Brad Spellberg @BradSpellberg
CMO Los Angeles General Medical Center, hospitalist, infectious diseases expert, researcher bradspellberg.com Joined March 2016-
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@BradSpellberg @DrToddLee @TorontoIDDoc @edenhelmi @Cortes_Penfield Guideline writers before Wiki guidelines live footage below
Latest #ClinicalConundrum from @LAGeneralMed 30yo M w/ESRD on HD, lupus & APLS w/recurrent VTE/PE. Had been on warfarin but complicated by hemorrhagic stroke in setting of supratherapeutic INR 3mo previously. What would you do re anticoag? #MedTwitter
As @LAGenHospMed indicated, Hospital Medicine is leading the way in @LAGeneralMed 's journey to high reliability. From our Governing Body report. Amazing transformation of both mortality and length of stay. More exciting news about our hospital-wide transformation coming soon!
As @LAGenHospMed indicated, Hospital Medicine is leading the way in @LAGeneralMed 's journey to high reliability. From our Governing Body report. Amazing transformation of both mortality and length of stay. More exciting news about our hospital-wide transformation coming soon! https://t.co/LeDLhNZniC
@DrToddLee @DrNeilStone Highlights the need for a highly effective #hospitalist group. @LAGeneralMed our #hospitalist group has driven down LOS *and* inpatient mortality to among the lowest in the @Vizient network
@KuhnboBio @baym Numerous studies in agriculture (mostly animals rather than soil). See nam.edu/antibiotic-res…
TB IGRA for diagnosing active TB Useless when positive Useless when negative Remember that next time you are tempted to order it
TB IGRA for diagnosing active TB Useless when positive Useless when negative Remember that next time you are tempted to order it
@BradSpellberg 💯, market looks much better than 10 years ago, still not amazing, but I think CPE nowhere near as bad in terms of tx options, and we have a few for VRE also etc.
Well said. I will add, having been actively involved in policy solutions to the AMR problem since 2003, hyperbole DOES NOT HELP! We are substantially better off today than in 2009. The Chicken Little syndrome costs credibility. Constant exaggeration makes solutions less likely.
Well said. I will add, having been actively involved in policy solutions to the AMR problem since 2003, hyperbole DOES NOT HELP! We are substantially better off today than in 2009. The Chicken Little syndrome costs credibility. Constant exaggeration makes solutions less likely.
Now THAT…THAT is the best response by far. Simply genius. All you out there should be following @LAGenHospMed. It’s these pearls of wisdom y’all are missing out on.
Now THAT…THAT is the best response by far. Simply genius. All you out there should be following @LAGenHospMed. It’s these pearls of wisdom y’all are missing out on.
Don’t get me wrong I cannot wait for Ontario to cover IGRAs, but I do actually like that they’re not available at all to inpatients. An IGRA never needs to be done on an inpatient.
Don’t get me wrong I cannot wait for Ontario to cover IGRAs, but I do actually like that they’re not available at all to inpatients. An IGRA never needs to be done on an inpatient.
Question. What is the psychology of people who plop meetings on your calendar without asking when you're available? Second question. How do you respond when people do that?
@BradSpellberg Totally agree! The sensitivity and specificity of the "criteria" have never been tested, and we know they are non specific. See pubmed.ncbi.nlm.nih.gov/38066877/
Does anyone else think that maybe we over diagnose HLH these days, that the criteria are overly sensitive for identifying which patients need frieking chemotherapy as opposed to treating the underlying dz? I mean, sometimes you need to. But it feels maybe more common these days?
Antibiotic Steward Ba.. @ABsteward
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AMR initiative Rwanda @amr_initiative
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Adam Rodman @AdamRodmanMD
17K Followers 2K Following Physician, educator, historian, author, co-director @iMEDEducation @BIDMC_IM, host of #histmed podcast @BedsideRounds, studies 🤖+🧠. He/him/his. 🖖🚲@DrToddLee @BradSpellberg @Infected_Terran @GA @DrToddLee : you got a reference for that at all? Is that why Canada uses Tobra over Gent as its aminoglycoside of choice?
@DrToddLee @BradSpellberg @Infected_Terran @GA My understanding was oto/vestibulotoxicity were associated with duration >5-7d, and irreversible, whereas the AKI was almost always reversible and dose dependent; hence Scotland’s “72h Gent, then phone micro for advice” policy. V little Ototox seen north of the border…
@BradSpellberg @Infected_Terran @GA Unpredictable but rare before 5 days. Risk with Gent > tobramycin last I checked
@DrToddLee @BradSpellberg @GA My 16 years of left sided tinnitus agrees with you. And I think ototoxicity is much harder to predict by measuring levels. Some of it if I remember correctly is somewhat idiosyncratic
@BradSpellberg @AaronGoodman33 I was offered oral cancer screening at dental clinic during routine cleaning. No tobacco use history, no family history, relatively young. Umm..no.
@DrToddLee @BradSpellberg @GA Your point is well taken and I was mostly joking. In reality it's the kidneys that don't worry me too much. The ears terrify me. That being said, eternal vertigo to me personally would be worse.
@Infected_Terran @BradSpellberg @GA As someone who has lost hearing in one ear due to sensorineural hearing loss, it scares me a lot.
@BradSpellberg @DrToddLee @TorontoIDDoc @edenhelmi @Cortes_Penfield Guideline writers before Wiki guidelines live footage below
@BradSpellberg @TorontoIDDoc @edenhelmi @Infected_Terran @Cortes_Penfield This is another discussion section of the wiki guidelines full supplement that I am proud of.
@BradSpellberg very small N but this is all i could find for QFT assessment over time during TB infection treatment ncbi.nlm.nih.gov/pmc/articles/P…
@BradSpellberg got it, understood! yes TB disease was pretty confidently excluded in this case to my understanding
@BradSpellberg wait, can you round out this logic for my simple mind? let’s say she was started on INH monotherapy after the first Quant (not my pt so need to confirm this): we’re saying even in TB infection (not TB disease), treatment with any ATT restores/increases T cell response?
@BradSpellberg @sebpoule @Infected_Terran @Cortes_Penfield Exacte!!!!
@TorontoIDDoc @Infected_Terran @BradSpellberg @Cortes_Penfield The likelihood of finding a surgical indication in this situation is very low, given the lack of clinical concerns such as heart failure, PR prolongation, new BBB, and absence of large vegetation on TTE, so I would say the TEE would be unlikely to change your management.
@BradSpellberg @TorontoIDDoc @Infected_Terran @Cortes_Penfield There isn’t one, I would NOT get a TEE. It’s an invasive test, I’ve seen esophageal perforation from this. In this situation, it won’t change my management hence would not get one.
@BradSpellberg @TBrnaughtTB Thank you very much!
@Infected_Terran @TorontoIDDoc @BradSpellberg @Cortes_Penfield Unlikely. So I don’t need a TEE.
@TorontoIDDoc @BradSpellberg @edenhelmi @Infected_Terran @Cortes_Penfield In the situation described, I would say it doesn’t change management. Hence I wouldn’t get a TEE in this case. Shouldn’t do an invasive test, or any test for that matter, if it doesn’t change your management.
@BradSpellberg @edenhelmi @Infected_Terran @Cortes_Penfield Yes agree. And that is the key: maximizing the number of TEEs done, where it changes the path of management.
Medical historians typically situate the origins of the antimicrobial era during the early germ period at the turn of the 20th century. 🆕️🔥 Review article @CIDJournal @UMich Dr. Powel Kazanjian Origin of Antimicrobial Therapy Cc @BradSpellberg academic.oup.com/cid/article/do…
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