The ECG represents the electrical activity of the heart. Key things to assess include the rate, rhythm, intervals, axis, and any ischemic or injury changes. The standard ECG reports the QRS axis in the frontal plane from -30 to 90 degrees. ST elevation in contiguous leads indicates an acute MI, and the distribution of ST changes corresponds to the location of blockage in the coronary arteries. Characteristic sequential changes occur over time with an evolving MI.
This document provides a list of medical topics and diseases in a table format for easy review and study. It includes over 150 medical conditions, disorders, and syndromes. For each entry it lists the condition's name and 1-3 key details about signs, symptoms, causes, or characteristics. The table is intended as a high-yield study guide for the USMLE Step 1 and Step 2 exams, highlighting topics that are often tested.
This document provides a detailed summary of EKG patterns and abnormalities, including:
- Normal EKG measurements and intervals
- Alterations in heart rhythm originating from the sinoatrial node
- Irregular rhythms caused by a wandering pacemaker or multifocal atrial tachycardia
- Premature beats, tachyarrhythmias, and other irregular rhythms originating from different areas of the heart
- Specific arrhythmias and conditions like atrial fibrillation, ventricular tachycardia, Wolff-Parkinson-White syndrome, and sick sinus syndrome
This document discusses fluid, electrolyte, and acid-base balance. It begins by listing the objectives of describing fluid and electrolyte regulation, imbalance, major electrolytes, populations at risk, and related diagnostic tests and nursing responsibilities. It then covers topics like body fluid distribution, maintaining fluid balance, fluid volume excess and deficit, electrolyte regulation and imbalances, and acid-base regulation and imbalances. It discusses related nursing interventions like monitoring intake and output, weight, lab tests, and treating imbalances through oral or IV fluid replacement depending on the situation.
This document provides guidance from the Chartered Institute of Public Relations (CIPR) on best practices for public relations professionals engaging with Wikipedia. It discusses Wikipedia's role and policies, the sometimes uneasy relationship between Wikipedia and the PR industry, guidelines for disclosure and engaging respectfully with the Wikipedia community to make edits or resolve disputes. The goal is for PR professionals to understand Wikipedia's operations and adhere to its content and community standards when contributing.
Writing A College Essay, Part 2- The Extended Outline CAmanda Summers
1. While housing prices have risen steadily, reports of a new housing bubble are overblown according to experts.
2. While more homes are considered overvalued compared to income levels, overvaluation alone does not indicate an impending crash like in 2008.
3. Strict lending standards since the 2008 crisis mean fewer risky loans are being issued, reducing the chances of a bubble and subsequent crash even if prices decline.
The Power of Customer Misbehavior - AKF Partnersmfisher5kavika
The Power of Customer Misbehavior explores the idea that customer misuse of features is the key to viral growth through product development based on this information. This book introduces the concept of self-identity as a motivator for participation in social networks as well as product purchases. Additionally, The Power of Customer Misbehavior covers several technological features such as the user interface and page load time and their impact on user adoption and retention.
http://akfpartners.com/books/the-power-of-customer-misbehavior
The ECG represents the electrical activity of the heart. Key things to assess include the rate, rhythm, intervals, axis, and any ischemic or injury changes. The standard ECG reports the QRS axis in the frontal plane from -30 to 90 degrees. ST elevation in contiguous leads indicates an acute MI, and the distribution of ST changes corresponds to the location of blockage in the coronary arteries. Characteristic sequential changes occur over time with an evolving MI.
This document provides a list of medical topics and diseases in a table format for easy review and study. It includes over 150 medical conditions, disorders, and syndromes. For each entry it lists the condition's name and 1-3 key details about signs, symptoms, causes, or characteristics. The table is intended as a high-yield study guide for the USMLE Step 1 and Step 2 exams, highlighting topics that are often tested.
This document provides a detailed summary of EKG patterns and abnormalities, including:
- Normal EKG measurements and intervals
- Alterations in heart rhythm originating from the sinoatrial node
- Irregular rhythms caused by a wandering pacemaker or multifocal atrial tachycardia
- Premature beats, tachyarrhythmias, and other irregular rhythms originating from different areas of the heart
- Specific arrhythmias and conditions like atrial fibrillation, ventricular tachycardia, Wolff-Parkinson-White syndrome, and sick sinus syndrome
This document discusses fluid, electrolyte, and acid-base balance. It begins by listing the objectives of describing fluid and electrolyte regulation, imbalance, major electrolytes, populations at risk, and related diagnostic tests and nursing responsibilities. It then covers topics like body fluid distribution, maintaining fluid balance, fluid volume excess and deficit, electrolyte regulation and imbalances, and acid-base regulation and imbalances. It discusses related nursing interventions like monitoring intake and output, weight, lab tests, and treating imbalances through oral or IV fluid replacement depending on the situation.
This document provides guidance from the Chartered Institute of Public Relations (CIPR) on best practices for public relations professionals engaging with Wikipedia. It discusses Wikipedia's role and policies, the sometimes uneasy relationship between Wikipedia and the PR industry, guidelines for disclosure and engaging respectfully with the Wikipedia community to make edits or resolve disputes. The goal is for PR professionals to understand Wikipedia's operations and adhere to its content and community standards when contributing.
Writing A College Essay, Part 2- The Extended Outline CAmanda Summers
1. While housing prices have risen steadily, reports of a new housing bubble are overblown according to experts.
2. While more homes are considered overvalued compared to income levels, overvaluation alone does not indicate an impending crash like in 2008.
3. Strict lending standards since the 2008 crisis mean fewer risky loans are being issued, reducing the chances of a bubble and subsequent crash even if prices decline.
The Power of Customer Misbehavior - AKF Partnersmfisher5kavika
The Power of Customer Misbehavior explores the idea that customer misuse of features is the key to viral growth through product development based on this information. This book introduces the concept of self-identity as a motivator for participation in social networks as well as product purchases. Additionally, The Power of Customer Misbehavior covers several technological features such as the user interface and page load time and their impact on user adoption and retention.
http://akfpartners.com/books/the-power-of-customer-misbehavior
Essay On The Vietnam War Memorial. Online assignment writing service.Paula Poer
The document provides instructions for requesting writing assistance from HelpWriting.net. It outlines a 5-step process: 1) Create an account; 2) Complete a request form with instructions and deadline; 3) Review writer bids and qualifications; 4) Review the completed paper and authorize payment; 5) Request revisions to ensure satisfaction. The service promises original, high-quality content or a full refund.
This document summarizes plans by Koch Nitrogen to expand its fertilizer plant in Enid, Oklahoma. The $1.3 billion expansion project, which will take place over three years, will be the largest in Koch Industries' history. It will include building a new urea plant and upgrading existing units, increasing the plant's production capacity by over 1 million tons. The expansion will improve the plant's efficiency and product quality while reducing its environmental impact. It will allow Koch to provide more fertilizer products to meet customer demand globally.
The power of brand advocates.
Do you know other great Brand Advocacy Cases?
Let us know and we’ll add them to this presentation!
Be sure to check out the other presentations we gave at our LBi Client Afternoon.
Med Start 2009 Extreme Googling & Web 2.0jdondoyle
This document provides an overview and introduction to finding quality medical information online. It discusses using Google and other search tools effectively, evaluating the reliability of websites, and how web 2.0 technologies like blogs, wikis, and social networking can be used for collaboration and information sharing. Students are encouraged to think critically about the sources of information they find and focus on authoritative medical sites like .gov, .edu, and .org domains.
This document discusses fraudulent keto supplement companies that falsely claim to be associated with or featured on the TV show Shark Tank. It notes that while Shark Tank has helped popularize many legitimate products, no keto supplements have actually been featured on the show. The document aims to warn consumers about marketing scams used by keto supplement brands, help consumers identify fake supplements, and protect consumers from purchasing fraudulent products. Specifically, it details how some supplement companies illegally use photos of Shark Tank investors and references to the show in their advertising to mislead customers into thinking the products were vetted on the show.
The document discusses the digital marketing strategies of several major companies including Coca-Cola, Hershey's, and Time Warner. It notes that Coca-Cola plans to double its business by 2020 using content marketing to educate and entertain consumers. It also mentions that Hershey's manages multiple brand pages on Facebook and encourages user engagement. Finally, it provides an overview of Time Warner's media properties and their social media presence across platforms like Facebook, Twitter, and YouTube.
This document discusses the concept of Web 2.0 and how physicians can utilize new technologies like blogs, RSS feeds, and online collaboration tools. It provides examples of how easy it is to create websites and blogs using free platforms like Blogger.com. The author argues that Web 2.0 can help physicians stay updated, share knowledge, advance their research and careers, and potentially attract more patients. Physicians are encouraged to use these tools while still complying with HIPAA and institutional policies regarding patient privacy and discussions online.
The document discusses Johnny Cash's accomplishments and impact as a musician. It notes that Cash was considered one of the most rebellious artists due to his sharp criticism of political agendas in the US and interference with private and public politics, making him an activist rather than just a musician. Cash developed unique ways of expressing himself through engaging his music with politics. His life experiences, including a difficult childhood, influenced his creative works and message of hope that impacted many listeners.
The document provides instructions for creating an account and submitting an assignment request on the HelpWriting.net website. It outlines a 5-step process: 1) Create an account with an email and password. 2) Complete a form with assignment details, sources, and deadline. 3) Review bids from writers and choose one. 4) Review the completed paper and authorize payment. 5) Request revisions if needed, and the site guarantees original, high-quality work or a refund.
Sun Basket Content, Popularity &Traffic AnalysisMadi Nolte
This paper is an analysis of SunBasket.com, including value content, metrics, and more as well as comparing it alongside HomeChef.com. This was done as an assignment for a university Intro to Web Publishing course.
The passage discusses Nike's responsibility for working conditions in foreign factories where its products are made by subcontractors. While Nike does not own these factories, some argue it should still be responsible for their working conditions as a large global company. Others counter that imposing stricter standards could hurt Nike's competitiveness. The passage suggests Nike ensure its subcontractors comply with local labor laws by appointing inspectors to monitor factories and report on working conditions.
The presentation proposes launching a new kids fruit bar called Minute Maid Kids Fruit+ Bar. It will target middle-class, health-conscious mothers of children ages 4-11. Market research shows the kids snack market is large and growing, and parents prioritize healthy options. The product will contain 100% fruit juice with no added sugar and provide vitamins and minerals. An investment of $48 million is requested, which will be recouped in the second year as market share grows to an estimated 6%.
Gavin Baker and Bob Wilson of Moxley Carmichael present to Knoxville Chamber members on how to get started in making the best use of Facebook for their organization. Titled, “Facebook for Business,” it was part of the Bright Ideas series.
The presentation had three parts:
1. Why Facebook matters to you today
2. How to launch your page
3. What to do next with your page (and fans!)
The Marijuana Industry is Essential, But is It Equal?Cannabis News
Does the marijuana industry need more diversification, read this https://cannabis.net/blog/opinion/the-cannabis-industry-is-now-essential-but-is-it-equal
Illustrated Food Webs for Elementary Presentation.pptxHenriSandoval
This document provides instructions and templates for creating a presentation about food webs using Google Slides, PowerPoint, or Canva. It includes templates for slides on topics like what is a food web, examples of food chains and webs, and activities like having students build their own food web. Students are guided through slides with brief text descriptions and templates to add their own content. The final slides provide resource information and instructions for using and sharing the presentation.
Facebook fans have value beyond direct media value by driving indirect media value through social proof and homophily effects. Tracking direct response metrics from Facebook posts can show value from increased clicks, sales, and other actions. Building loyalty through sharing and recommendations on Facebook appears to positively impact brand preference metrics. Marketers should focus less on fan growth alone and more on optimizing engagement, sharing, and integrating Facebook with other marketing channels.
Understanding the shift to the social web, the rise of 2-way conversations and the importance of marketing in today's world of social media and social networking.
Can your used coffee grounds help you grow great weed Cannabis News
Can you use old coffee grounds to grow great cannabis, read this https://cannabis.net/blog/how-to/can-your-used-coffee-grounds-help-you-grow-great-weed
This document lists potential conflicts of interest for the author, including honoraria from several pharmaceutical companies (ZS Pharma, Relypsa, Alexis) and speaker bureaus (Astute). It also notes that the author is a partner in multiple dialysis units and a vascular access center owned by Davita.
This document discusses diabetic kidney disease and intensive glucose control. It begins with the author's conflicts of interest related to pharmaceutical companies. It then reviews several major studies on intensive glucose control including the DCCT, UKPDS, ADVANCE, ACCORD, and VADT trials. The studies showed reductions in microvascular complications with intensive control but mixed results for cardiovascular outcomes, with the ACCORD trial finding higher mortality in the intensive control group. Overall the document examines the evidence from major trials on benefits and risks of tight glycemic control.
Essay On The Vietnam War Memorial. Online assignment writing service.Paula Poer
The document provides instructions for requesting writing assistance from HelpWriting.net. It outlines a 5-step process: 1) Create an account; 2) Complete a request form with instructions and deadline; 3) Review writer bids and qualifications; 4) Review the completed paper and authorize payment; 5) Request revisions to ensure satisfaction. The service promises original, high-quality content or a full refund.
This document summarizes plans by Koch Nitrogen to expand its fertilizer plant in Enid, Oklahoma. The $1.3 billion expansion project, which will take place over three years, will be the largest in Koch Industries' history. It will include building a new urea plant and upgrading existing units, increasing the plant's production capacity by over 1 million tons. The expansion will improve the plant's efficiency and product quality while reducing its environmental impact. It will allow Koch to provide more fertilizer products to meet customer demand globally.
The power of brand advocates.
Do you know other great Brand Advocacy Cases?
Let us know and we’ll add them to this presentation!
Be sure to check out the other presentations we gave at our LBi Client Afternoon.
Med Start 2009 Extreme Googling & Web 2.0jdondoyle
This document provides an overview and introduction to finding quality medical information online. It discusses using Google and other search tools effectively, evaluating the reliability of websites, and how web 2.0 technologies like blogs, wikis, and social networking can be used for collaboration and information sharing. Students are encouraged to think critically about the sources of information they find and focus on authoritative medical sites like .gov, .edu, and .org domains.
This document discusses fraudulent keto supplement companies that falsely claim to be associated with or featured on the TV show Shark Tank. It notes that while Shark Tank has helped popularize many legitimate products, no keto supplements have actually been featured on the show. The document aims to warn consumers about marketing scams used by keto supplement brands, help consumers identify fake supplements, and protect consumers from purchasing fraudulent products. Specifically, it details how some supplement companies illegally use photos of Shark Tank investors and references to the show in their advertising to mislead customers into thinking the products were vetted on the show.
The document discusses the digital marketing strategies of several major companies including Coca-Cola, Hershey's, and Time Warner. It notes that Coca-Cola plans to double its business by 2020 using content marketing to educate and entertain consumers. It also mentions that Hershey's manages multiple brand pages on Facebook and encourages user engagement. Finally, it provides an overview of Time Warner's media properties and their social media presence across platforms like Facebook, Twitter, and YouTube.
This document discusses the concept of Web 2.0 and how physicians can utilize new technologies like blogs, RSS feeds, and online collaboration tools. It provides examples of how easy it is to create websites and blogs using free platforms like Blogger.com. The author argues that Web 2.0 can help physicians stay updated, share knowledge, advance their research and careers, and potentially attract more patients. Physicians are encouraged to use these tools while still complying with HIPAA and institutional policies regarding patient privacy and discussions online.
The document discusses Johnny Cash's accomplishments and impact as a musician. It notes that Cash was considered one of the most rebellious artists due to his sharp criticism of political agendas in the US and interference with private and public politics, making him an activist rather than just a musician. Cash developed unique ways of expressing himself through engaging his music with politics. His life experiences, including a difficult childhood, influenced his creative works and message of hope that impacted many listeners.
The document provides instructions for creating an account and submitting an assignment request on the HelpWriting.net website. It outlines a 5-step process: 1) Create an account with an email and password. 2) Complete a form with assignment details, sources, and deadline. 3) Review bids from writers and choose one. 4) Review the completed paper and authorize payment. 5) Request revisions if needed, and the site guarantees original, high-quality work or a refund.
Sun Basket Content, Popularity &Traffic AnalysisMadi Nolte
This paper is an analysis of SunBasket.com, including value content, metrics, and more as well as comparing it alongside HomeChef.com. This was done as an assignment for a university Intro to Web Publishing course.
The passage discusses Nike's responsibility for working conditions in foreign factories where its products are made by subcontractors. While Nike does not own these factories, some argue it should still be responsible for their working conditions as a large global company. Others counter that imposing stricter standards could hurt Nike's competitiveness. The passage suggests Nike ensure its subcontractors comply with local labor laws by appointing inspectors to monitor factories and report on working conditions.
The presentation proposes launching a new kids fruit bar called Minute Maid Kids Fruit+ Bar. It will target middle-class, health-conscious mothers of children ages 4-11. Market research shows the kids snack market is large and growing, and parents prioritize healthy options. The product will contain 100% fruit juice with no added sugar and provide vitamins and minerals. An investment of $48 million is requested, which will be recouped in the second year as market share grows to an estimated 6%.
Gavin Baker and Bob Wilson of Moxley Carmichael present to Knoxville Chamber members on how to get started in making the best use of Facebook for their organization. Titled, “Facebook for Business,” it was part of the Bright Ideas series.
The presentation had three parts:
1. Why Facebook matters to you today
2. How to launch your page
3. What to do next with your page (and fans!)
The Marijuana Industry is Essential, But is It Equal?Cannabis News
Does the marijuana industry need more diversification, read this https://cannabis.net/blog/opinion/the-cannabis-industry-is-now-essential-but-is-it-equal
Illustrated Food Webs for Elementary Presentation.pptxHenriSandoval
This document provides instructions and templates for creating a presentation about food webs using Google Slides, PowerPoint, or Canva. It includes templates for slides on topics like what is a food web, examples of food chains and webs, and activities like having students build their own food web. Students are guided through slides with brief text descriptions and templates to add their own content. The final slides provide resource information and instructions for using and sharing the presentation.
Facebook fans have value beyond direct media value by driving indirect media value through social proof and homophily effects. Tracking direct response metrics from Facebook posts can show value from increased clicks, sales, and other actions. Building loyalty through sharing and recommendations on Facebook appears to positively impact brand preference metrics. Marketers should focus less on fan growth alone and more on optimizing engagement, sharing, and integrating Facebook with other marketing channels.
Understanding the shift to the social web, the rise of 2-way conversations and the importance of marketing in today's world of social media and social networking.
Can your used coffee grounds help you grow great weed Cannabis News
Can you use old coffee grounds to grow great cannabis, read this https://cannabis.net/blog/how-to/can-your-used-coffee-grounds-help-you-grow-great-weed
This document lists potential conflicts of interest for the author, including honoraria from several pharmaceutical companies (ZS Pharma, Relypsa, Alexis) and speaker bureaus (Astute). It also notes that the author is a partner in multiple dialysis units and a vascular access center owned by Davita.
This document discusses diabetic kidney disease and intensive glucose control. It begins with the author's conflicts of interest related to pharmaceutical companies. It then reviews several major studies on intensive glucose control including the DCCT, UKPDS, ADVANCE, ACCORD, and VADT trials. The studies showed reductions in microvascular complications with intensive control but mixed results for cardiovascular outcomes, with the ACCORD trial finding higher mortality in the intensive control group. Overall the document examines the evidence from major trials on benefits and risks of tight glycemic control.
The document discusses the anion gap, which is a calculation used to assess acid-base imbalances. It is determined by subtracting the measured cations (sodium) from the measured anions (chloride and bicarbonate). An increased anion gap occurs when there are excess unmeasured anions like those produced during metabolic acidosis from substances such as alcohols, lactic acid, or renal failure. A decreased anion gap occurs when there are excess unmeasured cations like potassium or calcium, or decreased unmeasured anions like albumin or phosphorus. The example given at the end shows a patient with a negative or decreased anion gap.
A doctor prescribes medicine to six of his patients to treat their infections, including his best friend. All six patients die after taking the medicine, which the doctor had used safely for years. The doctor realizes the new liquid form of the medicine, recommended by a pharmaceutical company, was actually a deadly poison. The doctor experiences immense mental and spiritual agony over being responsible for the deaths of his patients.
The document discusses the history of dialysis and definitions of acute kidney injury. It notes that Dr. Haas invented the first dialysis machine for humans in 1928 but all 6 of his initial patients died. In 1943, Dr. Kolff created the second human dialysis machine from household items and successfully treated a patient with nephritis. It introduces the RIFLE and AKIN criteria for classifying acute kidney injury based on changes in creatinine and urine output. Studies found RIFLE and AKIN criteria effectively stratified patients by risk of poor outcomes like mortality and need for renal replacement therapy. Oliguria is highly sensitive but not very specific for predicting subsequent acute kidney injury defined by creatinine changes. There is
This document discusses using mobile apps to help manage chronic conditions like diabetes and hypertension. It summarizes studies showing tight control of blood glucose, blood pressure, and other factors can significantly reduce health risks. However, blood pressure control may be even more important. The document advocates using phone cameras to easily track home blood pressure readings, which better predict health outcomes than office readings. It also discusses a trial where patients safely titrated their own antihypertensive medications using an app, maintaining control with fewer visits. The ideal prescription app would partner with physicians using a public, validated algorithm to safely adjust medications.
Creatine supplements are commonly used by athletes to increase phosphocreatine stores in muscles and provide short bursts of energy. While creatine increases serum creatinine levels, studies of short, medium, and long-term supplementation show no significant effects on kidney function as measured by creatinine clearance, urea excretion, and other markers. However, rare cases of kidney damage have been reported with very high doses of creatine. Potential neuroprotective benefits of creatine have also been seen in mouse models of ALS. Overall, creatine appears reasonably safe when used as recommended but may pose risks for those with pre-existing kidney conditions.
Imaging in Acute Kidney Injury, how not to harm patientsJoel Topf
This document summarizes evidence on the use of imaging and dialysis techniques to minimize harm in patients with acute kidney injury. It finds that while hemodialysis is generally not effective at protecting the kidneys from contrast-induced nephrotoxicity, it may be beneficial in patients with the most severe kidney impairment. Preemptive hemofiltration initiated before and continued after contrast exposure is the most effective strategy shown in randomized trials to reduce the risk of nephrotoxicity and associated outcomes like need for dialysis and mortality. However, risk also depends on the specific gadolinium-based contrast agent used, with agents having higher stability and weaker binding to gadolinium posing lower risks like nephrogenic
The document discusses the history and development of dialysis for treating acute renal failure. It describes how Dr. Haas invented the first dialysis machine for humans in 1928 but all 6 of his initial patients died. Dr. Kolff then created the second human dialysis machine in 1943 and was able to successfully treat his first patient. The document also examines biomarkers like KIM-1 and NGAL that can help diagnose acute kidney injury earlier than creatinine. It analyzes the RIFLE criteria for classifying the severity of acute renal failure.
Grand Rounds which summarizes the data pointing to fructose and sugar intake as the chief cause of hypertension and the use of allopurinal to treat pediatric hypertension.
It is difficult to clinically distinguish SIADH from volume depletion in hyponatremic patients without edema, with correct prediction occurring in only around 40% of cases. The gold standard for diagnosis is the sodium response to fluid challenge. A urine sodium less than 30 mmol/L favors SIADH, but this can miss salt depletion in elderly patients. A fractional excretion of sodium less than 0.5% identifies patients with salt depletion but misclassifies around half of SIADH cases. Combined fractional excretion of sodium less than 0.5% and urea less than 55% may best differentiate SIADH from salt depletion.
This document discusses diabetic nephropathy and its treatment. It begins by describing how diabetic nephropathy progresses from hyperfiltration to proteinuria to declining kidney function over many years. It then discusses treatments including tight blood pressure and glucose control as well as ACE inhibitors and ARBs to slow disease progression. While ACEi and ARBs are beneficial, their combination leads to increased side effects like higher potassium with unclear benefits and potential harms.
The document discusses various alcohols that can cause toxicity when ingested, including methanol, ethylene glycol, diethylene glycol, isopropyl alcohol, and mannitol. It provides details on their mechanisms of toxicity, clinical effects, indications for treatment including alcohol dehydrogenase inhibition or dialysis, and factors that determine their dialyzability. Lactic acid is also discussed and does not typically cause an osmolar gap.
This document discusses sodium regulation and hyponatremia. It explains that sodium levels indicate osmolality rather than having direct effects. Changes in sodium cause cell volume changes through osmosis. Hyponatremia occurs when water intake exceeds electrolyte free water clearance by the kidneys. Symptomatic hyponatremia is treated aggressively while asymptomatic cases are managed conservatively to avoid complications like central pontine myelinolysis from overcorrection.
Hyponatremia occurs when water intake exceeds water excretion from the kidneys, diluting sodium levels in the blood. It can be caused by drinking more water than the kidneys can clear. The kidneys clear both a solute component and free water component from the urine. Free water clearance calculates the amount of solute-free water excreted in the urine and is used to determine if urine is dilute or concentrated, which affects serum osmolality and sodium levels.
The Two Faces of Geriatric Kidney DiseaseJoel Topf
1) A study modeled the outcomes of 10,000 older patients with CKD who received yearly evaluations over 18 years comparing reporting of creatinine levels versus eGFR using the MDRD formula. eGFR prevented 29 cases of ESRD and 13 premature deaths but also overdiagnosed CKD 11,348 times.
2) A 10-year study in Tromso, Norway of 58,086 people found that among those with eGFR of 30-59, two-thirds had no events while 31% died and 2% developed renal failure within 10 years on average. Older patients had faster loss of GFR but lower risk of renal failure.
3) A study of 112 older
This document summarizes the case of a patient transferred from a nursing home with altered mental status, decreased oral intake, and diarrhea. Initial labs show acute renal failure, metabolic acidosis, and hyponatremia. A repeat potassium level comes back at 9.9 mEq/L. Immediate treatment for hyperkalemia should include calcium chloride or gluconate given every 5 minutes until the EKG normalizes, with the exception of patients with digoxin toxicity or contraindications to calcium. While EKGs have low sensitivity for detecting hyperkalemia, changes may include peaked T waves, PR and QRS widening, and sine wave patterns. Insulin with glucose can also be used to induce intracellular potassium
The document compares late referral versus early referral for patients needing dialysis, showing that early referral results in longer survival on dialysis. It initially concludes that early referral has a large effect on survival on dialysis. However, it then presents additional information showing that while early referral leads to earlier initiation of dialysis and prolonged survival on dialysis, it does not ultimately change overall patient survival.
This document summarizes a presentation on fluid and electrolyte disorders given by Dr. Joel Topf. It discusses cases of hypokalemia, hypomagnesemia, and hypophosphatemia seen in patients with alcoholism, starvation, and vomiting. Specific causes of electrolyte abnormalities are explored, including decreased intake through alcohol abuse or starvation, and renal losses induced by vomiting. Treatment strategies are also covered, such as intravenous potassium and magnesium administration.
This document discusses HIV and its impact on the kidney. It begins with biographical information about the author, Joel M. Topf, MD, a clinical nephrologist. It then covers topics like the history of HIV, the identification of HIVAN (HIV-associated nephropathy) as a renal manifestation of HIV, characteristics of HIVAN such as its association with African Americans, and changes in HIV renal disease over time with the introduction of antiretroviral therapy. It provides data on prevalence of HIVAN from renal biopsies and risk factors associated with HIVAN compared to other kidney conditions in HIV+ patients.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
2. Social Media and Healthcare
Ready or Not Here it Comes
Joel Topf, MD
Assistant Clinical Professor Oakland University
William Beaumont School of Medicine
2
3. Social Media and Healthcare
Ready or Not Here it Comes
Joel Topf, MD
Assistant Clinical Professor Oakland University
William Beaumont School of Medicine
PBFluids.com
@kidney_boy
https://www.facebook.com/StClairSpecialty
http://bit.ly/SJHMCsmhc
#SJHMCsmhc
2
4. Social media are web and mobile
based technologies which support
user generated content, engagement,
and collaboration among individuals,
companies and organizations.
http://en.wikipedia.org/wiki/Social_media
3
24. February 11, 2011: FDA approves Makena by KV
Pharmaceutical
Makena is 17-hydroxyprogesterone
caproate (17OHPC) for the prevention
of premature birth in women with a
single fetus of less than 37 weeks
gestation who had at least one previous
preterm birth.
11
31. Why a Facebook page? Let's
harness the power of social
media. Maybe if we stand
together and make a
statement that this self-serving
greed is exploiting families in
their darkest moments,
perhaps someone will notice.
Perhaps someone will care.
Christine Hess O'Connell
15
32. Why a Facebook page? Let's
harness the power of social
media. Maybe if we stand
together and make a
statement that this self-serving
greed is exploiting families in
their darkest moments,
perhaps someone will notice.
Perhaps someone will care.
Christine Hess O'Connell
15
33. Why a Facebook page? Let's
harness the power of social
media. Maybe if we stand
together and make a
statement that this self-serving
greed is exploiting families in
their darkest moments,
perhaps someone will notice.
Perhaps someone will care.
Christine Hess O'Connell
15
34. Why a Facebook page? Let's
harness the power of social
media. Maybe if we stand
together and make a
statement that this self-serving
greed is exploiting families in
their darkest moments,
perhaps someone will notice.
Perhaps someone will care.
Christine Hess O'Connell
founder of Shame on you KV Pharmaceutical and CEO Gregg Divis
15
57. c. If they interact with patients on the Internet,
physicians must maintain appropriate boundaries of
the patient-physician relationship in accordance with
professional ethical guidelines just, as they would in
any other context.
d. To maintain appropriate professional boundaries
physicians should consider separating personal and
professional content online.
24
60. The rejection seems like
a perfect solution until
that awkward moment
when the patient comes
in for his next visit.
26
61. Prior to rejecting the request use Facebook to send
the patient a message
Sorry Mr. Peterson, I reserve my Facebook for personal
friends and do not "friend" any patients or co-workers. I
do have a number of social media personas that
welcome patients. You can find and interact with me at:
@kidney_boy on twitter
http://pbfluids.com on blogger
http://facebook.com/scsp on facebook
27
62. Instead of reject, redirect
Prior to rejecting the request use Facebook to send
the patient a message
Sorry Mr. Peterson, I reserve my Facebook for personal
friends and do not "friend" any patients or co-workers. I
do have a number of social media personas that
welcome patients. You can find and interact with me at:
@kidney_boy on twitter
http://pbfluids.com on blogger
http://facebook.com/scsp on facebook
27
65. Nursing assistant Nai Mai Chao spent eight days
in jail, was banned from Facebook and other
social networks, lost her job and nursing license.
29
66. Nursing assistant Nai Mai Chao spent eight days
in jail, was banned from Facebook and other
social networks, lost her job and nursing license.
29
67. Nursing assistant Nai Mai Chao spent eight days
in jail, was banned from Facebook and other
social networks, lost her job and nursing license.
29
68. Nursing assistant Nai Mai Chao spent eight days
in jail, was banned from Facebook and other
social networks, lost her job and nursing license.
posting a photo of a dying
patient's buttocks
29
69. Alexandra Thran, hospital employed
emergency doctor in Rhode Island,
inadvertently violated confidentiality by revealing
details of an injury that could reveal personally
identifiable information on Facebook.
30
70. Alexandra Thran, hospital employed
emergency doctor in Rhode Island,
inadvertently violated confidentiality by revealing
details of an injury that could reveal personally
identifiable information on Facebook. She never
revealed the patient’s name.
30
71. Alexandra Thran, hospital employed
emergency doctor in Rhode Island,
inadvertently violated confidentiality by revealing
details of an injury that could reveal personally
identifiable information on Facebook. She never
Fired
revealed the patient’s name.
Fined $500
Sent for re-education
30
76. Gitelman’s syndrome
• Hypokalemia
• Hypomagnesemia
• Metabolic alkalosis
• Normal to low blood pressure
• Intense salt cravings
Incidence is 1 in 40,000,
most are undiagnosed
33
81. Should I get a port-a-cath? Should I get a picc line?
35
82. Should I get a port-a-cath? Should I get a picc line?
35
83. Should I get a port-a-cath? Should I get a picc line?
The pharmacy changed forms of
potassium. How can I get the old one?
35
84. Should I get a port-a-cath? Should I get a picc line?
The pharmacy changed forms of
potassium. How can I get the old one?
Is liquid potassium better than pills?
35
85. Should I get a port-a-cath? Should I get a picc line?
The pharmacy changed forms of
potassium. How can I get the old one?
Is liquid potassium better than pills?
I get more muscle pain after IV
potassium. Is that normal?
35
86. Should I get a port-a-cath? Should I get a picc line?
The pharmacy changed forms of
potassium. How can I get the old one?
Is liquid potassium better than pills?
I get more muscle pain after IV
potassium. Is that normal?
Is magnesium taurate okay?
35
103. Twitter is the second largest
social network after Facebook
this is not a Coke vs Pepsi pairing,
they are different animals
47
104. Twitter is the second largest
social network after Facebook
this is not a Coke vs Pepsi pairing,
they are different animals
47
105. Twitter is not Facebook
• Facebook, friends are a mutual decision
• everyone you are friends with is simultaneously your friend
• Twitter is asymmetric
• People you follow, do not
necessarily follow you back
48
106. Twitter is not Facebook
• Facebook, friends are a mutual decision
Facebook allows you to connect with
people you already simultaneously your friend
• everyone you are friends with is
know.
Twitter allows you to meet people you
• Twitter is asymmetric
want to know.not
• People you follow, do
necessarily follow you back
48
107. Twitter is not Facebook
• Facebook, friends are a mutual decision
Facebook allows you tolie to people you
is where you connect with
know. you are friends with is know.
people you already simultaneously your friend
• everyone
Twitter allows you to meet people you
is where you're honest with
• Twitter is asymmetric
strangers. do
want to know.not
• People you follow,
necessarily follow you back
48
108. Best tutorial on how twitter works:
http://www.momthisishowtwitterworks.com
49
111. who to follow
• be vicious with your follow list
• people who tweet their lunch
• people who suggest “earn great income, work at home”
• Anything by Zoey Deschanel
52
112. ot
n follow
who to
• be vicious with your follow list
• people who tweet their lunch
• people who suggest “earn great income, work at home”
• Anything by Zoey Deschanel
52
113. ot
n follow
who to
• be vicious with your follow list
• people who tweet their lunch
• people who suggest “earn great income, work at home”
• Anything by Zoey Deschanel
52
114. who to follow: https://twitter.com/MGKatz036
Pt: "I'm just here for a second opinion...
Already got my first one online."
53
115. who to follow: https://twitter.com/precordialthump
4 medication classes linked to 67% of drug-
related hospitalizations http://t.co/ZR9CUszI
Get these right: sugars and bleeding
54
116. who to follow: https://twitter.com/drves
What do people die of? Mortality rates
and data for every cause of death in
2011 visualized http://
bit.ly/RDXkVz
55
117. who to follow: https://twitter.com/MedPedsDoctor
The biggest challenge in MedEd is to
demonstrate improved pt outcomes
from any education intervention, not just
learner satisfaction
56
118. who to follow: https://twitter.com/daniellenjones
If you haven't found a Twitter friend/
colleague you want to chat with over
coffee, you're advertising too much &
interacting too little.
57
119. who to follow: https://twitter.com/medicalaxioms
The job of the ER physician admitting a
medicine patient is to tell you why the
patient can't go home, not to tell you
the diagnosis.
58
120. who to follow: https://twitter.com/zdoggmd
I shocked the sheriff...but they claim it
was asystole. #MedicalMarley
59
122. who to follow: https://twitter.com/Skepticscalpel
Correlation & causation went into a bar
The bartender asks "Are you two
related?" Correlation answers "Hey,
what are you implying?"
61
123. The anonymous tweeter
Physicians who write anonymously online say it affords
them the opportunity to vent their frustrations with
patients, colleagues, administrators and health plans with
less fear of crossing legal and ethical lines.
Kevin O’Reilly reporting for AMA News
62
124. The anonymous tweeter
"Doctors do need to vent," said Dr. Vartabedian, who
blogs and tweets under his own name. "I limit that venting
of frustration to my immediate working staff and to my
immediate colleagues. I don't feel it's appropriate for me
to relate my frustrations with patients in a public place
where everybody can see them."
Dr. Vartabedian, @Doctor_V
62
125. The mask will come off
and sometimes, not at
the time of your choosing
63
126. Robert P. Lindeman, an Ivy League-educated
pediatrician sat on the stand in Suffolk
Superior Court, defending himself in a
malpractice suit involving the death of a 12-
year-old patient.
The opposing counsel startled him with a
question.
“Are you Flea?”
64
127. Flea, was the screen name for a blogger who
had written about a trial remarkably similar to
the one happening at Suffolk Superior Court.
Flea had ridiculed the plaintiff's case and the
plaintiff's lawyer.
He had revealed the defense strategy.
He had accused members of the jury of dozing.
65
128. Lindeman admitted that he
was, in fact, Flea.
The next morning, he settled
for what is described as a
substantial settlement.
66
129. •Tweet under your own name.
•It will remind you that you aren't
scrawling graffiti behind the high school.
•Sign your name and you will be more
careful with what you say.
•You never are as anonymous as you
think you are.
67
155. The blood of Jesus
against Obama history
made 4 Nov 2008 a
Taliban Muslim illegally
elected president
USA:Hussein.
74
156. Three fundamental things to know about Twitter
• Who to follow
• What to do : Twitter Chats
• What to say
75
157. Twitter Chats
• Twitter Journal Club
• MedEd Chat
• HealthCare Social Media Chat
• Symplur keeps a database of regular healthcare twitter chats at:
• http://www.symplur.com/healthcare-hashtags/tweet-chats/
76
158. #MedEd TweetChat Nov. 15: Academic Integrity
• 3 questions for discussion
• Topic 1: How comfortable would you be with reporting
someone for academic dishonesty? What if it were a close
colleague?
• Topic 2: What are the gray areas of academic dishonesty?
What about overlooking a "minor" or 1st time occurrence?
• Topic 3: How comfortable would you feel working with
someone who had cheated in medical school? Should
academic dishonesty be a career ender?
77
160. suggest topics by DM or email #meded
Thu Nov 15 19:07:56 PST 2012
mumbaiprepared RT @jvrbntz: Amen!!! RT @EMIMDoc: #meded For trainees to respect the system, the
system must respect the trainees.
Thu Nov 15 19:13:20 PST 2012
#MedEd TweetChat Nov. 15: Academic Integrity
• 30 participants
• 274 Tweets
78
162. #KidneyWk12 The American Society of Nephrology
Annual Meeting
• 281 participants
• 1,362 Tweets
79
163. #KidneyWk12 The American Society of Nephrology
Annual Meeting
• 281 participants
• 1,362 Tweets
79
164. ArborResHealth Dr. Ramirez rcved a distinguished faculty invit to present Disease Management in
#ESRD Pts at 6 pm, Rm 5 #kidneywk12 http://t.co/98a7gdkl
Thu Nov 1 13:31:36 PDT 2012
#KidneyWk12 The American Society of Nephrology
Annual Meeting
• 281 participants
• 1,362 Tweets
79
172. •Find your own voice.
•Everything you say is written in pen.
•Staying quiet and watching is a good
way to get started.
•Find people you respect and see
how they interact on Twitter.
83
173. Mayo Clinic has a twelve word social media policy:
Don’t Lie, Don’t Pry,
Don’t Cheat, Can’t Delete,
Don’t Steal, Don’t Reveal
84
174. 523 physicians found
209 with < 500 followers
range: 500 to 1,910,700
314 with ≥ 500 followers followers (17,217)
54 excluded for other
reasons
• 9 non-English tweets
• 8 not individuals
260 included in analysis • 7 no tweets in last 6 months
• 7 private accounts
• 5 deleted accounts
20 most recent tweets
5 users did not have 20
tweets
analyzed 5,156 tweets
Chretien KC, Azar J, Kind T.JAMA. 2011 Feb 9;305(6):566-8.
85
175. 523 physicians found
209 with < 500 followers
range: 500 to 1,910,700
314 with ≥ 500 followers followers (17,217)
54 excluded for other
reasons
• 9 non-English tweets
• 8 not individuals
260 included in analysis • 7 no tweets in last 6 months
• 7 private accounts
• 5 deleted accounts
20 most recent tweets
5 users did not have 20
tweets
analyzed 5,156 tweets
Chretien KC, Azar J, Kind T.JAMA. 2011 Feb 9;305(6):566-8.
85
176. 523 physicians found
209 with < 500 followers
range: 500 to 1,910,700
314 with ≥ 500 followers followers (17,217)
54 excluded for other
reasons
• 9 non-English tweets
• 8 not individuals
260 included in analysis • 7 no tweets in last 6 months
• 7 private accounts
• 5 deleted accounts
20 most recent tweets
5 users did not have 20
tweets
analyzed 5,156 tweets
Chretien KC, Azar J, Kind T.JAMA. 2011 Feb 9;305(6):566-8.
85
177. 523 physicians found
209 with < 500 followers
range: 500 to 1,910,700
314 with ≥ 500 followers followers (17,217)
54 excluded for other
reasons
• 9 non-English tweets
• 8 not individuals
260 included in analysis • 7 no tweets in last 6 months
• 7 private accounts
• 5 deleted accounts
20 most recent tweets
5 users did not have 20
tweets
analyzed 5,156 tweets
Chretien KC, Azar J, Kind T.JAMA. 2011 Feb 9;305(6):566-8.
85
178. 523 physicians found
209 with < 500 followers
range: 500 to 1,910,700
314 with ≥ 500 followers followers (17,217)
54 excluded for other
reasons
• 9 non-English tweets
• 8 not individuals
260 included in analysis • 7 no tweets in last 6 months
• 7 private accounts
• 5 deleted accounts
20 most recent tweets
5 users did not have 20
tweets
analyzed 5,156 tweets
Chretien KC, Azar J, Kind T.JAMA. 2011 Feb 9;305(6):566-8.
85
189. Ethical breaches and unprofessional content
were rare but observed. Particularly concerning
was the presence of potential patient privacy
violations and conflicts of interest. The study
was limited to established, self-identified
physician users of Twitter with the most
followers, a sample who may represent heavier
users.
88
190. Ethical breaches and unprofessional content
were rare but observed. Particularly concerning
was the presence of potential patient privacy
violations and conflicts of interest. The study
was limited to established, self-identified
physician users of Twitter with the most
followers, a sample who may represent heavier
users.
88
191. Ethical breaches and unprofessional content
were rare but observed. Particularly concerning
was the presence of potential patient privacy
violations and conflicts of interest. The study
was limited to established, self-identified
physician users of Twitter with the most
followers, a sample who may represent heavier
users.
88
194. Representative?
Average user has 208 followers
6 of 10 users has no followers
http://www.beevolve.com/twitter-statistics/#b1
89
195. Representative?
Average user has 208 followers
6 of 10 users has no followers
Only 3.6% have >500
http://www.beevolve.com/twitter-statistics/#b1
89
196. Representative? Nope.
Average user has 208 followers
6 of 10 users has no followers
Only 3.6% have >500
http://www.beevolve.com/twitter-statistics/#b1
89
200. b. Thus, physicians should routinely monitor their own
Internet presence to ensure that the personal and
professional information on their own sites and, to
the extent possible, content posted about them by
others, is accurate and appropriate.
92
221. Following a bad experience people want to
complain, share and be made whole.
If you have a venue for this they can direct it at
you.
Without a venue the feedback will likely be
anonymous, public and out of your control.
96
222. Following a bad experience people want to
complain, share and be made whole.
If you have a venue for this they can direct it at
you.
Without a venue the feedback will likely be
anonymous, public and out of your control.
96
223. • Maritz Research surveyed an online panel of 1,298 US Consumers
• Twitter users who frequently tweet
• Have used Twitter to complain about a specific product, service, brand, or
company
• At least 18 years of age
Yes
376
No Yes
661 636
No
921
When you tweeted your complaint, did Has anyone from the company
you expect the company to read it? contacted yo about your complaint?
97
225. How satisfied were you with the company’s response?
Very Satisfied 34.7%
Somewhat satisfied 39.7%
Neutral 9.9%
Somewhat dissatisfied 10.1%
Very dissatisfied 5.6%
0% 15% 30% 45% 60%
98
226. How satisfied were you with the company’s response?
Very Satisfied 34.7%
Somewhat satisfied 39.7%
Neutral 9.9%
Somewhat dissatisfied 10.1%
Very dissatisfied 5.6%
0% 15% 30% 45% 60%
How did you feel when the company contacted you regarding your complaint?
I loved it 32%
I liked it 51.5%
Neutral 12.5%
I didn’t like it 3.2%
I hated it 0.8%
0% 15% 30% 45% 60%
98
227. Summary
• With everybody connected, social media is an unprecedented revolution in
communication
• Numerous platforms but the two biggest are
• Facebook
• Twitter
99
228. Summary: Facebook
• When patient friend requests you, redirect, don’t just
reject
• Privacy
• Facebook is the new elevator conversation
• Patient communities
• Facebook has forever eliminated the friction keeping
patients apart.
100
229. Summary: Twitter
• Asymmetric. People you follow may not be following
you. Vice-versa
• http://www.MomThisIsHowTwitterworks.com
• Ruthlessly prune your follower list
• Use TweetChat.com to follow chats and conferences
101