
Associate Prof of EM & Surgery, Ass Fellowship Dir @Northwell_EM . Ex- @PennTrauma @UpennEM @imperialcollege| In pursuit of happiness. tweets are not med advice
New York, USA
Joined February 2009
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This is so meta.
AFC Richmond Women and Ted Lasso will debut in #FC27.
The team will be playable across Kick Off, Career Mode, and Football Ultimate Team game modes 🎮
Rogue Reta made it to JAMA!
jamanetwork.com/journals/jam…
همه چیز این اکانت سراپا شلختگی و سر هم بندی و بی مسئولیتی است. ادمین احساس ذوق هنری کرده و بیستون را به ستون ربط داده. بضاعت اداره کنندگان این اکانت همین هست: نسخه جعلی و روحوضی از نامی پر شکوه که حتی شکل درست ش هم برای ایشان ناشناخته است.
«بهیستون» و نه بیستون، در پارسی باستان واژه مرکب به معنای جایگاه خدایان است.
«بیستون» آغاز به کار کرد، ستونی برای اندیشیدن به ایران.
این بخش تازه در وبسایت «ایران را پس میگیریم»، خانهای است برای کسانی که به مسائل ایران و راهحلهای پیش روی ایرانیان میاندیشند، فضایی آزاد برای آنکه پندار نیک در گفتار نیک جلوه یابد و راه را برای کردار نیک روشن کند.
برای خواندن مطالب «بیستون»، به وبسایت «ایران را پس میگیریم» سر بزنید.
iranopasmigirim.com/fa/bistu…
This is "avoid peanuts at all costs until kids grow up to prevent peanut allergy" but for education, and with much longer lasting consequences.
I made the modest proposition, a while ago, to abandon all compliance mandates except for ones that has evidence of benefit. This is a low bar. And it brings back into focus the trade offs, and away from safetyism.
ICU Opinion:
I have worked in ICUs long enough to have been through plenty of The Joint Commission (TJC, formerly JCAHO) survey weeks. And I have to admit, the longer I do this, the more skeptical I become about how much of the bureaucracy around hospital accreditation actually makes patients safer.
I am not against standards. Hospitals need outside scrutiny and TJC has done important work. Medication safety, infection prevention, handoffs and procedural safeguards matter. Outside pressure has helped change practices that needed to change.
My problem is when patient safety turns into compliance theater.
If you've worked in a hospital during survey week, you know the ritual. Suddenly everyone is worried about where your coffee is sitting. Tape disappears from walls. Doors, ceiling tiles, refrigerators and labels become urgent concerns. At least my beloved ultrasound machine is finally back where it belongs and plugged into the wall!
Then administrators who rarely set foot on the unit, and probably haven't visited us since the ribbon-cutting ceremony, show up to remind us about rules that somehow become much more important when the surveyors are in the building.
Meanwhile, the ICU is still the ICU. A nurse is titrating three vasopressors, managing CRRT and trying to stop a delirious patient from pulling out his femoral arterial line. Someone is intubating. Another patient is spitting at us and demanding to leave AMA.
But please, let's talk about that covered cup.
The coffee is actually a good example of the larger problem. Even the famous “TJC says you can't drink at the nursing station” rule isn't that simple. Hospitals can designate safe areas for food and drink based on exposure risk. But by the time a rule works its way through hospital committees, policies and layers of administration, the nuance is often gone.
Rules beget rules.
Hospitals write policies around standards. Consultants prepare hospitals for surveys. Staff are prepared for the consultants who are preparing everyone for the survey. My work mailbox gets an email every other day warning me about the visit. Eventually, nobody remembers whether a requirement came from CMS, OSHA, TJC, the hospital—or something somebody heard years ago that somehow became hospital law.
All of this takes time. So what are we getting in return?
A BMJ study of more than 4.2 million Medicare admissions found no significant 30-day mortality associated with accreditation, or for TJC-accredited hospitals compared with other independent accreditors.
That doesn't settle whether accreditation works. Mortality is only one outcome. But it should make us question the assumption that more compliance automatically means better care.
There is also a part of this system worth being transparent about. Hospitals pay accrediting organizations to evaluate them. TJC has a controlled affiliate, Joint Commission Resources, that provides education and consulting services related to accreditation and quality. That relationship does not by itself mean anything improper is happening. Formal safeguards separate the accreditation and consulting functions to address potential or perceived conflicts of interest. Still, I think it's reasonable to ask how that relationship works and how those safeguards are maintained.
To be clear: I don't want to abolish accreditation or leave hospitals to police themselves. My point is simpler: if we're going to ask a nurse or physician to do something in the name of patient safety, we should be able to show that it actually makes patients safer.
Every requirement costs something: money, another click in the EHR, another mandatory module or a few more minutes spent on compliance instead of with a patient.
We ask for evidence before we do things to our patients. I don't think it's unreasonable to ask for evidence before we make clinicians do things in the name of protecting them.
The ICU does not become safer because TJC survey week started.
And yes, let the night-shift ICU nurse drink her coffee.
I think the correct conclusion from all of this is to understand that humans are deeply religious animals and even in destroying the gods of the old, they create new ones and offer sacrifices to them. It follows that we should always stay humble in the face of the New Thing.
Reading about the 70m Bayeux Tapestry coming back to the country it depicts for the first time in 1000 years, and then finding out the French had nearly cut it up in 1794 to decorate a carnival float makes me so ANGRY.
You mean to tell me they were this close to draping a medieval textile of Harold taking an arrow in the eye around some actress in a toga playing the Goddess of Reason?
At this time, the Cult of Reason was at its peak; Notre Dame had been turned into a Temple of Reason. So you have this fragile, stunning, miraculous textile from history - horses, ships, oaths, guts in the margins - and some committee in Year II looks at it and goes, "perfect. Let’s chop it into ribbons so a woman in oak leaves can bounce down the street while we clap for Reason." wtf
I am far more offended that it was almost turned into bunting than by whatever Napoleon or the Nazis intended for it. However vile their purposes, they at least recognized the tapestry as an intricate object of significance and an almost impossible feat of skill and effort. They saw its greatness and valued it as a sacred and durable expression of the human spirit.
The Revolutionary mind was different; its instinct was to destroy. A thousand-year record of ships, oaths, and the unpretty scenes of conquest was to become trim for a civic entertainment, because the calendar had been reset to Year 0 and the old world was obsolete.
An honest reckoning with the Enlightenment has to admit this reflex alongside its genuine liberations. Inquiry, criticism, the rejection of superstition and magical thinking - these are not small inheritances.
But there is a shadow that travels with them, a conviction that once the sacred has been abolished, what remains is only matter, and matter may be rearranged for the festival of the present. It leads to horror, in the name of enlightened rationalism, and it would play out disastrously later.
A reminder that the habit is still with us, and it still misfires.
Since @stephwakefield_ asked what is a better branding for data centers that won't provoke as much negative response, I have a modest proposal: call them Silicone Brains. Silicone resonates with economic boom of the past decades and who is against more brains?
The US Engineers seeding the world with Liberalism, only to wake up decades later and dismantling it. The rest of the West seems to be on the same trajectory that humans followed in Prometheus.
Dear @MarkJCarney we want to bring the relationship with Canada to the highest level possible.
I would like to work with you on opening the door for Canada to being the first associate member of the EU.
And create a common prosperity and economic security space.
Rest in peace, 👑. I knew he played in great movies but my mind instinctively went for Red Alert. @bog_beef
This was one of the best PC softwares I have ever used. You could lose yourself in reading article after article, using hyperlinks inside them. Such magical times.
Humbling watch for clinicians. I also recently read @MartyMakary 's blind spots and I think the history of modern medicine should be taught to future doctors to immunize them against fads. Every medical student learns about Tuskegee experiment, but very few know this.
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It's incredible that people think this is a deep or new insight. It's a true and banal statement. Because there is no safe level of ANYTHING. There is no safety in living. Because death is woven into the condition of living. Safetyism is a civilizational rot.
There is no safe level of alcohol.
Chris Williamson cited the largest Lancet study ever done on the subject. Every single drink moves you closer to death a little faster. Zero is the only number that doesn’t.
He didn’t pretend people will stop. It’s the same trade-off as eating a cheeseburger, you know it’s not optimal, but it tastes good in the moment, so you do it anyway.
Clear data. Honest cost-benefit. No moralizing.
این درجه از مجیزگویی شرمآور است. تنها کسانی که از این نمایشهای خجالتآور شادمان هستند، چپی های انیرانی هستند.
دیدار شاهزاده رضا پهلوی و مازیار جزنی، فرزند بیژن جزنی، یکی از نمادینترین و امیدبخشترین دیدارهای تاریخ معاصر ایران بود. نشانه بزرگ دیگری از آنکه ملت ایران از گفتمان ایرانستیز و آزادیستیزِ ۵۷ به طور کامل گذر کرده است.
در این دیدار، آینده زیبای ایران را میبینیم؛ آیندهای که در آن، ایرانیان با همدلی و عشق به میهن میخواهند کشوری آزاد، آباد و پیشرفته بسازند.
آغوش ملت ایران و شاهزاده رضا پهلوی به روی همه ایرانیانی که میخواهند بخشی از راهحل باشند، گشوده است و همین آغوشِ باز، ضامن ثبات، همبستگی ملی و دموکراسی در آینده ایران خواهد بود.
کالبد شکافی این شکست، که صاحب ش مدعیان رهبری هستند و هزینهاش را مردم ایران با خون خودشان پرداختهاند ، بیش و پیش از هر چیزی، نیازمند مسئولیت پذیری است. ذهن هیأتی و پیشامدرن از مسئولیت پذیری ناتوان است.
من و هماندیشانم، مسئولیت داریم چون با وجود اعتراض به نابکاری ها، در نهایت زور جلوگیری از شکست را نداشتیم. این از ما. اما تمام کسانی که تقیه کردند و «در برهه حساس کنونی» به ناراستیها نپرداختند هم مسئول هستند. باند فاسد نوفدی هم مسئول آنچه شروان نوشت هستند و هزار و یک چیز دیگر. رهبر جنبش هم مسئول اشتباهات پرشمار هستند.
در نهایت، میزان مسئولیت پذیری بایستی رابطه مستقیمی با نزدیکی به راس هرم قدرت داشته باشد، و الا داستان گنه کرد در بلخ آهنگری، به شوشتر زدند گردن مسگری تکرار خواهد شد.
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Really proud of our team putting in an immense amount of effort to get the granual data I believe will transform our understanding of cardiac arrest care, the video recording of the entire resuscitation. Big shout outs to our ex resident Dr Ramraj, and our aspiring MS3 Elaine Chen
Every second counts in cardiac arrest.
This study found that retaining EMS equipment for initial ED rhythm analysis was associated with substantially shorter times to both rhythm analysis and defibrillation in patients with OHCA.
Could a simple workflow change help teams deliver lifesaving care faster?
Check it out at annemergmed.com
#EmergencyMedicine #EM #CardiacArrest #OHCA #CPR #Resuscitation #EMS #EmergencyDepartment #Defibrillation #FOAMed #MedED #MedTwitter
@Dr_DRoll @danieljafari
The future is here, it's just not evenly distributed.
Presented at #EAACICongress2026:
In a phase 3, randomized trial of lonvo-z, an in vivo gene editing therapy, patients with hereditary angioedema who received the drug had a significantly lower attack rate than those who received placebo. Full HAELO trial results: nej.md/4gaSsbi
@EAACI_HQ

ALT A graph from the article "Lonvogran Zicluemeran — In Vivo CRISPR Gene Editing in Hereditary Angioedema" published in the New England Journal of Medicine, dated June 11, 2026. The trial name, HAELO, is in parentheses next to the article title. A graph the mean number of angioedema attacks per month between "Placebo" and "Lonvoz-2" groups over time.

























