iiinova — where your digital self keeps evolving

Will Preston @willpreston.bsky.social · 23/09/2026

Great CoreIM ep- cardiologist’s take on post op Afib and comparison with Open Evidence recommendations. I like how Dhaliwhal puts it, our profession is about managing uncertainty.

open.spotify.com

#208 AI vs. Human with Post-Op AFib: Bread & Butter Series

Core IM | Internal Medicine Podcast · Episode

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Ed Zitron @edzitron.com · 17/09/2026

being very professional in my latest monologue

Shut the fuck up! You build cloud software! You are in full control of what gets built or not! Just because you don’t fully understand how Large Language Models make their decisions doesn’t mean that they’re “out of control” or “have their own intentions,” and your unwillingness to explain the difference and further fuel anthropomorphism only makes me more certain that you need to shut your fucking mouth.

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Will Preston @willpreston.bsky.social · 13/09/2026

Wonder how many fantasy leagues are out there where every single guy used AI to draft their team. Like whole leagues of AI playing itself.

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Will Preston @willpreston.bsky.social · 18/08/2026

Lots of pearls in the gram negatives update - presumed ESBL for E ecoli and K pneumo when ceftriaxone MIC >4ug/ml - Added Hafnia alvei as significant Amp-C producer - More evidence for avoiding Zosyn for the Amp-C bugs

idsociety.org

2026 AMR Guidance

This updated IDSA AMR Guidance document provides treatment suggestions for infections caused by extended-spectrum β-lactamase–producing Enterobacterales (ESBL-E), AmpC β-lactamase–producing Enterobact...

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Will Preston @willpreston.bsky.social · 16/08/2026

sailor in 1806: - work all day (climb the rigging, holystone the ship, stand watch) - salted pork - ration of watered rum - sing - gamble - tell stories sailor in 2026: - work all day (computer) - whatever is on the menu - scroll phone - gym - shower - no grog

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GWIZ 🎧🌙✨ @gwizofthestars.com · 24/07/2026

A Hero Must Rise. Believe. WalMart.

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Ryan H. @ryan.blacksky.app · 07/07/2026

Pausa de Humiliacion

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Jason Rabinowitz @airlineflyer.net · 05/07/2026

A $3 @mta.info subway fare and some good Q train timing can buy you one hell of a view of the July 4th fireworks and the Brooklyn Bridge light show! Huge shoutout to the train operator for slow rolling over the Manhattan Bridge and the conductor for announcing it.

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Will Preston @willpreston.bsky.social · 11/06/2026

75% of the patients met criteria for immune compromise based on the diagnosis of a solid malignancy… is it reasonable to extrapolate the finding to the much smaller number on chemo, chronic steroids and HIV/AIDS?

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Will Preston @willpreston.bsky.social · 28/05/2026

How to dx cerebro-spinal fever in 1899: “the most reliable method is Quincke's lumbar puncture, which is easily performed and free from danger. The puncture should be made between the second and third or the third and fourth lumbar vertebræ with an ordinary exploratory or "antitoxine" needle…

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Will Preston @willpreston.bsky.social · 21/05/2026

This is the smartest dog ever. She can solve complex equations but she chooses not to.

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Will Preston @willpreston.bsky.social · 19/05/2026

On a lark started reading Osler’s textbook from 1899. One of my mentors had his quote “listen to your patient, he’s telling you the diagnosis” framed in her office (shout out Darlene)… took me until being an attending to really appreciate that one. I guess I wondered if maybe more wisdom in there?

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Mayor Zohran Kwame Mamdani @mayor.nyc.gov · 09/05/2026

Let’s go Liberty!

Mayor Mamdani poses with Ellie the Elephant at tonight’s New York Liberty basketball game.

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Will Preston @willpreston.bsky.social · 24/04/2026

If y’all aren’t watching Jamie Ding’s run on jeopardy you’re missing out. Today’s ep better than the Super Bowl.

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Brad Lander @bradlander.bsky.social · 23/03/2026

ICE agents have become synonymous with terror, not safety. Trump’s goal in deploying them into our airports is to push ICE’s menacing presence into more & more places. Organizing & public pressure pushed them out of Minneapolis. So we’ll have to get louder in saying it here: Abolish ICE.

nydailynews.com

ICE agents patrol JFK airport amid growing lines

Small groups of ICE agents walked through JFK terminals as huge crowds lined up at security checkpoints during the morning rush hour.

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Will Preston @willpreston.bsky.social · 07/03/2026

You think he’s not alive? Look at how anxious he looks.

I googled furby and used the first image

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Will Preston @willpreston.bsky.social · 04/03/2026

Last year I got a MKSAP question wrong about PE management - vignette was a high risk patient likely needing intervention but without shock and I chose LMWH instead of UFH. I emailed the editor to complain and argue for my answer but they shut me down. Just want to say now completely vindicated.

Management diagram from new AHA/ACC PE guideline recommending LMWH for the situation in the post

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Will Preston @willpreston.bsky.social · 04/03/2026

True daily Ken, periorbital… WAIT😭

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Ken Jennings @kenjennings.bsky.social · 19/02/2026

Hemingway was once bet that he couldn’t write the world’s happiest short story in just 5 words. He replied,

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Letters of Note @lettersofnote.com · 12/02/2026

Happy birthday to one of my favourite haters, Charles Darwin

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NYSNA @nynurses.bsky.social · 09/02/2026

BREAKING: ~10,500 NYSNA nurses at Montefiore, Mount Sinai, & Mount Sinai Morningside/West reached tentative agreements late Sun/early Mon. Nurses won: enforceable safe staffing, maintain their health benefits, workplace violence protections, and more! www.nysna.org/press/victor...

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NYSNA @nynurses.bsky.social · 15/01/2026

Want to help out NYC's nurse heroes on the picket line? Check out four ways you can support nurses preparing to strike!

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Brad Lander @bradlander.bsky.social · 15/01/2026

ICE must be abolished. It has become a lawless, rogue agency. Federal law enforcement agencies must follow the law, if they're going to have any credibility enforcing it. We are demanding justice for Renee Good and the prosecution of ICE agent Jonathan Ross for her murder.

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Will Preston @willpreston.bsky.social · 13/01/2026

It’s January 12th and already this year I’ve spent 30 hours on the NYC subway AMA

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Jane @jane.meangirls.online · 09/01/2026

in a way Patrick O’Brien’s Captain Jack Aubrey was the first mecha pilot and his ship the first Gundam

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Will Preston @willpreston.bsky.social · 08/01/2026

Making a fan edit of The Pitt that accurately reflects how I spend my day. The 2-3 min scene in the first ep of the ED team rounding plays on a loop for 10 hours and to fill the other 2 hours I’m looking for B roll of someone standing in a supply closet unable to find what they’re looking for.

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Sam @postmalort.bsky.social · 02/01/2026

It’s too late, I have already portrayed myself as Chortling Bernie and you as Seething Eric Adams

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Will Preston @willpreston.bsky.social · 01/01/2026

New trend for 2026: referring to them as hyperaquaremia and hypoaquaremia

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Will Preston @willpreston.bsky.social · 05/12/2025

Things we published things we do for no reason about for no reason

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josh farkas 💊 @pulmcrit.bsky.social · 28/11/2025

updated the acute liver failure chapter biggest change is increasing support for early CRRT to remove NH3 (to reduce elevated intracranial pressure) now rec'd for clinically overt encephalopathy (Grade 2-4) if admitting to ICU for ALF & encephalopathy, just dialyze emcrit.org/ibcc/alf/ #EMIMCC

article: https://pubmed.ncbi.nlm.nih.gov/37377263/

IBCC chapter about acute liver failure: https://emcrit.org/ibcc/alf/

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Will Preston @willpreston.bsky.social · 26/11/2025

Immensely enjoying the Beatles Anthology 4 released last week but disappointed to see no Maxwell’s Silver Hammer (Take 3,057)

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Lars Mølgaard Saxhaug @load-dependent.eurosky.social · 17/11/2025

Reharing my #shiny leaf plot app, demonstrating the relationship between prevalence/pre-test probability, sensitivity, specificity and post-test probabilities. lmsaxhaug.shinyapps.io/Leaf_App/ #rstats #meded #emimcc #cardiosky #medsky

Screenshot from shiny web app where you can select sensitivity and speicifity and produce a plot resembling a leaf which shows post-test probability as a function of a negative or positive test and pre-test probability.

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A K @aklingus.bsky.social · 04/11/2025

Don DeLillo punching a wall in anger that he didn’t come up with this dialogue bsky.app/profile/jami...

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CORE IM @coreimpodcast.bsky.social · 22/10/2025

1/ 🚨 NEW #5Pearls: Hepatorenal Syndrome Part ✌️ Let’s dive into treatment 🌊! 1️⃣ Vasoconstrictors 2️⃣ Albumin 3️⃣ Diuretics Goal: raise MAP by 10-15 ‼️ 🖥️: www.coreimpodcast.com/2025/10/22/h...

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Will Preston @willpreston.bsky.social · 15/10/2025

5 pearls is such a great series because even when it’s covering a topic I think I know well, there’s always something important I learn — many such moments in this excellent episode.

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Paul Sax @paulsaxmd.bsky.social · 10/10/2025

What the DOTS trial of Staph bacteremia tells us: • Dalbavancin d1 and d8 vs daily IVs for WEEKS • No left-sided IE/CNS/prosthetics • Dalba not superior by DOOR endpoint, but similar clinical outcomes. Big implications for inpt care. More here! #IDSky tinyurl.com/3hjzkt96

tinyurl.com

DOTS: Optimism Around a “Negative” Dalbavancin Trial

The DOTS randomized clinical trial of dalbavancin versus standard-of-care for Staph aureus bacteremia (SAB) just landed in JAMA, where it undoubtedly will be featured in numerous ID, hospitalist, and ...

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NEJM.org @nejm.org · 09/10/2025

Case Record of the MGH: A 36-year-old man was admitted because of fever, hypoxemia, and bacteremia. Imaging revealed pulmonary opacities, thickening of the duodenal wall, and a thrombus in the right renal vein. A diagnosis was made. Full case details: nej.md/3KYBaAE #MedSky

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Will Preston @willpreston.bsky.social · 08/10/2025

The NEJM case records this week is an all timer with Dr Dhaliwal. They do a Watson on jeopardy! style challenge where his answers are compared to an AI’s - should definitely read for yourself but just want to be the first to say humanity’s still got it baby!

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Joshua Budhu @jbudhu.bsky.social · 06/10/2025

5/6🧵Unauthorized immigrants contribute billions to the U.S. health system — more than they receive in care. In 2017 alone, net contributions totaled: $20.8B to Medicare $21.3B to Medicaid $14.7B to private insurance They are net funders, not burdens.

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Will Preston @willpreston.bsky.social · 28/09/2025

Almost like people want socialized healthcare! Best we can do is cut the largest public insurance, replace vaccines with crank science, gut our research institutions, and prevent any new HCWs from coming here but here’s an AI video of our demented president saying he’ll make you live forever.

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Brendel @brendelbored.bsky.social · 23/09/2025

Trump: don’t take acepitoemponoene RFK Jr: *moth crawls out of mouth* A nude man is in the background, only referred to as “the colonel” Person watching on tv: well if they say so

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Will Preston @willpreston.bsky.social · 25/08/2025

I am loath to report the most parsimonious diagnosis is scurvy. I recommend continued palliation with poultices as seen here or perhaps cauterization of the most severe lesions, as well as an extra portion each of hardtack and grog for the remainder of his voyage.

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josh farkas 💊 @pulmcrit.bsky.social · 24/08/2025

Every hospital in the US had immediate access to expert toxicologists (via poison control). Most hospitals *lack* access to inpatient addiction medicine services. Structurally, we’re great at resus, but then we often fail at chronic tx of substance use disorders. jamanetwork.com/journals/jam...

jamanetwork.com

Substance Use Disorder Program Availability in US Hospitals

This cross-sectional study examines differences in the delivery of different substance use disorder programs in safety-net hospitals vs non–safety-net hospitals across the US and evaluates whether the...

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Ken Jennings @kenjennings.bsky.social · 17/07/2025

This is correct. Any candidate cynically “triangulating” on trans kids is a non-starter, and now is the time to say so. There’s still so much time to advance candidates that DON’T suck.

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Will Preston @willpreston.bsky.social · 20/08/2025

As clinicians there is little we can do about radiology interpretations, but should try to stick to the diagnostic algorithms and avoid relying on hunches. Missed PE has <5% risk of recurrence and mortality which is probably less than major bleeding risk from cumulative years on an unnecessary DOAC.

pubmed.ncbi.nlm.nih.gov

The mortality of untreated pulmonary embolism in emergency department patients - PubMed

Much of the literature on pulmonary embolism that is commonly referenced by emergency physicians begins with statistics concerning how often the diagnosis is missed and the lethality of pulmonary embo...

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Will Preston @willpreston.bsky.social · 20/08/2025

Writing up a case with my residents and shocked at what I'm learning about diagnosis of PE. PIOPED II the last RCT of CTA had a PPV of only 58% in the low risk group; more recent retrospective had 25% of all positive scans deemed false positive on expert review (including 16% of lobar PE).

ajronline.org

Overdiagnosis of Pulmonary Embolism by Pulmonary CT Angiography | AJR

OBJECTIVE. The purpose of this study is to evaluate the rate of overdiagnosis of pulmonary embolism (PE) by pulmonary CT angiography (CTA) in a tertiary-care university hospital. MATERIALS AND METHODS...

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Will Preston @willpreston.bsky.social · 06/08/2025

I’ve never wanted be embroiled in online cancel culture and I really hate to say this as a fan, but last night at the NY Liberty game I didn’t feel John Turturro was clapping with adequate enthusiasm during the Big Ellie Stomp.

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