Roger Struble, MD, MPH

How was this affected by the amount of intubated patient days? How did the level of CT scans compare? In the MICU, there may be more comfortability with ultrasound. Any thoughts on ways to control for this?

Just had a case of Bradykinin mediated angioedema this week in which we had to perform nasotracheal intubation. Was given steroids, epinephrine, and diphenhydramine with no response. In hindsight should have intubated earlier

Johns Hopkins sues federal government over NIH funds Johns Hopkins University joined several universities in a lawsuit on Monday evening suing the federal government over NIH funding.

Johns Hopkins officials said the NIH funding cut puts at risk approximately 600 current and ongoing clinical trials at Hopkins, including open clinical trials in cancer, pediatrics and children’s health, heart and vascular studies and the aging brain. www.thebaltimorebanner.com/education/hi...

The possible long-term impact of Trump's cuts to medical research funding The Trump administration recently announced the National Institutes of Health will make big changes in the way it funds researchers. Scientists say the move will have a huge effect on their work. We h...

Former U of Iowa President & physician-scientist featured on PBS! Learn how to communicate effectively with friends, patients, and policymakers about NIH-funded research. What are ‘indirect costs,’ and why does this matter to our communities? Watch! #ScienceMatters #NIH
 
www.pbs.org/newshour/sho...

NIH cuts billions of dollars in biomedical funding, effective immediately The move halts a large slice of money for most universities and research institutions virtually overnight, imperiling vital research in everything from cancer to heart disease.

NIH has cut billions of dollars in biomedical funding, effective immediately
The move halts a large slice of money for most universities and research institutions virtually overnight, imperiling vital research in everything from cancer to heart disease.

www.washingtonpost.com/health/2025/...

I built my entire future on the hope of securing NIH funding. Now, countless junior faculty like me are watching our academic dreams slip away. We’re not just losing careers—we’re losing the research breakthroughs we could have delivered. Here’s hoping this NIH crisis ends soon. #medsky #NIH

We have resorted to heavy bribes. My daughter ate a cupcake today. Not proud of it, but so hard to clean poopy undies after a long day at the hospital.

To all the amazing doctors, nurses, APPs, unit clerks, food service, environmental service workers in the hospital today. We see you, we thank you, and your patients depend on you. Merry Christmas to all! #medsky

The Blue Journal thanks Spyridon Fortis, MD, PhD, MSc, for his contribution to the December 15 issue

Association of Ground-Glass Opacities with Systemic Inflammation and Progression of Emphysema

www.atsjournals.org/doi/full/10....

Mama is at work so I’m stuck on Daddy duty. Please coffee, give me strength

Do We Need to Administer Fludrocortisone in Addition to... : Critical Care Medicine atabases, including PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov, along with other relevant websites, were searched until August 31, 2023. STUDY SELECTION: Randomized controlled tri...

journals.lww.com/ccmjournal/f...

Thoughts on adding fludrocortisone? Could it help in hyponatremia? APROCCHSS dosing may not hit detectable levels, and hydrocortisone offers some mineralocorticoid activity. But latest meta-analysis hints at benefits w/ no clear harms—but big RCT data is still missing. 🤔 What’s your take?

Inspiring! Excited to read the review

This is great, thank you. Would love to join the list if there is still room.

The hospital is full of tough calls. For stable, improving, immunocompetent, gram-negative bacteremia (not Staph aureus), 7 days of antibiotics is likely enough. Safe. Effective. Gut-friendly. More patient and system-friendly. 🦠🚫

Real-world reality check: 23% of "7-day" patients got extra antibiotics anyway (vs. 11% in the 14-day group). Docs often extended treatment based on clinical judgment. This trial supports shorter intended courses, not rigid rules. ⚖️

Before you start ordering 7-day courses for everyone, here’s the fine print:
Staph aureus? Excluded.
Indwelling devices? Excluded.
Severely immunocompromised? Yep, excluded.
This is for gram-negative bacteremia without major complications. Keep your judgment hat on. 🧠👨‍⚕️

The numbers:
Mortality: 14.5% (7 days) vs. 16.1% (14 days)
C. diff rates? Same.
No harm detected in most subgroups, though confidence intervals were wide in some (e.g., gram-positive infections, high frailty scores). 🤔

First, the basics: 3,608 patients, 74 hospitals, 7 countries, 9 years. This wasn’t a quick study—it was a global, multicenter marathon to settle the “7 vs. 14 days” debate for bloodstream infections. 🏥🌍

Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections | NEJM Bloodstream infections are associated with substantial morbidity and mortality. Early, appropriate antibiotic therapy is important, but the duration of treatment is uncertain. In a multicenter, non...

Bloodstream infections (bacteremia) are serious—over 500K cases/year in the U.S. alone. The BALANCE trial challenges a key treatment norm: Do we need 14 days of antibiotics, or is 7 days enough? Let’s dive in. 🔬💉
#MedSky #IDSky
www.nejm.org/doi/full/10....

a man in a blue shirt and tie is standing in front of a bulletin board with papers on it . ALT: a man in a blue shirt and tie is standing in front of a bulletin board with papers on it .

Since we’re entering the last month of 2024, here is a non-systematic review of #pulmcrit trials published this year that I found particularly noteworthy. Not comprehensive, so please include any that I may have missed!

(🧵1/11)

#emimcc #critcare #pulmsky #medsky

If #MedSky is going to thrive, we need more journals sharing key research. Great to see ATS community joining the conversation—here’s to advancing knowledge together! #PCCMsky

Nothing hits like a hot coffee on a crisp Iowa morning—13 degrees, a fire crackling, and the perfect mug from @BluebirdDiner.

A thread 🧵 on trials I think have changed or will change ICU practice (at least my own). #emimcc

Spending Thanksgiving differently this year: on ICU call overnight, wife working at the hospital, skipped cooking a big meal. But gratitude fills our home. Dancing with my daughters, putting up Christmas decorations—reminded that joy is in the little moments. ❤️ #Thanksgiving

Would love to join the community, let's have some fun.

How does this change our practice? If you see a patient with asthma, will you be checking A1c? If you have a patient with asthma and T2DM, will you be discussing their diabetes regimen? Interested to hear the communities thoughts. #MedSky #PCCM #Pulmonary

While the findings are interesting, I'm still having trouble understanding the mechanisms behind the reduction. Seems independent of weight loss and A1c. Does metabolic health affect regulatory T cells? Are their unmeasured confounders? Follow up prospective trials for validation are needed

Antidiabetic Medication and Asthma Attacks - PubMed The results of this cohort study suggest that metformin was associated with a lower rate of asthma attacks, with further reductions with the use of GLP-1RA. This appeared to be associated with mechani...

Could diabetes drugs reduce asthma attacks?
New observational study shows metformin linked to 30% fewer asthma attacks—and adding GLP-1RA meds cut attacks by another 40%!?
#Asthma #Pulmonary #MedSky #PCCM

pubmed.ncbi.nlm.nih.gov/39556360/

Fascinating thread. Thank you for brining your brilliance and enthusiasm to Bluesky. Excited for this journey