Category: Lectures and Presentations

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The “How I do a Presentation” Presentation

This morning I gave a lecture on how to do a presentation to the residents at St John Hospital and Medical Center.

Here is the presentation:

How to give a Lecture (375 MB)

I used some material from this older version

Meta lecture (148 MB)

Much of the lecture was just stepping through the SGLT2i presentation and demonstrating the different techniques I use to annotate my talks.

Resources you should use to make superior presentations:

Presentation Zen Blog by Garr Reynolds

Presentation Book by Garr Reynolds

The Noun Project for icons

Visual Abstract example and Primer by Andrew Ibrahim

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Spooky Sodium 👻: The Grand Rounds

At Lankenau Medical Center in Philadelphia at 8:00 AM, January 12. I will be talking about Spooky Sodium 👻.

Here is the title slide

If you can’t make it, first of all, what’s wrong with you? But second of all don’t worry, you can get the high points from the man who discovered them in this 13 minute TedX Talk from Vanderbilt.

And from this article in the NYT

And a deep dive in this lecture at Indiana University by Jans Titze’s collaboratorDr. Fred Left.

And don’t forget about the excellent NephJC coverage, including an editorial from Rodby.

I will eventually post a slidecast of my presentation.

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Resident lecture on NAGMA

One hour lecture on NAGMA. Just some small changes edits from the last time I gave it. It is one of the few lectures that is still in PowerPoint. It is due for a complete overhaul. It also needs a slide on the treatment of RTA that covers the amount of bicarbonate in a 650 mg tablet (8 mmol) and the fact that distal (type 1) RTA requires a limited amount of bicarbonate (at most 1 mmol/kg). This is appropriate for residents and medical students.

If you are interested in ward teaching and RTA, take a look at this post by Robert Centor.

Also this is a nice article on the issue of saline having a pH of 5.5, covering both the reason (its the PVC bag) and the implications (none).

NAGMA (PPT)

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My SGLT2 inhibitor grand-rounds lecture

This past autumn I was invited to give a lecture at the Michigan ACP. I love that meeting. I decided to talk about the mortality data on SGLT2 inhibitors and how we got that data and how curious that data is. Then, last week I had the opportunity to give the lecture again for grand rounds at St John Hospital and Medical Center. Here it is in 4 chapters:

Chapter 1: The History and top line CV outcomes

Chapter 2: What’s driving the improvement in outcomes?

Chapter 3: Renal outcomes

Chapter 4: Side effects and conclusions

Here is the Keynote presentation for your editing pleasure: Keynote (278 mb)

In response to chapter 2, Matt Sparks had this interesting tweet:

This brings up an important point. One of the most intriguing slides is the one below that looks at how long it takes for the Kaplan-Meier to separate.

With glycemic control and blood pressure interventions, their is notable lag, but with the SGLT2i drugs the lines diverge from the very first dose. We also see that pattern with ACEi in heart failure and aldosterone antagonists in heart failure. This may be a clue of where to look for the cause of the survival advantage.

RALES (3 months)

CONSENSUS (first dose)

I will be adding this slide to the next version of the talk.

 

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Lecture on autosomal dominant polycystic kidney disease

My practice has a number of nurse practitioners and physician assistants. The partners do quarterly teaching sessions for them. It is some of my favorite teaching. They come to each session with a lot of experience and the sessions are more like guided conversations rather than traditional lectures. I usually try to frame the session with a clinical practice guideline and we just go through it step by step. This time I did autosomal dominant polycystic kidney disease. I couldn’t find a clinical practice guideline, so I just went with the KDIGO Controversies paper and went from there.

Update from Twitter (where else?)

You mentioned in your post there is no CPG in ADPKD. There is a Canadian one recently published:https://t.co/TFBeI0Kw02

— Dr. Jordan Weinstein (@drjjw) June 5, 2017

The slides:

We use these to make sure we cover all aspects of the disease during the session. They really don’t stand alone. They serve primarily as an outline of the conversation.

9 mb Keynote | 4.7 mb PowerPoint | 5.4 mb PDF

The bibliography:

  1. Clinical practice. Autosomal dominant polycystic kidney disease (PubMed)
  2. Autosomal-dominant polycystic kidney disease (ADPKD): executive summary from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference (PDF)
  3. Blood Pressure in Early Autosomal Dominant Polycystic Kidney Disease HALT-PKD (PubMed)
  4. Extended Follow-Up of Unruptured Intracranial Aneurysms Detected by Presymptomatic Screening in Patients with Autosomal Dominant Polycystic Kidney Disease (PMC full text)
  5. KHA-CARI Autosomal Dominant Polycystic Kidney Disease Guideline: Management of Renal Stone Disease (PDF)
  6. The Natural Course of Unruptured Cerebral Aneurysms in a Japanese Cohort (NEJM)
  7. Tolvaptan in Patients with Autosomal Dominant Polycystic Kidney Disease TEMPO 3:4 (NEJM)

The Tweets:

Look at this chart from KDIGO ADPKD conference. Looks like there are mistakes. pic.twitter.com/IYJE2vWbaU

— Joel Topf, MD FACP (@kidney_boy) June 2, 2017

Specificity should rise with a lack of cysts at higher ages, why is it going own? Thoughts @goKDIGO

— Joel Topf, MD FACP (@kidney_boy) June 2, 2017

Cat making it hard to finish my presentation pic.twitter.com/4sMRVjPbwN

— Joel Topf, MD FACP (@kidney_boy) June 2, 2017

In casse you always wanted to know what 50 pounds of kidneys looks like https://t.co/qxvVeVsBf8 pic.twitter.com/truZRQxznI

— Joel Topf, MD FACP (@kidney_boy) June 2, 2017

Best summary in this review of ADPKD liver involvement is: “huge, silent, and durable”https://t.co/ZXwWJDRaMA

— Joel Topf, MD FACP (@kidney_boy) June 2, 2017

The GFR lies to you in ADPKD. See the late MRI image…the GFR is normal.https://t.co/Zk2HCegvpB pic.twitter.com/vwXhUmFjQD

— Joel Topf, MD FACP (@kidney_boy) June 2, 2017

The Cake:

The NPs andPAs bought me a cake for winning the Robert Narins Award. So nice.

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Herbal Medication talk for Wayne State School of Medicine Alumni Day

I was invited to speak at the Wayne State Alumni Day. It felt pretty special to come back to my old medical school and speak. They put together a great morning of lectures for their CME session.

Here is a Twitter moment from the morning

WSU School of Medicine Alumni Day

I gave my herbal medicine lecture. Download the slide deck here.

176 mb

This is a shorter 30 minute version of the talk.

You can find the full length lecture and additional information at these links:

Link to the 1-hour presentation I gave at the ACP of Michigan.
450 mb
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Ad hoc blood pressure lecture

I am attending on the dialysis service in December and the residents requested a lecture on hypertension. This was a sharp group so I decided to do an update on the literature and go through four papers in the session. It went well. We had lots of great discussions and answered a lot questions.

SPRINT. We talked about the impressive results but really focused on the very selective patients population and how it was not consistent with a lot of patients we see in clinic. We also focused on how they assessed blood pressure and how different it is than standard blood pressure assessment.

The next study was HOPE-3 shows that when you apply what you know from SPRINT but use a standard blood pressure assessment and pair it to a less sick population you get a negative result.

Then we looked at PATHWAY-2 to put add some evidence to the question of how should we treat resistant hypertension.

Then we finished with “Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials” a fascinating meta-analysis that looked at dose response curves, and side effects. Really interesting paper. H/T Ricky Turgeon PharmD. The conclusion from the data is that adding additional drug classes at lower than standard doses results in a nice blood pressure improvement with a clean side effect profile.

Other suggestions that didn’t make the 40 minute cut:

— Ross Nesbit (@RossNesbit) December 30, 2016

Treatment of Hypertension in Patients 80 Years of Age or Older

Agree this is an important study.

@kidney_boy Bit late to this but ASCOT-BPLA

— Annette Neary (@feline_charm) December 30, 2016


Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial

I almost feel that a trial that has Atenolol in the control arm is practically a placebo. That drug never reduces events. I think the official tag line is “Atenolol: when all you care about is reducing the number on the dial.”

@kidney_boy ACCORD BP (lower not always better, esp. In Diabetics) since SPRINT included non-Diabetics. Would also include HYVET

— James Pritsiolas, MD (@Nephro_Doc) December 29, 2016

Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus

This is the opposite side of the SPRNT coin. Low blood pressure appeared to be of no benefit and possibly harmful (Table 2). Nice reduction in stroke though (Figure 2). 

@kidney_boy … and Symplicity HTN-3

— Indranil Dasgupta (@idasgupta7) December 29, 2016

A Controlled Trial of Renal Denervation for Resistant Hypertension

The mother of all medical reversals. Great study. Totally upset a runaway freight train of interventions. To me this shows that industry sponsored trials (when designed with the intension of FDA approval) are not marketing shams but can add clarity to medical knowledge.