Thread by @iwashyna

In the midst of all the grief + chaos of 2020, it's hard to remember there were good things

For me, an incredible group of young scholars doing highly relevant science was the #Bestof2020. Here are my favorite 2020 paper by each of several young scholars with whom I get to work

To see where some of these folks were last year see this thread

let's start this #BestOfResp2020 with @UM_IHPI K-awardees

https://twitter.com/iwashyna/status/1210250295088955398?s=20

.@msjoding changed the way I look at pulse oximetry in @nejm, rethinking my bedside care

This paper has rightly gotten a lot of attention

https://twitter.com/msjoding/status/1339426753509519360?s=20

But I think it is useful to look at it as an example of what makes Mike's work so interesting. A grant to build a dataset just to look at this project would, I think, have been un-fundable. Instead Mike had built an infrastructure to look at ARDS detection

When @msjoding came across Prof Amy Moran-Thomas's provocative @BostonReview essay (bostonreview.net/science-nature…) he was able to pivot that data infrastructure to ask an important question...

because he had done a ton of bedside #COVID19 care, had a broad @ncspMICHIGAN education, + rigorous epi training in addition to his machine learning work. @UM_MiCHAMP's book group had primed him to thing about algorithmic bias. And he had MIMIC clean to rapidly replicate

Serendipity + the prepared mind -- in an environment instrumented (in terms of both technical infrastructure + colleagues) to be able to go answer questions that arise from bedside intuitions + broad reading + vigorous discussions, w enough financial + time flexibility to do that

.@tsvalley fielded a survey to every Michigan hospital in the midst of the first wave pandemic, to investigate how hospitals were helping--or not--families stay in touch with ICU patients. The results were horrifying when they came out in @ATSBlueEditor

https://twitter.com/tsvalley/status/1291406000994443264?s=20

.@UMichNursing superstar Sue Anne Bell was helping to organize everything from #COVID19 field hospitals to #COVID19 nursing home care while serving on an @theNASEM panel on health effects of climate change

https://twitter.com/UMichNursing/status/1322149391914905604?s=20

I loved Sue Anne Bell's clever @PLOSONE paper that used public data on clinician's office locations to examine another threat of disasters to health -- disruptions of relationships with clinicians + diminished access to care

pubmed.ncbi.nlm.nih.gov/33232383/

I also work with a group of K12 scholars, supported by @nih_nhlbi training grant in implementation science in critical care

Again, great examples of @Jdos_WoT's hypothesis that universities are a reserve force whose value, in part, is their ability to meet unforeseen challenges

.@RyanPBarbaro showed @TheLancet that initial pessimism about role of #ECMO in #COVID19 was wrong: ECMO outcomes for #COVID19 were quite similar to those for other causes of respiratory failure--full ICU support saves COVID lives

thelancet.com/journals/lance…

https://twitter.com/RyanPBarbaro/status/1309627018347245573?s=20

.@jpdonnepi showed @JAMA_current that #COVID19 does not always end at hospital discharge--readmission + post-discharge death are ongoing problems, comparable to other conditions for which readmission prevention is a major focus

jamanetwork.com/journals/jama/…

https://twitter.com/HalliePrescott/status/1338611075328208898?s=20

.@JenniferNErvin published a definitive review of 20 Evidence-Based Practices in mechanical ventilation in ARDS in @accpchest, just in time to help counter somer of the CRAZY things that were being proposed on twitter

journal.chestnet.org/article/S0012-…

https://twitter.com/JenniferNErvin/status/1327269792181579776?s=20

In this midst of #COVID19, @L_VigliantiMD submitted a superb #K23 to @nih_nhlbi and earned a "highly promising" score (comfortably inside the funding line, NOGA awaited), and provided #COVID19 surge care, and was still writing

.@L_VigliantiMD continued her pathbreaking work on #PersistentCriticalIllness -- rethinking why patients get stuck in the ICU in terms of cascading complications rather than simply non-resolving respiratory failure

This piece in @yourICM, for example

https://twitter.com/L_VigliantiMD/status/1268885121119199232?s=20

#COVID19 emphasized the importance of @L_VigliantiMD's clinical + epi + HSR work, as I wrote in support of her back in May (which seems an eternity ago, doesn't it?)

And while I do not get to work closely enough with @abrnurse to get even any reflected glory--@AnneSales4 + @DeenaKCosta are her amazing mentors--I must bring to your attention in this thread her nationwide work rethinking burn center staffing

pubmed.ncbi.nlm.nih.gov/32123911/

All of that science was made possible by @nih_nhlbi's support for clinician scientist, plus the incredible environment of @UMIntMed + @UM_IHPI + @VA_CCMR + @MichiganPulmCC @UM_MICReW + @ncspMICHIGAN -- we benefit from multiple mutually supportive institutions

But that's not all! There are an amazing group of @ncspMICHIGAN Scholars (and those in the associated @UM_IHPI Master's Program) that I get to work with

Before she returned to yet more hand surgery training, @BilligJessica capped her @ncspmichigan series on potentially inappropriate #gabapentin use with a lovely paper looking at its role--and there should be almost none--in carpal tunnel syndrome

jhandsurg.org/article/S0363-…

And @ncspMICHIGAN Scholar @ADeRooMD showed results that ought to fundamentally change the way we assess the risks + benefits of some surgeries

pubmed.ncbi.nlm.nih.gov/32404660/
and also
journals.lww.com/dcrjournal/Abs…

Nurse @ashleevance_phd is primarily mentored by @DeenaKCosta and continues her amazing line of work on the impact of medical complexity in neonatal ICUs and parenting -- for #PedsICU, taking the family rather than the organ as the unit of analysis/care

https://twitter.com/ashleevance_phd/status/1258113658946752513?s=20

(@ashleevance_phd has a SUPER COOL project on the incoherent variation in children's hospital visitation policies under review that I can't wait for you to see, too)

.@DrHuerto, primarily mentored by @chang_tammy, continues to be an unflinching voice for racial equity in care, from @ConversationUS ( theconversation.com/minority-patie… ) to @Health_Affairs (healthaffairs.org/do/10.1377/hbl…)

Dr @v_valbuen of @ncspmichigan has written powerfully about our moral and professional obligations as clinicians in this hard, hard year

pubmed.ncbi.nlm.nih.gov/32956173/

even as her emerging Stata skills have some great new data almost ready for submission

And @lcagino of @MichiganPulmCC capped her first 6 months of protected research time (after so many months of extra #COVID19 care) with an important new paper @AnnalsATS with @dulcetarpeggio and @JackieKercheval on benefits of tracheostomy in #COVID19

pubmed.ncbi.nlm.nih.gov/33233918/

That analysis by @lcagino, @JackieKercheval, @dulcetarpeggio certainly moved my thinking in 2 different directions--redoubling my commitment to re-implement A2F bundle w @dclaar22 even in #COVID19, but also supporting earlier trach given the very long arc of #COVID19 recovery

Have I mentioned I get to work with the best people?

This is so much fun

Let me wrap this up with 2 other remarkable projects by young scholars to watch for this #Bestof2020 #bestofresp2020

Newly minted @UMSociology PhD @KatieHauschildt deeply changed how I think about the challenges of recovery with her intensive, nationwide ethnography on #FinancialToxicity after ARDS

@CritCareMed pubmed.ncbi.nlm.nih.gov/32697479/ #BestOf2020

https://twitter.com/KatieHauschildt/status/1260931249222201344?s=20

.@KatieHauschildt's work directly informed @vineet_chopra @HalliePrescott's paper showing just how hard #COVID19 has been on survivors

acpjournals.org/doi/10.7326/M2…

Finally, during the dark days of the Spring 2020 Wave 1 #COVID19 surge, a group of medical students worked across institutions to invent a brand new role to help address crucial expertise shortages -- the Respiratory Therapist Extender

https://twitter.com/JackieKercheval/status/1244624433635000320?s=20

A team led by @Tom_B_Hester, @JuliaCartwright, @DomenicDiGiovi1, @kevinkarlic, and @JackieKercheval AS MEDICAL STUDENTS built an open source respiratory care curriculum working closely with RTs, trained student volunteers, and staffed shifts 24x7 to let RTs focus on the sickest

The student's incredible work inventing the role of #RespiratoryTherapistExtender has been #FOAMed published in @ATSScholar (atsjournals.org/doi/full/10.34…), described in a podcast (scholarly.transistor.fm/episodes/train… with @NitinSeam) remains relevant as we continue our failed response to #COVID19

somehow I screwed up the threading on this... reconnecting here

https://twitter.com/iwashyna/status/1343946300581023746?s=20

So, yeah, 2020's been an awful awful year

2021 is going to be long and hard, too

But these incredible scholars, plus the remarkable clinicians I work with at @umichmedicine @VAAnnArbor and collaborate via Twitter, they give me hope and are the #BestOf2020