iiinova — where your digital self keeps evolving

John Zupancic @johnzupancic.bsky.social · 08/05/2025

Lots more info (including state-specific relevant to your situation) at ccf.georgetown.edu and www.kff.org

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John Zupancic @johnzupancic.bsky.social · 08/05/2025

3. That makes it one of our most important tools for ensuring equity (slide courtesy of Dr. Shah)

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John Zupancic @johnzupancic.bsky.social · 08/05/2025

Dr. Shetal Shah (@nicubatman on Instagram and the Other place) Harvard BIDMC Newborn Epidemiology and HSR conference, reminding us that 1. Health insurance for all children is a civil right and 2. Medicaid is the single biggest payor for US births

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Neena Modi @neenamodi1.bsky.social · 17/12/2024

COLLABORATE, coming 2025, will determine the effects of donor milk, formula, and cow-milk fortifier on surgical NEC, survival & cognition in extremely preterm babies, key questions parents & clinicians have been asking for many years. Explainer & summary here: www.imperial.ac.uk/neonatal-dat...

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Neena Modi @neenamodi1.bsky.social · 19/12/2024

The National Neonatal Research Database is an amazing collaborative effort by all neonatal units in England, Scotland & Wales. Read our Christmas Newsletter here sway.cloud.microsoft/TRwgQx0jRac9... @99nicu.bsky.social @neonatalnursesuk.bsky.social @

sway.cloud.microsoft

Created using Microsoft Sway

COLLABORATE is an efficient, UK-wide, real-world-data-enabled, digital technology-facilitated, adaptive, group-sequential, 2-randomisation, controlled trial to determine clinical efficacy, effect size

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Atul Malhotra @atulmalhotra.bsky.social · 21/12/2024

Sharing new paper from our workshop in #PAS2023 Navigating Information Overload on Social Media: Opportunities & Misadventures for Clinicians and Professionals www.newbornjournal.org/abstractArti... @briankingneo.bsky.social @souvikneo.bsky.social #neosky @ebneo.bsky.social @espr-esn.bsky.social

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John Zupancic @johnzupancic.bsky.social · 21/12/2024

Case reports and series may be prone to bias, but in the hands of committed scientists, observation is still the entry point to improved outcome. 5/6

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John Zupancic @johnzupancic.bsky.social · 21/12/2024

…including progression of disease with path, clinical, radiological lenses; very early discussion of acquired pulmonary hypertension; role of oxygen; separation of two overlapping disease entities with eventual demonstration of distinct treatment modalities. 4/6

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John Zupancic @johnzupancic.bsky.social · 21/12/2024

For your consideration: Careful description, with no statistical comparisons, still brought a number of lasting truths to the table in this first comprehensive description of BPD… 3/6

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John Zupancic @johnzupancic.bsky.social · 21/12/2024

From the article: “The two outstanding findings are the prolongation of the healing phase of [RDS} and the appearance of a new chronic pulmonary syndrome that is associated with intermittent positive pressure respirators and High Oxygen for longer than one hundred and fifty hours (six days).” 2/6...

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John Zupancic @johnzupancic.bsky.social · 21/12/2024

#52MoreChallenge Week 4! Northway WH Jr, Rosan RC, Porter DY. Pulmonary disease following respiratory therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med. 1967; 276(7):357. PMID: 5334613. pubmed.ncbi.nlm.nih.gov/5334613/ #neoSky #neoEBM #52MoreChallenge 1/6...

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John Zupancic @johnzupancic.bsky.social · 21/12/2024

GRADE obviously also supports this broadly within a given review at the body-of-literature level. I am not sure that we have Cochrane NRSI SRMA examples in neonatology yet. Might be worth taking one on in the above area as a pilot?

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John Zupancic @johnzupancic.bsky.social · 21/12/2024

But there has always been rx evidence beyond RCTs (just think what we got from the Framingham study). Cochrane has expanded its charter to non-randomised studies of the effects of interventions (NRSIs) and is developing tools to support that endeavor (eg see the observational RoB tool ROBINS-I v2)

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John Zupancic @johnzupancic.bsky.social · 21/12/2024

It's such an important point @briankingneo.bsky.social . SRMAs with few or no RCTs are of course an essential part of the evidence synthesis process - I suspect that @souvikneo.bsky.social's review might find itself into the rationale for a new CIHR trial application or two :)

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John Zupancic @johnzupancic.bsky.social · 11/12/2024

Great! Dr. Saigal is always happy to hear from people if you have questions or comments.

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John Zupancic @johnzupancic.bsky.social · 20/11/2024

I guess it's not surprising that our organizations and journals must lag a bit in adoption of a new platform, but they are an important part of the conversation. Let's encourage whatever we're affiliated with to take the leap. We can log them here (currently pretty sparse) go.bsky.app/DwfZqQF

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European Society for Paediatric Research (ESPR) @espr-esn.bsky.social · 10/12/2024

🌟 Save the Date! 🌟 Join us for the inaugural Congress of the European Paediatric Academic Societies (CEPAS) in Lyon, France, from 28–31 October 2026. Mission: Uniting paediatric professionals to advance child health through cutting-edge research, education, and collaboration.👉Learn more at cepas.org

cepas.org

Congress of the European Paediatric Academic Societies 2026

Welcome to CEPAS 2026 where we unite paediatric professionals in advancing child health through cuttingedge research, education, and collaboration.

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John Zupancic @johnzupancic.bsky.social · 10/12/2024

(The #52MoreChallenge is a follow-up of the #52in52RCTChallenge. We're currently replaying the first month from Twitter and will start new articles in week 5. If you have candidates for the 52 most important non-RCT articles in the #NeoSky literature, please let me know)

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Brian King @briankingneo.bsky.social · 10/12/2024

The next AAP SONPM Journal Club is Thursday (December 12th) at 4:00 pm EST. Andrew Beverstock, neonatal fellow, will review the Diamond trial, with mentors Tanith Alexander (trial investigator) and Ariel Salas. #neosky #neoEBM Register - tinyurl.com/c87skbeh Trial- nejm.org/doi/full/10.10…

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John Zupancic @johnzupancic.bsky.social · 10/12/2024

Follow-up bonus about follow-up: Dr. Saigal interviewed the now-adult members of the same cohort decades later for a less prosaic, and quite moving, book and accompanying videos. See a.co/d/411zd3u and www.youtube.com/@PreemieVoices (the latter with both 2014 and 2024 interviews) 🧵fin

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John Zupancic @johnzupancic.bsky.social · 10/12/2024

From the paper: “Nevertheless, the vast majority of ELBW respondents view their health-related quality of life as quite satisfactory and are difficult to distinguish from controls." 🧵4/5

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John Zupancic @johnzupancic.bsky.social · 10/12/2024

The participants in this work were part of a long-term, geographically-defined (and therefore low-selection-bias) cohort, also a significant contribution to a literature that had been (and remains) plagued by single-center, short-term studies. 🧵3/5

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John Zupancic @johnzupancic.bsky.social · 10/12/2024

Dr. Saroj Saigal took to heart the insight that EBM includes not only critical appraisal but also patient values & preferences. Her research used tools f/ economics & psychology to demonstrate that patients & families may have different impressions of their own 'medical sequelae' than expected. 🧵2/5

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John Zupancic @johnzupancic.bsky.social · 10/12/2024

#52MoreChallenge WEEK 3: Saigal S, Feeny D, Rosenbaum P, et al. Self-perceived health status and health-related quality of life of extremely low-birth-weight infants at adolescence. JAMA. 1996; 276(6):453. PMID: 8691552. pubmed.ncbi.nlm.nih.gov/8691552/ #neoSky #neoEBM #52MoreChallenge 🧵1/5

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Charles C Roehr @ccroehr.bsky.social · 04/12/2024

A close look at the evidence-base for treating the most premature babies, as in international newborn early-life care guidelines (ILCOR, ERC and Euro-RDS consensus) - take a look and share your thoughts @ebneo.bsky.social doi.org/10.1016/j.jp... @drbretty.bsky.social @donsharkey.bsky.social

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Joan Alker @joanalker1.bsky.social · 06/12/2024

@georgetownccf.bsky.social is holding a webinar open to all next Tuesday Dec 10th at 2p ET about Medicaid's financing structure and ways in which the new Congress may try to change it. This will be the first in a series of webinars. You can register here ccf.georgetown.edu/2024/12/03/r...

ccf.georgetown.edu

The Georgetown University Center for Children and Families (CCF) invites you to a special virtual session of our new Child Medicaid Policy Institute. This webinar is free and open to the public. Wh…

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ORCID @orcid.org · 21/11/2024

This is a great idea! 💡 ⬇️ #academicsky

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Erika Edwards @erikamedwards.bsky.social · 25/11/2024

There's been a proliferation of "systematic reviews". Are these AI tools playing some role? Authors (and editors, if applicable!) need to apply vigilant assessment of the quality of the reviews. Simply following a checklist does not make a review systematic. www.nature.com/articles/d41...

nature.com

Can AI review the scientific literature — and figure out what it all means?

Artificial intelligence could help speedily summarize research. But it comes with risks.

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Darren Dahly @statsepi.bsky.social · 27/11/2024

So look. I've given about 20 talks where I highlight clinical research waste, and I now always ask the audience if they recognize that figure below. The answer is *always* the same - overwhelmingly No. If *you* recognize it, because you are here and informed, you must help spread the word. Please.

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John Zupancic @johnzupancic.bsky.social · 25/11/2024

Maybe analogous to what happened when the world got broad access to software that could perform logistic regression? It all seems pretty easy, but appearances are deceiving. Agree that editorial & peer review is crucial, but that system is a bit broken with the paucity of reviewers.

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John Zupancic @johnzupancic.bsky.social · 25/11/2024

I think we did start to see an increase in SRMAs including network MAs prior to the take-off of AI capabilities though, so the checklist/factory mentality might be contributing independently of poor old GPT, which is trying its best I suppose.

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John Zupancic @johnzupancic.bsky.social · 25/11/2024

It's a disconcerting thought given lack of validation of these tools & the fact that SRMAs tend to drive practice.

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John Zupancic @johnzupancic.bsky.social · 24/11/2024

Ha, likewise! I'm wondering now if we need a "Neo Talk Over Scotch" starter pack. There are certainly a lot of cocktails over here, so the party could even include people who add stuff to their scotch. Like ice. It's a very inclusive place, is Bluesky. 🤔 🥃🍸 @kentwillismd.bsky.social

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John Zupancic @johnzupancic.bsky.social · 24/11/2024

If populations are described by their risk characteristics, and each evaluated for efficacy prospectively in the same RCT, then we are more likely to be able to apply results across settings without risking confounding OR, as authors above suggest, routinely planned individual patient meta-analysis

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John Zupancic @johnzupancic.bsky.social · 24/11/2024

For the problem at hand in this thread, I would propose that external validity might actually be enhanced by RCT-driven precision medicine.

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John Zupancic @johnzupancic.bsky.social · 24/11/2024

Yes - part of a problem of reflex response that I see often in solicited reviews. Checklists for clin epi (eg everything on @equatornetwork.bsky.social) have been remarkably helpful, but we tend to ask ourselves whether a study or protocol satisfies each checkbox, a process that might lack nuance

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John Zupancic @johnzupancic.bsky.social · 24/11/2024

The above approach could be applied to so many Rx reviews in neonatology. Caveat though: this works both ways. Our sometimes-irrational exuberance for a rx shown to be efficacious in a high-prevalence popn may not justify universal adoption (consider fluconazole prophylaxis, some NEC prevention Rxs)

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John Zupancic @johnzupancic.bsky.social · 24/11/2024

There's not only common sense but math behind that. In a population with a high control event rate, a lower relative risk will result in a larger number of prevented events (assuming i) risk of adverse events is constant across disease prevalence; and ii) no population effects like herd immunity &c)

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John Zupancic @johnzupancic.bsky.social · 24/11/2024

The pre-treatment probability of disease (ie control or baseline event rate) should arguably drive both interpretation of RCT results and recommendations for adoption @briankingneo.bsky.social

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John Zupancic @johnzupancic.bsky.social · 24/11/2024

Agree. I'm glad that you highlighted the generic issue. We tend to employ blunt inclusion criteria w/ parsimonious planned subgroup analyses. And at the implementation stage, society recommendations are typically based on similarly blunt criteria. Both potentially leave some efficacy on the table

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John Zupancic @johnzupancic.bsky.social · 24/11/2024

For more on the historical aspects, read this perspective by Henry Halliday onlinelibrary.wiley.com/doi/full/10.... [And don't forget, all new #52MoreChallenge articles arriving in week 5] fin

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John Zupancic @johnzupancic.bsky.social · 24/11/2024

The surfactant employed was made by this group through lipid extraction & modification of whole calf lung extract, & eventually became Survanta. (In the same era, Tore Curstedt & Bengt Robertson @karolinskainst developed the porcine product that would be Curosurf (“Curstedt-Robertson surfactant”).

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John Zupancic @johnzupancic.bsky.social · 24/11/2024

A very small case series made compelling through i) multi-perspective evaluation (PaO2, pH, BP, AaDO2, x-ray, clin. course); ii) two time points showing lack of improvement prior to intervention (key deficiency in many before-after studies) Clinical trials impressively followed within 6-8 years.

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John Zupancic @johnzupancic.bsky.social · 24/11/2024

“After extensive studies to establish the safety of this surfactant as a drug, we have tried it in ten infants severely ill with hyaline membrane disease.”

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John Zupancic @johnzupancic.bsky.social · 24/11/2024

Building on last week's Avery and Mead report establishing surfactant as the underlying cause of RDS in preterm infants, this week’s classic article is by Dr. Tesuro Fujiwara, with the report of the first-in-human use of intratracheal surfactant.

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John Zupancic @johnzupancic.bsky.social · 24/11/2024

Time for #52MoreChallenge WEEK 2 (rebroadcast on BlueSky): Fujiwara T, Maeta H, Chida S, Morita T, Watabe Y, Abe T. Artificial surfactant therapy in hyaline-membrane disease. Lancet. 1980 Jan 12;1(8159):55-9. PMID: 6101413. pubmed.ncbi.nlm.nih.gov/6101413/ #neoSky #neoEBM #52MoreChallenge 🧵 1/6

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