Announcing the Successful Launch of #RheumJC: Rheumatology Journal Club on Twitter

Paul SufkaAnnouncements, Education

slack_for_ios_upload

Although still in it’s infancy, I’m happy to announce the successful launch of a new Rheumatology Journal Club on Twitter: #RheumJC. We just completed the our first online discussion of Tacrolimus versus mycophenolate mofetil for induction therapy of lupus nephritis and had a great turnout, with 519 tweets on the day of the journal club (summary available here). We thank the BMJ publishing group at the Annals of the Rheumatic Diseases for contributing to our success by making this article open access for our discussion.

The founding members of the #RheumJC team include Dr. Chris Collins (@RheumPearls), Dr. Suleman Bhana (@DrBhana), Dr. Aruni Jayatilleke (@rheumed), Dr. Jonathan Hausmann (@hausmannMD) and myself (@psufka).

We look forward to hosting further journal clubs on a regular basis.

Be sure to follow @RheumJC on Twitter and our blog at RheumJC.com.

If you would like to be involved in #RheumJC or have any other feedback or suggestions, please let us know via Twitter.

My 2015 WordPress Setup

Paul SufkaSocial Media

WordPress Setup

”I don’t have big ideas. I sometimes have small ideas, which seem to work out.” – Matt Mullenweg

I previously detailed my WordPress setup, but over the last few weeks, I have given my site (another) overhaul worthy of an updated blog post.

New WordPress Theme

I recently switched to the X WordPress Theme. This theme comes with four different minimalist style layouts that help focus on blog readability over everything else, yet remain easily and highly customizable through the built-in WordPress customizer. I’ve played with a ton of different WordPress themes, and for a premium theme, this one is as easy as they come. If you want to make any very specific modifications, you may need to learn a little bit of CSS and/or PHP.

Strong Focus on Increasing Site Speed

The speed that your site loads is highly important for two reasons:

  1. Improved experience for readers (better chance that readers will actually read your writing). According to KISSmetrics:

”47 percent of visitors expect a website to load in less than 2 seconds, and 40 percent of visitors will leave the website if the loading process takes more than 3 seconds.”

  1. Improved SEO. While I don’t spend a lot of time thinking about how to optimize for SEO (I’ve written before that the 80/20 of SEO is to write good content and write accurate blog titles), it is worthwhile to know that Google PageRank pays attention to site speed.

You can check your site’s speed according to Google and get general tips on how to optimize at Google PageSpeed Insights.

Unfortunately, many of the tips offered by Google are difficult to know exactly how to optimize. Besides having your site hosted on a fast server, the lowest hanging fruit are easily solved with a few WordPress plugins:

  • W3 Total Cache. [Update 01/19/2015: I’m going back to using WP Super Cache because of problems with W3 Total Cache causing problems (although I had no trouble removing it).] WordPress cache plugins work to minimize load on your sever by having static copies of your site cached and ready to send to readers. I previously had used and recommended WP Super Cache, but recently switched given W3 Total Cache’s ability to minify and compress JavaScript, CSS, and HTML, which results in greater performance. Making this switch increased my PageSpeed scores by about 20, and most comparisons I found shows that it seems to be just a bit faster. Despite offering better performance, W3 Total Cache is more complex to set up, whereas WP Super Cache only really requires you to turn it on or off [Update 01/19/2015: although turning on the advanced setting to compress pages is also helpful, if your server can handle it]. In either case, you should have a WordPress cache plugin running on your site.
  • WP-Optimize. This plugin actually increased my PageSpeed score by 10–14 points, and works by removing any excess junk such as comment metadata in your WordPress pages.
  • Smush.It. This optimizes images in several lossless ways, such as stripping JPEG metadata and optimizing compression. The free version can “smush” image files under 1MB.
  • BJ Lazy Load. This plugin uses a jQuery script to improve site loading by delaying loading of any images files until just as the reader has scrolled down to that image.
  • No longer using: WP deferred javaScript and Use Google Libraries. These plugins actually slowed my site and caused problems with BJ Lazy Load, likely having to do with loading jQuery from a different server and/or interfering with W3 Total Cache.

SEO

Security and Backup

Other Recommendations

  • WP Hide Post gives you better ability to control the visibility of posts/pages on your blog and comes in handy occasionally.
  • Unchanged recommendation: Contact Form 7 is still the best and most popular contact form.

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I’m always curious to hear if anyone has any better recommendations for WordPress plugins. If you have any suggestions, add it to the comments.

Morning Routines: Optimizing Your Startup Sequence

Paul SufkaUncategorized

riley-filtered

“It sounds plausible enough tonight, but wait until tomorrow. Wait for the common sense of the morning.” ― H.G. Wells

Humans don’t wake up ready to give 100%.

Our daily startup sequence has more similarities to older PCs that run best if restarted daily than modern devices that are always ready to go. Most of us benefit from going through some type of morning routine to get ourselves set for optimal output.

A well defined morning routine is important because it decreases the number of choices that you make in the beginning of your day, which reduces decision fatigue.

This concept was explained recently in a short podcast by Tim Ferriss:

“Imagine you have 100 points for making decisions every 24 hours. The more decisions you rack up in one area, the fewer decisions you can effectively make elsewhere.

If you make a ton of unnecessary decisions: which email to check, what to do first in the morning, what breakfast to have, you are going to deplete your hit points, and that will lead to poor decision making later, because you’re going to run out of your 100 points.”

An effective morning routine should essentially be a mental do-confirm checklist with the goal of getting minimizing or eliminating unnecessary decisions as you get ready for the day.

My typical morning has five things that rarely deviate:

  • Water. The first thing I do is drink a large glass of water. As much as I wish I could start with coffee, water is what wakes me up in the morning.
  • High protein breakfast. For at least the last 10 years, I have eaten two eggs almost every morning, typically with some sausage or ham. Rare exceptions are when I’m traveling or eat at a restaurant. (I’d love to eat bacon every day, but don’t typically have time to do the full bacon method). Sometimes I’ll have a small handful of berries, depending on the season.
  • Coffee. Usually French press with freshly ground beans. Caffeine is a wonderful thing.
  • Walk the dog. Although I typically only have time for a 5-10 minute walk on work days, I always find it refreshing to get outside and move around. Bonus: it keeps the dog from plotting against me.
  • Shower. I always feel mentally fresher after a shower, and given a chronically busy schedule, I used to say, “a shower is worth 2 hours of sleep.” We now know that sleep is much too important to skimp on, but my patients probably prefer that I take a morning shower anyway.

Over time, I’ve essentially designed my work wardrobe in the style of Steve Jobs’ daily uniform, so that I could get dressed in the dark (which occasionally happens) and still match.

On my way to work I usually listen to an audiobook on Audible (I recently finished and highly recommend Hatching Twitter) or a podcast.

What would I change about my routine?

I’m hoping to try adding about 10-15 minutes of meditation each morning right after waking, which is a common practice of many successful people. I simply need to form this into a habit.

Resources for designing your morning routine

Two websites exploring morning routines that are worth checking out are Morning Do and My Morning Routine, especially their list of recommended articles.

Rheumatology joining December 16th #NephJC discussion on “Rituximab versus Azathioprine for Maintenance in ANCA-Associated Vasculitis”

Paul SufkaEducation, Social Media

Rituximab

Image: Rituximab crystal structure. Credit: Wikimedia Commons.

I’m thrilled to announce that the online rheumatology community has been asked to join the next #NephJC, which will be held Tuesday, December 16 from 9-10 PM EST / 8-9 PM CST.

We’ll be discussing the recent NEJM article Rituximab versus Azathioprine for Maintenance in ANCA-Associated Vasculitis (PMID: 25372085)

For my rheumatology colleagues that are not familiar, #NephJC is a thriving nephrology journal club on Twitter and NephJC.com. If you’re relatively new to Twitter and using hashtags, but would like to participate, the simplest way would be to follow the instructions on their site.

I’m excited to see what we’re able to learn from our nephrology colleagues, and hope us rheumatologists have much to share as well.

Background on establishment of the use of rituximab for ANCA-associated vasculitis

Until recently, the only standard therapy for treatment of ANCA-associated vasculitis had been induction with cyclophosphamide plus glucocorticoids. In 2010, the RAVE and RITUXVAS trials respectively established rituximab as non-inferior therapy for the induction of systemic and renal ANCA-associated vasculitis, with similar adverse events.

The RAVE trial compared rituximab to oral cyclophosphamide, and had a primary outcome of complete remission and tapering of glucocorticoids at 6 months, with results as follows:

  • Rituximab group: 63/99 patients (64%)
  • Cyclophosphamide group: 52/98 patients (53%)

Despite a trend toward improved outcomes in the rituximab group, the RAVE study was powered as a non-inferiority trial, and the differences between the groups were not statistically significant (p=0.09, 95% CI -3.2 to 24.3).

Upon achievement of remission in the RAVE trial, patients on cyclophosphamide were switched to azathioprine, whereas patients treated with rituximab were not given maintenance immunosuppression. Further analysis of the RAVE trial further supported effectiveness of rituximab for the induction of ANCA-associated vasculitis (discussed on episode 17 of The Rheumatology Podcast), however longer term follow up at 12 and 18 months showed the following remission rates:

  • Rituximab: 48% at 12 months, 39% at 18 months.
  • Cyclophosphamide/azathioprine: 39% at 12 months, 33% at 18 months.

Again, despite the numerical trend, this data was only able to support rituximab as non-inferior to cyclophosphamide. Additional analysis showed that in patients with relapsing disease, rituximab was superior at 6 months (p=0.01) and 12 months (p=0.009), but this effect did not extend out to 18 months (p=0.06).

The difficulty of frequent relapse in ANCA-associated vasculitis

Clearly, maintenance of remission for patients with ANCA-associated vasculitis remains a challenge and patients continue to relapse frequently despite current management strategies. Prior studies looking at remission rates with maintenance immunosuppression show significant relapse rates:

NephJC-Table3-NEJM2008-Pagnoux

From NEJM 2008;359:2790-803.

What is the role of rituximab in maintenance therapy for ANCA-associated vasculitis?

Until now, only retrospective data has suggested that rituximab might be useful as a maintenance strategy for ANCA-associated vasculitis. This question was addressed in our current journal club article:

NepjJC-NEJM-article-header

Study design

Patients

This study recruited patients aged 18-75 with newly diagnosed ANCA-associated vasculitis who were in complete remission after treatment with glucocorticoids plus pulsed cyclophosphamide. Disease activity was measured using BVAS, a standard vasculitis activity measure. Patients who previously received rituximab were excluded.

Treatment protocol

Induction of remission in both groups was:

  • Prednisone starting at 1 mg/kg with gradual taper, with some patients initiated with pulse methylprednisolone 500-1000 mg for 1-3 days.
  • Pulse cyclophosphamide 0.6 g/m² on days 0, 14, and 28, followed by 0.7 g/m² every 3 weeks for 3-6 additional pulses until remission was attained.

After 4-6 months, patients were randomly assigned 1:1 to either:

  • Rituximab 500 mg on days 0 and 14, then at months 6, 12, and 18.
  • Azathioprine 2 mg/kg for 12 months, 1.5 mg/kg for 6 months, then 1 mg/kg for 4 months.

In both groups, prednisone was further tapered to approximately 5 mg/day for at least 18 months, after which prednisone could be further tapered at investigator discretion.

End points

“The primary end point was the percentage of patients with major relapse (reappearance or worsening of disease with a BVAS >0 and involvement of at least one major organ, a life-threatening manifestation, or both) at month 28.”

Secondary end points: Rates of minor relapse, adverse events, mortality.

Statistics

Under the hypothesis that rituximab would decrease major relapses by 25% at month 28, assuming 5% exclusion or dropout, to have 80% statistical power and a 2-sided alpha risk of 0.05, 118 patients had to be enrolled in the trial.

Results

115 patients were enrolled (87 with GPA, 23 with MPA, and 5 with renal-limited ANCA-associated vasculitis). 58 received azathioprine and 57 received rituximab. Patient demographics were not significantly different in either group. 80% of patients had newly diagnosed disease, and 20% had relapsing disease.

Primary end point

At month 28, major relapse rates in each group were:

  • Azathioprine 17/58 patients (29%)
  • Rituximab 3/57 patients (5%)

Which was statistically significant, with hazard ratio for relapse, 6.61; 95% confidence interval, 1.56 to 27.96; P=0.002.

To put it another way, in the authors words, “hence, to avoid one major relapse, 4 patients (95% CI, 3 to 9) had to be treated with systematic rituximab infusions rather than with azathioprine.“

NephJC-NEJM-Fig2a

Secondary end points

  • Minor relapses were not statistically different between each group, with 9/58 (16%) in the azathioprine group and 6/57 in the rituximab group (11%) (p=0.43).
  • Rates of infection were similar in both groups, with 8/58 (14%) in the azathioprine group and 11/57 (19%) in the rituximab group.
  • There were two deaths in the azathioprine group, one with vasculitis involvement of the aortic valve who had a major relapse and received pulse steroids but died of E. coli bacteremia. The second patient had developed pancreatic cancer.

Author’s discussion

The authors concluded that “in the present study, rituximab was superior to azathioprine at maintaining remission of ANCA-associated vasculitis; this was especially true for granulomatosis with polyangiitis, which was the condition seen in most of the study population.”

“Our data also show that successive 500-mg infusions of rituximab, given every 6 months up to month 18 after remission, were not associated with more frequent severe adverse events than azathioprine.”

Interestingly, the authors note that the 6-month interval between rituximab infusions was chosen based on expected B-cell reconstitution and relapses after a median of 1 year.

They also state that a single 500 mg rituximab dose was chosen because patients were already in remission (i.e. B-cell deplete) and in hopes of decreasing risk of infection.

Study limitations:

  • Unblinded.
  • Unable to generalize to all patient types with ANCA-associated vasculitis since most had PR3-ANCA/GPA.
  • Leaving prednisone tapering up to discretion of investigators after 18-months (although authors note that only 2/20 relapsed patients had stopped prednisone).
  • Azathioprine maintenance until month 22, with a gradual taper (although 8 relapses occurred in the first 12 months at a dose of 2 mg/kg, and only 2 relapses occurred between months 12 and 22).

Another important point from the authors is that “several major relapses (7 of 17 in the azathioprine group and 2 of 3 in the rituximab group) occurred after treatment with the trial maintenance drugs was stopped.”

My thoughts

Having personally used rituximab in the clinical setting for both remission-induction and treatment of relapse for ANCA-associated vasculitis, and knowing that B-cells play a significant role in disease activity, I was not surprised that rituximab would be an effective therapy. This being said, I certainly did not expect a NNT of only 4 patients. I was also impressed were able to achieve these results using only single 500 mg doses of rituximab every 6 months, which may be important not only for potential decreased infectious risks, but may have financial implications as well.

One concerning observation in this study is that after stopping maintenance therapy in either group led to several major relapses. I have often wondered if we can ever safely stop all immunosuppressive therapy in these patients, and if so, how to identify which patients this can be safely achieved.

[Update 12/12/2014: Added slideshow version of the Storify below by @nephondemand. This gives additional background on management of ANCA-associated vasculitis and the trial covered in this journal club.]

Managing Difficult Decisions in Medicine with the 40-70 Rule

Paul SufkaMedical Practice

road-toward-yellowstone

“Stay committed to your decisions, but stay flexible in your approach.” — Tony Robbins

The ability to make difficult decisions is the mark of an effective physician.

While decisions in medicine can be difficult for a number of reasons, ways to manage many of these challenges are readily available.

If the difficulty lies in defining the goals of treatment, we can solve this by spending more time listening and talking to our patients. If the difficulty is lack of comfort in managing a particular situation, we can become more literate with online resources to access information and converse with other physicians. If the problem is our own cognitive biases or decision fatigue, becoming aware of these errors in thinking can minimize their effect.

Despite ways to manage many of these challenges, certain decisions in medicine are inherently going to remain extremely difficult.

Features of extremely difficult decisions in medicine:

  • An incorrect decision has a high risk of adverse consequences.
  • Limited information is available to make the decision.

Of these two features, we typically have no way to control the amount of risk involved in our decision. We might also feel that we have no control over having limited information, but this is incorrect.

We are actually able to manage information limitations in medicine.

The 40-70 Rule in Decision Making

Former U.S Secretary of State and General Colin Powell is known for the 40-70 rule in decision making, stating that a leader should make a decision when they have between 40% and 70% of the information available.

”If they make the decision with less than 40% of the information, they are shooting from the hip. But waiting for more than 70% of the information delays the decision unnecessarily.”

Applying this to medical decision making:

  • By the time you have gathered 40% of necessary information, a skilled clinician should have narrowed diagnostic and treatment possibilities enough to make an effective decision.
  • By waiting for more than 70% of information to become available, we may actually increase risk by delaying a decision.

The surprising part here is that by delaying our decision beyond a certain amount of information, we may end up with worse outcomes.

#ACR14 Follow Up: Social Media Bootcamp, Tweetup, Podcasts, and #RheumJC Beginnings

Paul SufkaConferences, Rheumatology Podcast, Social Media

acr14-tweetup-group

Group picture from #ACR14 Tweetup.

“A tribe is a group of people connected to one another, connected to a leader, and connected to an idea. For millions of years, human beings have been part of one tribe or another. A group needs only two things to be a tribe: a shared interest and a way to communicate.” ― Seth Godin

A few weeks ago I was able to attend my seventh consecutive American College of Rheumatology Annual Meeting (ACR) in Boston.

Despite the fact I was only able to attend the meeting for a relatively short time (Saturday evening until late Monday morning), I was able to be involved in a number of activities. I’ll have to come back for sightseeing in Boston another time.

The biggest thing I was involved in while in Boston was the ACR Social Media Bootcamp, with excellent sessions on Twitter and blogging for rheumatologists.

Sunday sessions:

Monday sessions:

Also check out these Storify timelines regarding social media at #ACR14:

The next big thing was the #ACR14 Tweetup. This event is designed with the goal of helping myself and others meet more people face-to-face at a major medical conference, and was again a big success. As always, it was great to catch up with a number of friends from all over the globe.

During the conference, I had Tweeted out a link to one of my favorite articles:

In this article, titled “You don’t have to be local”, Derek Sivers writes:

You can focus your time locally or globally.

But if you over-commit yourself locally, you under-commit yourself globally, and vice-versa.

If you’re local, then you’re probably social, doing a lot of things in-person, and being a part of your community. But this means you’ll have less time to focus on creating things for the world.

If you’re global, then you want to focus on creating things that can reach out through distribution to the whole world. But this means you’ll have less time to be part of your local community.

One of the great things about having a tweetup is that by meeting some of the people that we communicate with in person, I think it brings some balance to the local vs global feeling.

Somehow during all of this, Dr. Suleman Bhana (@DrBhana) and I were able to record two live episodes of The Rheumatology Podcast.

Episode 35 – Live at #ACR14 with Dr. Philip Robinson

Episode 36 – Live at #ACR14 with Dr. Rebecca Grainger and Dr. Jonathan Hausmann

I’m also including a link to “Episode 34 – Interview with Irish rheumatologist Ronan Kavanagh”, since it was such a fun episode to record and we had discussed a bit about the social media bootcamp (among many other things).

Last, a good meeting wouldn’t come to a close without plans for the future. Toward the end of the meeting, talk about a Twitter based online journal club started to pop up, which has been deemed #RheumJC, and in the process of planning and organizing, and should launch soon.

For anyone interested in this, be sure to check out:

How to Blog – #ACR14 Social Media Bootcamp

Paul SufkaConferences, Education, Med Tech, Medical Practice, Social Media

“When you first start off trying to solve a problem, the first solutions you come up with are very complex, and most people stop there. But if you keep going, and live with the problem and peel more layers of the onion off, you can often times arrive at some very elegant and simple solutions. Most people just don’t put in the time or energy to get there.” – Steve Jobs

The goal for this presentation is to try to remove the major barriers to entry into the world of blogging. Before moving onto the technical aspects of setting up a blog, I hope that the following observations also help break down a few other hurdles that might also be holding you back from starting.

Reasons that I think people don’t blog:

Taken together, this means that:

  • As a content creator, you have the chance to have significant impact. 
  • We overestimate the effort required to become a content creator. 

Blogging has become a mainstream and powerful platform that is accessible to anyone. While detailed knowledge is not required, knowing the key terminology and background can be extremely valuable.

I would suggest spending a few minutes going through this Prezi presentation which “describes what blogs are, history, and future influence in society” and then a few minutes scanning through the terms defined in WordPress.org’s “Introduction to Blogging.”

There are a number of excellent blogging platforms currently available. As a general rule, the more control the platform gives you over the design of the blog, the more technical knowledge will be required. The 80/20 rule applies here again, such that only a small amount of technical understanding can have you running one of the most powerful blogging platfiorms: WordPress.

Why do I suggest WordPress?

Furthermore, I also suggest running a self-hosted WordPress site since you are not limited in ways you can change the design of your blog, nor are you limited in the plugins that you use.

Setting up your self-hosted WordPress site:

  • Chose a host to run your site. Two of the WordPress.org suggested hosts, bluehost and Dreamhost offer 1-click WordPress installation. I personally use Dreamhost to run this site. If you’d prefer to use a different host, the instructions are relatively simple.
  • If your hosting service doesn’t offer it, register a domain name using a company that offers WHOIS privacy. My suggestion for this service is Hover.
  • Going through the tutorial on learn.wordpress.com will teach you almost everything else you need to know.

Designing your site:
 
The best way to set up the design of your site is a relatively personal one. I think you should design a blog that you would enjoy reading. As you browse around the web, take note of which sites draw you in. Personally, my blog is inspired by the readability and simplicity of Medium.com and Instapaper.

In WordPress, the design or template of your blog is called a Theme. WordPress.org currently has over 2,700 free and premium themes in their directory, which can be installed with just a few clicks. Alternatively, a number of more advanced profession themes are available. This site is currently running Thesis 2 (of note, this specific theme does require you to be a bit more technically savvy, but the majority of them minimal additional technical knowledge).

WordPress Plugins:

These are the tools to add various functions to your blog.  Often enough, whenever you think of something you want to add, a plugin already exists that you can install and have running with a few clicks. Details of the types and specific plugins I recommend are covered in my prior post: My WordPress Setup, Plugins and Writing Tools.

Driving traffic to your site:
 
Typically, the biggest driver of readers to your site is going to come from social media. On Twitter. adding a hashtag can be extremely helpful, and in the world of rheumatology, top suggestions  would be to use a conference hashtag such as #ACR14 or the rheumatology education hashtag #RheumEdu.

The other way that people will find their way to your blog will be through search engines, which is referred to as organic search. Because of the algorithms that Google uses to index pages, it is worthwhile to think a little bit about Search Engine Optimization (SEO) so that readers can find you organically. On WordPress, there are a number of plugins that take care of most of this automatically. If you’re looking to really dig into some of the details you can read through Google’s Starter Guide.

The 80/20 of SEO for most bloggers simply requires that you:

  • Write good content.
  • Give your writing accurate titles.

Adding visual content to your site:

Humans are visual creatures, so adding images to your site and posts both draws people in, and will also improve social sharing.
If you’re not using one of your own photos, options for free images include public domain images (works that are free of known copyright around the world) or else images with certain Creative Commons licenses that usually allow works to be used with proper attribution. A nice resource for free images can be found here.

Last, I want to include a list of all of the current active rheumatology bloggers that I’m aware of at the time of #ACR14:

(This post was originally fueled by significant amounts of caffeine, so if I’ve accidentally left you off this list, please let me know.)

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Thanks for checking out my presentation. As always, if feel free to give feedback or ask questions below in the comments, or else by reaching out to me on Twitter at @psufka.

Modern Doctors Bag: My Everyday Carry

Paul SufkaRandom

Bag contents oct 2014

“There was a time when nails were high-tech. There was a time when people had to be told how to use a telephone. Technology is just a tool. People use tools to improve their lives.” — Tom Clancy

“One of the great challenges of our age, in which the tools of our productivity are also the tools of our leisure, is to figure out how to make more useful those moments of procrastination when we’re idling in front of our computer screens.” — Joshua Foer

On episode 32 of The Rheumatology Podcast, we discussed what bags we use for work, and I had promised to disclose the contents of my work bag.

I’m always drawn to everyday carry type posts and trying to figure out the optimal set of daily tools, which should have the following set of characteristics:

1. you use in your day to day life
2. a first tier level of preparedness for an unforeseen emergency
3. they need to be functional.

My current everyday carry gear (clockwise, from top left):

  • MacBook Air (13.3-inch, Mid 2013, 1.7GHz dual i7, 8GB memory, 512GB SSD). I bought the best MacBook Air available at the time refurbished from Apple, which was an amazing deal and would suggest to anyone. With the SSD, it is strikingly fast. The only thing keeping it from being the perfect machine is lack of Retina display, but everything else makes up for that.
  • iPad mini with Retina display. (64GB, Space Gray, WiFi only) with Blue Smart Case. I primarily use this for consuming longer form content using these four apps: Kindle App, Instapaper (saved articles from web), NewsBlur (RSS reader), or Documents by Readdle (for PDFs).
  • Apple Magic Mouse. 
  • Lacrosse ball. For keeping my tissues mobile at work using tricks from MobilityWOD, especially the feet or hamstrings.
  • Kleen Kanteen (27 oz, stainless steel). These are great because they’re dishwasher safe. I have a few of them. Stay hydrated my friends.
  • 3M Littmann Cardiology II S.E. Stethoscope. This is an older stethoscope that appears to have been replaced by the Cardiology III I have two stethoscopes: a Littmann Master Cardiology that I keep at the clinic I spend the majority of my time, and this one that I carry in my bag for when I’m seeing patients at the hospital or my weekly satellite clinic.
  • Aveeno Lotion. Because Minnesota = dry skin.
  • Small, cheap umbrella. I don’t believe in buying a big, expensive one.
  • Cocoon Grid-It. A great tool for organizing various cords and other things that end up wandering around your bag. I currently travel around with a 1 m Apple Lightning to USB cable, Apple EarPods, and a short micro-USB cable. There is also a pocket on the back that I keep a microfiber cloth.
  • Pocket size Moleskin Cahier Journal. For analog entry. Relatively cheap and widely available.
  • Uni-ball Jetstream RT Fine Point pens (black).
  • Moo.com business cards. 
  • Apple Mini DisplayPort to VGA Adapter. 
  • Apple 45W MagSafe 2 Power Adapter.
  • Kershaw Leek Knife. Highly versatile for everyday usage.
  • IntoCircuit Power Castle 11,200 mAh USB Battery Pack. Carries enough power to recharge most of your devices multiple times. For comparison purposes, the iPhone 5S has a 1570 mAh battery, the iPhone 6 has 1810 mAh, the iPhone 6 Plus has 2915 mAh, and the iPad mini with Retina display has 6471 mAh.

Not pictured:

  • Clinic ID badge.
  • Pager. The 1990s paged and wanted this back.

#ACR14 Social Media Bootcamp & Tweetup

Paul SufkaAnnouncements, Conferences, Social Media

Acr14 sm 500x500

“Tell me and I forget, teach me and I may remember, involve me and I learn.” ― Benjamin Franklin

The use of social media in medicine has experienced enormous growth in the past few years, and this short blog post can’t even start to scratch the surface.

A great overview of the importance of social media in the field of rheumatology was recently published earlier in 2014 by Dr. Francis Berenbaum (@Larhumato), rheumatologist from Paris, titled The social (media) side to rheumatology in Nature Reviews Rheumatology. This paper includes discussion of the use of social media in medical education (for providers and patients), how it has affected the doctor-patient relationship (in a great way), and its role in medical research.

Twitter has become the centerpiece of social media in the medical world, and has become an increasingly important part of major medical meetings. The upcoming American College of Rheumatology Annual Meeting in Boston will be using the Twitter hashtag #ACR14.

A great resource if you’re new to using Twitter and hashtags at a medical meeting is Symplur’s Healthcare Hashtag Project, who currently has an #ACR14 Conference Hashtag page, which is helpful in getting an overview of the conference from the perspective of Twitter. In their words:

Our hope is that we can lower the barriers of entry, decrease the learning curve, and enhance the experience of new users.  But we’d also like to introduce experienced healthcare Twitter users to a fresh look, to new information, and to new people who share your passions.

Additional rheumatology hashtags to explore:

With all of this in mind, I’m extremely excited to be part of the following social media events this year in Boston:

Social Media Bootcamp

The goal of the social media bootcamp is to introduce more individuals to the core tools in social media: Twitter and blogging. These sessions are the brainchild of Dr. Ronan Kavanagh (@RonanTKavanagh), and I’m happy to be involved moderating the Sunday session and speaking on the technical aspects of setting up a blog on Monday. Also speaking are Dr. Philip Gardiner (@PhilipGardiner) and Dr. Christopher Collins (@RheumPearls).

More information about the Social Media Bootcamp was discussed in the Preview Issue of the Annual Meeting Daily News and in The Rheumatologist.

Times and descriptions:

  • Sunday, Nov. 16, 9:00–10:00 a.m.: Twitter Basics—The thoughts, opinions and ideas of your rheumatology colleagues, in 140 characters or less, shared in real time for open discussion. Learn how to tweet and engage participants in live tweet forums during the conference!
  • Monday, Nov. 17, 9:00–10:00 a.m.: Blogging for Beginners—Learn the basics of setting up a blog and how to use it effectively to communicate with targeted audiences. Blogging can be a great resource for communicating timely and relevant content in easily digestible quantities. These will include two sessions.

#ACR14 Tweetup

  • When:  Sunday November 16 from 4:30-6:00pm
  • Where: Room 150 of the Boston Convention Center

The yearly gathering of rheumatology Twitter friends from across the globe has gotten to be a bigger and better event each year. Take a look at my post on last years #ACR13 Tweetup and this post that includes links back to every prior rheumatology tweetup that I could find.

Just as last year, this event will again open to anyone who would like to attend. No need to RSVP (although I would appreciate it if you would leave a quick comment to this post if you plan on going, just to get a sense of how many people might attend).

If anyone has questions, feel free to ask me on Twitter (@psufka) or else in the comments below.

I look forward to catching up with everyone again this year.

Speaking at HealthPartners Primary Care Update Conference

Paul SufkaAnnouncements, Conferences

Shutterstock 115380175

I’m happy to be invited to speak for the upcoming conference HealthPartners Primary Care Update: Pathways to Knowledge on September 19, 2014.

I’ll be giving a presentation titled Rheumatology Pearls from 11:15-12:00, which will briefly review:

  • Common labs ordered in rheumatology
  • Differentiating inflammatory from non-inflammatory arthritis.
  • Gout: diagnosis, acute and chronic management

Download slides:

Other posts of mine that you may find helpful:

If anyone has questions before or after the conference, feel free to get in touch.