Jeffrey Wagner
@drjeffmdmcr.bsky.social
Hospital Medicine at @CUMedicalSchool. Associate Editor @JGIM. Reader of methods & supp sections. Interested in EBM, clinical medicine, & POCUS. Opinions are my own
curious what is happening in Delaware
two people standing next to each other with the words " hi i 'm in delaware " on the bottom
ALT: two people standing next to each other with the words " hi i 'm in delaware " on the bottom
media.tenor.com
October 27, 2025 at 5:03 PM
curious what is happening in Delaware
As medical advocate for the gut: ‘Anything’ is inadmissible—lacks nutrition and intent. Enter fruits/veg into evidence.
October 26, 2025 at 3:09 PM
As medical advocate for the gut: ‘Anything’ is inadmissible—lacks nutrition and intent. Enter fruits/veg into evidence.
Indeed which has been fascinating to see. A great example of how broadly applied dichotomous thresholds (Hgb<7 =transfuse) miss nuances.
Certainly if risk profile is lower argument more could benefit is reasonable. Unfortunately donor supply is decreasing www.bbc.com/news/article...
Certainly if risk profile is lower argument more could benefit is reasonable. Unfortunately donor supply is decreasing www.bbc.com/news/article...
October 26, 2025 at 3:03 PM
Indeed which has been fascinating to see. A great example of how broadly applied dichotomous thresholds (Hgb<7 =transfuse) miss nuances.
Certainly if risk profile is lower argument more could benefit is reasonable. Unfortunately donor supply is decreasing www.bbc.com/news/article...
Certainly if risk profile is lower argument more could benefit is reasonable. Unfortunately donor supply is decreasing www.bbc.com/news/article...
It’s an odd term. There ref says it is “as an unanswerable question”… that is not what most docs are doing IME.
Clinical medicine is humbling. I try to preface my ? of trainers w/ these are ? I ask myself to probe thinking and understanding.
IMO, it’s instructive to ?
Clinical medicine is humbling. I try to preface my ? of trainers w/ these are ? I ask myself to probe thinking and understanding.
IMO, it’s instructive to ?
October 23, 2025 at 11:49 AM
It’s an odd term. There ref says it is “as an unanswerable question”… that is not what most docs are doing IME.
Clinical medicine is humbling. I try to preface my ? of trainers w/ these are ? I ask myself to probe thinking and understanding.
IMO, it’s instructive to ?
Clinical medicine is humbling. I try to preface my ? of trainers w/ these are ? I ask myself to probe thinking and understanding.
IMO, it’s instructive to ?
This is spicy indeed 🌶️ 🔥
October 23, 2025 at 4:44 AM
This is spicy indeed 🌶️ 🔥
Important to note, even with 3 findings, the LR tells you the test result is x7 more likely in those with cholecystitis versus those without. Reiterates the point we all know, the story of the patient going into scanner matters ALOT more
October 18, 2025 at 3:59 AM
Important to note, even with 3 findings, the LR tells you the test result is x7 more likely in those with cholecystitis versus those without. Reiterates the point we all know, the story of the patient going into scanner matters ALOT more
Such a great thread and clinical pearl!
Conceptually, sensitivity and specificity # s get confused. Retrospective case series illustrates why I prefer LR. With more findings of cholecystitis, LR+ 4.5→6→7 (more=⬆️ prob of sure Dx) but at same time LR– 0.1→0.4→0.7 (more=⬆️ prob of missing some)
Conceptually, sensitivity and specificity # s get confused. Retrospective case series illustrates why I prefer LR. With more findings of cholecystitis, LR+ 4.5→6→7 (more=⬆️ prob of sure Dx) but at same time LR– 0.1→0.4→0.7 (more=⬆️ prob of missing some)
October 18, 2025 at 3:59 AM
Such a great thread and clinical pearl!
Conceptually, sensitivity and specificity # s get confused. Retrospective case series illustrates why I prefer LR. With more findings of cholecystitis, LR+ 4.5→6→7 (more=⬆️ prob of sure Dx) but at same time LR– 0.1→0.4→0.7 (more=⬆️ prob of missing some)
Conceptually, sensitivity and specificity # s get confused. Retrospective case series illustrates why I prefer LR. With more findings of cholecystitis, LR+ 4.5→6→7 (more=⬆️ prob of sure Dx) but at same time LR– 0.1→0.4→0.7 (more=⬆️ prob of missing some)
I prefer to think in terms of interval likelihood ratios, and account for pretest prob. Agree that the above language anchors to broadly in description & highlights how “test-centric” decision making has become.
A common pearl is the story/history is (probably) the best performing test we have
A common pearl is the story/history is (probably) the best performing test we have
October 18, 2025 at 3:22 AM
I prefer to think in terms of interval likelihood ratios, and account for pretest prob. Agree that the above language anchors to broadly in description & highlights how “test-centric” decision making has become.
A common pearl is the story/history is (probably) the best performing test we have
A common pearl is the story/history is (probably) the best performing test we have
Definitely applies to HFrEF, but I haven’t seen reimbursement tied to HFpEF-specific GDMT. Here’s a summary of current therapies. With cost/access issues around GLP-1 RAs and SGLT2is, curious how implementation will go—most patients unlikely to get both.
October 12, 2025 at 2:54 AM
Definitely applies to HFrEF, but I haven’t seen reimbursement tied to HFpEF-specific GDMT. Here’s a summary of current therapies. With cost/access issues around GLP-1 RAs and SGLT2is, curious how implementation will go—most patients unlikely to get both.
I really worry about this use of AI/LLMs in peer review, specifically for methods review. The brakes analogy is apt. All for pursuing progress, but how this does not spin out of control seems unlikely in the current climate #pumpthebrakes
October 11, 2025 at 5:02 PM
I really worry about this use of AI/LLMs in peer review, specifically for methods review. The brakes analogy is apt. All for pursuing progress, but how this does not spin out of control seems unlikely in the current climate #pumpthebrakes
Efficiencies?! 🤦
Providing public health through a lens of scalable business is short sighted and, well, counter to the mission.
Much worse in 🇺🇸. the pulling back of public safety net in larger society (housing, education, etc) coincides with move to align care models based on ROI
Providing public health through a lens of scalable business is short sighted and, well, counter to the mission.
Much worse in 🇺🇸. the pulling back of public safety net in larger society (housing, education, etc) coincides with move to align care models based on ROI
October 11, 2025 at 11:55 AM
Efficiencies?! 🤦
Providing public health through a lens of scalable business is short sighted and, well, counter to the mission.
Much worse in 🇺🇸. the pulling back of public safety net in larger society (housing, education, etc) coincides with move to align care models based on ROI
Providing public health through a lens of scalable business is short sighted and, well, counter to the mission.
Much worse in 🇺🇸. the pulling back of public safety net in larger society (housing, education, etc) coincides with move to align care models based on ROI
🙋🏻♂️I have seen the same. it has been a common teaching of mine to correct with learners on service. Unfortunately I am seeing it in cardiologist notes now too.🤦
data does not support outcomes beyond improvement in NT-pro BNP and HF hosp. we need docs to push back against this
data does not support outcomes beyond improvement in NT-pro BNP and HF hosp. we need docs to push back against this
too.data
October 11, 2025 at 11:45 AM
🙋🏻♂️I have seen the same. it has been a common teaching of mine to correct with learners on service. Unfortunately I am seeing it in cardiologist notes now too.🤦
data does not support outcomes beyond improvement in NT-pro BNP and HF hosp. we need docs to push back against this
data does not support outcomes beyond improvement in NT-pro BNP and HF hosp. we need docs to push back against this
Anecdotal, though hypothesize the correlation coefficient for a patient who asks to start testosterone for low energy despite normal levels who will subsequently ask me to empirically treat for parasites/cancer unspecified with ivermectin is 0.84
August 30, 2025 at 4:45 AM
Anecdotal, though hypothesize the correlation coefficient for a patient who asks to start testosterone for low energy despite normal levels who will subsequently ask me to empirically treat for parasites/cancer unspecified with ivermectin is 0.84
The Bible of Medicine. Spreading the gospel of Longo, Fauci, et al.
August 15, 2025 at 1:03 AM
The Bible of Medicine. Spreading the gospel of Longo, Fauci, et al.
I have wondered why no LLM for UTD? They have content with nuance, which seems ripe for a partnership with AI (such as NEJM and JAMA with Open Evidence). Indeed, fewer trainees are using it too
August 5, 2025 at 10:42 PM
I have wondered why no LLM for UTD? They have content with nuance, which seems ripe for a partnership with AI (such as NEJM and JAMA with Open Evidence). Indeed, fewer trainees are using it too
10/12
Thanks to my amazing co-authors and the broader infection prevention community working to make indoor spaces safer! 🙏Shout out to @cudeptofmedicine.bsky.social
#InfectionPrevention #IndoorAirQuality #PublicHealth #EngineeringControls #COVID19 #RespiratoryInfections #Evidence #SystematicReview
Thanks to my amazing co-authors and the broader infection prevention community working to make indoor spaces safer! 🙏Shout out to @cudeptofmedicine.bsky.social
#InfectionPrevention #IndoorAirQuality #PublicHealth #EngineeringControls #COVID19 #RespiratoryInfections #Evidence #SystematicReview
August 5, 2025 at 9:54 PM
10/12
Thanks to my amazing co-authors and the broader infection prevention community working to make indoor spaces safer! 🙏Shout out to @cudeptofmedicine.bsky.social
#InfectionPrevention #IndoorAirQuality #PublicHealth #EngineeringControls #COVID19 #RespiratoryInfections #Evidence #SystematicReview
Thanks to my amazing co-authors and the broader infection prevention community working to make indoor spaces safer! 🙏Shout out to @cudeptofmedicine.bsky.social
#InfectionPrevention #IndoorAirQuality #PublicHealth #EngineeringControls #COVID19 #RespiratoryInfections #Evidence #SystematicReview
9/12
🎯 MOVING FORWARD: We need:
✅ More human outcome studies
✅ Standardized intervention classifications
✅ Better reporting of both benefits AND harms
✅ Real-world effectiveness trials
The framework is there - now we need better evidence.
🎯 MOVING FORWARD: We need:
✅ More human outcome studies
✅ Standardized intervention classifications
✅ Better reporting of both benefits AND harms
✅ Real-world effectiveness trials
The framework is there - now we need better evidence.
August 5, 2025 at 9:54 PM
9/12
🎯 MOVING FORWARD: We need:
✅ More human outcome studies
✅ Standardized intervention classifications
✅ Better reporting of both benefits AND harms
✅ Real-world effectiveness trials
The framework is there - now we need better evidence.
🎯 MOVING FORWARD: We need:
✅ More human outcome studies
✅ Standardized intervention classifications
✅ Better reporting of both benefits AND harms
✅ Real-world effectiveness trials
The framework is there - now we need better evidence.
8/12
💡 WHY THIS MATTERS: Indoor air quality affects everyone. Post-COVID, there's huge interest in engineering controls, but our review shows the evidence base has significant limitations.
We're making policy decisions with incomplete information.
💡 WHY THIS MATTERS: Indoor air quality affects everyone. Post-COVID, there's huge interest in engineering controls, but our review shows the evidence base has significant limitations.
We're making policy decisions with incomplete information.
a cartoon of a man sitting at a desk with the words everyone has to follow protocol below him
ALT: a cartoon of a man sitting at a desk with the words everyone has to follow protocol below him
media.tenor.com
August 5, 2025 at 9:54 PM
8/12
💡 WHY THIS MATTERS: Indoor air quality affects everyone. Post-COVID, there's huge interest in engineering controls, but our review shows the evidence base has significant limitations.
We're making policy decisions with incomplete information.
💡 WHY THIS MATTERS: Indoor air quality affects everyone. Post-COVID, there's huge interest in engineering controls, but our review shows the evidence base has significant limitations.
We're making policy decisions with incomplete information.
7/12
🏥 REAL-WORLD IMPACT: The heterogeneity in study designs makes it challenging to give clear guidance to healthcare facilities, schools, and offices about which engineering controls to prioritize.
We need more standardized approaches to evaluation.
🏥 REAL-WORLD IMPACT: The heterogeneity in study designs makes it challenging to give clear guidance to healthcare facilities, schools, and offices about which engineering controls to prioritize.
We need more standardized approaches to evaluation.
August 5, 2025 at 9:54 PM
7/12
🏥 REAL-WORLD IMPACT: The heterogeneity in study designs makes it challenging to give clear guidance to healthcare facilities, schools, and offices about which engineering controls to prioritize.
We need more standardized approaches to evaluation.
🏥 REAL-WORLD IMPACT: The heterogeneity in study designs makes it challenging to give clear guidance to healthcare facilities, schools, and offices about which engineering controls to prioritize.
We need more standardized approaches to evaluation.
6/12
⚠️ SAFETY BLIND SPOT: Studies rarely measured harms like toxic byproducts from disinfection systems.
We need to know not just "does it work?" but "is it safe for continuous human exposure?" This gap is especially important for occupied spaces.
⚠️ SAFETY BLIND SPOT: Studies rarely measured harms like toxic byproducts from disinfection systems.
We need to know not just "does it work?" but "is it safe for continuous human exposure?" This gap is especially important for occupied spaces.
a group of nurses are dancing in a hospital room
ALT: a group of nurses are dancing in a hospital room
media.tenor.com
August 5, 2025 at 9:54 PM
6/12
⚠️ SAFETY BLIND SPOT: Studies rarely measured harms like toxic byproducts from disinfection systems.
We need to know not just "does it work?" but "is it safe for continuous human exposure?" This gap is especially important for occupied spaces.
⚠️ SAFETY BLIND SPOT: Studies rarely measured harms like toxic byproducts from disinfection systems.
We need to know not just "does it work?" but "is it safe for continuous human exposure?" This gap is especially important for occupied spaces.