iiinova — where your digital self keeps evolving

Jack Iwashyna @iwashyna.bsky.social · 32m

Who will you be at the end of the world? I tried to be a good parent. I tried to be a good friend. ~ Emily St John Mandel 😢

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Jack Iwashyna @iwashyna.bsky.social · 1h

Professional organization cowardice

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Jack Iwashyna @iwashyna.bsky.social · 5h

“doing nothing is a very demanding job when other people are constantly on your back” ~ Erland Loe, Doppler [not cross posting to LinkedIn, because really, what would be the point?]

Cover of book Doppler, that has a moose on it, in front of an open window overlooking Baltimore Harbor

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Jack Iwashyna @iwashyna.bsky.social · 21h

Thank you! There is a vast relevant experience in looking for, measuring, and interpreting these context effects in implementation science, so we do not have to reinvent the wheel

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Jack Iwashyna @iwashyna.bsky.social · 08/10/2026

I feel confident that at some level of not perfusing, it becomes a problem?

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Jack Iwashyna @iwashyna.bsky.social · 08/10/2026

“You know what no one tells you about life in an authoritarian state? How exhausting it is” ~ Emily St John Mandel in Exit Party

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Jack Iwashyna @iwashyna.bsky.social · 08/10/2026

I hope you are right, at least about the great potential

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ProfKori @profkori.bsky.social · 08/10/2026

Everything Solnit says… because this is know-your-place aggression, too.

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Jack Iwashyna @iwashyna.bsky.social · 08/10/2026

I realize I am posting a lot this week, but it's part of why academic medicine is so exciting ... lots of things to learn and think about This morning, I'm learning from Dr Amelita Woodruff about "Approach to Caring for Hospitalized Incarcerated Patients" at @hopkinspccm.bsky.social

Title slide about "Approach to Caring for Hospitalized Incarcerated Patients"

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Jack Iwashyna @iwashyna.bsky.social · 08/10/2026

I look forward to your thoughts

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Jack Iwashyna @iwashyna.bsky.social · 08/10/2026

I got to reflect on 26 years of sepsis resuscitation studies in @nejm.org, and came to argue that Michael Pollan was right: “Re-establish perfusion. Not too high. However is safest for you.” My editorial on ARISE/FLUIDS www.nejm.org/doi/full/10....

nejm.org

More Than One Way to Save a Life in Septic Shock | NEJM

Septic shock — the dysregulated response to infection that leads to end-organ hypoperfusion — remains a worldwide threat to patient’s lives and ability to thrive.1 There is consensus that excellent...

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Jack Iwashyna @iwashyna.bsky.social · 08/10/2026

Regardless of what the bigots may say, trans people are people deserving all our love and respect as people — and people exceptionally committed to living in their truth

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Jack Iwashyna @iwashyna.bsky.social · 07/10/2026

"Poetry, pop songs, and presentations on morning rounds rely on strong norms about structure to allow concise information transfer and understandability to the reader" Thanks, @nejm.org, for giving me a chance to show my work.

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Greg Bryson @glbryson.bsky.social · 07/10/2026

Some excellent advice for authors of medical research. Be sure to pick off relevant reporting guidance as you go (CONSORT, STROBE, etc)

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Jack Iwashyna @iwashyna.bsky.social · 07/10/2026

Look, I know reposts are not endorsements, but can I please pretend this one from Prof @marydixonwoods.bsky.social is actually an endorsement?

Screenshot of Mary Dixon-Woods reposting this post

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Jack Iwashyna @iwashyna.bsky.social · 07/10/2026

Look, I know reposts are not endorsements, but can I please pretend this one from Prof @marydixonwoods.bsky.social is actually an endorsement?

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Jack Iwashyna @iwashyna.bsky.social · 07/10/2026

New @nejm.org Voices: how I write an introduction to a research manuscript “My first piece of advice…: write your introduction backwards. “My second piece of advice: innovate in your ideas, not in the structure of how you present the ideas.” voices.nejm.org/doi/full/10....

voices.nejm.org

Start Here to Write a Research Introduction Section

A step-by-step guide to writing a concise introduction to a clinical research manuscript

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anil oza @aniloza.bsky.social · 06/10/2026

head scratcher of a study from @iwashyna.bsky.social @ashfawzy.bsky.social and co

In the Hopkins study, pulse oximeters gradually shifted from overestimates to underestimates over the course of the five years when compared to arterial blood gas tests. When oximeters overestimate oxygen levels, clinicians run the risk of not providing care to patients when they need it. But underestimating can also come with issues, like providing unnecessary care or keeping patients in the hospital longer than necessary. Overall, “it is not at all clear these things are fit for use in the way that we’re using them,” said Jack Iwashyna, a pulmonologist and critical care physician who is an author on the Hopkins paper.

The recent crop of papers also raises a question about how to best study the shortcomings of pulse oximeters. The landmark 2020 paper that brought renewed attention to the devices’ bias was a retrospective, gleaning a trend from past data. Researchers at the time hoped prospective studies, where scientists actively collect data to get to the root of a problem, would be more helpful in understanding why pulse oximeters fell short in the way they do.

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anil oza @aniloza.bsky.social · 06/10/2026

Pulse oximeters rose to prominence bc they OVERestimated oxygen in patients with darker skin tones during the pandemic Now they seem to be UNDERestimating oxygen levels... What's happening? We still don't know but it could point to deeper issues w/ the devices www.statnews.com/2026/10/06/p...

statnews.com

In this hospital, pulse oximeters went from overestimating to underestimating blood oxygen. Why?

Researchers found pulse oximeters went from overestimating blood oxygen levels to underestimating them; inaccuracies were worse in patients of color.

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Jack Iwashyna @iwashyna.bsky.social · 06/10/2026

So how do you know which to beleive?

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Jack Iwashyna @iwashyna.bsky.social · 06/10/2026

“If you have a broken clock and you know how it’s going to be five minutes slow every time, you can adjust your routines to take care of that,” @tvalley.bsky.social said. But now, it’s unclear whether that metaphorical clock is running fast or slow. #PulseOx www.statnews.com/2026/10/06/p...

statnews.com

In this hospital, pulse oximeters went from overestimating to underestimating blood oxygen. Why?

Researchers found pulse oximeters went from overestimating blood oxygen levels to underestimating them; inaccuracies were worse in patients of color.

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Jack Iwashyna @iwashyna.bsky.social · 06/10/2026

“These findings are important because they suggest that the Spo2 measurements used to guide oxygen therapy for tens of millions of acutely ill patients each year are inaccurate or inconsistent to a degree that is greater than has been recognized previously”

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Jack Iwashyna @iwashyna.bsky.social · 05/10/2026

Yeah, this is somehow even worse than I expected as well, and my expectations were not high

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Jack Iwashyna @iwashyna.bsky.social · 05/10/2026

An AI trial wanted to use pulse oximeters to optimally titrate oxygen. When they put two pulse oximeters on the same patient, they disagreed by a clinically meaningful amount more than 1 in 3 times.

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Jack Iwashyna @iwashyna.bsky.social · 05/10/2026

"Paired Spo2 measurements differed by ≥ 3% during 33% of monitored time (95% CI, 30%-35%) and by ≥ 5% during 13% of the time (95% CI, 12%-15%). The concordance correlation coefficient was 0.41, indicating poor agreement between paired Spo2 measurements." www.chestcc.org/article/S294...

chestcc.org

Discrepancy Between Peripheral Oxygen Saturation Measurements Obtained Simultaneously From 2 Pulse Oximeters Made by Different Manufacturers in Acutely Ill Patients

Among adults hospitalized with acute hypoxemia, Spo2 values measured simultaneously by 2 pulse oximeters from different manufacturers differed by a clinically meaningful amount approximately one-third...

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@NewsJennifer (Jennifer Schulze) @newsjennifer.bsky.social · 05/10/2026

As a longtime Chicago journalist I want to say that if you fail to put Hastert's serial CHILD SEX ABUSE in the headlines about his death, you are doing it wrong. So far, this is the only headline I've seen that has been crystal clear about what the Illinois pol did to kids. Credit @reuters.com.

Dennis Hastert, former US House speaker and admitted child molester, dies at 84

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Jack Iwashyna @iwashyna.bsky.social · 05/10/2026

What if we didn’t let OMB, HHS and NIH leadership repeatedly imperil American Science? These stop gaps 🧪 🩺 are important and good, but we need to stop needing them every few weeks

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Jack Iwashyna @iwashyna.bsky.social · 05/10/2026

“Get this into your head, [our] business is resource management. We find them, we use them up, we move on. That includes Human Resources” ~ The Rig s1e6

Screen shot of stereotypical executive condescending to a younger worker

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Brendan Cantwell @cantb.bsky.social · 03/10/2026

America: reaching new lows every day

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Jack Iwashyna @iwashyna.bsky.social · 05/10/2026

I confess the entire RCT edifice built on highly non-probability samples does sometimes worry me, but I figure if @statsepi.bsky.social is ok, I can be ok, right?

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Brian Clevinger @bclev.bsky.social · 03/10/2026

The man famous for definitely paying people promises to pay me too? Wow!

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Abigail Breiseth @abinbaltimore.bsky.social · 03/10/2026

This show was amazing! I didn’t quite realize, walking in, how many absolute Broadway legends I’d be spending the evening with. 🎵Good evening, #Baltimore!🎵 Oct 2-4, at Center Stage, hurry up! #Hairspray #JohnWaters #Centerstage

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Mark McKenna @markpmckenna.bsky.social · 03/10/2026

This is a complete disaster

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Jack Iwashyna @iwashyna.bsky.social · 03/10/2026

@stephruhle.bsky.social @11thhourmsnow.bsky.social did a nice piece on this back in March — when the NIH Director promised this would not happen — and continued accountability of NIH leadership and OMB meddling are needed NIH staff are working so hard but being blocked constantly

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Jack Iwashyna @iwashyna.bsky.social · 03/10/2026

It is intentional killing of our nation’s golden goose — is its science and education productivity

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Jack Iwashyna @iwashyna.bsky.social · 03/10/2026

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Jack Iwashyna @iwashyna.bsky.social · 03/10/2026

NIH makes yet again new LOW number of grants report.nih.gov/nihdatabook/...

Table from NIH showing drop of nearly 8,000 grants vs 2023

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Jamie McKelvie @mckelvie.bsky.social · 03/10/2026

The usual way - neurodivergent next door neighbour into heavy metal and goblins

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Jack Iwashyna @iwashyna.bsky.social · 02/10/2026

“ we were Americans, which is another way of saying that chaos felt like home “ - @emilymandel.bsky.social

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Jack Iwashyna @iwashyna.bsky.social · 02/10/2026

Bicarb's not even helpful if your pH < 7.25... pubmed.ncbi.nlm.nih.gov/42820515/ in @critcarescience.bsky.social A secondary analysis of the SODa-BIC randomized clinical trial using multiple hierarchical composite outcomes

pubmed.ncbi.nlm.nih.gov

Checking your browser - reCAPTCHA

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Emily @emilydawn.bsky.social · 01/10/2026

@hockeyviz.com I found some beautiful data viz for you

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