The #NephJC chat on the #Descartes workgroup statement had a thriving conversation. One of the questions that came up was about allowing one's children to donate.
Fabulous chat. Huge - and discussion highlights including the excellent hosting/moderating from Matt and Ben, and the participation of authors Katalin Susztak, Jeff Miner and many more basic scientists.
New rule for visual abstract. We need to stop adding the logo of the publishing journal. Replace the logo with the authors name. So here is the latest visual abstract in the new style.
The team at Symplur have teamed up with Stanford to compile a comprehensive library (217 articles!) of medical publications on social media. You can sort the list by altimetric score, title, first author's last name, yet, journal or impact factor. Looks very cool.
Last year a number of the NephJC work group began research and compiling a comprehensive history of the journal club. This evolved into this AJKD publication:
We missed posting the wrap up on this one!
Here are the transcripts
Storify by the folks at #JHMChat. Great to have first author Sam Silver join us. Fabulous participation.
Last week my summary of Cost of Acute Kidney Injury in Hospitalized Patients included a bubble chart of Table 2.
This made clear one of the points of the study that is hard to accept, the fact that an myocardial infarction adds only $14. Does this indicate that the model flawed in some way? Or does this represent a medical system that has developed detailed and efficient pathways for the diagnosis of acute MI such that these patients do not represent meaningful increase in cost of care?
I do not suppose there is anything to learn if the model is merely broken. But if we suppose the model is accurate what can that teach us about how we should take care of AKI?
Hospitals are tuned for the inpatient management of acute MI. Chest pain units that quickly and efficiently guide patients through risk stratification, then intervention versus medical management leading to brisk outpatient follow-up are all components that allow efficient quality care for acute MI. The proof is in the outcomes.
What would an AKI pathway look like? Can we systemitize the management of these patients to shorten admissions?
Over and over again I see decisions made by nephrologists that prolong hospitalizations while not providing advantages to the patient.
Can we agree that if the creatinine is falling for a day or two we do not need to watch the creatinine fall all the way to baseline before they are ready for discharge? I have seen that done.
In rhabdomyolysis, if the patient didn't develop AKI when the CPK peaked at 20,00 do we need to keep the patient admitted on IV fluids until the CPK is normal? I have seen that done.
If the patient has AKI and the creatinine is stable and the electrolytes are good, we do not need to keep the patient admitted until renal recovery. We should not emphasize creatinine voyeurism as an end to itself.
AKI is so expensive because we have not researched or developed validated pathways for dealing with these patients quickly, efficiently and personally.