Allan Joseph

Off the top of my head, the classic Baicker and Chandra Health Affairs article "Cooper's Analysis is Incorrect" has a devastatingly straightforward takedown of the paper it cites. Can't get to the underlying citation from my phone but here is the takedown:

www.healthaffairs.org/doi/10.1377/...

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Different field, same problem.

bsky.app/profile/more...

"I didn't write my documentation" is probably not an airtight defense, either.

My favorite line (as a Notre Dame alum) is when Martin says "ah I hate when Fr. Mike covers Bulldog's show, it's all just Notre Dame, Notre Dame, Notre Dame" because it's also incredibly accurate

God I love this show. S4E1 is my favorite episode but it is stiff competition

Don't forget the third measure otherwise you might have an existential crisis over your age

This would be incredibly complicated for me.

What we need is a critical care trial that uses AI/ML when it could have used logistic regression, with a noninferiority design with a wide margin permitting an NNH of 20 for one additional mortality. Then there will be plenty of takes from her account alone.

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Tremendously insightful. (Coincidentally, another peds-adult difference I'd love to explore...a HUGE portion of inpatient/ICU resources are spent on a small fraction of kids with medical complexity/tech dependence, but they are also unlikely to die. So there may be more persistence.)

As usual I recommend @emilymoin.com's ongoing and insightful thread on this RCT

I also bet that SICUs/transplant ICUs/trauma ICUs have better outcomes and the PICU is basically one giant mixed unit (though in large hospitals the congenital cardiac ICU is separate)

Ah my (old, heuristic-y) number was 30-50% mortality but those are probably more like tertiary/quaternary MICUs. (I think the general PICU population is like 2% on average but some of that is denominator inflation by admitting kids to PICUs whose equivalents never would have been in MICUs)

100% agree conceptually. The snarky (but correct) answer is "it depends on which rivets and why they crash!" Which is also true for our heterogeneous ICU patients. I also wonder about second-order effects. If we put fewer A-lines in...does our capacity to insert/maintain them worsen over time?

If you want to compare/contrast with the Peds ICU, let's chat. On the one hand, our mortality rate is an order of magnitude lower (so less has to go "right" to survive since 95% of patients do) but on the other my gut instinct is that individual interventions may have higher marginal benefit.

I actually emailed Joe when I published that 8-state version and included the screenshot. Absolute legend. #IYKYK

She's not kidding - here's a screenshot of notes I took in a class in 2016, in all likelihood followed by a text to Adrianna.

Super cool work which could unlock a whole new era of pediatric acute care research.

Oh the coffee at Constellation rules.

The @criticalcarereviews.com newsletter is a game-changer.

Some of my newest work - amidst everything going on, we're still trying to deliver excellent care to really sick children. But the system is under a lot of strain:

Maybe analogous: in '16 the Neonatal Resuscitation guidelines stopped routine intubation/suction for meconium. Delivery room intubations dropped a ton, and what was once a resident job became a fellow job...and I'd bet effective BVM training got worse too.

publications.aap.org/hospitalpedi...

One was a halfback pass, right? Because I think the stat would get more play if it was 5 straight INTs by the QB

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The athletic just did an article on this phenomenon!

www.nytimes.com/athletic/660...

Let me know if you want to think about peds inpatient/specialty care in this project

Very different population but this is something the neo and peds groups have tried to assess, and I'm sure someone will do after Oxy-PICU too. Two examples:

www.nejm.org/doi/full/10....

jamanetwork.com/journals/jam...

Our institution uses it as a very late pressor: journals.lww.com/ccejournal/f...

We try to stratify by direct renin levels if possible too

Thanks!

You have a citation re ketamine direct effects handy so I can share with my fellows?

Is there a real advantage to ketamine over parenteral beta agonists? Does ketamine have direct bronchodilation effects beyond catecholamine release?