2025 UPTODATE - Middle meningeal artery embolization for chronic subdural hematoma (nature).pdf

Codified by ABFL

Glossary: 

💉= IV; SJS/TEN = Stevens-Johnson syndrome/toxic epidermal necrolysis;

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, Nature, ? ➖ interventional
➕ 7 pxs ➕ ? ➖ P I C O:
   - P: adults w_SJS/TEN
   - I: JAK inhibitors (also received high-dose 💉 glucoCORTICOIDS) ➩ abrocitinib or tofacitinib)
   - C: NA
   - O: clinical improvement; sOC = adverse events
3. EVIDENCE:
   - NO TTO for SJS/TEN, just supportive care
6. RESULTS
   - All I ➩ rapid clinical ↗️
   - Re-epithelialization wo_adverse events

   - Still, further studies needed to confirm EFFICACY + OPTIMAL use.

2024 THE CONVERSATION - Can listening to music make you more productive at work (Fiveash) [r].pdf

Codified by ABFL

Glossary: 

BM = Background music;SJS/TEN = Stevens-Johnson syndrome/toxic epidermal necrolysis;

1. Listening to music ➩ ↗️ or ↘️ productivity at work
2. NO one-size-fits-all answer
3. Personalize the type of music according to everyone
4. Factors that hep us understand it:
   - Personality traits
   - What you’re doing
   - What kind of music you’re listening to
5. Arousal ➩ mental alertness, and the readiness of the brain to process new information.
6. Optimal arousal = FACILITATES = state of "flow"
7. INTROVERTS 🆚 EXTROVERTS ➩ high arousal baseline level 🆚 lower arousal baseline level ➩
8. Personality:

9. What you’re doing:
       - Complex music = music w_lyrics
       - Reading + writing at the same time as listening to COMPLEX MUSIC is DIFFICULT
       - Simple + repetitive tasks w_BM (upbeat & complex) ➩ ↗️ productivity
       - MECHS ➩ effects on motivation + attention + ⊕ 🧠 reward networks
10. Type of music: for complex tasks

11. In MEMORY ➩ calming music WORKS
12. WHAT works best will be different for everyone. Based on:
         - Personality
         - Familiarity w_music
         - Musical preferences
         - Cultural context (AMA)
13. Music should be rewarding (meaningful) ➩ attention + mood + motivation ➩ ↗️ performance (specially in simple tasks)
14. What about COMPLEX TASKS?
         - Complex tasks = a cognitively demanding task involving 📖 + ✍🏽
         - LISTEN before doing your work
15. What works for you?
         - TRY different tasks and different types of music
         - Start w_your FAVORITE music.
         - Listening to music without lyrics and with a strong beat might help you focus on the task at

           hand.
        - Use BREAKS to listen to your music.   

        - Moving along with music is suggested to ↗️ reward processing, especially in social

          situations.   

        - DANCING works.

Monday, February 17, 2025 at 23h30 BE AMA, ABFL, MAAT, JQB, HIBN, AAQC

⏳ TIME MANAGEMENT
01:26:13

Round: 7 00:42:75 Comments

Round: 6 25:32:42 Wrap-up
Round: 5 10:43:11 ART 2 ➩ -20 min
Round: 4 23:12:44 Wrap-up
Round: 3 04:53:27 ART 1
Round: 2 10:06:93 Select JR
Round: 1 11:02:46 Past JR

2024 NEJMjw - Are 7 Days of Antibiotics as Good as 14 Days for Bloodstream INF (NEJM).pdf

Codified by ABFL

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, NEJM, ❓ ➖ mn_nonINF (BALANCE) ➕ 3.6k H+ ➕ ❓ ➖ P I C O:
    - P: adults hospitalized ➩ bloodstream INF
    - I: 7d of ATB
    - C: 14d of ATB
    - O: MM90, sOC = relapse
  3. EVIDENCE:
  - Mantra = "shorter is better”
  - Does it apply to BSI? few (underwhelming) results from small trials
  - The mantra applies to UNCOMPLICATED INF syndromes
  4. METHODS.
- RANDOM ➠ 7 🆚 14 d
  - Drug choice + route + dose ➩ discretion of CLINICIAN
- INTERV ➠
6. RESULTS
  - BSI sources:
       * Urinary tract 42%
       * 🫃🏽 or biliary tree 19%
       * 🫁 13%
  - Pathogens
       * E. Coli 44%
       * Klebsiella spp. 15%
       * Enterococcus spp. 7%
  - MM90 ➩ SIMILAR in both groups (≈15%) [idem in respecified criterion for noninferiority]
  - RElapse ➩ UNCOMMON in both (<3%)  
  7. ≈ better than ~ (verified thanks to AMA remark)
  8. Key strength = large size
  9. BALANCE should change practice ❗
10. Excluded cases MUST GUIDE our application:
         - S. Aureus BSI
         - Severe immunocompromised (↓N, 💉 immunosuppression [transpants: solid-organ OR stem

            cell])
         - Prostetic 🫀 elves
         - Vascular grafts
         - Undrained abscesses
         - Other w_prolonged TTO (endocarditis + osteomyelitis + septic arthritis)

11. OK 7d in uncomplicated BSI ✔

⏳ TIME MANAGEMENT
01:07:13

Round: 10 01:19:87 Comments
Round: 9 14:24:20 Wrap-up
Round: 8 08:51:00 Analysis
Round: 7 03:24:94 ART 2
Round: 6 01:18:88 ART selection
Round: 5 01:18:31 Comments
Round: 4 12:46:31 Wrap-up
Round: 3 13:53:40 ART 1
Round: 2 02:30:08 Select ART
Round: 1 07:26:35 Past JR

2025 NEJMjw - Can Tracking Inflammatory Biomarkers Shorten ATB Duration in Patients s_S (JAMA).pdf

Codified by MAAT

Glossary: ♾ = kidneys = renal; ✖ = discontinuation; BSI = bloodstream infection; UC = usual care

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, JAMA, UK ➖ mc_nonINF ➕ 2,7k critILL (60yo)➕ ❓ ➖ P I C O:
   - P: adults, 41 ICU
   - I: ATB ✖ w_PCT OR ATB ✖ CRP
   - C: usual care (UC)
   - O: MM28
3. EVIDENCE:
   - Adverse events + efficacy = unknown ➩ ATB duration
4. METHODS.
- RANDOM ➠ 3 groups (2 in I and 1 in C)
- INTERV ➠ blinded allocation ➕ no bioMAR values ➕ in I groups daily automated advice (cutt-off + % baseline value) ➕ in C group (daily advice to continue)
6. RESULTS
   - PCT 🆚 UC = d_ATB ↓ 1d (11d 🆚 10d)
   - CRP 🆚 UC = NOT SHORTER (11d both)
   - MM28 ➩ slightly ↑ in both bioMAR groups (~21%) 🆚 UC (19%) ➩ w_prespecified statistical

     criteria = ATB ✖ w_PCT was NOT INFERIOR to ATB ✖ w_UC (in MM)
   - Adverse events ➩ rare + similar
7. The COST to ↓ d_ATB is debatable or controversial (just 1 day?)
8. BioMARK in isolation to guide ATB decision is NOT the best idea - is not recommended.

Thursday, February 13, 2025 at 23h30 BE AMA, ABFL, MAAT, JCAU, HIBN, AAQC

Thursday, March 27, 2025 at 23h30 BE AMA, BAH, HIBN, AAQC

2025 NEJMjw - C. difficile Infection w_ Reduced Fidaxomicin Antibiotic Susceptibility May Develop Among Hospitalized Pxs (CID)

Codified by ABFL

Glossary: CID = Clostridioides difficile infection.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, CID, USA (Cleveland Veterans Affairs Medical Center)➖ COHORT ➕ 122 - 108 fidaxo ➕ t ➖ P I C O:
   - P: adults w_CDI
   - I: Fidaxomicine
   - C: NA
   - O: pOC = Susceptibility; sOC = Failure + recurrent disease
3. EVIDENCE:
   - ↓ susceptibility to fidaxomicin for CID
   - Its clinical implications are unclear
4. METHODS.
   - stool cultures for C. Difficile + susceptibility test
   - Whole-genome sequencing
6. RESULTS
   - Failure ➩ 7%
   - Recurrent disease ➩ 13%
   - 108 pxs w_fidaxomicin ➩ 6pxs (5.6%) w_↓ susceptibility
   - 4 of the 6 ➩ ↓ susceptibility only AFTER THERAPY
   - 2 of the 6 ➩ resistance (onset of disease + clinical failure)
   - RNA polymerase mutations = in all ↓ susceptibility isolates
7. RATIONALE
   - There are VARIANTS of C. difficile that ↓ susceptibility

   - Consider: vancomycin OR ↑doses of fidaxomicin (if no response to initial therapy + if subsequent recurrence)

2025 NEJMjw - Automated Blood Pressure Measurement — Without a Clinician in the Room (AJH).pdf

Codified by ABFL

Glossary: ↔ = between, AMAP = ambulatory monitoring of arterial pressure

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, AJH, USA (Boston, hypertension clinic)➖ single-center ➕ 67 - 44pxs ➕ t ➖

P I C O
   - P: out of hospital pxs
   - I: unattended BP measurement
   - C: AMAP
   - O: pOC = delay times; sOC = intervals ↔ 3 measurements
3. EVIDENCE
   - Time + space are IMP to measure BP
   - Automated devices ➩ can measure BP in ≠ INTERVALS + w_px in a quiet location = UNATTENDED BP measurement
4. METHOD
   - DELAY TIME = 3-5 min for 1st measurement after clinical left
   - INTERVALS ↔ 3 measurements (30-60sec)
   - All pxs had undergone AMAP
5. RESULTS
   - Longest ➩ 5min delay + 1min interval ➩ 67 pxs
   - Shortest ➩ 3 min delay + 30 sec intervals ➩ 44 pxs
   - 3 lectures (average) were SIMILAR
   - BOTH PROTOCOLS (short ➕ long) were CORRELATED CLOSELY w_AMAP
6. RATIONALE
   - SHORTER was as accurate as the longer in approximating to AMAP
   - “Whether this study's findings can be extrapolated to delays and intervals when multiple BP

      readings are taken directly by clinical staff is unclear.” Allan Brett

⏳ TIME MANAGEMENT
01:12:42

Round: 6 00:41:27 Comments
Round: 5 16:06:02 Wrap-up
Round: 4 11:47:36 ART 2
Round: 3 18:12:81 wrap-up
Round: 2 11:39:50 ART 1
Round: 1 14:15:93 Past JR + change of place

⏳ TIME MANAGEMENT
01:38:15

Round: 4 01:01:17 Comments
Round: 3 01:27:31 ART + logistics
Round: 2 01:14:93 Corrections
Round: 1 08:27:82 Past JR

2025 CC - Physiology and pathophysiology of mucus + mucolytic use in CrIll pxs (Roe) [r].pdf

Codified by AMA

Glossary: [ ] = proportion, ↑r = increased risk, ↓ AP = hypotension, ⊕ = induction, ♾ = kidneys/renal, ❃ = mucus, 💧 = secretion, 🔘 = cells, 🧠 = brain, 🫀 = heart, 🫁 = lungs, 🚀 = transport, 🛡 = protection, AARC = American Association for Respiratory Care, AD = advantages, AM = adhesion molecules, ARF = acute respiratory failure, ASL = airway surface layer, aw_ = airway, BTS = British Thoracic Society, DIS = disadvantages, HME = heat and moisture exchangers, HTS = hypertonic saline, MECHS = mechanisms, neb_HTS = nebulised hypertonic saline, NICE = National Institute for Health and Care Excellence, NIV = non-invasive ventilation, Par = participants, PPV = positive pressure ventilation, R = resistance.

1. Table 2. Mucus collection techniques
      - Induced/spontaneus sputum ▶ ask for spontaneous cough ➕ inhale neb_HTS (several mins) to

        loosen secretions → ⊕ cough
            * AD. No training needed ➕ ↑ ↓ aw_ + in alert pxs
            * DIS. Saliva contamination ➕ use of HTS (facilitate expectoration): uncomfortable for pxs +

              alter mucus composition
      - Endotracheal sampling ▶ only in intubated ➖ suction catheter is inserted and samples collected

        (∂ suction).
            * AD. Minimal technical skill

            * DIS. Intubation required ➕ ↑ aw_ ➕ intra/inter individual variability (content & volume)
      - Bronchoscopy/BAL ▶ bronchoscope enters the branchial tree w_saline flushes + suctioning.
            * AD. Therapeutic benefit (❃ plugging) ➕ performed regularly for ↓ aw_
            * DIS. Sedation & intubation needed ➕ personnel & equipment needed.
2. NAC/carbocisteine
      - NAC = ❃lytics ➖ carbocisteina = ❃regulators
      - Erdosteine = UK licensed (acute bronchitis) BUT ✖ REC by NICE. Commonly used in the NHS.
      - NAC MECHS: disrupts 2sulphide bonds (mucin polymer) ➩ substituting sulfhydryl groups FOR

        2sulphide bonds ➩ ↓ viscocity & elasticity.
      * Administration route:
            * PO. No mucolytic properties demonstrated. (other indications: antioxidant effect as glutathion

              precursor)
            * Nebulised. Preferred due to rapid local mucosal action.
            * IV.
      * SIDE EFFECTS.
            * Nebulised. Nausea, unpleasant smell, sticky residue. Hypersensitivity → anaphylactoid

              reaction (18%) leads to bronchospasm, angioedema and ↓AP. ∑ a trail nebulised is needed.
            * PO and IV not commented.
            * If previous reaction in any form, 🚫 its use.
      * APPLICATIONS.
            * Weak evidence ➩ no ↗️ in expectoration, viscocity, O2tion, MM.
            * srMA (13 RCTs + 1712 pxs ARF): 3 NAC trials w_2 ≠ routes of administration (💉 +

              nebulised) ➩ NO ↗️ (OCs: d_MV, h_LOS or mv_FD)
            * RCT, 40pxs, MV >3d ➩ I: Nebulised NAC 🆚 C: normal saline ➩ OCs: modest ↑ SO2 within

              12h (I)
            * srMA (4 studies, 355 par) ➩ no ≠ (OCs: incubation rate, O2 index, icu_LOS, h_LOS or MM)

            * ∑ studies failed to show any ↗️

Thursday, March 13, 2025 at 23h30 BE AMA, MAAT, HIBN, AAQC

⏳ TIME MANAGEMENT
02:05:57

Round: 9 00:01:31 Final
Round: 8 08:48:17 Comments, all the ART
Round: 7 34:24:58 Format and Method
Round: 6 04:43:33 Storytelling
Round: 5 07:17:00 Comments
Round: 4 14:33:01 Comments + ART
Round: 3 35:42:21 ART
Round: 2 07:02:69 ART selection
Round: 1 13:24:64 Past JR

2025 CMGS - Gamification Revolutionising Healthcare Training for Leaders+Professionals (Cirino) [r].pdf

Codified by ABFL

Glossary: IHF = International Hospital Federation

1. It is important not only to develop skills in teams but also to provide an environment in which

    learning is free from the pressure of achieving results
2. One approach (from different paths) is:
      - Planning
      - Purpose and objective
      - Storytelling
      - Format and method
      - Structuring and communication
      - Implementation and evaluation
3. Constant challenge ➩ HEALTHCARE
      - Complexity to diversity of professions + expected results ➩ competencies ➕ skills
      - Continuous updates needed + improvements
4. 2023, IHF ➩ developed a LEADERSHIP MODEL (main competencies)
      - Values
      - Self-development
      - Execution
      - Relations
      - Transformation
      - 30 competencies in 2 areas: action domains ➕ enabling domains5. To continue…

Monday, March 31, 2025 at 23h30 BE AMA,  MAAT, HIBN, AAQC

Thursday, April 10, 2025 at 23h30 BE AMA, MAAT, JCAU, AAQC

2025 NEJMjw - Are We Giving the Right Doses of Antifungals to CIpxs (ICM).pdf

Codified by ABFL

Glossary: AF = atrial fibrillation, MM ‎ = mortality, TTO = treatment, alt_ = altered

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, ICM, 12 countries ➖ pros_MC ➕ 339 pxs (30 ICU) ➕ ? ➖ P I C O:
     - P: CIpxs (62yo, 61% ♂)
     - I: find the dose (triazole + echinocandin + polyene)
     - C: NA
     - O: pOC = appropriate PK/PD
3. EVIDENCE:
     - Fungal 🪲 are common
     - ↑ MM despite TTO
     - ↑ ↓ dosing OCCURS:
          * alt_pharmacokinetics ➩ OD
          * Drug interactions
4. METHODS. Levels measured between 1-3 d ➕ 4-7 d
5. RESULTS
     - 45% ▶ Candida albicans + Nakaseomyces glabratus + C. parapsilosis (most prevalent)
     - ANTIFUNGAL levels achieved PK/PD targets:
          * 80% ➩ fluconazole, caspofungin, or anidulafungin ➩ APPROPRIATE
          * 42-64% ➩ voriconazole, posaconazole, micafungin, or amphotericin B ➩ LOWER
          * >25% ➩ DID NOT ATTAIN
     - MORE LIKELY to attain the targets ➩↗️ PROPHYLAXIS (🆚 TTO)
6. RATIONALE
     - This study DID NOT demonstrate ↔ “insufficient dose ➖ TTO failure”
     - Other parameters need to be studied (to understand APPROPRIATE dosing)
     - More data needed to know if MONITORING should be performed

⏳ TIME MANAGEMENT
01:20:41

Round: 7 00:38:22 Comment
Round: 6 29:42:62 ART 2 - wrap up
Round: 5 06:26:00 Comments
Round: 4 16:41:57 Wrap-up
Round: 3 12:26:22 ART 1
Round: 2 05:33:87 ART selection
Round: 1 09:13:35 Past JR by AMA

2025 NEJMjw - Optimal Antithrombotic Strategy for Afib Pxs w_ Prior Brain Hemorrhage (LANCET).pdf

Codified by ABFL

Glossary: AF = atrial fibrillation, b_ = benefit, ICH = intracerebral hemorrhage

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, LANCET, 6 EUR (75 H+)➖ ol_RCT ➕ 319 ➕ 4y (2019-2023) ➖ P I C O:
     - P: AF (79yo, 35% ♂) prior ICH w_antiCOAG indication + mRankin ≤4
     - I: DOAC therapy
     - C: No antoCOAG
     - O: pOC = 1sr ischemic S† + 1st recurrent ICH
3. EVIDENCE
     - DILEMA ➩ AF and prior ICH
     - Balance ↔ r_isch_S† 🆚 r_majorBLEED
4. METHOD
     - Clinicians selected the DOAC
     - 7w af_ICH
5. RESULTS:
     - Most used ➩ apixaban (54%) + dabigatran (21%)
     - Isch_S† = ↓ in DOAC – 0.83 🆚 8.6 /100pxs /y
     - Isch_S† = ↓ in DOAC – absolute ↓ 7.77 events / 100px /y
     - Recurrent ICHs ➩ ↑ w_DOAC – 5 🆚 0.82 /100pxs /y
     - Recurrent ICHs ➩ ↑ w_DOAC – absolute ↑ 4.18 events / 100px /y
     - LOCATION no change (Prior lobar 🆚 nonlobar ICH)
     - NET clinical benefit ➩ weak trend ↗ DOAC (32 🆚 45 events)
6. RATIONALE
     - Valuable info given

     - Combination of this and other trial would provude PRECISE DATA ➩ r_ 🆚 b_ DOAC + which px

        to select

⏳ TIME MANAGEMENT
01:08:59

Round: 3 00:24:64 Comments
Round: 2 57:45:53 WRAP-UP
Round: 1 10:49:73 Past JR

2025 CMGS - Gamification Revolutionising Healthcare Training for Leaders+Professionals (Cirino) [r].pdf

Codified by ABFL

Glossary: bet_ = between, 📈 = marketing, 🎙 = communication, 🤝 = cooperation, HC = healthcare, IHF = International Hospital Federation, 🧠🔨 = knowledge, 🏞 = environment, 🏭 = organizational, QOL = quality of life.

1. …
2. 2023, IHF ➩ developed a LEADERSHIP MODEL (main competencies)
      - Values
      - Self-development
      - Execution
      - Relations
      - Transformation
      - 30 competencies in 2 areas: action domains ➕ enabling domains
3. Challenges of HC organizations ➩ To remain current + capable in their ROLES
4. TRAINING goals: develop skills in teams THROUGH PLAY + provide appropriate environment

    (learning is free from the pressure) ➩ culture focused on EXCELLENCE (align w_ideals of

    wellbeing + QOL)
5. Historically (childhood to adolescence) ➩ board + digital games are IMP for logical reasoning +

    strategic thinking + others.
6. Gamification was FIRST applied in education ((Damaševičius et al. 2023) ➩ arrives bringing new

    perspectives in HC training
7. Scenarios (fictitious + real) have been stablished for a controlled, r_-free environment
8. IF purpose (development) is aligned to gamification, ∑:
      - 🧠🔨 fixation. By using the senses =↗️ retention of knowledge (by solidifying concepts +

        theories + discussions)
      - 🤝 🏞. A healthy atmosphere is IMPORTANT (even w_competitions are involved). Strengthen →          🤝 ➕ fostering → 🎙
      - 🏭 climate + 🧘🏽‍♂. Allow deeper connection + innovative care/training
      - Connection of routine issues with the game. Participation in PROJECTS + PROCESSES ➩

        make conceptual connection + draw on experiences (game related) ∑ ↗️ understanding of   

        SITUATIONS + mm of CONFLICTS.
9. How to plan an EFFECTIVE GAMIFICATION:
      - PLANNING
           * We make decisions that impact → subsequent stages
           * ★ most time + effort
           * Avoids ‘REWORK + 🎙’ issues bet_teams
           * Check the list of questions to guide the steps
                 * WHAT: Best strategy? Time and resources? Subject? Aim? Ways of learning? Desires?   

                   References? Is this (activity, programe, project)? Story to tell? Sensation + learnings?

                   Skills to develop? Rewards?
                 * WHICH: Category? hierarchical level? Areas to contribute + approve?
                 * WHO: public participating?
                 * HOW: make resources more effective? is it aligned to the 🏭 plan? To motivate?
                 * CAN: conduct benchmarking? Development, quality management? Define de rules?
      - PURPOSE + OBJECTIVE
           * MUST BE well-aligned w_🏭 strategy.
           * We need an outline for EACH perspective scorecard
           * Should align w_annual training + development plan (training strategy)
           * Focus on: 🎙 + 📈
           * … to continue…
      - STORYTELLING
      - FORMAT + METHOD

      - STRUCTURING + COMMUNICATION

      - IMPLEMENTATION + EVALUATION

Monday, April 07, 2025 at 23h30 BE AMA, MAAT, JCAU, HIBN, AAQC

Thursday, April 17, 2025 at 23h30 BE AMA, AHO, HIBN, AAQC

2025 CC - Social media insights on sepsis mm using advanced NLP techniques (Shankar) [comm].pdf

Codified by  JQB.

Glossary: 🔥 = dangerous, ☁ = reply, LDA = Latent Dirichlet Allocation, RT = retweets, VADER = Valence Aware Dictionary and sEntiment Reasoner

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, CC, SGP ➖ multi-method approach ➕ 4080 posts ➕ 4y (2020 - 2024) ➖

P I C O:
      - P: all population in X (past Twitter)
      - I: posts in X
      - C: NA
      - O: OC = + & - sentiments
3. EVIDENCE:
      - Early recognition + prompt initiation of TTO
      - Public insight is SUBOPTIMAL ➩ DELAYS in care-seeking + worse prognoses
4. METHODS.
      - Various methods:
      - Sentiment analysis. VADER
      - Topic modeling. LDA
      - Aspect-based sentiment. Parsing + lexicons
      - Engagement analysis. RT, 👍🏽, ☁ metrics
      - Inductive thematic analysis. Braun & Clarke 6-phase frameword.
6. RESULTS
      - Sentiment analysis. Complex landscape
          * Neutral 46%
          * Negative 36%
          * Interplay ➩ factual info-sharing ➕ emotionally changed personal narratives
      - Topic modeling. 6 key themes
          * Sepsis awareness 25%
          * Personal experiences 21% ➩ MOST PREVALENT
          * 🗣 ONLY TRIGGERED by direct encounters w_condition (own OR loved one’s)
      - Aspect-based sentiment analysis
          * ⊖ ↔ (strong) ➩ shock ➕ organ failure
          * ⊕ ↔ ➩ survivors ➕ awareness
          * It shows the public understands S• is 🔥 but also sees hope in early TTO.
          * ↑ variability + ↑ intensity ➩ sentiments post -2022 ➩ C19 ▶ scatter plot
          * S• terms: frequency distribution ← 🆚 → how often + emotional impact ▶ Bar charts
7. To continue…

⏳ TIME MANAGEMENT
01:30:15

Round: 5 00:41:27 To continue…
Round: 4 35:47:36 Wrap-up + symbol creation
Round: 3 45:12:81 ART 1
Round: 2 5:39:50 ART selection
Round: 1 5:00:93  Past JR

⏳ TIME MANAGEMENT
36:45:24

Round: 4 00:48:27 Comments
Round: 3 21:13:15 Wrap-up
Round: 2 14:28:07 ART selection
Round: 1 00:15:73 Past JR 10 min

2025 NEJMjw - Antibiotics vs. Appendectomy for Imaging-Confirmed Acute Appendicitis in Adults (LANCET).pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: QX = surgery

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, LANCET GH, ? ➖ srMA 6 RCTs ➕ 2100 ➕ -Jun 6, 2023 ➖ P I C O:
      - P: imaging-confirmed acute appendicitis
      - I: ATB
      - C: QX
      - O: pOC = COMPLICATION 1y | sOC = APPENDICECTOMY 1y
3. EVIDENCE:
      - It is viable to use ATBs as an alternative to surgery
4. RESULTS at 1 year, I:
      - 1/3 (34%) ➩ underwent Qx
      - Complications = (5% and 8%)
      - Complications w_APPENDICOLITHS ↑ common (6%)
      - Appendectomy = Appendicoliths (49%) 🆚 not appendicoliths (31%)
5. RATIONALE
      - Safe alternative
      - Careful w_complications + liths

      - Appendicoliths = appendectomy

      - Now we have more date 🙂

Monday, April 14, 2025 at 23h30 BE .......

Thursday, April 24, 2025 at 23h30 BE AMA, MAAT, HIBN, AAQC

2025 NEJMcd - Beta-Blocker Therapy after AMI — To Block or Not to Block (Kotanidis) [cd].pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: BB = beta blocker, CA = coronary artery, CBC = complete blood count, hiSTATIN = high-intensity statin, JVP = jugular venous pressure, MI = myocardial infarction, NV = normal value, pPCI = primary percutaneous coronary intervention, SR = sinus rhythm, TT = thrombolytic therapy.

1. 54yo ♂
       * Pain ➩ severe, subesternal
       * CVD ➩ no
       * MEDs ➩ no
       * Work ➩ pharmacy
       * Activity ➩ walks his 🐕 3x/w
2. Examination
       * HR 72 + BP 115/65 + RR 21 + SaO2 100% air
       * BMI 26
       * Physical ➩ edema ✖, JVP ✖ ↑ , 🫁 ✔
       * ECG ➩ SR ➕ T inverted II, III, aVF ➕ ST depressions V5 & V6
       * LAB ➩ CBC ✔ , metabolic ✔ TnI ↑ = 1.4 (NV<0.04)
       * MEDS ➩ ASA 324 ➕ clopidogrel 600 ➕ heparin
3. Catheterization
       * Right dominant system
       * 80% stenosis ➩ proximal → CA
       * ✔ ➩ ← CA
       * Stent ✔ ➩ revascularization ✔
4. ECHO at D1
       * LVEF 55%
5. 2d later, to BB or not to BB
       * DAVID MARON
       * MAs ➩ efficacy [before reperfusion] = before TT or pPCI ➩ clear SS benefit
       * Most trial = large ST-segment ➕ ↓ LVEF
       * MEDs (ASA, statins, RAAS ⊖, others underused or not AVAILABLE)
       * MA ➩ efficacy [reperfusion era] = no MM benefit BUT “may be” ↓ recurrence of MI
       * MA ➩ efficacy [prereperfusion era] ➩ IN SS of MI wo_HF (i.e., preserved LVEF) ➩ ↓ acMM
       * In the case ➩ NSTEMI = now more common ➩ do TTO: ASA + hiSTATIN + 🫀 rehabilitation.
       * AHA + ACC… GL…
6. TO CONTINUE…

⏳ TIME MANAGEMENT
01:23:13

Round: 7 19:53:82 Wrap-up
Round: 6 13:15:64 Analysis
Round: 5 04:17:62 Option 2
Round: 4 23:28:11 Option 1
Round: 3 11:18:53 ART 1 - Vignette
Round: 2 02:00:66 ART selection
Round: 1 08:58:71 Past JR

⏳ TIME MANAGEMENT
01:47:00

Round: 7 01:40:10 Comments
Round: 6 44:45:56 Wrap-up
Round: 5 19:26:45 ART 2
Round: 4 15:23:65 Wrap-up
Round: 3 16:19:56 ART 1
Round: 2 03:28:38 ART selection
Round: 1 05:56:77 Past JR

2025 HEALIO - Obesity more likely for adults w_ high dietary sodium intake (ECO) [r].pdf

Codified by ABFL

Glossary: FFQ = Food frequency questionnaire

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, EUR CONG OBE, FI ➖ cohort ➕ 2222 ♂ + 2792 ♀ ➕ 2017 ➖ P I C O:
      - P: adults
      - I: Na levels (blood + urine) ➩ National FinHealth 2017 study
      - C: NA
      - O: pOC = BMI (general obesity) | sOC = waist circumference (abdominal obesity)
3. EVIDENCE:
      - WHO recommends max 5g
      - ↑ Na = ↑ r_advOC (S† + MI)
      - Population-level on individual-level strategies ➩ LESS EFFECTIVE
      - Food environment has changed habits + diversified
4. METHODS.
      - 𝗜𝗡 ➠ Adults from the National FinHealth 2017 Study
      - INTERV ➠ intake (FFQ) + samples (blood, urine)
5. RESULTS
      - Sodium intake + urine spot:
          * Highest quartile = ↑ obesity
          * ♀ & ♂ = ↑ general (♂ OR6 🆚 ♀ OR4) & abdominal obesity (♂ OR5 🆚 ♀ OR3 ) = highest

            quartile
      - Similar in urine
6. RATIONALE
      - Surprising for authors
      - ❝the findings cannot answer whether there is a causal relationship
      - More research is needed. Santalahti
      - When shopping, check the salt content.
      - Opt for lower-salt alternatives
      - ❝ The taste buds quickly adapt to lower levels of salt, and soon enough, the change will go

        unnoticed. Santalahti.

Monday, April 21, 2025 at 23h30 BE AMA, RD, AAQC

2025 NEJM - Modest Blood Pressure Increase W_ Age in Adults W_ Down’s Syndrome (Kelly) [corr].pdf

Codified by ABFL

Glossary: ^ = plateau, CVD = cardiovascular disease, FHS = Framingham Heart Study, MC4R = gene encoding the melanocortin 4 receptor, OSA = obstructive sleep apnea, PP = pulse pressure, RDUK = Research Datalink in the United Kingdom

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, NEJM, USA ➖ post_Cohort ➕ >20k ➕ ? ➖ P I C O:
      - P: Down S, ≥20yo
      - I: measures (SAP, DAP, PP)
      - C: Group of 20 - 25yo
      - O: pOC = BP increase w_age | sOC = BMI
3. EVIDENCE
      - ↑ SBP ➩ ↑ age
      - ↑ DBP ➩ ↑ childhood + adolescence + young adulthood
      - ^ ➩ middle age
      - ↓ ➩ af_60yo ➩ ↑ PP ➩ arterial stiffness.
      - PP is the BEST predictor of CVD (FHS) ➩ >60yo
      - CVD + HTA = uncommon in adults Down S. (Supported by RDUK) ➩ DESPITE:
          * ↑ BMI (than wo_Down S.)
          * ↓ physical activity
          * INFLAMMATION
4. METHODS
      - EHR (TriNetX) + longiutunal models
      - “SBP, DBP, PP” to AGE
      - 5-year age groupings
      - Sex, race, BMI
      - >♀ ➕ 34yo* ➕ 29.5kg/m2*
5. RESULTS
      - SBP* + PP*= ↑ marginally (slightly) w_advancing age
      - DBP* = <2mmHg (lowest age 🆚 any age)
      - “SAP + DAP + PP” ▶ slightly ↑ ♂ ▶ ↔ ⊕ w_BMI
6. RATIONALE
      - Phenotype (unique 🫀 )
          * ALTHOUGH Shorter stature ↔ ↑ SBP & ↑ r_CVD, Down S. pxs = normal SBP & PP
          * MECHS unclear
          * Blunted “sympathetic activity + responsiveness“ = Down Syndrome DURING exercise ➩

            PROTECTION (against arterial stiffening)
          * Operative in monogenic obesity (mutation in MC4R) ➩ r_HTA is ↓ ➕ simp
      - ∑ Protection from atheroma
      - The UNDERSTANDING of 🫀 phenotype is IMP:
          * Screening
          * mm practices
      - Coexisitng conditions should be considered (intersections): SAOS + dementia
      - TERMS: Modestly, marginally, slightly
          *Median [IQR]

⏳ TIME MANAGEMENT
01:13:34

Round: 4 19:04:93 Comments
Round: 3 41:30:52 JR
Round: 2 12:06:33 Past JR
Round: 1 00:52:50 Intro

2025 NEJMcd - Beta-Blocker Therapy after AMI — To Block or Not to Block (Kotanidis) [cd].pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: ABYSS = Assessment of Beta-Blocker Interruption 1 Year after an Uncomplicated Myocardial Infarction on Safety and Symptomatic Cardiac Events Requiring Hospitalzation, BB = beta blocker, CA = coronary artery, CBC = complete blood count, ESC = European Society of Cardiology, hiSTATIN = high-intensity statin, JVP = jugular venous pressure, MI = myocardial infarction, NV = normal value, OCAD = obstructive coronary artery disease, pPCI = primary percutaneous coronary intervention, REDUCE-AMI = Randomized Evaluation of Decreased Usage of Beta-Blockers after Acute Myocardial Infarction, SR = sinus rhythm, † = death, TT = thrombolytic therapy.

1. Continuing…
2. DAVID MARON – YES BB
       * MAs ➩ efficacy [before reperfusion] = before TT or pPCI ➩ clear SS benefit
            * Most trial = large ST-segment ➕ ↓ LVEF
            * MEDs (ASA, statins, RAAS ⊖, others underused or not AVAILABLE)
       * MA ➩ efficacy [reperfusion era] = no MM benefit BUT “may be” ↓ recurrence of MI
       * MA ➩ efficacy [prereperfusion era] ➩ IN SS of MI wo_HF (i.e., preserved LVEF) ➩ ↓ acMM
       * In the case ➩ NSTEMI = now more common ➩ do TTO: ASA + hiSTATIN + 🫀 rehabilitation.
       * GL: AHA + ACC:
             * CLASS I = initiate BB w_1st 24h af_event (wo_contraindications)
             * CLASS IIa = continue BB in NSTEMI + pLVEF
             * Both in prereperfusion + reperfusion ERAS
       * GL ESC 2023:
             * BB ‘added 🫀 protective role’ (SCA pLVEF) needs to be clarified.
       * GL US 2014, EU:
             * CLASS IIa = all pxs w_ACS regardless LVEF.
       * REDUCE-AMI
             * BB TTO (MI w_pLVEF) ➩ did NOT ↓ ‘incidence_† or infarction’
             * LIMITATIONS: open-label + no placebo + events not adjudicated centrally + 14% (af_1y)                       from NO BB group were taking BB 7+ 18% from BB group stopped TTO.
             * Maron = continue BB despite this only trial.
3. TOMAS JERNBERG – NO BB
       * 1980: ↑ SS w_long-term BB after large MI [← biomarkers, ← interventional + pharmacological                TTO]
       * Nowadays, only OBS studies on MI w_pLVEF (many = no effect).
       * Due to LACK OF EVIDENCE, several trials (2017 + 2018) examined l-t_BB in MI
       * REDUCE-AMI
             * >5k pxs
             * MI + LVED ≥50%
             * OCAD w_angiography + intervention ➩ l-t_BB 🆚 no BB
             * BB = NOT ↓ ‘r_† OR MI’
             * Any meaningful effect was unlikely ➩ Overlapping time-to-event curves + consistent findings                 in subgroups + sOC
             * B1-receptors = Metoprolol (aimed to 100mg) + bisoprolol (aimed to 5mg) ➩ both ↓ r_CVE.                   ➩ w_commonly doses in current practice.
             * OBS ➩ similar effects = low OR moderate 🆚 higher doses
       * ABYSS ➩ ✋🏽l-tBB (MI w_LVEF ≥40%) ➩
             * ✋🏽 = continuation (p for noninferiority = 0.44) [2.3 percentage points]
             * OC = composition of ‘acMM, nonfatal MI, nonfatal S† OR H+ 🫀reasons’

       * Effects (ANGINA  + ISCHEMIA) of BB known since 1960s

       * SIDE EFFECTS + affect ADHERENCE       to other TTOS  (proven efficacy) should be                            considered.

       * IF angina pectoris, 📈, HF, or HTA develops at a later time, BB may then be indicated.

Monday, April 28, 2025 at 23h30 BE AMA, MAAT, AAQC

Monday, May 5, 2025 at 23h30 BE AMA, AHO, BLAS, HIBN, AAQC

2025 ICUmmp - Rationale for Early Arginine-Vasopressin Administration (ICM).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: ACP = Acute Cor Pulmonale, AVP = Arginine-Vasopressin, bioM = Biomarkers, CI = Cardiac Index, EF = Ejection Fraction, HRS = Hepatorenal Syndrome, LVOTO = Left Ventricular Outflow Tract Obstruction, N-RRT = Need of Renal Replacement Therapy, OF = Organ Failure, sARF = Severe Acute Respiratory Failure, SV = Stroke Volume, 🫀 = Heart, 💨 = Flow, 📈 = Arrhythmia.

1. AVP = ↑ attention
2. Rationale + implications + advantages ➩ AVP
3. BASIC
       * Receptors (distribution + response)
       * Dopamine ➩ unpredictable effects
       * Epinephrine ➩ unfavorable balance (O2 supply 🆚 demand)
       * Dobutamine ➩ ↓ CI
       * CHALLENGES of early use ➩ splanchnic ↓💨 , ↑ FC, 📈 , ↑ bioM
       * Norepinephrine ➩
             * inotrope
             * Decompensated 🫀 pxs: ↑ impact ➩ ↑ α receptor expression in 🫀 ➩ ↑ EF + SV
4. HIGH-DOSE
       * Dosage + duration INFLUENCES px OC
       * ↑ dosis (>0.3) = ↑ MM + 🫁 changes + fluid accumulation + OF
       * Prolonged use = refractory hypotension
5. ELASTANCE + SVR
       * Balance ↔ both
       * HTA crises ➩ ↑ afterload
       * SSØ ➩ r↓ afterload
       * So, prolonged use ➩ stress-related cardiomyopathy (Takotsubo)
6. ALTERNATIVE VP
       * Acts on V1, V2, V3 receptors (balanced effect)
       * VASST → safe to use at 0.26 NE (although NOT OC benefit)
            * Subgroup: ↑ SS in 0,15 - 0.2 👏🏽
       * MA → SSØ ➩ ↓ supraventricular 📈 + ↓ AFib.
       * C19 ➩ →ventricular DYSF + ACP (complication of sARF)
7. ♾ PROTECTION
       * VASST ➩ Subanalyses =↗️ Cr + ↓ N-RRT
       * VANISH ➩ ‘trend↗️’ ♾ function (p>0.05)
8. HH SØ
       * Trauma study
            * ↓ N-transfusions (RBC, FFP, PLT, CRYO)
            * NO SS benefit
            * Role in coagulation + volume management
9. LVOTO
       * Mitigate this condition exacerbated by catecholamine-induced hypercontractility and reduced                afterload.
       * Study, 500 pxs. SSØ = prevalence 22%
            * ↓ NE requirements
            * O2 ↑
            * Gradients ↓
10. 🆚 TERLI
       * Another V1 receptor agonist.
       * Longer half-life
       * Stronger vasocontrictive effect
       * Indicated in HRS + variceal bleeding
11. Recommendations by the author:
       * 🦠 Septic Shock: Vasopressin can be added to norepinephrine, especially at moderate doses

          (0.15–0.2 µg/kg/
       * ❤‍🔥 LVOT Obstruction: Acts as a safer primary vasopressor by avoiding beta-adrenergic
       * 🫀 Pulmonary Hypertension / RV Dysfunction: Early use may reduce 🫁 pressure and

           support → 🫀 function.
       * 🧠 Stress Cardiomyopathy (e.g., Takotsubo): Helps prevent by ↓ excess stress hormone
       * 🩸 Hemorrhagic Shock: May ↓ transfusion needs and improve blood

       * ⏳ Prolonged Septic Shock (>4 days): Can replace depleted natural vasopressin levels for                     better vascular support.

⏳ TIME MANAGEMENT
01:49:36

Round: 6 00:14:39 Comments
Round: 5 29:09:01 Wrap-up
Round: 4 34:20:04 Comments
Round: 3 33:01:72 ART 1
Round: 2 02:05:68 JR selection
Round: 1 10:45:87 Past JR

⏳ TIME MANAGEMENT
01:05:54

Round: 6 00:28:58 Comment
Round: 5 25:32:21 Wrap-up
Round: 4 04:37:50 ART 2
Round: 3 14:32:60 ART 1
Round: 2 07:35:89 ART selection
Round: 1 13:07:27 Past JR

1. NPWT ➩ does not ↓SSI post-emergency laparotomy

 2. Hypothesis: NPWT ➜ ↓ wound morbidity > standard dressings (esp. in ER Qx)
 3. RCT (n=840):
        * NPWT 🆚 surgeon’s choice (dressing)
        * OC = 30d SSI = NO DIFF
 4. Conclusion: Routine NPWT is not useful in ER
Glossary:
Aa_Ca formulas = albumin-adjusted calcium formulas
N_Ca = normal calcium

1. IF ALB is abnormal → use Aa_Ca formulas TO GET the free calcium (when unavailable)

 2. None formula is universally acceptable
 3. Cross-sectional (N=17,5k)
        * ALB
        * Total Ca
        * Ionized Ca
        * RESULTS:
              * ≤0.3% w_ALB <3g/dL ▶ ↑Ca (ionized)
              * PROBLEM = N_Ca (missclasified w_Aa_Ca)
              * 44% ▶ ↓Ca (ionized)
              * PROBLEM = N_Ca (missclasified w_Aa_Ca)
              * 6.8% ▶ N_Ca (ionized)
              * PROBLEM = ↑Ca (missclasified w_Aa_Ca)
 4. IF IONIZED Ca is unavailable, total Ca should be corrected by Aa_Ca formula.

 5. The ACCURACY may be poor, though.

 6. So:

        * IF Aa_Ca formulas = ↑Ca = is most likely reliable

        * IF Aa_Ca formulas = ↓Ca = the same, but less than ↑Ca

2025 UPTODATE - Pediatric deaths (MMWR), wound therapy (JAMA), free calcium (JAMA).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: ER = emergency, NPWT = Negative pressure wound therapy, SSI = surgical site infection.
Negative pressure wound therapy does not reduce infection after closed emergency laparotomy incisions

Thursday, May 1, 2025 at 23h30 BE AAQC

Monday, May 12, 2025 at 23h30 BE 

BLAS, HIBN, AAQC

2025 HEALIO - Depression may hasten development of chronic health conditions in adults (PlosMed).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

1. Depression ➩ ↑ physical conditions (each year) d_7y
2. Whole body condition = depression
3. Those w_DEPRESSION ➩ ↑ 30% faster of physical health conditions
4. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
5. 𝙄𝙌𝘾 BS 🟰 2025, Plos Med, UK ➖ cohort nationwide ➕ >150k participants ➕ 2006-2010

    + f-up 7y ➖ P I C O:
        * P: bio bank UK (40-71yo)
        * 🅸: depression diagnosis
        * 🅲: NA
        * O: pOC = association w_ comorbidities
6. EVIDENCE
        * ↓ physical activity + smoking ➩ ↑ rate of comorbidities
        * Depression as possible rf has been under-researched.
        * 1/2 of multimobidities INCLUDE depression (U. Of Edinburgh in Scotland)
7. RESULTS
        - 69 kinds of comorbidities
        - Baseline 18% DX ➩ w_PHYSICAL CONDITION 2,9%w_ 🆚 2,1% wo_depression
        - Each year both (w_ & wo_) ↑ 0.2 & 0.16 per year
        - Physical morbidity FASTER w_depression 🆚 wo_depression
        - ↑ maintained faster in those w_depression ➩ attenuated after adjusting (baseline condition,

          lifestyle & social factors)
        - MOST common
              * Osteoarthritis
              * Hypertension
              * GERD
8. RATIONALES
        - IT CAN be prevented
        - Mental health should support their pxs (specially w_smoking, diet, obesity, exercise)
9. LIMITATIONS
        - Underestimation of the strength of ↔
        - UK Biobank participants are generally healthier + ↓ likely to live in deprived areas 🆚 general

           population ➩ APPLICABILITY is hurt
10. Message: “The results show that depression should be looked at as a “‘whole body’ condition, as

      well as the importance of integrated approaches to managing both mental and physical health

      outcomes” researchers.

2025 MB - Cancer Statistics for 2025 (CA Cancer J Clin).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: 🫁 = lungs, GERD = gastro-esophageal reflux disease

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, CJC, USA ➖ projections ➕ all population ➕ 2025 → ➖ P I C O:
P: US citizens
🅸: US citizens
🅲: NA
O: pOC = MM | sOC = CA diagnoses
3. RESULTS
   - In 2025, >600k will die from CA in the US ➩ 1700 per day (>300k ♂ 🆚 >290k ♀ )
   - In 2025, >2M will be DX ➩ 5.6k new cases per day (>1M ♂ 🆚 >900K ♀)
   - Most common:
        * ♀ ➩ breast (32%), 🫁 + bronchus (12%), colorectal (7%)
        * ♂ ➩ prostate (30%), 🫁 + bronchus (11%), colorectal (8%)
   - Deadliest:
        * ♀ ➩ 🫁 + bronchus (21%), breast (14%), pancreatic (8%)

        * ♂ ➩ 🫁 + bronchus (20%), prostate (11%), colorectal (9%)

⏳ TIME MANAGEMENT
48:39:46

Round: 7 03:02:74 Comments
Round: 6 15:48:01 Wrap-up
Round: 5 08:58:64 ART selection
Round: 4 02:40:39 Comments
Round: 3 10:20:40 Wrap-up
Round: 2 02:07:32 ART 1
Round: 1 05:41:92 Past JR

2024 MB - Which AI Chatbot Can Assess Cancer Cases Most Accurately (JAMA).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, JAMA, CH ➖ cross-sectional ➕ 10 chatbots (7 uni + 3 multi) + 79 cases ➕ ? ➖ P I C O:
P: oncology cases
🅸: multimodal chatbots
🅲: unimodal chatbots
O: pOC = accuracy | sOC = reliability
3. EVIDENCE:
   - Multimodal ➩ process COMPLEX MEDICAL IMAGE + text-based info
   - Unimodal ➩ text-only processing
   - Hypothesis ➩ multimodal would OUTPERFORM unimodal
4. METHODS.
   - 𝗜𝗡 ➠ multiple-choice ➕ free-text questions ➕ images ➕ multi = ChatGPT-4 Vision, Claude-3

     Sonnet Vision, and Gemini Vision ➕ uni = ChatGPT-3.5, ChatGPT-4, Claude-2.1, Claude-3

     Sonnet, Gemini, Llama2, and Mistral Large.
5. RESULTS
   - MULTIPLE-CHOICE
         * ACCURATE:
               * Mistral Large = 73%
               * Claude-3 Sonnet Vision = 71%
               * ChatGPT-4 = 68%
         * INACCURATE
               * Incorrect = 89%
               * Refused wo_reason = 7%
               * Refused w_reason = 4
         * MORE ACCURATE w_DX questions 🆚 MM questions
   - FREE-TEXT
         * NO DIFF in accuracy ↔ diagnostic 🆚 management
         * ACCURATE
               * ChatGPT-4, Claude-3 Sonnet, and Claude-3 Sonnet Vision = 38%
               * Mistral Large 37%
               * Gemini = 32%
               * Gemini Vision = 32%
         * INACCURATE
               * Incorrect = 90%
               * Refused w_reason = 8%
               * Refused wo_reason = 2%
6. RATIONALE
   * “In this cross-sectional study of chatbot accuracy tested on clinical oncology cases, multimodal

      chatbots were not consistently more accurate than unimodal chatbots” the author

   * We need more research to optimize the multimodeal chatbots

Thursday, May 8, 2025 at 23h30 BEAMA, BLAS, HIBN, AAQC

⏳ TIME MANAGEMENT
57:38:67

Round: 6 00:37:18 Comments
Round: 5 20:21:16 Wrap-up
Round: 4 12:22:79 Appraisal
Round: 3 04:17:58 ART 1
Round: 2 13:25:23 ART selection
Round: 1 06:34:70 Past JR + 9 min

Monday, May 19, 2025 at 23h30 BEAMA, BLAS, HIBN, AAQC

2025 INC - How to Make 2025 Seem Twice as Long (in the Best Possible Way) (haden)[R].pdf

Codified  by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (MAAT)

1. “I’ve become my parents” remark used…
2. Study ➩ annual meeting of S. Of Neuroscience:
        * Internal clock runs more slowly as you age
        * Life seems to speed up
        * Aging ↓ dopamine release
        * ↑ dopamine = new things
3. Neuroscience and Biobehavioral Reviews ➩ ↓ dopamine = time to seem like it passed more quickly
4. Other studies ➩ info to ABSORB and PROCESS ▶ defines PASSAGE OF TIME.
        * Young: most seems new
        * Older: little is new (“same stuff, different day”)
5. Time = blend MEMORY ➕ ATTENTION
6. PLOS One ➩ when busy = time seems to pass quickly
7. 1st STEP to ↓ time ➩ NOVELTY
        * Surprise WRITES DOWN you memories ➩ changes your circuitry
        * Through life: 🧠 develops BETTER MODELS of the world ➩ less carries much surprise = fewer

           memories
        * ∑ seek novelty
8. Doing sth NEW still sparks a dopamine hit, less intense.
9. Key ➩ as new as possible in as many ways as possible.
10. Memories become denser when you experience a FIRST with vivid memories.
11. PLANNING also helps ➩ make plans, talk about the trip, talk about what you’ll do.

        * Applied Research in Quality of Life: showed HIGHEST spike in vacation happiness =

          d_PLANNING STAGE.

        * People enjoy ANTICIPATION

2025 JAMA - Loneliness and Social Isolation Among US Older Adults (malani) [lett].pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary:Fb = feedback.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA, US (U. Michigan Nal. Poll) ➖ cross-sectional, surveys ➕ >2000 - 2500 ➕2018 - 2024 ➖ P I C O:
        * P: 50-80 yo
        * 🅸: surveys (6 samples, 6 time points)
        * 🅲: NA
        * O: loneliness & social isolation
3. METHODS
        * Past year felt:
              * Lack of companionship
              * Felt isolated
        * Hardly ever, some of the time, OR often
4. RESULTS
        * LACK OF COMPANIONSHIP
              * 2018. Some of the time OR often ➩ 34% ➖ 2020. ↑ 41%
              * 2021. 37% ➖ 2022. 42% ➖ 2023. 37% ➖ 2024. 33%
        * Loneliness
              * MOST COMMONLY reported = not working, living alone, lower household incomes =
              * HIGHER RATES = fair + poor ‘physical + mental health’ (compared to excellent, very good   

                 or  good phys…)
        * Social isolation
              * Similar pattern
              * 2018. 27% “some of the time” or “often” ➖ 2020. 56%
              * 2021. 46% ➖ 2022. 44% ➖ 2023. 34% ➖ 2024. 29%
              * Same groups as loneliness for social isolation
5. RATIONALE
        * Loneliness + isolation = substancial ← pandemic →
        * Higher rates ➩ self-reported fair or poor physical & mental health
6. LIMITATION
        * Recall bias
        * Self-reported
        * Not longitudinal
        * 2020 survey asked from last 3 months
        * Not generalize to excluded from the poll
7. Recommendations: Ask about diet + exercise ➕ Screening for loneliness + social isolation in

    OLDER ADULTS ➕ CONNECT w_appropriate resources

⏳ TIME MANAGEMENT
01:21:02

Round: 8 00:42:20 Comments
Round: 7 21:15:01 Wrap-up + analysis
Round: 6 07:45:26 ART 2
Round: 5 03:04:66 Comments
Round: 4 29:54:37 Wrap-up + analysis
Round: 3 08:05:39 ART 1
Round: 2 06:53:38 ART selection
Round: 1 03:22:39 Last JR

Thursday, May 15, 2025 at 23h30 BE

AAACC. AMA, MAAT, BAH,, AAQC

2025 JAMA - Electronic Sepsis Screening Among Hospital Ward Pxs (bellomo) [lett].pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: AF = atrial fibrillation, ARDS = acute respiratory distress syndrome, CA = cardiac arrest, GE = gastroenterology, 🫀 = heart, RRS = rapid response systems

1. Recent study discussed ➩ SCREEN trial, JAMA 2025
2. Concerns ➩ generalizability ➩ should we use it in H+ w_well stablished RRS?
3. INT 15% 🆚 RRS 5% ➩ In AUS = 7% typically, 10% teaching H+, 14% their H+
4. Was thought ➩ 1/3 of alerts + adherence ↓ (early mm in 12h), audit:
       * Lactate 97%
       * Hemocultures 78%
5. Overall MM:
       * High in the study ➩ 3.1%
       * Although DNR and 🫀 excluded
       * ▶ Blue code = 10 per 1000 admissions
       * Even if 1/5 were true BCs ➩ 2 per 1000
       * 7 H+ AUS ➩ 2017, true BCs = 0.62 per 1000
6. AUS ➩ since 2010 RRS are MANDATORY
       * 2 tiered escalation system
       * Moderate = ICU led RRT
       * Milder = floor RRT (Cardiologists, internists, etc.)

       * ↓ in-H+ CA in AUS

2025 JAMA - Electronic Sepsis Screening Among Hospital Ward Pxs (brender) [lett].pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary:Fb = feedback.

1. SCREEN trial ➩ concluded: ↓ MM90 when electronic screening
2. DISTINCTION:
       * Electronic sepsis alert 🆚 clinical deterioration warning
       * 🚨 FATIGUE ▶ activated → nurse acknowledged → assessment → communication to

          physicians.
       * DISREGARD of the alarm IF already “sepsis suspected” ➩ in the study: 3/4 ATBs ➕ 1/2

          documented source
       * Nurse’s update ➩ different from the alarm ➩ ❝might prompt a broader diagnostic and

          therapeutic reexamination. (More reliable?)
3. IMPLEMENTATION
       * Study ▶
       * staff was trained (timely assessment, vitals documentations, early mm)
       * Clinicians access to dashboards + monthly fb reports
       * H+ administrators
       * Quality ↗ personnel
       * MM↓ ➩ ONLY after unit-level clustering
       * So… RESULTS are attributable < 🚨 than IMPLEMENTATION
       * ❝ its successful implementation is not the alarms and the true value lies outside the electronic

         health record.

⏳ TIME MANAGEMENT
01:30:40

Round: 7 00:44:99 Comments
Round: 6 26:43:21 analysis + wrap-up
Round: 5 03:58:62 ART 2
Round: 4 35:12:95 Wrap-up
Round: 3 04:05:32 ART 1
Round: 2 07:17:20 ART selection
Round: 1 12:37:81 Past JR

Thursday, May 29, 2025 at 23h30 BEMAAT, BAH, HIBN, AAQC

⏳ TIME MANAGEMENT
01:21:02

Round: 8 00:42:20 Comments
Round: 7 21:15:01 Wrap-up + analysis
Round: 6 07:45:26 ART 2
Round: 5 03:04:66 Comments
Round: 4 29:54:37 Wrap-up + analysis
Round: 3 08:05:39 ART 1
Round: 2 06:53:38 ART selection
Round: 1 03:22:39 Last JR

2025 JAMA - Extended Caffeine for Apnea in Moderately Preterm Infants (carlo) [R].pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL or MAAT)

Glossary: aft = after, DC = discontinuation, DISC = discharge, ED = emergency department, FHx = family history, H+ = hospitalizations = hospital, HA = high-altitude, PMA = post menstrual age, wGA = weeks gestation.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA, USA ➖ RCT ➕ 827 (416 🅸 🆚 411 🅲), 29 H+ ➕ 2019-2022, follow-up 2023 ➖ P I C O:
   - P: moderately preterm infants
   - 🅸: oral caffeine citrate 10mg/Kg/d until 28d af_DISCH
   - 🅲: placebo
   - O: pOC = d_DISC af_RANDOM
   - O: sOC:
       * Days to Physiological Maturity ➩ Apnea-free for 5d ➕ full oral feeds ➕ wo_incubator > 48

          hours
       * Postmenstrual Age at Discharge ➩ Age in weeks since the mother’s last menstrual period at

          discharge
       * ac_H+ Readmissions
       * ac_ sick + ED Visits
       * Safety OC
       * Death
3. EVIDENCE:
       - Most common factors for prolonged H+ ➩ delayed resolution of ‘apnea of prematurity’ +

         attainment of oral feeding
       - Caffeine + methylxanthines ➩ highly effective in ↓ apnea
       - Effectiveness + safety (extending caffeine therapy) ➩ limited evidence
       - MA 2024 ▶ limited data on benefits + harms of CAFFEINE CESSATION strategies ➩ causes     

         WIDE PRACTICE VARIATION
       - Cohort ▶ 80k pxs, <25w, >300 nICUs ➩ DC = 32-37w ❯ ↔ earlier postmenstrual age
       - H+ practice when DC = 5-10d af_DC caffeine ➩ because: therapeutic levels could mask   

         immature respiratory control.
       - In theory ▶ continuing caffeine (H+ ➕ beyond DISC) = ↓ h_LOS OR H_readmissions OR sick

          visits
4. METHODS.
   - 𝗜𝗡 ➠ Infants born at 29–33 wGA were eligible if ALL of the following were met:
       1. PMA 33–35w at randomization.
       2. Receiving caffeine (w_plan to stop TTO).
       3. Feeding ≥ 120 mL/kg/d (PO ± tube).
       4. Able to i_TTO ≤72h aft_ caffeine DC.
   - 𝗘𝗫 ➠ Infants excluded if ANY of the following:
       1. Respiratory support (i.e., O₂ > room air [HA sites], nasal cannula, CPAP, or MV).
       2. Apnea monitor due to:
              • underC (DIS or +FHx, e.g., sibling SIDS)
              • parental request
       3. Congenital heart DIS ≠ ASD, VSD, or PDA.
       4. Neuromuscular DIS affecting respiration.
       5. Major congenital malformation ± genetic DIS.
       6. Planned transfer → non-NRN site bef_ disch.
   - RANDOM ➠ 1:1 allocation
5. RESULTS
   - pOC =    

   - sOC all = EXCEPT apnea free days

Monday, May 26, 2025 at 23h30 BEAMA, AHO, HIBN, AAQC

2025 NEJM - The Definition of Failure (Gurney) [persp].pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: HF = heart failure; 🫀 = heart; 🧠 = brain; 🫁 = lungs; NSH = North Shore Hospital

1. C19 case in his mom ➩ 🫁 + 🧠 symptoms
     - Next week: barking
     - Week 3: Pale + ↑ 🫀
     - NSH: pleural effusion + AF (at arrival) + US = LVEF ~35%
2. HF = major public health problem
     - Affects 64M adults
     - Impact NOT EQUALLY: 4-6x ↑ in Māori
3. Discharge summary ➩ “heart failure” generously plastered
4. Bordering on panic
5. ❝ Why, then, were the doctors intimating with their diagnosis that she was about to die? And why

    had no one explained either the term or her condition adequately?
6. It was not so SEVERE to think she was about to die
     - Reassurances given by the son
     - She could continue to lead a full life
7. It is tricky to shake a moniker ➩ term “heart failure”
8. Consequences ➩ INTERNALIZATION + SELF-BLAME
     - Form of victim blaming
9. CDC + US NHLBI ➩ “Heart failure is a serious condition, but it does not mean that the heart has

    stopped beating“ ➩ COULD MISLEAD PXS
10. FAILURE ➩
     - Implies an acuteness
     - NOT APPROPRIATE for ↑ chronic + manageable condition
     - only SEVERE + ACUTE INSTANCES
11. MA ➩ <75yo, HF ➩ SS_5y 60-80% (depending on age)
12. ✖ colon failure (colon cancer) ✖ pancreatic failure (diabetes) ✖ brain failure (dementia) ➩ TIME

      TO shift the term
13. Germany ➩ “herzinsuffizienz” = heart insufficiency.
14. Changing the term could mean MANY STEPS (dx codes, clinics renamings)… ➩ ❝ focus on the bit

      that matters most: the patient’s experience.
15. PROPOSAL:
     - Enumerate all INSTANCES (inpatients + outpatients + clinicians + public-facing reports + other

       communications) where the term was used
     - Ask the meaning of HF to pxs + families
     - Beta-test some alternatives
     - ❝ The new term will have to balance the need to accurately emphasize the severity of the

        condition with avoiding a deadly ring of finality.
     - Research context ➩ qualitative (surveys) + quantitative (groups)
     - Plan for incorporating the new term

16. We have a substantial impetus to at least make a start.

⏳ TIME MANAGEMENT
01:35:08

Round: 4 02:37:72 Comments
Round: 3 01:11:09 ART selection + ART 1
Round: 2 02:28:87 Comments
Round: 1 18:52:95 Past JR

Thursday, June 19, 2025 at 23h30 BEMAAT, BAH, HIBN, AAQC

⏳ TIME MANAGEMENT
41:34:55

Round: 2 38:47:64 ART
Round: 1 02:46:91 ART selection

2025 NEJMjw - Stop Correcting Calcium Levels (JAMA).pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL or MAAT)

Glossary: ALB = albumin, cCa = corrected Calcium, iCa = ionized Calcium, Mm = management, tCa = total Calcium.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:

2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA, CA ➖ cohort ➕ >22k (60yo) ➕ ? ➖ P I C O:
   - P: ↓ Ca + ↓ ALB pxs
   - 🅸: tCa
   - 🅲: iCa
   - O: pOC = coherence
3. EVIDENCE:
   - Half of circulation Ca is bound to ALB.
   - Payne formula (1973) from 200pxs.
4. METHODS.
   - 𝗜𝗡 ➠ >22k pxs
   - 𝗘𝗫 ➠
   - RANDOM ➠
   - INTERV ➠ simultaneous measurement ➕ Payne & 9 similar formulas used ➕ iCa (normal) =

     1,15 - 1,35mmol/L.
5. RESULTS
   - Half had serum ALB measured.
   - ↔ ↗️ : tCa - iCa

   - ↔ ↘️ : cCa - iCa

   - ↔ ↗️ : cCa (complex: requiring pH OR derived locally) - iCa

   - REAL low Ca ➩ OVERESTIMATED by cCa

   - Payne formula ➩ ERROR in 41%

   - tCa ➩ ERROR in 25%

6. RATIONALE

   - Many use corrections (based on training) still.

   - STUDIES (multiple) support discontinuation of this practice.

   - ❝ “Correcting” calcium could lead to missed episodes of true hypocalcemia (Clement Lee)

   - If ↓Ca suspected ➩ measure iCa for DECISION-MAKING + mm

Monday, June 16, 2025 at 23h30 BEAMA, AHO, HIBN, AAQC

⏳ TIME MANAGEMENT
01:13:20

Round: 7 00:23:41 End comments
Round: 6 27:55:64 Perspectives, hopes, realities
Round: 5 08:20:07 Comments
Round: 4 15:03:64 Wrap-up
Round: 3 04:10:68 ART 1
Round: 2 05:00:29 ART selection
Round: 1 12:26:28 Past JR

2025 NEJMjw - An Update on Sudden Cardiac Arrests in Marathon Runners (JAMA).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: CA = cardiac arrest, CAD = coronary artery disease, MV = mechanical ventilation

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA, USA ➖ propective (registries) ➕ 29.3M ➕ 2000-2009 🆚 2010-2023 ➖ P I C O:
   - P: marathon runners
   - 🅸: sudden CA 2010-2023
   - 🅲: sudden CA 2000-2009
   - O: pOC = hALT impact on LBW, SGA, SPTB | sOC = magnitude LBW
3. EVIDENCE:
   - Long-distance running ➩ more popular last 2 decades
4. METHODS.
   - Assessed: Incidence + cause + need for CPR
5. RESULTS
   - 176 sudden CA in both cohorts
   - 0.39 to 0.20 (former 🆚 latter cohorts) CA deaths (incidence) ➩ ❝dropped about a half
   - Common CA causes:
         * CAD 27,
         * unexplained OR autopsy-negative CA 17,
         * anomalous coronary arteries 6,
         * hypertrophic cardiomyopathy 4.
6. RATIONALE
   - Although limitations:
         * ↗️ SS
         * ↗️ in resuscitation:
            * CPR

            * Acces to AED

            * Medicad preparedness on race days

2025 NEJMjw - Medication-Induced Erythrocytosis Common Culprits+Possible Consequences (Blood Adv).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: DC = discontinuation

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, BA, ? ➖ sr_retro> ➕ 45 studies ➕ ? ➖ P I C O:
   - P: pxs w_testosterone & SGLT-2 ⊖ ➩ w_erythrocytosis
   - 🅸: erythrocytosis
   - 🅲: NA
   - O: pOC = thrombosis
3. EVIDENCE:
- Unclear if erythrocytosis caused by TES + SGLT-2 ⊖ cause thrombosis
   - Secondary erythrocytosis ↑COMMON than primary.
4. METHODS.
   - Looked at DX, MM, clin_OC of drug-induced
   - Testosterone = 35 studies
   - SGLT-2 = 5 studies
5. RESULTS
   - Testosterone (for hypogonadism) ➩ RBC rates = 0 - 67% (more w_IM formulations)
        * Thrombotic complications RARE
        * mm strategies = heterogeneous = ↓ reduction + drug DC + phlebotomy + antiCOAG.
   - SGLT-2 ⊖
        - RBC rates = 2.1 - 22%
        - Hb plateaued in some
        - Hb normalized d_use OR af_DC
   - 2 studies ➩ described the THROMBOEMBOLIC events ➩ thrombosis rates = 6 - 10%
6. RATIONALE
   - Clinicians are tempted to treat SEC. ERYTHROCYTOSIS and POLYCYTHEMIA VERA in the same

      way (despite ≠ pathophysiology)
   - Hard to address confounding baseline risk factors for thrombosis in this study.

   - Multidisciplinary collaboration is IMP to weight risk-benefit BEFORE stopping culpable MEDS.

⏳ TIME MANAGEMENT
01:05:06

Round: 5 00:10:93 Final comments
Round: 4 22:46:10 ART 2 + wrap-up
Round: 3 27:36:67 ART 1 + wrap-up
Round: 2 07:17:70 ART selection
Round: 1 07:15:34 Past JR

2025 NEJMjw - Does Social Media Use Differ Among Adolescents w_ or wo_Mental Health Difficulties (Nat Hum Behav).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: SoMe = social media, MHC = mental health conditions,

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, NATURE HB, UK ➖ survey ➕ 3340 adolescents ➕ ? ➖ P I C O:
   - P: adolescents using social media (15yo mean)
   - 🅸: w_ mental health conditions
   - 🅲: wo_ mental health conditions
   - O: pOC = time and satisfaction
3. EVIDENCE:
   - How adolescents ENGAGE w_peers + communities ➩ revolutionized by SoMe
4. METHODS.
   - Standarized DX assessments for mental health conditions
5. RESULTS
   - w_MHC 🆚 wo_MHC:
        * ↑ 1h more daily
        * ↓ happiness w_their number of online friends
        * ↑ likelihood of DYSFUNCTIONAL BEHAVIORS
        * ↑ likelihood of ↑ mood sensitivity to FEEDBACK
   - Internalizing disorders:
        * Anxiety
        * Depression
        * Phobias
        * Eating disorders
6. RATIONALE
   - DOES excess of screentime contribute and perpetuate POORER mental health?
   - REFLECTION of quantity & nature of their SoMe might be beneficial for their WELLBEING
   - NO CONCLUSIVE EVIDENCE to restrict use.

   - OFFLINE ACTIVITIES ➩ JOY + foster friendship + healthy physical activity ✔

Monday, June 30, 2025 at 23h30 BEMAAT, BAH, HIBN, AAQC

Monday, June 23, 2025 at 23h30 BEAMA, AHO, HIBN, AAQC

2024 NEJMjw - Should E-Cigarettes Be Recommended as a Harm-Reduction Tactic for Smoking Cessation (NEJM+JAMA+Cochrane).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: 🚭 = avoid smoking, BID = bis in die, CH = Switzerland, NRT = nicotine-replacement therapy, VTA = ventral tegmental area

1. Several trials in 2024 ➩ effectiveness + short-term safety
2. PREVALENCE ➩ dropped steadily in recent decades.
3. 2006 ➩ FDA approved ➩ VARENICLINE (smoking-cessation medication) ➖ same year that e-cigs DEBUTED in the US.
4. E-CIG = battery0operated devices that heat a liquid (w_nicotine), w_subseequent aerosol inhaled or “vaped”.
5. E-CIG ➩ maintins a smoker’s nicotine DEPENDENCE. (Eliminates exposure to toxins) ▶ ∑ promise a 🚭 strategy
6. VARENICLINE
       - mech of action = partial agonist of nicotine receptors (alfa 4, ß2, high affinity)
       - 0.5 (white pill) and 1mg (blue pill)
       - Final effect on VTA DA neurons
       - Oral administration ➩ 1mg BID after D8, for 11w – ok for 6m, acceptable till 12m… never more

        (no evidence).
       - Nasal administration ➩ BID in each nostril

7. 𝙄𝙌𝘾 BS ➩ 2024, JAMA im, FIN ➖ placebo-controlled ➕ >450 adults ➕ ? ➖ P I C O:
       * P: adults
       * 🅸: VARENICLINE + e-cig
       * 🅲: placebo
       * O: 6m cessation ➩ R: 🅸 44% + 40% 🆚 🅲 20%.
8. 𝙄𝙌𝘾 BS ➩ 2024, NEJM, CH ➖ open-label, controlled trial ➕ >1200 ➕ 2018 - 2021 ➖ P I C O:
       * P: smokers
       * 🅸: e-cig + counseling
       * 🅲: counseling alone
       * O: 6m cessation ➩ R: 🅸 29% 🆚 🅲 16%
9. 𝙄𝙌𝘾 BS ➩ 2024, Cochrane, USA ➖ sr ➕ ? ➕ ? ➖ e-cig effective 🚭for 6m (at least).
    - High certainty = better than NRT
    - Low certainty = more effective than nicotine-free e-cigs

10. Editorial 2024 (CH trial) ➩ “It is now time for the medical community to … add e-cigarettes to the

      smoking-cessation toolkit”… seems reasonable

11. RATIONALE- Do people use e-cig to STOP smoking, or is it creating new tobacco users? ⏤

      Andrea (AMA)

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

1. Dr. Zhao Lui and colleagues ➩ “Efficacy of electronic cigarettes vs varenicline and nicotine chewing

    gum as an aid to stop smoking: A randomized clinical trial”
2. Published online: January 2024 ➩ Print issue: JAMA Internal Medicine, March 2024 (Vol. 184, p.

    291)
3. Retracted

⏳ TIME MANAGEMENT
01:40:15

Round: 7 00:53:88 Comments
Round: 6 56:47:22 Appraisal VARENICLINE
Round: 5 10:15:85 Wrap-up
Round: 4 14:53:71 ART
Round: 3 07:11:48 ART selection
Round: 2 09:05:71 Past JR
Round: 1 01:08:06 Past JR

Monday, July 7,  2025 at 23h30 BEAMA, AHO, HIBN, AAQC

2025 SRLF - Cathéter de dialyse en réanimation à la recherche de la voie (veineuse) du samouraï (JCC).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: CVC = central venous catheter, DVC = dialysis venous catheter, RRT = renal replacement therapy, VP = vasopressors.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JCC, 🇺🇸 ➖ retro_mono➕ >2k, 214 IN ➕ 2019 - 2022 ➖ P I C O:
   - P: ICU adult pxs
   - 🅸: CVC (prior) + need of DVC (second time)
   - 🅲: NA
   - O: pOC = number needed to change DVC site + with guide + total | sOC = complications

      (bacteremia, bleeding, arterial puncture, venous thrombosis, pneumothrorax, need of PICC line)
3. EVIDENCE…
4. METHODS.
    - 𝗜𝗡 ➠ adults ➕ CVC ➕ DVC
    - 𝗘𝗫 ➠ chronic dyalisis ➕ DVC prior to CVC ➕ another CVC ➕ femoral or subclavian CVC ➕          anatomic or clinically documented contraindication for a right yugular access.
5. RESULTS.
    - Group 1 ➩ 100 right jugular CVC ➖ Group 2 ➩ 114 left jugular CVC ▶ Demo similar in both
    - Admission DXs: § (20%, 16% S•) ➕ ARDS (18%).
    - No DIFF: anticoagulation + VPs + MV ➖ Similar modes of RRT
    - Median delay ‘CVC↔DVC’ 🟰longer in right jugular (2d) 🆚 left (1d).
    - Re-catheterization ➩ new DVC ➩ ↑ right jugular 40% 🆚 left 2.6%. ➩ confirmed in the

      multivariate 🤓
    - Catheter change ↑ frequent in the right (23% 🆚 0.9%)
    - More venous interventions in the right group = 38% 🆚 2.6% (left)
    - 2 bleeding + 1 DVT ➩ right jugular CVC
    - 0 cases ➩ sOC (except DVT + bleeding)
6. RATIONALE.
    - Dialysis number = 9.8% ➩ < epidemiology RRT of AKI in ICU (13%)
    - IRA at admission = 23% w_RRT
    - ECHO use ↓ risk of complications (↑ security) ➩ severe ↓O2 OR hemostatic troubles.
    - Similar PROSPECTIVE study w_similar results ➩ 2019 GL = use right jugular DVC ▶
      * ↗ effectiveness of depuration
      * ↓ r_INF
      * ↓ number of site changes
      * ↓ venous punctures
      * ↓ mechanical complications (<3%)
7. STRENGHTS
    - Results are consisten w_previous PROSPECTIVE study.
    - So… good to use the right jugular access for DVC.
8. LIMITATIONS.
    - Retrospective = bias: info + residual confusion
    - Monocentric = no external validity
    - Low inclusion = reproducibility is cuestionable.

    - Not possible to perform complications subanalysis ← low number of complications ➩ problem w_statistical power.

⏳ TIME MANAGEMENT
32:18:40

Round: 5 01:09:79 Comments
Round: 4 13:05:53 Questions + VID cacao
Round: 3 11:50:39 'Link to upload' creation
Round: 2 03:21:91 Q&A

Round: 1 02:50:74 Intro

Thursday, July 3, 2025 at 23h30 BEAMA, AHO, HIBN, AAQC

2025 NEJMjw - How Accurate Is BMI as a Measure of Obesity (JAMA).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: EA = excess adiposity, MV = mechanical ventilation

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA, US ➖ survey data ➕ >2k (39yo) ➕ 2017-2018 ➖ P I C O:
    - P: adults
    - 🅸: excess adiposity = ‘waist circumference + DEXA’ scan
    - 🅲: BMI
    - O: pOC = concordance
3. EVIDENCE.
    - BMI does not distinguish between FAT 🆚 MUSCLE 🆚 BONE
    - Concern in some populations like athletes.
4. METHODS.
    - Obesity = BMI ≥30 (≥27,5 in non-Hispanic Asians)
    - Waist circumference ≥102cm in ♂ (except in non-Hispanic Asians)
    - DEXA scanning ≥35% in ♀
5. RESULTS.
    - Obesity ▶ BMI 39,7% 🆚 EA 39,1%
    - Obesity by BMI ▶ 98% ALSO had excess adiposity.
    - Similar in SUBGROUP 🤓 : age, racial, ethnic, sex
6. RATIONALE.
    - Athletes might deserve special ASSESSMENTS.
    - No need to measure WAIST CIRCUMFERENCE or performa a DEXA scan.

⏳ TIME MANAGEMENT
01:42:50

Round: 8 16:08:39 Comments
Round: 7 31:51:81 Wrap-up
Round: 6 15:05:97 ART 2
Round: 5 10:22:88 Wrap-up + Ω
Round: 4 09:01:31 ART 1
Round: 3 11:35:28 The best JR-JC
Round: 2 03:04:87 ART selection
Round: 1 05:39:85 Past JR

2025 NEJMjw - Prevention of Acute Episodic Migraine (AIM).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: AEM = acute episodic migraine, ab = antibodies, BB = beta blockers, CBT = cognitive behavioral therapy, CGRP-r ⊖ = calcitonin gene-related peptide-receptor antagonist, mAbs = monoclonal antibodies, Œ = adverse events.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, AIM, US ➖ GL ➕ NA ➕ NA ➖ P I C O:
   - P: nonpregnant adults
   - 🅸: NA
   - 🅲: NA
   - O: prevention of AEM
3. EVIDENCE.
   - AEM is a clinical issue
   - Prevention in IMP
   - DEF = 1-14 headache days monthly
   - Evidence shows: MORE drug-placebo 🆚 LESS drug-drug
4. RESULTS
   - 3 ★ (non rigid, inviolable hierarchy): sequence of drug choice to BALANCE effectiveness ➕

     potential Œ ➕ costs:
          * 1st line. BB (meto, propra) ➕ psychotropics (valproate + venlafaxine + amitriptyline)
          * 2nd line. IF NO RESPONSE or NO TOLERANCE:
                * 💊 CGRP-r ⊖ (atogepnat + rimegepant)
                * 💉 CGRP mAbs (eptinez- + fremanez- + galcanez- + eren-➖ UMAB) ▶ EMPTY

                   FREEMAN in a GALAXY ERA◀
           * 3rd line. IF NO RESPONSE or NO TOLERANCE:
                * TOPIRAMATE
   - Triggers ➩ identity them
   - Prophylaxis ➩ 2-3month trial should be respected ← switching
   - Non drug 🅸 ➩ CBT + mindfulness-based TTO + relaxation training.
   - Cost ➩ high cost of CGRP-r ⊖ + CGROP mAbs.
6. RATIONALE.
   - Think of: preferences ➕ contraindication ➕ comorbidities
   - ❝ There is no one-size-fits-all criterion or threshold for starting preventive treatment

   - Check International Headache Society GL

     https://journals.sagepub.com/doi/10.1177/03331024241269735 (neurologists + free) as a more-

     detailed GL. (Allan Brett)

Thursday, July 14, 2025 at 23h30 BEMASP, AMA, HIBN, AAQC

2024 NEJMjw - Increasing Evidence Supporting Preventive Benefits of Exercise in Women (JAMA).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: ac_MM = all cause mortality, 🫀 = cardiovascular, ↓HF, HF = heart failure, 🏃🏾‍♂ = physical activity

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, JAMA cardio, ? ➖ pros_coh_obs ➕ >5k ➕ ? ➖ P I C O:
   - P: only women (63-93yo)
   - 🅸: accelerometer-measured physical activity
   - 🅲: “incident HF”
   - O: pOC = intensity + # steps + sedentarism ➩
         * Results:
               * ↑ intensity (moderate to vigorous)
               * ↑ # steps / day
               * Light 🏃🏾‍♂
               * ↓ sedentarism.
               * ALL above: ↔↓HF & ↓HFpEF ✔ , but NOT↔ ↓HFrEF

3. 𝙄𝙌𝘾 BS 🟰 2024, JACC, USA ➖ survey ➕ >400k ➕ ?➖ P I C O:

   - P: ♂ ➕ ♀ (55% ♀, 44yo)

   - 🅸: leisure-time 🏃🏾‍♂

   - 🅲: NA

   - O: pOC = MM | sOC = 🫀MM

               * Results:

               * Strong: 🏃🏾‍♂ ↔ MM in ♀

               * 18% ↓r ac_MM ➩ ~300min walking/week ➩ ♂

               * 18% ↓r ac_MM ➩ ~140min walking/week ➩ ♀

               * 24% ↓r ac_MM ➩ ~300min walking/week ➩ ♀

               * 🫀MM ➩ = ↔

               * 🫀MM ➩ NO ≠ → 🏃🏾‍♂🆚 🏋🏽

4. RATIONALE.

   - Empower ♀ to PREVENT: HFpRF incidence ➕ 🫀 MM ➕p ac_MM

   - Daily goal >3k steps (±30 min)

   - ↓ sedentarism <10h

   - Smart phones + smart watches MIGHT HELP (follow-up).

⏳ TIME MANAGEMENT
01:07:10

Round: 7 01:42:17 Comments
Round: 6 34:09:32 Wrap-up
Round: 5 07:29:93 Notes
Round: 4 03:14:70 ART
Round: 3 08:11:97 ART selection
Round: 2 04:57:36 Comments

Round: 1 07:24:58 Past ART

Thursday, July 10, 2025 at 23h30 BEMASP, AAQC

2025 FAST COMPANY - Why taking a break mid argument is the best conflict resolution hack (Jones-fosu) [r].pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: 🧠 = brain, ↗ = improve

1. Taking a break mid-argument is USEFUL
2. The author Justin comments about his argue with John, talking about politics.
3. His nervous system was lighting up = pinball machine.
4. ❝ I was not responding, I was reacting.
5. His pause ➩ changed TONE + OUTCOME of the conversation.
6. A pause is not a shutdown
      - 3 selves: superior ➕ inferior ➕ equal
      - Explains that his words and tone were dehumanizing (superior self)
      - Shutdowns happen w_ SUPERIOR & INFERIOR.
      - ❝ I noticed this conversation is starting to feel unproductive. I’d like to take a break so I can come back with more clarity and respect.
      - DIFFERENT FROM disappearing ➩ signaling your intent to return ➕ taking responsibility
7. The 90-second rule
      - AMYGDALA = fear center.
      - It hijacks your ability to think clearly.
      - Jill Bolte ▶ takes 90 sec for the STRESS HORMONES to clear the body.
      - CAVEAT:
          * It can be longer ❗
          * If the issue: touches CORE VALUES or PAST TRAUMA or you are EMOTIONALLY

            DEPLETED ➩ ↑ TIME = 10 min, hours, days, or even WEEKS.
8. Strategic pause
      - Difficult to practice when the amygdala hijacks our brain.
      - DAniel Goleman ▶ amygdala overrides the rational PREFRONTAL CORTEX → impulsive

        reactions
      - NEUROPLASTICITY ➩ adapt + change in response to EXPERIENCES + PRACTICES.
      - Strategies = mindfulness + illeism ➩ both STRENGTHEN the neural pathways ↔ prefrontal

        cortex → ↗ self-control ➕ emotional awareness.
      - IF you recognize the DYSREGULATION, take the BREAK.
      - ❝ I’m feeling overwhelmed and want to pause so I can come back with more respect and

        intention.
9. What to do during the break
      - ✖ stewing in righteous anger
      - ✖ rehearsing comebacks
      - ✖ texts to 3rd-party validation
      - Use ILLEISM ➩ talking to yourself in the 3rd person:
         * Why am I so upset ✖
         * Why is Justin so upset ✔
      - BUT not cure-all ➩ ∆ escalate (the other) ➕ refuse to reengage.
      - ADVANTAGES to return as your Equal Self ➩ clear + respectful + regulated → ↗ chance to move

        forward CONSTRUCTIVELY.

⏳ TIME MANAGEMENT
39:31:40

Round: 6 02:05:35 UPDATES
Round: 5 02:37:78 WEBSITE
Round: 4 07:21:93 ARTICLES
Round: 3 07:08:27 VIDEOS
Round: 2 16:05:86 Training
Round: 1 04:12:18 Q & A

Thursday, July 17, 2025 at 23h30 BEMASP, MACR, HIBN, AAQC

2025 MEDSCAPE - Think Glass Bottles Are Safer Think Again (Lara) [r].pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary:  ♾ = kidneys = renal, 🫃🏽 = abdomen = abdominal, 🫀 = heart, 🧠 = brain, 🫁 = lungs, ANSES = French Agency for Food, Environmental and Occupational Health & Safety, CA = cancer, FR = France, MI = myocardial infarction, MP = microplastic(s), S† = stroke.

1. A study in ANSES measured MP in beverages (FR)
2. Contamination found in all, GLASS bottles included.
3. Toxicological data needed to measure health risks.
4. Since 1950, ↑ plastic production ➩ terrestrial + aquatic pollution
5. Its degradation form MICRO- and NANO- plastics that affect the ecosystem ➩ ❝ 10,000 m beneath

 the ocean surface to Himalayan glaciers and even clouds.
6. MICROSOF project ▶ FR, led by Research Institute for Agriculture, Food and Environment and

 Institute for Research in Materials, RESULTS:
    - MP contamination of 75%
    - 33 sites
7. Although it is CHALLENGING to quantify, MICRO- ➕ NANO-plastics can penetrate:

8. REPORT ▶ Parliamentary Office for Scientific and Technological Assessment:
   - MP detected in human 🧠 , reaching 0.5% by weight.
   - 🫁 accumulation ↑ w_age (lt_persistence)
   - ↑r stomach CA, MI, S†
   - Toxicity ➩ chemical substances (contain OR absorb from environment) ➖ 4k = hazardous to

      human health
9. CONTAMINATION LEVELS
   - Main ingestion through contemned food + drinks
   - MULTIPLE STUDIES ▶ presence of MPs in:

10. ANSES ▶ measured in: bottled 💧, soft 🧃, iced 🫖, lemonades, 🍺, and 🍷 ➩ 30µm - 500µm

 (every beverage, ≠levels by type)
   - Bottled 💧= ~3 MP/L = ↓ [] compared to OTHER STUDIES
   - Sodas = ~31 MP/L
   - Lemonades = ~101 MP/L
   - Iced 🫖 = ~15 MP/L
   - 🍺 = 84 MP/L = NO DIFF ‘↔brands’
   - Wine glass bottles = 12 MP/L = other STUDIES reported ↑
   - | Authors: comparing studies is challenging due to:
        * Variations in standars
         * Variability of size
         * Samples + Volume
   - Glass bottles = HIGHER LEVELS of MP 🆚 plastic bottles OR cans
   - MPs = color ➕ polymer composition of the CAP MATERIALS ➩ cap abrasion d_large-scale 

     storage DRIVES CONTAMINATION
         * Washing caps ← sealing = ↓ MP levels
         * Wine stands out ➩ use of cork stoppers.
   - ❝ In this study, the MPs found in the glass bottles corresponded to the color and polymeric

      composition of the paint on the caps, which are coated with alkyd thermosetting resin or PES/PET-

      based paint.

⏳ TIME MANAGEMENT
01:22:45

Round: 5 30:07:27 Comments
Round: 4 34:43:14 Analysis + wrap-up
Round: 3 06:10:77 ART
Round: 2 05:22:40 ART selection
Round: 1 06:21:53 Past JR

2024 ICUmmp - Early Mobilisation When Evidence Comes to Single pxs (Nydahl) [GL].pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary:  🚶🏾‍♂️ = walking, **ARDS** = acute respiratory distress syndrome, **CC** = critical care, **cogDEC** = cognitive decline, **DC** = discontinue, **DM** = diabetes mellitus, **DVT** = deep venous thromboses, **EM** = Early mobilization, **ICU-AW** = ICU-acquired weakness, **QOL** = quality of life, **SBT** = spontaneous breathing trial, **S†** = stroke, **sec_** = secondary, **VAP** = ventilator associated pneumonia, **VP** = vasopressor.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:

2. 𝙄𝙌𝘾 BS 🟰 2024, ICUmmp, DE ➖ r ➕ NA ➕ NA

3. EVIDENCE.

   - PROBLEM ▶︎ ICU pxs ➩ hr: ↓ functionality + ICU-AW + cogDEC + delirium…
   - SOLUTION ▶︎ EM ➩ ↓r ➩ DEF = mobilization within 72h af_ICU admission. Benefits:
      - Functional independence
      - ↓ incidence + days in delirium
      - <days on MV
      - <day on H+
      - l-t_cognitive function
      - QOL
      - VAP complications
      - Pressure sores
      - DVT

4. FORMS.

   - Active mobilization
   - Pasive mobilization
      - Range of motion
      - Cycling
      - Active exercise in 🛌 (active range of motion, sitting up in 🛌)
      - Out-of-🛌 activities (sitting on the edge, standing, active/pasive transfer to 🪑, 🚶🏾‍♂️)
   - Electrical stimulation ➕ assist devices ➕ robotics ➩ useful for EM ➩ feasible ➕ safe ▶︎ even

        w_MV + VP + ECMO

5. PROTOCOLS.

   - ABCDEF bundle (whole interprofessional CC team)
      - Analgesia + sedation
      - Delirium
      - SBT
      - Mobilization
      - Family integration
   - Should INCLUDE:
      - Criteria ➩ for mobilization in & out-side of 🛌 ➩ traffic light 🚥  system = go, caution, stop 

        MOBILIZATION
      - Assessment consciousness + function
      - Scales ➩ ICU mobility scale (planning, performing and documenting )
      - Safety criteria to DC mobilization
      - Checklists for devices ➩ plannification table shows how to decide the type of activity ALWAYS

         communicating and checking for safety Variables to consider:
            - Sedation
            - Arms and legs
            - Pelvic stabilization

6. RIGHT DOSE.

   - VARIABLES 🟰 intensity/level ➕ frequency ➕ duration
       - Frequency ▶︎ 2016 ❯ proposed daily (a number)
       - Duration ▶︎ 2018 ❯ 60-90 min/day
       - Level + duration ▶︎ 2021 ❯ combination ➩ ⊕ influence (synergy)
       - Needs ADAPTATION (individualization/personalization) to each case based on:
       - clinical assessment (capacity + tolerance)
       - comorbidities
   - Examples of DANGER:
       - TEAM trial sec_Analysis ▶︎ ↑ max intensity 🟰 ↑ MM180 ▶︎ DM
       - 2015, 2016 ▶︎ very early + longer 🟰 ↑MM ▶︎ S†

   - Higher dose for HIGHER PHYSIOLOGICAL RESERVES.

   - START should be a variable (AMA)

Thursday, August 7, 2025 at 23h30 BEBAH, AHO, AMA, MASP, YZE, AAQC

⏳ TIME MANAGEMENT
01:25:10

Round: 5 00:44:76 Comments
Round: 4 58:32:20 Wrap-up + analysis (part 1)
Round: 3 04:38:56 ART 1
Round: 2 07:47:83 ART selection
Round: 1 13:27:21 Past JR

Monday, August 5, 2025 at 23h30 BEMASP, AAQC

2024 NEJMjw - Managing Elevated Blood Pressure in the Hospital (Hypertension).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary:  ACEP = American College of Emergency Physicians, ACS = acute coronary syndrome, 🥃 = alcohol, AHF = acute heart failure, aoDIS = aortic dissection, asymp_↑BP = asymptomatic elevated blood pressure, 😩 = pain, 🤬 = stress, cHH = cerebral hemorrhage, 🥱 = sleep deprivation, ED = emergency department, f-up = follow-up, 💉 fluids = intravenous fluids, H+ = hospital, HELLP = hemolysis, elevated liver enzymes, low platelets syndrome, Hº = home, hta_encephalopathy = hypertensive encephalopathy, 💊HTA therapy = oral hypertension therapy, mm = manage, NSAIDS = nonsteroidal anti-inflammatory drugs, PRES = posterior reversible encephalopathy syndrome, 💉 = recreational drugs, S† = stroke, TO = target-organ, 🤪 = withdrawal.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, H, 🇺🇸 ➖ GL ➕ NA ➕ NA
3. EVIDENCE.
   - 1st time GL asymptomatic ↑ BP (hospital + discharge)
   - ↑ BP ➩ adverse OC w_use:
       * Parenteral antiHTA agents
       * ↑ oral agents
   - Past GL ➩ no ⓘ on these matter. (AIM 2024)
   - Settings ➩ ER, ICU, non-ICU ▶ most relevant recent study data.
4. HTA emergency
   - PAS ≥180 ➕ PAD ≥110 ➕ TO damage (new OR ↘)
   - TO systems = BARKH
      * 🧠 brain ▶ S†, cHH, hat_encephalopathy, PRES
      * Arteries ▶ aoDIS, preemclampsia, eclampsia, HELLP.
      * 👁 retina ▶ acute HTA retinopathy
      * ♾ kidney ▶ AKI, thrombotic microangiopathy.
      * 🫀 heart ▶ ACS, AHF, 🫁 edema
   - Manage as 2017 GL (multisociety HTA clinical practice - 2018 JACC)
5. Asymptomatic ↑ inPX BP
   - Appropriate BP cuff size.
   - 🔍 + mm ➩ REVERSIBLES CAUSES ▶ 🤬, 😩, 🥱, 🤪 (🥃 OR 💉)
   - ✋🏽, 🚫, 🤔 ➩ MEDICATIONS that ↑ BP ▶ 💉 fluids, NSAIDS, corticosteroids, stimulant MEDS.
   - AVOID TTO in most situations ➩ including asymptomatic MARKEDLY ↑ BP (≥180/110)
   - IF TTO needed, even wo_TO_damage:
      * On prior MEDS 🟰 resume oral BP meds
      * On prior MEDS 🟰 individualize start (H+ 🆚 outpatient)
6. Transition of care
   - ED discharge Hº ➩ ACEP (AEM 2013) 👎🏽 antiHTA meds to mm asymp_↑BP in the ED ▶ BUT,

     start 💊HTA therapy on discharge Hº (some pxs), in facilitation of primary care FOLLOW-UP.
   - H+ dischage Hº:
      * ✔ (maintain) preH+ BP regimen
      * ✖ intensification BP meds (JAMAim 2021)
7. RATIONALE
   - AHA distinguishes ↑BP: new OR ↘ TO dysfunction 🆚 asymptomatic ↑BP.
   - Goal of the GL ➩ ↓ overTTO of both: ↑ inPX BP ➕ intensification BP meds.
   - IF no TO + no TTO ➩ balance FACTORS ▶
      * Severity
      * Previous history      

      * OutPX f-up plan - Ongoing relationship w_primary care provider ▶ communicate ❗

⏳ TIME MANAGEMENT

Session timing not available.
Total time 1h15

2024 ICUmmp - Early Mobilisation When Evidence Comes to Single pxs (Nydahl) [GL].pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary:  DEL = delirium, eMOB = early mobilization, EOLC = end-of-life care, ET = endotracheal, HDins = hemodynamic instability, ID = identification, iCONSCIOUSNESS = impaired…, mm = management, PICS = post-intensive care syndrome, SDM = shared decision making, VP = vasopressor.

1. **Barriers** that can avoid eMOB **(Dubb 2016):**
      - PXS ➩ HDins, ET tubes (other lines), DEL, agitation…
      - Structural ➩ time constraints, staff shortage, lack of protocols OR equipment…
      - Missing ➩ education, knowledge, culture
      - Strategies to implement eMOB
          - Baseline asessment of mobilization
          - ID of local barriers
          - Re-assessment of the MOB rates
          - Reflection
          - Feedback to the team
          - Resources (given by ICU mm & H+)
2. These topics should be supported by the mm level w_own ideas at an EARLY STAGE. (better resulst for pxs + cost savings)
3. Mobility teams is HELPFUL ➩ challenging in staff shortages times. Measure to ↑ willing to work (even ↑ hours):
      - Flexible time models
      - Financial incentives
4. Mobility aids (ROBOTICS)
      - ↑ important
      - Empiridcal data (use to support the staff) is limited
      - It should demonstrate:
          - Benefit for the pxs
          - ↓ workload ` staff
      - Investment ➩ Robots 🆚 HC professionals recruitment + retention ➩ UNTIL robotic technique adds VALUE to conventional MOB.
5. In CIpxs ➩ iCONSCIOUSNESS, pain, fatigue ▶︎ Individualize the standarized MOB
6. Therapy GOALS ➩ `SMART` 🟰 specific, measurable, achievable, reasonable, time-bounded.
7. l-t **$≠$** s-t GOALS ➩ sensible
8. ↑ px `ADHERENCE ➕ clin_OC` = SDM to set goals ▶︎ prevent **WRONG EXPECTATIONS**
9. Mr. Smith ▶︎ in ICU (S• + DEL + ICU-AW + MV) ➕ 🧟‍♂️ weak & 🧠 fatigued ▶︎ MOTIVATING DIALOGUE + INVOLVE FAMILY (to know his personal interests + s-, l-t goals) to motivate him for REHABILITATION.
      a. room personalized w_photos
      b. notes “get-to-know-me” ➩ helped to tailor his daily habits + interests.
      c. MV standing exercises in the garden.
      d. He could meet his family and dog.
      e. Returns w_bright eyes + smiles.
      f. Dairy ➩ “Today, you reached a milestone!”
      g. eMOB 🟰 10-73%
      h. eMOB w_MV 🟰 7-33%
10. CONCLUSION
      - eMOB ↗️ px OC when APPROPRIATELY DOSED
      - Individualized approach ➩ not yet completely studied due to COMPLEXITY (multiple

         components)
      - Factos to consider to humanize critical care:
          - capabilities
          - needs
          - experiences
          - values
          - contexts
      - Humanization involves ➩ multiprofessional + mult-disciplinary approach that includes:
          - effective communication
          - px wellbeing
          - flexible visiting hours
          - participation of relatives
          - prevention + TTO of PICS
          - humanized architecture + infrastructure

          - appropriate EOLC

Thursday, August 14, 2025 at 23h30 BEBAH, AHO, AMA, MASP, YZE, AAQC

⏳ TIME MANAGEMENT
01:06:16

Round: 4 02:14:97 Comments
Round: 3 47:33:86 Wrap-up
Round: 2 05:52:83 CONTINUE previous JRRound: 1 10:35:10 Past JR

Monday, August 11, 2025 at 23h30 BE

AMA, HIBN, AAQC

2009 NEJM - ABG and CO2 in climbers on mount Everest (grocott) [R].pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary:  

🧠 = brain
🫁 = lungs
🫀 = heart
🫃🏽 = abdomen = abdominal
♾️ = kidneys = renal
🩸= blood = hematology
🪲 = infections
💨 = flow
➰ = pressure
🤓 = analysis;
⚡️ = cardiac arrest;
📈 = arrhythmia;
🗣 = suggestion(s)
★ = recommendation(s)

AF = atrial fibrillation;
ARDS = acute respiratory distress syndrome;
CA = cancer;
GE = gastroenterology;
MV = mechanical ventilation

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS ➩ 2009, NEJM, UK ➖ int_pros ➕ 10 ➕ … ➖ P I C O:
     - P: climbers, volunteers
     - 🅸: ABG, ascent + descent
     - 🅲: NA
     - O: pOC = hALT impact on LBW, SGA, SPTB | sOC = magnitude LBW
3. EVIDENCE.
4. METHODS.
     - 𝗜𝗡 ➠
     - 𝗘𝗫 ➠
     - RANDOM ➠
     - INTERV ➠
5. RESULTS.
     - ↓ PaO2
     - = SaO2
     - Hb ↑ ➩ = CaO2 (at or above sea-level values) ➩ until 7100m
     - 4 samples ➩ **8400 m** = Pb 272mmHg
     - PaO2 (FiO2 21%) = 24,6mmHg
          - PaCO2 (FiO2 21%) = 13,3mmHg
          - CaO2 26% ↓ than 7100m ➩ AaO2≠ = 5,4mmHg

6. RATIONALE.

7. LIMITATIONS.

⏳ TIME MANAGEMENT
01:42:03

Round: 5 01:07:59 ART + wrap-up
Round: 4 19:51:32 Wrap-up
Round: 3 04:45:11 Reading + notes
Round: 2 03:40:99 ART selectionRound: 1 05:47:36 Past JR

Monday, August 19, 2025 at 23h30 BEMASP, AMA, AAQC

⏳ TIME MANAGEMENT
01:06:16

Round: 4 02:14:97 Comments
Round: 3 47:33:86 Wrap-up
Round: 2 05:52:83 CONTINUE previous JR
Round: 1 10:35:10 Past JR

2025 ICUmmp - Serum Cardiac Troponin Elevation+S MM (CC).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary:  aOR = adjusted odds ratio, AMI = acute mayocardial injury, hr_ = high risk, hs-cTn = high-sensitivity cardiac troponin, MI = myocardial injury, nSS = non-survivors, OD = organ dysfunction, OR = odds ratio, S• = sepsis, SMD = standarized mean difference, SS = survivors, ‿ = correlates.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS ➩ 2025, CC, ? ➖ sr ➕ >6k - 17 studies ➕ ? ➖ P I C O:
      - P: sepsis & septic shock
      - 🅸: hs-cTn
      - 🅲: NA
      - O: pOC = MM_ICU & ED
3. EVIDENCE.
     a. ↑ MM
      b. S• can cause AMI.
      c. hs-cTn is ↑ used to detect 🫀 injury.
      d. Previous studies ➩ `↑cTn ↔ ↑ MM` (sepsis) BUT lacked consistency.
          i. px selection
          ii. cTn asessment
          iii. confounding factors
4. METHODS.
      - Sepsis-3 criteria was used
      - Random effect models (OR + aOR) ➩ ↑ 🆚 normal
      - SMD ➩ SS 🆚 nSS
5. RESULTS.
          a. s-t MM 17% 🆚 54%
          b. nSS: > hs-cTn
          c. ↑ hs-cTn ↔ ↑MM
          d. Adjusted confounders ➩ NO longer SIGNIFICANT.
6. RATIONALE.
          a. AMI in S• is multifactorial 
          b. hs-cTn is more effective than *conventional* assays.
          c. Past studies did NOT use SEPSIS-3 (so, no OD considered)
          d. ↑ hs-cTn in S• ‿ ↑OD (not just MI)
          e. Still valuable, although not an independent MM predictor.
          f. ID: hr_advOC
          g. Useful for clinical r_stratification
          h. hs-cTn is NOT independently

              associated with MM r in S•

  2025 JAMA - A 25-Year-Old With Palpitations, Fatigue+Migraines (jones) [cc].pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary:  aOR = adjusted odds ratio, Ao DISS = aortic dissection, hs-cTn = high-sensitivity cardiac troponin, MEN = multiple endocrine neoplasia, NF = neurofibromatosis type 1, nSS = non-survivors, OD = organ dysfunction, OR = odds ratio, SDHx = succinate dehydrogenase gene, SMD = standarized mean difference, SS = survivors, ‿ = correlates..

1. ♀25yo, migraines, 10y
2. Palpitations + fatigue + worsening migraines
3. ECG + ECHO ➩ normal
4. 48h-holter ➩ ↑ HR sinusal, 108
5. Metoprolol 25mg qd
6. 6m later ➩ 1d fevers + nausea + → lower quadrant pain
7. 38,7, 103, 138/89
8. CT: left anterior pararrenal retropeironeal mass
9. MRI: 4-3.5 cm T1 + T2 hypointense, enhancing infrarenal left para-aortic mass (no tissues OR vascular invasion)
10. Normetanephrine = 0.7pg/mL (0-145)
11. Metanephrine = normal
12. DX = retroperitoneal paraganglioma
13. Start doxazosin 2mg BID
14. NO biopsy ➩ can precipitate HTA emergency + MI, S†, Ao DISS (release catecholamines)
15. NO DC metoporolol ➩ can prevent reflex tachycardia ‿ alfa 1 blocker
16. NO Gallium-68 ➩ no needed, we can see everything.
17. DX rare = 0.95 x 100k, anually
18. Sympathetic ➩ secretory (catecholamines + metanephrines)
19. Parasympathetic ➩ head + neck (nonsecretory) ➩ can cause hoarseness. + dysphagia
20. PET Gallium-68 ➩ for metastases
21. GL say to look for the GERMLINE GENETIC TEST ➩ 40% paragangliomas ➩ von-Hippel-Lindau, MEN2, NF 1, SDHx.
22. TTO
      a. 1st line = surgical resection
      b. ALFA adrenergic blocker medication ➩ phenoxynenzamine (nonselective alfa 1-20adrenoceptor

           blocker) ➖ doxazosin, prazosin, terazosin (selective competitive alfa-1-adrenoceptor blocker)

           ➩ PREVENT excessive vasocontricttion and severe HTA
      c. ß-Adrenergic blockers ➩ TO treat ↑ HR, ONLY AFTER adequate alfa blockade has been

          achieved.
      d. To avoid RECURRENCE ➩ biomarkers (metanephrine + catecholamines) 2m (af_Sx resection)
      e. Repeat tests 6-12 months
      f. Anual biochemical metanephrines + catecholamines
      g. MRI ➩ biennial
23. PATIENT CASE
      a. Initial TTO: Doxazosin 4 mg BID + Metoprolol ↑ to 50 mg BID.
      b. SX: Open resection of paraganglioma (3w post-presentation).
      c. Histology: Confirmed paraganglioma.
      d. PO course: Palpitations & fatigue resolved; migraines ↗️ progressively, fully resolved af_~1

          year.
      e. Genetics: Pathogenic *SDHB* variant identified (hereditary paraganglioma panel, 12 genes).
      f. Follow-up:
          - Annual plasma metanephrines: normal.
          - MRI (neck, chest, abdomen, pelvis): no lesions detected. 

          - Most recent MRI: 6 years post-presentation.

⏳ TIME MANAGEMENT
01:44:00

Round: 5 00:30:54 Comments
Round: 4 21:19:67 Wrap-up
Round: 3 56:51:72 Reading + notes

Round: 2 08:09:05 Selection + reading

Round: 1 17:09:98 Past JR

2025 HEALIO - Women physicians report burnout tied to EHRs, citing poor team dynamics (JGIM).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary:  PX = patient; PPM = patient portal messages

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS ➩ 2025, JGIM, USA, Michigan ➖ survey ➕ 406 physicians (57% ♀) ➕ 2023-2024 ➖

    P I C O:
      - P: Physicians
      - 🅸: EHR in-basket task time
      - 🅲: NA
      - O: pOC = burnout | sOC = time for:
         - placing and processing orders
         - taking notes
         - reviewing clinical records and lab results
         - managing inbox messages
         - responding to patients.
3. EVIDENCE.
   a. Few studies evaluating how GENDER differences in EHR workload affect `WELLBEING`
4. METHODS.
   - Mixed-effects model
5. RESULTS.
    a. ♀ spend ↑ time ➩ EHR tasks
       i. ORDERS: 34min (♀) 🆚 28min (♂︎)
       ii. NOTES: 70min (♀) 🆚 53min (♂︎)
    b. ♀ reported LACK OF EFFECTIVE TEAMWORK ➩ main contributors to **BURNOUT**
    c. Others:
       i. OVERALL: 34min ♀ 🆚 32min ♂︎
       ii. TURNAROUND: 0.76 ♀ 🆚 1.96 ♂︎
       iii. MESSAGE DAILY: ~50 each
       iv. ♂︎ reported burnout caused by:
             1. PPM OR 1,76
             2. ⊖ messages OR 1,61
             3. ↑ clinical assessment in: PPM (OR 1,6) + px education (OR 2,08).
    d. Volume ➩ SIMILAR in ♀ 🆚 ♂︎ ➩`DEPTH OF WORK` mattered
    e. Lack of (ineffective) teamwork ➩ CONTRIBUTOR to BURNOUT (OR 1,24)… provoked

         potentially by:
       i. COVID disruption
       ii. ↑ federal requirements
       iii. mergers
       iv. financial strains
       v. staff shortages
       vi. centralization and compliance issues
    f. EHR for ♀ :
       i. Easier to use OR 2,03
       ii. Not deter quality OR 0.57
6. RATIONALE.
    a. Factors contributing to the results:
       i. Cultural perception ▶︎ nurturing + caretaking.
       ii. LACK OF: Face-to-face connection
       iii. ↓ team-based work environment
       iv. Local team benefit LOST in trying to solve financial and staff problems.
    b. ❝ Small, specialized teams that you know personally foster greater trust and

        understanding of specific patient needs, GRETA BRANFORD

7. LIMITATIONS.

⏳ TIME MANAGEMENT
01:48:49

Round: 5 16:58:47 Comments
Round: 4 01:03:12 Notes + wrap-up
Round: 3 11:52:69 Reading
Round: 2 05:37:80 Selection
Round: 1 11:07:70 +10min = Past JR

Thursday, August 28, 2025 at 23h30 BEMASP, AMA, AAQC

Monday, August 25, 2025 at 23h30 BEAMA, BAH, HIBN, YZE, AAQC

2025 THE CONVERSATION - Forget chatbots research suggests reading can help combat loneliness+boost the brain (Sahakian) [r].pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary:  AF = atrial fibrillation, ARDS = acute respiratory distress syndrome, CA = cancer, GE = gastroenterology, MV = mechanical ventilation, 🧠 = brain, 🫀 = heart, 🫁 = lungs, 🗣 = suggestion(s).

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. Loneliness ➩ widespread problem
      a. Silicon VAlley billionares ➩ market AI companions
      b. M. Zuckerberg: “the average American has <3 friends”
3. WHO ➩
      - crisis of isolation + loneliness
      - 25% older adults are socially isolated
      - 5-15% adolescents are lonely
4. 2023 study ▶︎ 5 close friends (children + adolescents) to thrive ➩ ↗️ brain structure + cognition + academic performance + mental health.
      a. < 5 close friends. No enough.
      b. > 5 close friends. Less likely to be close friends.
      c. Dilemma of TECH ➩ many social media friends, BUT not close ▶︎ social support is not provided.
5. Chatbots less beneficial than FACE-TO-FACE social interaction. ▶︎ STUDY
6. Survey (The Queen’s Reading Room, charity and book club of Queen Camila) + other surveys ▶︎

    READING FICTION ↓ feeling of loneliness ➕ ↗️ wellbeing.
7. Survey (The Reader) ▶︎ 2k ➕ young adults:
      a. 59% (18-34yo) → more connected to others
      b. 56% less alone d_pandemic
8. Survey (U. Liverpool) ▶︎ 4k ➩ powerful benefits → ↓ stress ➕ ↗️ personal growth (health +

    hobbies + empathy).
      a. 64% ➩ ↗️ understanding others’ feelings.
9. Emotional ➕ social BENEFITS ▶︎ book clubs ➕ shared reading ➩ study:
      a. 43% greater connection
      b. 61% deeper understanding of others’ experiences + beliefs
      c. 14% ↓ loneliness
10. sr ▶︎ 11 intervention studies (NEUROIMAGING) ➩ shared reading OLDER ADULTS → ↗️

      wellbeing ➕ ↓ loneliness ➕ ↓ social isolation.
11. How does reading ↓ loneliness? By ↗️ OUR social cognition = ABILITY to understand ➕ connect

      w_others
12. Study (NEUROIMAGING) ▶︎ young adults ➩ READING FICTION ➩ passages w_social content`

      ▶︎ ⊕ 🧠 area dorsomedial prefrontal cortex:
      a. social behaviour
      b. emotional understanding.
      c. social cognition ➩ 🗣️ NEURAL PATHWAY greater social connectedness
13. DEMENTIA ▶︎ ↓ ➩ STUDY, <500 people, > 75yo, NO DEMENTIA at baseline… fu 5,1y. Protective

      factors:
      a. playing board games
      b. playing musical instruments
      c. dancing
      d. reading ➩ ↓ 35% r_dementia
14. Studies ➩ cognitively stimulating activities ➩ ↓ COGNITIVE DECLINE ➕ ↓ r_dementia.
15. Cambridge ▶︎ 10k children ▶︎ ABCD study ▶︎ pleasure early in life ➩ R: ↗️ 🧠 structure ➕

      cognition ➕ academic achievement ➕ longer d_😴  ➕ ↗️ mental health ▶︎ ‘↓ inattention ➖ ↓

       stress ➖ ↓ depression’ when adolescents.
      a. ↓ screen time
      b. ↗️ social interactions

16. Chatbots and AI are not the solution to everything.

⏳ TIME MANAGEMENT
01:59:47

Round: 5 02:04:89 Comments
Round: 4 33:54:18 Wrap-up
Round: 3 59:28:57 Reading + notes
Round: 2 08:06:23 Selection
Round: 1 16:13:67 Past JR

Thursday 4, September , 2025 at 23h30 BEAMA, BAH, MASP, AAQC

2025 ICUmmp - Optimal Vasopressin Initiation in SS (JAMA).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary:  EHR = electronic health records, ML = machine learning, NE = norepinephrine, OVISS = Optimal Vasopressin Initiation in Septic Shock, VP = vasopressin

1. OVISS 🟰 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA, USA, California ➖ reinforcement learning model ➕ <14500 pxs SØ, 232 H+, >3500 SØ pxs ➕ 2012-2023 ➖ P I C O:
      - P: ICU SØ pxs
      - 🅸: vasopressin use
      - 🅲: standard of care
      - O: pOC = H+_MM | sOC = kidney function ➕ catecholamine exposure ➕ clinical vigilance
3. EVIDENCE.
      a. >250k † per YEAR ➩ US ER
      b. NE = 1st option
      c. VP = 2nd option
      d. Timing of VP is UNCLEAR
      e. Limited CLINICAL TRiAL guidance.
      f. Reinforcement learning = ML technique to develop and validare a strategy.
4. METHODS.
      - 𝗜𝗡 ➠ EHRs
      - DERIVATION ➩ 3608, 63yo, SOFA 5.
      - VALIDATION ➩ 10845, 67yo, SOFA 6.
      - INTERV ➠ the RULE: look for an OPTIMISED VP initiation strategy in the VALIDATION         COHORT
      - Validation cohort = 10845pxs, 227 H+ ➩ weighted importance sampling ➕ pooled logistic         regression w_inverse probability weighting.
5. RESULTS.
      a. Initiation ▶︎ 87% 🆚 31%
      b. Earlier ▶︎ 4 🆚 5h af_Ø onset
      c. Lower NE doses ▶︎ 0.2 🆚 .37 ug/Kg/min
      d. ↓ MM 🟰 consistent accross validation sets
      e. Potential benefits ▶︎ ↗️ ♾️ function ➕ ↓ catecholamine exposure ➕ ↗️ clinical vigilance.
6. RATIONALE.
      a. GL ▶︎ optimal TIME + DOSING remain unclear. ➩ due to lack of RCTs.
      b. OVISS suggests to use VP earlier and at LOWER NE doses.
      c. GL SSC 2021 ▶︎ In our practice, vasopressin is usually started when the dose of norepi‑
          nephrine is in the range of 0.25–0.5 μg/kg/min
7. LIMITATIONS.

     a. Still, CONFOUNDING factors remain.

⏳ TIME MANAGEMENT
01:56:01

Round: 6 00:02:07 Good-bye
Round: 5 23:35:89 Comments
Round: 4 01:08:20 Analysis
Round: 3 07:13:35 Reading + notes
Round: 2 05:22:51 SelectionRound: 1 11:26:79 Past JR

Monday, September 1, 2025 at 23h30 BEAMA, BAH, MASP, AAQC

2025 ICUmmp - Variability in Interprofessional ICU Staffing (AATS).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary:  ABN = advanced bedside nurse, AF = atrial fibrillation, AP = attending physicians, 🫁 = respiratory, 🍏 = dietitians, HCW = healthcare workers, 💊 = pharmacists, ⛪️ = pastoral

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, AATS, USA ➖ survey ➕ >500 ICU ➕ before COVID-19 ➖ P I C O:
   - P: ICU staff
   - 🅸: survey
   - 🅲: NA
   - O: pOC = interprofessional variability ➩ 11 HCW types | sOC = rounds participation of dietitians +

      rehabilitation specialists + social support.
3. EVIDENCE.
   a. *ICU staff: ICU physicians, ICU nurses, dietitians, rehabilitation specialist, social support,

       pharmacists,
   b. Factors that influence staffing variation:
       i. work-hour limitations
       ii. ↑ use of advance pracice providers
       iii. telemedicine
       iv. shortages of HCW
   c. Limited evidence on INTERPROFESSIONAL TEAMS that deliver ICU care ⏤ more evidence ON

       individual roles.
4. METHODS.
   - Categories: AP support + ABN support ➖ metropolian area, non-metropolitan area
   - Ordinal logistic regression ➩ ICU characteristics‿staffing variations*.
5. RESULTS.
   a. ICUs
     i. 94% ➩ metropolitan
     ii. 64% ➩ teaching H+
     iii. 74% ➩ >250 beds
     iv. 66% ➩ mixed px populations.
     v. 34% ➩ single px type.
     vi. Average ICU 🟰 21 beds (27% use telemedicine)
   b. HCW
     i. Intensivists + 🫁 therapists + 💊 
        1. 88% all 3
        2. 1/4 had each type
     ii. staffing models varied
        1. 167 configurations identified
        2. + common = 7% ICU: 10/11 HCW types, excluding NURSE AIDS.
     iii. 6 categories
        1. core HCW
        2. 3 support HCW groups = AP support + ABN support + nurse aides.
        3. 28 combinations
        4. + common = 38% ICU:
            a. intensivists, 🫁 therapists + 💊 
            b. all 3 support HCW types.
     iv. ICU staffing:
         1. 80% = AP support + ABN support
         2. 75% = nurse aides
         3. 3% = no support HCW types (nonmetropolitan areas)
         4. Larger ICUs ➕ larger H+ ➕ single-px type ICUs ➕ those wo_telemedicine 🟰 ↑ likelyhood

           of 3 support HCW types.
     v. MOST ICUs ▶︎ 96% ICU = ROUNDS
         1. 77% daily
         2. 78% w_weekends
         3. 97% intensivists participation
         4. 85% 💊
         5. 72% 🫁 therapists
         6. 62% 🍏
         7. 16% speech pathologists
         8. Weekend rounds = ↓ HCW except intensivists
     vi. ALL ICUs ▶︎
         1. 60% 🍏
         2. 35% rehabilitation
         3. 80% social support
         4. + common patterns
           a. NONE = 31%
           b. ALL 3 = 28%
6. RATIONALE.
      a. Most ICUs STAFFED intensivists ➕ 🫁 therapists ➕ 💊. 
      b. Variability in the presence of: house officers ➕ NP ➕ PA ➕ clinical nurse ➕ nurse educators

         ➕ resouce nurse ➕ 🍏 ➕ speech pathologists ➕ social workers ➕ physical & occupational

          therapists ➕ ⛪️ care.
      c. Larger ICUS, in larger H+ 🟰 ↑ comprehensive interprofessional teams.
      d. ICU w_↓ support = use TELEMEDICINE.
      e. Teaching H+ status ➕ urban 🆚 rural 🟰 NOT‿staff composition.

      f. ❝ contemporary view of interprofessional staffing models.

⏳ TIME MANAGEMENT
01:30:41

Round: 5 03:30:22 Comment
Round: 4 48:14:06 Wrap-up
Round: 3 29:09:82 Analysis
Round: 2 06:10:41 Reading + notes
Round: 1 03:36:70 Past JR (15 min) + selection

2024 ICUmmp - Rethinking Septic Shock Management Uncovering the Potential of Early VP Use to ↗️ px OC (Sacha) [r].pdf 

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: CAT = cathecolamine, HD = hemodynamic, MB = morbidity, MM = mortality, NE = norepinephrine, RRT = renal replacement therapy, SS = survival, VP = vasopressin, 🩸 = coagulation, 🫀 = heart, 🫁 = lungs.

1. Definitions of SSØ ➩ Evans 2021 (SSC), Singer 2016 (SEPSIS-3), SSC 2012 (Dellinger) 🟰 severe, LIFE-THREATENING `response` to INF
     a. ↑ inflammation   
     b. ↓ flow (persistent)
     c. ↓ pressure (persistent + severe) despite adequate fluids 
2. SSø ➩ does NOT respond to fluids… = despite adequate volume resuscitation. 
3. SSø ➩ ↑ MB + MM ➩ in ICU ▶︎ need to MITIGATE damage from `↓ flow`
4. SSC recommends fluids + VP to maintain MAP >65mmHg ▶︎ NE is the 1st line VP
5. NE (other cathecolamines) ➩ `DISADVANTAGES` = 🫀 + 🫁 + 🩸 + immune + METABOLISM + others…
6. Evans 2021 ➩ SSC ➩ POTENTIAL cut-off `0.25-0.5 ug/Kg/min` to add VP (despite uncertainties on TIMING)
7. 3 retrospective OBS: (Sacha 2018, 2021 + Bauer 2022) ▶︎ MM PREDICTORS of VP response ➩ ph + lactate       
8. VASOPRESSIN `RESPONSE` = while maintaining MAP ≥65mmHg + ↓NE d_6h + under VP ▶︎ ↓ MM ➕ ↓ RRT ➕ ↓CAT doses.
     a. the 2 predictors were:
         i. ↓ Lactate 🟰 worse 🆚 best 🟰 5.4 🆚 4, p<0.001  
         ii. pH ↓ = bad condition ➩ bad OC when “↓0,1 U in pH < 7.4”       
9. H+_MM ➩ NE dose + lactate
     a. ↓ NE 🟰 10µg/min ✔ (↗️ *SS*) 🆚 **w_ each additional 10µg/min** (additional to 60ug/min) ▶ **21%** iH+_MM 
     b. ↓ Lactate 🟰 2.3 mmol/L ✔ ➩ ↑ every 1mmol/L ✖ ➩ H+_MM **w_ each 1mmol/L** ▶ **18%**
10. `Useful` to start VP:
     a. CAT requirements are low to moderate ➩ ↗️ VP’s HD effects
     b. Low lactate ➩ better OCs
     c. pH ≥7.4

Tuesday, September 30, 2025 at 01:00:47 in BE

AMA, BAH, HIBN, MASP, AAQC

Friday, September 26, 2025 at 00:31:30 in BEEMS, MASP, AAQC

2024 NEJMjw - Long-Term Efficacy and Safety of Renal Denervation for BP Reduction (Hypertension).pdf

Codified by  𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: HTA = arterial hypertension, RCT = randomized controlled trial, RDN = renal denervation, SAP = systolic arterial pressure, TTO = treatment.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, HYPERTENSION, AUS (Melbourne) ➖ srMA ➕ 4 OBS = >250 ⏤ 2 RC(sham)T = 257 RDN, 75 sham ➕ OBSs = 10y ⏤ RCT = 3y ➖ P I C O:
   - P: adults w_HTA
   - 🅸: RDN
   - 🅲: just in RC(sham)Ts
   - O: **pOC** = ↓SAP
3. EVIDENCE.
   a. Novel TTO for HTA.
   b. Previous studies ➩ modest↓ (still using antiHTA TTO) ▶︎ short duration
4. RESULTS.
   a. Clinically significant ↓BP in both GROUPS (observationals + RCTs)
   b. 4 OBS ➩ ↓ SAP = -15mmHg (8y average)
   c. 2 RCT ➩ ↓ SAP = -13mmHg (3y postprocedure)
   d. AntiHTA 💊 burden ➩ NO CHANGES “baseline ↔ follow-up assessments”
   e. 🚨 adverse events ➩ NOT ASSOCIATED (beyond what is expected w_aging)
5. RATIONALE.
   a. Looks ✔︎ for efficacy + safety.
   b. Still NEED substantial antiHTA 💊
   c. ❝ In cases of resistant hypertension, I will think about using RDN as
adjunctive therapy. (Karol Watson)
   d. EMS comments on the use of RDN + the importance of a last alternative to use + multifactorial causes of HTA (we should care about them) + the study in Tarija, Bolivia:
      i. “Relación entre participación familiar y control de hipertensión arterial del adulto mayor del centro integral de medicina familiar 15 de abril CNS Tarija gestión 2024”
   e. Interventional cardiologists + interventional radiologists + vascular medicine specialist or nephrologists ➩ perform the procedure.
   f. RDN ▶︎ is an ADJUNCTIVE therapy, not YET described and studied as a replacement for the traditional step-up therapy.

2025 JAMA - Corticosteroids—A Not-So-Novel TTO for SAKI (Sanghavi) [comm].pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (MASP)

Glossary: DIS** = disease, **INF** = infection, **KRT** = kidney replacement theray.
MV = mechanical ventilation

HC = hydrocortisone

wo_ = without

1. 𝙄𝙌𝘾 BS 🟰 2025, JAMAno, AUS ➖ postHOC ➕ 3161 pxs (ADRENAL)➕ NA ➖ P I C O:
      a. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
       - P: ADRENAL pxs
       - 🅸: exclusion: withdrawn OR received KRT
       - 🅲: NA
       - O: **pOC** = predictors of KRT requirement
2. EVIDENCE.
     a. ADRENAL:
         i. 2018, NEJM, AUS ➖ RCT ➕ 3800 ➕ 4h ➖ PICO ➩ SØ, MV + VP for minimum 4h. ➩ R = 200mg 💉 HC daily for 5,5d reulted in FASTER RESOLUTION 🟰 `NO DIFF in MM, d_MV, KRT.`
         ii. Lista
         iii. db_RCT HC in SØ, 3800
     b. Lista
3. METHODS.
    - Reevaluates ADRENAL wo_
    - 𝗜𝗡 ➠
    - 𝗘𝗫 ➠
    - RANDOM ➠
    - INTERV ➠
4. RESULTS.
5. RATIONALE.
6. LIMITATIONS.

Monday, October 6, 2025 at 14:13:05 in BE

AAQC

⏳ TIME MANAGEMENT
01:06:16

Round: 4 02:14:97 Comments
Round: 3 47:33:86 Wrap-up
Round: 2 05:52:83 CONTINUE previous JR
Round: 1 10:35:10 Past JR

Thursday, October 2, 2025 at 18:19:23 in BE

YZE, BAH, EMS, MASP, AAQC

2025 NEJMjw - The Season for Tick-Borne INF Is Lengthening in New England (OFID).pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (MASP)

Glossary: 🌎 = globe, DIS = disease, DX = diagnosis, INF = infection, SYMPon = symptom onset.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, OFID, USA ➖ retro_ANALY ➕ 1130 pxs (3 Massachusetts centers)➕ 31-year ➖ P I C O:
      - P: adults w_babesiosis
      - 🅸: sesionality of babesiosis
      - 🅲: NA
      - O: **pOC** = month of SYMPon
3. EVIDENCE.
     a. Last 30y ➩ # months of BABESIOSIS has ↑
     b. 🌎 warming ➩ impact the epidemiology of medical conditions
4. RESULTS.
       a. # babesiosis ➩ ↑ by 14%.
       b. SYMPon ➩ June and July.
       c. ↑ of SYMP ➩ 0.3 months / annually
       d. 1993 ▶︎ SYMPon was in July.
       e. 2021 ⏤ 2023 ▶︎ Februray to December.
5. RATIONALE.
       a. 🌎 warms unrelated (that are UNMASKING latent DIS):
             i. awareness of the INF
             ii. improved DX testing:
                  1. nucleic-acid amplification assays (NAATs)
                  2. immunosuppressive and B-cell–
depleting therapies (BCDT)
        b. 🌎 warms related:
              i. Vector (Ixodesscapularis) expansion to the north
              ii. less winter die of tichs & mammalian hosts
              iii. ↑ human-tick contacts during winter        c. Physicians should expect febrile pxs (tick-borne INF) on a year-round basis

2025 NEJMjw - Should Hospitalized Patients Receive Normal Saline or Lactated Ringer's Solution (NEJM).pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (MLHG)

Glossary: 
🧠 = brain
🫁 = lungs
🫀 = heart
🫃🏽 = abdomen = abdominal
♾️ = kidneys = renal
🩸= blood = hematology
🪲 = infections
💨 = flow
➰ = pressure
🤓 = analysis;
⚡️ = cardiac arrest;
📈 = arrhythmia;
🗣 = suggestion(s)
★ = recommendation(s)

CI = critically ill

incid_ER = incidence of an emergency room visit;
LR = Lactated Ringer’s;
NS = Normal Saline;
intra-periOP = intra and perioperative units;
H+ = hospitalized

C19 = COVID-19

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, NEJM, CA ➖ ol_CO_trial ➕ >43k, 7 H+ ➕ f-up 12m ➖ P I C O:
      - P: H+, adults ➩ ER, wards, ICU, intra-periOP
      - 🅸: NS
      - 🅲: LR
      - O: **pOC** = composite = death OR readmission within_90d | **sOC** = LOS + incid_ER within 90d
3. EVIDENCE.
     a. CI pxs ➩ balanced 🆚 saline = the same in MM (NEJM 2022)
     b. Effects on OC in “broader swath of hospitalized” ➩ UNKNOWN
4. METHODS.
      - RANDOM ➠ after 12w, pxs were switched to either solution.
      - INTERV ➠ 16H+ was the plan, but IT STOPPED due to C19.
5. RESULTS.
     a. NO DIFF ↔ GROUPS (p=0.35)
     b. sOC were also the same
6. RATIONALE.
     a. Strenghts
          i. Large size
          ii. All H+ areas
     b. Weaknesses
          i. early termination ➩ small ≠ were not detected

Thursday, October 16, 2025 at 18:15:24 in BE

MLHG, BAH, EMS, RMF, MASP, AAQC

⏳ TIME MANAGEMENT
51:37:95

Round: 6 18:43:49 Comments
Round: 5 11:29:08 Wrap-up
Round: 4 08:03:28 Intepretation
Round: 3 04:55:90 Reading + notes
Round: 2 04:48:04 Selection
Round: 1 03:38:13 Past JR

Thursday, October 9, 2025 at 18:00:48 in BE

YZE, GSM, EMS, RMF, MASP, AAQC

2025 NEJMjw- Shingles Vaccination Probably Protects Against Heart Disease (EHJ).pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary:
🧠 = brain
🫁 = lungs
🫀 = heart
🫃🏽 = abdomen = abdominal
♾️ = kidneys = renal
🩸= blood = hematology
🪲 = infections
💨 = flow
➰ = pressure
🤓 = analysis;
⚡️ = cardiac arrest;
📈 = arrhythmia;
🗣 = suggestion(s)
★ = recommendation(s)

AF = atrial fibrillation;
INF = infection
VAX = vaccine;

HF = heart failure

🧠 🫀 disorders = cerebrovascular disorders

DIS = disease

📈 = arrhytmias
r_advCVE = risk of adverse cardiovascular events;
VZV = varicella-zoster virus

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, EHJ, KR ➖ OBS ➕ 1,3M ➕ f-up 6y ➖ P I C O:
      - P: VZV live attenuated vax (≥50yo)
      - 🅸: vax
      - 🅲: NA
      - O: **pOC** = r_advCVE | **sOC** = HF, 🧠 🫀 disorders, ischemic 🫀 DIS, thrombotic, 📈
3. EVIDENCE.
      a. Same type of VAX ↓r_DEMENTIA ▶︎ ↓ neuroinflammation caused by VZV INF (*Alz Dem 2025*)
      b. Small studies ➩ same VAX might protect from 🫀 DIS ▶︎ ↓ vascular inflammation
4. METHODS.
     - National database
5. RESULTS.
     a. Ajusted to CONFOUNDERS ➩ ↓r_~25% ➩ overall ADV_CVE ➕
          i. HF
          ii. 🧠 🫀 disorders
          iii. ischemic 🫀 DIS
          iv. thrombotic disorders
          v. 📈
6. RATIONALE.

      a. MENTION to pxs this IMPORTANT BENEFIT.

⏳ TIME MANAGEMENT
58:57:28

Round: 6 03:38:08 Comments
Round: 5 09:42:27 Wrap-up
Round: 4 03:55:78 Analysis
Round: 3 02:11:73 Reading + notes
Round: 2 28:16:46 Selection
Round: 1 11:12:92 Past JR

2024 NEJMjw - Prevalence and Outcomes of Persistent Hypertension Postpartum in Women w_ a Hypertensive Disorder of Pregnancy (JAMA).pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: ABPM = ambulatory blood pressure monitoring, af_ = after, d_ = during, DIS = discharge, H+ = hospital, HTA = hypertension, wo_ = without, 🤓 = analysis.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, JAMA cardiology, ? ➖ cohort ➕ >2500 ➕ 6w ➖ P I C O:
      - P: pregnants
      - 🅸: HTA disorder during pregnancy [preeclampsia or gestation hypertension](wo_prepregnancy HTA)
      - 🅲: NA
      - O: **pOC** = H+ readmission & ED visits ➩ after delivery d_6w
3. EVIDENCE.
      a. Pregnants continue to have HTA af_delivery.
4. METHODS.
      - INTERV ➠ ABPM in 1 H+
5. RESULTS.
      a. Af_H+ DIS
           i. >2k ♀ (82%) = persistent HTA = BP ≥140/90 OR TTO w_antiHTA
           ii. >350 ♀(14%) = severe HTA = BP ≥160/100
      b. Initiation of HTA medication
           i. 47% ♀
           ii. Half = ← DIS
           iii. Half = → DIS
      c. HIghest rates of persistent HTA “severe + nonsevere”
           i. ED visits = 16% 🆚 12%
           ii. H+ readmission = 13% 🆚 4%
           iii. Normalized postDIS BP = 8% 🆚 3%
      d. Multivariate 🤓 Severe, persistent HTA:
           i. 2x ➩ ED visit
           ii. 7x ➩ H+ readmission
           iii. Both compared with NORMAL postDIS BP.
6. RATIONALE.
      a. Be careful w_persistent HTA 6w postpartum.
      b. The author mentions 3-6m 😳 even.

      c. Monitor closely to AVOID missing patients that progress to **CHRONIC HTA.**

Thursday, October 23, 2025 at 18:05:52 in BE

MLHG, YZE, EMS, APES, HIBN, MASP, AAQC

⏳ TIME MANAGEMENT
52:12:58

Round: 6 06:42:99 Comments
Round: 5 21:58:35 Wrap-up
Round: 4 10:23:83 Interpretation
Round: 3 04:27:42 Reading + notes
Round: 2 05:00:61 Selection
Round: 1 03:39:36 Past JR`

Monday, October 20, 2025 at 12:15:00 in BE

MLHG, AMA

2025 NEJMJw - Lifestyle Modifications in the Treatment of Afib (JACC).pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (MLHG)

Glossary: Afib = atrial fibrillation, GL = guidelines, IMP = important, LsMOD = lifestyle modifications, yo = years old, 🥃 = alcohol, 🫁 = lungs.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JACC, ? ➖ RCT ➕ 203 ➕ 23,5 months ➖ P I C O:
      - P: Pxs w_Afib (60yo, 32%♀, 35 BMI, 56% paroxysmal) – any type of Afib
      - 🅸: catheter ablation
      - 🅲: LsMOD + antiarrhythmics
      - O: **pOC** = freedom of Afib | **sOC** = weight loss, HbA1c
3. EVIDENCE.
       a. LsMOD are critically IMP for pxs w_Afib.
       b. LsMOD backed up by GL.
       c. Retrospective + prospective registries ▶︎ benefits of ↓weight, ↓ caloric intake, ↑ physical activity, ↓ 🥃 intake.
       d. Very few RCTs conducted
4. METHODS.
       - INTERV ➠ catheter ablation technique:
          - Paroxysmal ▶︎ 🫁 vein isolation.
          - Persistent ▶︎ extended lesions sets.
          - 7-day Holter monitoring every:
                - 3m d_1st year
                - 6m thereafter
          - f-up 23,5m
5. RESULTS.
        a. **pOC** at 12m 🟰 73% (ablation) 🆚 35% (LsMOD)
        b. LsMOD 🟰 ↓weight ➕ ↓HbA1c
6. RATIONALE.
        a. Measuring LsMOD on Afib is VERY DIFFICULT
        b. LsMOD still mantains importance for the author (Mark Link) based on “as such modifications combined with catheter ablation have been shown to be better than catheter ablation alone”

⏳ TIME MANAGEMENT
48:27:77

`Round: 6 06:44:47 Comments
Round: 5 19:59:30 Wrap-up
Round: 4 07:57:64 Interpretation
Round: 3 04:29:71 Reading + notes
Round: 2 05:46:97 Selection
Round: 1 03:29:65 Past JR`

2025 ICM - Does ability and willingness to use continuous RRT improve patient outcomes. A few answers, plenty of questions and opportunities for research (Gaudry) [ed].pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (MASP)
Glossary:
🧠 = brain
🫁 = lungs

AF = atrial fibrillation;
ARDS = acute respiratory distress syndrome;
CA = cancer;
GE = gastroenterology;
MV = mechanical ventilation

af_ = after

CKD = Chronic Kidney Disease

LOE = level of evidence

iHD = intermitent hemodyalisis

CRRT = continuous renal replacement therapy

EX = excluded

HCP = healthcare provider

n_RRT = need for renal replacement therapy

Order it alphabetically in one paragraph, separating them by commas, respecting the symbols and embolden the abbreviations.

1. EVIDENCE.
      a. AKIKI 2016 ➩
           i. early (immediately af_RANDOM) 🆚 delayed (72h af_RANDOM + conventional criteria)
           ii. pOC = SS60
      b. IDEAL-ICU 2018 ➩
           i. early (first 12h af_AKI documentation) 🆚 delayed (>48h if recovery had not occurred)
           ii. pOC = MM90
      c. STARRT-AKI 2020 ➩
           i. accelerated (>12h af_eligibility) 🆚 standard (>72h)
           ii. pOC = acMM90
      b. Conventional criteria:
           i. Severe ↑K
           ii. Metabolic acidosis
           iii. 🫁 edema
           iv. BUN >112 mg/dL
      e. Delayed (over-lenghty) ➩ ↑r_subsequent CKD dysfunction(AKIKI, STARRT-AKI) ▶︎ preexisting CKD
      f. Conflicting data NOWADAYS – RCTs needed ➩ iHD 🆚 CRRT
           i. NonRCTs ➩ intermediate LOE ➩ iHD ▶︎ 1st use = ↑ chronic dialysis dependence
     g. USA ➩ decide 1st modality according to LOCAL H+ PREFERENCES ▶︎ permiting 🤓 w_similar characteristics + backgrounds.
     h. mc_OBS ⏤ dataset ➩ if ABILITY + WILLINGNESS to perform CRRT was ↔ w_OC
           i. annualized data of CRRT
           ii. high use 🆚 low use (of CRRT)
           iii. R ➩ ↓MM90 ➕ MM_Dis ➕ MM_Trans
           iv. Regionalization of RRT based on EXPERT CENTERS SKILLS in continuous modalities
           v. Exclusion criteria focused on taking pxs who had both options (if no CRRT available, they were excluded, and viceversa.)
           vi. 70% were retained in the final 🤓 , EX:
                  1. <3d data af_RRT
                  2. missing data (1st RRT)
           vii. Preference factors (complex interaction):
                  1. Case-mix
                  2. Demand of RRT
                  3. HCP training and beliefs
                  4. Timing + urgency of n_RRT
                  5. local logisc
                  6. cost constraints
     i. CRRT use IMP↔ center characteritics
          i. ↑ use = larger centers = teaching facilites = diverse specialist medical conditions
          ii. HD instability made CRRT chosen ➩ overall severity
          iii. Multivariable 🤓 ➩ adjusted:
                 1. severity
                 2. demographics
                 3. center characteristics
         iv. Unmeasured factors:
                 1. quality
                 2. knowledge
                 3. enthusiasm of staff
                 4. financial and human resources available
                 5. nephrology team
                 6. Other factor NOT DIRECTLY RELATED to modality of RRT.
2. Did not examine ➩ TOTAL VOLUME of RRT (including iHD) – explanation to why a Nepho team…
3. RRT volumes are IMP:
       a. Achieve better OCs due to ORGANIZATIONAL EXPERTISE
       b. CRRT or iHD were used by frequent costumed use
       c. Sensitivity 🤓 ➩ IT APPEARS “being treated in center with higher CRRT is beneficial even in pxs using iHD as 1st modality” ➩

              - 𝗜𝗡 ➠
              - 𝗘𝗫 ➠
              - RANDOM ➠
              - INTERV ➠
1. RESULTS.
2. RATIONALE.
3. LIMITATIONS.

⏳ TIME MANAGEMENT
51:37:95

Round: 6 18:43:49 Comments
Round: 5 11:29:08 Wrap-up
Round: 4 08:03:28 Intepretation
Round: 3 04:55:90 Reading + notes
Round: 2 04:48:04 SelectionRound: 1 03:38:13 Past JR

2025 ICM - Let PEEP do the talking (Bellone) [ed].pdf