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Non-anion gap Metabolic Acidosis

Non-anion gap metabolic acidosis (Powerpoint, PDF)
  • Case-based
  • 70 slides, 1 hour
  • Revised May 2013
  • Now optimized for App.GoSoapBox
  • Now available as a screencast.
  • In your chloride intoxication group of causes, add TPN
  • In your GI loss of HCO3, “change HCO3 to HCO3 precursors” since what we lose in diarrhea is not HCO3 per se since pH of the stool is not acidic, we lose citrate, etc which transform into HCO3 eventually
  • Interesting comment on renal bicarb loss: I would add an extra group and call it decrease renal NH4+ excretion and add distal RTA, renal insufficiency and hypoaldosteronism. You don’t lose HCO3 in distal RTA or hypoaldosteronism. You could argue that NH4+ synthesis in proximal tubule generates “new HCO3” but the student will get lost in that concept
  • In the renal HCO3 loss group I would add post-treatment of DKA, and post-hypocapnia
  • Toluene can cause both anion gap and non anion gap metabolic acidosis but the non anion gap is more common because the unmeasured anions are rapidly excreted by the kidneys
  • Pentamidine also blocks ENaC and can cause hyperkalemia
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Lecture: Social Media and Health Care

Social Media and Healthcare (Keynote)
  • Huge slide deck that can be mixed and matched for use with different audiences
  • 639 MB for the Keynote file and 62.6 mb for the PDF
  • Find references, links and meta information here.
  • Alternate form of the lecture for a transplant audience (Keynote | PDF)
    • This was an audience of social workers, nurses, transplant recipients, and policy experts.
    • Lecture is cut down to 30 minutes
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Clay Shirky on publishing

Saw this on Twitter (thanks Brian):

I retweeted it, but sometimes a retweet is not enough.

 

Publishing is not evolving. Publishing is going away. Because the word “publishing” means a cadre of professionals who are taking on the incredible difficulty and complexity and expense of making something public. That’s not a job anymore. That’s a button. There’s a button that says “publish,” and when you press it, it’s done.

–Clay Shirky

It’s so good I think I will publish it, and by that I mean press a button:

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Two more NephTalk Podcasts

I was given the opportunity to work with Satellite Healthcare on their NephTalk podcast and hosted three episodes. The first one, on infection in dialysis units, was posted via RSS and picked up by iTunes. But the next two episodes I hosted were not posted to the RSS feed and so won’t show up in your podcast player of choice (by which I mean Overcast).

So you you’ll have to listen to them like your grand father did, as he walked to school bare foot, through the snow, uphill, both ways, via a web player. Sorry.

Joel Topf, M.D. interviews Steven D. Weisbord, M.D., lead researcher on a study recently published in the New England Journal of Medicine.

Joel Topf, M.D. interviews Linda F. Fried, M.D., lead researcher on a study recently completed for the U.S. Department of Veterans Affairs.

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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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New to Twitter? Here is a short course on counting Tweets

One of the things that is intoxicating about social media is watching  how many people see, interact and respond to your content. This is at the heart of the difference between the little red circle on Twitter (dopamine!) versus the the little red circle on Mail (dread!).

Tracking likes and Retweets

The simplest analytics are shown below the tweet and anyone can see them.

This tweet from new NSMC intern Dr. Dave has 5 retweets and 28 likes.

Impressions and Engagements

The next level of analytics can only done one’s own tweets. Select one of your tweets, preferably one with a picture or a link, or both, and press “View Tweet activity”

This opens up a panel that reveals two new analytics: Impressions and Total engagements.

Impressions are a bit confusing. Here Impressions represent the number of people the Tweet was actually displayed to. So someone that was scrolling through twitter and this tweet passed her eyes would add one to the impression. This is very different than how that same term is used by Symplur (see below).

Engagements are the total number of people who have interacted with the tweet in some way. Click View all engagements to see what that means.

Twitter does a nice job of tracking and breaking down the elements that make up engagements.

Analyzing Your Twitter account

The next level in analytics is looking at your twitter account. Make sure you are logged into your twitter account on the web and then type in https://analytics.twitter.com

The analytics page has an explosion data. The top gives you your 28 day trend for Twitter.

January is not looking like a good month for me.

There is a menu of additional pages of information. The only one that I find useful is Tweets. More on that later.

Scrolling down you see a summary of every month you have been on Twitter Actually I’m not sure how far it goes back, but pretty far. For each month it tells you:

  1. Your Top Tweet. The tweet from that month with the most impressions
  2. Your Top media Tweet. The tweet with an embedded picture, video, gif, or poll(?) with the most impressions (if your Top Tweet has attached media, the Top Media Tweet will be the tweet with the second most impressions)
  3. Top Follower. The Twitter account that followed you that month with the most followers. Some of my months don’t list a top follower. I wonder if that is because that person no longer follows me? (And no I don’t know why Follower is capitalized)
  4. Top mention. The Tweet that mentioned you that garnered the most impressions that month.
Nothing dispels the notion that number of followers translates to interesting person faster than scrolling through your history of Top Followers. They are rarely someone interesting. Not you Soledad, I think you are very interesting, I’m talking about other people.

Next to these four pieces of information is a summary of your use of Twitter that month. I find it interesting to scroll through and see how your Twitter activity climbs and falls month to month.

Now click on Tweets at the top of the page (between Home and Audiences)

At the top Twitter shows you a histogram with the number of tweets (grey) and impressions (blue). On the right rail there are a series of histograms with the daily count of some of the components that make up engagements.

The bulk of the page is a collection, in reverse chronologic order, of all of your Tweets for the month. If you want to look at another time period you can do that with the date picker in the top right corner of the page. For each tweet you can see impressions and engagements and the rate (engagements/impressions). For each tweet you can click to reveal the full breakdown of engagements.  You can sort and filter the list by pressing Top Tweets and get a short list of your top Tweets.

There are a few more tabs to explore in Analytics, but I have not found them useful.

Hashtag Analytics

At the end of every #NephJC and #AskASN, Matt and I race to see who can post the analytics for the chat first. To do this we are taking advantage of a service called Symplur. Symplur tracks all health hashtags. If you come up with a new health hashtag for a conference, you should go to Symplur and register that a hashtag. To use Symplur, go to their homepage and click on the magnifying glass and enter your medical hashtag.

Then click on #NephJC in the search result page. This take you to the #NephJC page in Symplur.

Ignore the schedule in Symplur, NephJC moves around inside the month enough that they never have it right. To get the Symplur analytics for an event you need to scroll to the bottom of that page, use the date picker to select the time you are interested in and press Get Analytics.

This will give you the analytics for that time period. Here is the analytics for the ACC/AHA Hypertension chat on January 16th.Mentions is the number of times a person on Twitter was mentioned along side the hashtag in question (#NephJC in this case). Tweets is the number of tweets composed by the individual which contains the hashtag. And then there is Impressions. These impressions are not the same as the impressions that Twitter tracks. Twitter impressions are real. Symplur impressions are a lie. Symplur impressions are the number of tweets multiplied by the number of followers the author has. Since I have 11k followers, each of my tweets increases my impression count by 11k. Impressions rack up gaudy numbers fast and often a larger conference will have impression counts in the 100s of millions. This is absurd. Do not believe impressions. Matt and I, when we tweet the analytics for the chat, edit out impressions. However in one of our publications we did publish impression counts for NephJC. Matt swears it wasn’t him and I swear it wasn’t me but it’s in there. Sorry.

That’s the basics on Twitter analytics. A number of people have developed more advanced analytics that you might want to explore but I have not found that they add much witter experience. This is enough for me. Your mileage may vary.