@RimaForAAPS Obviously, I think Rima is the best, but I may be a smidge biased. However, I can absolutely attest to her long-standing dedication to these issues. She's also a proven collaborator and team player. Perfect for this role.
@jpogue1 And as far as @jpogue1, can you imagine having access to THAT brain during a pandemic when rapid-fire critical, nuanced literature evaluation is absolutely essential? However highly you think of him, your bar is still way too low.
@jpogue1 We all know how intense/bewildering/exhausting/etc. it was to develop and maintain COVID guidelines for our institutions over the past year +; can you imagine NIH guidelines? Can't thank @IDPharmProf enough, who was there from the beginning and helped us all.
@RimaPharmD @UMichPharmacy@riteaid This team went from identifying vaccine that needed to be used by Monday on Saturday PM, to setting up this clinic, to vaccinating >125 members of the community within 24hrs. Astonishing.
@Tejal_N_Gandhi @jbaang @zhoushiweis @jpogue1 @MeganKlatt3 And Nick Dillman, our Peds stewardship pharmacist, who somehow designed and runs that website in his 'spare time'!
@ClancyNeil Agreed. But what is that patient population? I can't define it in anything approaching 'easy to use' (or at all). Even machine learning algorithm (for candidemia) could only hit 5% positivity (Bhavani Crit Care Med 2020).
@ClancyNeil Right, but that's using a test to stop use that should have never started in the first place. Not arguing that's not real-life, but then the effort should be spent stopping 'fly by seat' use, not adding lab with lots of false positives that gets you into trouble.
@ClancyNeil This is also informed by things like a.) MSG-01 algorithm is complicated but still misses half of IC cases b.) How much is SICU IAC outcome modified by (early) AFs? Most important time-sensitive intervention is source control, which also gets us cultures...
@ClancyNeil Agree re: NPV, but don't share your optimism about identifying a practical algorithm (+ BDG/T2) that improves outcome of ICU pts. Love to be proven wrong, but literature to date leaves me pessimistic.
@ClancyNeil I'd argue that RCTs that identified patients with that (5%-15%) threshold, and tested early antifungals, didn't show a pronounced benefit (Knitsch CID 2015; Schuster Ann Intern Med 2008; MSG-01).
@ClancyNeil But are EMPIRICUS 'high risk' criteria practical? Complicated rules don't work outside RCTs. From what I can tell it involves multi-site colonization assessment (mean 5 sites sampled at inclusion- eTable 1).