Next I’m here for this @ESICM #LIVES2022 chat on ‘diversity’ with amongst others @iceman_ex

My first thought is that this should be in a main theatre
The first question is ‘what is’ diversity

@ElieAzoulay5 says it is ‘us…all of us”

(My own thought on that is the sense of ‘us’ is sometimes the issue but I get the intention)

Ellie says there’s a generation gap - need to understand elements of language that we don’t share
(I agree with that we can’t be afraid to learn form each other)
Marlies Ostermann says it’s not just gender or ethnicity etc …it’s about *individuals* beyond those demographics …and also about the MDT and professionals we work with
Weiss mentions diversity again mentions the gender stats for speakers at the conference used but ‘diversity’ is overused

(And often not understood )
Iliopoulou is a nurse, she says everyone needs to be represented in the activity of @ESICM and we should always look for biases - but also that she feels she has opportunity
@iceman_ex says diversity is very difficult to define but you know it when you see it

It is that you arrive and know your not other

That you know ‘there are people like me’ who occupy sorts of this organisation

(THIS IS A DEFINITION I GET)
@ElieAzoulay5 says we are building on period that wasn’t so ‘easy’ (think he means in terms of diversity - welcome recognition of a problem) and we need to let each other know when we fail

(yes but that depends on who each other is. You get views of those around you)
Now again we’re back to gender split…Marlies Ostermann is asked about how we improve that, taking into account prior lack of female presence on @ESICM council
(The state of fixation single attributes in particular gender, as opposed to the complexity of intersectionality is at this point really grating on me)

But also seems at odds with @ElieAzoulay5 then clearly speaking up today for the importance invisible and visible diversity
Carol Hodgson speaks to the research that shows that woman as leaders are prone to the bias that sees them as less likeable

(don’t I know it)

and that just saying team-leader reframes the role as ‘caring’ and is often more acceptable …interesting
Weiss says we need to make sure that we’re not forcing others to fit the ‘white straight male’ typical leader that we’re used to…we need to accept individuals
@ElieAzoulay5 says he was chief editor of @yourICM and that he knows the number of ‘women’ presenting research in big journals is describing & he still sees racism & sexism and we need quality markers to guide us to help us improve …he says that’s need ‘checklists for diversity’
A (female) published researcher in the audience says her research confirms that there are less first or senior authors in high ranking journals, and they DO submit but they they’re less likely to be published
@iceman_ex takes the mic to bring forward the concept of allyship

He also says that whether we like it or not - affirmative action is the only thing that has evidence that shows that it works…. (see Rooney Rule)

operations.nfl.com/inside-footbal…
It’s put to him that affirmative action (like Rooney rule) isn’t democratic….

(Do I feel like all elections are necessarily democratic with equitable access for candidates to have exposure and support …not sure. Thinking about targeted emails I mysteriously received)
@ElieAzoulay5 says that if we move on, we need to agree a ‘routine’ check list for any important position but we need to make change very early on the process

We need to remember the basics to be flexible like ‘let’s meet at 8pm’ isn’t possible for everyone (I agree with this)
@iceman_ex talks strategy - and says ‘you cannot he what you cannot see’ is important and he been hugely important for him
Weiss says there is not doubt that’s diversity makes us stronger and increase excellence

…but that he would like it be less political in its end points

He also feels we need research and to publish on it (e.g gender diversity and impact on care is neglected)
@iceman_ex answers a question about someone saying ‘when we look for diversity we create differences’ (or words to that effect) by saying that if we don’t understand each others perspectives how can we improve at all?

(I agree)
And then followed a lively discussion about whether the society should ,outside of research, collect information about individual characteristics at all….
And I wedged in my own challenge that we stop using the phrase ‘problem or diversity’ because diversity is always an opportunity
…and that as fixation on one thing gender like split of speakers doesn’t make me feel included, it’s a 2D claim - about a complex issue…so can we do better at signalling in our inclusivity?

And so to end. There was other nuance. I did my best

#LIVES2022

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More from @WhistlingDixie4

Oct 26
Last up we have Hot Topics…. #LIVES2022 ImageImageImage
First comes @JAMyburgh with #SuDDICU looking at selective decontamination (SDD) of the digestive tract on hospital mortality

(To know- Aim of SDD is to prevent VAP caused by pathogenic gram negatives organisms and overgrown of fungus from upper GI tract)
The paper is open access here

jamanetwork.com/journals/jama/…

And summarised in graphic by @JAMA_current. Image
Read 19 tweets
Oct 26
🧠 Heading here this morning for joint @ERC_resus session ‘How do I predict neurological outcome after cardiac arrest” at #LIVES2022

This is a core part of my day to day and frequent conversation I have with the junior team so interested to listen … Image
So far the audience have been asked four times to move closer to the front. Nobody moves.
The first q is ‘how do you do it’.

Sandroni says Neuron specific enolase (NSE) for 3 days, clinical exam from day 3, EEG starting early…used later, CT is repeated in patients with prolonged unconsciousness and MRI in those that aren’t waking up..

They have protocol on unit
Read 25 tweets
Oct 25
It’s 16:40 - I’ve come to palliative care session

I *think* (but cannot be sure) that it won’t mention biomarkers

Impressive turnout for such late session. It’s actually nearly full!

#LIVES2022 ImageImage
First speaker Hartog said she’s surprised by the turnout ☺️

She comments that the WHO definition of palliative care (PC) doesn’t mention death

She directs us to concept that it accompanies curative care - then takes overtakes it - and eventually, no even continues after death Image
She points to this paper and graphic.

(You should know now the room is so full that people are standing, which is tiring imagine- but good to see for such an important topic)

link.springer.com/content/pdf/10… Image
Read 25 tweets
Oct 25
Up next at #LIVES2022

🧠 Optimising Brian perfusion after resuscitation.

This is another debate (read chat, more than debate)

So I’ll try to keep up… Image
It opens by saying we know that 2/3 of unconscious patients in ITU post cardiac arrest die

And most of them die from brain injury

(I’ll use HIE to say hypoxic ischaemic encephalopathy from now)

❓Do we need to improve perfusion to the brain and can it help anyway❓
HIE brains have inflammation, reorganisation and things which alter interaction with systemic circulation.

Robba is surprised that we don’t seem to categorise post arrest brains as other brain injuries and so treat them with the same systematic approach
Read 24 tweets
Oct 25
🫁 🧬 ARDS in Sepsis - Are biomarkers helpful? #LIVES2022

(The answer for me is - minimally…I rarely have access to them at the beside 🛌 but I presume the answer from JM Constantin has meat to it, so I’m here to listen)
We start here by asking is ARDS due to sepsis the same as that due to peritonitis or pneumonia?

And he has now changed the title to Are biomarkers helpful in ARDS?
Q1 Do we need them for diagnosis?

No- The Berlin criteria does not need them
Read 12 tweets
Oct 25
Are biomarkers helpful? #LIVES2022

(That’s the question)
Jokes, it isn’t

“Are biomarkers helpful in characterising inflammation V infection?”
The goal is to prevent both under AND over treatment of infection.

As clinicians we have bias
- Tend towards ‘action’
- Over estimate risk of infection
- Over estimate/misattribute improvement (outcome bias)
Read 13 tweets

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