Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 13/04/2025I love it lol - also it’s exactly what I wear on shift 😍 190
Reposted by Joshua Niforatos, MD, MTSJustin Morgenstern @first10em.bsky.social · 12/02/2025CJEM debate: clinical decision rules–thinking beyond the algorithm link.springer.com/article/10.1... We need to think deeply about how we use decision rules in medicine Thank you so much @emlitofnote.bsky.social @lwestafer.bsky.social @reverendofdoubt.bsky.social for joining me in this debatelink.springer.comCJEM debate: clinical decision rules–thinking beyond the algorithm - Canadian Journal of Emergency MedicineCanadian Journal of Emergency Medicine - 1144
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 31/03/2025for the oncologists out there: which types of presumed new cancer diagnoses (non-liquid tumors) found in the ED require expedited inpatient work-ups vs outpatient referrals? i.e.: time from diagnosis to therapy is critical? 030
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 31/03/2025"Overall, we found no high- or moderate-level evidence to suggest that SEP-1 compliance was associated with improved mortality; however, there may be a signal of mortality benefit in certain populations." | Annals of IM www.acpjournals.org/doi/10.7326/...acpjournals.orgThe Effect of Severe Sepsis and Septic Shock Management Bundle (SEP-1) Compliance and Implementation on Mortality Among Patients With Sepsis: A Systematic Review: Annals of Internal Medicine: Vol 0, N...Background: The Centers for Medicare & Medicaid Services (CMS) Severe Sepsis and Septic Shock Management Bundle (SEP-1) is now included in the Hospital Value-Based Purchasing (VBP) Program. Purpose: T... 020
Reposted by Joshua Niforatos, MD, MTSRyan Radecki MD MS @www.evidencetriage.com · 05/02/2025Do clinical decision rules actually help with diagnosis in medicine? The latest #CJEMDebate explores the question with @first10em.bsky.social @emlitofnote.bsky.social @lwestafer.bsky.social @reverendofdoubt.bsky.social and @paulatkinsonem.bsky.social. #medsky link.springer.com/article/10.1...link.springer.comCJEM debate: clinical decision rules–thinking beyond the algorithm - Canadian Journal of Emergency MedicineCanadian Journal of Emergency Medicine - 065
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 04/02/2025Apparently the fad of using propensity matching is switching to the new fad of target trial emulation, regardless of the quality of data. 120
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 04/02/2025The fact that this paper got so much press despite its profound limitations and really not adding anything to the literature is more of a testament of how physicians have no research background or ability to interpret the academic literature pubmed.ncbi.nlm.nih.gov/39173173/pubmed.ncbi.nlm.nih.govEvaluation of Etomidate Use and Association with Mortality Compared with Ketamine among Critically Ill Patients - PubMed<span><b>Rationale:</b> Uncertainty remains regarding the risks associated with single-dose use of etomidate. <b>Objectives:</b> To assess the use of etomidate in critically ill patients and compare o... 110
Reposted by Joshua Niforatos, MD, MTSDeandre.King2.0 @doctororbust.bsky.social · 30/01/2025When EM has to absorb all of the social failings of society it’s going to lead to long wait times. 131
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 30/01/2025I’m 100% convinced that until hospital reimbursement is tied to ED boarding times, no meaningful changes will occur. 020
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 30/01/2025It ain’t easy… :( www.cbsnews.com/baltimore/ne... 210
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 15/01/2025Whenever I hear "tox/metabolic etiology,"... you should be able to identify the toxidrome or metabolic derangement causing [insert X] condition... 010
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 08/01/2025A total of 2.5 hours of shoveling my driveway over the last two days and my entire body hurts 050
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 03/01/2025I wish someone would’ve told me as a medical student and as a resent that working your @$$ off for years with dozens and dozens of first author publications (study design, data analysis, writing, presentations) means nothing at the early career level … I would’ve done things differently. 140
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 01/01/2025This editorial by J. Broder on imaging utilization in the ED is the best piece I've ever read on the topic: when there are no CDRs for abdominal pain, no time to see patients, unreliable exam findings, high rates of (+) imaging, expectations of "zero miss culture" pubmed.ncbi.nlm.nih.gov/39487590/media.tenor.coma man standing in a parking lot with the words " what the hell am i supposed to do " above himALT: a man standing in a parking lot with the words " what the hell am i supposed to do " above him 000
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 01/01/2025New paper from @abfriedman.com uses NHAMCS data from 2007-2019 for CT imaging rates of abdominal pain visits to the ED. 1. CT scan rates ⬆️ 26.2% to 42.6%! But... 2. Test positivity, i.e., an emergency general surgical diagnosis, ⬆️ increased 17.2% to 22.9%! pubmed.ncbi.nlm.nih.gov/39313946pubmed.ncbi.nlm.nih.govTrends in visits, imaging, and diagnosis for emergency department abdominal pain presentations in the United States, 2007-2019 - PubMedDespite more abdominal pain ED visits and increased imaging rates per visit, test positivity continues to rise. Our findings do not support claims that CT and ultrasound are being used less appropriat... 173
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 01/01/2025New paper from Johns Hopkins (radiology/EM) questioning the use of "age over 65" for C spine imaging in trauma patients Of 9455 CTs performed in pts ≥ 65, 192 (2.0%) fractures were identified (113 females); 28 (0.30%) were in asymptomatic pts pubmed.ncbi.nlm.nih.gov/38940447/#:~...pubmed.ncbi.nlm.nih.govIs older age an appropriate criterion alone for ordering cervical spine computed tomography after trauma - PubMedCervical spine fractures in posttrauma patients ≥ 65 years are uncommon, with the lowest incidence in those 65 to 70 years old. Excluding asymptomatic individuals aged 65-70 from routine CSCT presents... 031
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 01/01/2025Majoring on the minors: Regulatory organizations turn a blind eye to emergency department boarding in favor of rare conditions | #AcademicEmergencyMedicine pubmed.ncbi.nlm.nih.gov/39034656/pubmed.ncbi.nlm.nih.govMajoring on the minors: Regulatory organizations turn a blind eye to emergency department boarding in favor of rare conditions - PubMedMajoring on the minors: Regulatory organizations turn a blind eye to emergency department boarding in favor of rare conditions 000
Reposted by Joshua Niforatos, MD, MTSJoshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 24/12/2024This concerns me. A 2015 paper showed that < 50% of VA ED physicians were board certified EM physicians... I did a quick skim of the paper, and they did not break it down by IM vs EM, unless I missed it... which is a HUGE problem for this paper.... pubmed.ncbi.nlm.nih.gov/25936477/pubmed.ncbi.nlm.nih.govEmergency medicine in the Veterans Health Administration-results from a nationwide survey - PubMedVeterans Health Administration emergency physicians have primarily clinical responsibilities, and less than half have formal emergency medicine board certification. Despite most VHA EDs having univers... 121
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 24/12/2024I think the idea that admissions are to solely reduce mortality doesn’t make any sense tbh…. sure, sometimes an admission may do that. The real question is: was the admission indicated or not indicated. Haven’t read the paper yet but… did it stratify by IM and EM docs in the ED? 230
Reposted by Joshua Niforatos, MD, MTSJonathan Howard @joho.bsky.social · 11/12/2024Part of being anti-RFK Jr. is calling out doctors who spread pro-RFK Jr. propaganda. If you partner with and/or support these doctors in any way, you are enabling RFK Jr no matter what you say about him yourself. Sorry. 613538
Reposted by Joshua Niforatos, MD, MTSPeter Morley ♿️ @petermorley.bsky.social · 14/12/2024Never underestimate the POWER of a Vaccine Scientist. If RFK Jr. is voted DOWN for head of HHS (and he should NOT be confirmed), it's not because of Congress, it will be because people like Dr. Peter Hotez spoke out.🙏💜 8659351137
Reposted by Joshua Niforatos, MD, MTSNick Mark, MD @nickmark.bsky.social · 09/12/2024#ADAPTtrial released & the results are interesting… Compared to SOC, Procalcitonin guided antibiotics in sepsis resulted in: - FEWER antibiotic days: 10.7 vs 9.8 (p=0.01) BUT - HIGHER 28 day mortality: 19.4% vs 20.9% (p=0.02) though this did not meet the pre-specified non-inferiority margin 🤔 1/ 63413
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 09/12/2024Omg… www.propublica.org/article/thom...propublica.orgA Hospital Helped a Beloved Doctor’s Practice Flourish Even as It Suspected He Was Hurting PatientsHailed as a savior upon his arrival in Helena, Dr. Thomas C. Weiner became a favorite of patients and his hospital’s highest earner. As the myth surrounding the high-profile oncologist grew, so did th... 030
Reposted by Joshua Niforatos, MD, MTSCJ Ciaramella @cjciaramella.bsky.social · 08/12/2024NYPD officials say a massive, citywide hunt for overtime pay is underway. 752373458
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 08/12/2024EAST guidelines for ED thoracotomy were written in 2015. WTA (West) guidelines were just updated in 2024 and are presented below: Adult emergency resuscitative thoracotomy: A Western Trauma Association clinical decisions algorithm journals.lww.com/jtrauma/full... 030
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 08/12/2024Who benefits from resuscitative thoracotomies following penetrating trauma: The patient or the learner? A tough read, but the results should be noted... pubmed.ncbi.nlm.nih.gov/37716863/pubmed.ncbi.nlm.nih.govWho benefits from resuscitative thoracotomies following penetrating trauma: The patient or the learner? - PubMedDespite up-trending rates, a resuscitative thoracotomy may not improve mortality in adults with penetrating, traumatic cardiac arrest. University teaching hospitals are nearly twice as likely to perfo... 2145
Reposted by Joshua Niforatos, MD, MTSAustin Slaughter @austinslaughter.bsky.social · 05/12/2024No, it's not. Musk and Ramaswamy wrote an op-ed saying they wanted to cut all programs with expired authorizations. That includes the programs in Rattner's list. www.cbsnews.com/news/musk-ra...cbsnews.comMusk and Ramaswamy say DOGE will target $500 billion in spending. Here's where they say they'll cut.Billionaires Elon Musk and Vivek Ramaswamy say the Department of Government Efficiency has targets in mind for cost cutting. 3326
Reposted by Joshua Niforatos, MD, MTSEd @notdred.bsky.social · 05/12/2024Eliminating the NIH is a particularly rich idea coming from a biotech billionaire whose companies literally specialize in scooping up other people’s inventions to commercialize them, good luck with that strategy Vivek 1315
Reposted by Joshua Niforatos, MD, MTSCorrie Chumpitazi MD MS @pedisedationdoc.bsky.social · 03/12/2024Monumental day for a bluesky debut with the opening of our new Pediatric Emergency Department #DukeChildren’s #PEM #pediatricreadiness 5202
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 04/12/2024Doctors commit their lives to improving the health of others, but who’s helping us improve our financial and career well-being? Enter Offcall, a new platform redefining what it means to care for physicians. I’m thrilled to participate in this and encourage you to sign up! www.offcall.comoffcall.comOffcall: Elevating transparency, empowering physicians.Our mission is to dramatically reverse burnout by improving the wealth and wellbeing of physicians. 131
Reposted by Joshua Niforatos, MD, MTSGraham Walker, MD @drgrahamwalker.com · 04/12/2024So I'm finally allowed to tell you about what I've been working on for the past year: It's called Offcall. It's built by physicians for physicians, and we're starting with one of the biggest problems we've heard amongst physicians: salary and workplace transparency. 3277
Reposted by Joshua Niforatos, MD, MTSAndrew M. Ibrahim MD, MSc @andrewmibrahim.bsky.social · 17/11/2024How to write a scientific paper in four slides. Full guide here: www.surgeryredesign.com/s/WritingFor... YouTube format here: youtu.be/fgeahUrXVaY?... #meded #medsky #research 108326
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 03/12/2024I really wish patients could listen in on the conversations emergency physicians have with consultants about their care… 110
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 01/12/2024I find myself opening up X less and less frequently and instead scrolling through BlueSky #MedSky 3140
Reposted by Joshua Niforatos, MD, MTSTyler Olson, EA @olsonplanner.bsky.social · 30/11/2024There’s an attitude that goes around medicine that is harmful. It’s an air of superiority over having an earnest discussion surrounding the financial impact of training decisions and specialty choices. Don’t drink this Kool-Aid. 3142
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 29/11/2024Craft V3 is out!!! www.theverge.com/2024/11/28/2...theverge.comCraft 3 is shockingly close to my ideal productivity appCraft does calendar, notes, and tasks — and now does them all remarkably well. 100
Reposted by Joshua Niforatos, MD, MTSCulture Crave 🍿 @culturecrave.co · 27/11/2024#Bluesky passes 23M users 🦋 927860672
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 27/11/2024This is a pretty incredible #WikeGuidelines on UTIs. Wow—a must-read!!! Interestingly, "male" is no longer defined as a 'complicated UTI'! #MedSky jamanetwork.com/journals/jam...jamanetwork.comGuidelines for the Prevention, Diagnosis, and Management of Urinary Tract InfectionsThis consensus statement creates a clinical guideline for the diagnosis and management of urinary tract infections that addresses the gap between the evidence and recommendation strength. 050
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 27/11/2024As an academic emergency physician, navigating whether a traditional research career is for me vs working part-time clinical/part-time industry vs ED administration, I'm using LinkedIn a lot more! Here's my latest #LinkedIn post on what I use to stay productive :) #MedSky www.naturl.link/xsg4Wt 140
Reposted by Joshua Niforatos, MD, MTSJay Schuur, MD @jschuurmd.bsky.social · 27/11/2024Excited to move to @bsky.app I am an emergency physician & healthcare executive, who serves as chief of a safety net ED at a trauma center in Massachusetts w/ interests in #emergencymedicine, #climatechange, #healthpolicy, & #cycling. Interested in views I am not exposed to & that challenge me. 5233
Joshua Niforatos, MD, MTS @reverendofdoubt.bsky.social · 24/11/2024As a society, we have utterly failed our patients with psychiatric illness. Psychiatric illness + poverty + substance use is essentially a social death sentence. 2322
Reposted by Joshua Niforatos, MD, MTSThe House of Pod @kavehmd.bsky.social · 21/11/2024A list of all the wonderful guests and cohosts I've had on the show. As more people join BlueSky, please let me know if there's someone I need to add! go.bsky.app/MKpZp1t 5215
Reposted by Joshua Niforatos, MD, MTSRobert Goulden @emrobg.bsky.social · 20/11/2024New WTA resus thoracotomy (RT) algorithm. 2 new/key points: -Now incorporates POCUS: if no organised cardiac rhythm and no tamponade on POCUS, no RT (regardless of time since arrest / mechanism). -RT if pulse but refractory SBP <60 plus {blunt/penetrating thoracic injury OR tamponade on POCUS} 121
Reposted by Joshua Niforatos, MD, MTSJay 🦋 @jay.bsky.team · 19/11/2024Bluesky now has over 20M people!! 🎉 We've been adding over a million users per day for the last few days. To celebrate, here are 20 fun facts about Bluesky: 307013027616061
