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Will Preston

@willpreston.bsky.social

Hospitalist in Bronx NY Interests include clinical epidemiology and med ed. Shasta connoisseur.

130 Followers  |  288 Following  |  91 Posts  |  Joined: 10.11.2024  |  2.4661

Latest posts by willpreston.bsky.social on Bluesky

5 pearls is such a great series because even when it’s covering a topic I think I know well, there’s always something important I learn β€” many such moments in this excellent episode.

15.10.2025 18:12 β€” πŸ‘ 1    πŸ” 1    πŸ’¬ 0    πŸ“Œ 0

PARAGON-HF was a negative trial but I’m seeing the subgroup analysis being used to justify changing ACE or ARB to ARNI all the time without consideration of other patient-centered factors

11.10.2025 00:19 β€” πŸ‘ 1    πŸ” 0    πŸ’¬ 0    πŸ“Œ 0
Preview
DOTS: Optimism Around a β€œNegative” Dalbavancin Trial The DOTS randomized clinical trial of dalbavancin versus standard-of-care for Staph aureus bacteremia (SAB) just landed in JAMA, where it undoubtedly will be featured in numerous ID, hospitalist, and ...

What the DOTS trial of Staph bacteremia tells us:
β€’ Dalbavancin d1 and d8 vs daily IVs for WEEKS
β€’ No left-sided IE/CNS/prosthetics
β€’ Dalba not superior by DOOR endpoint, but similar clinical outcomes.
Big implications for inpt care. More here! #IDSky tinyurl.com/3hjzkt96

10.10.2025 10:55 β€” πŸ‘ 19    πŸ” 6    πŸ’¬ 2    πŸ“Œ 1

I’d like to nominate this case for a pulitzer prize

09.10.2025 20:22 β€” πŸ‘ 0    πŸ” 0    πŸ’¬ 0    πŸ“Œ 0
Initial imaging studies.

Initial imaging studies.

Case Record of the MGH: A 36-year-old man was admitted because of fever, hypoxemia, and bacteremia. Imaging revealed pulmonary opacities, thickening of the duodenal wall, and a thrombus in the right renal vein. A diagnosis was made. Full case details: nej.md/3KYBaAE

#MedSky

09.10.2025 16:01 β€” πŸ‘ 6    πŸ” 1    πŸ’¬ 1    πŸ“Œ 1

The NEJM case records this week is an all timer with Dr Dhaliwal. They do a Watson on jeopardy! style challenge where his answers are compared to an AI’s - should definitely read for yourself but just want to be the first to say humanity’s still got it baby!

08.10.2025 19:20 β€” πŸ‘ 0    πŸ” 0    πŸ’¬ 0    πŸ“Œ 0

5/6🧡Unauthorized immigrants contribute billions to the U.S. health system β€” more than they receive in care.
In 2017 alone, net contributions totaled:
$20.8B to Medicare

$21.3B to Medicaid

$14.7B to private insurance

They are net funders, not burdens.

06.10.2025 15:06 β€” πŸ‘ 1    πŸ” 1    πŸ’¬ 1    πŸ“Œ 0

Almost like people want socialized healthcare! Best we can do is cut the largest public insurance, replace vaccines with crank science, gut our research institutions, and prevent any new HCWs from coming here but here’s an AI video of our demented president saying he’ll make you live forever.

28.09.2025 12:03 β€” πŸ‘ 1    πŸ” 0    πŸ’¬ 0    πŸ“Œ 0

There’s a great one on thickened liquids. Also over using RPP.

26.09.2025 06:57 β€” πŸ‘ 2    πŸ” 0    πŸ’¬ 1    πŸ“Œ 0

Trump: don’t take acepitoemponoene

RFK Jr: *moth crawls out of mouth*

A nude man is in the background, only referred to as β€œthe colonel”

Person watching on tv: well if they say so

23.09.2025 00:44 β€” πŸ‘ 7104    πŸ” 1335    πŸ’¬ 88    πŸ“Œ 49

Reading the blog awhile but turns out scrolling right past the podcast lol. Great ep. I guess even tho the 2mm in all 4 leads has LR 16, it’s from a case-control with only 4 such cases so is it really enough to go by? Seems straightforward enough to repeat a similar study tho maybe I’ll try.

17.09.2025 16:24 β€” πŸ‘ 0    πŸ” 0    πŸ’¬ 1    πŸ“Œ 0
Preview
RSV Vaccine Effectiveness Against Hospitalization Among US Adults Aged 60 Years or Older During 2 Seasons This study investigates respiratory syncytial virus vaccine effectiveness against hospitalization among US adults aged 60 years or older during 2 seasons.

Just off the press

05.09.2025 16:31 β€” πŸ‘ 1    πŸ” 0    πŸ’¬ 0    πŸ“Œ 0

You should go to the hospital if you break your spine

31.08.2025 22:22 β€” πŸ‘ 13    πŸ” 0    πŸ’¬ 2    πŸ“Œ 0
Always has been meme with the caption β€œwait it’s all volume status”

Always has been meme with the caption β€œwait it’s all volume status”

26.08.2025 03:02 β€” πŸ‘ 1    πŸ” 0    πŸ’¬ 0    πŸ“Œ 0

I am loath to report the most parsimonious diagnosis is scurvy. I recommend continued palliation with poultices as seen here or perhaps cauterization of the most severe lesions, as well as an extra portion each of hardtack and grog for the remainder of his voyage.

25.08.2025 01:47 β€” πŸ‘ 2    πŸ” 1    πŸ’¬ 0    πŸ“Œ 0
Preview
Substance Use Disorder Program Availability in US Hospitals This cross-sectional study examines differences in the delivery of different substance use disorder programs in safety-net hospitals vs non–safety-net hospitals across the US and evaluates whether the...

Every hospital in the US had immediate access to expert toxicologists (via poison control).

Most hospitals *lack* access to inpatient addiction medicine services.

Structurally, we’re great at resus, but then we often fail at chronic tx of substance use disorders.

jamanetwork.com/journals/jam...

24.08.2025 18:13 β€” πŸ‘ 23    πŸ” 5    πŸ’¬ 4    πŸ“Œ 0

This is correct. Any candidate cynically β€œtriangulating” on trans kids is a non-starter, and now is the time to say so. There’s still so much time to advance candidates that DON’T suck.

17.07.2025 01:03 β€” πŸ‘ 23161    πŸ” 4738    πŸ’¬ 408    πŸ“Œ 398

As clinicians there is little we can do about radiology interpretations, but should try to stick to the diagnostic algorithms and avoid relying on hunches. Missed PE has <5% risk of recurrence and mortality which is probably less than major bleeding risk from cumulative years on an unnecessary DOAC.

20.08.2025 20:43 β€” πŸ‘ 1    πŸ” 0    πŸ’¬ 0    πŸ“Œ 0
Preview
Overdiagnosis of Pulmonary Embolism by Pulmonary CT Angiography | AJR OBJECTIVE. The purpose of this study is to evaluate the rate of overdiagnosis of pulmonary embolism (PE) by pulmonary CT angiography (CTA) in a tertiary-care university hospital. MATERIALS AND METHODS...

Writing up a case with my residents and shocked at what I'm learning about diagnosis of PE. PIOPED II the last RCT of CTA had a PPV of only 58% in the low risk group; more recent retrospective had 25% of all positive scans deemed false positive on expert review (including 16% of lobar PE).

20.08.2025 19:32 β€” πŸ‘ 1    πŸ” 0    πŸ’¬ 0    πŸ“Œ 1

ID doesn’t want us to read the forbidden trial

jamanetwork.com/journals/jam...

07.08.2025 02:45 β€” πŸ‘ 2    πŸ” 0    πŸ’¬ 0    πŸ“Œ 0

I’ve never wanted be embroiled in online cancel culture and I really hate to say this as a fan, but last night at the NY Liberty game I didn’t feel John Turturro was clapping with adequate enthusiasm during the Big Ellie Stomp.

06.08.2025 20:45 β€” πŸ‘ 1    πŸ” 0    πŸ’¬ 0    πŸ“Œ 0

Two and a half years from the last ep but at its best. Such great reflections on how we reason and how to improve. I’ll never conclude a case conference with β€œhigh index of suspicion” ever again.

02.08.2025 01:24 β€” πŸ‘ 0    πŸ” 0    πŸ’¬ 0    πŸ“Œ 0

New hoofbeats let’s goooooo πŸ˜ŽπŸ€™

02.08.2025 00:46 β€” πŸ‘ 1    πŸ” 0    πŸ’¬ 1    πŸ“Œ 0
PUP: Tiny Desk Concert
YouTube video by NPR Music PUP: Tiny Desk Concert

Folk's...... The Tiny Desk

www.youtube.com/watch?v=Gh9p...

24.07.2025 18:11 β€” πŸ‘ 254    πŸ” 40    πŸ’¬ 9    πŸ“Œ 12

It’s too bad she won’t live! But then again, who does?

21.07.2025 18:54 β€” πŸ‘ 0    πŸ” 0    πŸ’¬ 0    πŸ“Œ 0
Diagnostic schema to help remember the causes of dyspnea organized hierarchically by organ system (lung, heart, blood, acid/base) now including a corner labeled "accidental aspiration of king cake baby to R mainstem."

Diagnostic schema to help remember the causes of dyspnea organized hierarchically by organ system (lung, heart, blood, acid/base) now including a corner labeled "accidental aspiration of king cake baby to R mainstem."

Actually, I fixed it.

10.07.2025 20:19 β€” πŸ‘ 1    πŸ” 0    πŸ’¬ 0    πŸ“Œ 0

To help remind that ~20% starting the drug experience dyspnea (only 5% require stopping). Obvi some omissions on this schema.. pulmonary hypertension, neuromuscular weakness, other embolic sources like fat emboli or endocarditis, tense ascites, hepatopulm, aspiration of king cake baby to R mainstem

10.07.2025 20:11 β€” πŸ‘ 0    πŸ” 0    πŸ’¬ 1    πŸ“Œ 0
A diagnostic schema to help recall the causes of dyspnea arranged hierarchically by organ system (lung, heart, blood, acid/base) with another corner drawn on labeled ticagrelor

A diagnostic schema to help recall the causes of dyspnea arranged hierarchically by organ system (lung, heart, blood, acid/base) with another corner drawn on labeled ticagrelor

Major innovation in medical education: the dyspnea pyramid is now the dyspnea rhombus

10.07.2025 19:47 β€” πŸ‘ 1    πŸ” 0    πŸ’¬ 1    πŸ“Œ 0
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You know things are bad when trauma surgeons are talking about Stoic philosophy.

Seriously, though, this is an interesting article. #EMIMCC

07.07.2025 15:52 β€” πŸ‘ 20    πŸ” 6    πŸ’¬ 1    πŸ“Œ 0
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1/ 🚨 NEW #5Pearls: Pleural Effusions 🌊

Did you know up to 30% of pleural effusions of have more than one etiology?

Let’s dive in!

πŸ–₯️: www.coreimpodcast.com/2025/07/09/p...
Sponsor: Oakstone CME
Featuring: @pulmpeeps.bsky.social

09.07.2025 12:11 β€” πŸ‘ 9    πŸ” 4    πŸ’¬ 1    πŸ“Œ 1

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