Aaron Guinn
@aaronguinn.bsky.social
Emergency physician, teacher, amateur ultra-endurance cyclist, husband and father. Professional interests: EBM, toxicology, clinical reasoning, nerdy things in general, cute animal pictures. Winnipeg, Canada.
Reposted by Aaron Guinn
Kudos to this study team using LLMs to write ED handoffs. Gen AI notes scored better on automated measures, but a bit lower on physician review. Zero critical safety issues, but a few issues with logic/completeness. Smart new framework for safety eval. #EMedSky
jamanetwork.com/journals/jam...
jamanetwork.com/journals/jam...
Developing and Evaluating LLM-Generated Emergency Medicine Handoff Notes
This cohort study evaluates large language model (LLM)–generated emergency medicine–to-inpatient handoff notes and evaluates their accuracy and safety compared with physician-written notes.
jamanetwork.com
December 16, 2024 at 4:09 PM
Kudos to this study team using LLMs to write ED handoffs. Gen AI notes scored better on automated measures, but a bit lower on physician review. Zero critical safety issues, but a few issues with logic/completeness. Smart new framework for safety eval. #EMedSky
jamanetwork.com/journals/jam...
jamanetwork.com/journals/jam...
Reposted by Aaron Guinn
A regimen of inhaled insulin plus basal insulin showed similar HbA1c outcomes compared to usual care for type 1 diabetes patients.
by Hirsch IB, Beck RW (...) Calhoun P et 37 al. in Diabetes Care #MedSky
📖 read the article:
by Hirsch IB, Beck RW (...) Calhoun P et 37 al. in Diabetes Care #MedSky
📖 read the article:
A Randomized Trial Comparing Inhaled Insulin Plus Basal Insulin Versus Usual Care in Adults With Type 1 Diabetes
OBJECTIVE. To evaluate a regimen of inhaled Technosphere insulin (TI) plus insulin degludec in adults with type 1 diabetes, who prestudy were predominately
diabetesjournals.org
December 15, 2024 at 12:51 PM
A regimen of inhaled insulin plus basal insulin showed similar HbA1c outcomes compared to usual care for type 1 diabetes patients.
by Hirsch IB, Beck RW (...) Calhoun P et 37 al. in Diabetes Care #MedSky
📖 read the article:
by Hirsch IB, Beck RW (...) Calhoun P et 37 al. in Diabetes Care #MedSky
📖 read the article:
Reposted by Aaron Guinn
You’re never too busy to show kindness to a child.
When this preschooler showed up for a race (on his pedal-less strider bike) at the local BMX park, his family discovered that he was the only one in his age group to attend.
(Thread 🧵)
When this preschooler showed up for a race (on his pedal-less strider bike) at the local BMX park, his family discovered that he was the only one in his age group to attend.
(Thread 🧵)
December 14, 2024 at 2:01 PM
You’re never too busy to show kindness to a child.
When this preschooler showed up for a race (on his pedal-less strider bike) at the local BMX park, his family discovered that he was the only one in his age group to attend.
(Thread 🧵)
When this preschooler showed up for a race (on his pedal-less strider bike) at the local BMX park, his family discovered that he was the only one in his age group to attend.
(Thread 🧵)
One of my favorite case reports. Includes 3D reconstruction CT images of a bag of gummy bears 😂
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...
Ingestion of gelatinous candy, mimicking acute gastric bleeding
A detailed medical history is vital in the correct interpretation of medical images: Peer‐to‐peer feedback and a thorough medical history can help avoid diagnostic pitfalls and unnecessary therapy. Ke...
pmc.ncbi.nlm.nih.gov
December 12, 2024 at 1:51 PM
One of my favorite case reports. Includes 3D reconstruction CT images of a bag of gummy bears 😂
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...
Interesting result…
>Importantly, despite mortality benefit for the entire patient population studied, the authors found no effect of the intervention on mortality for patients with an alert, raising the possibility that the intervention was exerting broader effects on care patterns
>Importantly, despite mortality benefit for the entire patient population studied, the authors found no effect of the intervention on mortality for patients with an alert, raising the possibility that the intervention was exerting broader effects on care patterns
The always-thoughtful Derek Angus, master of the large randomized trial, calls for “a qualitative assessment of [the clinical team’s] experience [to] provide insight on how the intervention worked and on features considered unhelpful”
The future of RCTs includes qual
jamanetwork.com/journals/jam...
The future of RCTs includes qual
jamanetwork.com/journals/jam...
Do Sepsis Alerts Help?
A great hope of moving from paper to electronic health records (EHRs) is that health data could be scanned in real-time, alerting the care team of potential gaps in care before untoward consequences o...
jamanetwork.com
December 12, 2024 at 1:49 PM
Interesting result…
>Importantly, despite mortality benefit for the entire patient population studied, the authors found no effect of the intervention on mortality for patients with an alert, raising the possibility that the intervention was exerting broader effects on care patterns
>Importantly, despite mortality benefit for the entire patient population studied, the authors found no effect of the intervention on mortality for patients with an alert, raising the possibility that the intervention was exerting broader effects on care patterns
It’s like a Platonic solid just with less albumin usually.
December 9, 2024 at 1:50 AM
It’s like a Platonic solid just with less albumin usually.
Reposted by Aaron Guinn
Does Andexanet Alpha Improve Outcomes Compared With Four-Factor Prothrombin Complex Concentrate for Reversal of Direct Oral Anticoagulants? www.annemergmed.com/article/S019... #education #MedSky #MedTwitter #EMSky #EMedSky #BlueSky
November 22, 2024 at 1:37 AM
Does Andexanet Alpha Improve Outcomes Compared With Four-Factor Prothrombin Complex Concentrate for Reversal of Direct Oral Anticoagulants? www.annemergmed.com/article/S019... #education #MedSky #MedTwitter #EMSky #EMedSky #BlueSky
Reposted by Aaron Guinn
Between 1997 and 2022, splash pads across the country were linked to at least 60 outbreaks, with the largest sickening over 2,000 water frolickers in one go.
Splash pads really are fountains of fecal material; CDC reports 10K illnesses
A big problem is leaky swim diapers and kids sucking up recirculated water.
arstechnica.com
December 5, 2024 at 2:53 PM
Between 1997 and 2022, splash pads across the country were linked to at least 60 outbreaks, with the largest sickening over 2,000 water frolickers in one go.
Reposted by Aaron Guinn
Happy Friday!
Just going to leave this here and hopefully put a smile on one or two faces 😀
Our hospital greeter
#dogtherapy #MedSky
Just going to leave this here and hopefully put a smile on one or two faces 😀
Our hospital greeter
#dogtherapy #MedSky
November 29, 2024 at 10:16 PM
Happy Friday!
Just going to leave this here and hopefully put a smile on one or two faces 😀
Our hospital greeter
#dogtherapy #MedSky
Just going to leave this here and hopefully put a smile on one or two faces 😀
Our hospital greeter
#dogtherapy #MedSky
Reposted by Aaron Guinn
A liberal transfusion strategy in acute brain injury patients leads to better neurological outcomes than a restrictive approach.
by Taccone FS, Rynkowski Bittencourt C (...) Vincent JL et 25 al. in JAMA
📖 read the article:
by Taccone FS, Rynkowski Bittencourt C (...) Vincent JL et 25 al. in JAMA
📖 read the article:
Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury
This randomized clinical trial assesses the effect of a liberal vs a restrictive hemoglobin threshold for red blood cell transfusion on unfavorable neurological outcome in patients with acute brain injury.
jamanetwork.com
November 28, 2024 at 6:40 AM
A liberal transfusion strategy in acute brain injury patients leads to better neurological outcomes than a restrictive approach.
by Taccone FS, Rynkowski Bittencourt C (...) Vincent JL et 25 al. in JAMA
📖 read the article:
by Taccone FS, Rynkowski Bittencourt C (...) Vincent JL et 25 al. in JAMA
📖 read the article:
Reposted by Aaron Guinn
Hot off the Press: Enhancing Emergency Department Triage Equity With Artificial Intelligence: Outcomes From a Multisite Implementation www.annemergmed.com/article/S019... #education #MedSky #EMSky #EMedSky #BlueSky
November 25, 2024 at 5:34 PM
Hot off the Press: Enhancing Emergency Department Triage Equity With Artificial Intelligence: Outcomes From a Multisite Implementation www.annemergmed.com/article/S019... #education #MedSky #EMSky #EMedSky #BlueSky
Reposted by Aaron Guinn
#news "The model exhibited clinically meaningful performance, notably its high negative predictive accuracy"
"Clinical use of comparable #AI in first-line, quick-response triage of patients with chest pain or dyspnoea appears as a valuable option" #emedsky #medsky
openheart.bmj.com/content/11/2...
"Clinical use of comparable #AI in first-line, quick-response triage of patients with chest pain or dyspnoea appears as a valuable option" #emedsky #medsky
openheart.bmj.com/content/11/2...
Predicting troponin biomarker elevation from electrocardiograms using a deep neural network
Background Elevated troponin levels are a sensitive biomarker for cardiac injury. The quick and reliable prediction of troponin elevation for patients with chest pain from readily available ECGs may p...
openheart.bmj.com
November 26, 2024 at 10:45 PM
#news "The model exhibited clinically meaningful performance, notably its high negative predictive accuracy"
"Clinical use of comparable #AI in first-line, quick-response triage of patients with chest pain or dyspnoea appears as a valuable option" #emedsky #medsky
openheart.bmj.com/content/11/2...
"Clinical use of comparable #AI in first-line, quick-response triage of patients with chest pain or dyspnoea appears as a valuable option" #emedsky #medsky
openheart.bmj.com/content/11/2...
Reposted by Aaron Guinn
NYU gave their staff access to HIPAA-secure ChatGPT last year. It's a pretty great paper looking at real-world usage of GenAI. If you run the numbers, you could arguably give healthcare users access for like $20 a year, which seems kind of mind-blowing to me.
academic.oup.com/jamia/advanc...
academic.oup.com/jamia/advanc...
Health system-wide access to generative artificial intelligence: the New York University Langone Health experience
AbstractObjectives. The study aimed to assess the usage and impact of a private and secure instance of a generative artificial intelligence (GenAI) applica
academic.oup.com
November 27, 2024 at 3:46 PM
NYU gave their staff access to HIPAA-secure ChatGPT last year. It's a pretty great paper looking at real-world usage of GenAI. If you run the numbers, you could arguably give healthcare users access for like $20 a year, which seems kind of mind-blowing to me.
academic.oup.com/jamia/advanc...
academic.oup.com/jamia/advanc...
Reposted by Aaron Guinn
Skytorial: can you crack the case?
A middle-aged healthy patient undergoes colonoscopy under propofol sedation.
Colonoscopy is unremarkable.
Post-procedure, the patient doesn't wake up and has rhythmic movements involving the legs as shown here.
Labs are normal.
What might be going on?
A middle-aged healthy patient undergoes colonoscopy under propofol sedation.
Colonoscopy is unremarkable.
Post-procedure, the patient doesn't wake up and has rhythmic movements involving the legs as shown here.
Labs are normal.
What might be going on?
November 25, 2024 at 10:31 PM
Skytorial: can you crack the case?
A middle-aged healthy patient undergoes colonoscopy under propofol sedation.
Colonoscopy is unremarkable.
Post-procedure, the patient doesn't wake up and has rhythmic movements involving the legs as shown here.
Labs are normal.
What might be going on?
A middle-aged healthy patient undergoes colonoscopy under propofol sedation.
Colonoscopy is unremarkable.
Post-procedure, the patient doesn't wake up and has rhythmic movements involving the legs as shown here.
Labs are normal.
What might be going on?
Reposted by Aaron Guinn
📣 New perspective paper: Insights into durability against resistance from the antibiotic nitrofurantoin
We discuss what makes nitrofurantoin robust against resistance evolution, in spite of prolonged and extensive usage against UTIs #MicroSky
Open access/CC-BY-4.0: www.nature.com/articles/s44...
We discuss what makes nitrofurantoin robust against resistance evolution, in spite of prolonged and extensive usage against UTIs #MicroSky
Open access/CC-BY-4.0: www.nature.com/articles/s44...
Insights into durability against resistance from the antibiotic nitrofurantoin - npj Antimicrobials and Resistance
npj Antimicrobials and Resistance - Insights into durability against resistance from the antibiotic nitrofurantoin
www.nature.com
November 25, 2024 at 8:41 AM
📣 New perspective paper: Insights into durability against resistance from the antibiotic nitrofurantoin
We discuss what makes nitrofurantoin robust against resistance evolution, in spite of prolonged and extensive usage against UTIs #MicroSky
Open access/CC-BY-4.0: www.nature.com/articles/s44...
We discuss what makes nitrofurantoin robust against resistance evolution, in spite of prolonged and extensive usage against UTIs #MicroSky
Open access/CC-BY-4.0: www.nature.com/articles/s44...
Reposted by Aaron Guinn
Achieving optical transparency in live animals with absorbing molecules. @science.org #scisky #Medsky #News #Technology
Read more
www.science.org/doi/10.1126/...
Read more
www.science.org/doi/10.1126/...
November 25, 2024 at 12:32 PM
Achieving optical transparency in live animals with absorbing molecules. @science.org #scisky #Medsky #News #Technology
Read more
www.science.org/doi/10.1126/...
Read more
www.science.org/doi/10.1126/...
Interesting. Definitely had been taught to avoid cephalexin in pyelo. Our lab still comments on urine cultures that it’s not appropriate to use to treat pyelo. #medsky #emedsky
Oral cephalosporins for pyelonephritis?!
🆕️⚡️⚡️COPY-ED
Multicenter, retrospective study
N=851
No difference in 14-day pyelonephritis treatment failure for oral cephalosporins* vs FQ/TMP-SMX for outpatient pyelonephritis in the ED #idsky #medsky
* Mostly cephalexin
www.sciencedirect.com/science/arti...
🆕️⚡️⚡️COPY-ED
Multicenter, retrospective study
N=851
No difference in 14-day pyelonephritis treatment failure for oral cephalosporins* vs FQ/TMP-SMX for outpatient pyelonephritis in the ED #idsky #medsky
* Mostly cephalexin
www.sciencedirect.com/science/arti...
November 25, 2024 at 2:41 PM
Reposted by Aaron Guinn
#EntomologyConsult: A patient has a persistent rash. Concerned about insects are the cause, looked through the bedroom and found these. Would these have caused the rash?
November 24, 2024 at 12:51 PM
#EntomologyConsult: A patient has a persistent rash. Concerned about insects are the cause, looked through the bedroom and found these. Would these have caused the rash?
Sometimes, you just need to bow to the absurd a little bit…
November 23, 2024 at 1:24 AM
Sometimes, you just need to bow to the absurd a little bit…
Equally applicable in my line of work! #emedsky
Aircrews do not train as teams, yet no-one has died from an accident on a British commercial aircraft for 35 years.
Teams training together costs a lot, therefore teams don't train at all!
Should we be more like pilots and train individually?
#AnSky #MedSky #SafetySky
https://buff.ly/3COBTjM
Teams training together costs a lot, therefore teams don't train at all!
Should we be more like pilots and train individually?
#AnSky #MedSky #SafetySky
https://buff.ly/3COBTjM
November 22, 2024 at 2:37 PM
Equally applicable in my line of work! #emedsky
Reposted by Aaron Guinn
Your baby may be able to sit upright without assistance as early as 6 months, but, like most skills, this is one perfected over time.
This happy little guy is almost there. It’s hard when Dad has more jokes than you have balance and core strength!
(Thread 🧵)
This happy little guy is almost there. It’s hard when Dad has more jokes than you have balance and core strength!
(Thread 🧵)
November 22, 2024 at 1:12 PM
Your baby may be able to sit upright without assistance as early as 6 months, but, like most skills, this is one perfected over time.
This happy little guy is almost there. It’s hard when Dad has more jokes than you have balance and core strength!
(Thread 🧵)
This happy little guy is almost there. It’s hard when Dad has more jokes than you have balance and core strength!
(Thread 🧵)
Reposted by Aaron Guinn
Your energy affects everyone around you. 😄
November 17, 2024 at 5:36 AM
Your energy affects everyone around you. 😄
Reposted by Aaron Guinn
The last few years have sucked. >20h WTBS times regularly, lucky to see 1 px/hr many days. You get so used to just putting your head down and persisting. Here’s to those days that are like a ray of light and make you look up and remember *why* you’re persisting through all this still. #emedsky
November 21, 2024 at 6:14 PM
The last few years have sucked. >20h WTBS times regularly, lucky to see 1 px/hr many days. You get so used to just putting your head down and persisting. Here’s to those days that are like a ray of light and make you look up and remember *why* you’re persisting through all this still. #emedsky