Joshua (@reverendofdoubt) header
Joshua (@reverendofdoubt) profile picture
Everywhere All at Once
Joined April 2012
Photo by Joshua (@reverendofdoubt)Photo by Joshua (@reverendofdoubt)Photo by Joshua (@reverendofdoubt)Photo by Joshua (@reverendofdoubt)Photo by Joshua (@reverendofdoubt)Photo by Joshua (@reverendofdoubt)Photo by Joshua (@reverendofdoubt)Photo by Joshua (@reverendofdoubt)Photo by Joshua (@reverendofdoubt)Photo by Joshua (@reverendofdoubt)
Joshua retweeted
🚨 ED overcrowding is not an emergency department problem. It is a health system failure. The new CAEP position statement argues that hospital access block, not inappropriate ED use, is the primary driver of crowding. Patients waiting for inpatient beds experience worse outcomes, while clinicians face increasing burnout and moral distress. Key messages: ✅ Overcrowding is a patient safety crisis ✅ Access block is the main cause ✅ Boarding harms patients and staff ✅ Hospitals need occupancy targets, flow accountability, and discharge capacity ✅ Governments must expand acute, long-term, community, and mental health care capacity The solution is not "fixing the ED." The solution is fixing patient flow across the entire health system. #EmergencyMedicine #HealthPolicy #PatientSafety #AccessBlock #EDCrowding #CAEP #MedTwitter #FOAMed #CJEM link.springer.com/article/10…
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Joshua retweeted
💬 Editor's Note by JAMA Statistical Editors Issa Dahabreh, MD, ScD, and Roger Lewis, MD, PhD: #RegressionDiscontinuity approaches assess treatment effects in #ObservationalStudies by using a threshold that changes the probability of treatment and comparing outcomes among individuals near that cutoff. Causal language is appropriate only when the estimand, identification strategy, assumptions, and analysis are aligned, which has implications for how clinicians and journals interpret evidence from threshold-guided care. ja.ma/4sCkEIg
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I built an app to help learn PVC localization, and it's now live in the App Store 🎉 The idea started when I was asked to localize a PVC on rounds and struggled to put the ECG clues together. I wanted a way to practice with 12-lead ECGs and guided explanations. Thank you to everyone who tried the earlier version and shared feedback! If you try it, I'd love to hear what you think and what would make it more useful. Which PVC origin do you find the hardest to localize? apps.apple.com/us/app/learn-… #EPeeps #Cardiotwitter #MedEd @WvuCvFellows @wvudeptofmed
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Explore the latest version of The Physiology Lab. Now featuring Simple and Advanced modes, along with enhanced continuous thermodilution simulations. Open access. Interactive. 🔗 systole.live/labs/physiology… #TCT2026 @ColletCarlos @BernardBruyne @MortonKern @wfearonmd @divaka_perera @DrKeeble @SYSTOLE_live
AI is transforming cardiovascular medicine—and how we learn, teach, and understand. Excited to share The Physiology Lab, a new, open-access interactive tool to explore coronary physiology. 💻 systole.live/lab.html This is just the beginning. 🫀 The U.S. Physiology Course | Feb 1–2, 2027 | Charlotte, NC: event.fourwaves.com/systole-… @esbrilakis @ColletCarlos @wfearonmd @DrArgyle @claireraph @BernardBruyne @JEscaned @MortonKern @SYSTOLE_live @realarainmd #TCT2026
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When doing a peer-review of an article for a medical/surgical journal, you notice a key citation is missing and it happens to be your seminal work on the topic. What do you do? What do journal editors think?
75%Suggest they cite you
25%Ignore missing reference
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Joshua retweeted
📊 JAMA Guide to Statistics and Methods: #RegressionDiscontinuity approaches can help estimate causal effects in #ObservationalStudies when treatment depends on whether a patient measurement crosses a prespecified threshold. These methods are most informative when patients just above and below the cutoff are comparable, which can reduce confounding from measured and unmeasured characteristics. ja.ma/4sFTxwj
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IABP vs Impella for LV Unloading in VA-ECMO. Supply: demand improved with IABP but not Impella. Presented @crfheart #TCT2026 and published simultaneously @SaadEzad @divaka_perera @UKheartresearch @VPanoulas @PBSherren @K_DeSilva @DrMattRyan @hollymorgs ahajrnls.org/4icUqZy
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Your patient's RV is dilating while the MAP sags. Do you give fluids, pressors/inotropes, an inhaled pulmonary vasodilator, or reach for a device? This long, thorough review sorts it out by phenotype. 🎩 tip to the authors. eddyjoemd.com/foamed
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I’m excited to share the next step for my Anatomy Atlas: fracture fixation! I built an interactive 3D model of a proximal phalanx fracture and lag-screw fixation. Tools like this may improve surgical education and help patients better understand their surgery. Built with AI starting from open-source 3D anatomy models. Try it: anatomy-atlas.pridgenmd.chat…
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For those interested in learning- multimodality imaging free tools- check out MOOC program by @mingyen_ng from University of Hongkong! So honored to be contributing to this course! #whyCMR edx.org/learn/medicine/unive… #Echofirst edx.org/learn/medicine/the-u… #yesCCT tl.hku.hk/2020/05/advanced-c…
Free tools built by clinicians for learning the many facets of cardiology🫀🩻⚡️🧮📚🕹️ Explore these resources👇🏼: 🩻Echocardiography: intro2echo.com by @David_Ouyang 🩻Angiography Views: angioview.com by @AnnasRahmanMD ⚡️Localize PVCs: learnpvcs.com by @Challa1218 ⚡️Localize VTs: simvt.vercel.app by @ArunUMahtani ⚡️LBBAP Simulator: pacingsimulator.com by @jo3_assad 🩻LAA TEE/ICE/CT Simulator: laa.liorjankelson.com by @ExtraStim 🧮Interactive Core Cardiology Tools and Calculators: tools.rueyhu.com by @ruey_hu 📚Latest Trials and Guidelines: cardiolads.com by Jay Gohri, Adhish Beri, and @KochharGunjan 🩻Interactive M Mode: pulmonarypocus.com by @HoosierPocus 🕹️Night Float Simulator: cardsnightfloat.netlify.app by @AbedfromBeirut 🕹️Congenital Heart Disease, Pacemaker, ECG Simulators: cardiorender.com by Dinesh Raja P This list keeps growing. Know a free, clinician-built tool that belongs here? Drop the link below #Cardiology #CardioTwitter #MedEd #MedTwitter #FOAMed #VibeCoding #AI #AIinMedicine #LLMs #DigitalHealth @ACCinTouch @escardio @ASE360 @Heart_SCCT @HRSonline @SCAI @CardioNerds
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Free tools built by clinicians for learning the many facets of cardiology🫀🩻⚡️🧮📚🕹️ Explore these resources👇🏼: 🩻Echocardiography: intro2echo.com by @David_Ouyang 🩻Angiography Views: angioview.com by @AnnasRahmanMD ⚡️Localize PVCs: learnpvcs.com by @Challa1218 ⚡️Localize VTs: simvt.vercel.app by @ArunUMahtani ⚡️LBBAP Simulator: pacingsimulator.com by @jo3_assad 🩻LAA TEE/ICE/CT Simulator: laa.liorjankelson.com by @ExtraStim 🧮Interactive Core Cardiology Tools and Calculators: tools.rueyhu.com by @ruey_hu 📚Latest Trials and Guidelines: cardiolads.com by Jay Gohri, Adhish Beri, and @KochharGunjan 🩻Interactive M Mode: pulmonarypocus.com by @HoosierPocus 🕹️Night Float Simulator: cardsnightfloat.netlify.app by @AbedfromBeirut 🕹️Congenital Heart Disease, Pacemaker, ECG Simulators: cardiorender.com by Dinesh Raja P This list keeps growing. Know a free, clinician-built tool that belongs here? Drop the link below #Cardiology #CardioTwitter #MedEd #MedTwitter #FOAMed #VibeCoding #AI #AIinMedicine #LLMs #DigitalHealth @ACCinTouch @escardio @ASE360 @Heart_SCCT @HRSonline @SCAI @CardioNerds
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i’m giving one of you a fucking ROLEX like + repost + follow me one random winner picked 48 hours from this tweet. no purchase necessary
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Ever wondered why a coronary occlusion gives the ECG it does? Block any part of the coronary circulation on a 3D heart and watch the 12-lead (and the echo!) evolve. Free for learning and teaching. Have fun! cliffreid.com/culprit #FOAMed #ECG #OMI #MedEd #Cardiology
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General neurology is the foundation of every neurology supra-specialty!🧠 This superb review in @GreenJournal by @SanRaffaeleMI is a great chance to brush up on cranial neuropathies, with practical algorithms and clinical pearls. This is what clinical reviews should be: clinically focused and practical, going beyond a narrative summary of the literature that AI could write! 👉🏼doi.org/10.1212/CPJ.00000000… #Neurology #NeuroTwitter
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Pleased to share tinyurl.com/practiceivus Built an interactive tool to learn IVUS (currently learning IVUS myself) using @claudeai. Images are synthetic. Currently beta version with possible errors. Appreciate feedback for improvement. #IVUS #cardiotwitter #MedED #FOAMed
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“I’m good at this, but my colleagues could benefit from this AI.” A sentiment we often hear at conferences. Yet ECG quizzes and studies consistently reveal a gap between perceived and actual ability to recognize STEMI/OMI. Recognizing our own limitations takes humility.
Replying to @PowerfulMedical
Average room accuracy: 60%. Spotting occlusion MI on an ECG is harder than it looks. 🫀
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I recommended rejection for a paper that was, in my opinion, AI slop in both content and style. I was satisfied the editorial decision was for rejection, but it concerns me is that none of the other reviewers seemed to find problematic the AI-typical rhetoric. I don’t want to punish AI use automatically, and, indeed, I use AI in some of my own writing. The ideas content should be evaluated for what they’re worth. But in persuasive or semi-persuasive writing like position statements/perspectives (which this was), narrative reviews, or discussions of research articles, I do think reviewers/readers ought to be on the lookout for typical, whole-cloth AI writing that is super slick. I’m talking about out-of-the-box default model output that is unedited by human and scores 100% on Pangram. It can dress up vacuous claims and poor logic trains with vague clickbait statements and sales-pitch verbiage that inflates the importance of the supporting evidence. You see it all over LinkedIn and it’s begun to infiltrate scholarly journals. Editorial norms are still forming on this issue. What do you think?
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Replying to @reverendofdoubt
I know what you mean. But nothing unique there. Guidelines across all societies are really terrible. Please sign our petition calling for change! Will only take 20 seconds and will help push societies to rethink how guidelines are done. gopetition.com/petitions/ref…
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