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Jeffrey Wagner @drjeffmdmcr.bsky.social · 1d

Definitely applies to HFrEF, but I haven’t seen reimbursement tied to HFpEF-specific GDMT. Here’s a summary of current therapies. With cost/access issues around GLP-1 RAs and SGLT2is, curious how implementation will go—most patients unlikely to get both.

Jeffrey Wagner @drjeffmdmcr.bsky.social · 1d

I really worry about this use of AI/LLMs in peer review, specifically for methods review. The brakes analogy is apt. All for pursuing progress, but how this does not spin out of control seems unlikely in the current climate #pumpthebrakes

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Jeffrey Wagner @drjeffmdmcr.bsky.social · 2d

Efficiencies?! 🤦
Providing public health through a lens of scalable business is short sighted and, well, counter to the mission.

Much worse in 🇺🇸. the pulling back of public safety net in larger society (housing, education, etc) coincides with move to align care models based on ROI

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Jeffrey Wagner @drjeffmdmcr.bsky.social · 2d

🙋🏻‍♂️I have seen the same. it has been a common teaching of mine to correct with learners on service. Unfortunately I am seeing it in cardiologist notes now too.🤦

data does not support outcomes beyond improvement in NT-pro BNP and HF hosp. we need docs to push back against this

too.data

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Jeffrey Wagner @drjeffmdmcr.bsky.social · 3d

Prevalence statistics inform pre-test probability. These numbers are staggering and reflect my anecdotal experience. When considering interventions, Kaiser's PHASE program implements an effective intervention but prevention efforts will be key. www.amjmed.com/article/S000...

Jeffrey Wagner @drjeffmdmcr.bsky.social · Aug 30

Anecdotal, though hypothesize the correlation coefficient for a patient who asks to start testosterone for low energy despite normal levels who will subsequently ask me to empirically treat for parasites/cancer unspecified with ivermectin is 0.84

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Jeffrey Wagner @drjeffmdmcr.bsky.social · Aug 15

a group of children are standing next to each other with their arms in the air and shouting .

ALT: a group of children are standing next to each other with their arms in the air and shouting .

media.tenor.com

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Jeffrey Wagner @drjeffmdmcr.bsky.social · Aug 15

The Bible of Medicine. Spreading the gospel of Longo, Fauci, et al.

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Jeffrey Wagner @drjeffmdmcr.bsky.social · Aug 5

I have wondered why no LLM for UTD? They have content with nuance, which seems ripe for a partnership with AI (such as NEJM and JAMA with Open Evidence). Indeed, fewer trainees are using it too

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Jeffrey Wagner @drjeffmdmcr.bsky.social · Aug 5

10/12
Thanks to my amazing co-authors and the broader infection prevention community working to make indoor spaces safer! 🙏Shout out to @cudeptofmedicine.bsky.social
#InfectionPrevention #IndoorAirQuality #PublicHealth #EngineeringControls #COVID19 #RespiratoryInfections #Evidence #SystematicReview

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Jeffrey Wagner @drjeffmdmcr.bsky.social · Aug 5

9/12
🎯 MOVING FORWARD: We need:
✅ More human outcome studies
✅ Standardized intervention classifications
✅ Better reporting of both benefits AND harms
✅ Real-world effectiveness trials
The framework is there - now we need better evidence.

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Jeffrey Wagner @drjeffmdmcr.bsky.social · Aug 5

8/12
💡 WHY THIS MATTERS: Indoor air quality affects everyone. Post-COVID, there's huge interest in engineering controls, but our review shows the evidence base has significant limitations.
We're making policy decisions with incomplete information.

a cartoon of a man sitting at a desk with the words everyone has to follow protocol below him

ALT: a cartoon of a man sitting at a desk with the words everyone has to follow protocol below him

media.tenor.com

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Jeffrey Wagner @drjeffmdmcr.bsky.social · Aug 5

7/12
🏥 REAL-WORLD IMPACT: The heterogeneity in study designs makes it challenging to give clear guidance to healthcare facilities, schools, and offices about which engineering controls to prioritize.
We need more standardized approaches to evaluation.

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Jeffrey Wagner @drjeffmdmcr.bsky.social · Aug 5

6/12
⚠️ SAFETY BLIND SPOT: Studies rarely measured harms like toxic byproducts from disinfection systems.
We need to know not just "does it work?" but "is it safe for continuous human exposure?" This gap is especially important for occupied spaces.

a group of nurses are dancing in a hospital room

ALT: a group of nurses are dancing in a hospital room

media.tenor.com

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Jeffrey Wagner @drjeffmdmcr.bsky.social · Aug 5

5/12
🧪 WHAT DO STUDIES ACTUALLY MEASURE? Most commonly:

Non-pathogenic organisms in air (332 studies)
Non-biological particles (197 studies)
Actual pathogens (149 studies)

Translation: We're often measuring proxies, not the bugs that actually make us sick.

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Jeffrey Wagner @drjeffmdmcr.bsky.social · Aug 5

4/12
⚙️ WHAT INTERVENTIONS WORK? We found 3 main categories:
🦠 Pathogen INACTIVATION (405 studies) - UV-C, heat, chemicals
🌪️ Pathogen REMOVAL (200 studies) - filtration, air cleaning
💨 Air EXCHANGE/DILUTION (143 studies) - ventilation systems

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Jeffrey Wagner @drjeffmdmcr.bsky.social · Aug 5

3/12
🔬 Of those 672 studies, only 57 (8.5%) included human participants.
Most research (90%) only looked at environmental samples - not actual infection outcomes in people. This is a major evidence gap! 🚨

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Jeffrey Wagner @drjeffmdmcr.bsky.social · Aug 5

2/12
📊 THE SCOPE: We systematically reviewed 672 studies published between 1929-2024 examining engineering interventions to reduce indoor respiratory infection transmission.
That's almost a CENTURY of research on making indoor air safer! 🕰️

Purifiers Air GIF

ALT: Purifiers Air GIF

media.tenor.com

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Jeffrey Wagner @drjeffmdmcr.bsky.social · Aug 5

🧵 THREAD (1/10)
🏢💨 How effective are engineering controls at stopping respiratory infections indoors? Our new scoping review in @annalsofim.bsky.social examined nearly 100 years of research to find out. The results reveal both promise and concerning gaps...
Link: www.acpjournals.org/doi/10.7326/...

Engineering Infection Controls to Reduce Indoor Transmission of Respiratory Infections: A Scoping Review: Annals of Internal Medicine: Vol 0, No 0

Background: Engineering infection controls include a wide range of interventions used indoors to reduce occupants’ exposure to respiratory pathogens. Purpose: To identify and describe primary studies ...

www.acpjournals.org

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Jeffrey Wagner @drjeffmdmcr.bsky.social · Jul 24

This makes my heart flutter

Medlife Crisis (Rohin) @medcrisis.bsky.social · Jul 24

Yes that’s right I’ve launched my own cryptogenic currency like a true grifting YouTuber choo choo get on board NOW!!

Nik Butler -- next stop PlayFest - London Sept @awittyremark.bsky.social · Jul 24

this ... is ... amazing !
www.youtube.com/watch?v=IwqZ...

@medcrisis.bsky.social goes full Bro-gada !!

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Jeffrey Wagner @drjeffmdmcr.bsky.social · Jul 8

Where does lung POCUS fit here? I have found lung POCUS + uJVP to be easier to obtain and clinically useful. Perhaps a new paradigm? This 2016 article juxtaposes PAWP with extravascular lung water (EVLW), which may reflect the clinical utility of lung POCUS in this space

Ultrasound of extravascular lung water: a new standard for pulmonary congestion

Extravascular lung water (EVLW) is a key variable in heart failure management and prognosis, but its objective assessment remains elusive. Lung imaging has been traditionally considered off-limits for...

www.ncbi.nlm.nih.gov

Jeffrey Wagner @drjeffmdmcr.bsky.social · Jul 4

💯 I find the mechanism elegant. hope outcomes will support adoption

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Jeffrey Wagner @drjeffmdmcr.bsky.social · Jul 4

Just had a case of this. The question is good but the enrollment # is small. Subgroup analysis has even smaller numbers. Hard to anchor on these findings IMO, especially when many of the recurrent cases I see fit a higher risk profile than the inclusion criteria. Maybe my own intervention bias 🤷🏻‍♂️

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Jeffrey Wagner @drjeffmdmcr.bsky.social · Jun 24

Unbearable cyclic vomiting

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Jeffrey Wagner @drjeffmdmcr.bsky.social · May 20

Of the writing I have done, this was the most personal and special. A dedication to all parents who are doctors, and of course my baby girl. Out today in @annalsofim.bsky.social, “Doctor Dad”. Thank you, Dr. Lacomb for the beautiful reading www.acpjournals.org/doi/10.7326/...

Doctor Dad | Annals of Internal Medicine

www.acpjournals.org

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