BC HEALTH
Saved by @Mollyycolllinss

In medicine, reckoning with racism includes reappraising the very syntax we use every day. Proud to add my voice w/ @J_Ikeme and @RWGrantMD in this @JAMAInternMed pub addressing:

Does race/ethnicity belong in the first line of the patient

 Some background: I’ve struggled with this question since early in medical school

Medical syntax is designed to communicate information in a predictable sequence with key elements prioritized to facilitate efficient communication and formation of an assessment and plan

2/
From preclinical lectures to Qbank questions to clerkship rotations, race/ethnicity was often prioritized in the same sentence as age + gender.

I grew accustomed to reading/hearing: a 70-year-old Black man w/ history of x, a 50-year-old Hispanic woman presented w/ y.

3/
However, when it came time for me to use race/ethnicity, there was always tension. Race/ethnicity are self/socially-ascribed identities that in clinical practice are almost always assumed by providers based on appearance. I was also concerned about the potential for bias

4/
I wondered how my own care would be impacted or not impacted by my ethnicity (Hispanic) – I have light skin so I’m not sure if my doctors would even identify me as such – but how would my care be different if I was presented as a 30-year-old Hispanic male?

5/
That said, I was taught race could have implications for the assessment and plan (e.g., eGFR – I’ll come back to this). Moreover, racial disparities are real and could inform a pt’s care. So, I reported race on a PRN basis, but still felt uneasy. I wondered what others did …

6/
In @JAMAInternMed, we get insight from Balderston et al. on this use of race in medicine. In 1200 admissions to an academic medical center, 33% of Black pts had their race documented in the first line of their admission note compared to 17% of white pts
https://t.co/GMKXsx6Z02
7/
They also found that Black clinicians had 58% lower odds of documenting race than white clinicians and attending physicians had 2.37 times greater odds of documenting race than resident physicians.

8/
Though this study was conducted at a single center and does not investigate *why* Black patients had race identified more often or *how* this impacts subsequent care, the differential documentation of race in the HPI merits further scrutiny.

9/
Fortunately, there has been much scrutiny and expertise dedicated to the (mis)representation of race in medicine this year – including this important work by Amutah et al.

https://t.co/8Ej4LvDi2a

10/
🔑 pts:
-race is not a meaningful scientific construct in the absence of context
-race is not a biologic category based on innate differences that produce unequal health outcomes.
-it is a social category that reflects the impact of unequal social experiences on health

11/
🔑 points (cont.):
-Unfortunately, race in medical education often misses the mark and can lead to race-based diagnostic bias or pathologizing race (see below table)

12/
Notably, they “are not arguing that race is irrelevant” but rather “that it can be a starting point to generate hypotheses about environmental exposures and social processes that produce disparities” and that “discussing race is essential to promoting an antiracist culture.”
13/
In another expert review, Borrell et al. similarly write it is “inappropriate to simply abandon the use of race in research and clinical practice ... these variables capture important epidemiologic information, including social determinants of health”

https://t.co/Yt28mUqPqg
14/
Key points:
- Race, ethnicity, and ancestry have a complex and intertwined relationship that demands nuanced analyses
- we should not assume that environmental, social, or genetic factors represent the only contributors to a given disease until causation has been proven

15/
Back to eGFR, and the use of race in research and clinical decision making, at large. My thoughts continue to evolve as a clinician and researcher on handling race in this context, but I want to provide one last article by Vyas et al:

https://t.co/aVM0k4GCEv

16/
This article provides a useful framework to eval race correction in clinical settings:
Is race correction based on robust evidence?
Is there a plausible causal mechanism for the racial difference?
Would implementing this correction relieve or exacerbate health inequities?

17/
As it applies to GFR, raceless markers are an ideal solution, but in lieu of ready access to these, I will continue to seek a nuanced understanding of how we can best estimate GFR in a manner that is based on robust evidence and doesn’t exacerbate health inequities.

18/
For many of the reasons made in these eloquent pieces (which I highly encourage reading), we feel that the rote documentation of race in the first line of the HPI is unlikely to serve a useful function and the practice of differential documentation offers potential for harm

19/
However, given the important implications related to structural racism and the potential that addressing race has in reducing health inequity, we suggest that race/ethnicity be documented as part of a complete social history, where it can be given appropriate context

20/20
@j_ikeme @RWGrantMD @RFRedberg @JAMAInternalMed @Adali_Mtz @brandon_s_scott @DestinyRoseman @Sarah_SchaeffMD @UCSFIMChiefs @CPSolvers @dereckwpaul @jbullockruns @AntiRacistUCSF @Neil_R_Powe @KBibbinsDomingo @tsaiduck77 @thegud_doc @Anand_Habib

More from Health

The Tycoon Mindset
The Tycoon Mindset
@tycoonmindset05
APL Apollo conducted their earnings con-call today at 2:00 pm

"Vision of capacity of 4 Million Tone till 2025"

@hiddengemsindia @gvkreddi

Here are the key highlights 😀👇

Business Updates:

• Net Working Capital Remains under 10 days which is best in the building material
• Continue expanding rural region.
• Added 15 new distributors.
• Value added products contributed 50-60% of the topline.

Revenue breakup


• EBIDTA Margin Improvement: This was mainly because of cost structarize and better operational

• Working Capital Cycle as per mgmt should remain sustainable

• Blue Ocean: Company owns 100% subsidiary which contributes nothing but own property where corporate office is there

Improvement in Net Selling Realization:
• With expanding capacities at 2.6Million Tones and utlization of 75%, scalability has been affected.
• While the prices of steel has gone by by around 35%, due to shortage of steel.

• Apl Apollo being the dominant player past connection with steel companies worked well.
• Steel tubes supply from China is shrinking.
• Hence the discounting factor while selling the products has went away.
HEALTH
Ottawa Public Health
Ottawa Public Health
@OttawaHealth
THIS IS A CATCHY & ATTENTION-GRABBING TITLE

Today, the Province will likely announce what zone of the reopening framework we'll shift into as of Tuesday. Whatever is announced, though, doesn't change what we need to do. Why?

Kindly read these 14 tweets & we'll tell you. (1/14)

Fun fact: COVID-19 does not follow us on Twitter. COVID doesn't know, or particularly care, if we're in the Red or Orange zone.

The behaviours of the virus do not depend on the current ‘zone’ of public health restrictions. And, to be perfectly candid, neither should ours. (2/14)

Once upon a time we used to say #WeAreInThisTogether in our messaging. Here's the thing: we are, but we aren't. Not everyone is experiencing this pandemic the same.

Nurses, doctors, paramedics & healthcare workers have experienced things much differently than most of us. (3/14)

Some people have been home & isolated for months, while others haven't been able to stop working.

Business owners & hospitality workers have been on a rollercoaster of openings & closures.

Students, parents, teachers & school staff have had to adapt to going from online (4/14)

to in-person learning (and back again) numerous times.
And this virus has disproportionately affected some groups more than others.

But there's the thing: while our experiences of this pandemic haven't been shared, we do have a shared goal.

And we can reach it together. (5/14)
HEALTH
Advertisement
Stephen Wolfe
Stephen Wolfe
@PerfInjust
Thread:
I'm thinking about Tim Keller's influence.

There is the curious fact that Keller is well-regarded among the culture elite (or at least has not suffered the sort of vilification one might expect given his influence). How can we explain this?

Looking at Prodigal God and other writings, you see that his approach to urban ministry is deeply political in a way that appeals to Democrat-heavy cities. It involves two moves:

1) equalizing sins: elevating the sin of hypocrisy, "moralism," and "religion" (the sins of "conservatives") and equating these with the sins tolerated among liberal (e.g., homosexuality)
&
2) emphasizing "self-righteousness" as a sort of chief sin (the sin of "red states").

Keller effectively downplays the sins that liberals tolerate while elevating the sins of their political enemies, the red state conservatives.

But the greatest appeal to liberals is that critiquing the "self-righteous" vilifies political action, particularly the action of social conservatives (e.g., anti-gay marriage). And the equalization of sins eases concerns over changes in social policy (e.g., gay marriage).
HEALTH , GOVERNMENT
Pete Wharmby
Pete Wharmby
@commaficionado
Once again I'm reminded that every action has an equal and opposite reaction. The recent push by a large number of autistic people to 'own' their diagnosis and try to raise acceptance and dispel harmful myths has kicked up a minority of autistic people to fight against this.

This may seem bizarre - who fights against improved acceptance? - but actually has clear roots in the ongoing culture war the West seems engaged in. The identity positive autistic movement, of which I am a part, is viewed by some as another manifestation of 'wokeness'.

This is the right-wing definition of 'wokeness', of course - ie a modern equivalent of the pejorative take on political correctness, but it's definitely at the core of this 'neurorealist' movement - the idea the autistic community is being hijacked by 'woke lefties'.

They believe that the push for acceptance of neurodiversity and rejection of the medicalisation of autism is misguided and drawing attention away from those autistic people who, in their view, need more help and intervention.

The trouble is, this view is pretty much baseless. Firstly, there is little evidence that autistic advocates who push for acceptance are in any way harming autistic people who require more help and support. Second, the view effectively silences those of us who are able to share.
HEALTH
G Peters \u267f\ufe0f It's still a pandemic btw.
G Peters ♿️ It's still...
@mssinenomine
Let's talk honestly about "informed consent."
Someone with decades of training gives someone with none advice usually packed into 1-3 mins. Huge amount is based on trust. Huge potential for bias built in. But also there is no obligation to provide real alternative options.


I am classified as 'gifted' (obnoxious and ableist term). I mention because of what I am about to say. You all know that I was an ambulatory wheelchair user previously - could stand - but contractures have ended that. When I pleaded for physio, turned down. But did you know...

I recently was chatting with a doctor I know and explaining what happened and the day the physiatrist told me it was too late and nothing could be done. The doctor asked if I'd like one of her friends/colleagues to give second opinion. I said yes please! So...

She said can you send me MRI and other imaging they did to determine it wasn't possible to address your contractures.

Me: What?
Dr.: They did a MRI first before deciding right?
Me: No
Dr: What did they do??!
Me: Examined me for 2 minutes.
Dr: I am very angry rn. Can't talk.

My point is you don't even know if you are making "informed" decisions because the only source of information you have is the person who has already decided what they think you should do. And may I remind you of a word called 'compliance.'
HEALTH

You May Also Like

Noah Smith
Noah Smith
@Noahpinion
Remember: Just because an idea is old doesn't mean it's good.

Knowing whether old ideas are more likely to be good requires understanding whether conditions have changed in important ways.

Horse archery was an amazing method of warfare for over a thousand years...then people invented guns, and suddenly this great idea that had stood the test of time became obsolete.

Then again, when underlying conditions don't change much, tried-and-true approaches are probably better.

"Learning the lessons of history" usually just means assuming ergodicity and stationarity in an informal time-series model...

(end)
SOCIETY
Kaspars Ozolins
Kaspars Ozolins
@lettlander
THREAD: Meditations on marriage metaphors in Ruth

The book of Ruth is, of course, a story about a beautiful marriage. But even before the courtship and the wedding and the important genealogy at the end, we find interesting language that is strikingly reminiscent of Genesis 2:24


That important verse reads:

'Therefore a man shall leave [יַֽעֲזָב] his father and his mother and hold fast [וְדָבַ֣ק] to his wife, and they shall become one flesh.'

The verb עזב can be quite strong in force. For example, Joseph leaves behind [וַיַּעֲזֹ֤ב] his garment as he flees from Pharaoh's wife's sexual advances. Countless times, Israel is depicted abandoning the LORD, for example in Judg 2:12 [וַיַּעַזְב֞וּ], and going after other gods.

Likewise, the verb דבק is rather striking. Lot is mortified of disaster overtaking him [תִּדְבָּקַ֥נִי] as he flees from Sodom. Israel is commanded in Deut 10:20 to cling fast [תִדְבָּ֔ק] to the LORD and serve him and swear by his name.

Together they illustrate how radical God designed marriage to be. Marriage is a real severing of family relations in order to form a new, permanent bond with another human being.

Something very similar to this takes places in Ruth's life.
HISTORY
Advertisement
Suhas S. Hardutt
Suhas S. Hardutt
@HarduttSuhas
Chennakeshava Temple, Somanathapura, Karnataka.

This temple, not to be confused with the Belur Chennakeshava temple, was built during the Hoysala period by a Hoysala general named Dandanayaka Somanatha. The temple dedicated to lord Vishnu was consecrated in 1258.


Dandanayaka Somanatha established a village named Somanathapura on the banks of river Kaveri. He sought the permission of King Narasimha III, to begin construction of a grand temple dedicated to Lord Vishnu that would also showcase the might of Hoysalas.(1)


The temple rests on a high star shaped platform (jagati) with 3 sanctums (garbha griha) making it a trikuta, set in a square matrix oriented along the east west and north south axes.(2)


The western sanctum is dedicated to Kesava, the northern sanctum to Janardhana and the southern sanctum to Venugopala, all are forms of lord Vishnu.(3)


The sanctums share a common community hall (sabha mandapa) with many pillars. Above each of these sanctums rise the 16 pointed star shaped tower called vimana or shikara.(4)
RELIGION
Numberonepal
Numberonepal
@numberonepal
1/ Stolen from the greatawakening(DOT)win...

I will only be making one post here. Do not ask who I am. Do with this information as you please.

The Trump Card is being played. It's much simpler than you all realize. Some of you have gotten it right.
TRUMP , THE LAST DAYS IF THE REVOLUTION
Justin Kan
Justin Kan
@justinkan
1/ Throughout my startup career, I’ve seen many founders have an aversion to sales. This is a mistake that can kill your startup.

2/ Sales is often viewed as either a saving grace or proof that the product isn’t good enough (because it should sell itself). Neither are ever true. Some common mistakes that result in...

3/ Mistake 1: Hire a sales rep before reaching product/market fit to get your initial batch of customers. This is a mistake because founders need to work through their MVP with early adopters to truly understand what it is they’re selling.

4/ Mistake 2: Reach product/market fit, need to scale, and rely entirely on self-serve. For enterprise products that require big commitments and internal shifts, almost no product is self-explanatory enough to sell itself.

5/ Mistake 3: Make a first sales hire who isn’t scrappy enough to help mold the sales process from scratch. Some salespeople are amazing at their jobs, but not cut out to establish the processes that others end up following. This skillset is what @rdedatta calls a “sales ninja”.
STARTUPS