Ted Rogovein MD

YouTube video by UnidiscMusic The Box - My Dreams of You (Official Musical Video)

Good morning. This ear worm has been there since Friday. Great song from an under appreciated 80’s Canadian band

youtu.be/dDrKOjaY5oE?...

And yet the data i saw yesterday, on cbc, still shows a conservative majority win but not the blowout predicted months ago. Thoughts on the disparity?

ICU Stories:

70 yo pt w history of A. fib presented to the ED 4 d earlier w slurred speech/diplopia/weakness. CT brain: no stroke. TTE: normal LV/RV, severely dilated LA. Brain MRI: "small multifocal acute infarcts from central embolic source". Admitted & started on heparin drip

Interesting. Thx

YouTube video by The Rolling Stones The Rolling Stones - Paint It Black - Live 1990

Very old school….

youtu.be/QCgwCJt5NQI?...

I had a similar experience at a critical care conference in my country. I was amongst a few people masked in a very large room that included people who were, theoretically, exponentially brighter than I am. What information do these people have that I do not have?

Thx. I have not had your success with mortgage lifter. Big plants but few tomatoes. Not sure why. I am a 100% container gardener for veg as no real land on my property.

No problems and great tomatoes from the other two you mentioned.

Green zebra and pineapple have been my most successful.

Physicians Flock to Bluesky,
"Bluesky reminds me of what Twitter felt like circa 2018 or 2019 or early in the pandemic," Nick Mark, MD, a critical care physician in Seattle "Less hateful, less political, and more just medical professionals talking about medical stuff."

Thx. It’s a really interesting study and getting a lot of notice. But. 3 years to recruit -160 pts in only 2 hospitals looking at 2 different ( overlapping) diseases. Impressive KM curves on a rather small sample size. CCM has been down this road so many times. Larger validation trial to come?

Positive single-center randomized trials and subsequent multicenter randomized trials in critically ill patients: a systematic review - Critical Care Background It is unclear how often survival benefits observed in single-center randomized controlled trials (sRCTs) involving critically ill patients are confirmed by subsequent multicenter randomized...

In critical care, it is common for an intervention that reduced mortality in a single-center RCT to show no mortality difference in subsequent multicenter RCTs. Even if published in top journals, changing practice based on single-center RCTs can be risky.
ccforum.biomedcentral.com/articles/10....

Agree. Very interesting. Two comments.
1 This seems a pretty small sample size and # of involved hospitals given the prevalence of the diseases studied. Larger trial planned?
2 Not sure why they only show the blended results in the main article (the more important graph, imho, is in the appendix)

Finally had a moment to watch. Thx. Nice talk. Found the last ten minutes amongst the most useful as it addressed some of my concerns. Going to take your ( and the speaker’s ) advice and play a bit more with one of the LLM engines. I have a bunch of queries lined up. Let’s see…

It blows my mind that NASA is able to receive data from 4.67 billion miles away, but I lose Wi-Fi signal in my kitchen.

Just because a bunch of professors at Stanford say COVID’s no big deal doesn’t make it true. You know this. You know someone who’s died from covid. You know someone with long covid. You’ve probably had covid several times yourself. They are spreading misinformation because it fits their ideology.

Thx. What gives me pause is when an LLM based question generates poor answers and we accept that simply because those answers were generated by AI.

I’m cautiously skeptical but happy to be convinced. Let me start with the video you sent.

Thx. I’ll give it a watch. More questions soon I’m sure.

Hi William. I too am glad to see the return of a CCM social media resource.

As to your provocative statement…any data to support this approach? Whenever I talk about mainstream AI with my computer science trained and practicing daughter…she is very skeptical of what it actually is doing.

Late to this party and not adding too much new ( and doesn’t that sound familiar) ICU attending for 33 years. The sensation that one doesn’t know anything hasn’t gone away but it does change over time. Not so much an imposter as someone always trying to keep up. It’s not a bad way to practice CCM.

I shall start right now!
The order shall be "randomly as they occur to me"

Please add me to the list. Thx. Ted

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So I came away from this trial result with a likely practice change … in non staph aureus bacteremia I will PLAN to do 7 days and will adjust according to clinical state. Previously my plan was to do 10-14 days and adjustaccordingly. I think that fits with the results. Thoughts? Concerns?

This is my gremlin, Figment.

Or set the IV RL or saline rate to 106cc/hr. See how long that lasts…

ICU doc in Toronto.
Just joined. Left Twitter some time ago. Figuring Bluesky out.