SCCM Resource Library-Evidence and Research: Navigating Dissemination Then and Now, During a Pandemic

Evidence and Research: Navigating Dissemination Then and Now, During a Pandemic

Video Transcription

Hello, my name is Craig Coopersmith, I'm a former president of SCCM and it is my tremendous  honor to be moderating this session with a group that could best be described as luminaries or perhaps legendary speakers and we're going to get right into it so everybody knows as  you're listening to me, each speaker is going to talk for about 10 to 15 minutes and then we're pre-recording a discussion amongst the five of us and then we'll still give everybody  listening to us about 20 to 30 minutes to live answer questions. So our first speaker I'm sure needs no introduction, Dr. Phil Dellinger is professor of medicine  and distinguished scholar at Cooper Medical School of Rowan University. He's a senior critical care attending and director of the Cooper Research Institute  at Cooper University Health. He's the associate editor of our journal Critical Care Medicine. He's past president of SCCM and is a recipient of the SCCM Lifetime Achievement Award.  Dr. Dellinger will be speaking on Adjudicating Conflicting Literature and Integrating Personal Experience at the Bedside of the Critically Ill COVID-19 Patient.  Dr. Dellinger, take it away. Thank you very much Craig, it's indeed a pleasure to be here with you today and I hope everyone  had a great holiday season as different as it probably was as any holiday season you've had before. I certainly know that mine was.  Let's get started, Craig told you what I'm going to talk about. Don't be intimidated by the title, it's actually a lot simpler than that.  The objectives of my talk will be to first discuss some of the conflicting literature about COVID-19 characterization and recommended management as an example, to talk about one  particularly problematic area to intubate or not to intubate, that is the question, and finally close with offering my take on how we might best cope with conflicting COVID-19  critical care information. I'm going to start by taking us back to the first surge in the U.S., for me it's East  Coast, back to April of 2020 when most of us were dazed and confused by the onslaught of critically ill COVID patients on ventilators, renal replacement therapy, ECMO, and I know  in my case, almost 40 years of critical care experience left me totally unprepared for what I was dealing with.  In April, there was a publication from the Italian group proposing that there were different phenotypes of COVID-19 hypoxemic respiratory failure. These are now known widely.  That's the L phenotype and the H phenotype. The L phenotype, low lung weight, low elastance, low VQ, and low lung recruitability, and the  H phenotype, high lung weight, high elastance, high shunt, and high lung recruitability. With these two different phenotypes, potential to progress from the L to H, and also having  treatment, potential treatment implications in that the L phenotype might be amenable to using larger tidal volumes safely.  And then not shortly after that, there was a counter to this particular position with the phenotypes, the perils of premature phenotyping in COVID, a call for caution, pointing that  there was no evidence that these phenotypes had been that well established and no data to indicate that they should be treated differently than how we had treated ARDS in the past,  pointing that all of our studies that have demonstrated treatment benefits for ARDS have been carried out in a wide mixture of etiologies of ARDS using the commonality of  only the ARDS Berlin definition. Also in July of 2020, we began to see amalgamations or publications that took a synthesis of work that had been published.  This is one from Fan et al., comparing compliance across multiple publications now, including  large number of patients from New York, and remember that the higher the number for compliance,  the more compliant the lung is in ML's personamine rewarder, and you can see that the Italian numbers of 50 compliance is now in some of these studies looks more like what I'll call  traditional ARDS. And now I'll take us forward to August 2020, and here you can see what I think is a very  nice publication, very good scientific design, looking at comparing compliance COVID and non-COVID with a very structured, protocolized approach across multiple Italian hospitals,  and my take on this is, although it's not demonstrable, you can see it is significant in that the compliance in the COVID group does appear to be better than in the non-COVID  group, the historical controls, and also if you look at the PAO2-FIO2 ratio, there's no difference here, but yet at that same PAO2-FIO2 ratio, the compliance is better in the COVID  patients. So now let's move on to another example of how the difference of opinion in the literature  can come to the bedside and perhaps leave us perplexed to innovate or not to innovate, that is the question.  And this relates to patient self-inflicted lung injury or PCILI in COVID-19. I think COVID-19 has brought patient self-inflicted lung injury to the forefront, but it's certainly  been around. It's not new to discussions of acute hypoxemic respiratory failure, and what I'm showing  you on this figure is that physiology dictates that if you have for any given tidal volume shown at the bottom of this figure across control ventilation, spontaneous breathing,  and partial assisted breathing, that to get any tidal volume, the flow over time has to be identical, and so does the transpulmonary pressure at the end of inspiration because  that is controlled by tidal volume with all other variables equal. But what is different is how that flow is achieved.  You can see here on control mechanical ventilation, it's all positive pressure from the ventilator with spontaneous breathing.  It's all negative intrapleural pressure here measured with esophageal monitoring, and with partial assist, it's a combination of positive pressure from the ventilator and negative  pressure in the pleural space, and this is important, and this is what was driving the concern in patients that were not yet intubated with COVID-19 ARDS, a concern that they might  have big intrapleural pressure swings generating high transpulmonary pressures and putting the patient at risk for high mechanical power and lung injury.  This is described in a paper by Brochard et al. from 2017. Here you can see that with initial lung injury, there's capillary leak and lung edema, and  then increased respiratory drive, and then the potential for these big intrapleural pressure swings creating increase in mechanical power, PCILI exacerbating the capillary leak and  lung edema and creating a vicious circle. So some of the leaders, niche leaders in mechanical ventilation of ARDS had recommended  in a paper in JAMA 2020 actually presented a table, and in that table pointed to the fact that prior to intubation, in their opinion, we needed to consider PCILI, needed to avoid  vigorous breathing and recognize the potential for lung injury from big intrapleural pressure swings from spontaneous breathing, and in a subsequent paper published not long after  this had an even stronger statement about perhaps considering a low threshold for intubation in order to better control mechanical power.  But again, a counter from the academic community with another group of well-known experts in mechanical ventilation offering caution about early intubation in mechanical ventilation  in COVID-19, pointing to the fact that this is all chalkboard logic and to let it influence decision making without further evidence was perhaps not the best thing to do, and  this back and forth exchange in peer review journals has persisted at least through November.  So in the final section of the talk, I wanted to discuss coping with conflicting COVID-19 clinical care information.  This is the way it was for us at Cooper back at the height of the first surge, now being in the second surge, occasionally confusing with the HNL phenotypes, cytokine storm, which  I did not talk about, treatment choices listed on the left. Some of these have become clearer now as we are in the midst of the second surge.  Some of these have been clarified about drugs that work and don't work, cells that don't work and do work or potentially could work.  The earlier late to non-invasive ventilation along to extend proning ECMO and withdrawal of support.  What we did here at Cooper that I wanted to offer to those here today is we created a biweekly WebEx conference to try to deal with some of this conflicting information.  We had anywhere from 10 to 16 treating physicians and physician extenders on these calls twice a week for about an hour. We shared personal experience.  We discussed new literature and everyone's take on it. We discussed difficult cases that were currently in the unit, decisions that were being made  and why, got input from the group, and were able on multiple occasions to move toward consensus and some standardization.  The example I'll use with PEEP setting strategy is after a lot of discussion and looking at the literature, there was general consensus of using driving pressure in preference to  ARS-Net PEEP tables, which in actuality many of us were already doing. It also incentivized us to set up a program that would give us capability to measure the  recruitment to inflation ratio, which at that time we were now seeing more and more chalkboard logic as to why that might be perhaps a better way to set PEEP.  In closing, how different is COVID-19 ARDS from a traditional ARDS and how should that affect management?  Going back to March 2020, I think a lot of us felt that this was going to be a very unique, different form of ARDS.  I think by December of 2020, the pendulum has certainly shifted back significantly to the center as we get more and more information. I think in the end, where will it be?  Perhaps a little bit still toward COVID having some unique characteristics. Certainly one that I don't think anyone would deny is the very strong procoagulant thromboembolic effect.  So I'll stop there and say thank you. Thank you very much Dr. Dellinger for an outstanding talk. Our next speaker also needs no introduction.  Dr. Judy Jacoby is a critical care pharmacist with 38 years of bedside experience in a variety  of critical care specialty units, including as a program director of a critical care pharmacy residency.  Since leaving bedside practice, Dr. Jacoby has been a senior consultant with VisAnt Incorporated with a focus on medication safety, IV therapy, and the pharmacy practice model.  Dr. Jacoby is a past president of SCCM and a founding member of the CPP section. She's also a past president of the American College of Clinical Pharmacy.  She'll be speaking on Between a Rock and a Hard Place, Are Early Results from Preprint Servers and Press Releases Helpful or Harmful? Dr. Jacoby, take it away.  Thank you Dr. Cooper-Smith and very happy to be here presenting for the 50th anniversary of SCCM, a very exciting virtual event.  I have no disclosures relative to the content of this presentation, but obviously if you see my picture, I came through the pandemic with a different hair color, but if that's  the worst change that I had over all that time, it's nothing to be too concerned with. We were confronted with a whole variety of different challenges over the last year and  as a consultant, one of the roles that I could have was to support my fellow clinicians by helping to collect and summarize the plethora of new literature that was coming out by the  bucketfuls every day.  One of the things that we were confronted with were a variety of press-related briefings.  Obviously everyone was stressed and the press was trying to do what they could to help inform  people that indeed we were learning and progress was being made, perhaps to boost some optimism,  perhaps to boost some stock prices, or perhaps to just inform clinical practice, but there was obviously an element of political opportunism as a part of it as well.  Very early on with the hydroxychloroquine hype, certainly as a clinician I evaluated a ridiculously small study that had numerous defects and yet all of a sudden here was a  product being hyped in a number of different places. I did my research on the author and discounted that data pretty quickly, but obviously that  persisted and frankly in some places still persists. But just some of the notable things that happened, certainly in April we were introduced to  remdesivir as a promising treatment according to the Act 1 study and perhaps kind of pressured into it, but released by Dr. Fauci in a press release, probably on a Friday.  That was a challenge for us to interpret that, but a little less problematic since we didn't have access to that drug unless we were in the clinical trial.  In May we heard some preliminary results from the Moderna Phase 1 trial and certainly stock prices surged for them.  June we had the recovery trial and this was probably the biggest challenge to clinicians because suddenly a product that we did have readily available was being discussed without  access to the data to really help us understand the nuances of the patient population and timing and a variety of the circumstances of its use.  So certainly for those people who were in favor of steroids, at least at some point in the treatment of ARDS, that was perhaps a confirmatory of their bias.  For those who were skeptical, perhaps they were a bit more skeptical and certainly wanted to wait until they had some data before they acted.  Again, it was widely reported by the press and so put extra pressure as family members or patients perhaps had different expectations.  We heard about the antibody cocktail and some preliminary data on use in outpatients in September and certainly in November.  The press release and we're still getting these about, oh, our product is 90% effective. What exactly is that measure? What does it mean?  So we've just been challenged by a variety of different events. As I was reviewing the literature, honestly, it was my first awareness of the preprint  servers and we'll go through a little bit of their history. They certainly weren't new, but I think many of us were introduced during the early  days of COVID and one of the ones that I saw most often was the Med Archive, a preprint server that has attempted to give, as it says, preprints of a variety of different scientific  reports in trying to avoid editorials, textbooks, narrative reviews, that sort of thing. Depending upon your journal, it could be posted simultaneously or actually in some cases,  you can post to the preprint server and then launch it to the journal from that platform. It does allow for revisions at any time and they do track that as you go along.  It is funded by the Chan Zuckerberg Initiative with the cooperation of British Medical Journal,  Gale, and the Cold Spring Harbor Laboratory and so not a fly-by-night initiative by any means. That, to me, was a huge shift.  Recently we've been deluged with a huge number of articles related to the COVID-19 epidemic and so it continues to be a challenge for us.  So where in the world did these preprint servers come from? Well, it started back in the 60s where the NIH actually came up with the notion.  It stopped after a short time because journals wouldn't accept those papers. As I said, the bioarchive started actually in 2013.  In 2016, the ASAP bio, Accelerating Science and Publication in Biology, came along. In 2017, additional options from the Medical Research Council, Wellcome Trust, and NIH  as a cooperative, the MedArchive 2019, there was a change to increase access to open access sources, the JMIR, and in 2020, Science Yellow.  So a whole variety of these have really come along and so it's really not as new as we would have, at least would have been my impression.  So there are actually 44 preprint platforms, about half of them are independent, some owned by a variety of not-for-profit groups or some by for-profit publishers for the most part.  Most of them do a little bit of screening and from those sites can publish in any peer reviewed journal.  They may be externally indexed on Google Scholar and for the most part, they have a plan to  preserve the product as well as many of these allow a lot of updates and it keeps that record in place and provides some usage metrics.  There are pros and cons.  In theory, these were designed for faster dissemination to establish primacy. All right, I'm the first one that in COVID was a problem because people were in such  a hurry to publish their observations that a lot of the preprint papers initially came out with very incomplete data where half the patients they were observing, for example,  were still in their ICU. But the idea is to foster open science, show evidence of productivity for your institution,  and mostly to give visibility to emerging research with the opportunity for other researchers to provide some feedback and perhaps develop new collaborations and increase the option  or the number of citations that your paper might get.  Concerns might be that it could prejudice publication as we've seen some kind of preprint wars about who's really first or who has complete data.  If you post it after you've sent it to a journal, perhaps you will violate embargo agreements.  As we saw, there could very well be poor quality and irreproducible data  and maybe premature claims of primacy or priority and a fear that perhaps others are going to scoop my work because I put it out there too soon.  In the area of prejudicing publication, an interesting statement from the New England Journal of Medicine in June kind of opened up the door, I think, for use of preprint  servers a little bit more extensively on that platform.  But again, I suspect they really watch for the quarantine period as well in some cases.  Critical care medicine, looking at their website, certainly the funding source probably  has a greater impact on the embargo time before you can put it on an open access server unless you pay for open access publishing.  I think what we really have is a landscape that continues to shift. It certainly might have happened anyway, but certainly was accelerated by COVID.  We will see, I think, probably some evolving policy around these, but certainly has the potential to speed some research availability to clinicians and in a really rapidly moving  situation that has been helpful.  There are some new rules, however, that the BioRxiv is blocking studies now on COVID  potential therapies that are based strictly on computational models. And it has perhaps resulted in lower quality submissions to some key journals as observed for JAMA.  If we look at the open access preprint servers, that is typically a situation that the data flows a little bit more readily and probably could end up being a bit more of a model for  some of the other journals to allow the data to flow a little bit more readily from preprint  to the publication status.  What's the effect of these preprint servers?  This was an evaluation of proposed COVID treatments that were posted on MedRxiv and in journals  and comparing their altmetric attention score, and it was higher for those articles with preprints.  But really, truly the only thing that was statistically different was the number of citations was higher if you had previously published a preprint.  A similar evaluation, again, found a higher altmetric attention score.  The news certainly figured out how to pick up these and did result in more page views  with the use of open access. So it does seem to have some benefits for individual researchers. So where are we going with all of this for future of scientific communication?  Well, the horse is out of the barn and I think we're gonna continue to see the use of preprints and press releases.  For a clinician, I think it makes us have to be really critical in terms of what's the motivation for release of data, certainly via press release.  It's gonna try us all in terms of our patients to be able to wait for at least a portion of the data and improved interpretation. And I think it's gonna be important for clinicians  as we get some of this early data to have a vehicle to get some perspective and opportunity for discussion. And we're gonna hear a lot about social media.  That to me has been an incredible resource for gaining perspective from other individuals and clinicians. Gosh, because the world's a bell-shaped curve. We've got skeptics.  Is this too good to be true? Is this even feasible? What are the risks? What are the alternatives?  And how should we really incorporate all of this? And I think clinicians can look at themselves a little bit and say, well, gosh, what's my practice? Am I an early adopter?  Do I like to try new drugs when they come on the market or would I rather wait and see what some of the other experience is?  Just be aware that others may be an early adopter if you're not and you have to  perhaps find some common ground. As I said, the social media has been an incredible help with Twitter and various virtual journal clubs, but by all means, when we can,  need to get the data, read it for ourselves.  Normally I wouldn't say wait for guidelines. I've been involved in a lot of guidelines and it takes years sometimes for us to publish those.  I have to admit the NIH guideline process and certainly Dr. Coopersmith could reflect on that a little bit in the question.  They've been able to turn around some guideline recommendations incredibly quickly.  And as I think we'll talk about, we really have the opportunity to use our local teams to design utilization guidelines that are going to work the best in our situation.  And so I just hope that we never feel like anybody is going to be completely alone in this endeavor of trying to interpret new literature  that we've got all kinds of people around us that can have input and really help to give us a much better basis for our assessments. Thank you. Thank you so much Dr. Jacoby  for that really interesting talk. Our next talk will be from Dr. Sapna Kuchadkar who's an Associate Professor of Anesthesiology and Critical Care Medicine and Pediatrics  and Physical Medicine and Rehabilitation at the Johns Hopkins University School of Medicine. She's the Associate Vice Chair of Research  in the Anesthesiology and Critical Care Medicine and the Director of Pediatric Critical Care Research at Hopkins. Her passion for social media to connect  the global pediatric critical care community has translated to her role as the Associate Editor of Social Media for the journals of both Pediatric Critical Care Medicine  as well as Critical Care Explorations.  She'll be talking on preaching from the rooftops while drinking from the fire hydrants. The role of hashtag so me in science dissemination.  Dr. Kuchadkar, I am not on social media at all and so I am very much looking forward to your talk. Wow, wonderful. Thank you so much Dr. Kupfersmith for that kind introduction  and it's an honor to speak at the 50th Congress with these esteemed colleagues on this panel. A very hot and timely topic. So with no further ado, let's get started.  I don't have any disclosures other than the fact that I am the Social Media Editor  as Dr. Kupfersmith mentioned for both PCCM and Critical Care Explorations. It's a volunteer position, but obviously it does color some of my views  on social media in the pandemic and beyond.  I do need to remind you to engage on Twitter at SophnicAMD is my handle. Hashtag CCC50 is the official hashtag for this entire Congress. And some of my near and dear hashtags  are hashtag pedsicu. I am a pediatric intensivist and anesthesiologist and hashtag so me.  So this is often the reaction that most people have when we talk about using social media professionally, right? We're all used to the notion of posting photos  of the holidays on Instagram and Facebook, but sometimes the thought of using professional social media can be very daunting and it's obvious why, right?  There are many different social media platforms that are used across the board for many different reasons and it can be overwhelming.  However, there is no question that social media has impacted our Society of Critical Care Medicine and this Congress and Congresses and meetings across the globe and beyond.  This is a hot off the press publication on the growth of the digital footprint of the Society of Critical Care Medicine Congresses starting in 2014 through 2020.  2014 with the inception of a social media committee as part of SCCM. And as you can see here just in 2020 alone, last year, we had 117 million views  of SCCM Congress content across the globe and this was just before COVID-19 was declared a pandemic.  So it's a small world, but we've run in very big circles, right? So even though there was a finite number of people in the convention hall at the time for the Congress,  clearly the message went broadly.  So today I'd like to focus in the next few minutes, I can't talk about the good, the bad and the ugly of social media because we have to acknowledge that all of those things exist.  However, today I'd like to focus on the good and how we can potentially utilize social media to disseminate information in the pandemic and beyond.  So nothing to fear, why social media? And I'm going to focus specifically on Twitter to stay focused here. We wanna compliment lifelong learning in real time.  It enables us to initiate collaborations and interface with the international pediatric critical care community, adult critical care community and beyond.  And there's multiple different hashtags or keywords based on your specific interests. And I put just a few of those there. Being a part of timely and relevant conversations,  timely is of the essence here. Enriching our conference experience or long distance participation. All of us are at SCCM virtually from home or in our offices,  but we can still interact with our global community using for example, Twitter. But the most important reason is to expand our education, clinical and research networks,  and really to disseminate science and get out of our bubbles. We have to get out of our bubbles. So what do I mean by that? Well, let me tell you a little bit about  why I got so excited to join social media professionally. I had to do some self-reflection myself and I had several bubbles that I needed to acknowledge.  I had a pediatric critical care medicine bubble, academia, pediatric anesthesia. I live and work in the United States and I work at Johns Hopkins Hospital,  it's a large academic institution.  So social media expanded my bubble very quickly. And I realized that I was living and working in one environment, but I had so much to learn from my global community.  And this is just one picture of the people that I interact with across the globe on almost every continent each day. In 2017, when Dr. Pat Kohanek asked me  to become the social media editor for PCCM, we wrote a foreword. And I think this sentence really captures exactly why I'm so passionate on this topic  and why we need to capitalize on social media in a pandemic in a positive way. It's evident that we have much to learn from each other  and the cycle of local to global communities of practice can be fueled by leveraging social media. Pre-pandemic cycle of local to global communities,  which is exactly what we have done as you would all agree in 2020.  In fact, we have international social media ambassadors because we realized we can't just tweet in a specific time zone. We need to make sure that we're tweeting  in several languages, that we're sharing information across the globe at times that are convenient for all of our leadership.  So there are multiple benefits to social media for professionalism. I'm gonna focus on the learning and the teaching, but there's also the facet of protecting  and controlling your online reputation. So let's talk a little bit about the learn and the teach.  How do we keep up? Even before COVID-19 was declared a global pandemic, the amount of literature coming out on a daily basis  in our specific areas of expertise and interest was massive. It was virtually impossible to keep track of the data and the literature then.  So social media became a way for me and my colleagues to filter content. So while you may think, oh my gosh, it's overwhelming to have all this information out there,  social media can actually be a way of making sure the content that you want comes directly to you. Following others with similar interests  and bringing that relevant content where it needs to go.  We do know that tweetations, we talked about the altmetric score, you heard about that from Dr. Jacoby, we'll talk about that a little bit more momentarily,  occur earlier than citations. There's no question that the papers that are going to have a broad impact and get cited later on are going to be the papers  that have the highest impact early on as well. Now it is possible to get negative attention for a paper, but for the most part, when a paper gets a lot of attention,  it clearly is going to have a global impact and a clinical impact as well.  All of the large journals have adopted social media broadly in the dissemination of the articles and their journals specifically,  you see JAMA, New England Journal of Critical Care Medicine, the Lancet, the DMJ, and a lot of our subspecialty journals as well, all have robust social media presence.  And if we felt like we were overwhelmed by all of the literature, the COVID-19 literature has gone above and beyond in making us feel like we're drinking  from a fire hydrant constantly every day. And those numbers are just going up. At the very beginning, we had no literature, and then all of a sudden now we've gotten to a peak  where journals are publishing the papers, getting them out there,  and it's overwhelming.  For example, Critical Care Medicine, CCE and PCCM as the SCCM journals have done an excellent job of getting the information out there and making it freely available to the masses.  So you can actually go to the SCCM website and find all of the COVID-19 articles. You'll see this little orange tag shows that it's available, it's COVID-19 specific,  and it's free for download and readership.  There has been a multitude of different articles published on the role of social media and COVID-19 in terms of information dissemination,  not only reliable information dissemination, but also misinformation. And we will touch upon that momentarily. I'd like to use though one paper  and one example from our Peds Critical Care community. So on March 15th, 2020, when COVID-19 was declared a pandemic, we decided we needed to start sharing  information across the globe with our Pediatric Critical Care community. We already had this established hashtag. So we decided to start using hashtag COVID-19,  which is the most commonly used hashtag for the pandemic along with Peds ICU to cohort information in one place because it was getting really hard to keep track of it all.  We created a shortened bit link in order to get people to all of that information at once. And then we took it a step forward. Myself and Christopher Carroll,  who's one of our former Social Media Committee Chairs as well for SCCM, decided that we were gonna study it to see how rapidly this information went across the masses.  And what we found was truly extraordinary. So you heard me talk about SCCM Congress, and obviously Congress brings a lot of tweets along the way, about 9,000 tweets at the time.  And then when COVID-19 was declared a pandemic, you see there was this increase in discussion about COVID-19 in the Peds community. And as many of you know, in pediatrics,  COVID-19 wasn't affecting kids in the acute phase of illness. However, something really extraordinary happened here in April and May, and we saw a huge uptick in discussion  about COVID-19 in pediatrics.  Why did that happen? Again, the power of a hashtag, the power of social media. We saw that hashtag Peds ICU and hashtag COVID-19 were used synonymously  by the Pediatric Intensive Care Society, now the Pediatric Critical Care Society in the UK, to describe this Kawasaki-like syndrome that was potentially associated with COVID-19.  And now we know that as MISC, which does impact kids significantly. This one tweet had 7 million views across the globe. And because social media was used in a knowledgeable way  to disseminate that information, it got to all of us very quickly. We didn't have to wait for a paper. We started to see the hashtags that were most highly used.  We started to see the links that were used. And these are all links to reliable information, which was critically important to us because we wanted to make sure  we weren't sharing misinformation or providing a platform for misinformation.  And our network continued to grow. And these are the top 50 tweeters regarding COVID-19 information. And these are all people who tweet reliable information  on a daily basis within our community.  So our conclusion here is that it was imperative moving forward that our critical care leaders familiarize themselves with social media as an essential resource  to ensure we have reliable content expertise and international representation. Since social media is a central component of the educational armamentarium for interprofessional staff  caring for critically ill patients worldwide, both during and beyond the pandemic.  Communicating our science is often seen as self-promotion. If you're publishing a paper and you put it out there on Twitter, oh, they're just trying to get their profile higher  and get more followers. But I would argue that it's also our duty to do it responsibly. Yes, it's great to get your work out there, but we need to share our science responsibly  in order to have an impact on public health. And I love the title of this article. A crisis in science literacy and communication does reluctance to engage the public  make academic scientists more complicit. We need to ask ourselves, are we being complicit? Because otherwise, we are actually going to boost the spread of coronavirus misinformation  as opposed to science on social media.  So we need to preach not only to the choir, but we need to sing from the rooftops. It's not enough to just talk in our little bubble of intensivists or pediatric intensivists  or adult intensivists or surgeons. We need to talk to the public. We need to talk to the people who are making the decisions, who are advocating for public health.  We need to get our science out there.  This is another great example from JAMA, the clinical characteristics of 58 kids who had MIS-C. And the first author actually tweeted this paper out. Now it's a JAMA article.  It was likely gonna get a lot of attention either way. However, this author tweeted her paper out and within 24 hours, it was already in the top 5%  of all research outputs scored by Altmetric. And with that larger network, this is as of a month ago, 951 Altmetric score. This paper is very commonly used in the literature  when we're citing and talking about management of our patients in the ICU. And as you can see here, it had international reach,  but the most important thing, it's members of the public that we're actually having an impact on. So again, letting people know what we're doing, what we're learning along the way.  I have recently asked some of my colleagues on MedTwitter, social media, why they thought social media had benefited them in their own practice.  It's facilitated access to information and improved communication between colleagues across the world. I hope all this leads to an improvement in our own clinical practice.  Here you see Dr. Balut says, I agree with all that's been said during the pandemic. So me, Peds ICU proved to be essential, not only dissemination of the most current information  and patient care experiences with the most remote part of the world, but also establish a sense of community and support for each other. And I think this one really hits home.  Again, in our ivory towers, large academic institutions, we have to remember that for lower and middle income countries with less access to academic conferences,  free open access journals, it helps them stay abreast of what's happening and discussion and trends. And if many people are talking about big studies,  it's helpful to read the articles, see the debate unfold. It makes the world feel smaller and flatter.  So in my last 30 seconds, I just want to say that it is okay if you are on the outer rungs of these levels of social media engagement, being a lurker is totally fine.  If you don't take in the information, you can't benefit from it. So just watch what's happening in the conversation and over time, follow, engage, endorse, and finally contribute.  So what do you need to do? Get a professional Twitter handle, follow people and thought leaders and organizations who share your interests, share links to yours and others' papers,  reference the journal if they have a handle, encourage all trainees and faculty to join and follow specific hashtags and post anything educational  for the critical care community, citing the source.  But as Dr. Jacoby already said, it's important to not just read the highlights or the abstract, read the whole article,  beware of eminence-based medicine, EVM, and double-check surprising and exceptional news. And that applies to research papers as well.  I will finish with my basic social media rules, which I always do, it's very important. Don't ever sacrifice collegiality due to a difference of opinion.  Don't ever give specific medical advice or diagnose online. Don't write about actual patients or cases. Don't forget to cite the source.  Don't post slides of unpublished data without permission. And finally, remember that a post lasts a lifetime.  Sharing information is the only path to new knowledge. I look forward to seeing all of you out there on the Sony. Thank you.  Thank you so much, Dr. Kuchadkar.  The truth is, if there's a level zero below the level one, below a lurker,  that's where I am. For full disclosure, and she knows this, I had to actually ask what a hashtag so me was, whether it was pronounced so me or some.  So I learned a lot from that talk. It's the perfect start. And we're going to go along the same theme in the next talk from Dr. Scott Weingart.  Dr. Weingart is an ED intensivist from New York who did fellowships in trauma, surgical critical care, and ECMO. He humbly says he's best known for talking to himself  about resuscitation and critical care on a podcast called MCRIT. But truthfully, the podcast known as MCRIT has been downloaded over 40 million times.  Dr. Weingart is going to speak to us about independent medical social media is essential, powerful, and dangerous. Take it away, Dr. Weingart. Thanks so much, Dr. Kuber-Smith.  And it's wonderful to be talking to Society of Critical Care Medicine on their 50th anniversary. It's the only organization I could still tolerate.  I've been either kicked out or left voluntarily from all the others. So this is kind of my home. As Dr. Kuber-Smith mentioned, I am an ED intensivist.  I spend my time only in an ED ICU, so just seeing the sickest patients for the first 24 hours of their care. My conflicts of interest are actually the topic  of my conversation today. I run a site called MCRIT.org where we discuss resuscitation and critical care. I'm actually a member of a team there. We have two EM critical care docs  and one pulmonary critical care doc. And the lens by which we operate is aggressive bedside clinical care. We all work in the trenches. None of us have high leadership positions.  We are just taking care of patients on the everyday basis. My two partners have an extensive background in methodology and my background is in bedside translation of research.  And our site is free open access medical education, meaning you don't have to pay for it and you don't have to go through a paywall or a password protected server.  You just come and you read and you comment. It's long form, it's edited. And as we will discuss in a bit, it is peer reviewed. We are amongst the top three medical blogs worldwide.  And I think at this stage of the game, we are the top medical podcast in this space. And this represents a different form of social media than what Dr. Khachatkar was mentioning  in terms of Twitter. This is long form. This is the essentially filling the same space as what review articles would have in traditional medical journals.  We take research, we analyze it, we translate it and then we try to disseminate it to the world. But what we also offer that is not commonly seen in traditional print journals  is tacit knowledge transmission. How we actually do things at the bedside.  The stuff you'd normally find in the hallway, talking to one of your colleagues about a rough case. This is now providing a forum for that form of knowledge transmission,  which really has not been offered in the past. This wasn't a traditional outlet of traditional medical research publications.  And the other thing a independent social media outlet has is agility and speed. We don't need any approval. We don't need any pre-checking of our work.  We could put it out with an immediacy that really benefited the specific conversation we're having today, which is COVID-19. And COVID-19 for us was an acid test  of everything we'd been doing for the decade before. Because it was like nothing else we had ever seen, at least in our lifetimes of clinical practice,  nothing else compared to the COVID-19 surge.  All of us were on the Eastern Seaboard. So we were seeing a real impressive level of case presentation during the first surge. And the conflict of information  that Dr. Dellinger alluded to really belied 15 years of my clinical practice. I'd seen nothing like this.  In the past, hypoxemia was a shorthand for a patient who was gonna clinically decompensate very quickly. And it was an easy way to say a patient needed intubation.  And we did that initially, much at the urging of the other, both research and organizational outlets out there. They told us intubate early. If a patient sat was less than 90%,  you might as well just intubate. And we were doing that. And we rapidly ran out of ICU beds. And it wasn't making a lot of sense because these patients did seem different.  And I agree with Dr. Dellinger that once these patients are on the ventilator, indeed, the pendulum has swung pretty close to center. We're pretty used to these patients.  It's not that different. I still have not had elucidated to me a very different clinical presentation before they're on the ventilator.  I've still had no one explain to me how this works and why these patients look the way they do. It's still, for me, unexplained, uncharacterized,  and the best treatment for these patients, still not elucidated. So I felt the need for more guidance, as did my colleagues at the site. And the publications that were being put out  in the preprint service that Dr. Jacoby mentioned were overwhelming. And we were having trouble parsing through the literature. And this is what we do on an everyday basis.  On the second day of March, 2020, my Palm Creek colleague, Josh Farkas, put up a COVID-19 information page. And I put up a page on how to manage airway in a COVID-19 patient.  And for both of us, we were either working in our ICUs, or we were sleeping, or we were updating these pages based on the best available evidence.  And we weren't just using local experience. We had doctors in China and Italy who were also on the front lines, constantly feeding us their experiences.  And these pages were updated essentially minute by minute. And we made deliberately a bias towards what we really know, rather than a fleeting back and forth momentum.  Because as new data emerged, if you were just gonna fly by what the wind was pushing you towards, it was a very dangerous thing. So we really stood on a bedrock  of a Bayesian approach to all of this. We would only change if it was a real alignment of what our previous beliefs were from our experience in critical care  and the extent research. And only then, if it agreed with that,  would new literature push us to make a different recommendation. And what we discovered is that people were desperate for this form of tacit knowledge transmission  in the midst of this epidemic. We went from 25,000 unique page visits per day, which wasn't too shabby, to 250,000. So an order of magnitude increase in the number of viewers.  And in some ways, that was very scary and very costly from a server maintenance perspective. But it just showed that there was nothing out there  supplying what people felt they needed, which was alternative information stream. And this is really the essence of what I'm talking about today,  is that conventional publications are absolutely essential.  The journals are totally necessary. They are the best pipeline for research transmission.  But there needs to be alternative streams as well that can translate that research to bedside utility, that can provide a path to the tacit knowledge  that people so desperately need. The genie's out of the bottle. People are not gonna go back to not having those alternative streams.  So if independent, free, open access medical education was not out there, people would not just go back to occasionally grabbing a journal from their pile in their living room.  They're going to go to alternative sources. And some of those sources are good. Like the well-orchestrated Twitter that Dr. Kachatkar mentioned is a fantastic source,  but there's also a lot of garbage Twitter out there. And Facebook is a cesspool of bad information and bad motivations. And YouTube is potentially even worse.  The preprint servers that Dr. Jacobi spoke about are dangerous. I feel their anathema in their current iteration. And then the lay press is solely looking for eyeballs  and their motivations are aligning them to pathways that potentially put us in very dire straits from getting accurate information that is unbiased.  Dr. Dellinger's institutional WebEx that they were doing every couple of weeks is a perfect example of a workable solution to this problem. But if he took that WebEx  and opened it to a world of experts occasionally, and then disseminated it worldwide as opposed to just within their institution, what he would have essentially created  is an independent form of social media. And if he gave those watchers of his videos the ability to comment, he would have what is in essence what we create at MCRIT.  And I agree, it is essential and powerful. And unfortunately, in some ways, once you disseminate to the public, potentially dangerous.  Now, on MCRIT, we have immediate and robust peer review.  The second I put out a mistake, I stick my foot in my mouth, I hear about it on Twitter, by email, by immediate comment response on the blog  with an alacrity and immediacy that scares me sometimes.  And I am humbled by the robust feedback I get. And I have the ability to change any errors instantaneously.  My community is some of the best in the business. the people who listen and watch the MCRIT product scare me with how eminent and powerful they are in the worlds we traffic in.  And I got buddies with similar sites, Rebelliam, Life in the Fast Lane, St. Emelan's. Those sites have no problem with peer review. And I'd say this peer review system in some ways  is better than the journal peer review. The danger comes that small sites that don't have a big audience don't get this same level of peer review.  But the problem is these small sites look like the big sites. That's one problem in the arena of independent social media sites, is small sites look like big sites  and small sites do not get peer review.  The standard social media outlets, Twitter, it's designed to lack nuance. It's designed to make you say just snippets of what you'd actually wanna say,  and that's built to create arguments. Facebook actually has an algorithm that alters who your articles reach. And if they're good scholarship and they're unarguable,  then they don't get big dissemination. Facebook will only send them to a 10th of your audience. On the other hand, if they're controversial,  if they cause debate, if they cause people to be miserable, then the algorithm sends it around with a massive surge of publicity. The algorithm wants to piss you off.  YouTube is perhaps the most dangerous thing out there. Even though it is one of the best sources of information, video speaks even louder than words.  But the problem is production value used to be linked to respectability. You could not afford the $250,000 to make something look good unless you had an organization  and that organization was vetted. Now, with a couple hundred bucks and a desire to give misinformation, you can make a video that looks just as good as CNN's  without too much trouble in your bedroom. And as a result, there's been a massive influx of dangerous conspiracy misinformation spread on YouTube.  The lay press is no better at this point. They're part of the social media economy. They're playing by the same rules as people trying to get popular on Twitter and Facebook.  And as a result, they've lost some of their standing as independent vetted sources. I gave a lot of lay press interviews and I stopped doing it  because I'd give an hour long discussion with them. And they just take out of context the five minutes that were most controversial and put that as their article.  And then the problems alluded to by Sapna about the fact that my site at least does not engage the public. And therefore the public has to go to other sources  rather than good scientific based medicine to find information is an enormously unaddressed problem. But for all those dangers I just laid out,  robust independent social media represents the best source of alternative information streams to back up the research published in traditional journals.  It is the best site and way of transmission of tacit knowledge and research translation out there. And it's not going away. So we need to learn to use it as best as possible  for the good of all of the people out there, both practitioners and lay public. And with that, I thank you for your attention. Thank you so much, Dr. Weingart.  I confess I'm a little bit intimidated because you're obviously equally clinically to me, but you seem to have an entire media empire and I'm a little bit intimidated right now.  Having said that, we're going to go to questions. Again, for those listening out there, we're gonna do about 25 minutes of questions and I'm gonna sort of moderate,  but then on actual day when you're listening to this, we're gonna have about 30 minutes or so for you to put questions into the chat room for everybody listening right here.  And we are gonna start with you, Judy. So you talked about how there were lower quality papers this year.  You also talked about the preprint servers.  How do we find the sweet spot between something which is incredibly important? So when stories come out, there's a press release that says steroids save lives in our patients,  and not like a 1% difference, a massive difference. And if you're waiting for that to come out in the New England Journal of Medicine, you have weeks and weeks and weeks to wait.  And while Scott says it's anathema, at the same time, those are lives that we could be saving. So how do we find the sweet spot  between impact and rapidity and peer review and quality?  Well, specifically talking about press releases, I think that if there was more than a two-sentence summary of the results, at least a data table that could be a supplement  to the press release, anything to give people a little bit more framework would certainly go a long way, especially in the setting where something  like dexamethasone is being discussed and it's readily available,  and we can turn around and use it tomorrow, because hopefully we all have a lot of it.  But if it's something that suddenly, it's a product that's not readily available, tocilizumab was discussed early on for the quote-unquote cytokine storm.  Well, that's not something that people start routinely unless you were a CAR-T center,  typically, or a bigger facility, and even then you only had a couple doses. And so it's not something that you could turn around and start to use readily anyway,  and comes with significant risks. So I think that if there was an effort from the folks writing press releases to be a little bit more informative,  that would certainly go a long way.  I'm sorry, Jayne. Oh, well, I was going to, so I'm open to comments, because I was going to talk now about the preprint servers. And so if anybody feels differently,  or if that's unattainable, perhaps I'm unrealistic.  Yeah, I'll make a comment about,  you know, as a associate editor, and on the Editorial Executive Committee for Critical Care Medicine,  it's competing agendas. One is to publish things rapidly, and two is to be careful to not publish something that's problematic, because you rushed it out, and there's a balance.  And I think we saw some examples of when the balance shifted too much to getting papers out sooner.  But I think that's, and it's not bad that you're trying to get things out sooner. And if you are in a regular cycle,  there's a lot more time, there's frequently more reviewers,  there's probably even more front-end work done by the authors. So it's the effect of the emergent,  urgent situation you're in.  Let me follow up on that with first Scott, and then Sapna. And Sapna, it looks like you're muted right now.  So Scott, what counts as enough evidence that you're going to say, I'm going to talk about this. Clearly, New England Journal of Medicine, CCM, you're going to say,  I'll talk about it. One-page press release, one-line press release, what's enough for you to say, okay, I'm going to put this out there in my alternative media?  Yeah, it's a fantastic question. Even when the entire piece was placed on a pre-print server, we were reluctant, because we watched them change in real time.  As we tracked these publications, and folks were going on YouTube interviews for these sessions, and we then go back to the article, and we'd see completely different things  day-to-day from what they actually said. So we were reluctant until a finalized format was placed out there to make any definitive statements.  Now, we'd say there seems to be something brewing up, but we'd always hesitate to not propend that with the idea that this is very tentative.  And to add on to what you were saying earlier, Craig, is I would love pre-print servers run by an organization like Society of Critical Care Medicine,  with a little bit of vetting done on the front end before they appeared on the pre-print server. It's the Wild West nature of these things,  where all of the motivations were left unsaid and unknown as to why these were going up that made me so leery. So Sapna, let me follow up on that. Let's go to the Wild West.  So you're not in your role as social media editor for CCE and PCCM right now, but you're somebody who uses hashtag so me, something I've learned about in the last hour and a half.  What's your threshold? It's something that could change patient care tomorrow, but it's the Wild West, and you just have a couple of lines. Where do you go? When do you tweet?  Yeah, no, so this is my personal bias is I completely agree with Scott that it is the Wild West, and I am extremely wary of tweeting about any of the pre-prints that are out there,  regardless of the broad public health impact that they may have, primarily because you have to also be aware of your audience. And I'm aware that many of my audience  are young trainees and junior faculty, and potentially a lot of people who are quite impressionable. And if someone like Scott or myself or anyone,  even you, Craig, who's not on social media, if you tweeted about this,  that people would listen and people actually care what you say. And so I have to say, I'm extremely conservative about sharing these things on social media,  unless I feel that I can make a determination for my own practice or how I'm gonna use it in my own clinical practice, that everyone has a different approach to it.  Some people just will go out there and start lambasting an article or vice versa, start talking about, extolling the virtues. I feel that there is a very real danger in that.  And again, I'm never gonna know the impact of my words on social media, right? There's no way of knowing what someone's gonna go do at the bedside  because of something I might've said. I'm not trying to say that my opinion is going to change someone's practice, but little bits and pieces put together  may change someone's practice. And I think that's really important to remember.  The Ivermectin paper was a brilliant example where it appeared in a pre-press from the Surgisphere supposed database.  And for those places that have, and those individuals who are willing to kind of latch on to a variety of different things that may or may not be well evidence-based,  Ivermectin has become a hugely utilized therapy  in South America, extensively related to that preprint article, which was retracted. And so indeed, that's a good example of the implications.  Now, I have to admit though, Scott, so I'm intrigued because I didn't regularly go back and re-review those preprint papers. So it appears from your comment  that they were revised in response to feedback from other researchers or other individuals. And because I just, especially in a COVID world,  find it hard to believe that there were people who had the time to do that and actually take care of patients. But so this notion of gosh, we're going to get immediate feedback  and we'll produce so much better final paper. I've been very skeptical that that occurs, but perhaps there are things behind the scene that I wasn't aware of.  Oh, it was just the opposite. It was people that had, and this is my opinion, sketchy motivations to begin with, and then people start providing negative feedback  that really eliminates the thrust of what they're trying to accomplish. And they would revise to address those criticisms in real time to support a more powerful message  for what they were trying to get across. So their motivations were, their motivation as to why they would revise so quickly made complete sense, even if the actual desires they had  were not necessarily for the good of all man and womankind. Interesting. There's also the factual statement that papers change between pre-print and peer review  because they undergo peer review. And so two things happen. They undergo peer review, but also the data changes. You would think the data doesn't change, but in the time of COVID,  you have, this is my one week follow-up or two week follow-up. And somebody says, okay, can you give me a one month follow-up? It's very easy to say in the ICU,  your mortality is X if you have two day follow-up. Your mortality might be Y if you have 30 day or 60 day follow-up, which can very much change your outcomes. In non-COVID times,  you would never get through a peer review with this is my three day follow-up. In a pre-print review, you might. And that did happen with the hydroxychloroquine papers extensively.  I think your initial point, Craig, about just the peer review process, right? Regardless of where it occurs, anyone who reviews a lot of papers for journals,  any journal knows that there is a massive amount of work that goes into many publications in order to modify them and get them to a point where they're ready for publication  and put them out there. And that's whether it's a statistical technique or the messaging, there's so much nuance and finesse that goes in  that the reader never sees on the back end, right? They see this well presented paper in a highly prestigious journal, but often as a reviewer, you have helped them make this paper,  hopefully much better. And often I know the authors don't always see it that way, but hopefully the combined process of the three or four reviewers makes it better.  And just to me, it's kind of scary to know that like this stuff is getting out there without anyone looking at it, right? And I think that's to me,  that brings me the most trepidation. Yeah, Phil. So, I mean, I think there's some aspects of this that are not new to the COVID era. I think that I'm aware of situations  where papers are published with different endpoints  and what were posted on clinicaltrials.gov.  And I think that's an area where often reviewers and even associate editors don't go back and look at clinicaltrials.gov to see what the analytic plan that was posted for endpoints,  whether it jives with the publication.  So, Sam, let me ask you, because Judy's brought up a couple of very hot button stories, one of which I think is fully concluded and one of which I would say is ongoing.  I would say hydroxychloroquine is concluded and ivermectin is ongoing.  But in both of them, there's a fairly robust social media network from people outside of medicine, not just outside of critical care and not outside of ID,  but outside of medicine entirely,  whose social media networks frequently are much broader than ours are. How do we handle it when the message goes outside of us and the lay public hears about it  and some of our colleagues hear about it and they don't have the nuance to listen to MCRIT? Right, I think that is the biggest challenge of being on these platforms,  is your audience is your audience and you can tweet as much as you want and share as much as you want, but your audience is only gonna get so far,  the bubble can only expand so much, right? And as you mentioned before, some people have 10 million followers and it's because they sent out one tweet  that went viral for whatever reason. And that even in the med Twitter community is the same as well. There's also a hashtag med Twitter, Dr. Coopersmith,  so I'll mention that as well. So I think all we can continue to do is continue to share what we feel is reliable information. And a lot of people have different thoughts  about whether you amplify those voices that maybe are sharing misinformation. For example, if I were to quote tweet, share someone's tweet that is just full of nonsense  and say, oh my gosh, this is horrendous, like no one listened to it. In a way, I'm already amplifying that message, right? So there's two strategies  and I don't know which one's the right one. I'll throw it out here to the rest of the group. It's to ignore, ignore, ignore, ignore and share reliable information,  share reliable information over and over and over again. Or it is to amplify those people and make it clear. It's very easy to get into fights.  It's very easy to get into tense situations. And I firmly believe social media shouldn't be used for that purpose. Professionally, it's a very deep tunnel you can fall into.  I choose to ignore and just continue to share what I can with who I can. I post on Facebook, which I know gets outside of my academic bubble, gets more to the lay public bubble.  So those are the ways I kind of deal with that, but there's no good answer. I'd love to hear what others think.  Well, part of the challenge is the same one that the TV press confronts.  Data is presented or as an individual,  I choose to follow more people who have the same beliefs that I do. And so there's going to be an amplification of whatever is in that realm,  good information or misinformation.  And so getting people to go outside of their bubble is going to be exceptionally difficult because they don't really want to hear it other than just fight.  So I found Scott's comments on the Facebook algorithm  to be quite revealing. And I'm just not sure that between individual behaviors  and that type of structure that there's any way that we can counter what people absorb on the outside.  So let's talk about a different type of dissemination. And you briefly talked about this in your talk, Judy.  But if one looks at 2004 or 2008 or 2012, and one looks at the surviving sepsis guidelines, the very first name you're going to see is Phil Dellinger.  So Phil is sort of like a godfather of critical care guidelines.  What's the role for guidelines in 2020 in a pandemic?  Well, unfortunately, most of the conflicting  decision-making areas can't be helped by guidelines because the reason that it's problematic for the bedside clinician is they're dealing with opinions versus opinions  and observations versus observations without any level of evidence-based medicine. And what I now see, some of them aren't mainstream,  but at least peer-reviewed journals where you have different camps of respected academic physicians with totally diametrically opposed views  about several areas dealing with management of COVID hypoxemia and respiratory failure. And it's sort of like a pro-con debate. You know, there's two types of pro-con debates  and they're usually are in areas where there's not high-level evidence because that makes a good pro-con debate. That brings people into the hall.  And then you have two people that go at each other and one of two things happen. Either at the end, they're sort of like, well, you know, your points are well taken.  Yeah, your points are well taken too. And they sort of find middle ground. And then people leave that and it's very instructional for care because they now see both sides.  And it's not like a war, but to some degree, what we've seen in our peer-reviewed journals is totally unyielding positions  and the inability for bipartisanship and crossing the aisle to try to work for something that would be useful for the bedside clinician.  That was provocative. I read them because I am a pharmacist and I just was curious as to where that battle was gonna go. So it might've been good for publications. Scott?  Yeah, you know, I found in most organizations I truck with, the guideline committees have been reluctant to diverge from areas where there's good evidence  and I understand their reluctance, but on something like COVID-19, I would like them to walk into the fray. And I would love to hear what Phil Dellinger is doing,  even in the areas where there's not great evidence. And ostensibly the people on these guideline committees have been vetted for their excellence  in both thinking about evidence-based medicine and clinical practice. So if they were allowed to have a dissemination pipe of which they could say,  all of this is an evidence-free zone, but I'm a bedside practicing intensivist and here's what I do, I think that would be valuable.  And I think the organizations have been reluctant to step into that morass. And I think they should. I think SCCM's guideline committees,  NIH's guideline committees should still comment in areas where there is no evidence on what the hell they're doing on a day-to-day basis in COVID-19.  So Craig, I'm gonna throw that one back at you because certainly SCCM members were really well represented on the NIH panels. And so give us a kind of a sense of the volume of work  that you guys did and how you came to your decisions. I wouldn't say did so much as doing. Do it, there you go. I'm on both actually. So I'm on the NIH COVID guidelines.  I'm one of multiple SCCM representatives. And I'm also on the surviving sepsis COVID guidelines of which the revision is going to be coming out probably right around the time  that you're listening to this. And they work remarkably differently actually. Not only are they different people on it because the surviving sepsis  is all people involved in critical care.  And the NIH COVID guidelines goes from the outpatient to critical care  with a wide variety of expertises going with the entire spectrum of disease but using different strategies. So surviving sepsis uses grade just like surviving sepsis uses grade.  And it's a remarkably robust way of doing it. And you come down to a very small number of grade questions. There's a PICO question and you end up  and at the end up, you can't end up with a suggestion  except as a best practice statement because grade says there's insufficient evidence. And so if your PICO question says there's insufficient evidence, even if we all say we do this,  which is probably unlikely when you have 30 or 60 of us in the room, you're left with the evidence. The COVID guidelines, they're both COVID guidelines, I'm sorry.  The NIH COVID guidelines, which are literally every single week, multiple hours, every single week, we're at eight months right now. And it's a minimum of two hours a week,  but frequently more every single week of different teams, sub teams, and then the entire panel together on Fridays. And it's three or 400 pages.  We actually struggle with this because it's not using grade. It's using, we look at the evidence and then we have A, B, C, one, two, three,  or one, two, A, two, B, et cetera. And we do talk about what happens when we take internal votes. And we say the majority of us would do this.  And we actually have waited in at times to exactly what Scott is saying, to saying we would recommend this expert opinion.  And so it gets a strong recommendation as an A3. We believe strongly based upon expert opinion that we'll do this, which is different from surviving sepsis.  And so for those who are sort of nerdy wonky, I guess like I am, who actually will look at not just the first letter, which is a strength of the recommendation,  but based on what it's based on, is it based upon an RCT? Is it based upon a subgroup analysis of an RCT? Is it based upon expert opinion? For instance, do you use remdesivir  and dexamethasone alone together? Well, there's data on dexamethasone. There's data on remdesivir. There are no data on using the two of them together.  And then you have patients in ordinal six and the such. Do you use it together? And so we actually have come up with that, but different guidelines, different things.  The moderator is not supposed to be talking. So I'm gonna stop there. We don't have that much time left. So let me see. I'm gonna ask, let me ask Phil,  the academic debates that have gone into the mainstream media, is that a good thing? Is that a bad thing? Is that an indifferent thing, both in terms of the general population  and also in terms of shaping our own practice? Yeah, I think currently it's more of a bad thing  because I think there has been no common ground,  nothing for the bedside clinician to do, but pick or choose a side  instead of being able to get  just general help for decision making.  Yeah.  So you have two credible sources  that are saying different things. And so that's not a good situation for the person that's not an expert in that area. Well, look at the treatment that Dr. Fauci has received  and the number of people who continue to go back to his early statements, who then hold that as absolute letter of the law and just can't either read between the lines  when he says something based on evolving evidence that perhaps we hear completely differently. It has left the public very confounded.  And again, maybe people hear what they wanna hear, but it has certainly been disruptive as people try and interpret his, I think eloquent statements.  Yeah.  So we wanna make sure that we leave time for you, our audience, to question us live. So is there any other final comments that anybody would like to say  before we turn over to the live portion of this?  I'll just say that when we do the live section,  I'll have much better antibodies than I do now, but I feel pretty good about having 13 days of antibodies.  I will as well. I actually got rapid tested on Friday and get my vaccine on Wednesday.  So I just wanna thank everybody for this portion of it. Again, you're gonna see us all live in person two seconds from now,  but we'll be wearing probably different clothing for what was a really, really remarkable session. And so to Phil and Judy and Scott and Sapna, I learned a ton from each of you.  So thank you. And for everybody watching us, wherever you are in the world, let's continue the conversation.  Thank you so much. And tell us your perspectives. What did you make work in your institutions? Did you find a team of people to get together to solve these issues  as you were confronted with them at the bedside?  There's some incredibly novel ideas and we wanna hear your feedback. And come up with some really tough questions for Judy.  Absolutely.  All right, see you soon. See you all. Bye bye. Bye all.  Hello, everybody. It feels like two seconds for you, but it feels like a few weeks for us. So we're going to get right to your questions, and there are a lot of great ones, so thank  you. The first question is for Sapna, and it says, as we've learned of late, social media is a tool for disinformation as well as for dissemination of knowledge.  This appears to be true in medicine as well as in other areas. Given that, should clinicians consider using or creating more moderated platforms other  than the regular platforms in widespread use, like Twitter? That's a spectacular and very hard question to answer.  So when I think about these different platforms, if you think about your own subspecialties  and within critical care, and I'm a pediatrician within pediatrics, those platforms already exist, right?  So we all already have our little platforms within our bubbles, and it's hard to imagine a platform where absolutely everybody from a stakeholder perspective that you would  want to come would actually join and be a part of it, right? There's Medscape and Doximity, and there's all these different places that people congregate,  and there's no way of kind of controlling where all those people go because they're going to go where they feel most at home.  Student Doctor Network is another place that there's a lot of trainees and a lot of folks having conversations about various things.  I think, and again, if you would ask me, should everyone go on this one platform called Twitter  that everyone and their mom can be on, and they can say whatever they want, do you think that's a good idea?  10 years ago, 15 years ago, when I had no idea about Twitter, I probably would have said, that sounds like a horrible idea, right?  A retrospective scope is a very good thing, but at the same time, now I look at it, and I think that Twitter is an awesome platform because we have access to the public.  We're not just trying to convince ourselves of what the right thing is to do. We're trying to educate everyone, and I think the broader impact we can have, the better,  and those public platforms, if we can create our own communities within those platforms, is probably ideal. But again, that could change. Talk to me in 10 years.  It might be different. There's no way of knowing. Well, we're going to talk about 10 years by talking about now and the next five years. So Scott, this question goes to you.  Should we create curriculum to teach use of digital media and social media in medical education, research, and clinical dissemination?  Is FOMED and SOMI able to teach a better way for critical thinking on open platforms without cancel culture? Yeah.  But definitively, everyone needs to be digitally literate, and I think anyone who has a career  in academics is missing out on a huge platform if they don't develop some minimal level of digital literacy.  I have a lecture on this on the MCRIT site, and the first prescription for existing in this new world is you need to exist in the digital realm.  If the only things that come up on a Google search of your name are all of those doctor rating sites, you've failed somehow.  So the first thing is to create a profile so that people can find you and that you exist and you have control over how people see you in the digital realm.  But then learning how to utilize this for both education and dissemination of your own work is absolutely necessary.  And there's already nascent stages of curriculum development, but I think it will become a standardized portion of every medical student's education.  Well, let me make that broader because we're a multi-professional society. My phone is going off and I apologize. Live and truly live.  But Judy, you're our first pharmacy president and we're a multi-professional society, so I don't want to make this about medical students or future physicians.  How do we make this part of everybody in the critical care team, every training, whether they're critical care or not?  From the pharmacist who works at Walgreens to the pharmacist that works in the ICU, from the nurse who works in the outpatient clinic to the nurse who works in the ICU, et cetera.  How do we make this multi-professional and standardized? Or can we? Well, starting at the end, I'm not sure that standardization is going to be realistic because  each audience needs a slightly different focus. But I have to admit, I'm constantly impressed within each of those specialty worlds, how  some of these social media and educational platforms have developed. And so here we are at SCCM and we're a multi-professional world and have to applaud the organization  for being multi-professional on panels. We're hearing different points of view, different perspectives of the same topic. So here we have that opportunity for sharing.  And so I think it's growing in each small world and we're probably going to need other platforms that bring all the information together.  But I go to MCRIT and a variety of other sources to get my information as well, TwitterRx has a whole group of pharmacists. But I also go to MedTwitter.  And so there's so much cross-pollinization already for folks who practice in that multi-professional  world that I think it's only going to grow in various educational and social media platforms. Can I just add something to it? I was about to ask you, so please do. Okay.  No, I wanted to just comment on another benefit of something like Twitter, for example, where  it is much broader and it's not our specific community platform. For example, I don't read the American Statistician on a daily basis.  That's not a typical journal that comes across for my field, but I have a PhD in clinical investigation.  I'm interested in this stuff, but I would never find an article that just beautifully outlaid how to write a research paper and the basics for my own mentees, for example.  But that was in the American Statistician. It wasn't in a CCM journal. I found it.  And it's been a resource that I use across the board. So I think having exposure to the whole world and all of the great things that they're putting  out and having it randomly come across your feed is, I think, one of the freshest parts of being on a larger platform like that, because we can get a lot of the same same.  It's easy to create same same in our lives, but something like Twitter can really be capitalized  on that, as long as you know how to filter out the bad noise, which I'm sure we'll talk about some more. Let's take the bad noises as a follow up for Phil.  With increased use of social media from journals, what type of security is there to monitor  retweets which may have views that don't actually match the journal or even match the authors?  It's not just a matter of monitoring how close to something that could potentially be legitimate a tweet would be or whatever social media.  But you would need to have some stick in order to really do what you wanted to do, which is make people hesitate to put out false information.  So it would have to have both to be effective, the capability to fairly judge and the capability to do something about it.  And we've seen that recently with Twitter on the political scene. And Facebook has had that for longer, but it's got to be two-pronged.  Sapna, are there any things in place in our own societal journals about that? With regards to what specifically, Craig, just to clarify?  Security of monitoring retweets that perhaps don't match the authors of the journal or frankly false. Yeah.  I can speak from the PCCM and CCE perspective, and I know CCM uses the same strategy. So we are very deliberate about the people who have control of the accounts that actually  share information from the journal accounts. We make sure that the messaging is consistent and not overreaching.  But then once that's deployed from the journal accounts themselves, there's really no way to monitor what gets retweeted slash stated about a specific tweet.  But the key is that what comes out of the society's accounts is consistent and reliable information.  And what people do with that information is really, there's nothing we can do to control that messaging.  I do think that it's really great to see that people say, oh yeah, this article is going to get a ton of social media attention, but it'll never get cited.  I can tell you that the vast majority of papers that are highly tweeted and retweeted and get a lot of attention early, and there's research to support this, are the ones that  are highly cited much later on. And it's just because that you get increased attention early on, on Twitter, citations take a year, two years, much longer to actually show up.  And I think the coolest part though, the only time we see a discrepancy is those papers that have the highest impact for the bedside providers who aren't writing the research  papers that are citing these papers. So I know, I do ICU rehab research, and it's very important for me to, for that research to reach the interprofessional team at the bedside.  So I don't care if that paper is as highly cited, as long as the people at the bedside who are doing the hard work are reading the papers, and sometimes those papers actually  get more attention upfront. So you have to be cognizant about the variability and that attention that these different papers can get. I'm struck.  The next couple of questions are going to be for Scott and Sapna, I'm not forgetting about you, Judy and Phil.  But I'm struck by the differences between sort of where your hearts potentially lie. Understanding that we use a lot of social media, because Sapna, you were all about Twitter  and Scott, you were all about the long form and saying we're very, very different. So I think Judy put in the chat room, this is all about the nuance, but let's take something  that I mentioned before, which has certainly not been solved in the last few weeks since we recorded it, and that's ivermectin.  I don't want to talk about the pros and cons of ivermectin, but how do we take something like that when there's so much passion on both sides?  And people can't even agree on what the data are. When somebody says, this is my meta-analysis and clearly you should use it, and somebody  says, I don't believe your meta-analysis because I went into the studies and I don't believe it. How do we, Scott, how do we get the word out? What should we do? Wow.  It's a perfect question that I'm going to slightly turn on its side because I've been thinking about this a lot.  And if I wanted people to use ivermectin, like that was my personal belief, whether it was for nefarious or completely laudable motives, with the platform I have, I could  create a storm of allegations that this is being blocked for all sorts of drug company interest and it's too cheap and it's coming out of the third world and therefore we shouldn't  even regard it as a... And that's what the papers are talking about and that's why it's not happening.  And I could create a big storm that would get lay press attention and that would rile people up and potentially cause people to use it.  If you go with the message of the evidence isn't there yet, we've made this mistake before, let's just wait and see better evidence to emerge. I can't motivate any storm for that.  And there's not going to be any lay press coverage. And so there's a huge incentive if what you want is to get a message across that is against  the mainstream, all of the incentives, all of the possibilities, all the potential, all point to making that very easy to happen.  And the message of let's just have a good evidence-based medicine approach and do the right thing from that perspective has really very little steam behind it.  So the incentives are all aligned to one side of the issue and not the other. I don't know if that answers your question, Craig, but that's what I've been mulling over  for these past few weeks. So now let's take the concept of nuance further. We're going to move away from ivermectin, but we're going to take a bunch of drugs that  in COVID work in select patient populations or potentially dexamethasone works in some patients, but not in outpatients.  Remdesivir makes time to recovery sooner if you're not in the ICU, but doesn't help in the ICU.  Tocilizumab has a zillion negative studies and the Remap-CAP study, which is remarkably positive. So every one of these is nuanced.  How do you get that nuance of use this drug in this patient population, but not this patient population in however many characters you get in the tweet?  I don't know how many it is, but I know it's not a lot. It's 280. And yes, it's not a lot.  And you know, I can't believe we used to only have 140, but then you doubled it and it still doesn't seem like enough. Yeah, that nuance is, it's virtually impossible to fit in.  You know what, you could write a 20 tweet thread going through your personal opinions as a thought leader in the field on medication use and COVID and all of the nuances, but  people might stop reading after the second tweet in the thread, right?  You don't know for sure that they're going to get through all the information. And that's why, you know, Scott's platform is advantageous because it's all there, right?  And it's all in one place. It's not captured in these little sound bites, literally, or tweet bites as we would call them. So it's hard.  And I think it's really important that people who are thought leaders on Twitter and, you know, people who do practice evidence-based medicine, for example, I'll throw out two  of my mentors in the IC liberation space, Wessie Lee and Dale Needham, obviously highly, highly respected people in the field.  And you know, when they say something, people listen, right? Because not only do they talk the talk, they walk the walk, they've studied this stuff.  And what they're sharing is reliable. And I think they both are excellent examples of people who share the nuance of how they  practice, but also amplify other people's voices who maybe don't have as quite a broad platform, who are saying reliable things and sharing good information and sharing nuance.  And that's what I try to emulate in my own practice on social media. So I think it's just important to know your audience, share with your audience, your opinions.  And again, on the journal side of things, that's a more formal approach. And all you're doing on the journal side is sharing the evidence-based medicine.  You're stating what the papers show and letting people interpret it as they will. And then as an individual, because I have my own personal opinions, I share that with  nuance, understanding that people may take it at face value and knowing what the ramifications of that may be. So the next question is for Phil.  I mentioned that you kind of are the godfather of surviving sepsis. The wonderful thing about surviving sepsis, it is, I would say, the Bible of sepsis around  the world every four years. How do we move that to a more living, breathing? The NIH guidelines get updated every week or two.  Surviving sepsis, COVID, has already been updated once in between when we recorded this and now it came out a couple of days ago.  How do we make guidelines living, breathing and then get the information out in social media so it's not we're talking about a study that came out three years ago or we're talking  about the study that came out a couple of weeks ago, implement this now?  First, I need to comment concerning the godfather of the surviving sepsis campaign. There's certainly a lot of other people that deserve plenty of credit, Mitch Levy and others.  I'm sitting here thinking, why didn't we move toward a living document? As early as the 2008 guidelines, there's mention in the guidelines of that is something  that is planned down the road or it could have been 2012, but at least two or three guidelines ago, it was brought up in the guidelines document itself as being something we should  strive to achieve, but we haven't done it. I can't think of why we shouldn't be able to do it, particularly since in 2021, people  go to their computers for their guidelines information and don't go to hardcover journals.  Maybe your question and my comment and other people listening that are making the decisions with the guidelines now would realize that that is something that does need to happen.  It obviously would still need to be similar timing of use of evidence-based medicine as is used in the guidelines document itself, but it would be like having a guidelines meeting  to see what new fleshed out evidence-based medicine is now available and what recommendations  would it affect and how should the group come together to do the modified Delphi process  and how would the change in the recommendation be approved through what particular channels, but then it could clearly go electronic.  Thank you and certainly no offence meant to Mitchell Levy, and probably just like we're having our 50th anniversary for SCCM, this is I guess about the, I'm not so good at math,  about the 20th anniversary, or pretty close to it, of surviving sepsis, and we want to thank all the forefathers and foremothers, though it is fair to say you were the first  author on the first three guidelines.  Judy, the next question goes to you.  Just any advice on how we handle preprints and folks that want to adopt new practices  before peer review publication?  So, you know, I think that Sapna has said so well, you know, you see something on Twitter,  you can't just take that short statement at face value.  Clinicians have got to go look at the actual paper, and  I recognize that not everyone is a peer reviewer,  but you have to then have an understanding of what is a peer reviewer looking for? And we're going to be looking for, you know, is this even a feasible  thing to consider doing on a broader level?  You know, some things we can do in research that we can't do on a broader level. Were the authors looking at endpoints that were practical and measurable?  Did they consider all the variables? And, you know, the majority of those early papers, and quite a few of them still, are retrospective data analysis.  Well, when I look at that, I say to myself, who collected the data? What was the source of the data?  What else were they looking for? You know, if you set out to say, I'm going to study drug A and collect only information  that pertains to drug A, you may have missed confounding variables that go well beyond any impact of that drug.  And then finally, you know, are the results too good to be true?  Or does that seem feasible? And, you know, sometimes it's tough. And I look at the early studies saying, well, gosh, a drug has an effect on virus replication.  And therefore, this might be a great therapeutic target. Well, little did we know that the cells that they were studying in terms of viral penetration  or viral replication were completely not appropriate models for humans. So, gosh, it's tough because there is so, as I said, the word of the day is nuance.  There is so much nuance to evaluating a study.  But you just have to look at it.  In particular, it was in a preprint server format to say, is this data consistent? Is there enough of it?  And if I were to consider looking at my patient, what else might I think would be important?  I wanted to build on something Judy said that's just so important and get on my soapbox for a second, as I'm one of the newest senior associate editors for PCCM.  And I just want to make a plea that, you know, from a critical care community perspective, we need to teach all of our trainees from the get-go how to do strong peer review.  You don't learn how to peer review from the very beginning. And, you know, you don't start peer reviewing papers until well into your faculty years,  or you get your first invitation. If you don't get connected into that system, then you are more likely to look at a tweet  and just take it at face value and not hit the link and go read the paper and actually critique it.  So I just think the importance of educating our community on the importance of peer review, how to be a good peer reviewer, regardless of the platform, whether it's a journal or  otherwise, a website, et cetera, I think is just so, so, so important.  Well, let's follow up on that for a little bit.  Phil, how do we get the next generation of peer reviewers? So you're a senior associate editor. I apologize. I have the title wrong.  But certainly a senior editor at CCM and have been for years. Or at least certainly I'm senior.  How do we get the next generation of people learning to do peer review so they can, in a continuum, move up and do the outstanding reviews that we need?  Yeah.  Um, on a personal note, I'm looking for ways to contribute to our fellow education and our critical care fellowship program.  And I have found that that is a good way to do it. I'll bring a fellow in to look at a paper that I'm managing as associate editor and  actually assign them so they really get to see other reviewers and associate editor and editor-in-chief comments.  And I found that that's a great learning experience. Plus, they can list on their CV that they review for critical care medicine.  I think the other thing that was a great idea that when we launched critical care explorations,  Tim Buckman saw the potential to get fellows involved in reviews, find the fellows that do a good job, make them feel like they're part of the process.  But again, it's important that they're mentored.  But working closely with someone that is an experienced reviewer or the associate editor that's assigned to that manuscript, and you quickly see trainees that have talent and  pick up on it quickly and can begin to contribute.  And then they become an asset in addition to making it a good mentoring experience.  Scott? Yeah, just to carry on with that conversation. I wrote a book about evidence-based medicine.  I don't feel qualified to be a evidence-based medicine peer reviewer on many of the publications that are coming out. And I peer review for a number of journals.  And my colleagues at the MCRIT site are far better at methodology than I am. And I would bow out of most requests for peer review when it comes to evaluating the quality  and comprehensiveness of the research. But I think one thing that we're missing in peer review quite often is alongside that  methodological perspective, there needs to be reviewers with an intimate clinical knowledge of the specific topic of the paper. And I think that's often missed.  And they get folks who may be very good at evaluating the methodology. And this is their profession, so they have a generalized knowledge of what's going on.  But many papers slip through that people who have read every publication on that particular topic and do it at the bedside all the time immediately know has no face validity, even  though the methodology may be good. And finding a way to get both of those types on every paper in a peer review board, I think,  would go a long way to getting better research out there.  Yeah, and Scott, I think that we're beginning to see that.  And we've expanded not only our editorial board, but also our pool of associate editors to bring somebody in that is niched in a particular area.  You know, as an associate editor, when I see a patient that's using machine learning to  assess the ability to come to conclusions in a sophisticated clinical topic, some nuanced sepsis topic, you know, who are you going to send that to?  I mean, if you send it to a machine learning person, they don't understand the clinical content.  You send it to the clinical content person, they don't understand the machine learning. So you really need to have at least two pieces.  So I think we have time only for a couple of more questions.  This question comes from one of our viewers that says, I'm obviously biased for Twitter,  but it's hard to follow the medical literature content as well. And it can easily be overwhelming and overconsuming.  So a question for the panel, what strategies do you have to switch off from the constant flow of information?  Not switch on, not how do we get more information, but how do you not be 24 by 7 in your face with your phone or your podcast?  I guess I could tackle that one. I probably don't do a very good job at that.  But also, you know, since I was social media editor for two journals, I kind of felt a responsibility to kind of stay on all the time.  And now since I've kind of transitioned those roles, it's kind of nice because now I can focus more on, you know, my focused area of expertise and then, you know, the journal  work from the SAE perspective. But, you know, I think having a twice a day type of approach to look at, you know, curating  the hashtags that are most important to you from a content perspective, whether it's hashtag farm ICU or hashtag peds ICU, you know, whatever it is, looking at those hashtags  and what is showing up on those feeds, you know, once in the morning and once at night, right?  Like maybe first thing in the morning before you go to bed and then leave it at that and try not to get absorbed in it the rest of the day.  I know everyone has issues with time management and distractions. And obviously, if you need to sit and write and you need to sit and do work, having Twitter  constantly barraging you with, you know, tweets is not helpful. And I think we can all attest to that. So I think it's just being deliberate.  It's fine to shut it off over the weekends. I'll be honest with you. There's not a lot of med Twitter, science Twitter stuff that happens on the weekends that's as productive.  So I would do that and just use things like Medline and the PubMed, you know, automatic emails, you know, set up your search strategy using a very comprehensive search strategy.  Put it in PubMed or My NCBI. You'll get a daily email with all the papers that are relevant to you. So there's different ways of doing it.  So you're not constantly like consumed by social media.  Final question. I don't want to get into anybody's age, but we do represent the spectrum of ages and generations on this.  How do we convince the people who are on the older side who maybe don't want to fully dip their toe in or kind of scared about this to actually go into social media?  The advantage of it. We talked about the good, the bad and the ugly. Let's finish on the good. What can social media do for us as critical care practitioners? Scott, how about it?  Yeah, well, this is totally self-serving, but, you know, I'd say don't go on Twitter and Facebook. I'm not sure if the risks are outweighed by the benefits. Listen to a podcast.  Just pretend that it's a tape recorder and you'll have an intimate familiarity with what you're doing.  And you just put on the headphones and you could see if that new form of knowledge transmission works for you. And I'd say give it a shot if you haven't already.  Stop that couple of seconds. I would just say, you know, again, if the more senior generation is, they're pushing back a bit.  They don't have to engage actively, you know, just observing the conversation, seeing what's out there.  Pat Kohanek asked me to be the social media editor because he saw something cool was happening, but he wasn't actively tweeting.  So I think that's a perfect example of how to engage without actually getting consumed.  I wish that we could do this all afternoon into the evening because this has been so much fun.  But my little thing there has turned from green to red that says we're nine seconds over.  So I wanted to thank our absolutely phenomenal panel. This has been truly, truly an honor to be with you guys. And thank you so much. And hope everybody's enjoying our 50th.  I hope to see each other in person in Puerto Rico for the 51st. Thanks, Greg. Great job. Thank you for joining us.

Video Summary

Dr. Scott Weingart discusses the importance and dangers of independent medical social media, highlighting his website as an alternative source of research dissemination and knowledge transmission. He emphasizes the need for agility and speed in social media platforms to provide immediate information based on evidence. However, he cautions about the wide range of quality and credibility in social media and emphasizes the peer review process on independent sites. The panel discussion expands on the challenges of disseminating information through social media platforms and the need for a balance between speed and quality. They discuss the role of guidelines, preprint servers, and critical thinking when consuming information on social media. The importance of peer review, training in digital literacy, and evidence-based medicine is emphasized. The panel concludes by discussing strategies for managing information overload and encouraging the adoption of social media platforms among older generations, while acknowledging the limitations and challenges of these platforms. Overall, they highlight the importance of disseminating accurate and reliable information through social media while navigating its challenges.

Asset Subtitle

Crisis Management, Professional Development and Education, 2021

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Learning Objectives

Compare the pros and cons of rapid dissemination of science as it evolves
Demonstrate strategies for rapid research collaboration and clinical trials
Discuss the implications of social media, prepress releases, and the peer review process
Review positive aspects of clinical and research collaboration from the pandemic

Balancing Pragmatic Application of Evolving Clinical and Research Experience at the Bedside During a Pandemic
R. Phillip Dellinger

Between a Rock and a Hard Place: Are Early Results from Prepring Servers and Press Releases Helpful or Harmful?
Judith Jacobi

Preaching from the Rooftops While Drinking from the Fire Hydrand: The of #SoMe in Science Dissemination
Sapna Kudchadkar

Is Society Ready To See and Hear Science as It Evolves? Social Media and Medicine
Scott D. Weingart

Meta Tag

Content Type Presentation

Knowledge Area Crisis Management

Knowledge Area Professional Development and Education

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag COVID-19

Tag Communication

Tag Evidence Based Medicine

Year 2021

Keywords

Dr. Scott Weingart

independent medical social media

research dissemination

knowledge transmission

agility

speed

social media platforms

evidence-based

peer review process

challenges

information dissemination

balance

guidelines

critical thinking

digital literacy

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