musings of a salt whisperer
So Pi Day is just about over but during the day we did a three stooges around the Topf household. After taking the pie to the kisser I wrote a check to the National Kidney Foundation of Michigan for $31.41.
I’d like to challenge Matt Sparks, Kenar Jhaveri and Edgar Lerma to take pie and write a check.
Pi Day Kidney Challenge from joel topf on Vimeo.
I did a quick 10 minute presentation at morning report for the residents to get them excited for NephMadness.
You can download the presentation here:
Video:
NephMadness: What’s up with that? from joel topf on Vimeo.
Only eight more days. Get those entries in!
Last Sunday we launched NephMadness
for the third time. This began as a last minute Hail Mary by the crew at AJKDblog to commemorate World Kidney Day in 2013. The response was so overwhelming that despite initially thinking this would be a one-and-done we decided to come back and improve the idea.
We have steadily improved the execution of NephMadness.
Last year we introduced a system to allow online bracket submissions. We found a company that provides white labelled online tournament brackets. This gave us streamlined registration and allowed for automatic scoring. Participation sky rocketed. Last year we also brought in content experts to act as our selection committee to make sure we had the best field possible.
This year, we have a number of further improvements. The primary complaint last year was seemingly arbitrary way the winners of each match up were determined, basically it was a system we called “Matt and Joel decide.” Not surprisingly people were not enamored with this system and this year we have deputized a blue ribbon panel of nephrology experts to make the decisions.
We are also getting better at producing the brackets themselves and filling out the field. We now have written on 192 concepts since we started NephMadness. We have seen that the best match-ups pit related concepts up against each other and we have really increased the use of that technique in this year’s brackets. In addition we have themed the entire tournament as nephrology’s interaction with other specialties.
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| Download a PDF of the brackets |
We have also changed the schedule. The first two years we tried to track the schedule of March Madness as closely as possible. This meant we opened the brackets on Selection Sunday and closed them a week later. This year we opened the brackets on March 1 and accept submissions for 3 weeks, until March 22. This will, hopefully, increase participation.
Another area of improvement is in the Tourneytopia rollover descriptions. Last year we just copied the scouting reports from AJKDblog and pasted them in to the roll overs. They had a bunch of links and were really long. This resulted in really long descriptions that were difficult to read in the rollovers. This year we have a short 2-3 sentence description for the rollovers written solely for that purpose. Oh and a picture.
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| Go to Tourneytopia to submit your brackets for NephMadness |
Last year we had a confusing collection of three sites, Tourneytopia, NephMadness.com and AJKDblog. This year we jettisoned NephMadness.com and completely redesigned AJKDblog to be a much more effective container for NephMadness. The editorial staff at AJKD really did an outstanding job with the redesign.
This year the journal, AJKD, is really behind the contest. The Feb and March issues of AJKD had pack ins to promote the contest.
And the journal website has two high profile ads for NephMadness.
The last change is we are partnering with MedScape, a long time partner with the NKF and AJKD to promote NephMadness. Medscape is republishing all the content from the scouting reports and e-mailing their audience.
At St John Hospital and Medical Center we are having all of our fellows and faculty complete their own brackets and then we will have a consensus conference and build a collective entry to see if we can do better as a pit crew or as lone cowboys (and cowgirls).
I have been involved in Nephrology social media for years now, and it has been rewarding seeing the global community of nephrologists connect and develop a voice over that time.
While social media in general and Twitter in particular was once thought of as a time waster, it is now recognized as critical communication channel that allows back and forth communication as well as side to side communication.
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| First order communication: traditional top down |
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| Second order communication: back and forth |
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| Third order communication: back and forth and side to side |
The side to side communication is what builds the community and is what twitter excels at. Imagine how boring the NephJC chats wold be if the only communication you saw was from the NephJC host? The whole point of the chat is to leverage the diversity of expertise in the crowd.
Improving albumin levels among hemodialysis patients
Last week I delivered my grand rounds to both St John Hospital and Providence Hospital. This grand rounds on Kayexalate and the new therapies to increase colonic potassium clearance. Take a look. I hope you enjoy. I have more to say about this talk, and hopefully I will do a directors commentary of the presentation. I have 99 problems but have no for that time now.
Potassium Wars, The Native Keynote file (431 mb) Alternative link.zip (307 mb)
Potassium Wars, The PDF of the Keynote (184 mb)
Potassium Wars, The Movie, It’s almost like being there (1.05 gb)
Or stream it:
K wars, The Movie from joel topf on Vimeo.
Case 1: Mitchell H. Rosner (Discussant)
A 60 year-old man with a history of a heart transplant and stage 4 CKD was diagnosed with a gout flare 6 days ago and was prescribed prednisone, 30 mg daily; allopuri- nol, 100 mg daily; and colchicine, 0.6 mg three times daily, for the first 2 days and then colchicine, 0.6 mg twice daily thereafter. Before the gout attack, the patient had been feel- ing well and his baseline creatinine was 2.9 mg/dl with an eGFR of 29 ml/min per 1.73 m2. Other medications in- cluded mycophenolate mofetil, cyclosporine, pravastatin, carvedilol, calcitriol, and furosemide.
After 48 hours of taking the allopurinol, colchicine, and prednisone, the patient developed nausea, intermit- tent vomiting, and profuse diarrhea. This continued in- termittently over the next 2 days. However, during the past 2 days, he has developed worsening lethargy; muscle aches; and continued nausea, diarrhea, and abdominal pain. His family brings him to the emergency depart- ment (ED).
In the ED, he was found to be confused, tachycardic, and hypotensive, with a BP of 76/42 mmHg and pulse of 120
Question 2a
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| FourSquare, remember when that was a thing? |
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| Burton Rose |
Mark Parker, the chair of the ASN Workforce Committee, will be on Twitter next Tuesday to discuss the latest report. This report is the second done by Ed Salsberg and his colleagues at GWU. This report is all about the fellow experience in getting a job.
The report is available here.
Dr. Parker answered some questions to stoke the fires of discussion, that interview can be seen on Medium.
ASN Nephrology Workforce Report
The first workforce report stimulated some discussion on Twitter, that discussion is saved here:
A summary of the discussion about the second report so far is available here:
USMGs had a median debt of $100,000 to $149,999. IMGs were significantly different with a median debt of $0 and 65% having no debt.
Career plans
Nephrology breaking barriers, has higher starting salaries for women compared to men:
Female respondents had a slightly higher median anticipated base income than male respondents, who had a median anticipated base income of $150,000 to $174,999.
Job hunting troubles were much more common among IMGs with only 22% finding a satisfactory job compared to 56% of USMGs. Visa problems and unappealing locations were leading problems in job hunting. 71% reported no or very few jobs within 50 miles of their training location.
Happily 72% of respondents indicated they would recommend nephrology to medical students and internal medicine residents.
It’s an interesting report, take a look and…
Please join Dr. Parker to talk about #NephWorkForce Tuesday, January 13 at 9pm
In February I’m giving grand rounds on the Potassium Wars (what, you didn’t realize we are in the opening stages of the potassium wars?). I was looking at the original research on Kayexalate from 1961 and came across this ad. Check out the doses of spironolactone they were slinging:
