Live Tweeting lectures

Social media in health care is a fascinating and rapidly mutating field. One of things that makes it so interesting is that just as we start to master one set of tools, new ones arrive. Twitter is the latest tool to catch fire in the Healthcare Social Media arena. The real time nature of Twitter and the ability to have conversations with colleagues around the world is one of the most globe-shrinking experiences in which I have ever participated.

Twitter is great for exchanging single ideas and single sentences, but as the thought becomes more complex, the elegance of Twitter breaks down. People are forced to send tweet after tweet to express an idea. As the tweet stream begins to lengthen, it should becomes obvious that Twitter is not the right tool for the job. We do not live in a world with only hammers.
The quintessential example of this is the trend to “Live Tweet” meetings. Sometimes this is appropriate. For example when the meeting contains breaking news. This happens at the Late Breaking Clinical Trials session at Kidney Week. Here the presenters are providing the world with its first glimpse at new information. I remember live tweeting the Bardoxolone results 6 months before they were published in the NEJM. That however is not what we tend to see with people live tweeting a meeting. Usually it is a string of hopelessly unintelligible tweets trying to express the words, images, references and ideas of a presenter in 140 characters (actually it is never 140 characters because no live tweet is complete without the obligatory meeting hashtag, #KidneyWeek12)
I have heard people defend live tweeting as a way of keeping notes for a meeting. It’s great that you are taking notes but if you think that twitter is as good way to archive information, you must be new here. Old tweets regularly disappear from the Twitter database or become functionally unobtainable within a few weeks. Writing your notes on the back of a business card that you stick to the coffee house bulletin board would be a more reliable way to archive your thoughts. Additionally, if you are taking notes, why go through the overhead of parsing them into 140 character thoughts and posting them?
In the end, live-tweeting a meeting seems intellectually lazy. I think it is great for participants to take notes, think about the speakers and post their summaries or conclusions to the internet. I just feel that Twitter is a terrible way to do it. If you want to post longer thoughts, careful notes or thoughtful conclusion, it sounds like you might like blogging.

On the other hand if you want to make snarky side comments about the use of Comic Sans in the presentation Twitter is the perfect tool.

Pot meet Kettle. Kettle meet pot:
I have agreed to live Tweet Med 2.0’12 in September for eAJKD. I am going to try and filter my tweets and use the tool rationally. I want to pair a modest bolus of tweets with short individual posts for each session in which I participate.

OUWB MS2 Renal Section Course Materials

I am teaching at the Oakland University Beaumont Medical School in August. Here are the lecture materials I used.

Sodium and Water PDF (for medical students, longer than the hand out of the same name I use for third years). This is the 40+ page handout for the TBL on sodium and water. Here is the file from pages in case you wanted to fix some of my typos: Pages

Acid Base Long-ass lecture PowerPoint (3 hours of Acid-Base fun)

Acid Base hand out for workshop pdf | pages

NAGMA Cases this is the brief powerpoint of NAGMA cases as part of the Acid-Base workshop

Excel table for doing Henderson-Hasselbalch, anion gap and adjusted sodium. Useful if you need to rite a lot of acid-base problems and you are stickler for ABGs that are, you know, possible.

Fluids and Electrolyte Companion This is a 500 page opus I wrote a decade ago. Most of the pictures and concepts that I taught from come right from this book. The acid-base section holds up pretty well, as does the potassium section. The Sodium section is a bit more variable.

How well do you know the nephrology blogosphere?

I was reading Andrew Sullivan’s The Daily Dish the other day and came across this blurb:

The current Ryan budget will impact today’s seniors immediately, due to its cuts to Medicaid. I blog about dialysis; here’s how the Ryan budget plays out in the provision of dialysis:

The blurb is from an e-mail and Sullivan does not name the author or give a link back. You should read the whole post. It is well written and very clear. The author opened my eyes about the importance of Medicaid to incenter dialysis.

After I finished it, I wondered who the author was. After a minute I sent off an e-mail to my best guess and today I received an e-mail telling me I was right.

Can you guess the author. Put your guess in the comments.

Kidometer is out!

For the last few months my partner and I have been working on an application for the iPhone. We finished it last week and now its available in the App Store!

The application is for pediatricians or any health professional who works with kids. Its called the Kidometer and it is a database of age-based normals. In pediatrics everything changes with age, from the normal range for alkaline phosphatase to the proper size of a laryngoscope blade to the appropriate advice to a parent to keep the tot safe. All of that information is available to the user of Kidometer instantly.

Chek out Kidometer.com for further details or better yet shoot us a few bucks by trying it out.

Custom dialysate solutions

I get nervous when I need to dialyze someone who is severely hyponatremic. Dialysis has the power to change the sodium concentration very fast. Patients with chronic, compensated hyponatremia need their sodium corrected slowly. Experts recommend increasing the sodium by less than 12 mEq/L/day and to actually undertarget only 6 mEq/L/day to give you some margin for error.

Over the week-end we were consulted on a patient with a sodium of 106 and acute renal failure. By the time we were forced to dialyze the patient the sodium was up to 112. To do this safely we selected CVVHD and then diluted our dialysate down to 120 mEq/L.

Here is a Keynote (100 mb), PDF (155 kb) and a narrated version of that presentation (118 mb) where I walk through the algebra on how to mix a dialysate of any final sodium concentration.

The movie available for download is very high quality. Below is a YouTube conversion of that video to save you the 118 mb download.

This is some serious Sodium Jujitsu and I awarded my team the first Nephrology Merit Badge: Sodium Ninja (pages | pdf). Designed for Avery 5163 2×4 labels.

Nephrology Merit Badge, updated for the 21st century as a sticker for your iPad

PBFluids breaks into the medical literature.

The first time PBFluids was referenced in the medical literature was in Matt Sparks’ article on nephrology internet resources.

Today I received an e-mail from Tom Oates. Apparently, when he is not researching the unique genetic predisposition of the WKY rat to crescentic glomerulonephritis he is an avid reader of both Hemodialysis International and PBFluids. He sent me this article in Hemodialysis International regarding the highest creatinine ever. The key sentence in the article:

Extremely high levels of serum creatinine have been reported in the literature.3 The highest level of serum creatinine reported was 37 mg/dL.3

So what is the highest previous creatinine reported in the literature? Well according to the author, Said Abuhasna, it’s 37 from this post at PBFluids. Nice to see blogs being included in the canon of medical literature. Though it would be even nicer if they spelled my name right.

The death of MobileMe and a whole mess of broken links at PBFluids–Updated

One of the best stories about Steve Jobs was his tirade is response to the MobileMe disaster.

He gathered the MobileMe team together and asked,

“Can anyone tell me what MobileMe is supposed to do?”
Having received a satisfactory answer, he continues,
“So why the f*** doesn’t it do that?”

He then picked another executive to run the project on-the-spot. Ultimately, this resulted in the service being shuttered and replaced with iCloud.

I never had any problems with MobileMe; it always worked fine for me. However, I foolishly relied on it to host files for PBFluids. This includes all of the presentations and handouts that are the highest trafficked pages of the site. Well, MobileMe stopped accepting new subscriptions a year ago and as of June 30th the hosted files are no longer accessible. I have downloaded all of the material and will start re-uploading the files to DropBox.  The problem is rewiring all of the past links to the new file locations. This will take some time.

As I looked through the collection of files that used to be hosted at MobileMe I found a lot of journal articles and other copyrighted works. I have no idea how popular these links were but I remember when I uploaded them, PBFluids was a lonely backwater, where I was the sole source of traffic. I put the files the files online for my own use in teaching and on rounds. I don’t plan on replacing these files.

Update: 
7/3/12 Lecture tab is ported to DropBox
7/3/12 Handout tab is ported to DropBox through Adventures in Renal Imaging
7/5/12 Handout and Book tabs ported to DropBox

July 3, first lecture of the year

For the past few years I have had the honor of giving the July 1st morning lecture for the internal medicine residents at St John Hospital and Medical Center. Unfortunately, July 1st was a Sunday and Monday mornings are dedicated to a formal sign out rounds in our division. So July 3rd was my first lecture.

I gave my Fluids, Diuretics and Sodium for the Terrified Intern lecture. You can down load it here: