No abstract

Advancements in patient care and longevity over the past century are largely attributed to discovery and innovation in science and health care delivery. Historically, these developments were disseminated through reports in high-caliber medical journals, often meticulously prepared months in advance. Responses from the medical community would be curated, and then published several months after the original report. Technological evolution has expedited and compressed this process. Cutting edge advancements and clinical investigations are now reported by journals on their websites, where internet-and social media-based readership often surpasses print-based readership. 1 Twitter, a social media platform with > 300 million active users, has become a crucial and accepted means by which ideas are spread rapidly in the medical community. 2 In the era of 'information overload', Twitter posts or 'tweets' are ideas efficiently condensed to 280 characters or less.Twitter has become a centralized source for vetting ideas, sharing information, discussing health trends, and posing questions and polls regarding controversial topics. Vascular medicine practitioners from different specialties have already adopted Twitter to propose ideas or ask questions, share information, promote evidence-based practices, and discuss issues of clinical and scientific import. The inherently public nature of Twitter has created a 'democratization of voices' that breaks down the hierarchies that hinder transparency and open communication. It allows peer-to-peer dialogue between colleagues and trainees, world experts, principal investigators of major trials, cutting edge researchers, and patients in the same forum. 3 Clinical trial results are discussed in real-time, including the insights gained, limitations, and applicability to patient care. Informal polls regularly posted on the platform often reveal gaps in knowledge that support the need for additional studies or consensus statements. This platform has also created vascular learning communities and is a powerful educational tool.

A 49-year-old man with progressive dyspnea on exertion and a remote history of syncope presented with hypotension and acute right ventricular failure, and was ultimately diagnosed with acute pulmonary embolism. Laboratory data revealed a prolonged activated partial thromboplastin time, which confounded treatment options. He was ultimately diagnosed with anti-phospholipid syndrome and factor XII deficiency, and underwent a thromboendarterectomy procedure with resolution of right ventricular failure and symptoms. Careful attention to history, initial physical examination manifestations, and clinical data often permit a timely diagnosis of and treatment for chronic thromboembolic pulmonary hypertension. (J Vasc Surg Cases and Innovative Techniques 2019;5:402-5.) A 49-year-old Caucasian man with some vascular risk factors presented to the office of a cardiologist who initially felt his symptoms were concerning for angina. Prestress echocardiographic imaging revealed a severely dilated and hypokinetic right ventricle (RV). He was then referred to the emergency department. The patient described dyspnea in the preceding months, which became profound after walking several feet.

It covers all the adult critical care topics including obstetrics. It is very abbreviated, well set out in point form with many tables, algorithms and the most clear, helpful illustrations I have seen, particularly in the Intensive Care procedures chapter. It has a definite surgical approach and is a mixture of "how to do it in our unit" and general guidelines, all of which are sensible and practical. This is not a handbook for the starting intensive care trainee or occasional practitioner. There is little basic science, many abbreviations are unexplained, many lists again with no explanation and constant referrals back to the parent book for explanation. However, as an aide memoire and "have I remembered everything?" pocket book for experienced trainees it is excellent and several I know swear by it. There is a trend away from pocket books for Intensive Care into big tomes and this should fill this niche well. At $81 it is also well priced. GILL BISHOP Sydney, N.S.W.