iiinova — where your digital self keeps evolving

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Peter Tennant @pwgtennant.bsky.social · 27/08/2026

Does the new shingles vaccine (Shingrix) protect against cardiovascular disease (CVD)? Yes, according to a new 'natural experiment' study in @natmed.nature.com. But the truth is sadly far less convincing! Pull up a chair and let's examine another peer review failure in a Nature journal. 1/10 🧵

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Raj Mehta @raj-mehta.bsky.social · 18/05/2026

@richard-lehman.bsky.social I have learned so much from your words, spoken and written. I am sad we wont have any future conversations, but I am grateful for the ones we had. Medicine is better because of your efforts. Richard, thank you for everything.

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Simon Cleary @simoncleary.bsky.social · 18/05/2026

Sad to hear of the loss of Richard Lehman. Grateful to him and @raj-mehta.bsky.social for recording this podcast - an excellent teaching resource: creators.spotify.com/pod/profile/...

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Darren Dahly @statsepi.bsky.social · 26/02/2026

This is basically why, at least in medicine, I think it's a fool's errand to pretend like we are estimating effects. I think it's much more realistic to frame it as evaluating claims, and accepting that at some point residual uncertainty will have to be left to clinical judgement.

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Darren Dahly @statsepi.bsky.social · 24/02/2026

Worth a read. But.. 😜 - All statistical methods rely on assumptions and thought exercises. - The good advice here about the importance of context and assumptions, and moving away from resting everything on "a calculation", is widely applicable to sample size evaluation.

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Brittany Trang @brittanytrang.com · 03/12/2025

We finally have randomized, controlled clinical trial results from ambient AI scribes. But what do these RCTs actually tell us? Look at the below chart. Time savings are often low, but doctors give the technology rave reviews, esp in anecdotes that people tend to believe more than data 👀 🧵 🖥️🩺

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Mike Johansen @mikejohansenmd.medsky.social · 18/12/2025

In Clinical Scholars- literally one of the first 5 things Rod talked about. cc: @jeremysussman.bsky.social @iwashyna.bsky.social

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Mike Johansen @mikejohansenmd.medsky.social · 20/12/2025

The creation of a medical reversal.

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James Lind Library @jameslindlibrary.bsky.social · 17/12/2025

Listen in as @richard-lehman.bsky.social and @raj-mehta.bsky.social explore why it took so long for fair tests of treatments to develop, and the transition from anecdotal and authority-based decisions to empirical methodologies in the 18th and 19th centuries. www.jameslindlibrary.org/blogs/the-fi...

jameslindlibrary.org

Podcast: The first steps towards Evidence-Based Medicine - The James Lind Library

This video covers the first section of the James Lind Library essays, exploring why it took so long for fair assessments of medical treatments to develop.

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 09/09/2025

The new ⌚️ will have hypertensive notifications This doesn’t seem like a cuffless BP - but more like a notification ‘you may have hypertension, go check your BP’ ? From www.apple.com/newsroom/202... @jordybc.bsky.social @drwanpen.bsky.social @spjuraschek.bsky.social @daichishimbo.bsky.social?

Hypertension Notifications

Building on its suite of advanced health features, Apple Watch Series 11 introduces groundbreaking hypertension notifications, which can alert users if signs of chronic high blood pressure — or hypertension — are detected.5 Hypertension is the leading modifiable risk factor for heart attack, stroke, and kidney disease, and impacts approximately 1.3 billion adults globally. It is frequently undiagnosed because it often has no symptoms, many people do not see a doctor regularly, and even during a clinical visit, it can be easily missed with a single measurement.
Hypertension notifications on Apple Watch use data from the optical heart sensor to analyze how a user’s blood vessels respond to the beats of the heart. The algorithm works passively in the background reviewing data over 30-day periods, and will notify users if it detects consistent signs of hypertension. These notifications provide users with valuable insights into their health as it relates to this widespread condition simply by wearing their Apple Watch, so they can begin making potentially lifesaving behavioral changes, or start treatment to reduce their risk of serious, long-term health events.
Replay video: Apple Watch Series 11 Hypertension Notifications

Hypertension notifications use data from the optical heart sensor on Apple Watch to analyze how a user’s blood vessels respond to the beats of the heart.
Like all of Apple’s health features, hypertension notifications are grounded in rigorous scientific validation. The feature was developed with advanced machine learning and training data from multiple studies totaling over 100,000 participants. Its performance was then validated in a clinical study of over 2,000 participants. While hypertension notifications will not detect all instances of hypertension, with the reach of Apple Watch, the feature is expected to notify over 1 million people with undiagnosed hypertension within the first year.

Hypertension notifications use data from the optical heart sensor on Apple Watch to analyze how a user’s blood vessels respond to the beats of the heart.
Like all of Apple’s health features, hypertension notifications are grounded in rigorous scientific validation. The feature was developed with advanced machine learning and training data from multiple studies totaling over 100,000 participants. Its performance was then validated in a clinical study of over 2,000 participants. While hypertension notifications will not detect all instances of hypertension, with the reach of Apple Watch, the feature is expected to notify over 1 million people with undiagnosed hypertension within the first year.
“Hypertension is the leading preventable cause of heart attack and stroke, yet millions remain undiagnosed,” said Harlan Krumholz, MD, SM, cardiologist and scientist at Yale University and Yale New Haven Hospital. “Making accurate detection easy and part of daily life can help people get care earlier and prevent avoidable harm.”
A user’s iPhone and Apple Watch Series 11 show “Possible Hypertension” and offer more details.
Hypertension notifications were developed with advanced machine learning and training data from multiple studies totaling over 100,000 participants.
If users receive a hypertension notification, it is recommended that they log their blood pressure for seven days using a third-party blood pressure cuff and share the results with their provider at their next visit, which is consistent with the latest American Heart Association guidelines for the diagnosis and management of hypertension.
Clearance for hypertension notifications from the FDA and other regulators is expected soon, and the feature will be available in more than 150 countries and regions — including the U.S. and the EU — this month. Hypertension notifications will be available on Apple Watch Series 9 and later, and Apple Watch Ultra 2 and later, with watchOS 26.

Hypertension Notifications

Hypertension notifications use data from the optical heart sensor on Apple Watch to analyze how a user’s blood vessels respond to the beats of the heart.
Like all of Apple’s health features, hypertension notifications are grounded in rigorous scientific validation. The feature was developed with advanced machine learning and training data from multiple studies totaling over 100,000 participants. Its performance was then validated in a clinical study of over 2,000 participants. While hypertension notifications will not detect all instances of hypertension, with the reach of Apple Watch, the feature is expected to notify over 1 million people with undiagnosed hypertension within the first year.
“Hypertension is the leading preventable cause of heart attack and stroke, yet millions remain undiagnosed,” said Harlan Krumholz, MD, SM, cardiologist and scientist at Yale University and Yale New Haven Hospital. “Making accurate detection easy and part of daily life can help people get care earlier and prevent avoidable harm.”
A user’s iPhone and Apple Watch Series 11 show “Possible Hypertension” and offer more details.
Hypertension notifications were developed with advanced machine learning and training data from multiple studies totaling over 100,000 participants.
If users receive a hypertension notification, it is recommended that they log their blood pressure for seven days using a third-party blood pressure cuff and share the results with their provider at their next visit, which is consistent with the latest American Heart Association guidelines for the diagnosis and management of hypertension.
Clearance for hypertension notifications from the FDA and other regulators is expected soon, and the feature will be available in more than 150 countries and regions — including the U.S. and the EU — this month. Hypertension notifications will be available on Apple Watch Series 9 and later, and Apple Watch Ultra 2 and later, with watchOS 26.

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Jordy Cohen @jordybc.bsky.social · 14/08/2025

Some key changes that stood out to me (got the opportunity to help w writing these!): 1) Stronger recs for single pill combos 2) Broader recs for screening for primary aldo (now consider in anyone with stage 2 HTN — i.e., BP >=140/90) 3) Just. Say. No… to cuffless BP devices… and to EtOH 2/

no.to

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 31/07/2025

should we screen for CKD in the general population? Finally, flozins, finerenone and GLP1s allow a good cost-effectiveness case www.nephjc.com/news/2025/7/... for #NephJC shorts Time to stop just being dialysis-ologists and flozinate, glipinate! #NephSky

nephjc.com

NephJC Shorts: Should we Screen for Kidney Disease? — NephJC

Should we screen for CKD?

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Leora Horwitz @leorahorwitzmd.bsky.social · 23/07/2025

Heard from #AHRQ that the entire grants staff has been let go! They are unable to issue funds for grants already funded, let alone fund new grants. This is outrageous and will make Americans poorer and sicker. Why? A brief thread about just some recent AHRQ-funded research: #MedSky #HealthPolicy

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Saskia Middeldorp @middeldorps.bsky.social · 22/06/2025

This is what we were waiting for. A direct comparison between apixaban and rivaroxaban for the treatment of acute VTE. Apixaban reduces bleeding risk in the first 3 months by >50%! Practice changing investigator-initiated RCT. #ISTH2025

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Atul Gawande @agawande.bsky.social · 27/02/2025

Rubio terminated 5800 USAID contracts – more than 90% of its foreign aid programs – in defiance of the courts. Here’s a list of just some of the lifesaving awards that were terminated. Nearly all were Congressionally mandated. They’ve saved millions of lives. 🧵

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Eric Topol @erictopol.bsky.social · 14/02/2025

A randomized trial of tailored A.I.-guided ablation of atrial fibrillation vs standard-of-care, anatomical ablation demonstrated superiority of AI guidance www.nature.com/articles/s41...

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Eric Topol @erictopol.bsky.social · 14/02/2025

I wrote a book The Creative Destruction of Medicine (2013, title adopted after Schumpeter). This title of the book for what we are now seeing in the U.S. is just The Destruction of Medicine.

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David Gorski, MD, PhD @gorskon.bsky.social · 08/02/2025

Indirects support infrastructure for translational research and clinical trials. Look for clinical trials to be paused or halted because universities will no longer have funds to keep them open. This will be devastating for cancer patients at NCI-designated comprehensive cancer centers, for example.

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JAMA @jama.com · 05/02/2025

From JAMA Cardiology: South African regulations limiting sodium in processed foods were associated with reductions in sodium consumption and blood pressure among rural adults aged 40 years or older. ja.ma/4hMWyUW #CardioSky

Figure 2. Sodium Content on Packaging in a Basket of Food Products in the Agincourt-Bushbuckridge by Wave and Legislative Target

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 30/01/2025

In @ajkd.bsky.social www.ajkd.org/article/S027... Revisiting protein restriction: did they get it wrong? Yes they did it wrong. But they don’t admit that in this commentary, sadly 😕

Editorial commentary title in AJKD by Bill Mitch and colleagues
‘Revisiting Protein Restrictions in Early CKD: Did we get it wrong’?

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 17/01/2025

Finally! Antibiotics are not non-inferior to appendectomy despite a generous 20% non-inferiority margin They are actually inferior: www.thelancet.com/journals/lan... in the @thelancet.bsky.social #MedSky

At 12-month follow-up, primary outcome data were available for 846 (90%) patients. Treatment failure occurred in 153 (34%) of 452 patients in the antibiotic group, compared with 28 (7%) of 394 in the appendicectomy group (difference 26·7%, 90% CI 22·4–30·9).

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Eric Topol @erictopol.bsky.social · 07/01/2025

The potential importance of reactivation of herpes simplex virus type 1 (HSV-1) as a contributing factor to developing Alzheimer's disease www.science.org/doi/10.1126/...

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Eric Weinhandl @ericweinhandl.bsky.social · 20/12/2024

We need some of these phrases for nephrology! Kidney failure = Filter futility Peritoneal dialysis = Abdominal cleaning Hyponatremia = Salt shortage

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Altmetric @altmetric.com · 19/12/2024

THREAD This Is The Story Of The The Pernicious Rise of AI-Generated Papers and their Online Impact An Incomplete History Told In The Voice of Documentarian Adam Curtis 1/31

Adam Curtis Title Card: We Too Are Trapped In A System. Text over a background of a large office building

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Ryan Marino, MD @ryanmarino.bsky.social · 06/12/2024

The data speaks for itself

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richard-lehman.bsky.social @richard-lehman.bsky.social · 01/12/2024

A book that needs to be part of every doctor's lifelong learning. Huge riches hinted at in my little review, which is mostly about uncertainty in general practice: bjgplife.com/the-art-of-u... @marydixonwoods.bsky.social @johnlauner.bsky.social

bjgplife.com

The Art of Uncertainty: How to Navigate Chance, Ignorance, Risk and Luck

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Richard Ferro, MD MSc @richferro.com · 27/11/2024

This should be a pretty good indication to any medical journal out there that Bluesky is the ideal platform to post your publications. Unlike Threads and X, pub links aren’t throttled by the algorithm here. #Medsky

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Annals of Family Medicine @annfammed.bsky.social · 25/11/2024

For the 1st time on #BlueSky, we release a FULL issue of Annals of Family Medicine! The November/December 2024 issue is AVAILABLE NOW! Our video preview has an exclusive glimpse into our latest issue and the newest research in #PrimaryCare #Medsky #FMsky www.annfammed.org/content/22/6...

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Miguel Hernan @miguelhernan.org · 26/11/2024

Does #randomization ensures balance of risk factors between groups? Consider this: In Denmark 860 individuals were randomly allocated to either intervention or control. Individuals were unaware of their allocation. No intervention took place. Mortality was higher in the intervention group (p=0.003)

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 25/11/2024

New today - @thelancet.bsky.social DM/Endo GLP1RAs and kidney/CV outcomes - SR from @sunilbadve.bsky.social Tuttle, Perkovic et al www.thelancet.com/journals/lan... ($🔒) - with/out DM - kidney outcomes (not albuminuria)

Forest plot of kidney outcomes with GLP1RAs

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Ed @notdred.bsky.social · 26/11/2024

I don’t want to quote dunk on that person, but GLP-1ra drugs are so effective that the FDA is literally allowing compounding pharmacies to defy patent law because so many people can benefit from them and can’t get them due to low supply

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 23/11/2024

AI for medical transcription - in this case Whisper sneaks in its own hallucinatory phrases apnews.com/article/ai-a... though i wish the AI did invent ‘hyperactivated antibiotics’ we are going to need them soon 😏 h/t @placentadoc.bsky.social #MedSky

apnews.com

Researchers say an AI-powered transcription tool used in hospitals invents things no one ever said

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JAMA @jama.com · 22/11/2024

FDA Commissioner Robert Califf speaks with JAMA+ AI Editor in Chief Roy Perlis about the challenges of regulating AI in health care. ja.ma/3B4SFux

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Ryan Marino, MD @ryanmarino.bsky.social · 20/11/2024

When insulin was first patented in 1923, the discoverers declined to put their names on it as they felt that insulin belonged to the public. 101 years later, insulin is inaccessible to thousands of Americans because of price gouging by near-monopoly private insurance corporations and their PBMs.

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JAMA @jama.com · 18/11/2024

Zerlasiran, a small-interfering RNA, reduced time-averaged lipoprotein(a) concentrations by more than 80% during 36 weeks of treatment in patients with atherosclerotic cardiovascular disease. #AHA24 ja.ma/4fSsXYX

Figure showing percent changes in lipoprotein(a).

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