#JHMChat Transcript

Healthcare social media transcript of the #JHMChat hashtag.
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J Hospital Medicine @JHospMedicine
Welcome to our 3rd #JHMChat for @jhospmedicine - pls introduce yourself and remember to tag all your tweets #JHMChat tonight
J Hospital Medicine @JHospMedicine
Special welcome tonight to author @KurtPfeifer who is one of the authors of updates in #periop medicine for @JHospMedicine #JHMChat
MedscapeChat @medscapechat
This is Tejas Desai, @nephondemand, tweeting for @MedscapeChat tonight. #jhmchat
Costs of Care @CostsofCare
RT @JHospMedicine: 1h til #JHMChat on updates in #periop medicine w @KurtPfeifer @FutureDocs - join us 9p ET https://t.co/sPbVCnHxXE
Robert J. Mahoney, MD @mahoneyr
Joining #JHMChat from delightful St. Louis, MO
Kurt Pfeifer @kurtpfeifer
Great to be on with @JHospMedicine! Looking forward to awesome discussion about the fun & challenges of periop! #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @KurtPfeifer: Great to be on with @JHospMedicine! Looking forward to awesome discussion about the fun & challenges of periop! #JHMChat
J Hospital Medicine @JHospMedicine
This is the article for today's #JHMChat - Updates in #periop medicine by @KurtPfeifer and colleagues https://t.co/9A9xBjLkDk
Charlie M. Wray @WrayCharles
Joining #JHMChat from snowy(!) Chicago
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: Great to be on with @JHospMedicine! Looking forward to awesome discussion about the fun & challenges of periop! #JHMChat
ABIM Foundation @ABIMFoundation
RT @JHospMedicine: Special welcome tonight to author @KurtPfeifer who is one of the authors of updates in #periop medicine for @JHospMedicine #JHMChat
J Hospital Medicine @JHospMedicine
@MedscapeChat @nephondemand @MedscapeChat Welcome back to #JHMChat - great to have you! July will be hypertension FYI
Society of Hospital Medicine @SocietyHospMed
And, we're live with #JHMChat! https://t.co/uxrjxg5VzU
J Hospital Medicine @JHospMedicine
RT @SHMLive: And, we're live with #JHMChat! https://t.co/uxrjxg5VzU
Kapil Mehta @kapm23
Joining #JHMChat from Indy @laurelfick
Sunil K Sahai MD @drsunilksahai
#JHMChat trying to listen in from the home of the #FinalFour #Houston!
Malvinder Parmar @wittykidney
Malvinder Parmar from Ontario, Canada no COI #JHMChat
J Hospital Medicine @JHospMedicine
T1 up in a moment #JHMChat - welcome #periop community members, fellow hospitalist & others. remember to tag your tweets #JHMChat
Brandon Hill @07g35s
Let's do this! #JHMChat
J Hospital Medicine @JHospMedicine
RT @07g35s: Let's do this! #JHMChat
Robert J. Mahoney, MD @mahoneyr
Thank goodness. Thought my timing was off. July will be fascinating as well. @JHospMedicine @MedscapeChat @nephondemand #JHMChat
J Hospital Medicine @JHospMedicine
@DrSunilKSahai Glad we made it on your radar tonight! welcome #JHMChat
J Hospital Medicine @JHospMedicine
@wittykidney welcome to our international colleagues as well #JHMChat
Society of Hospital Medicine @SocietyHospMed
Are you ready to talk #periop? #JHMChat https://t.co/RtB6IfN0Wp
MedscapeChat @medscapechat
And we're working with NOD Analytics tonight to bring you realtime Twitter data about this chat #jhmchat
J Hospital Medicine @JHospMedicine
Lots of Midwestern tweeters representing - @futuredocs here in Chicago where it is indeed snowing like @charliewray writes #JHMChat
Rachel Thompson @rthompsonmd
Signing in from Omaha tonight #JHMChat
J Hospital Medicine @JHospMedicine
@MedscapeChat thank you - we are grateful for your analytic help #JHMChat
Daniel Wolfson @WolfsonD
#JHMChat Glad to be participating w @SHMLive @FutureDocs @ABIMFoundation #choosingwisely Important topic of perioperatve care
J Hospital Medicine @JHospMedicine
T1 in updates in #Periop med, @KurtPfeifer et al rec NO routine periop beta blockade. is this controversial why or why not? #JHMChat
J Hospital Medicine @JHospMedicine
RT @WolfsonD: #JHMChat Glad to be participating w @SHMLive @FutureDocs @ABIMFoundation #choosingwisely Important topic of perioperatve care
MedscapeChat @medscapechat
T1: great question about beta-blockade. POISE suggests ⬆︎risk of CVA & mortality. Confuses the picture #jhmchat
Kurt Pfeifer @kurtpfeifer
I think periop B-blockers is maybe less controversial now. Current guidelines fall more in line with rational clinical practice #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: I think periop B-blockers is maybe less controversial now. Current guidelines fall more in line with rational clinical practice #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: T1 up in a moment #JHMChat - welcome #periop community members, fellow hospitalist & others. remember to tag your tweets #JHMChat
Kurt Pfeifer @kurtpfeifer
Use common sense, not rigid thinking, with BB #JHMChat
Robert J. Mahoney, MD @mahoneyr
T1 definitely controversial in that it was considered canonical not too long ago @JHospMedicine @KurtPfeifer #JHMChat
Rachel Thompson @rthompsonmd
? to @KurtPfeifer, #JHMChat: what was your personal favorite finding in your review
J Hospital Medicine @JHospMedicine
T1 live on #JHMChat- join @futuredocs @kurtpfeifer @SHMLive & others as they discuss improving value in #periop med #choosingwisely
Vinny Arora MD MAPP @FutureDocs
T1 live on #JHMChat- join @futuredocs @kurtpfeifer @SHMLive & others as they discuss improving value in #periop med #choosingwisely
Society of Hospital Medicine @SocietyHospMed
We're glad you're joining us for #JHMChat once again - welcome! https://t.co/oBIcj2melZ
Society of Hospital Medicine @SocietyHospMed
Our #JHMChat on #periop med is LIVE now - don't forget to include the hashtag #JHMChat in your tweets! #perioptalk #periopmed #periopcare
J Hospital Medicine @JHospMedicine
Great question! RT @RThompsonMD ? to @KurtPfeifer, #JHMChat: what was your personal favorite finding in your review
Malvinder Parmar @wittykidney
T1- peri-op beta blockers, if need to given pt should be on for few days b4 surgery, not to start on day of surgery #JHMChat
Society of Hospital Medicine @SocietyHospMed
T1 ready to roll! Don't forget to include #JHMChat in your tweets! https://t.co/pKt0tT6ZVs
Kurt Pfeifer @kurtpfeifer
@RThompsonMD That briding for lack of a better word is usually bad. It's such a pain - to us & our pts #JHMChat
MedscapeChat @medscapechat
T1: definitely a surprising amount of hypotension, bradycardia in POISE @JRKnightMD #jhmchat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: T1 live on #JHMChat- join @futuredocs @kurtpfeifer @SHMLive & others as they discuss improving value in #periop med #choosingwisely
J Hospital Medicine @JHospMedicine
@KurtPfeifer @RThompsonMD that's great- wait for T3!! we will get to bridging and BRIDGE I promise! #JHMChat
J Hospital Medicine @JHospMedicine
RT @MedscapeChat: T1: definitely a surprising amount of hypotension, bradycardia in POISE @JRKnightMD #jhmchat
J Hospital Medicine @JHospMedicine
RT @wittykidney: T1- peri-op beta blockers, if need to given pt should be on for few days b4 surgery, not to start on day of surgery #JHMChat
Charlie M. Wray @WrayCharles
@JRKnightMD @MedscapeChat You are correct James, it was 200mg - as the initial dose. some thought this might have masked sepsis...#JHMChat
J Hospital Medicine @JHospMedicine
@Kurtpfeifer? RT @JRKnightMD @MedscapeChat I felt like Poise started with an excessive dose of metoprolol. Is there any newer data? #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Great question! RT @RThompsonMD ? to @KurtPfeifer, #JHMChat: what was your personal favorite finding in your review
J Hospital Medicine @JHospMedicine
RT @WrayCharles: @JRKnightMD @MedscapeChat You are correct James, it was 200mg - as the initial dose. some thought this might have masked sepsis...#JHMChat
Malvinder Parmar @wittykidney
From Dec15 review #JHMChat https://t.co/S6Cb0qMrwg
ABIM Foundation @ABIMFoundation
RT @WolfsonD: #JHMChat Glad to be participating w @SHMLive @FutureDocs @ABIMFoundation #choosingwisely Important topic of perioperatve care
Rachel Thompson @rthompsonmd
certainly high dose BB associated with bad outcomes; more concerning finding has been BB withdrawal in my opinion #JHMChat
J Hospital Medicine @JHospMedicine
@RThompsonMD can you elaborate #JHMChat?
MedscapeChat @medscapechat
#JHMChat Did POISE use too high a 💊 dose of metoprolol?
J Hospital Medicine @JHospMedicine
RT @MedscapeChat: #JHMChat Did POISE use too high a 💊 dose of metoprolol?
J Hospital Medicine @JHospMedicine
Great question what do tweeters think? RT @MedscapeChat #JHMChat Did POISE use too high a 💊 dose of metoprolol?
J Hospital Medicine @JHospMedicine
Great question what do tweeters think? RT @MedscapeChat #JHMChat Did POISE use too high a 󾔊 dose of metoprolol?
Rachel Thompson @rthompsonmd
#JHMChat - BB not continued in those already taking associated with increase periop risk and mortality
Daniel Wolfson @WolfsonD
#JHMChat Wondering if there are cascade effects of perioperative & what we know. @SHMLive #choosingwisely
Malvinder Parmar @wittykidney
T1 there is role, if pt already on, continue; reduces peri-op non-fatal MI, possibly reduces peri-op risk of Afib, #JHMChat
Kurt Pfeifer @kurtpfeifer
Most of the evidence about BB comes from the large POISE trial which gave large doses of BB a couple hours before surgery #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: Most of the evidence about BB comes from the large POISE trial which gave large doses of BB a couple hours before surgery #JHMChat
J Hospital Medicine @JHospMedicine
Great answers on T1 - keep them coming. T2 up in a moment. #JHMChat
Charlie M. Wray @WrayCharles
What do you think? Is Metop 200mg starting dose too high? #JHMChat https://t.co/1mKTHmVpi9
Kurt Pfeifer @kurtpfeifer
Not surprising pts in POISE got brady & hypotensive - totally agree with takeaway that need time to titrate BB - as with all meds #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Great question what do tweeters think? RT @MedscapeChat #JHMChat Did POISE use too high a 󾔊 dose of metoprolol?
Rachel Thompson @rthompsonmd
#JHMChat POISE had broad inclusion criteria; 200mg given as 100 and repeat dose if VS stable within hours of surgery
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: Not surprising pts in POISE got brady & hypotensive - totally agree with takeaway that need time to titrate BB - as with all meds #JHMChat
MedscapeChat @medscapechat
T1: any ideas why DECREASE showed different results than POISE, especially with all-cause death? #jhmchat
J Hospital Medicine @JHospMedicine
RT @WrayCharles: What do you think? Is Metop 200mg starting dose too high? #JHMChat https://t.co/1mKTHmVpi9
Society of Hospital Medicine @SocietyHospMed
RT @MedscapeChat: #JHMChat Did POISE use too high a 💊 dose of metoprolol?
Society of Hospital Medicine @SocietyHospMed
RT @WolfsonD: #JHMChat Wondering if there are cascade effects of perioperative & what we know. @SHMLive #choosingwisely
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Great answers on T1 - keep them coming. T2 up in a moment. #JHMChat
Robert J. Mahoney, MD @mahoneyr
Us old-timers remember 15y ago when beta-blockers were all the rage: https://t.co/OmGLe3qrE0 #JHMChat
J Hospital Medicine @JHospMedicine
T2 (1/2) in updates #Periop med, @KurtPfeifer et al rec NO bridging anticoag in AF patients because increased bleeding #JHMChat
MedscapeChat @medscapechat
#JHMChat Looks like the results are pretty unequivocal -- too high a dose of metoprolol in POISE https://t.co/9VIBMUEHcc
Kurt Pfeifer @kurtpfeifer
BB withdrawal remains a concern - ACC says to continue if already on them...BUT... #JHMChat
ABIM Foundation @ABIMFoundation
RT @Medscape: We're participating in #JHMchat w/@MedscapeChat, "As-needed intravenous antihypertensive therapy and blood pressure control" STARTING NOW!
Kurt Pfeifer @kurtpfeifer
Also it’s OK to hold BB if pt hypotensive or brady – not continue it at all costs because “guidelines say so” #JHMChat
Charlie M. Wray @WrayCharles
Definitely agree @KurtPfeifer, but #hospitalists often don't have the luxury of time to titrate #JHMChat @SHMLive https://t.co/uBNtioRxyN
J Hospital Medicine @JHospMedicine
LIVE NOW T2 (2/2) Is bridging anticoag still being used? how can we get the word out about the risks to change practice? #JHMChat
Rachel Thompson @rthompsonmd
BB should to be tailored to the individual; blanket 200mg dosing dangerous #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: BB withdrawal remains a concern - ACC says to continue if already on them...BUT... #JHMChat
J Hospital Medicine @JHospMedicine
RT @MedscapeChat: #JHMChat Looks like the results are pretty unequivocal -- too high a dose of metoprolol in POISE https://t.co/9VIBMUEHcc
Society of Hospital Medicine @SocietyHospMed
Time for T2! #JHMChat https://t.co/Hu8CdBWyxF
Kurt Pfeifer @kurtpfeifer
Metop 200 is probably too high unless you are quite large. POISE done that way due to logistics - wanted to assure adequate HR dec #JHMChat
J Hospital Medicine @JHospMedicine
RT @SHMLive: Time for T2! #JHMChat https://t.co/Hu8CdBWyxF
Dan Ambrus @ambrus07
@JHospMedicine BRIDGE compared 3 end points in one arm to 4 in the other. Not a valuable comparison!! #JHMChat
Malvinder Parmar @wittykidney
@RThompsonMD agree #JHMChat
Brandon Hill @07g35s
@KurtPfeifer continuation of home dose with periop hold parameters seems logical. #JHMChat
Rachel Thompson @rthompsonmd
T2 Bridging: would you ever recommend bridging periop #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: LIVE NOW T2 (2/2) Is bridging anticoag still being used? how can we get the word out about the risks to change practice? #JHMChat
Kurt Pfeifer @kurtpfeifer
Hospitalists definitely don't have days to titrate a BB - why we should rarely start one. #JHMChat
J Hospital Medicine @JHospMedicine
Would love to hear what folks are doing RT @RThompsonMD T2 Bridging: would you ever recommend bridging periop #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: Hospitalists definitely don't have days to titrate a BB - why we should rarely start one. #JHMChat
J Hospital Medicine @JHospMedicine
RT @07g35s: @KurtPfeifer continuation of home dose with periop hold parameters seems logical. #JHMChat
Dan Ambrus @ambrus07
@JHospMedicine BRIDGE also enrolled low risk patients who were getting low risk surgeries. #JHMChat
MedscapeChat @medscapechat
#JHMChat T2: great question. Do you rec'd bridging anticoagulation in light of the BRIDGE trial results?
Kurt Pfeifer @kurtpfeifer
Scenario when I start BB in hospital: admitted for limb ischemia - going to OR in 2-3 days. Hi risk pt & time to titrate. #JHMChat
Malvinder Parmar @wittykidney
@KurtPfeifer I rarely use this high dose in clinical practice. You want agent to fail, use disproportionate dose #JHMChat
J Hospital Medicine @JHospMedicine
RT @MedscapeChat: #JHMChat T2: great question. Do you rec'd bridging anticoagulation in light of the BRIDGE trial results?
Society of Hospital Medicine @SocietyHospMed
Chime in on the #JHMChat on #periop med in progress NOW! https://t.co/KV4M7M3MUo
Society of Hospital Medicine @SocietyHospMed
RT @MedscapeChat: #JHMChat T2: great question. Do you rec'd bridging anticoagulation in light of the BRIDGE trial results?
Dan Ambrus @ambrus07
@JHospMedicine Having said that, bridging for stroke prophylaxis in chronic afib doesn't make common sense, esp in low risk pts.#JHMChat
J Hospital Medicine @JHospMedicine
T2 live...Lets hear from @kurtpfeifer & others on why he recommends against bridging anticoag #JHMChat #periop
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Would love to hear what folks are doing RT @RThompsonMD T2 Bridging: would you ever recommend bridging periop #JHMChat
J Hospital Medicine @JHospMedicine
RT @SHMLive: Chime in on the #JHMChat on #periop med in progress NOW! https://t.co/KV4M7M3MUo
Kapil Mehta @kapm23
BRIDGE trial had only 26 patients with CHADSVASC > 4 #JHMChat Would this change your rec if more patients?
MedscapeChat @medscapechat
#JHMChat T2: If you're contemplating bridging anticoagulation, which scoring system do you use to risk-stratify?
Kurt Pfeifer @kurtpfeifer
@wittykidney Agree though I don't think they wanted it to fail. Rather it was only way to do trial & achieve adequate HR reduction #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: T2 live...Lets hear from @kurtpfeifer & others on why he recommends against bridging anticoag #JHMChat #periop
Society of Hospital Medicine @SocietyHospMed
RT @MedscapeChat: #JHMChat T2: If you're contemplating bridging anticoagulation, which scoring system do you use to risk-stratify?
Kurt Pfeifer @kurtpfeifer
Ahh...bridging. Bridging to nowhere that is. ORBIT-AF, Kaiser VTE cohort and BRIDGE all show same thing - bridging = bleeding #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: Ahh...bridging. Bridging to nowhere that is. ORBIT-AF, Kaiser VTE cohort and BRIDGE all show same thing - bridging = bleeding #JHMChat
Dan Ambrus @ambrus07
@JHospMedicine @KurtPfeifer BRIDGE also had wildly dodgy power calculations. A poor study in truth. But I agree with conclusions.. #JHMChat
Sjögrens Forum @SjogrensForum
RT @JHospMedicine: 1h til #JHMChat on updates in #periop medicine w @KurtPfeifer @FutureDocs - join us 9p ET https://t.co/sPbVCnHxXE
Rachel Thompson @rthompsonmd
for those with low to moderate risk for periop thrombotic event no benefit to periop bridging with anticoag #JHMChat; what about high risk?
Kurt Pfeifer @kurtpfeifer
@ambrus07 @JHospMedicine Yes, the power calculations shifted due to event rates being lower than expected #JHMChat
Robert J. Mahoney, MD @mahoneyr
There is much confusion about bridging for different diagnoses (afib vs DVT/PE), likely driven by the use of the same medications #JHMChat
J Hospital Medicine @JHospMedicine
RT @mahoneyr: There is much confusion about bridging for different diagnoses (afib vs DVT/PE), likely driven by the use of the same medications #JHMChat
MedscapeChat @medscapechat
#JHMChat The nephrologist in me is sad to see that no one uses the R2CHADS2 scoring system !!! 😂😂 https://t.co/QnuIHmUqTR
Kurt Pfeifer @kurtpfeifer
@ambrus07 @JHospMedicine However, I think they explained sufficiently & results concur with other evidence #JHMChat
Society of Hospital Medicine @SocietyHospMed
Lots to discuss about #periop care - join the #JHMChat now! https://t.co/Hu9pNkNWQo
Rachel Thompson @rthompsonmd
? to @KurtPfeifer; increased risk of bleeding; is it ever balanced by thrombotic risk? #JHMChat
Kurt Pfeifer @kurtpfeifer
@RThompsonMD Yes. Available evidence suggests bridging be reserved for those with highest thromb risk & reasonably low bleed risk. #JHMChat
J Hospital Medicine @JHospMedicine
T2a Is bridging still being used in #periop practice? how can we get the word out to reduce risk/improve value? #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @RThompsonMD: ? to @KurtPfeifer; increased risk of bleeding; is it ever balanced by thrombotic risk? #JHMChat
Kurt Pfeifer @kurtpfeifer
@RThompsonMD Think of bridging like you would think about sending someone with an EF <30% to the OR. Need to think twice… #JHMChat
MedscapeChat @medscapechat
#JHMChat Bridge or no bridge, I still think using the R2CHADS2 is better than "thumb in the air" :) https://t.co/CL7UIp1WIW
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: T2a Is bridging still being used in #periop practice? how can we get the word out to reduce risk/improve value? #JHMChat
J Hospital Medicine @JHospMedicine
Great question - remember to tag your tweets #JHMChat https://t.co/V40k1jWzvk
Kurt Pfeifer @kurtpfeifer
@RThompsonMD Decision needs to be individualized but in context of evidence that for most bridging is probably not the right answer #JHMChat
Robert J. Mahoney, MD @mahoneyr
It would take significant evidence to convince me that a 0.15% risk of stroke in a week (8% risk per year) warranted reduction. #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: @RThompsonMD Think of bridging like you would think about sending someone with an EF <30% to the OR. Need to think twice… #JHMChat
Charlie M. Wray @WrayCharles
It'd be nice to know who's recommending. Lots of perop clinic now run by anethesiologists #JHMChat https://t.co/EIz9L34b22
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Great question - remember to tag your tweets #JHMChat https://t.co/V40k1jWzvk
Dan Ambrus @ambrus07
@KurtPfeifer @JHospMedicine I presented BRIDGE to my group. Power calcs threw us all off. #JHMChat
Kurt Pfeifer @kurtpfeifer
@RThompsonMD Saw pt today (no lie) - saddle PE (2nd in 3 yrs) 2 mo ago who must have surgery for gyn cancer. That's one to bridge. #JHMChat
Robert J. Mahoney, MD @mahoneyr
And it would take even more evidence that I could reduce that risk safely, without inducing bleeding. #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: @RThompsonMD Saw pt today (no lie) - saddle PE (2nd in 3 yrs) 2 mo ago who must have surgery for gyn cancer. That's one to bridge. #JHMChat
Rachel Thompson @rthompsonmd
@KurtPfeifer Great example - saving bridging for HIGHEST risk only #JHMChat
J Hospital Medicine @JHospMedicine
@KurtPfeifer @RThompsonMD great example of individualization of the bridging recommendations #JHMChat
J Hospital Medicine @JHospMedicine
RT @RThompsonMD: @KurtPfeifer Great example - saving bridging for HIGHEST risk only #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: @RThompsonMD Yes. Available evidence suggests bridging be reserved for those with highest thromb risk & reasonably low bleed risk. #JHMChat
Robert J. Mahoney, MD @mahoneyr
The same statistics, interestingly, apply to blood pressure reduction (see July's chat). Makes sense over years, not days. #JHMChat
Kurt Pfeifer @kurtpfeifer
@ambrus07 @JHospMedicine Thromboemb rate was way lower than expected. That shows 1 weakness - ~80% low risk proc = low risk for TE #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: @ambrus07 @JHospMedicine Thromboemb rate was way lower than expected. That shows 1 weakness - ~80% low risk proc = low risk for TE #JHMChat
MedscapeChat @medscapechat
@RThompsonMD do you feel that the current scoring systems adequately identify the HIGHEST risk patients? #jhmchat
Dan Ambrus @ambrus07
@KurtPfeifer @JHospMedicine @RThompsonMD How long after VTE event would you consider no long high risk of provocation unclear? #JHMChat
J Hospital Medicine @JHospMedicine
Keep the conversation going on T2 bridging anticoag, T3 up in a moment #JHMChat #periop edition with @KurtPfeifer @SHMLive and others
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Keep the conversation going on T2 bridging anticoag, T3 up in a moment #JHMChat #periop edition with @KurtPfeifer @SHMLive and others
Rachel Thompson @rthompsonmd
@RebeccaEBerger #JHMChat I'd say most would say don't bridge Afib with CHADS 2 <4 at this point, would you agree @KurtPfeifer
Kurt Pfeifer @kurtpfeifer
Risk of recurrent VTE highest within 1st mo after event but remains elevated up to 3 mo after. Beyond 3 mo risk sig lower. #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: Risk of recurrent VTE highest within 1st mo after event but remains elevated up to 3 mo after. Beyond 3 mo risk sig lower. #JHMChat
Robert J. Mahoney, MD @mahoneyr
Does anticoagulation prevent thrombosis, or embolization? @ambrus07 @KurtPfeifer @JHospMedicine @RThompsonMD #JHMChat
J Hospital Medicine @JHospMedicine
T2b How you you identify high risk patients that need bridging? Do you use scoring systems? #JHMChat
Rachel Thompson @rthompsonmd
@JHospMedicine #JHMChat great systems question - many barriers, fear being the largest; need to educate about balancing fear of bleeding
Society of Hospital Medicine @SocietyHospMed
Glad you've joined us & @JHospMedicine for #JHMChat on #periop med! Don't forget to include the #JHMChat hashtag in all chat-related tweets!
Kurt Pfeifer @kurtpfeifer
@RThompsonMD @RebeccaEBerger I would make it CHADS <5. BRIDGE had few CHADS 5-6 but enough 4s to say it didn't help. #JHMChat
J Hospital Medicine @JHospMedicine
RT @RThompsonMD: @JHospMedicine #JHMChat great systems question - many barriers, fear being the largest; need to educate about balancing fear of bleeding
Dan Ambrus @ambrus07
@KurtPfeifer @JHospMedicine Shouldn't fewer available outcomes mean you need more subjects to show desired effect? #JHMChat
J Hospital Medicine @JHospMedicine
RT @SHMLive: Glad you've joined us & @JHospMedicine for #JHMChat on #periop med! Don't forget to include the #JHMChat hashtag in all chat-related tweets!
Rachel Thompson @rthompsonmd
@RebeccaEBerger @KurtPfeifer Got it! Don't bridge for fib CHADS2 <5 #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: T2b How you you identify high risk patients that need bridging? Do you use scoring systems? #JHMChat
J Hospital Medicine @JHospMedicine
RT @RThompsonMD: @RebeccaEBerger @KurtPfeifer Got it! Don't bridge for fib CHADS2 <5 #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: @RThompsonMD @RebeccaEBerger I would make it CHADS <5. BRIDGE had few CHADS 5-6 but enough 4s to say it didn't help. #JHMChat
Kurt Pfeifer @kurtpfeifer
@mahoneyr @ambrus07 @JHospMedicine @RThompsonMD Interesting question. Probably the former and hope that prevents latter. #JHMChat
J Hospital Medicine @JHospMedicine
Time for T3 on #JHMChat....
J Hospital Medicine @JHospMedicine
T3 (1/2) #periop update, @KurtPfeifer et al-> starting ASA not beneficial & assoc w bleeding #JHMChat https://t.co/5e1pqpwiu5
J Hospital Medicine @JHospMedicine
T3 (1/2) #periop update, @KurtPfeifer et al-> starting ASA not beneficial & assoc w bleeding #JHMChat... https://t.co/q5mtMKppqZ
J Hospital Medicine @JHospMedicine
T3 (2/2) But also suggests need to individualize recommendation. How can we reconcile evidence & practice for #Periop ASA? #JHMChat
Robert J. Mahoney, MD @mahoneyr
The problem w/VTE bridging studies is that it's hard to predict/prevent embolization as easily as predicting/preventing thrombosis #JHMChat
Society of Hospital Medicine @SocietyHospMed
Let's go! T3 time on #JHMChat https://t.co/EgpJMQ47WF
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: T3 (2/2) But also suggests need to individualize recommendation. How can we reconcile evidence & practice for #Periop ASA? #JHMChat
Kurt Pfeifer @kurtpfeifer
POISE2 tells us that starting an ASA naïve pt on high-dose ASA right before surgery & cont low dose doesn’t help #JHMChat
J Hospital Medicine @JHospMedicine
RT @SHMLive: Let's go! T3 time on #JHMChat https://t.co/EgpJMQ47WF
Society of Hospital Medicine @SocietyHospMed
RT @mahoneyr: The problem w/VTE bridging studies is that it's hard to predict/prevent embolization as easily as predicting/preventing thrombosis #JHMChat
Kurt Pfeifer @kurtpfeifer
POISE2 also showed that stopping ASA of chronic taker ~7 days before surgery & then giving high-dose 1-2 hrs before surgery was bad #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: POISE2 tells us that starting an ASA naïve pt on high-dose ASA right before surgery & cont low dose doesn’t help #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: POISE2 also showed that stopping ASA of chronic taker ~7 days before surgery & then giving high-dose 1-2 hrs before surgery was bad #JHMChat
Kurt Pfeifer @kurtpfeifer
POISE2 doesn’t tell us what happens if we cont lo-dose ASA through surgery. Smaller studies suggest this is OK & may be beneficial #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: POISE2 doesn’t tell us what happens if we cont lo-dose ASA through surgery. Smaller studies suggest this is OK & may be beneficial #JHMChat
Kurt Pfeifer @kurtpfeifer
Also POISE2 had very few stent pts and none with stenting within past 6 months #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @KurtPfeifer: POISE2 tells us that starting an ASA naïve pt on high-dose ASA right before surgery & cont low dose doesn’t help #JHMChat
Kurt Pfeifer @kurtpfeifer
Decision on periop ASA also needs individualization – especially since the evidence is more mixed #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: Decision on periop ASA also needs individualization – especially since the evidence is more mixed #JHMChat
ABIM Foundation @ABIMFoundation
RT @SHMLive: Glad you've joined us & @JHospMedicine for #JHMChat on #periop med! Don't forget to include the #JHMChat hashtag in all chat-related tweets!
Noble Maleque @nobility75
Staying up past my bedtime to follow along and learn more about perioperative medicine #JHMChat
MedscapeChat @medscapechat
Many surgeons won't touch patients who've taken aspirin 4 fear of intra-/post-op bleeding. Their experience seems 2 match the data #jhmchat
Society of Hospital Medicine @SocietyHospMed
Our guest expert on #periop med @KurtPfeifer weighing in now on #JHMChat - jump in the convo! https://t.co/MzOjJLS7Mf
J Hospital Medicine @JHospMedicine
RT @nobility75: Staying up past my bedtime to follow along and learn more about perioperative medicine #JHMChat
Robert J. Mahoney, MD @mahoneyr
Is the BRUISE trial useful? Continue anticoagulation around surgery and you control perioperative bleeding https://t.co/dxLS1akQ1M #JHMChat
Rachel Thompson @rthompsonmd
@nobility75 @JHospMedicine Love it! Happy Monday to you Noble! #JHMChat
Vinny Arora MD MAPP @FutureDocs
Individualization is a theme of #periop recs discussed #JHMChat tonight - how to ensure right care for right person right time
J Hospital Medicine @JHospMedicine
RT @SHMLive: Our guest expert on #periop med @KurtPfeifer weighing in now on #JHMChat - jump in the convo! https://t.co/MzOjJLS7Mf
Rachel Thompson @rthompsonmd
@KurtPfeifer in your opinion, why did PJ look at ASA in this way? #JHMChat
Robert J. Mahoney, MD @mahoneyr
Admittedly, BRUISE was a specific kind of (mildly invasive) surgery and a specific kind of anticoagulation. #JHMChat
MedscapeChat @medscapechat
#JHMChat Periop Aspirin therapy -- more apt towards yea or nay?
Society of Hospital Medicine @SocietyHospMed
That's what we like to hear! Trust us; it's worth it. (And there's always coffee in the morning!) #JHMChat #periop https://t.co/yWxDYpPeCb
J Hospital Medicine @JHospMedicine
RT @FutureDocs: Individualization is a theme of #periop recs discussed #JHMChat tonight - how to ensure right care for right person right time
Society of Hospital Medicine @SocietyHospMed
RT @mahoneyr: Is the BRUISE trial useful? Continue anticoagulation around surgery and you control perioperative bleeding https://t.co/dxLS1akQ1M #JHMChat
Noble Maleque @nobility75
Wonder how common the practice of ASA 325 BID for VTE prophylaxis is for Ortho surgery? And what that means for the aspirin data? #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @FutureDocs: Individualization is a theme of #periop recs discussed #JHMChat tonight - how to ensure right care for right person right time
Brandon Hill @07g35s
#JHMChat. The trend we are seeing in ortho is ASA 325 BID as standard recommendation. But as has been stated one size does not fit all
Robert J. Mahoney, MD @mahoneyr
But the theory is when you continue anticoagulation, you have a better chance of identifying and controlling bleeding sites intraop #JHMChat
Society of Hospital Medicine @SocietyHospMed
What do you think about this hot #periop topic trending on #JHMChat? https://t.co/KzztT7nvm0
Kurt Pfeifer @kurtpfeifer
@RThompsonMD R U tryin to get me in trouble with him?! Partly was to improve standardization by washing out low-dose #JHMChat
J Hospital Medicine @JHospMedicine
RT @MedscapeChat: #JHMChat Periop Aspirin therapy -- more apt towards yea or nay?
J Hospital Medicine @JHospMedicine
RT @SHMLive: What do you think about this hot #periop topic trending on #JHMChat? https://t.co/KzztT7nvm0
Kurt Pfeifer @kurtpfeifer
@RThompsonMD Study of just cont low-dose would have been more useful in my opinion but also would have been harder with 2x2 design #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: @RThompsonMD Study of just cont low-dose would have been more useful in my opinion but also would have been harder with 2x2 design #JHMChat
Rachel Thompson @rthompsonmd
@KurtPfeifer makes sense it's the design... #JHMChat
J Hospital Medicine @JHospMedicine
Thanks for participating reminder to use #JHMChat index tweets so we can see https://t.co/Lmidji8Dwp
Society of Hospital Medicine @SocietyHospMed
RT @nobility75: Wonder how common the practice of ASA 325 BID for VTE prophylaxis is for Ortho surgery? And what that means for the aspirin data? #JHMChat
MedscapeChat @medscapechat
#JHMChat here's some NOD Analytics to mix things up -- 🔥 hottest tweets in the last 40-or-so minutes https://t.co/43ymMkkZGs
Robert J. Mahoney, MD @mahoneyr
When the aspirin is dosed once-daily, is there actually a dose-dependent effect on platelets? https://t.co/RTeHyJ9A9B #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Thanks for participating reminder to use #JHMChat index tweets so we can see https://t.co/Lmidji8Dwp
Ji Baang @jbaang
@medscapechat Low risk nay. (POISE-2). High risk already on aspirin yea (ATACAS, ASA withdrawal, Oscarsson A et al 2010). #jhmchat
Society of Hospital Medicine @SocietyHospMed
RT @MedscapeChat: #JHMChat here's some NOD Analytics to mix things up -- 🔥 hottest tweets in the last 40-or-so minutes https://t.co/43ymMkkZGs
Kurt Pfeifer @kurtpfeifer
@jbaang @MedscapeChat Agree with Oscarsson study - it's been lost in the glow of POISE-2 - it showed benefit from cont low-dose ASA #JHMChat
J Hospital Medicine @JHospMedicine
Last ? for the night...What is greatest gap between recommendations & practice in #periop updates? How to fix #JHMChat @kurtpfeifer
J Hospital Medicine @JHospMedicine
Last ? for the night...What is greatest gap between recommendations & practice in #periop updates? How to fix #JHMChat @kurtpfeifer
Society of Hospital Medicine @SocietyHospMed
Have insight to share? Follow the #JHMChat hashtag & share your expertise. (Don't forget to include the hashtag!) https://t.co/eEkYO5yCQL
Kurt Pfeifer @kurtpfeifer
@jbaang @MedscapeChat That's really the ? all were asking - not does starting hi dose ASA right before surgery help! #JHMChat
Kurt Pfeifer @kurtpfeifer
@JRKnightMD Based on recent ATACAS & Oscarsson studies not sure we should stop if high ischemic risk #JHMChat
Robert J. Mahoney, MD @mahoneyr
Seems like the biggest gap between evidence and practice in perioperative med is preop testing for risk reduction. Even EKG's. #JHMChat
Society of Hospital Medicine @SocietyHospMed
There's still time to join the #JHMChat discussion happening now on #periop med - follow along! https://t.co/ct2qOeAOAm
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Last ? for the night...What is greatest gap between recommendations & practice in #periop updates? How to fix #JHMChat @kurtpfeifer
MedscapeChat @medscapechat
Last ?: I'd say a gap (not necessarily gr8est) is disseminating the latest information 2 the key players who influence periop care #jhmchat
J Hospital Medicine @JHospMedicine
RT @MedscapeChat: Last ?: I'd say a gap (not necessarily gr8est) is disseminating the latest information 2 the key players who influence periop care #jhmchat
Ji Baang @jbaang
@kurtpfeifer @medscapechat continued ASA on CABG patient undergoing a colectomy. Had to persuade surgeon. It will be a fight. #jhmchat
J Hospital Medicine @JHospMedicine
RT @mahoneyr: Seems like the biggest gap between evidence and practice in perioperative med is preop testing for risk reduction. Even EKG's. #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @mahoneyr: Seems like the biggest gap between evidence and practice in perioperative med is preop testing for risk reduction. Even EKG's. #JHMChat
Kurt Pfeifer @kurtpfeifer
@JRKnightMD If on for 2ndary prev, I would resume on POD#1 - the bleeding up to POD5 in POISE may have been due to hi dose preop #JHMChat
Rachel Thompson @rthompsonmd
@nobility75 #JHMChat I think that varies by institution a good bit. POISE2 ASA data no help w/ this I don't think; @KurtPfeifer, thoughts?
Vinny Arora MD MAPP @FutureDocs
Big focus of #choosingwisely @WolfsonD @ABIMFoundation #JHMChat https://t.co/9nN1hXY1EG
Society of Hospital Medicine @SocietyHospMed
RT @FutureDocs: Big focus of #choosingwisely @WolfsonD @ABIMFoundation #JHMChat https://t.co/9nN1hXY1EG
Kurt Pfeifer @kurtpfeifer
@jbaang @MedscapeChat It takes time to build rapport. Once U do, you find that surg & hospialists see eye-to-eye quite often #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: @jbaang @MedscapeChat It takes time to build rapport. Once U do, you find that surg & hospialists see eye-to-eye quite often #JHMChat
Robert J. Mahoney, MD @mahoneyr
Tough to teach housestaff preop eval on hospital pts when even the AHA guidelines only recommend testing "if it will change mgmt" #JHMChat
Daniel Wolfson @WolfsonD
RT @FutureDocs: Big focus of #choosingwisely @WolfsonD @ABIMFoundation #JHMChat https://t.co/9nN1hXY1EG
Kurt Pfeifer @kurtpfeifer
@MedscapeChat Many challenges in periop but also greatest opportunity to showcase how interdiscipl & collab medicine should be #JHMChat
J Hospital Medicine @JHospMedicine
5 min left in #JHMChat - please share your closing thoughts on how to improve #value in #periop care #choosingwisely #JHMChat
MedscapeChat @medscapechat
#JHMChat This chat has been terrific: so far 315 tweets from 40 unique authors https://t.co/C8uoMvLK0g
Brandon Hill @07g35s
@JHospMedicine opinions vary on the results/constructs of the studies and therefore the recommendations are poorly adopted #JHMChat
Society of Hospital Medicine @SocietyHospMed
Great insight from our guest #JHMChat expert, @KurtPfeifer! https://t.co/ysXc16UNsH
Malvinder Parmar @wittykidney
@mahoneyr almost a decade after CARP study published, did influence pre-op CV testing #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: 5 min left in #JHMChat - please share your closing thoughts on how to improve #value in #periop care #choosingwisely #JHMChat
J Hospital Medicine @JHospMedicine
RT @SHMLive: Great insight from our guest #JHMChat expert, @KurtPfeifer! https://t.co/ysXc16UNsH
J Hospital Medicine @JHospMedicine
RT @07g35s: @JHospMedicine opinions vary on the results/constructs of the studies and therefore the recommendations are poorly adopted #JHMChat
J Hospital Medicine @JHospMedicine
RT @MedscapeChat: #JHMChat This chat has been terrific: so far 315 tweets from 40 unique authors https://t.co/C8uoMvLK0g
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: @MedscapeChat Many challenges in periop but also greatest opportunity to showcase how interdiscipl & collab medicine should be #JHMChat
Kurt Pfeifer @kurtpfeifer
@DrSunilKSahai @jbaang @MDAndersonNews Depends on bleeding risk of surg - I continue for pts with recurrent/recent isch events #JHMChat
Ji Baang @jbaang
@jhospmedicine Not much we can do to improve outcome. So don’t do too much. Talk with patients. Most get it. #jhmchat
Malvinder Parmar @wittykidney
@mahoneyr error should be didn't #JHMChat
J Hospital Medicine @JHospMedicine
RT @mahoneyr: Tough to teach housestaff preop eval on hospital pts when even the AHA guidelines only recommend testing "if it will change mgmt" #JHMChat
Francie Pucharich @fpucharich
Interesting discussion, thanks #JHMChat
Robert J. Mahoney, MD @mahoneyr
CARP study was for vascular surgery? https://t.co/5lfvjZE7Ah @wittykidney #JHMChat
J Hospital Medicine @JHospMedicine
before you go, please use this link to tell us how #JHMChat went and how we can make it better! https://t.co/OZvqnZ3gq1 THANK YOU!
Kurt Pfeifer @kurtpfeifer
@07g35s @JHospMedicine They are also just that. Recommendations. Surgery is too heterogeneous to make lots of rigid recs. #JHMChat
J Hospital Medicine @JHospMedicine
Special thx to author @KurtPfeifer for joining #JHMChat & our partners@CostsofCare @ABIMFoundation @SHMLive for promoting!
Rachel Thompson @rthompsonmd
#JHMChat ~ 22% inpts are surgical - 2x more costly c/w medical; hospitalist knowledge and presence essential 4 high value care
Malvinder Parmar @wittykidney
@mahoneyr yes, patients were high risk #JHMChat
Society of Hospital Medicine @SocietyHospMed
Thanks for joining us for #JHMChat, @fpucharich! https://t.co/t6OxCgZh41
Luis Saldana @lsaldanamd
RT @MedscapeChat: #JHMChat This chat has been terrific: so far 315 tweets from 40 unique authors https://t.co/C8uoMvLK0g
Francie Pucharich @fpucharich
@SHMLive interesting discussion, thanks #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @jbaang: @jhospmedicine Not much we can do to improve outcome. So don’t do too much. Talk with patients. Most get it. #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: before you go, please use this link to tell us how #JHMChat went and how we can make it better! https://t.co/OZvqnZ3gq1 THANK YOU!
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Special thx to author @KurtPfeifer for joining #JHMChat & our partners@CostsofCare @ABIMFoundation @SHMLive for promoting!
Robert J. Mahoney, MD @mahoneyr
Seems like data differ between patients undergoing vascular vs nonvascular surgery. Most of our preops are nonvascular @wittykidney #JHMChat
Society of Hospital Medicine @SocietyHospMed
Thx to @JHospMedicine, @FutureDocs, @KurtPfeifer, @ABIMFoundation, @CostsofCare & all participants for another great #JHMChat!
J Hospital Medicine @JHospMedicine
RT @SHMLive: Thx to @JHospMedicine, @FutureDocs, @KurtPfeifer, @ABIMFoundation, @CostsofCare & all participants for another great #JHMChat!
Tom Varghese Jr. MD @TomVargheseJr
RT @FutureDocs: Big focus of #choosingwisely @WolfsonD @ABIMFoundation #JHMChat https://t.co/9nN1hXY1EG
J Hospital Medicine @JHospMedicine
RT @RThompsonMD: #JHMChat ~ 22% inpts are surgical - 2x more costly c/w medical; hospitalist knowledge and presence essential 4 high value care
Kurt Pfeifer @kurtpfeifer
@07g35s @JHospMedicine We often long to be told what to do by guidelines, but it won't happen. Modern med too complicated. #JHMChat
Robert J. Mahoney, MD @mahoneyr
Agree! Thanks for an engaging chat @SHMLive @JHospMedicine @FutureDocs @KurtPfeifer @ABIMFoundation @CostsofCare #JHMChat
Ji Baang @jbaang
@mahoneyr @jhospmedicine CARP study all still had cath results and 50% LAD lesions were excluded. Important to know. #jhmchat
J Hospital Medicine @JHospMedicine
That's a wrap! Tune in next #JHMChat w @mahoneyr to discuss BP control in hospitalized patients July 11th 9ET https://t.co/SQYq5y9xgX
Rab Razzak @rabrazzak
Master communication w/ patients. Move from autonomy (in healthcare culture is not true autonomy) to shared decision making. #jhmchat
Kurt Pfeifer @kurtpfeifer
@jbaang @JHospMedicine Amen! Use common sense, communicate clearly with everyone & things usually go well. #JHMChat
Brandon Hill @07g35s
@KurtPfeifer @JHospMedicine leads to a lot of variability in treating the same situation when multiple providers in the rotation. #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: That's a wrap! Tune in next #JHMChat w @mahoneyr to discuss BP control in hospitalized patients July 11th 9ET https://t.co/SQYq5y9xgX
Society of Hospital Medicine @SocietyHospMed
@mahoneyr looking forward to you being our guest on our next chat - a summer night #JHMChat awaits!
Kurt Pfeifer @kurtpfeifer
@jbaang @mahoneyr @JHospMedicine Yes, "widow makers" were excluded - why ACC includes revac in algorithm - it's for these #JHMChat
Kurt Pfeifer @kurtpfeifer
@jbaang @mahoneyr @JHospMedicine However, we shouldn't stress everyone to find the occasional asymptomatic widow maker #JHMChat
Society of Hospital Medicine @SocietyHospMed
Tell us what you thought of tonight's #JHMChat - looking forward to having you back for our next one on 7/11! https://t.co/12fWloLxEU
Vinny Arora MD MAPP @FutureDocs
Pls fill out a SHORT Eval on #JHMChat and how to improve! Thx for great chat! https://t.co/9vsSshjJxE
Kurt Pfeifer @kurtpfeifer
@jbaang @mahoneyr @JHospMedicine We'd cause far more strokes and AKI than we would prevent cardiac events. #JHMChat
J Hospital Medicine @JHospMedicine
RT @SHMLive: Tell us what you thought of tonight's #JHMChat - looking forward to having you back for our next one on 7/11! https://t.co/12fWloLxEU
Kurt Pfeifer @kurtpfeifer
@rabrazzak Right on! #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: @07g35s @JHospMedicine We often long to be told what to do by guidelines, but it won't happen. Modern med too complicated. #JHMChat
Robert J. Mahoney, MD @mahoneyr
Can't wait! Should be a great discussion. And hopefully no snow in Chicago that night #JHMChat https://t.co/MYoQ5bPPee
Ji Baang @jbaang
@kurtpfeifer @mahoneyr @jhospmedicine This I agree! #jhmchat
Society of Hospital Medicine @SocietyHospMed
@SHMLive Thanks for joining us tonight on #JHMChat -Updates in #Periop Medicine. Share the convo w/colleagues https://t.co/RxwTzIP2vY
Robert J. Mahoney, MD @mahoneyr
RT @JHospMedicine: That's a wrap! Tune in next #JHMChat w @mahoneyr to discuss BP control in hospitalized patients July 11th 9ET https://t.co/SQYq5y9xgX
Vinny Arora MD MAPP @FutureDocs
@mahoneyr @SHMLive will be time to move then! Excited to host you for next #JHMChat
Kurt Pfeifer @kurtpfeifer
@mahoneyr @JHospMedicine Except the thought-process is the same for all situations, even urgent. That's what they need 2 learn. #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @FutureDocs: @mahoneyr @SHMLive will be time to move then! Excited to host you for next #JHMChat
Society of Hospital Medicine @SocietyHospMed
We'll be sure to heat things up in Chicago with #JHMChat no matter what! https://t.co/4ZVwxLKylf
Kurt Pfeifer @kurtpfeifer
Signing off. Thanks @SHMLive @FutureDocs @JHospMedicine ! Full day of preop clinic tomorrow - lots of bridging to do. JK!!! #JHMChat
J Hospital Medicine @JHospMedicine
RT @KurtPfeifer: Signing off. Thanks @SHMLive @FutureDocs @JHospMedicine ! Full day of preop clinic tomorrow - lots of bridging to do. JK!!! #JHMChat
J Hospital Medicine @JHospMedicine
@KurtPfeifer @SHMLive @FutureDocs funny! got really concerned for a moment :) thanks for a great #JHMChat !
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: @KurtPfeifer @SHMLive @FutureDocs funny! got really concerned for a moment :) thanks for a great #JHMChat !
J Hospital Medicine @JHospMedicine
RT @SHMLive: We'll be sure to heat things up in Chicago with #JHMChat no matter what! https://t.co/4ZVwxLKylf
James Legan MD @jimmie_vanagon
RT @RThompsonMD: @RebeccaEBerger @KurtPfeifer Got it! Don't bridge for fib CHADS2 <5 #JHMChat
#JHMChat content from Twitter.