iiinova — where your digital self keeps evolving

Jeff Linder @jefflinder.bsky.social · 02/10/2026

Got a preview of The New Ryan Field at Northwestern last night. Really nice!! 👍 Go Cats!! @northwesternu.bsky.social @nupress.bsky.social @nuintmed.bsky.social

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Jeff Linder @jefflinder.bsky.social · 01/10/2026

I particularly liked this paragraph that gets at the inherent inconsistencies in the administration's calls for "Gold Standard Science." We require rigorous peer review. BUT Political appointees make the final decisions. www.nejm.org/doi/full/10....

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Jeff Linder @jefflinder.bsky.social · 24/09/2026

The editors pulled out a choice sentence to highlight...

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Jeff Linder @jefflinder.bsky.social · 24/09/2026

This NEJM "Clinical Decisions" is about whether you should do a physical exam in an otherwise healthy person. How about the TOTALLY UNNECESSARY testing that's being done here. "Pursue a laboratory workup"?! For what!? ht: @ishaniganguli.bsky.social www.nejm.org/doi/10.1056/...

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Jeff Linder @jefflinder.bsky.social · 23/09/2026

For example, THIS episode on supplements was way more useful because it followed a framework. podcasts.apple.com/us/podcast/t...

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Jeff Linder @jefflinder.bsky.social · 17/09/2026

I was not selected to serve on the US Preventive Services Task Force. It is also concerning that several of the appointed members, who are supposed to be evaluating primary care-based preventive services, appear to be specialists. www.nytimes.com/2026/09/17/w...

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Jeff Linder @jefflinder.bsky.social · 08/09/2026

In a new publication in @jamanetworkopen.com, Jon Cloughesy led our group in examining initial Z-drug prescriptions for insomnia as a predictor of future use. The amount of initial z-drugs fill was predictive of future z-drug fills, up to 7 years later! jamanetwork.com/journals/jam...

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Jeff Linder @jefflinder.bsky.social · 30/08/2026

For my settings, Google should have “Lago América.” At least the “San Lorenzo” and “Golfo de América” are consistent. As they say in 🇨🇦: “Lo siento.”

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Jeff Linder @jefflinder.bsky.social · 17/07/2026

Anyone notice that the IQAir forecast always seems to improve about 8 hours in the future? Makes me think they’re using a historical model rather than fire/atmospheric conditions to drive the prediction. www.iqair.com/air-quality/...

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Jeff Linder @jefflinder.bsky.social · 05/07/2026

Sorry, but Ghana won the World Cup before the first ball was even kicked

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Jeff Linder @jefflinder.bsky.social · 23/06/2026

Ok, so maybe the 2 lbs of spaghetti I had last night wasn't the best (there WAS salad involved)... ...but this @thecurbsiders.bsky.social with @joansalgeblake.bsky.social on nutrition had me laughing out loud on my long run this morning. Informative, fun, clear. thecurbsiders.com/curbsiders-p...

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Jeff Linder @jefflinder.bsky.social · 26/05/2026

The intervention group got amox/clav bid for 90 DAYS. Only 8/85 (9%) got diarrhea? 🤔

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Jeff Linder @jefflinder.bsky.social · 22/05/2026

And this table shows “excellent reliability” with a single measurement, morning and night, for 3 days.

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Jeff Linder @jefflinder.bsky.social · 22/05/2026

Thank you! To push back, in that reference they say: “…there was good agreement with a minimum of 3 days of HBPM using the average of 2 morning and 2 evening measurements **or a single morning and single evening BP reading**.” And this graph shows there’s not much gained with 2 readings.

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Jeff Linder @jefflinder.bsky.social · 21/05/2026

For those 6 blood pressures -- just 6! -- I give them the AHA HBPM instructions and a link to validatebp.com. Is there really that much of a marginal gain of asking patients to get 28 blood pessures over 7 days versus 6 readings over 3 days? Happy to give up precision for ease and feasibility.

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Jeff Linder @jefflinder.bsky.social · 21/05/2026

For home blood pressure monitoring, asking patients to get 2 blood pressures twice a day for 7 days for a total of 28 readings, seems perfectly designed to make it not get done at all. I ask patients to do 1 blood pressure, morning and night for 3 days. @paulnwilliams.bsky.social

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Jeff Linder @jefflinder.bsky.social · 21/05/2026

For a change, I am being a good spaced learner and have almost finished relistening to this @thecurbsiders.bsky.social episode with @jordybc.bsky.social. But a question... thecurbsiders.com/curbsiders-p...

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Jeff Linder @jefflinder.bsky.social · 18/05/2026

Antibiotic overprescribing is not a microbiological problem. It is a sociobehavioral problem. jamanetwork.com/journals/jam...

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Jeff Linder @jefflinder.bsky.social · 18/05/2026

Also, you might hope that better targeting of antibiotics to patients who were more likely to have bacterial infections (those who did not have a virus detected), might result in better symptom resolution in the testing group. Nope.

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Jeff Linder @jefflinder.bsky.social · 18/05/2026

Amazingly, the decrease in antibiotic prescribing to patients who had a virus detected was PERFECTLY COUNTERBALANCED by an increase in antibiotic prescribing to patients who did not have a virus detected. That's exactly 123 antibiotic prescripitons to 273 patients in each group.

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Jeff Linder @jefflinder.bsky.social · 18/05/2026

We wrote this in response to a great study from Alistair Hay and colleagues at @capcbristol.bsky.social. They found that modern, rapid, point-of-care tests that identified 23 pathogens had no impact on antibiotic prescribng.

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Jeff Linder @jefflinder.bsky.social · 18/05/2026

For antibiotic overuse, I've heard for YEARS about how we just need better tests. But it's not that simple. Julie Szymczak and I have a new editorial in @jamainternalmed.com on modern microbiological testing failing to reduce antibiotic prescribing. jamanetwork.com/journals/jam...

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Jeff Linder @jefflinder.bsky.social · 29/04/2026

...and also provide potential actions: 1. Health systems should measure network metrics (e.g., density, continuity, stability of relationships) 2. Foster durable relationships, especially between PC and cardiology 3. Use social network analysis to understand and strenghten networks

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Jeff Linder @jefflinder.bsky.social · 29/04/2026

They beautifully describe what we think we're seeing: SES being associated with care networks that can deliver better outcomes.

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Jeff Linder @jefflinder.bsky.social · 29/04/2026

The @jcardfail.bsky.social has a commentary by Kristen Sethares and Michelle Whyte from @uofmass.bsky.social. They write that changes in "social processes" could improve outcomes versus our present focus on discrete tasks www.sciencedirect.com/science/arti...

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Jeff Linder @jefflinder.bsky.social · 29/04/2026

Higher SES patients seemed to have clinicians who were more central in their networks, had denser networks, and had more communication with patients. www.sciencedirect.com/science/arti...

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Jeff Linder @jefflinder.bsky.social · 29/04/2026

With Sijia Wei and others @nuintmed.bsky.social @feinberg.northwestern.edu @dukemedschool.bsky.social @duke-university.bsky.social. We found that one of the potential mechanisms heart failure patients with higher SES achieve better outcomes is by having *better clinician networks*.

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Jeff Linder @jefflinder.bsky.social · 29/04/2026

Remember, the "headline" of our peer comparison feedback was dichotomous. Either: "You are a top performer." or "You are not a top performer." That is a) a simpler message, b) attention-getting, and c) does not reveal where someone is in the distribution. jamanetwork.com/journals/jam...

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Jeff Linder @jefflinder.bsky.social · 29/04/2026

Craig Fox from @uclaanderson.bsky.social and I wrote about challenges of developing feedback. A consistent theme is that it is overengineered and overly complex. jamanetwork.com/journals/jam...

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Jeff Linder @jefflinder.bsky.social · 29/04/2026

Taking a look at the actual feedback report reveals potential problems: This feedback is: 1. Complicated 2. Unclear main message 3. Lacks immediately actionable information 4. Shows prescribers where they are on a distribution, which can lead to a "licensing effect" ("well, I'm not the worst")

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Jeff Linder @jefflinder.bsky.social · 29/04/2026

The accompanying editorial by Matthew Goetz from @deptvetaffairs.bsky.social mentioned: 1. Hospital antibiotic prescribing is more complex than outpatient (which we've studied extensively) 2. Diffusion of responsibility 3. Lack of clear benchmarks jamanetwork.com/journals/jam...

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Jeff Linder @jefflinder.bsky.social · 29/04/2026

Peer comparison feedback to hospitalists fails to reduce antibiotic prescribing or improve patient outcomes. WHY? From Witt and colleagues in @jamanetworkopen.com from @emorydeptofmed.bsky.social @emoryhealthcareatl.bsky.social @uofugim.bsky.social jamanetwork.com/journals/jam...

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Jeff Linder @jefflinder.bsky.social · 29/04/2026

…and comes to almost the same provocative conclusion I heard a biostatistician make ~2000: Maybe, when we diagnose patients with hypertension, we should put them on, say, 2 potent BP lowering agents and stop checking their blood pressure!!

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Jeff Linder @jefflinder.bsky.social · 29/04/2026

Benjamin Gallagher from @yalesom.bsky.social in @journalgim.bsky.social writes that measured BPs are more effected by: 1. Regression to the mean 2. Hawthorne effect 3. Visit-to-visit variability Than medication

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Jeff Linder @jefflinder.bsky.social · 27/04/2026

We conducted a multi-faceted stewardship program to address glucocorticoid prescribing for acute respiratory infections. Intervention consisted of a survey, education, feedback, and patient handouts. Glucocorticoid prescribing rate decreased from 20% to 8%. jamanetwork.com/journals/jam...

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Jeff Linder @jefflinder.bsky.social · 22/04/2026

💯+ Photo from my commute this morning. 🙂 (Downtown Chicago, Hancock Tower, in the distance.)

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Jeff Linder @jefflinder.bsky.social · 21/04/2026

Heartbreaking. And unnecessary. A reminder that measels causes subacute sclerosing panencephalitis that presents years after the initial infection and is fatal. www.nytimes.com/2026/04/21/o...

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Jeff Linder @jefflinder.bsky.social · 21/04/2026

...and was reminded of the 2023 SPORT Trial in which people were randomly assigned to rosuvastatin (5 mg), placebo, or one of 6 supplements. Fish oil, cinnamon, garlic, tumeric, plant sterols, and red yeast rice were not different from placebo. www.sciencedirect.com/science/arti...

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Jeff Linder @jefflinder.bsky.social · 21/04/2026

Under the 2026 ACC/AHA/Many others Guideline on the Management of Dyslipidemia, I'm going to start taking a statin myself. Wanted to call out this recommendation about supplements. "Not recommended."

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Jeff Linder @jefflinder.bsky.social · 14/04/2026

A regular reminder that “routine blood work” is not a thing. www.npr.org/2026/04/14/n...

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Jeff Linder @jefflinder.bsky.social · 13/04/2026

I am a doctor and have better things to be doing, but similar thought: What’s going up up here?! (Getting off blooski for the rest of the day)

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Jeff Linder @jefflinder.bsky.social · 13/04/2026

The bus is not the only other option.

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Jeff Linder @jefflinder.bsky.social · 11/04/2026

I am a hypocrite. I’ve been ranting about people’s obsession with vitamin D for years, but when my own levels came back borderline insufficient I started taking it. Now, thanks to vitamin D, my life is…exactly no different. www.self.com/story/supple...

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Jeff Linder @jefflinder.bsky.social · 03/04/2026

In an editorial, Gregory Simon of @kaiser-permanente.bsky.social and @uwsom-wwami.bsky.social writes that patients' familiarity with anticipated adverse effects may improve tolerability as well as challenges in the design of the trial. jamanetwork.com/journals/jam...

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Jeff Linder @jefflinder.bsky.social · 03/04/2026

An article in @jama.com finds that having patients use a decision tool results in less discontinuation and improved depressive and anxiety symptoms at 24 weeks. jamanetwork.com/journals/jam...

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Jeff Linder @jefflinder.bsky.social · 30/03/2026

Congratulations to @acpimphysicians.bsky.social for naming LeRoi Hicks, MD, MPH, MACP as the American College of Physicians' next CEO/EVP. This is great news in the midst of tough time!! www.acponline.org/acp-newsroom...

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Jeff Linder @jefflinder.bsky.social · 13/03/2026

More not good a week later. AHRQ funding opportunities for Diagnostic Safety, Health Services Research cancelled. A reminder that #AHRQ, the Agency for Healthcare Research and Quality, is the only part of HHS strictly dedicated to studying and improving health care delivery.

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Jeff Linder @jefflinder.bsky.social · 10/03/2026

…and this… pubmed.ncbi.nlm.nih.gov/36745691/

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