#NephJC CTscan Transcript

3/24/2015 #NephJCHealthcareSocialMediaTranscript
#NephJCtranscript
HealthcareSocialMediaTranscript
From: TueOct0717:00:00PDT2014
To: TueOct0721:00:00PDT2014
changetimeperiod
Whatis#NephJC?Whoweretheinfluencersduringthistimeperiod?#NephJCanalytics
HealthcareConferenceHealthcareTweetChatsHealthcareAnalytics
hswapnil RT@NephJC:90minutesuntil#NephJCWhoswithus!
TueOct717:02:09PDT2014
weddellite #nephjcwhat?!StonesAGAIN?!
brendonln RT@Nephro_Sparks:#NephJC#urojcRT@eAJKD:NephJC:CTScanor
UltrasoundfortheDiagnosisofSuspectedKidneyStoneshttp://t.co/USdV91F
nephro_sparks RT@iurojc:Our#urojcpaperforOctoberalsohappenstobethepaperfordiscussion
withour#nephjcfriendsdojointhemforongoingdi
hswapnil @iurojcwaitfor#nephJCinput?Thanks!Canwealsocompeteforyourprize,pretty
please?#urojc
hswapnil RT@iurojc:Our#urojcpaperforOctoberalsohappenstobethepaperfordiscussion
jojolaterrible RT@NephJC:90minutesuntil#NephJCWhoswithus!
pumasiwotily I'monline!!!Cmseemeeeehttp://t.co/FazFUuSiyS!#pororokepo#misano#nephjc
#chanelcruisedubai#cunyfirst
http://embed.symplur.com/twitter/transcript?hashtag=NephJC&fdate=10%2F07%2F2014&shour=17&smin=00&tdate=10%2F07%2F2014&thour=21&tmin=00 1/22
nephjc @iurojcwestartat9pm,whydontyouhaveyourguysjoinusforonelasthour?
#NephJC
nephjc @weddellite:#nephjcwhat?!StonesAGAIN?!Stonesforever.Ithoughtyou
pebbleologistslikedthisstuff
hswapnil @nephjcpebbleologists?thisisnopebble!#nephjchttp://t.co/90CpDQOMI6
hswapnil @NephJCpicturecourtesy@wellcomeimages#Nephjc
nephjc @hswapnilthatsnomoon#NephJChttp://t.co/eqdKYi4aeR
hswapnil RT@NephJC:@iurojcwestartat9pm,whydontyouhaveyourguysjoinusforone
lasthour?#NephJC
iurojc RT@NephJC:@iurojcwestartat9pm,whydontyouhaveyourguysjoinusforone
lasthour?#NephJC
iurojc @NephJCTotallyagree.Callingallurologists,pleasefeelfreetocommentonthe
samepaperbeingdiscussedrightnowon#NephJC
nephjc RT@iurojc:@NephJCTotallyagree.Callingallurologists,pleasefeelfreeto
commentonthesamepaperbeingdiscussedrightnowon#Nep
canesdavid RT@iurojc:Our#urojcpaperforOctoberalsohappenstobethepaperfordiscussion
arielfre RT@iurojc:@NephJCTotallyagree.Callingallurologists,pleasefeelfreeto
commentonthesamepaperbeingdiscussedrightnowon#Nep
nephjc hittingtheWCbeforestarting#nephjc
nephjc Welcometo#NephJCnumber12:CTscanversusU/SbyERMDversusU/Sby
radiologyforsuspectednephrolithiasis.http://t.co/R9ajr1VbPZ
nephjc MynameisJoelTopf,@kidney_boy.Iamacocreatorof#NephJCandwillbeyour
hosttonight.Pleaseintroduceyourselves.
hswapnil SwapnilHiremath,nephrologist,frombeautifulOttawa.OnlyCoI:don'tlikeCT
(contrastAKI)#NephJC#urojchttp://t.co/GFIHxaFzEj
marushla Shubha,nephrologist,CA#nephjc
kidney_boy JoelTopf.ClinicalnephrologistfromDetroit.Ihavenoconflictsofinterest.#NephJC
http://t.co/uIKp0z35S7
nephondemand TejasDesai,NephrologyFellowshipDirector&DeveloperofNephrologyOnDemand
Plushttp://t.co/WRZRbcu8v5#nephjc
hswapnil Wehopesome#uroJC,#ALiEMandradiologycolleaguesjoinustodayfor#nephjc
nephjc welcomTejas,SwapnilandShubha#nephjc
edgarvlermamd EdgarLerma,Nephrologist,Chicagobased#NephJC
nephjc Goldfarbislurking,andhopefullywillremembertoaddthehashtag#nephjc
nephjc hoedgar!#nephjc
hswapnil welcomeShubha,Edgar,Tejas#NephJC
nephjc FYIWearedoingalive#NephJCat#KidneyWk14inPhiladelphiaonSaturdayNov
15.WewillbeintheDoubleTreeBallroomat12:45.1/2
nephjc #NephJCLive2/2@medpagetodayisbuyinglunchforeveryonewhoRSVPs.Wewill
havetwoscientistspresentingdataanddiscussion.
weddellite #nephjcGoldfarblithologistCOI:CaOxstoneformer
hswapnil RT@NephJC:FYIWearedoingalive#NephJCat#KidneyWk14inPhiladelphiaon
SaturdayNov15.WewillbeintheDoubleTreeBallroomat12
hswapnil @weddelliteLithologistsoundsgrandcomparedtopebbleologist!#nephjc
rx_ed EdElSayed#NephJC
nephro_sparks MattSparks,DukeCOI:WorkinERonweekendssearchingforstones#nephjc
drraymondhsu hieveryone!nephrologistinsanfran#nephjc
hswapnil @DrRaymondHsuHey,Ray,welcome.ThistrialisfromUCSFknowanyofthose
guys?#nephjc
nephjc HoMattHoRay!#nephjc
drraymondhsu @hswapnilido!havedonemultiplerenalbx'swith1stauthor!#nephjc
nephjc AnyofyouthinkyouwillmakeittoNephJClive?#nephjc
marushla reallycoolscreenname@weddeliteforalithologist!#nephjc
edgarvlermamd Apictureisworthathousandwords#NephJChttp://t.co/ahqdQrhvys
marushla @NephJCwishIcouldbutnotattendingASNthisyear#nephjc
nephjc hoShubha#nephjc
hswapnil @NephJCIwill(havetoascofounder)makeitto#NephJCliveotherwise
@kidney_boywillcausesomebodilyharm!
nephro_sparks @NephJCI'llbethere#nephjc
canesdavid DavidCanes,UrologistinBurlingtonMA.WillmakemanyeGFRreferencestotrytofit
in#NephJC
nephjc David,gladyoucouldmakeit!#nephjc
nephjc This#NephJCisdoingthesamearticleastheLegendary#UroJCsohopefullysome
ofthesurgeonswillweighin.
hswapnil @CanesDavidthanksforcoming!#nephJC
nephjc This#nephJCisprimarilyastudyofemergencymedicineandsohopefullythat
communitywillalsoweighin.#ALiEM
hswapnil RT@NephJC:This#NephJCisdoingthesamearticleastheLegendary#UroJCso
hopefullysomeofthesurgeonswillweighin.
hswapnil RT@NephJC:This#nephJCisprimarilyastudyofemergencymedicineandso
hopefullythatcommunitywillalsoweighin.#ALiEM
nephro_sparks @nephjcthechoiceofdiagnosticmodalityformewhenworkingintheERisguided
mostlyonwhattimeofdayitis#nephjc
nephjc AbdominalCTisthemostcommoninitialimagingtestforsuspectednephrolithiasis
b/cofitshighsensitivityforstonedisease#NephJC
nephjc Unfortunatelyitpacksalotofradiation&leadstoincidentalfindings.Thiscauses
inappropriatefollowup,referral&treatment#NephJC
nephjc SystematicReview:31.1%(CI20.141.9)ofCTscanshaveincidentalfindings!
http://t.co/RARrdbfwOZ#NephJC
nephro_sparks @nephjcalsoabdominalCTisgoodatfindingothercausesofflankpain
#notalwaysastone#nephjc
hswapnil Notalkofradiationiscompletewithoutthis:fromhttps://t.co/KXMyLcZYHG#NephJC
#urojchttp://t.co/M1uZmRxWCb
hswapnil @Nephro_SparksIndeed.EasiertogetCTdonethanUSfromradiologists.ButifER
MDsdoit?differentballgameentirely!#nephjc
drraymondhsu RT@hswapnil:Notalkofradiationiscompletewithoutthis:from
https://t.co/KXMyLcZYHG#NephJC#urojchttp://t.co/M1uZmRxWCb
nephjc 1CTscanincreasesyourriskofcancerby24%.(IfyouareAustralian)Frightening.
#NephJChttp://t.co/7wa5JWcRchhttp://t.co/TDHJR2yITq
hswapnil QFT"Unfortunatelyitpacksalotofradiation&leadstoincidentalfindings.This
causesinappropriatefollowup,referral&Rx"#nephjc
kidney_boy RT@hswapnil:Notalkofradiationiscompletewithoutthis:from
rx_ed DosesfromMedicalRadiationSources.#NephJChttp://t.co/IcBlfsOXnz
nephjc Hereisthedataforabd/pelvisCTscans,itwastheworst(tiedwithchestCTscan)
#NephJChttp://t.co/9aGEwU0H0Dhttp://t.co/ezrEUsQYnh
hswapnil @weddellite:#urojc@edgarvlermamdhttps://t.co/JlLXrT7RgO#NephJC
nephjc PanScanRT@hswapnil:@weddellite:#urojc@edgarvlermamd
https://t.co/RwgaDEW9QN#NephJC
nephjc Incase@weddellitesaysthereisathresholdeffect&aCTscanisnotenough
radiationtoincreaseCa.#NephJChttp://t.co/t5BcWFJtH1
arielfre @nephjcArielFredrick.Urologyresident.Curiousaboutopinionsfromnonop
perspective.#NephJC
nephjc Looksprettylineartome.Source:http://t.co/MylW0We5iI#NephJC
http://t.co/Rvh35V6swR
hswapnil @arielfrethanksforjointinAriel!#nephjc
nephjc HerAriel,thanksforcoming.IrememberyouwereabigCTscanfanonSunday,amI
right?#nephjc
hswapnil RT@NephJC:Looksprettylineartome.Source:http://t.co/MylW0We5iI#NephJC
http://t.co/Rvh35V6swR
marushla @NephJC:anysuchdatainadults?#nephjc
hswapnil @NephJCbutit'srelativerisknotabsolute.Incrriskfrom0.05to0.065overlifetime
versusmisseddiagnosisnow?#nephJC#urojc
weddellite @NephJCwhat'stheyaxis?RRofusing$$$?Orcancers?#nephjc
nephjc @marushlaIjusttrackedthereferencesfromtheirintroduction.Sorry.Butcheckout
this:http://t.co/KBCvnDAX7j#nephjc
canesdavid @hswapnilhaveheardradiologistarguesinceCTsofarbelowyearlyradworker
limit,thatfearsoverblown#nephjc
weddellite @weddelliteIdon'thaveanopinionherethat'swhataCTologistsaid#nephjc
hswapnil RT@CanesDavid:@hswapnilhaveheardradiologistarguesinceCTsofarbelow
yearlyradworkerlimit,thatfearsoverblown#nephjc
nephjc @weddellitedevelopinghematologicorbrainmalignancy#nephjc
arielfre @nephjcNoway,I'mallforU/Sfirstlessradiation,nobigmisses.#NephJC
hswapnil @CanesDavidIamsympathetictothatPOV#nephjc#urojcaflightfromLAtoNYis
>>aCT
nephjc @CanesDavidsoundslikeeminencebasedmedicineBS.Thedataisgoingtheother
way.Threatenstheirwallet.#nephjc
nephjc QuestionofthestudyisdoesthehigherclinicalaccuracyofCTleadtobetter
outcomes?#NephJC
hswapnil Thisisastudyofstrategy:shouldwedoUSorCTFIRSTforsuspectedstonesnot
whichoneismoresensitive/specific#nephjc
nephjc 15differentcentersrandomized1:1:1U/SbyERdocU/SbyradiologistabdominalCT
scanfromOct11toFeb13#NephJC
canesdavid @NephJCgoodpoint.Thepropagandaisselfservingforsure#nephjc
hswapnil RT@NephJC:15differentcentersrandomized1:1:1U/SbyERdocU/Sby
radiologistabdominalCTscanfromOct11toFeb13#NephJC
hswapnil @NephJCAlso,kudosto@AHRQNewsforfundingthistrial!#NephJC#urojc
nephjc @CanesDavidIalwayswearsunscreenoncrosscountryplanetrips.
#TheMoreYouKnow#nephjc
rx_ed IndinavirstonesareradiolucentandusuallyundetectableonCT.#NephJC
nephjc Flankorabdominalpaineligibleforentryiftheemergencydocorderedimagingto
diagnoseorruleoutkidneystones#NephJC
nephro_sparks howmanyERdocsaredoingtheirownU/Sforsuspectedstone
#howdotheyhavetimeforthis#nephjc
nephjc RT@Rx_Ed:IndinavirstonesareradiolucentandusuallyundetectableonCT.
#NephJCHistoryimportantthere#nephjc
hswapnil Indeedandcantheybillforit?MT@Nephro_Sparks:howmanyERdocsaredoing
theirownU/Sforsuspectedstone#nephjc
rx_ed Summaryofthechemicalcompositionandradiologicalcharacteristicsofdrug
inducedstones.#NephJChttp://t.co/cuONIIEA5q
edgarvlermamd @AmerUrologicalrecommendsCTasfirstimagingtestforsuspectedstone#NephJC
http://t.co/zENYsVQQVA#urojchttp://t.co/N1n9XbPJsM
hswapnil RT@edgarvlermamd:@AmerUrologicalrecommendsCTasfirstimagingtestfor
suspectedstone#NephJChttp://t.co/zENYsVQQVA#urojchttp://t
nephjc @edgarvlermamdguidelinepredatethisstudy,itwillbeinterestingiftheychange
theirpositioninthefaceofyouknow,evidence.#nephjc
hswapnil @edgarvlermamd@AmerUrologicalButG/Lmaybelaggingbehindevidence?
#nephjc#urojc
nephjc highriskforseriousdiagnoses:acutechole,appy,aorticaneurysm,orbowel
disorders,werenoteligible.Nopregnantpts#NephJC
marushla importanttoremembertheentrycriteriaispatientssuspectedONLYofstones.Not
stonesinthebroaddifferential.#nephjc
edgarvlermamd @hswapnil@AmerUrologicalSoyouthinkthis1studyisPRACTICECHANGING???
#NephJC
hswapnil Inclusioncriteriaappropriatelybroadexclusionreasonable.Any1haveany
objections?#nephjc
hswapnil RT@marushla:importanttoremembertheentrycriteriaispatientssuspectedONLY
ofstones.Notstonesinthebroaddifferential.#nephjc
canesdavid @Rx_Edanyoneseenadrugstoneoutsideofatextbook?Ihaven'tin13yrs.#nephjc
arielfre @nephro_sparksUSshouldprobablybepartofagoodemergencyPEinmanycases
#NephJC
nephjc +1RT@CanesDavid:@Rx_Edanyoneseenadrugstoneoutsideofatextbook?I
haven'tin13yrs.#nephjc
nephjc Possibleproblem:Menweighingmorethan129kg(285lb)andwomenweighing
morethan113kg(250lb)wereexcluded#NephJC
nephjc 41.6%hadahistoryofstones,63.3%hadhematuria,52.5%hadcostovertebral
angletendernessPretestprobsoundshigh!#NephJC
hswapnil that'sthenewparadigm!@arielfre:@nephro_sparksUSshouldprobablybepartofa
goodemergencyPEinmanycases#NephJC
edgarvlermamd @CanesDavid@Rx_EdIwoulddeferthatquestionto@weddellite#NephJC
nephjc +1RT@arielfre:@nephro_sparksUSshouldprobablybepartofagoodemergency
PEinmanycases#NephJC
hswapnil excluding>129/113kgpeopledoesn'taffectinternalvalidityonlylimits
generalizabilitytothosepopulation#nephjc
nephro_sparks druginducedstonestendtoclusteraroundPearsonVUEtestingcenters
#onlyonboards#nephjc
hswapnil @kdjhaveri:@NephJCbutpretestprobshouldbehighforanytestyouorderthat
involvesradiationIthink.#NephJC
nephjc SeeingresidentsdoingtheirownU/Smakesmefeelold.#BehindTheTimes
#StillUsePercussion#NephJC
drraymondhsu RT@Nephro_Sparks:druginducedstonestendtoclusteraroundPearsonVUE
testingcenters#onlyonboards#nephjc
hswapnil @kdjhaverithanksforjoiningintheconvoKenar,#NephJC
kdjhaveri RT@NephJC:SeeingresidentsdoingtheirownU/Smakesmefeelold.
#BehindTheTimes#StillUsePercussion#NephJC
nephjc thatisreallyfunnyRT@Nephro_Sparks:druginducedstonestendtoclusteraround
PearsonVUEtestingcenters#onlyonboards#nephjc
nephjc Kenarmakesanappearance!#nephjc
marushla RT@Nephro_Sparks:druginducedstonestendtoclusteraroundPearsonVUE
testingcenters#onlyonboards#nephjc
nephjc 1outcomes:1highriskdiagnoses&complicationsrelatedtomissed/delayed
diagnoses2cumulativeradiationexposure3totalcosts#NephJC
hswapnil @Nephro_SparksAimingforthetweetoftheweekagain?#nephjc
hswapnil Premiseoftrialseemstobe:canUScomparedtoCTresultinsimilarnofmissed
nephjc Whatdoesitmeantohave3primaryoutcomes,Dotheyneedarefresheronthe
meaningofprimary?#nephjc
drraymondhsu @NephJClovetheseoutcomes,verypragmatic#nephjc
nephjc Patientswerecontactedat3,7,30,90,and180daysafterrandomizationtoassess
studyoutcomes#NephJC
marushla Ihadthesamequestion#3primaryoutcomes?#nephjc
marushla sowhichoutcomearetheypoweringtheirstudyto?#nephjc
hswapnil Pragmatic'stheword!orcomparativeeffectivenessresearchMT@DrRaymondHsu:
@NephJClovetheseoutcomes,verypragmatic#nephjc
hswapnil 1outcome(nodifferenceinmissed/delayeddiagnosis)should'vebeenanon
inferiorityQ.Butsamplesizesuggestsmaybenot.#NephJC#urojc
rx_ed CanU/Saccuratelydetectsmallstones(especiallyinthecorticomedullaryjunction)?
#NephJC
hswapnil Contd:great#openaccessreferenceonnoninferiority:http://t.co/nBeCLkmDWI
#NephJC#urojc
hswapnil @Rx_Edlikelynot:ThisisoneofthediagnosticaccuracypaperswithCTasgoldstd:
http://t.co/n8yKawzRcj#NephJC#urojc
nephjc 2outcomes:1.seriousadverseevents2.SAErelatedtoparticipation3.returntoED
&hospitalizationsafterd/c#NephJC
nephjc 2outcomes(cont):4.selfreportedpainscores5.diagnosticaccuracyfor
nephrolithiasis#NephJC
rx_ed @canesdavidDoesthatmeantheydon'texistorthatweneedtobelessvigilantwhen
prescribinghighriskdrugs?#NephJC
canesdavid Questionforthegroup:ifyouwerethereviewerwouldyouaccept?Revisions?
Reject?Why?#nephjc
amardbansal OnelessreasonforpatientstogetaCTaftervitalsignsaretakenintriage.#nephjc
drraymondhsu @marushlajustlookedatprotocolithinkall3outcomeswereconsideredforsample
size#nephjc
marushla @CanesDavidwouldn'tthatcometowardstheendofthediscussion?#nephjc
hswapnil @CanesDavidIwouldasksamplesizequestion.veryfewmissed/delayeddiagnosis
toproveUSisnoninferiortoCT#nephjc
signindoc RT@NephJC:SeeingresidentsdoingtheirownU/Smakesmefeelold.
#BehindTheTimes#StillUsePercussion#NephJC
nephjc Lookslikeatightstudy89%ofeligiblepatientsmadeittotheITTpopulation.Great
work!#NephJChttp://t.co/syJFP5oYfr
marushla @hswapnilthisgoestoshowyouhowgoodtheEDdocswereinclinicaldiagnosisof
stones!#nephjc
signindoc RT@NephJC:RT@Rx_Ed:Indinavirstonesareradiolucentandusually
undetectableonCT.#NephJCHistoryimportantthere#nephjc
hswapnil @DrRaymondHsuYes,butitstilllooksstrange.DidtheyexpectCTtobesuperiorto
US?Lookslikesetuptofail(myskepticside)#NephJC
hswapnil RT@NephJC:Lookslikeatightstudy89%ofeligiblepatientsmadeittotheITT
population.Greatwork!#NephJChttp://t.co/syJFP5oYfr
hswapnil @kdjhaveri:@hswapnil@DrRaymondHsu@NephJCtotallyanovelandpractical
approach#nephjc
nephjc Anybodythinkthereisanythingtoseeontable1?#NephJChttp://t.co/e7HCwW3BZO
kdjhaveri RT@NephJC:Kenarmakesanappearance!#nephjc
edgarvlermamd @hswapnil@CanesDavidWhat'sthenegativepredictivevalueofanU/Sindetecting
astone?#NephJC
hswapnil @NephJCproofofgoodrandomization?http://t.co/jv21cUFlf6#nephjc
nephjc @CanesDavidIwouldhavelikedtolookatclinicalcharacteristicsofU/Sptswhothen
gotCTscans.Fevers?AbnlU/A?Painscores?#nephjc
nephjc veryfewhighriskdiagnosis#NephJChttp://t.co/DjlrNM8NDF
nephro_sparks @NephJCanydataonpatientweights?thiscouldlimituseofU/S#nephjc
drraymondhsu @hswapnildon'tthinktheyassumedCTbetter,butuseddatafrompriorCTstudiesto
comeupwithpotentialdifferencewithUSgroup#nephjc
hswapnil @edgarvlermamdSensitivityishigh,butNPVwoulddependonprevalence/pretest
probability#nephjc
arielfre @nephjc@canesdavidalsowhatUSfindingspromptedCT?Justhydro?#NephJC
nephjc @Nephro_Sparksnodata.Justexcludedmenover129kgandwomenover113kg.
FatShaming?#nephjc
marushla @arielfreIdon'tthinkthatwasclearinthepaper#nephjc
drraymondhsu #ATLwasasitelikelybroadrangeofweights?#nephjc
rx_ed @canesdavidIwouldaskiftherewasahistoryofUTI,andiftherewereanyU/S
patientswhodevelopedspontaneousextravasation.#NephJC
nephjc AnythingofnoteonTable2?Didntseeanything.#NephJChttp://t.co/G5633Q6duN
hswapnil RT@NephJC:AnythingofnoteonTable2?Didntseeanything.#NephJC
http://t.co/G5633Q6duN
nephjc @arielfrefollowupCTafterU/SITTwasphysiciandirected.Notontheprotocol.
#nephjc
nephjc AllimportantTable3,alsoknownasthesweetmarrowofthestudy.#NephJC
http://t.co/U51MY2lzlP
weddellite @CanesDaviddruginduced:lotofTopomaxandsomeatazanavir(onlystonesNOT
seenonCTareproteaseinhibitors)#nephjc
marushla theERdocsknowing40%ofpatientshadh/okidneystonesandnowwithpain
potentialbias?#nephjc
marushla #table2:about40%ofpatientshadh/ostones.potentialbiaswhentheEDdocs
knowwhatthey'relookingfor?#nephjc
nephjc @weddelliteIhaveseetopomaxstonesafewtimes,butthoseareCaPhosstones,
notcrystalizeddrugstones#nephjc
drraymondhsu table2odd"enrollingphysicianhighlysuggestiveofappy,AA..."ithoughtthosewere
excluded#nephjc
nephjc Verylowtruepositiverateespeciallyhowrichthestudypopulationseemed.Only
32%stoned.#NephJChttp://t.co/3uUGfcLH3p
hswapnil ERlengthofstaywasnot1or2outcomebutpopsuphereintable3...hmmm
#nephjc
edgarvlermamd Thisstudyhttp://t.co/LltILzXLBtsuggeststhatifnephrolithiasisissuspected,1st
imagingmodalityshouldbeULTRASOUND,Right?#NephJC
nephjc DataminingRT@hswapnil:ERlengthofstaywasnot1or2outcomebutpopsup
hereintable3...hmmm#nephjc
signindoc @NephJC#NephJCEasiertogetaCTthanaUSeverywhere!(Table3LOS)
arielfre @NephJCmoreofa"justwondering"kindofquestion.Itwouldn'thavecontributedto
theoutcomesofthestudy#nephjc
edgarvlermamd Ifclinicalsuspicionfornephrolithiasisishigh,yetUSisnegative,thenCTwouldbe
the2ndimagingmodality,Right?#NephJC
marushla testtweet(didn'tseemy2priortweetscomethrough)#nephjc
nephro_sparks @hswapnilIthoughtthelengthofstaywouldbelowerwiththeU/SwieldingERdocs
#nephjc
hswapnil Goodcatch!@DrRaymondHsu:table2odd"enrollingphysicianhighlysuggestiveof
appy,AA..."ithoughtthosewereexcluded#nephjc
rx_ed U/Swiththetwinklingartifactforenhancedstonedetectionhasahugeclinical
potential.#NephJChttp://t.co/IRrvmWMHtx
hswapnil RT@NephJC:Verylowtruepositiverateespeciallyhowrichthestudypopulation
seemed.Only32%stoned.#NephJChttp://t.co/3uUGfcLH3p
marushla table2:about40%ofpatientshadpreexistingstones.potentialbiaswhenphysicians
knewwhattheywereprobablylookingfor.#nephjc
edgarvlermamd Ifclinicalsuspicionfornephrolithiasisishigh,andUSispositive,Iwouldthinkthe
nextstepwouldbetodoaCT#NephJC
hswapnil @Nephro_SparksItwasalsoCT.radiologistsdoingUSwaslongest,assuspected
#nephjc
nephjc 41%inthepointofcareU/Sgroupand27%intheradiologyU/Sgroupunderwent
CToninitialvisit.#NephJC
@Nephro_Sparks41%oftheU/SwieldingdoctorsthenorderedaCTscan.2images
nephjc slowerthan1.Butworth2000words.#nephjc
marushla @nephjc:table2:about40%ofpatientshadh/ostones.Potentialbiasastheyknew
whattheywerelookingfor!#nephjc
hswapnil @signindoc@NephJCHoRoss,thanksforjoiningin!#NephJC
hswapnil RT@edgarvlermamd:Ifclinicalsuspicionfornephrolithiasisishigh,andUSis
positive,IwouldthinkthenextstepwouldbetodoaCT
nephjc 5.1%ofthepatientsintheCTgroupunderwentultrasonography#NephJC
nephjc SpecificitydataonCTisshameful.Goldstandardwasinsensitive(capturedstone
only)stonescaughtbyCTloweredspecificity#nephjc
nephjc 5moreminutes.Finalthoughts?#nephjc
nephro_sparks @hswapnilmedianlengthofstayfortheU/SwieldingERdocwas6.3hrvs.donut
holeCTat6.4hr#nephjc
edgarvlermamd @signindoc@NephJCIthinkthe"curveball"hereisthattheERDocisalsothe
bedsidesonographer#NephJC
weddellite YoungpeoplelikecystinuriawillhavealifetimeofimagingMUCHmoreimptfor
them#nephjc
hswapnil @NephJCTheirstandardswereverystringent.PerhapsCTpickstinystonesthat
patientsdon'tnotice,orthatdon'tneedsurgery?#nephjc
nephjc @edgarvlermamdexplain?#nephjc
shomik_s RT@hswapnil:Notalkofradiationiscompletewithoutthis:from
nephjc @hswapnilI'msurethatsthecase.Butshouldthespecificitybedingedforthat?
#nephjc
nephjc +1RT@weddellite:Youngpeoplelikecystinuriawillhavealifetimeofimaging
MUCHmoreimptforthem#nephjc
nephondemand here'sacrazyideahowaboutwereintroduceultrasonographyforrenalfellows&
haveTHEMperformtheU/SintheED?#nephjc
nephjc LotsofrecurrentstoneformersgetactscaneveryERvisit.Thisisatragicwasteof
resourcesandpilingonofradiation.#nephjc
drraymondhsu trialhashighimpactforEDprovidersbutgeneralizeabilitylimitedieifUSnotreadily
availableacrossall#nephjc
hswapnil @NephJCtheyhadtosincethatwastheir"goldstandard"passageofstoneor
surgerytoostringentbutclinicallyrelevant#nephjc
nephjc +1RT@nephondemand:howaboutwereintroduceultrasonographyforrenalfellows
&haveTHEMperformtheU/SintheED?#nephjc
hswapnil RT@weddellite:YoungpeoplelikecystinuriawillhavealifetimeofimagingMUCH
moreimptforthem#nephjc
hswapnil RT@NephJC:LotsofrecurrentstoneformersgetactscaneveryERvisit.Thisisa
tragicwasteofresourcesandpilingonofradiation.#
signindoc .@weddelliteTrue,+RTAwith"gravel"andpaingetfartoomanyCTs.Opioidseeking
labelisadownside.IndicateUSonlyonchart#nephJC
nephro_sparks RT@NephJC:+1RT@nephondemand:howaboutwereintroduceultrasonography
forrenalfellows&haveTHEMperformtheU/SintheED?#nephjc
signindoc RT@edgarvlermamd:@signindoc@NephJCIthinkthe"curveball"hereisthatthe
ERDocisalsothebedsidesonographer#NephJC
drraymondhsu notsureifitchangesurologist/nephrologistpracticesbecauseweseemore
complicatedstoners#nephjc
hswapnil RT@DrRaymondHsu:notsureifitchangesurologist/nephrologistpracticesbecause
weseemorecomplicatedstoners#nephjc
edgarvlermamd @NephJCIwouldthinkit'dbefastertodoBedsideU/SintheERvsschedulingfor
transportpickup,CT,etc#NephJC
drraymondhsu @Nephro_Sparksthatmeansyouhavetogoinatnighttosupervisethem#nephjc
nephjc @edgarvlermamdbut40%requiredCTanyways,negatingspeedadvantage.
#nephjc
nephjc @DrRaymondHsuthat'swhatjuniorfacultyarefor.#nephjc
nephro_sparks @DrRaymonHsuI'llbeintheERmoonlightinganyway#nephjc
hswapnil newgenofERMDslikelyknowhowtodoUSorshould,importantbeyondkidney
stonesIMO#nephjc
nephro_sparks @DrRaymondHsuI'llbeintheERmoonlightinganyway#nephjc
nephondemand @DrRaymondHsuperhapsourdisinterestingoinginatnighttosuperviseourfellows
contributestotheirdisinterestinnephrology#nephjc
nephjc Thanksforshowingupandcontributingeveryone.Greatdiscussion.LookfortheLive
#NephJCsignupsoon!
signindoc @NephJC@nephondemandGreatcommentweneedtoencouragethisforsure!
#nephJC
drraymondhsu @nephondemandtrue.spokenlikeagreatclinicianeducator:)#nephjc
nephondemand @DrRaymondHsuorjusteducator!!notsureaboutthe"great"part.thanksthough.
appreciateit.#nephjc
edgarvlermamd @NephJCYup...justlikea"curveball"willnotalwaysgetastrike...Sometimesit's
justa"foulball"#NephJC
hswapnil greatdiscussion!specialthanksto@CanesDavidand@arielfrefrom#uroJCfor
joiningin!#nephjc
nephondemand @nephJC@hswapnilHereisthesummaryoftonight'sjournalclub
https://t.co/XbgCh8sVpP#nephjc
hswapnil RT@nephondemand:@nephJC@hswapnilHereisthesummaryoftonight'sjournal
clubhttps://t.co/XbgCh8sVpP#nephjc
weddellite Morestones!#nephjc
hswapnil @signindoc:.@hswapnilYetmorethanERdocsneedtounderstandthistechnique
#nephjc
urologymatch @iurojc:@NephJCTotallyagreeCallingallurologists,pleasefeelfreetocomment
onthesamepaperbeingdiscussedrightnowon#NephJC
azizenad RT@edgarvlermamd:Thisstudyhttp://t.co/LltILzXLBtsuggeststhatifnephrolithiasis
issuspected,1stimagingmodalityshouldbeULTRASOU
azizenad RT@edgarvlermamd:Ifclinicalsuspicionfornephrolithiasisishigh,yetUSis
negative,thenCTwouldbethe2ndimagingmodality,Right?
edgarvlermamd @NephJC@nephondemand2words:TurfWar#NephJC
arielfre @signindoc@nephjc@nephondemandAsdiscussedin#urojc,fellowswouldbe
thrilledtogetthatcallfromED#NephJC
nephondemand TurfWarseems2Bawarthatwekeeplosing:ICUvsRenal4CRRTUrolvsRenal4
stonesRheumvRenal4lupusCardsvRenal4UF#nephjc
edgarvlermamd @NephJC@nephondemandIthinkinsomeNephrologyprogramsegEmory,they
alreadydoRoutineU/SinInpatientsbutnotinER#NephJC
nephondemand Yes.ItrainedatEmorywedidourownU/S.PaintomovetheU/Smachinebutsuch
aterrificeducationalexperience#nephjc
k2optimist RT@hswapnil:Notalkofradiationiscompletewithoutthis:from
nephondemand @hswapnil@nephJCHereistheblogrecapsummarizedhttps://t.co/XbgCh8sVpP
#nephjc
nephjc Analyticsfor#nephjc12from@healthhashtagshttp://t.co/AJ4Sw2lbc3
signindoc .@arielfre@NephJC@nephondemandUrology/NephrologyPDsneedtosupportthis
(RCPSCrequirementwouldwork:))#NephJC?Jointcourses.
uretericbud #urojcand#NephJCdiscussingsamepaperinsameweek.Fascinating.Lookslike
gradelevelofaTweetsnearlydoubledovernight.
edgarvlermamd @nephondemandIdidmy2dayMiniFellowshipfollowedby7dayRenalU/S
trainingwithDrCharlieO'Neilaswell#NephJC
gameyadav RT@hswapnil:newgenofERMDslikelyknowhowtodoUSorshould,important
beyondkidneystonesIMO#nephjc
dr_nikhilshah RT@nephondemand:@nephJC@hswapnilHereisthesummaryoftonight'sjournal
clubhttps://t.co/XbgCh8sVpP#nephjc
uncurology RT@uretericbud:#urojcand#NephJCdiscussingsamepaperinsameweek.
Fascinating.LookslikegradelevelofaTweetsnearlydoubledover
alittlemedic RT@hswapnil:Notalkofradiationiscompletewithoutthis:from
romynsa RT@hswapnil:Notalkofradiationiscompletewithoutthis:from
amardbansal RT@NephJC:1outcomes:1highriskdiagnoses&complicationsrelatedto
missed/delayeddiagnoses2cumulativeradiationexposure3total
hswapnil @EBMGoneWild@CanesDavidAhhyouareright,mybad.EvenlowdoseCTis>>
flighthttp://t.co/UPXDW2vEVi#nephjc
edgarvlermamd Nephrolithiasis101:Appearanceofstonesonurinarytractimaging#Nephpearls
#NephJChttp://t.co/HqTLgMCzXQ
ajkdblog @NephJCYou'vebeenquotedinmy#Storifystory"#NephJC12"
http://t.co/kXD3l9ShEr
hswapnil #NephJC12https://t.co/QDrct3RlRbvia@eajkd
ajkdblog @weddellite@CanesDavid@arielfreYou'vebeenquotedinmy#Storifystory
"#NephJC12"http://t.co/kXD3l9ShEr
ajkdblog @marushla@DrRaymondHsu@Nephro_SparksYou'vebeenquotedinmy#Storify
story"#NephJC12"http://t.co/kXD3l9ShEr
ajkdblog @hswapnil@edgarvlermamd@UCRadSafetyYou'vebeenquotedinmy#Storify
story"#NephJC12"http://t.co/kXD3l9ShEr
edgarvlermamd Nephrolithiasis101:Appearanceofstonesonurinarytractimaging#Nephpearls
#NephJChttp://t.co/HqTLgMCzXQhttp://t.co/qba6a8gUsB
franloachamin RT@edgarvlermamd:Nephrolithiasis101:Appearanceofstonesonurinarytract
imaging#Nephpearls#NephJChttp://t.co/HqTLgMCzXQhttp:
franloachamin RT@edgarvlermamd:@nephondemandIdidmy2dayMiniFellowshipfollowedby
7dayRenalU/StrainingwithDrCharlieO'Neilaswell#NephJC
dr_nikhilshah RT@hswapnil:Notalkofradiationiscompletewithoutthis:from
dr_nikhilshah RT@nephondemand:TurfWarseems2Bawarthatwekeeplosing:ICUvsRenal4
CRRTUrolvsRenal4stonesRheumvRenal4lupusCardsv
dr_nikhilshah RT@nephondemand#nephjc@hswapnil@kidney_boy:...CardsvRenal4UFetc
TurfWarcontinuesproceduresradiologyvnephrology
dr_nikhilshah RT@nephondemand:@DrRaymondHsuperhapsourdisinterestingoinginatnight
tosuperviseourfellowscontributestotheirdisinterestinn
nephjc @hswapnil:newgenofERMDslikelyknowhowtodoUSorshould,important
beyondkidneystonesIMO#nephjccc@TChanMDforcomments?
matteoborselli RT@hswapnil:Notalkofradiationiscompletewithoutthis:from

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