I've worked at
@Penn
for 15 years now. I've come to work sick, amidst personal losses, through snowstorms, riots, on nearly zero sleep, through COVID lockdowns.
Hands down, today was the hardest day so far for me to come to work here. Looking forward to better days ahead.
I am honored to share this on behalf of the 375+ clinicians, research staff & patient partners in 🇺🇸&🇨🇦 who made REGAIN happen. Thank you to our 1,600 volunteer participants, to
@PCORI
for betting on us, and to
@NEJM
for publishing our work
Promotion to Professor is effective July 1, 2023!
Thank you to
@Penn
@PennAnesthesia
@PennMedicine
@NCSP_Penn
and all of the mentors, collaborators, and friends who have been part of my journey here since I arrived in Philly in July 2008.
Best is yet to come!
Out online today in
@_Anesthesiology
: 1y REGAIN outcome results. Outstanding work by 1st author
@emilyvailmd
& whole team to make this happen!
Long-term outcomes with spinal versus general anesthesia for hip fracture surgery: A randomized trial 1/2
WE DID IT! has completed enrollment with 1,600 patients randomized! Way to go
@templemedschool
for randomizing
#1600
today and THANK YOU to all of our participants & partners, our 46 accruing sites &
@PCORI
@PennMedicine
for support. Results coming soon!
Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial
True story: when we were setting up REGAIN, a patient partner told us that her ability to bounce back from adversity made the difference in her recovery from her hip fracture at age 95.
She told us to study that, so we did. Today, we published Eleanor's paper. 1/
10 years. 3 studies.
Regression:
IV:
RCT:
A progression from weaker➡️stronger inferences. Same question, different findings. We learned a lot along the way. Most importantly: randomized trials are worth it.
Thank you
@_Anesthesiology
for featuring our
@PCORI
funded REGAIN trial as this month’s cover article. Thrilled to have this recognition for our study & everyone who was part of it.
Had a great time today chatting with
@UPennTrauma
@PennAnesthesia
@pennsurgery
Critical Care fellows on how to break down a randomized trial paper.
It's summertime and I've got BBQ on the mind, so obviously, this is where I started👇. 🧵1/
As a medical student, I met a former
@RWJF
prez. I told him I wanted to go into anesthesiology and study health policy. He said: “That sounds pretty weird. You should do the Clinical Scholars Program.” I did, and it changed my career. It could change yours too. Learn more below.
The NCSP’s vision is to expand the nation’s cadre of nurse and physician leaders who will serve as change agents to improve health, health care, and health equity. Want to translate research into action? Our application opens on 5/2! To learn more, visit
So cool to get this in the mail yesterday from
@_Anesthesiology
! I am grateful & honored to have the opportunity to contribute to this storied journal.
Just got home after a truly incredible
#ANES21
meeting in San Diego. I am so grateful for this field of Anesthesiology that has given me so much, most of all an amazing community that I am proud and honored to be a member of. Thank you
@ASALifeline
.
Absolutely thrilled to receive funding from
@PCORI
to implement results from our REGAIN randomized trial. Excited to work with
@mcpoliti
@glynelwyn
& our outstanding team of collaborators and partners to make this a success. More info to follow soon!
Thanks to all of you who’ve reached out today! My heart is full from all the kind wishes I’ve received from so many near & far. These are challenging days but tomorrow will be better. Thanks especially to my
@PennAnesthesia
@PennMedicine
fam who took great care of me today. ♥️💙
I've worked at
@Penn
for 15 years now. I've come to work sick, amidst personal losses, through snowstorms, riots, on nearly zero sleep, through COVID lockdowns.
Hands down, today was the hardest day so far for me to come to work here. Looking forward to better days ahead.
Thrilled to be in DC today to represent
@ASALifeline
at the
@PCORI
physician roundtable. Looking forward to engaging with this incredible organization and physicians across specialties to advance research & improve health.
Most discussion around this seems to be on inference with randomized vs non-randomized study designs. But there’s another big issue I think deserves discussion: data quality 1/10
@joshmcgoo
The only way to become a good writer is to write a lot. Early on in my career I found that doing any academic writing was helpful. Case reports, editorials, book chapters might “count” for less on an academic CV but can provide valuable opportunities to practice your writing.
I rarely post my culinary accomplishments on this site, but this one was too good to keep to myself. Smoked & reverse-seared stuffed flank steak. S/o
@_Beardedbutcher
@KamadoJoe
Thrilled to have our August 2023 review on spinal vs general anesthesia for hip fracture recognized as top 10 most read paper in
@_Anesthesiology
for last year. Big thank you to my co authors & our readers!
@PennCPORT
@PennAnesthesia
I’ve gotten several requests over the past 2y to weigh in on the “controversy” surrounding the REGAIN anesthesia study.
Thanks
@stanfordanes
for the opportunity to share my reflections on REGAIN, its aftermath & what I’ve learned from the experience:
When we published REGAIN, using a patient-informed primary endpoint of walking recovery at 60d, one of the most common critiques we received from the anesthesia community was that we didn’t focus primarily on a more proximal outcome, like “complications” 1/
3/3 Our suggestion: listen to the pt. They want to “live longer and live better”. New primary endpoint: Hierarchical death or time-integrated change in QOL (generic > disease-specific), tested with the WIN ratio. We plan on implementing this in an upcoming trial, if funded.
Pastrami diaries, contd.
After experimenting with smaller cuts I took the plunge and did a (small) whole brisket. It took a while (12h @ 250F for a 5# brisket) but it was worth it. Best version so far.
@meathead
recipe,
@KamadoJoe
cooker,
@FogoCharcoal
super premium charcoal
Dementia is the
#1
risk factor for delirium after surgery. Yet RCTs comparing delirium with spinal vs general anesthesia often exclude ppl with dementia. The REGAIN trial successfully enrolled 200+ persons with dementia. Learn how we did it here👇
🎧 Listen in on the latest IMPACT Grand Rounds
#podcast
episode w/
@PennMedicine
's
@neumanmd
& Justin Clapp as they dive deeper into lessons learned from the REGAIN trial experience and potential next steps at:
More familiar surgeon-anesthesiologist dyads can yield better outcomes for complex GI surgery: each surgery done together is associated with 5% lower odds of morbidity for the next patient.
@HalletJulie
@DrTonyEskander
@propelresearch
And that’s a wrap for
@FAERanesthesia
#MRTGmeeting2023
! Thanks to
@neumanmd
who did a wonderful job of putting the program together. I’ll see you all in SF in October for the
@ASALifeline
annual meeting, and I Iook forward to meeting the next group of
#MRTG
recipients in 2024!
A new ‘Understanding Clinical Research’ discusses how research reporting focused on estimation of effects rather than hypothesis testing would help minimize negative or positive interpretations of research:
New review out today in
@_Anesthesiology
on spinal vs general anesthesia for older adults from Fritz Sieber, Derek Dillane, and me.
We look at recent evidence + review relevant issues in causal inference. And there are DAGs! Please check it out!
So many decisions go into designing a randomized trial.
A few years ago for
@DrJoelGelfand
's class, I charted as many of the decisions I could recall us having made in developing the REGAIN trial protocol on a PRECIS grid. Interesting to look back on it now that REGAIN is done.
I highly recommend this thoughtful
@BJAJournals
review on outcomes with neuraxial vs general anesthesia for elective joint arthroplasty from
@rljohnsonmd
. Lays out available evidence & future opportunities for prospective (ideally randomized) studies.
Thank you Betsy!! Teaching HPR 607 for
@Penn_MSHP
with
@CandonMolly
is always a highlight of my year! The 2022 group was outstanding!
In honor of our final lecture of the semester, here's my breakdown of causal inference methods, MCU-style.
Causalvengers, assemble!
No better way to end one of my favorite classes ever - comparing secondary data methods to Avengers characters.
Huge thanks to
@neumanmd
and Molly Candon for teaching me so much this semester!
Pointed but ultimately fair critique of REGAIN and other recent trials on hip fracture anesthesia out this week in
@BJAJournals
from
@alexbstone
@sgmemtsoudis
& others. Some thoughts: 1/10
Congratulations to Sachin Kheterpal, MBA, MD, and
@avidan_michael
for study funding approval to compare patients' experience and recovery from intravenous vs. inhaled
#anesthesia
to better inform patients of possible outcomes.
Learn more:
It was great to have Brian Bateman
@stanfordanes
visit us at
@PennAnesthesia
@PennCPORT
today. Thank you for making the trip and sharing your insights on research, leadership & clinical care!
True story: in 2014, Derek Dillane (
@UAlbertaAnesth
) wrote a letter critiquing a retrospective study we did. 2y later, I cold-called him to say we'd heard his critiques and had put together a trial to address them. He agreed to join us and his site became our best recruiter.
I trained with Dr. Brian Williams at
@BrighamWomens
and know that he is EXACTLY the kind of person we need in Congress right now. Brilliant, brave, caring, practical & committed. An outstanding surgeon & leader.
#DrBrianWilliamsforCongress
Links in thread below to learn more 👇
I’m excited to share that I am running for Congress in Texas’ 32nd District, here in the heart of Dallas where I live with my family. I’m an Air Force veteran, a trauma surgeon, & a gun safety advocate. Join our team today:
#DrBrianWilliamsforCongress
1/6
Research administrators are unsung heroes. Grant applications are complex & it takes skill & dedication to ensure that submissions are on-time & error-free. As an
@NIH
deadline approaches, I’m thankful for outstanding colleagues & support
@penn
@PennMedEVDCSO
@PennAnesthesia
If you need to come up with an entirely new theory of medical evidence to justify your preferred mode of clinical practice...then maybe science isn't really your thing?
Pain, Analgesic Use, and Patient Satisfaction With Spinal Versus General Anesthesia for Hip Fracture Surgery: A Randomized Clinical Trial: Annals of Internal Medicine
@AnnalsofIM
Nice pair of articles out today in
@RAPMOnline
debating interpretation of REGAIN findings.
#1
: from
@ESchwenkMD
@colinjmccartney
: General anesthesia is an acceptable choice for hip fracture surgery
Does avoiding general anesthesia reduce delirium after surgery for persons with cognitive impairment?
That’s the question we ask in new work from
@PCORI
REGAIN trial, out today in
@alzdemjournals
@alzassociation
Read more here 👇
Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial
Huge congrats to all of this year's grantees! Thank you
@FAERanesthesia
@ASALifeline
for continuing to invest in discovery and research to propel our field forward and improve health!
Huge thanks to
@neumanmd
for his time and energy organizing the
@FAERanesthesia
MRTG meeting in DC. here to celebrate my he many recipients of FAER Training grants. Will be a great two days!!
💯
I’ll go ahead and say the quiet part on loud…
If you have an issue with the primary outcome, or the population enrolled, or the regimens used, or the skill of the providers, there’s a simple fix that benefits everyone:
Do a better trial yourself.
The discourse surrounding this trial has been illuminating. I don't have anything substantive to add to what airway experts and seasoned trialists have discussed. What I find striking, though, is how these discussions can quickly spiral into negative, counterproductive arguments.
It is an honor to be part of this important effort to promote collaboration in anesthesia research. Thank you
@ASALifeline
@FAERanesthesia
@IARS_Journals
for this opportunity!
Creation of the Anesthesia Research Council: Anesthesia & Analgesia
Editor-in-Chief Evan Kharasch moderates Initial Results of Clinical Trials featuring
@neumanmd
@BrianIlfeld
and Joseph Rinehart at 4:30 pm today in Upper 6A
#ANES21
My Anesthesia Choice is now online!
Please visit us at to learn more about this
@PCORI
-funded project to help patients & their doctors make better decisions about anesthesia care.
Follow us
@MyAnesthChoice
for updates!
My Anesthesia Choice is now online!
Please visit us at to learn more about this
@PCORI
-funded project from
@WUSTLmed
&
@PennAnesthesia
We help patients with hip fractures & their doctors make better decisions about anesthesia care.
Learn more here 👇
Now mostly forgotten, the National Halothane Study was a landmark in at least 3 disciplines--anesthesiology, statistics, and health services research, which it played a pivotal role in creating.
#anes_twitter
#stats_twitter
#hsr_twitter
1/19
Thank you to Angela Bader & Alex Arriaga
@BrighamAnes
@AriadneLabs
@CSPH_BWH
for their outstanding editorial on our most recent paper from REGAIN: Severe Pain After Hip Fracture Repair in Older Adults: Challenging a Dominant Narrative
@AnnalsofIM
5/All this was done because of what one of our amazing patient partners recommended. We committed to write this paper to honor her life and all the contributions patients made to REGAIN. You can learn more about Eleanor here:
So proud of
@EmilyJMacKay
for this huge achievement! Will produce lots of important information to help advance patient-centeredness in CV surgery & anesthesia.
@PennCPORT
strong!💪💪💪
This feels like a big deal. The modern standard of care (spinal) fails in 1 of 25 cesarean deliveries. Glad to hear further multicenter work is being planned. Important info to share with patients.
What practical tradeoffs go into designing & running large pragmatic trials? Experiences from 3
@PCORI
trials, including our recently published REGAIN trial, offer some insights. W/
@MichaelKappel12
, E. Israel (
@BrighamResearch
) & S. Ellenberg (
@UPennDBEI
)
Thrilled to participate
@ASALifeline
geriatric anesthesia practice parameter meeting today. Outstanding group of experts & stakeholder reps. Amazing leadership from Dr. Sieber and Dr. Domino & help from ASA methodology staff.
@RealMilesBerger
@LizWhitlockMD
It was great to have the chance to participate in the
@ASRA_Society
RAPP podcast today.
@dr_rajgupta
and I talked about why we do pragmatic trials, what we learned in REGAIN, and ways clinicians can use findings from trials like ours to improve care. Please check it out!
@doctimcook
@JohnCSakles
One approach I hope we see more of in the future: benchmarking observational studies vs RCTs, then using those data to extend RCT findings. Look before you leap! See work from
@_MiguelHernan
on this below. Happy new year Tim Hope all’s well
Focusing on patient centered outcomes—and inviting patients to participate in outcome selection—is one way we can question est’d power dynamics inherent in trial design and share space with the actual consumers of healthcare in determining what it means for something to “work” 8/
#ICYMI
: Reasons provided for declining consent among 3,565 patients approached for participation in
#REGAIN
, a large pragmatic trial comparing outcomes with spinal versus general anesthesia for hip fracture surgery.
Numbers in Appendix Fig 1 here:
A props of twitter discussions about shared decision making in anesthesia.
Preprint out today in
@SSRN
:
My Anesthesia Choice-HF: Development and Preliminary Testing of a Tool to Facilitate Conversations About Anesthesia for Hip Fracture Surgery
Thank you
@KamGhadimiMD
@Duke_Anesthesia
for an outstanding visit! Great to be connecting in person again after so long. Truly inspiring work you & your colleagues are doing to advance our specialty. Happy to be able to share what we learned with you & your team
It was a real pleasure to have
@neumanmd
visit
@Duke_Anesthesia
for the past few days to discuss:
✅ Pragmatic vs Explanatory RCTs
✅ Perioperative RCT nuances
✅ Stakeholder engagement
✅ Research unit structure
✅ Lean design for a MCT
✅ Epidemiology and Mixed Methods