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Allan Joseph

@allanmjoseph.bsky.social
685 followers 177 following 59 posts

I take care of critically ill kids, study the systems in which we take care of them, and try to make those systems better.

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Allan Joseph @allanmjoseph.bsky.social · 08/10/2026
Loved the read and agree that interventions are context-dependent (obvious example: FEAST trial in peds septic shock). But, measuring/describing this kind of context and its effect modification to even be generalizable to similar settings is tough, to say the least...
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Reposted by Allan Joseph
Adrianna McIntyre @adrianna.bsky.social · 09/09/2026
#tbt to this NEJM perspective I wrote with @nbagley.bsky.social and @allanmjoseph.bsky.social nine(!!!) years ago
nejm.org
Small Change, Big Consequences — Partial Medicaid Expansions under the ACA | NEJM
The Trump administration may decide to permit states to partially expand their Medicaid programs to cover people with incomes up to 100% of the federal poverty level. Arkansas has requested a waive...
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Allan Joseph @allanmjoseph.bsky.social · 09/09/2026
plus ça change...
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Allan Joseph @allanmjoseph.bsky.social · 09/09/2026
NINE?!
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Allan Joseph @allanmjoseph.bsky.social · 08/09/2026
You don't run the same gag twice, Chris. You do the next gag.
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Allan Joseph @allanmjoseph.bsky.social · 29/07/2026
Ah cool, thanks
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Allan Joseph @allanmjoseph.bsky.social · 29/07/2026
I do find it helpful within-project, and it's only an annoyance when it goes across-projects/chats, but I may need to give it a try anyway
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Allan Joseph @allanmjoseph.bsky.social · 29/07/2026
It also loves to relate everything back to like 2 canonical examples from your history. Yeah I know I kicked around a research idea 8 months ago, this question isn't at all relevant. Worldview of "AI is a very eager, tireless master's student without domain expertise" remains undefeated.
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Allan Joseph @allanmjoseph.bsky.social · 23/07/2026
Depends on what population you're looking for. ACS has voluntary registries: www.facs.org/quality-prog...; certain fields have very comprehensive ones (e.g., STS for cardiothoracic: www.sts.org/registries). Otherwise I think you're stuck with our general admin databases (payer, HCUP, etc)
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Allan Joseph @allanmjoseph.bsky.social · 23/07/2026
1. Congratulations! 2. Small world, Nick and I went to college together! Hi @nickseewald.com !
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Reposted by Allan Joseph
Annals of Emergency Medicine @annalsofem.bsky.social · 21/07/2026
👶 How often do EDs care for critically ill children? New research examines the frequency of pediatric critical illness across EDs and the implications for pediatric readiness, training, and regionalized care. Read more: annemergmed.com doi.org/10.1016/j.an... #EmergencyMedicine #PedsEM #FOAMed
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Allan Joseph @allanmjoseph.bsky.social · 21/07/2026
A huge portion of kids in Ohio are managed in Medicaid ACOs run by the various children's hospitals, so it's not garden-variety MCOs, for what it's worth
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Reposted by Allan Joseph
Cincinnati Children’s Research @cincyresearch.bsky.social · 09/07/2026
Critically ill children are rarely seen in most emergency departments. A new Cincinnati Children's study published in Annals of Emergency Medicine found that regionalization alone isn't enough, highlighting the need for training and support across all care settings. Read more:
scienceblog.cincinnatichildrens.org
Limited Experience, High Stakes in Pediatric Emergency Care - Research Horizons
Study finds critically ill children are rarely seen in most EDs and few can be redirected, highlighting need for targeted pediatric readiness.
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Allan Joseph @allanmjoseph.bsky.social · 07/07/2026
Some new work, in @annalsofem.bsky.social - how often do EDs treat critically ill children? It's rare - the median ED sees just 5 a year. @cincyresearch.bsky.social summary here: scienceblog.cincinnatichildrens.org/limited-expe... Full open access text here: www.sciencedirect.com/science/arti...
scienceblog.cincinnatichildrens.org
Limited Experience, High Stakes in Pediatric Emergency Care - Research Horizons
Study finds critically ill children are rarely seen in most EDs and few can be redirected, highlighting need for targeted pediatric readiness.
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Allan Joseph @allanmjoseph.bsky.social · 04/07/2026
I remember this trip and this presser, distinctly
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Allan Joseph @allanmjoseph.bsky.social · 22/05/2026
Presuming this also means the TAF Medicaid files...
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Allan Joseph @allanmjoseph.bsky.social · 18/05/2026
Another for your files on this score (ignore the somewhat obvious title, look to the interesting data they assembled): academic.oup.com/qje/advance-...
academic.oup.com
Why Doesn’t the United States Have National Health Insurance? The Political Role of the American Medical Association*
Abstract. This study examines how the American Medical Association (AMA) helped shape the development of the U.S. health insurance system in the critical p
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Allan Joseph @allanmjoseph.bsky.social · 14/05/2026
As one of my colleagues frequently reminds me, there is a difference between kind and nice -- and intensivists are more likely to be kind than nice, which is more helpful for our fellows or recipients of our peer reviews anyway
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Allan Joseph @allanmjoseph.bsky.social · 14/05/2026
I hope this is the exact tone you use when reviewing papers.
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Allan Joseph @allanmjoseph.bsky.social · 06/03/2026
F1: the pinnacle of motorsport engineering in the pursuit of fractions of a second. Also F1: chewing gum instead of mouth guards
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Allan Joseph @allanmjoseph.bsky.social · 12/12/2025
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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Allan Joseph @allanmjoseph.bsky.social · 11/12/2025
premiumbusinessservices.com has been very good.
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Allan Joseph @allanmjoseph.bsky.social · 18/11/2025
Different field, same problem. bsky.app/profile/more...
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Allan Joseph @allanmjoseph.bsky.social · 17/11/2025
"I didn't write my documentation" is probably not an airtight defense, either.
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Allan Joseph @allanmjoseph.bsky.social · 14/11/2025
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
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Allan Joseph @allanmjoseph.bsky.social · 14/11/2025
God I love this show. S4E1 is my favorite episode but it is stiff competition
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Allan Joseph @allanmjoseph.bsky.social · 14/11/2025
Don't forget the third measure otherwise you might have an existential crisis over your age
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Allan Joseph @allanmjoseph.bsky.social · 13/11/2025
This would be incredibly complicated for me.
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Allan Joseph @allanmjoseph.bsky.social · 06/11/2025
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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Allan Joseph @allanmjoseph.bsky.social · 03/11/2025
Please consider serving as a job reviewer for HP OfficeJet 3550. You can sign up using EditorialManager, because even office printers have chosen to use this software for some reason.
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Allan Joseph @allanmjoseph.bsky.social · 29/10/2025
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.)
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Allan Joseph @allanmjoseph.bsky.social · 29/10/2025
As usual I recommend @emilymoin.com's ongoing and insightful thread on this RCT
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Allan Joseph @allanmjoseph.bsky.social · 29/10/2025
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)
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Allan Joseph @allanmjoseph.bsky.social · 29/10/2025
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)
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Allan Joseph @allanmjoseph.bsky.social · 29/10/2025
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?
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Allan Joseph @allanmjoseph.bsky.social · 29/10/2025
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.
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Allan Joseph @allanmjoseph.bsky.social · 28/10/2025
I actually emailed Joe when I published that 8-state version and included the screenshot. Absolute legend. #IYKYK
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Allan Joseph @allanmjoseph.bsky.social · 28/10/2025
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.
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Allan Joseph @allanmjoseph.bsky.social · 25/10/2025
Oh the coffee at Constellation rules.
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Allan Joseph @allanmjoseph.bsky.social · 14/10/2025
The @criticalcarereviews.com newsletter is a game-changer.
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Allan Joseph @allanmjoseph.bsky.social · 03/10/2025
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:
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Allan Joseph @allanmjoseph.bsky.social · 24/09/2025
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...
publications.aap.org
Impact of the Revised NRP Meconium Aspiration Guidelines on Term Infant Outcomes
OBJECTIVES:. To evaluate the association of the Neonatal Resuscitation Program, Seventh Edition changes on term infants born with meconium-stained amniotic fluid (MSAF).STUDY DESIGN:. We evaluated the...
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Allan Joseph @allanmjoseph.bsky.social · 14/09/2025
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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Allan Joseph @allanmjoseph.bsky.social · 07/09/2025
The athletic just did an article on this phenomenon! www.nytimes.com/athletic/660...
nytimes.com
The U.S. Open women’s final and the art of the Grand Slam runner-up speech
Sabalenka and Anisimova met in the U.S. Open final. Earlier this year, they gave losing speeches that showed how difficult the art can be.
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Allan Joseph @allanmjoseph.bsky.social · 05/09/2025
Let me know if you want to think about peds inpatient/specialty care in this project
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Allan Joseph @allanmjoseph.bsky.social · 12/06/2025
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...
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Allan Joseph @allanmjoseph.bsky.social · 03/06/2025
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
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Allan Joseph @allanmjoseph.bsky.social · 31/05/2025
Thanks!
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Allan Joseph @allanmjoseph.bsky.social · 31/05/2025
You have a citation re ketamine direct effects handy so I can share with my fellows?
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Allan Joseph @allanmjoseph.bsky.social · 31/05/2025
Is there a real advantage to ketamine over parenteral beta agonists? Does ketamine have direct bronchodilation effects beyond catecholamine release?
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