dave
@davembmd.bsky.social
Pediatric Orthopaedic and Spine Surgeon In Phoenix Arizona. Father of 4. Grandad. Surgical innovation. Additive prototyping. Woodwork. Applied regression analysis. Author. Curious.
If anyone knows if research that goes against the idea that pre-op planning is a good framework for contextualizing surgical learning; I am genuinely interested if you can send to me. Reply or DM.
January 29, 2026 at 7:52 PM
If anyone knows if research that goes against the idea that pre-op planning is a good framework for contextualizing surgical learning; I am genuinely interested if you can send to me. Reply or DM.
Even In The Pitt they do provisional reductions.
Even if only for the transport from ED to the OR: provisional reduction is the standard of care.
January 29, 2026 at 3:01 PM
Even In The Pitt they do provisional reductions.
Even if only for the transport from ED to the OR: provisional reduction is the standard of care.
January 29, 2026 at 2:39 PM
Even if only for the transport from ED to the OR: provisional reduction is the standard of care.
I’m old enough to remember when we used templates and copy-forward for everything instead of AI.
January 29, 2026 at 2:51 AM
I’m old enough to remember when we used templates and copy-forward for everything instead of AI.
Physicians should be paid for their good judgement and availability not their financial productivity, hours worked.
The problem is that business models rely on incentives and incentivizing judgement is hard.
So we use proxy: we give tenure for psychological safety, we incentivize research.
The problem is that business models rely on incentives and incentivizing judgement is hard.
So we use proxy: we give tenure for psychological safety, we incentivize research.
January 28, 2026 at 2:04 PM
Physicians should be paid for their good judgement and availability not their financial productivity, hours worked.
The problem is that business models rely on incentives and incentivizing judgement is hard.
So we use proxy: we give tenure for psychological safety, we incentivize research.
The problem is that business models rely on incentives and incentivizing judgement is hard.
So we use proxy: we give tenure for psychological safety, we incentivize research.
As a dad, I never leave home without my emotional-support ball-o-cords.
January 27, 2026 at 6:11 PM
As a dad, I never leave home without my emotional-support ball-o-cords.
“Parking now”
- db, 2026, AI - oil on canvas
- db, 2026, AI - oil on canvas
January 27, 2026 at 3:24 PM
“Parking now”
- db, 2026, AI - oil on canvas
- db, 2026, AI - oil on canvas
Permit acceptance conveyed with measured civility upon dawn’s arrival and receive my restrained recognition. Be assured; such acknowledgement is offered in composed fashion at outset. May this courtesy reach your attention as first observance preceding activity.
January 27, 2026 at 1:13 PM
Permit acceptance conveyed with measured civility upon dawn’s arrival and receive my restrained recognition. Be assured; such acknowledgement is offered in composed fashion at outset. May this courtesy reach your attention as first observance preceding activity.
The evening hours have besieged my attenuated, desiccated antiquity with their somnolent gravities, rendering my corporeal vessel an unwitting supplicant to the draping of said mortal architecture in heavy languors that foreshadow the dissolution of consciousness.
January 27, 2026 at 4:46 AM
The evening hours have besieged my attenuated, desiccated antiquity with their somnolent gravities, rendering my corporeal vessel an unwitting supplicant to the draping of said mortal architecture in heavy languors that foreshadow the dissolution of consciousness.
Granault’s Law: Whenever people who can’t do what you do are charged with telling you what to do, they will always make sure to transfer liability to you.
January 26, 2026 at 7:44 PM
Granault’s Law: Whenever people who can’t do what you do are charged with telling you what to do, they will always make sure to transfer liability to you.
… And now I wish to slink back to the fethered ossuary from whence I disgorged.
January 26, 2026 at 5:57 PM
… And now I wish to slink back to the fethered ossuary from whence I disgorged.
You may have a hard time paying 50$ for a single 12 page article.
Instead pay 25$ for a 400 page hardcover book written by the same people who write those $50 articles, published at cost. Usually textbooks this size are over $400.
This isn’t an ad. I will send you the PDF if it is still too much.
Instead pay 25$ for a 400 page hardcover book written by the same people who write those $50 articles, published at cost. Usually textbooks this size are over $400.
This isn’t an ad. I will send you the PDF if it is still too much.
January 26, 2026 at 2:15 PM
You may have a hard time paying 50$ for a single 12 page article.
Instead pay 25$ for a 400 page hardcover book written by the same people who write those $50 articles, published at cost. Usually textbooks this size are over $400.
This isn’t an ad. I will send you the PDF if it is still too much.
Instead pay 25$ for a 400 page hardcover book written by the same people who write those $50 articles, published at cost. Usually textbooks this size are over $400.
This isn’t an ad. I will send you the PDF if it is still too much.
The crepuscular hemisphere, its umbrage encroaching, having dislodged this inutile frame from contemplative station unto recumbent necessity, compels a temporary dissolution of sentience.
January 26, 2026 at 2:00 AM
The crepuscular hemisphere, its umbrage encroaching, having dislodged this inutile frame from contemplative station unto recumbent necessity, compels a temporary dissolution of sentience.
AIS PSF TXA 5RCT n475 (Hi184 Lo144 ctl147; age15.1y; fuse10.4). EBL mL: Hi787 Lo705 ctl1016; Hi-Lo MD-98 (CI -647,426). vs ctl: Hi-319 Lo-219 (NS; P ctl worst=81%). Transf: placebo PRBC 6/55(11%) vs0/56. AE: 0 TXA vs1 bleed ctl(0.7%). Prac: Lo ok; Hi only if max bleed risk.
![Introduction Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis entails notable bleeding and transfusion risk. yet optimal tranexamic acid dosing remains undefined. We conducted a network meta-analysis (NMA) comparing high dose. low dose, and no-TXA regimens in this setting.
Methods We conducted a PROSPERO-registered NMA (CRD420251033929) of RCTs in AIS patients undergoing PSF.
PubMed. CINAHL, EMBASE, reference lists, and grey literature were searched for trials comparing high dose (20-50 mg/ kg load; 10-20 mg/kg/h infusion), low dose (10 mg/kg load; 1 mg/kg/h infusion), or no TXA. Outcomes were pooled using a random-effects model to produce mean differences for continuous data and relative risks for binary data.
Results Five RCTs (n=475) were included. Patients had a frequency-weighted average (FWA) (SD) age of 15.1 (1.5) years. preoperative Cobb angle of 58.0 (7.9)°. 10.4 (1.3) levels fused, and operative time of 186.9 (62.0) minutes. They were
allocated to high-dose TXA (n = 184), low-dose TXA (n = 144), or no-TXA (n = 147) arms. The FWA total EBL was 787.3|
(261.5) ml. in the high-dose group, 705.3 (219.0) ml. in the low-dose group, and 1016.3 (492.2) ml. in controls. There was no significant difference in EBL. berween high- vs low-dose TXA (MD -98.3 ml. |-646.9, 426.2]). In the NMA, high-dose TXA reduced total EBL by 319 mL. (95% C1 -818 to 133) and low-dose by 219 ml. (95% C1 - 764 to 294) versus no TXA—an 81% probability that no TXA was worst strategy—though neither comparison reached statistical significance. When compared per fused level, High- and low-dose TXA reduced EBL. per level by 38.2 ml. (MD -38.2 |-86.3, d.I]) and 29.5 ml. (MD
-29.5 (-85.2, 27.3D) versus no TXA, respectively, without statistical significance; bowever, the no-TXA arm had an 87%
probability of being worst for EBL. by level. The FWA EBL. per level was 78.9 = 6.3 ml., 78.2 + 7.2 mlL., and 116.3+ 17.8 ml.
for high-dose, low-dose, and no-TXA groups (very low certainty). Wh…](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:f4no6nzyhlzqpxju6a6awtic/bafkreicp54xp5tczqd2h6jgmzag7rdafm56yqv62fyd3i2crrpucbdptei@jpeg)
January 25, 2026 at 2:21 AM
AIS PSF TXA 5RCT n475 (Hi184 Lo144 ctl147; age15.1y; fuse10.4). EBL mL: Hi787 Lo705 ctl1016; Hi-Lo MD-98 (CI -647,426). vs ctl: Hi-319 Lo-219 (NS; P ctl worst=81%). Transf: placebo PRBC 6/55(11%) vs0/56. AE: 0 TXA vs1 bleed ctl(0.7%). Prac: Lo ok; Hi only if max bleed risk.
Facetious though it may seem, this verisimilitudinous wanderer in beryl coverings, fecundity of energy utterly depleted, commits final act of soliloquy to the flame that accompanies tenebrous navigation toward osteoporotic salvation found only in the dispelling depths of slumber's embrace.
January 24, 2026 at 5:16 AM
Facetious though it may seem, this verisimilitudinous wanderer in beryl coverings, fecundity of energy utterly depleted, commits final act of soliloquy to the flame that accompanies tenebrous navigation toward osteoporotic salvation found only in the dispelling depths of slumber's embrace.
Reposted by dave
I'll show you ossuary - I was there, and like a crazy kid (and to my mother's immense horror), I stuck freshly picked flowers in several eye sockets. Thought they'd be a little gussied up, since they were so gray and plain 🤪 #Kudowazdroj #Poland #Childhood
January 23, 2026 at 3:11 AM
I'll show you ossuary - I was there, and like a crazy kid (and to my mother's immense horror), I stuck freshly picked flowers in several eye sockets. Thought they'd be a little gussied up, since they were so gray and plain 🤪 #Kudowazdroj #Poland #Childhood
Conceding with languid obeisance; I must now translocate from recumbent daybed whilst offering transient epistolary acknowledgement as I transmute my indolent corpus to my vespertine-bed, under the tacit lex of domestic heraldry.
January 23, 2026 at 1:33 AM
Conceding with languid obeisance; I must now translocate from recumbent daybed whilst offering transient epistolary acknowledgement as I transmute my indolent corpus to my vespertine-bed, under the tacit lex of domestic heraldry.
Y’all may like our next book. It’s a planning workbook and repository for residents and fellows. Trying to finish it by next month. It’s also has for each procedure a set of blank lines and almost a section like a coloring book where your color on your construct and how it will look on final films.
January 22, 2026 at 2:20 PM
Y’all may like our next book. It’s a planning workbook and repository for residents and fellows. Trying to finish it by next month. It’s also has for each procedure a set of blank lines and almost a section like a coloring book where your color on your construct and how it will look on final films.
At the first susurrus of dawn I uncoil these calcified continua from their nocturnal ossuary; my skeleton, erstwhile a callipygian relic of horizontal diplomacy, now undertakes absquatulation from the feathered tribunal of sleep without besmirching the dignity of either realm.
January 22, 2026 at 1:24 PM
At the first susurrus of dawn I uncoil these calcified continua from their nocturnal ossuary; my skeleton, erstwhile a callipygian relic of horizontal diplomacy, now undertakes absquatulation from the feathered tribunal of sleep without besmirching the dignity of either realm.
Med. Epicondyle “SCIENCE” RCT - Lancet (IF 104) 2026: N=334 randomized (166 NS vs 168 surg), age 7-15y. PROMIS UE @12mo Δ -0.81 (95%CI -3.33 to 1.70) favor NS; disloc subgroup Δ +2.07 (0.44-3.70) small. Surg comps 9% intraop + 11% HW removal; NS delayed surg 3 pts. Cost eff prob surg=0%
January 21, 2026 at 5:56 PM
Med. Epicondyle “SCIENCE” RCT - Lancet (IF 104) 2026: N=334 randomized (166 NS vs 168 surg), age 7-15y. PROMIS UE @12mo Δ -0.81 (95%CI -3.33 to 1.70) favor NS; disloc subgroup Δ +2.07 (0.44-3.70) small. Surg comps 9% intraop + 11% HW removal; NS delayed surg 3 pts. Cost eff prob surg=0%
Having outlived my last augmentation of stamina, I now confide my superannuated escutcheon from daybed to featherbed; shambling beneath fragile neurologic revolt, with bones insolvent from overuse, seeking moratorium in hopes no executory clause might interdict my somnolent escrow.
January 21, 2026 at 5:02 AM
Having outlived my last augmentation of stamina, I now confide my superannuated escutcheon from daybed to featherbed; shambling beneath fragile neurologic revolt, with bones insolvent from overuse, seeking moratorium in hopes no executory clause might interdict my somnolent escrow.
It’s funny how many healthcare problems can be understood by simply seeing as many patients as you reasonably can.
- productivity
- innovation
- recruiting
- teaching
- learning
- throughput
- cost/demand
- supply chain
- EMR/tech
- meeting bloat
- time
- culture
- incentives
- productivity
- innovation
- recruiting
- teaching
- learning
- throughput
- cost/demand
- supply chain
- EMR/tech
- meeting bloat
- time
- culture
- incentives
January 21, 2026 at 12:42 AM
It’s funny how many healthcare problems can be understood by simply seeing as many patients as you reasonably can.
- productivity
- innovation
- recruiting
- teaching
- learning
- throughput
- cost/demand
- supply chain
- EMR/tech
- meeting bloat
- time
- culture
- incentives
- productivity
- innovation
- recruiting
- teaching
- learning
- throughput
- cost/demand
- supply chain
- EMR/tech
- meeting bloat
- time
- culture
- incentives
John Shields, MD, FAAOS, FAOA knows how to design an instrument that will make surgeons say; “bone-broke, me fix!?” *unintelligible excited grunts of approval*
January 20, 2026 at 7:11 PM
John Shields, MD, FAAOS, FAOA knows how to design an instrument that will make surgeons say; “bone-broke, me fix!?” *unintelligible excited grunts of approval*
“Telehealth Clinic” Rembrandt, Oil on canvas. Year: 1644
January 20, 2026 at 4:57 PM
“Telehealth Clinic” Rembrandt, Oil on canvas. Year: 1644