Wael Hussein

Humans:

- Taking my job?

----- I hate AI!😡

- Helping me get rid of another human when doing something?

----- I love AI!🥰

We are doomed!!

www.msn.com/en-us/health...

Disseminating innovations in health care - PubMed Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly-if at all. Diffusion of innovations is a m...

The recipe includes: trust, incentives, visible early adopters, and leadership.

Innovation only starts at invention. Adoption is the next main component.

How many clever solutions do you know that need a push towards adoption?

Here is the JAMA article again: pubmed.ncbi.nlm.nih.gov/12697800/

The lesson? Discovery is only half the battle.

Without systems that support diffusion, life-saving interventions stay stuck in labs and journals instead of reaching patients.

In healthcare today, effective interventions (drugs, vaccines, care models) take DECADES to become routine.

Innovation diffuses slowly even when the benefits seem obvious.

"To introduce any new article of food among seamen... requires both the EXAMPLES and the authority of a Commander."
- Captain James Cook.

LEADERSHIP DRIVES DIFFUSION!

EVIDENCE ALONE IS NOT ENOUGH!

Adoption required authority, leadership, and culture change.

Cook saw this and he benefited from the immediate application for himself and his crews.

However, it wasn't until 1865 - 264 yrs after Lancaster, that the British Board of Trade required merchant ships to follow suit.

Two and a half centuries from proof to policy!!! So why so slow?? 😵‍💫

It took 48 more years for the British Navy to officially issue citrus rations.

Scurvy nearly disappeared from its fleets.

Year: 1747 (146 years later!)

James Lind repeated the test aboard HMS Salisbury.

Again, citrus worked!! Now, there should be immediate adoption, right? Again, not even close!!😢

Year: 1601. Nobody knows about vitamin C at that time.

Captain James Lancaster tested lemon juice at sea.
👉 His sailors remained healthy. 🎉💪
👉 All while almost HALF the crews on other ships died of scurvy.💀

You'd expect immediate adoption? Not even close. The Navy ignored it.

Disseminating Innovations in Health Care Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly—if at all. Diffusion of innovations is a m...

A fascinating story about prevention of scurvy shows how it can take CENTURIES between discovery and practice.

Meanwhile, there will be winners and losers.

Here is the story and some valuable lessons. A thread 🧵 below.

doi.org/10.1001/jama...

15 L interdialytic wt gain.

Record?

Pt was trying to beat nausea with chips and water.

How are our patients dealing with these tremendous costs?

Do you have ppl in ur clinic to help pts obtain these medicines at an affordable cost?

Source: Primer on Diabetes Management www.vumedi.com/video/primer...

In case you missed it on the #AJKDBlog:

AJKDBlog Interviews Editor Timothy Yau caught up with Dr. Subhash Chander to discuss if urea is effective for managing SIADH-induced hyponatremia.

bit.ly/ChanderBlog25 (FREE)

Do u have a local policy for picc- and mid-lines for pts with renal impairment?

🧭 Any simple algorithm that can be shared with other specialties?

⛔️ “Has to be discussed with nephrology” is a battle- we r the bad people who r inconsiderate of realities of the pt’s (immediate) care!
#askrenal

a good biomarker of what? 😊

Diet? Inflammation? Liver disease? Kidney disease? (Example etiologies)

High risk patients for mortality or other poor outcomes? (outcomes)

Not good as in non specific: yes.
But good as gold as risk marker.

⚠️ Calciphylaxis is a debilitating and painful condition that is hard to treat.

▶️ Do you use daily dialysis as part of treatment? If so, what criteria do you use?

#askrenal

pubmed.ncbi.nlm.nih.gov/21872378/

doi.org/10.1093/ndt/...

*screaming

I once witnessed a cardiothoracic surgeon (aka God) SCREENING in ICU: “I WANT DIALYSIS”

for a patient after he was told nephrology suggested a different plan. 😬😟

There are gaps in the evidence, particularly for whether interventions to increase alb directly lower the risk of adverse outcomes.

Treatment should target underlying causes of low alb rather than the lab values alone. Eg protein-energy wasting (PEW), chronic inflammation, poor dietary intake, and comorbidities (including infections and chronic inflammatory conditions).

+ nutritional interventions and tailored dietary plans.

The higher mortality associated with low serum albumin is dependent on systemic inflammation in end-stage kidney disease - PubMed Whereas mortality risk was increased in CKD stage 5 patients with low S-Alb and high CRP, it was not increased in patients with low S-Alb and normal CRP. Our observation suggests that inflammatory sta...

A suggestion that the relationship is mediated through inflammation in this CKD5 pts study

The Higher Mortality Associated With Low Serum Albumin Is Dependent on Systemic Inflammation in End-Stage Kidney Disease.

pubmed.ncbi.nlm.nih.gov/29298330/

KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update - PubMed The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for nutrition in kidney diseases since 1999. Since the publication of the fir...

Nephrology world: KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update.

doi:10.1053/j.ajkd.2020.05.006.

pubmed.ncbi.nlm.nih.gov/32829751/

Association of serum albumin and mortality risk - PubMed Reduced levels of serum albumin concentration, a routine blood test, within the "normal" range have been reported to be associated with mortality risk. The literature is reviewed, with a focus on coho...

Old paper: Association of Serum Albumin and Mortality Risk. Goldwasser P, Feldman J. Journal of Clinical Epidemiology. 1997;50(6):693-703. doi:10.1016/s0895-4356(97)00015-2.

pubmed.ncbi.nlm.nih.gov/9250267/

Serum albumin and risks of hospitalization and death: Findings from the Atherosclerosis Risk in Communities study - PubMed Lower baseline serum albumin was significantly associated with increased risk of both all-cause hospitalization and death, independent of pre-existing disease. Older adults with low serum albumin shou...

Some refs:

# Serum Albumin and Risks of Hospitalization and Death: Findings From the Atherosclerosis Risk in Communities Study. pubmed.ncbi.nlm.nih.gov/34298583/

The relationship persists even after adjustment for comorbidities, inflammation, and nutritional status, indicating low albumin is an independent prognostic *marker*, and not just a surrogate for underlying disease severity or acute illness.

Yes. The association has been reported in multiple populations, including hospitalized, acutely ill, and community-dwelling individuals. Eg, albumin < 37 g/L is associated with up to a two-fold increase in long-term mortality even after adjustment for other risk factors.

YouTube video by The Late Show with Stephen Colbert Stephen Colbert Announces The Cancellation Of “The Late Show”

That’s sad. I never imagined it would happen.

youtube.com/watch?v=AuqE...

Is it just me or is it really awkward?

".. and they are all known as non-steroidal anti-inflammatory drugs, or NSAIDs".

I am sure I lose patients at "non-ster.."!

How do you tell ur pts about them?

“Does not smoke, drink, or work”

Made my day 😂