMed
@grepmeded

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GrepMed

@grepmeded

Image Based Medical Reference: Sharing crowd-sourced checklists, algorithms, decision aids, #PhysicalExam #POCUS, and more - by @GeraldMDMD + @k00bideh

Sacramento, CA
grepmed.com
Joined March 2018

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    1. Joel Topf, MD FACP‏Verified account @kidney_boy 27 Nov 2019
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      Patients, that doctors see as high risk for AKI, get shifted away from IV contrast. So the “no contrast group” is enriched with high risk patients. The ideal way to deal with this is a randomized controlled trial. But there isn’t one. The next best thing is propensity scoring.pic.twitter.com/wFOFTgst0F

      1 reply 1 retweet 4 likes
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    2. Joel Topf, MD FACP‏Verified account @kidney_boy 27 Nov 2019
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      Individual patient have variable propensity for developing AKI following contrast. Patients with low GFR have higher risk. Patients with diabetes have higher risk. We can give every patient a propensity score based on that risk.pic.twitter.com/0eUGmfr2XK

      1 reply 1 retweet 4 likes
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    3. Joel Topf, MD FACP‏Verified account @kidney_boy 27 Nov 2019
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      The beauty of randomization is the risk gets balanced between groups.pic.twitter.com/22TVCsIySx

      2 replies 1 retweet 7 likes
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    4. Joel Topf, MD FACP‏Verified account @kidney_boy 27 Nov 2019
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      The problem with observational controlled trials is clever doctors keep trying to avoid contrast in their high risk patients, so that means the “No contrast” group is fortified with an additional helping of high-risk patients.pic.twitter.com/tYlISBgj9N

      1 reply 1 retweet 7 likes
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    5. Joel Topf, MD FACP‏Verified account @kidney_boy 27 Nov 2019
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      To fight this, statisticians do propensity matching where both sides get the same number of patients from every risk category.pic.twitter.com/XyPuIcEIRs

      1 reply 1 retweet 5 likes
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    6. Joel Topf, MD FACP‏Verified account @kidney_boy 27 Nov 2019
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      When this was done for contrast, the protective effect of contrast went away but there was no detectable excess risk of AKI from contrast. If contrast causes AKI it does so, so rarely as to be undetectable by the most sophisticated analysis available.pic.twitter.com/KiIK76HXsh

      1 reply 7 retweets 21 likes
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    7. Joel Topf, MD FACP‏Verified account @kidney_boy 27 Nov 2019
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      In the conclusion of Hinson’s propensity scored analysis, the authors wrote (https://www.annemergmed.com/article/S0196-0644(16)31388-9/abstract …)pic.twitter.com/wwMPvoBJWF

      1 reply 2 retweets 7 likes
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    8. Joel Topf, MD FACP‏Verified account @kidney_boy 27 Nov 2019
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      GE saw this and started a protocol to randomize patients. The indication was monitoring endovascular repair of abdominal aortic aneurysms. Patients with aortic stents go for yearly imaging, either CT w/o contrast + U/S or contrast CT. There is equipoise in imaging modality choice

      1 reply 1 retweet 5 likes
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    9. Joel Topf, MD FACP‏Verified account @kidney_boy 27 Nov 2019
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      The protocol can be seen at http://clinicaltrials.gov  NCT03119662 but it was abandoned due to insufficient recruitment. It turns out that even though contrast researchers have equipoise, the wider physician community does not.pic.twitter.com/tn6bvabFCS

      2 replies 1 retweet 6 likes
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    10. Joel Topf, MD FACP‏Verified account @kidney_boy 27 Nov 2019
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      So without a randomized clinical trial this is what we are left with. The highest quality epidemiology studies are unable to detect any increase in AKI, so those bumps in creatinine following contrast are almost certainly run of the mill AKI and not contrast induced AKI.pic.twitter.com/RZztPZTj7Q

      7 replies 14 retweets 56 likes
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      GrepMed‏ @grepmeded 28 Nov 2019
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      Replying to @kidney_boy

      any insight from these studies into the effect to which Non-con patients might have done worse because of delay or missed diagnosis?

      7:40 AM - 28 Nov 2019
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      • Jacob de Wolff
      2 replies 0 retweets 1 like
        1. Joel Topf, MD FACP‏Verified account @kidney_boy 29 Nov 2019
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          Replying to @grepmeded

          Joel Topf, MD FACP Retweeted Joel Topf, MD FACP

          Here is the best guess on this: https://twitter.com/kidney_boy/status/1199719247250952192?s=21 …https://twitter.com/kidney_boy/status/1199719247250952192 …

          Joel Topf, MD FACP added,

          2:20
          Joel Topf, MD FACPVerified account @kidney_boy
          Replying to @edgarvlermamd @hswapnil and 3 others
          Here is the section on renalism from my grand rounds on contrast nephropathy. pic.twitter.com/KQ03v0BR79
          0 replies 2 retweets 0 likes
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        1. Jacob de Wolff‏ @jfdwolff 29 Nov 2019
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          Replying to @grepmeded @kidney_boy

          I'm sure everyone can think of some incidents from previous experience. I certainly can. But the plural of anecdote is not data.

          0 replies 0 retweets 0 likes
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