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Wael Hussein @waelhussein.bsky.social · 22d

The lesson? Discovery is only half the battle.

Without systems that support diffusion, life-saving interventions stay stuck in labs and journals instead of reaching patients.

Wael Hussein @waelhussein.bsky.social · 22d

In healthcare today, effective interventions (drugs, vaccines, care models) take DECADES to become routine.

Innovation diffuses slowly even when the benefits seem obvious.

Wael Hussein @waelhussein.bsky.social · 22d

"To introduce any new article of food among seamen... requires both the EXAMPLES and the authority of a Commander."
- Captain James Cook.

LEADERSHIP DRIVES DIFFUSION!

Wael Hussein @waelhussein.bsky.social · 22d

EVIDENCE ALONE IS NOT ENOUGH!

Adoption required authority, leadership, and culture change.

Cook saw this and he benefited from the immediate application for himself and his crews.

Wael Hussein @waelhussein.bsky.social · 22d

However, it wasn't until 1865 - 264 yrs after Lancaster, that the British Board of Trade required merchant ships to follow suit.

Two and a half centuries from proof to policy!!! So why so slow?? 😵‍💫

Wael Hussein @waelhussein.bsky.social · 22d

It took 48 more years for the British Navy to officially issue citrus rations.

Scurvy nearly disappeared from its fleets.

Wael Hussein @waelhussein.bsky.social · 22d

Year: 1747 (146 years later!)

James Lind repeated the test aboard HMS Salisbury.

Again, citrus worked!! Now, there should be immediate adoption, right? Again, not even close!!😢

Wael Hussein @waelhussein.bsky.social · 22d

Year: 1601. Nobody knows about vitamin C at that time.

Captain James Lancaster tested lemon juice at sea.
👉 His sailors remained healthy. 🎉💪
👉 All while almost HALF the crews on other ships died of scurvy.💀

You'd expect immediate adoption? Not even close. The Navy ignored it.

Disseminating Innovations in Health Care

Wael Hussein @waelhussein.bsky.social · 22d

A fascinating story about prevention of scurvy shows how it can take CENTURIES between discovery and practice.

Meanwhile, there will be winners and losers.

Here is the story and some valuable lessons. A thread 🧵 below.

doi.org/10.1001/jama...

Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly—if at all. Diffusion of innovations is a m...

doi.org

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Wael Hussein @waelhussein.bsky.social · Sep 3

15 L interdialytic wt gain.

Record?

Pt was trying to beat nausea with chips and water.

Wael Hussein @waelhussein.bsky.social · Sep 2

How are our patients dealing with these tremendous costs?

Do you have ppl in ur clinic to help pts obtain these medicines at an affordable cost?

Source: Primer on Diabetes Management www.vumedi.com/video/primer...

Reposted by Wael Hussein

American Journal of Kidney Diseases @ajkd.bsky.social · Aug 3

In case you missed it on the #AJKDBlog:

AJKDBlog Interviews Editor Timothy Yau caught up with Dr. Subhash Chander to discuss if urea is effective for managing SIADH-induced hyponatremia.

bit.ly/ChanderBlog25 (FREE)

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Wael Hussein @waelhussein.bsky.social · Jul 25

Do u have a local policy for picc- and mid-lines for pts with renal impairment?

🧭 Any simple algorithm that can be shared with other specialties?

⛔️ “Has to be discussed with nephrology” is a battle- we r the bad people who r inconsiderate of realities of the pt’s (immediate) care!
#askrenal

Wael Hussein @waelhussein.bsky.social · Jul 23

a good biomarker of what? 😊

Diet? Inflammation? Liver disease? Kidney disease? (Example etiologies)

High risk patients for mortality or other poor outcomes? (outcomes)

Not good as in non specific: yes.
But good as gold as risk marker.

Wael Hussein @waelhussein.bsky.social · Jul 22

⚠️ Calciphylaxis is a debilitating and painful condition that is hard to treat.

▶️ Do you use daily dialysis as part of treatment? If so, what criteria do you use?

#askrenal

pubmed.ncbi.nlm.nih.gov/21872378/

doi.org/10.1093/ndt/...

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Wael Hussein @waelhussein.bsky.social · Jul 20

*screaming

Wael Hussein @waelhussein.bsky.social · Jul 19

I once witnessed a cardiothoracic surgeon (aka God) SCREENING in ICU: “I WANT DIALYSIS”

for a patient after he was told nephrology suggested a different plan. 😬😟

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Wael Hussein @waelhussein.bsky.social · Jul 19

There are gaps in the evidence, particularly for whether interventions to increase alb directly lower the risk of adverse outcomes.

Wael Hussein @waelhussein.bsky.social · Jul 19

Treatment should target underlying causes of low alb rather than the lab values alone. Eg protein-energy wasting (PEW), chronic inflammation, poor dietary intake, and comorbidities (including infections and chronic inflammatory conditions).

+ nutritional interventions and tailored dietary plans.

The higher mortality associated with low serum albumin is dependent on systemic inflammation in end-stage kidney disease - PubMed

Wael Hussein @waelhussein.bsky.social · Jul 19

A suggestion that the relationship is mediated through inflammation in this CKD5 pts study

The Higher Mortality Associated With Low Serum Albumin Is Dependent on Systemic Inflammation in End-Stage Kidney Disease.

pubmed.ncbi.nlm.nih.gov/29298330/

Whereas mortality risk was increased in CKD stage 5 patients with low S-Alb and high CRP, it was not increased in patients with low S-Alb and normal CRP. Our observation suggests that inflammatory sta...

KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update - PubMed

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Wael Hussein @waelhussein.bsky.social · Jul 19

Nephrology world: KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update.

doi:10.1053/j.ajkd.2020.05.006.

pubmed.ncbi.nlm.nih.gov/32829751/

The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for nutrition in kidney diseases since 1999. Since the publication of the fir...

Association of serum albumin and mortality risk - PubMed

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Wael Hussein @waelhussein.bsky.social · Jul 19

Old paper: Association of Serum Albumin and Mortality Risk. Goldwasser P, Feldman J. Journal of Clinical Epidemiology. 1997;50(6):693-703. doi:10.1016/s0895-4356(97)00015-2.

pubmed.ncbi.nlm.nih.gov/9250267/

Reduced levels of serum albumin concentration, a routine blood test, within the "normal" range have been reported to be associated with mortality risk. The literature is reviewed, with a focus on coho...

Serum albumin and risks of hospitalization and death: Findings from the Atherosclerosis Risk in Communities study - PubMed

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Wael Hussein @waelhussein.bsky.social · Jul 19

Some refs:

# Serum Albumin and Risks of Hospitalization and Death: Findings From the Atherosclerosis Risk in Communities Study. pubmed.ncbi.nlm.nih.gov/34298583/

Lower baseline serum albumin was significantly associated with increased risk of both all-cause hospitalization and death, independent of pre-existing disease. Older adults with low serum albumin shou...