We had 30 people tweeting and 421 tweets. We were delighted to have study author, Areef Ishani join us:
Also making his first appearance at NephJC was John Asplin with some excellent input
Transcript and analytics
NSMC internship class announced
In late December, we announced the first Nephrology Social Media Internship. We had a great response with 16 applications. Honestly, I was hoping to get at least four applications. It was difficult sorting through all the capable applicants but we managed and are delighted to announce the initial crew:
See more at the NSMC Internship Home Page and keep up with what the interns are doing at the Intern's Blog.
Speechless...NephJC on the PubMed homepage.
Check it out quick while it's still there.
The Back2Basics: DCT Tweetchat summary post
The NephJC team was more than a bit nervous about undertaking a basic science, basic physiology paper for NephJC. We should stop being nervous and just trust in the NephJC community. Once again you guys defied adversity and did an amazing job at both the EST and the GMT Tweetchats.
Before the chat:
After the chat
The tweet of the night goes to Dr. Hoenig, who was participating in her first NephJC
As much as credit as we would like total for the success it was apparent to everyone in attendance that both chats hinged on the phenomenal contribution of Arohan "Call me Ro" Subramanya
Full transcript and analytics for part 1 (EST chat for the Western Hemisphere) here:
Storify here:
The analytics for part 2 (the GMT chat for Europe and Africa):
Storify is still pending...
Brilliant video on Open Access Publishing
My favorite part is where they point out that there is no evidence that the current publishing model is optimal. Let's hold our scientific publishing to the evidence standards that we use to evaluate science, and if the evidence is insufficient, it is time to experiment with alternatives.
Analytics from NephJC 18, the DCT, part 1
We had a spirited discussion last night with the American (North and South America) edition of #NephJC. Arohan Subramanya, study author, was a super star. He joined the chat and answered a ton of questions. Hopefully he can join the Euro/African edition today at 8 pm GMT (3 pm EST).
The analytics were impressive, especially since the chat was almost entirely nephrologists.
Today is the deadline for applications to the NSMC Internship
If you want to be an intern in the inaugural class apply now!
Invited editorial: Why physiology?
I became a nephrologist because of Burton Rose. More specifically, because of the “yellow book” – the fourth edition of Clinical Physiology of Acid-Base and Electrolyte Disorders. As I look at my dog-eared and over-used copy I see it was published 1994 and last updated in 2001.
From this book, I learned that renal physiology is relavant to most hospitalized patients and is relevant to all patients in the ICU. Every hospitalized patient is either receiving IV fluids or diuretics. Electrolytes are checked daily, and most have at least a single abnormality. Edema from heart and liver failure are problems directly related to abnormal renal physiology. Understanding fluids and electrolytes is a foundational concept of hospital care, and understanding fluids and electrolytes is rooted in renal physiology.
From this book, I learned that the the kidney is amazing (and smart). One hundred eighty liters of plasma are filtered every day! The counter-current exchange can concentrate urine to 1400 mOsm/L from a serum a osmolality of 290! The concept of Tm is able to explain the apparently diverse findings in diabetes (glucosuria), proximal RTAs and Fanconi syndrome!
From this book, I learned renal physiology. And I understood how renal physiology related to the entirety of clinical medicine. And that was the most exciting part. Fluid and electrolyte problems and their management could be solved by applying the basic principles. There was logic to it – and I knew what the logic was. I became a nephrologists because it was the only subject that was explained really well and I understood it. Strangely, today a source of the lack in interest in nephrology is because it is “too hard”. Are we suffering from a post Burton Rose funk?
As the years accumulate since the last update to Rose's masterpiece, who is explaining renal physiology now? Who is demonstrating the intricate genius of the nephron? Who is making it clear that if you are interested in hospital medicine and critical care, that you are actually interested in (and need to know) renal physiology? Lots of residents are becoming hospitalists – is it because hospital medicine is so wonderfully accessable and understandable with the advent of UpToDate, another Burton Rose creation?
The editors of CJASN understand the situation perfectly. Understanding renal physiology is the essence of being a nephrologist. At this stage in my career, it is hard to imagine that I will be reading another textbook – thus, the CJASN series is filling an extremely important need for a comprehensive and comprehendible renal physiology resource. Hopefully, it can help inspire future nephrologists as well.
Sarah Faubel is a Professor of Medicine at the University of Colorado and chair of the ASN AKI advisory group. Her Twitter handle is Doc_Faubel.
NSMC Internship application deadline
The internship has garnered more response than we expected and we have a number of qualified applicants. This is going to be fun. We are going to close applications next Wed, January 7th, so if you were thinking of applying, now is the time.
While the applications have been coming in, we have been busy developing the curriculum and it should be great. We have added two more social media stars to the faculty, we are excited to welcome Joshua Schwimmer and Joe Weatherly. Each brings unique expertise to our team.
Happy New Year
Just in time for New Years Eve parties we have a DCT matching game. That's right, we are party animals!
Thanks to Malvinder Parmar for the game.
The next #NephJC, diving into CJASNs Renal Physiology Series
CJASN is doing an exemplary series on renal physiology. We will be examining the latest article in the series, the distal convoluted tubule, on January 6 and7 for NephJC. The editors wrote a great introduction to the series discussing both the mission and its means last July. The final few sentences from the editorial.
“The reviews will be brief but comprehensive, and, therefore, they will be accessible to practicing nephrologists, clinician educators, and trainees, but of sufficient heft to provide a focused review for renal physiologists. To enhance clarity, we will try to use a single visual vocabulary for diagrams of tubules and glomerular cells to make sure that the illustrations are consistent across the different review articles in the series. We hope that these reviews will be helpful to practitioners and trainees and useful as they teach physiology to the next generation of residents and medical students.”
Introducing the first nephrology social media internship
Social media is becoming a force in medical education the threatens to disrupt the establishment. Free open access medical education (#FOAMed) resources are changing the way doctors learn and keep up to date. Nephrology has been near the front of this revolution with a handful of blogs, innovative crowd-sourced contests like NephMadness and DreamRCT, and a vibrant online journal club (if I do say so myself).
Looking to the future, while the audience for FOAMed is growing, it is clear that nephrology needs more people producing this content. To that end, NephJC is proud to be a founding member of the Nephrology Social Media Collective (NSMC), a loose federation of leaders in social media, that are creating a social media internship for nephrology. The internship is unpaid (like the rest of social media) and open to all doctors and med students interested in the intersection of social media and nephrology. The internship is one year long with much of the learning self directed. However interns will get unique access to some of the leading social media projects in nephrology.
For more information and to apply check out the home page.
NephJC GMT just concluded...
Tom Oates did an excellent job taking the helm for our inaugural Old World NephJC. Tom did an excellent job with solid turnout.
A lot of the Nephrons we see on Twitter but don't typically make it to NephJC showed up. Shout outs to:
And we were honored to have social media super star Ronan Kavanagh join in.
Possible future NephJC: Back to uric acid?
We covered the uric acid CKD connection when we did Richard Johnson's review of Meso American Nephropathy. Here is a three year, randomized controlled trial of allopurinol in diabetics showing improved creatinine with treatment of asymptomatic hyperuricemia. Intriguing.
PubMed launches Journal Clubs
PubMed has been quite active recently - in surprisingly innovative ways. A few months ago they launched PubMed Commons, allowing comments on citations in PubMed. Recently, they have also added social media - sharing buttons, allowing you to tweet, like, and +1 directly from the PubMed page.
Overall, the grand vision is to encourage a platform for scientific discourse and post-publication peer review. Check out their blog - the posts are infrequent, but they summarize the strategy. There are other websites (PubPeer is a notable one, but also F1000, and the new kid on the block, Winnower), but PubMed is the 500 pound gorilla in this space.
The latest step is the launch of Journal Clubs on PubMed Commons. And guess what, #NephJC was one of three journal clubs to be part of the launch cohort! Check out the press release, and the NephJC home on PubMed Journal Clubs. This is an exciting development - and we are sure more journal clubs will eventually be added, but we got bragging rights for this one!
NephJC Has seen a solid post ASN #KidneyWk14 bump
Our last three NephJC chats have been our three biggest Twitter chats. It is possible with the GMT chat on Thursday we may break our record for number of participants. I hope this trend continues.
The Rheum Guys show up at #NephJC 17
Tonight we had the first leg of the #NephJC 17 - on Maintenance therapy in ANCA Vasculitis. Not only did Paul Sufka do a great job of the summary write up, he and his Rheum buddies showed up (Al and Sam in particular) and made for a fascinating discussion. Look forward to the #RheumJC starting sometime early next year, that will be a heckuva journal club, for sure.
And of course, we will be having a second 'leg' - on Thursday at 8 PM GMT, Tom Oates (@toates_19 and winner of the best tweeter #NephJC award at #Kidneywk14) will host another #NephJC on the same article, giving an opportunity for our transatlantic brethren to join in. Look forward to another update in a couple of days!
Curated Transcript
Storifys of the Awesome Hyperkalemia #NephJC
The #NephJC tweetchat on the two hyperkalemia papers was truly astounding. Broke all previous #NephJC stats. So putting out the storifys was also quite the gargantuan task - and Joel admirably stepped up to it, but by breaking it up into two parts. Part 1 deals with the Bactrim/Septra causing sudden death paper from BMJ:
And then Part 2, which also contains a link to another storify by Tejas (does that make it a meta-storify?).
Sometimes in the heat of the moment you tweet something a little fast
So in the middle of the potassium tweet fest this tweet caught my attention:
Just what we need, a modern trial that confirms or refutes this data showing the futility of Kayexalate:
That figure is from this 1998 Study by the great Michael Emmett. A modern study could confirm or refute the concerns about the safety signal regarding kayexalate:
From Gastrointestinal Adverse Events with Sodium Polystyrene Sulfonate (Kayexalate) Use: A Systematic Review The American Journal of Medicine Vol 126, Issue 3, Pages 264.e9–264.e24, March 2013.
So I was a little disappointed to see that the study had been halted
Then came the part that was too juicy for me to resist:
It was stopped due to a safety signal! I immediately thought it must be the previously known GI problems. Kayexalate was so dangerous that modern researchers couldn't even study the thing! I tweeted a little victory lap:
This has been retweeted 16 times at this moment. It is the tweet that has received the most engagement of any done by NephJC in the last week. It was the number 1 tweet!
But I think it is a bit misleading for a number of reasons:
- the study was being done by ZS Pharma the manufacturer of ZS9, not exactly an unbiased observer
- there were only two adverse reactions and they don't seem related to the study drug, they were A-fib and long QT
Seems a little fishy. The cynic could imagine that the early data showed ZS-9 to be no better than Kayexalate so the company started looking for a reason to cancel the project. They saw the unbalanced adverse events, 2 with SPS versus 0 with ZS-9 and spiked the study. Luckily, I'm not cynical.
I posted a retraction with the new data:
Predictably the retraction has not gotten the same social media traction
“A lie will go round the world while truth is pulling its boots on.”
NephJC goes crazy.
We just completed our most popular NephJC ever. We broke both the number of tweets record and the number of participants record. We also had the most authors ever participating, I think it was 4, two from each study.
Sixty people (previous record was 39) and lots of new faces
Here's how the potassium discussion looks compared to our other discussions:
Look for the Storify tomorrow.