Thread by @LWestafer

I was supposed to deliver the @SAEMonline #NERDS20 Keynote. Bummed it's canceled due to #COVID19, b/c it's one of my favorite topics...knowledge translation (and the impact of the digital era on KT). KT seems simple-knowing what the evidence-based approach is...and doing it

Knowledge translation is hard because knowing what the right thing to do is really really really hard. #1 There is an insurmountable amount of literature
#2 Much of it is irrelevant (or garbage)
#3 Researchers are sneaky
#4 things change (#medicalreversal )

...but, the hard part of knowledge translation? DOING. for example, let's look at handwashing....we've only known it's helpful for a couple of centuries...but we are still TERRIBLE at it*+ ...

*pre-SARS-CoV-2 data
+I'm sure it still ain't ideal

Part of the problem with knowledge translation is that it often involves unlearning (which is different than just shoving more *new* info in our brains). it's complex and *gasp* emotional shortcoatsinem.blogspot.com/2014/02/the-un… ..we get defensive when an article challenges our practices

Traditional dissemination takes TIME.
#1 Data collection ➡️analysis ➡️ publication (e.g. ~180-240 d from submission to pub in @AnnalsofEM) ➡️ dissemination
#2 There are multiple stages of dissemination (e.g. eventually into guidelines)
often PUSHED to providers (?bias)

Also...not sure traditional dissemination works...2010 guidelines...but many people still do pulse checks (which are different than rhythm checks in regards to time...)

Digital dissemination may be one way to mitigate this gap....early exposure and then repeated exposure. all forms of desensitization. When we're exposed to something early, we have more time to get accustomed to it. When we're exposed repeatedly, maybe we can't ignore it

PTX needle decompression is an example of early exposure (2012) via twitter juxtaposed with ATLS finally incorporating evidence into guidelines >5 years later...(and many protocols aren't updated in timely manner, people don't undergo re-training)

Authors are also increasingly engaging in digital dissemination. ...you MAY get near-immediate digital dissemination (yay!)..but, also probably going to get biased perspective

Journals and conferences are playing a huge role as well. E.g. @smaccteam / @codachange were leaders in #openaccess dissemination and @CritCareReviews has taken this further. E.g. check out the unveiling of #VITAMINS

Journals are using the #VisualAbstract and podcasts to push articles to clinicians.
Upside: This is where we know clinicians are, can get research to people who wouldn't otherwise be exposed
Downside: oversimplification, bias (can't get adequate methods in VA..which kills me)

digital dissemination in an epidemic (or pandemic) might be even more important. example: pre-prints for #COVID19 have exploded. sciencemag.org/news/2020/02/c…
Upside: Don't really have time to wait for lengthy publishing process.
Downside: haven't undergone peer review. Quality =?

But then again,peer review isn't infallible, research is hard, & traditional dissemination / journals still have errors, accidents (& occasionally malicious intent) that can result in #medicalreversal E.g. accidental error in @JAMA_current jamanetwork.com/journals/jama/…

Knowledge translation efforts through social / digital media are here. just check out pubmed (scoping review -> link.springer.com/article/10.100… @TChanMD ). Training responsible processing and use is vital.

It's tempting to believe that the digital era will mitigate the knowledge translation gap; however, I truly believe that the hardest part of knowledge translation isn't just getting information but unlearning...digital dissemination may help w/that but requires work on our part