William Zinsser taught writing at Yale, then wrote the book that has fixed more bad writing than every English class combined. Here are 10 cuts from "On Writing Well" that instantly make your writing twice as strong. 1) Delete every word doing no work

Strategies to Reduce Low-Value Cardiovascular Care via @American_Heart ahajournals.org/doi/10.1161/…

remapcap.org/oseltamivir-cli… With millions of cases of severe flu worldwide annually, this result should have been reached back in the 1990s. Oseltamivir should be withdrawn from hospital formularies. 2/4

We found another surreal place on our way. I know some people will say I’m too positive about everything I see, but this place was crazy. They had a shooting range in the store.

ARISE-FLUIDS has arrived and it's awesome 🥳 For over a decade, the Surviving Sepsis Guidelines recommended that septic patients get at least 30 cc/kg fluid. In the United States, these guidelines were weaponized into performance metrics, pressuring clinicians to prescribe arbitrary volumes to every patient. Evidence-based clinicians have LONG known that this guideline lacked evidentiary support. For example, I've attached a picture of a blog I wrote about this back in 2017. Despite the lack of evidentiary support and some evidence of harm, the Surviving Sepsis Guidelines INSISTED on perpetually recommending 30 cc/kg fluid resuscitation. We finally have a prospective RCT demonstrating that mandating early administration of 30 cc/kg fluid (as compared to early vasopressors) doesn't help and may actually cause harm. It's important to note that all of the hard endpoints in this trial were neutral (e.g., mortality, days free of organ support). I still think that 30 cc/kg fluid is a pretty reasonable volume of fluid for *most* patients. But the study does suggest that giving too much fluid may promote edema - so we should be *thoughtful* about this intervention rather than mandating it for every septic patient. Based on the subgroup analysis, the fluid-conservative strategy may have helped the subgroup of pneumonia patients the most. This is statistically nonsignificant but aligns with my expectation. ARDSy patients often don't respond well to fluid. (In contrast, I really doubt that a liter of fluids in either direction matters for most urosepsis patients.) This is a great example of the over-reach of guidelines and protocoled medicine. People get all upset about practice variation, so sometimes they try to stomp it out using guidelines and protocols. But these guidelines are highly fallible, so what may occur is that you standardize care in a way that harms everyone equally. 🤦‍♂️

America’s doctors just voted for war with RFK Jr. dlvr.it/TSzRvc

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A few Germans like Freddy, went to the United States for the World Cup and have been travelling around the country. They ended up going viral because they were genuinely amazed by America and shared their enthusiasm online. As someone who has been to the U.S. around twenty times and even lived there for a year, I can understand their reaction. In my experience, Americans are generally friendlier, more polite, and warmer than Germans, especially in smaller towns. And once you get away from the main tourist routes, there is an incredible amount of beautiful nature, unique experiences, and fascinating places to discover. If you know where to go, even the food can be outstanding. I think the reason their videos went viral is that, for the past decade or so, most of the news coming to Europe about America has been negative. As a result, many people have developed a distorted image of the country. If you follow German news and media, you mostly see stories about school shootings, racism, police brutality, political conflicts, and similar issues. I honestly cannot remember the last time I saw a genuinely positive portrayal of America in the German media. So when people actually visit the United States, they are often surprised by how different the reality feels from the image they had in their minds. In a way, I think America could use a rebranding. Growing up, I remember hearing stories about the "American Dream," and many of us in Germany dreamed of visiting or living in America. That sense of optimism and opportunity seems to have faded from the public conversation.

I love Americans. We were about to walk an hour to the stadium in the rain to save on an Uber, and the receptionist at the hotel we were parked in front of decided to drive us there.🙏

Somewhere in Tennessee

Kids have safety scissors now. But back in the day, we were totally allowed to use the classroom guillotine at 10 years old.