Anthony C Breu's research while affiliated with Harvard Medical School and other places

Publications (37)

Article
Part one of this series tracked the evolution of the death examination, noting its stability over the last century despite changing diagnostic and therapeutic technologies and social contexts. In part two, we discuss the practical and ethical debates surrounding the exact timing of death. Although the irreversible cessation of cardiopulmonary syste...
Article
Since their first appearance in 2018, tweetorials have emerged as a popular tool for medical education. Despite some calls for their inclusion in educational and promotion portfolios, questions have been raised about the appropriateness of these forms of digital scholarship. Also unclear is how a promotion committee might identify educational tweet...
Article
Guideline title: The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management RELEASE DATE: May 2020 PRIOR VERSION: American Society of Addiction Medicine guideline on management of alcohol withdrawal delirium DEVELOPER: American Society of Addiction Medicine FUNDING SOURCE: American Society of Addiction Medicine TARGET POPULATION: Adults...
Article
Cardiopulmonary determination of death is a mainstay of the practice of internal medicine and pulmonary physicians. Despite this, there is considerable variability in death exams. This article tracks the evolution of the tripartite death exam, initially developed in the middle of the nineteenth century to protect against premature burial. While the...
Article
Social media is an emerging tool for scholarship and education; however, there is limited guidance on how to incorporate social media scholarship into one’s curriculum vitae. We outline the importance of recognizing gastroenterology-focused social media scholarship and present a standardized method for reporting.
Article
Full-text available
#LiverTwitter has emerged as an academic forum that has begun to advance the field of hepatology by disseminating content on chronic liver diseases to a global audience. This article summarizes the content presented in a panel discussion at the 2019 Liver Meeting by highlighting the perspectives of several key types of participants in Twitter: the...
Article
Tweetorials are a form of threaded tweets that have emerged as a tool for medical education and knowledge dissemination. Making use of features not available in traditional formats, tweetorials offer novel opportunities for educators of all levels to engage with a potential audience of millions. Despite their increased use, questions remain about h...
Article
The “what” questions stressed in medical education are not as absorbing — and their answers not as gratifying — as “why” questions. Tweetorials provide a tool for physicians who aim to rekindle and stimulate curiosity about pathophysiology and mechanisms of disease.
Article
“Well, I wouldn’t want to be a vegetable.” This statement, which a colleague has termed the vegetable clause, is one that I have heard countless times from patients when the topic of cardiopulmonary resuscitation (CPR) is raised. Often made to an admitting resident during an overnight encounter, the vegetable clause is interpreted to mean that the...
Article
The differential diagnosis of an increase in alanine aminotransferase (ALT) level and/or aspartate aminotransferase (AST) level of ≥1000 IU/L often is stated to include 3 main etiologies: ischemic hepatitis, acute viral hepatitis (typically hepatitis A and hepatitis B), and drug-induced (more specifically, acetaminophen/paracetamol) liver injury (D...
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Full-text available
Introduction We created a standardized workshop to engage residents in quality improvement (QI) using the root cause analysis model. The workshop allows for a robust learning experience while providing solutions derived from clinicians to address important local problems. No prerequisite knowledge or experience is required. Methods The workshop is...
Data
A. Teaching PowerPoint.pptx B. Delayed Transfer to CCU.pptx C. Delayed Transfusion.pptx D. Supratherapeutic Heparin Drips.pptx E. Suggested Steps For Constructing 60-Minute RCA.docx
Article
Full-text available
Chief medical residents from the 3 affiliate residency training programs at VA Boston Healthcare System developed a mission statement for the educational experience of all medical trainees rotating through VA medical centers.
Article
Background: Although optimal utilization of blood cultures has been studied in populations, including emergency room and intensive care patients, less is known about the use of blood cultures in populations consisting exclusively of patients on a medical service. Objective: To identify the physician-selected indication and yield of blood culture...
Article
In Reply We would like to thank Dr Pino for his feedback on our article,1 and we agree that our statement on the use of propofol for procedural sedation deserves some clarification. In his letter, Dr Pino outlines the complex pharmacologic properties of the drug, and he appropriately stresses the importance of its use only in skilled hands.Our goal...
Article
The earliest safe withdrawal of sedation and mechanical ventilation leads to reduced risk of complications, reduced ICU and hospital stay, as well as reduced costs and utilization of resources. Article InformationCorresponding Author: Christopher Worsham, MD, Boston University Department of Medicine, Boston Medical Center, 72 E Concord St, Evans 1...
Article
Goals of care discussions, including those focused on code status, are meant to foster autonomous decision making. Unfortunately, these discussions often conflate decisions regarding the use of cardiopulmonary resuscitation for cardiac arrest and mechanical ventilation for prearrest respiratory failure. They also exclude discussions of outcomes, pa...
Article
Since the United States began folic acid fortification in 1998, the prevalence of folate deficiency in the general population has decreased.¹ Despite this, folate testing continues to be recommended for the evaluation of macrocytic anemia²,3 and is commonly performed to evaluate macrocytosis without anemia, normocytic anemia, dementia, delirium, an...
Article
BACKGROUND Delirium is common in hospitalized patients and warrants early diagnosis and treatment. Often the evaluation of delirium includes head computed tomography imaging. However, in hospitalized medical patients, the yield of head computed tomography is unknown.OBJECTIVE To determine the diagnostic yield of head computed tomography when evalua...
Article
Little is currently known regarding physicians' opinions on the relative appropriateness of inpatient management of medical conditions unrelated to the reason for admission. Investigate physician attitudes on the appropriateness of inpatient medication interventions, based on the interventions' relatedness to the reason for admission. Case-based su...
Article
To determine the accuracy of do-not-resuscitate/do-not-intubate (DNR/DNI) orders in representing patient preferences regarding cardiopulmonary resuscitation (CPR) and intubation. We conducted a prospective survey study of patients with documented DNR/DNI code status at an urban academic tertiary care center that serves approximately 250,000 patient...
Article
Serum folate levels are commonly ordered for multiple indications in the inpatient and emergency department settings. Since mandatory folic acid fortification in 1998, there has been a decreasing prevalence of folate deficiency in the United States. Our objective was to determine the indications, rate of deficiency, charge and cost per deficient re...
Article
The primary aim of advance directives (including both proxy directives and instructional directives) is to ensure that patients' wishes are enacted even when they no longer have the capacity to voice them. However, barriers remain and gaps persist, particularly in vulnerable populations. In addition, many objections have been raised regarding the c...
Article
Community-acquired pneumonia (CAP) is an acute infection of the lung parenchyma in patients who have acquired the infection in the community. Many viruses, bacteria, parasites, and fungi can cause CAP, but there are a limited number of pathogens responsible, the most commonly isolated of which is Streptococcus pneumoniae. This article outlines the...
Article
All patients must eventually deal with their own mortality and the hospitalist is often the provider who navigates them through the process. It is increasingly important that hospitalists are fluent in the language of end-of-life issues. This article introduces and enforces key concepts when treating patients who may be near the end of life.

Citations

... Recientemente se ha propuesto que el contenido de divulgación en redes sociales como Twitter (e.g., los Twittorials) sea revisado por pares 12 . Pese a que estas iniciativas permitirían eventualmente que los comités de evaluación académicos incluyan la divulgación en redes sociales como parte de la evaluación de las actividades profesionales, es importante reconocer que en la actualidad las redes sociales carecen de una estructura que permita integrar la revisión de alta calidad por pares académicos. ...
... Hospital systems use SoMe to promote brand presence, patient education, and reputation scores. 5 An estimated 25-65% of medical professionals are using SoMe 6-10 for clinical outreach, [11][12][13] career development, 8,[14][15][16][17][18][19][20][21] research, 15,[22][23][24][25][26][27][28][29][30][31][32][33] education, [34][35][36][37][38][39][40][41][42][43][44] and advocacy efforts. [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] However, there are misconceptions, anecdotal stories, and fears surrounding a medical professional's use of SoMe use, which can foster inappropriate use, skepticism, and criticism. ...
... Although in the past these channels were considered unstructured, an increasing rigor to such education modalities has been seen [50] with some resources such as #MondayNightIBD offering continuing medical education credits to participants. [51] The pandemic likely accelerated the uptake of many of these educational measures. Whether these innovations can stand the test of time would depend on whether changes in policy, training requirements, monetary investment, trainer buy-in and time are present. ...
... Social media sites, such as Twitter, have increasingly become up-to-date sources of information, often providing valuable information in an easily accessible format. 11 Twitter hashtags such as #ScopingSundays, #GITwitter, and #LiverTwitter have quickly gained popularity among trainees. Fellow-driven Web sites, such as Liver Fellow Network (https://liver fellow.org/), ...
... Hospital systems use SoMe to promote brand presence, patient education, and reputation scores. 5 An estimated 25-65% of medical professionals are using SoMe 6-10 for clinical outreach, [11][12][13] career development, 8,[14][15][16][17][18][19][20][21] research, 15,[22][23][24][25][26][27][28][29][30][31][32][33] education, [34][35][36][37][38][39][40][41][42][43][44] and advocacy efforts. [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] However, there are misconceptions, anecdotal stories, and fears surrounding a medical professional's use of SoMe use, which can foster inappropriate use, skepticism, and criticism. ...
... Social media (SoMe) has now become an inextricable modality used for facilitating communication globally. Clinicians, researchers, and members of the public all communicate within this space and use it to connect with each other [1][2][3][4]. Although many healthcare practitioners have often used these modalities for communication and connection with friends and families for decades, it is only in the 2010-2020s that many healthcare and medical professionals began harnessing its power for continuing professional development and scholarly discourse [1,5]. ...
... Physicians have also engaged in academic and didactic conversations in social media. For instance, many tweetorials, or threaded tweets combining educational points, linked articles, and teaching, have become a preferred method of medical teaching on Twitter [5]. Other active users, including dermatologists with the #dermtwitter hashtag, have created Twitter-based journal clubs [6]. ...
... Even though there is no substantive evidence that antihypertensive medications improve outcomes of hospitalized patients who develop HTN, physicians believe it is important.6 This could be due to fear that untreated HTN could progress to end organ damage or healthcare providers not being aware of the risks of overtreatment.38 However, a retrospective analysis of veterans admitted for non-CVD causes found an increased rate of 30-day adverse events and readmissions as well as higher 1-year risk of CVD events among patients who had their antihypertensive treatment intensified during inpatient admissions.39 ...
... On binding to its receptor on the plasma membranes, caveolae, (a complex of caveolin and its receptor proteins) are invaginated via clathrin-coated pits and vesicles. Following endocytosis, LDL receptor recycles to the coated pits while the cholesterol moiety is transported to lysosomes, where apo-B protein is enzymatically degraded to amino acids while the remaining component-cholesterol esters, are cleaved to cholesterol and free fatty acids [54]. The cholesterol so formed as a result of the enzymatic cleavage is either incorporated into the cell membrane or re-esterified and stored as lipid droplets [54]. ...
... [9][10][11] A novel attempt to overcome educational barriers has been the creation of freely available mock RCA workshops. [12][13][14][15] While such workshops are useful training tools, they typically provide skeleton frameworks with local error investigation that still requires significant faculty time. Furthermore, most workshops target a specific training population 13,14 and have not been studied across a variety of GME and UME learners. ...