Chelsea Messinger, MD, PhD
@chelsmessinger
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Studying causality in perioperative outcomes @CAUSALab • Resident physician @MGHAnesthesia • MD-PhD in Epidemiology @HarvardMed @HarvardChanSPH
Cambridge, MA
Joined May 2016
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MD, PhD ✔️
Last week, I graduated for the last time (? never say never) from
@harvardmed
! These past 8 years in the
@HarvardMITmdphd
program have been a privilege; I feel so grateful to so many. Now - on to 4 more years in Boston for my anesthesiology residency
@MGHanesthesia
!
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It takes a village! So grateful for my various communities and thrilled to begin my anesthesiology residency in the research track at
@MGHanesthesia
this summer.
8 years in Boston - here's to 4(+?) more!
#Match2024
@HarvardMITmdphd
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Beyond grateful to have spent four years here working towards my PhD in Epidemiology. Now, back to med school! PhD defense ✅
@HarvardEpi
@HarvardChanSPH
@HarvardMITmdphd
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Technically, I received my PhD
@HarvardEpi
in March. However, after walking in Commencement last week, it feels official enough to announce that I am now a post-doctoral fellow
@CAUSALab
@HarvardChanSPH
! Look out for our work with target trial emulation in perioperative care.
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Just “graduated” from my clinical year @ MGH - 12 months of rotations that I began in 2017 and will finish this month (w/ a PhD in the middle 🫠). Nothing like 4 years away to remind you why you fell in love with medicine in the 1st place. So happy to be back!
#mdphd
@MGHMedicine
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So honored to have the opportunity to voice my dual passions for medicine and for global public health in this article! And especially excited to be able to highlight organizations like
@BHCHP
and
@HGWISE
WiSTEM, which bring so much meaning and depth to my life in Boston.
A glimpse into the life of second-year student Chelsea Messinger
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Had a blast co-leading this year’s Advanced Methods Workshop with
@louisahsmith
at
#SPER2022
! My portion was on test selection bias in causal studies of COVID and maternal outcomes.
Material for both posted on . Thanks for inviting us SPER!
@HarvardEpi
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Our article entitled "Association Between Congenital Cytomegalovirus and the Prevalence at Birth of Microcephaly in the United States" is out today in
@JAMAPediatrics
w/ sr author Sonia Hernandez-Diaz, coauthors
@mlipsitch
@Katrina_Mott
et al.
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Views from the front row of
@Harvard
commencement, ft. a few generations of
@HarvardMITmdphd
grads! Sadly missing cameo from
@tomhanks
.
@LaylaSiraj
@HarvardGSAS
@harvardmed
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New meta-analysis of 12 RCTs in
@JournalofClinAn
: Thoracic surgery patients who received
#dexmedetomidine
during one-lung ventilation were less likely to develop postoperative pulmonary complications versus placebo, specifically atlectasis & hypoxemia.
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"Medical help is growing dangerously distant for women in rural America. At least 85 rural hospitals — about 5 percent of the country’s total — have closed since 2010, and obstetric care has faced even starker cutbacks."
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Surgical interventions are often cast as point interventions in trials. Out today in Eur J Epidemiol, we discuss the impact of longitudinal perioperative treatments on effect estimates and make recs for improving the design & analysis of surgical trials.
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@nyuschoolofmed
Incredible! Bravo! Here's to hoping that NYU is the first of many medical schools to make this important change for the future of American medicine.
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Having too much fun with the
@HarvardEpi
account takeover this week!
#SPER2023
At
#SPER2023
poster session 1, I presented a target trial emulation of transabdominal cerclage (a surgical procedure) for preventing preterm birth... and found myself next to fellow
@HarvardChanSPH
post-docs,
@dianasoria07
and
@ClaraPonsDuran
!
Have we even left Boston? 😂
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In addition to elderly, pregnant women are more vulnerable to severe disease in other viral respiratory diseases such as influenza, SARS & MERS. We need data on
#nCoV
in
#pregnancy
to understand if similar risk exists.
#COVID19
#PerinatalEpi
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Congratulations
@RWalensky
! I can't think of anyone more qualified to lead the CDC into this next, science-driven era.
@MassGenBrigham
@mgh_id
@HarvardMITmdphd
via
@politico
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The real motivation for going to grad school: personalized household items. Thanks for the remote holiday mail surprises
@HarvardEpi
/
@HarvardMITmdphd
🤗
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An American mother in 1990 had a better chance of surviving childbirth than her own daughter does today.
#ReverseTheTrend
@MerckforMothers
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Finding a reference group for studies of COVID-19 in pregnancy is challenging, and test selection bias can occur when an inappropriate group is used.
"Further Observations on Pregnancy Complications and COVID-19 Infection" via
@JAMAPediatrics
@JAMANetwork
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What will happen is patients coming in to hospital EDs for non-COVID related problems - trauma, emergent illnesses, overdose, pregnancy complications, etc. - will have delayed access to care. Fatalities related to
#COVID
will include those who the healthcare system fails.
The problem is much bigger than whether you think you will get sick. It’s about what will happen as the system gets overwhelmed with sick patients.
Ht
@mromara30
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@ElkhatibSafwan
@BrighamAnes
@UNMCCOM
@JGalvezMDMBI
@caseredoxlab
@DanielWJohnson9
@nmandersonmd
Congrats! Welcome to Boston / see you cross town :)
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My classmate and friend wrote this powerful essay about his experience with racism
@harvardmed
. Read it and share!
I wrote this piece 3 years ago as an MS1 at Harvard Medical School but was too scared to share it. I hope this reverberates across the internet. Enough is enough.
"A Memoir on Race and Inclusion at Harvard Medical School: We must do better"
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@QuinlanSievers
This is such a major dilemma for me always. Esp if they do so repeatedly but never say “call me X”!
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@ZeyitAli
@DVervoort94
@Phil_mce
@theG4Alliance
@daktari1
A very good point and I agree, maternal mortality is a much larger problem outside of OECD countries (particularly in SSA countries)! However, I also believe that global health starts at home, and the growing disparity in obstetric care in the USA is unacceptable.
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"Researchers and clinicians must distinguish between the use of race in descriptive statistics, where it plays a vital role in epidemiologic analyses, and in prescriptive clinical guidelines, where it can exacerbate inequities."
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Her Excellency Dr. Joyce Banda, former President of Malawi, speaking about the importance of engaging traditional leaders for reducing maternal mortality @ the
@MHTF
Global Maternal Health Symposium
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Had a great time presenting a platform on my research on microcephaly surveillance at the Teratology Society annual meeting in Clearwater, FL, funded by a Travel Award. Thanks for the opportunity and the awesome program
@TeratologySoc
!
#TS2018
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@BrianTDo1
Not to mention, students staying would require Harvard to mandate dining and other staff (many of whom in the at-risk age range) to show up to work to support them. What if those staff could not come in due to children being home from school/risk of exposures?
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Important to remember one of the most vulnerable populations in
#COVID19
: individuals experiencing
#homelessness
often cannot access hand washing/other sanitizing supplies and may have a high burden of comorbidities that increase risk for severe effects of
#nCoV
"...Shelter workers are using every possible means to communicate concerns about the virus."
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@SenatorLankford
US tax dollars have have never funded abortions performed by NGOs. The
#MexicoCityPolicy
prevents NGOs from... (1/2)
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Extremely interesting read about the
@IHME_UW
and it’s controversial role in setting the global health agenda.
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@BrianTDo1
Fin aid office is paying for flights for those who can’t afford them. Harvard’s decision was in line with what many physicians and epidemiologists are recommending - we must de-densify. Also, remember that many students and staff have health conditions that make them vulnerable.
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@BrianTDo1
House dorms are very densely populated and had everyone stayed, it would place those vulnerable individuals at immense risk. Quarantine for individual students would have been impossible. Also, they are making exceptions for those who have no safe place to return to.
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Absolutely incredible. This is the way forward for diversifying the physician workforce and ensuring that debt does not drive us away from the fields where our patients need us most. Will be interesting to see how this affects NYU's specialty distribution. Bravo
@nyuschoolofmed
!
We’re excited to offer full-tuition scholarships to all current and future students in the MD degree program!
#NYUSOM
#WhiteCoatCeremony
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Thanks for the shoutout and for a great conference! Not a doctor just yet, but it’s good motivation 😊
She's a busy, young scientist with a bright future! Dr. Chelsea Messinger, a student member in our society, already made an impression presenting at
#TS2018
. Here's a closer look at her work in birth defects research.
#IamTeratology
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@DrSarahWakeman
Exactly! If the healthcare system in the US reaches this point, it will have effects far beyond caring for patients with COVID - patients coming in for trauma, emergent illnesses, overdose, etc. will get worse care, too.
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Tl;dr, the prevalence of SARS-CoV-2 matters *a lot* for determining how meaningful these antibody tests are. If the prevalence is as low as 5%, a person with a positive result from the most accurate test available has a ~1 in 10 chance of not actually having antibodies. (6/8)
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Using a population-based cohort of 2.3 million pregnancies in US health care data from 2000-2015, we found that the prevalence of microcephaly was 2.1 to 7.7 per 10,000 live births, depending on case definition.
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Tonight, 7 incredible women surgeons from across the
@harvardmed
@MassGenBrigham
&
@BIDMChealth
system joined 50 undergraduates in Adams House at Harvard College for a Women in Surgery mentorship dinner. Each surgeon shared a few pearls of advice for the next generation:
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There is a lot of focus on how long hours, overnight call, etc. affects patient outcomes. Important to know, true; but can anyone point me to a good study on the effects of these factors on physician outcomes? Burnout, anxiety, depression, suicide, chronic health conditions?
A new
@HMSHCP
analysis of the relationship between physician fatigue and surgical outcomes suggests that when surgeons work overnight, the care that they provide the following day does not suffer
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"For example, medical management of acute hypertensive crisis might be an ideal topic for checklist development; in contrast, comprehensive management of preeclampsia with severe features would be a poor choice for a checklist because it does not have a single, specific goal."
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@RadhikaTandon17
@leah_pierson
@AimeeVester
@RadhikaTandon17
- so important! Even w/ diseases that predominantly affect BIPOC (most), BIPOC are not included in trials and research priorities don't focus on root causes of morb/mort disparities. Goes beyond which diseases are funded to which questions we ask about them.
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Of course, there is the added issue that we do not yet know if having SARS-CoV-2 antibodies confers lasting immunity and protection from subsequent infection. Taken together, think twice before paying $$$ for that antibody test “just to see”! (8/8)
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Congrats to an incredible scientist and mentor!
Congratulations to our H4P faculty member Sonia! 🎉👏Her paper on the birth weight paradox is recognized as one of the four most influential papers in the AJE’s 100 years. Check out her interview with Dr. Lorraine Dean, AJE Editor in Residency on the thinking behind the work.
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“It’s thus true that the Trump administration axed the executive branch team responsible for coordinating a response to a pandemic and did not replace it”
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First ASSH meeting with the MGH hand surgery team - thanks for an awesome learning experience
@HandSociety
!
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... and unsafe abortions contributed to 17% of reported pregnancy/childbirth deaths in 1965
#abortionfacts
#RoeVWade
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Nice article summarizing information available from China about
#nCoV
in
#pregnancy
. In 2 case series of a total 18 patients infected in 3rd trimester, one had severe disease, none died, no evidence of vertical (mom to baby) transmission. (1/2)
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💯
If the randomized clinical trial to test this hypothesis in
#COVID19
is not called the
#COVFEFE
trial - ie COVid Field Experiment For Emerging treatments, then we will have have missed a tremendous historical opportunity
@marklewismd
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Check out the directed acyclic graphs (DAGs) in the paper for an illustration of this bias
#epitwitter
#causalinference
@HarvardEpi
. And... thanks for the support
@HarvardMITmdphd
@NIH
!
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Thank you!! I’m excited to keep learning.
Congrats, Chelsea!
Best wishes for this new chapter and keep up the good causal inferences.
You know where to find us.
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Congenital cytomegalovirus (cCMV) was the strongest measured risk factor for microcephaly, increasing the relative risk by >7-fold. CMV is highly prevalent in the US, w/ >1/2 adults infected by age 40 and 1-4% seronegative women w/ primary infection in pregnancy.
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@BrianTDo1
It was no doubt a tough decision to make and logistically it’s going to be a nightmare, but I do believe it was the best decision from a public health standpoint. Harvard will have to do all they can to support students with challenging circumstances on a case-by-case basis.
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@LashNolen
's poignant article about representation in
#meded
highlights dangerous blind spots we have re: holes our education. Case in point: it honestly never occurred to me that I would not be confident in performing CPR on pts with breasts d/t exclusive use of male mannequins!
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2. While our data do not speak to potential preventive measures including screening (routine CMV screening is not performed in pregnancy/infancy in the US), they do suggest that CMV may warrant greater attention by physicians and public health officials.
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@RealMilesBerger
@MGHanesthesia
@HarvardMITmdphd
Thank you so much, Dr. Berger! See you at meetings!
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However, we need more data, especially for women infected in earlier trimesters where the risk to the mother and fetus (via maternal morbidity and/or pregnancy complications) may be different from in the third trimester. (2/2)
#COVID19
#pregnancy
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@saragoldrickrab
@BrandonJoDixon
@Harvard
They do have exceptions for students without safe homes to go home to. Residential staff are working with students to identify these cases.
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NYC showing up for women's rights. Definitely over 100k here, it's a standstill
#womensmarchNYC
#womensmarch
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@SenatorLankford
... receiving USAID funding if they provide or promote abortion, even if USAID $$ doesn't go towards these activities.
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"The angst that clinicians may experience when asked to withdraw ventilators for reasons not related to the welfare of their patients should not be underestimated — it may lead to debilitating and disabling distress for some clinicians"
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And, this is with the highest test sensitivity/specificity that I could find online, from unverified reports. I found numbers for other tests that were much lower, which would make the false positive rate even higher. (7/8)
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Conclusions:
1. Congenital CMV is an important cause of microcephaly in the US. Even w/ low baseline risk for microcephaly, given the high prevalence of CMV infection in pregnant women, the absolute excess # of microcephaly cases born each year because of cCMV is meaningful.
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