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American Journal of Kidney Diseases

NephMadness After 5 Years: A Recap and Game Plan for the Future

Published:January 08, 2018DOI:https://doi.org/10.1053/j.ajkd.2017.12.001
      NephMadness is a nephrology-focused online interactive medical education activity modeled after college basketball’s playoff structure that has gained momentum and enthusiasm as it has evolved over its first 5 years of existence.

      The Origins of NephMadness

      In 2010, Andrew S. Levey, then the Editor-in-Chief of AJKD, wanted to explore the potential of engaging readers through social media.
      • Levey A.
      • Weiner D.W.
      • Gilbert S.J.
      • et al.
      Ten years atop the masthead.
      He selected Kenar Jhaveri to create and lead the AJKD Blog (www.AJKDblog.org), which launched in 2011 under the name eAJKD,
      • Desai T.
      • Sparks M.A.
      • Nair V.
      • et al.
      The state of the blog: the first year of eAJKD.
      placing AJKD among the first medical journals to experiment with a blog and the first nephrology journal to do so.
      Jhaveri assembled an advisory board and contributors for the blog, who populated it with a rich array of author interviews, article commentaries, meeting coverage, and quizzes. In February 2013, the blog advisory board, of which we were members, was looking for a way to promote World Kidney Day and its mission of raising awareness of kidney health and disease. We came up with NephMadness, a homage to the National Collegiate Athletic Association (NCAA) Basketball Tournament, colloquially known as March Madness. In NephMadness, 64 unique nephrology concepts “compete” against each other, much like the basketball teams do, in a single-elimination “tournament,” conducted entirely online. The vision was to create a multiplatform social media campaign to showcase advances in nephrology while also teaching about landmark concepts and discoveries. To foster engagement and participation, we set up the pairing of first-round match-ups to feature comparable topics with familiar controversies (eg, fractional excretion of sodium vs fractional excretion of urea and normal saline solution vs lactated Ringer's solution). With a burgeoning presence among the nephrology community, Twitter was used as the primary vehicle to promote and discuss the tournament.
      The first year of NephMadness was a trial by fire, and the end result was a bit clunky. We invited people to complete their brackets but had no formal way to submit them, and we were left asking participants to tweet or e-mail a picture of their completed brackets. We received no more than a few dozen entries. Despite the last-minute scramble and lack of enrollment in the formal game, traffic to AJKD Blog went up—March 2013 was the busiest month the blog had seen to date. The #NephMadness hashtag on Twitter was used nearly 500 times by 77 different Twitter accounts (Table 1). We were energized and encouraged by the interest and began planning to improve NephMadness for the next year.
      Table 1NephMadness Participation Statistics and Overview 2013-2017
      YearFiltered Four
      The 4 finalist teams vying for the championship. The asterisk indicates the eventual “champion” (ie, the winning nephrology concept).
      No. of Entries on Tourneytopia
      Tourneytopia is an online bracket submission and scoring platform.
      No. of Blog PostsNo. of Twitter Accounts Using #NephMadnessNo. of Tweets Using #NephMadness
      2013Medicare ESRD Benefit

      HEMO Trial

      Captopril

      Kidney Transplantation
      The 4 finalist teams vying for the championship. The asterisk indicates the eventual “champion” (ie, the winning nephrology concept).
      NA2177484
      2014JNC8
      The 4 finalist teams vying for the championship. The asterisk indicates the eventual “champion” (ie, the winning nephrology concept).


      Urgent-Start PD

      Balanced Solutions

      Belatacept
      256371541,408
      2015Sudden Cardiac Death in ESKD

      sFlt1 in Preeclampsia

      APOL1
      The 4 finalist teams vying for the championship. The asterisk indicates the eventual “champion” (ie, the winning nephrology concept).


      Tyrosine Kinase Inhibitors
      342553824,085
      2016Conservative Care for ESKD
      The 4 finalist teams vying for the championship. The asterisk indicates the eventual “champion” (ie, the winning nephrology concept).


      Normalization of Hemoglobin

      “Omics”

      Atypical HUS
      498364894,521
      2017Anti-PLA2R

      CRISPR-Cas9

      Genes in ESKD Disparity
      The 4 finalist teams vying for the championship. The asterisk indicates the eventual “champion” (ie, the winning nephrology concept).


      SGLT2 Inhibitors
      736337826,615
      Abbreviations: ESKD, end-stage kidney disease; HUS, hemolytic uremic syndrome; JNC8, Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; NA, not applicable; PD, peritoneal dialysis.
      a The 4 finalist teams vying for the championship. The asterisk indicates the eventual “champion” (ie, the winning nephrology concept).
      b Tourneytopia is an online bracket submission and scoring platform.

      The Evolution of NephMadness

      Coming out of the first year, our primary goals were to increase the quality of the content introducing the concepts, colloquially termed “scouting reports”, and create a better system for people to participate. To address the former, we created the “NephMadness Selection Committee.” In college basketball, the selection committee selects the 64 basketball teams that make up the tournament. We adapted that concept to NephMadness by engaging leaders in various disciplines of nephrology to help us pick the concepts that constitute the competing teams in each bracket. These experts also reviewed the posts in their subject areas to ensure the accuracy of the content. To tackle the problem of tracking bracket submissions, Liz Bury, AJKD’s former Associate Managing Editor, found a vendor that provided a software platform (Tourneytopia) for bracket registration, scoring, e-mail notification, and social sharing.
      The second NephMadness in 2014 saw broader participation but revealed a new issue: What is the ideal way to pick the winner of every head-to-head match-up? In the inaugural year, the winners were determined by 2 systems:
      • 1.
        For the first 3 rounds of match-ups, the blog hosted online polls allowing the crowd to determine the winners.
      • 2.
        In the final 2 rounds of the game, we as game makers determined scripted winners to get the “best” teams and ideas to advance. We also ensured a few “upsets” to generate controversy.
      Neither solution was satisfactory. After much discussion, we devised a third way. In year 3 of NephMadness, we introduced the blue ribbon panel (BRP),
      • Sparks M.A.
      • Lerma E.V.
      • Kupin W.
      • et al.
      NephMadness 2015: nephrology as a cornerstone of medicine.
      a 7-member group (later expanded to 9) of respected nephrologists who would vote to select the winner of each contest. The BRP was charged with making selections based on a particular topic’s present or future ability to affect patients’ lives. Obviously, this still leaves room for subjectivity. We encouraged participants to tweet or blog their own viewpoints if they were upset about a particular outcome, which happened in a big way during the first year of the BRP when “Blood pressure for chronic kidney disease protection” won against “Blood pressure for cardiovascular disease prevention.” Participants took to Twitter for impassioned discussions, and a new hashtag was introduced: #BlueRibbonFail. Multiple submissions to the blog carried on the spirited debate. This is one of the best examples of how NephMadness has been able to generate and drive a global interactive discussion.

      NephMadness 2017: Year 5

      With the fifth iteration of NephMadness in 2017, we introduced several innovations. The first came from the addition of Timothy Yau, AJKD Social Media Editor, to the team. Yau won the 2016 American Society of Nephrology (ASN) Innovations in Kidney Education Contest for creating the Washington University in St. Louis Nephrology Web Series YouTube channel. Using his video production skills, Yau produced multiple videos for NephMadness, including an explanatory video and 2 bracketology videos, one with AJKD Editor-in-Chief Harold Feldman

      Yau T. NephMadness 2017 Interview with Dr. Eleanor Lederer. https://www.youtube.com/watch?v=bvi_sUQPO-4. Accessed April 11, 2017.

      and the other with ASN President Eleanor Lederer.

      Yau T. NephMadness 2017 Interview with Dr. Harold Feldman. https://www.youtube.com/watch?v=kF25-ooFXsk. Accessed April 3, 2017.

      Bracketology is a popular component of March Madness in which sports experts and celebrities provide their predictions on the winner of each pairing and advise people on how to complete their own brackets. In addition to Yau’s videos, which marked our first venture into this media, Cathy Quinlan, a pediatric nephrologist from Melbourne, Australia, produced highly stylized and compelling videos that reviewed the podocytopathy

      Quinlan C. NephMadness 2017: podocytopathy scouting report. https://www.youtube.com/watch?v=U8VNPpo-asg&t=11s. Accessed March 7, 2017.

      and ciliopathy

      Quinlan C. NephMadness 2017: ciliopathy scouting report. https://www.youtube.com/watch?v=kxWqcc9ppoE&t=1s. Accessed March 7, 2017.

      concepts. The videos were so well received, she also released an introductory

      Quinlan C. What is NephMadness. https://www.youtube.com/watch?v=gnj8V67fwrY. Accessed March 5, 2017.

      and a wrap-up video

      Quinlan C. NephMadness 2017 summary. https://www.youtube.com/watch?v=iMPutAtGKXw. Accessed April 5, 2017.

      for NephMadness 2017.
      The second innovation in 2017 was the incorporation of visual abstracts throughout the scouting reports and other blog posts. Visual abstracts—pictorial summaries of an article’s main findings—have a goal analogous to that of traditional text abstracts: to “preview” an article so readers can determine its relevance. However, in contrast to text abstracts, visual abstracts leverage the ability to rapidly interpret visual data. Visual abstracts are especially useful online, where they have become the preferred way to communicate medical research through social media.

      Ibrahim AM. Seeing is believing: using visual abstracts to disseminate scientific research [published online ahead of print September 19, 2017]. Am J Gastroenterol. https://doi.org/10.1038/ajg.2017.268.

      Additionally, visual abstracts can be viewed by all readers regardless of how social media–savvy they may be. In 2017, NephMadness created 11 visual abstracts and used graphical summaries to illustrate the BRP’s votes in 23 additional images.
      The third innovation in 2017 was the push to incorporate NephMadness into the curriculum of nephrology fellowships.
      • Hoenig M.
      Share your passion for nephrology: ten tips to invigorate attending rounds and precepting sessions.
      • Woods M.
      • Rosenberg M.E.
      Educational tools: thinking outside the box.
      While this effort began in 2016, it became more successful in 2017 as 32 fellowship programs submitted “group” (collaboratively generated) brackets. This surge in fellowship programs was paralleled by a continued growth in participation, with NephMadness entries growing from 498 to 736, close to a 50% increase. This was also seen on Twitter, where #NephMadness was tweeted 6,615 times by 782 unique Twitter accounts (Table 1).
      To incorporate the educational benefits of NephMadness into the journal, the AJKD editors started publishing editorials based on those years’ “champion.” “APOL1
      • Freedman B.I.
      APOL1 and kidney disease: new insights leading to novel therapies.
      and “Conservative Care”
      • Kurella Tamura M.
      Recognition for conservative care in kidney failure.
      were featured in 2015 and 2016, respectively. In 2017, the editors decided to seek full-length articles based on the concepts of the 4 finalists, the “Filtered Four”: “Anti-PLA2R and Membranous Nephropathy,” “CRISPR-Cas9,” “Genes in ESKD Disparity,” and “SGLT2 Inhibitors.” Be on the lookout for articles on the 3 latter topics in the upcoming issues of the journal (the first of these was recently covered in an AJKD review
      • Francis J.M.
      • Beck Jr., L.H.
      • Salant D.J.
      Membranous nephropathy: a journey from bench to bedside.
      ).

      The Future of NephMadness

      As NephMadness grows, we need more shooters coming off the bench to help ensure that it continues…and continues to improve and increase in value to its “players.” Leading the planning for 2018 is Yau, who joined us for NephMadness 2017, and Anna Burgner. We will continue to offer advice gained from running this initiative for the past 5 years. Staying with the sports theme, we will not be necessarily coaching from the floor, but will be providing guidance from the booth upstairs.
      The big announcement for 2018 is that NephMadness will offer up to 8.0 continuing medical education (CME) credit hours through the National Kidney Foundation to US-based participants. This is something that users have requested from the very beginning. We hope the CME accreditation will entice broader participation in NephMadness, especially for individuals in private practice.
      Looking back at the first year of NephMadness, it could have been a “one-and-done” project. Turning NephMadness from a 1-year blog experiment into a recurring educational initiative required producing compelling, accurate, and timely content. However, after the content is created, it is up to the nephrology community to generate social interaction,
      • Graham-Brown M.P.M.
      • Oates T.
      Social media in medicine: a game changer?.
      to write blog posts challenging decisions, and to promote personal favorites to victory. The success and vibrancy of NephMadness owes much to the community. Unlike a book or a journal article, NephMadness offers as its primary value the immediacy of discussion. As the initial organizers of NephMadness, we are grateful to the many people who have worked on, participated in, and encouraged the production of NephMadness over the last 5 years.

      Acknowledgements

      We thank all of the NephMadness team, BRP members, Selection Committee members, writers, bloggers, Nephrology Social Media Collective team, and everyone participating in NephMadness over the last 5 years; and Swapnil Hiremath, Michelle Rheault, Anna Burgner, Timothy Yau, and Tom Oates for critical review of the manuscript. We call special attention to Dr Levey’s editorial team, including Dan Weiner, Scott Gilbert, and Kenar Jhaveri, for giving us the opportunity to create NephMadness. Finally, there would be no NephMadness without the skillful project management and endless energy of our editorial office partners, Liz Bury and Alina Foo, Associate Managing Editors under Dr Levey and Feldman, respectively. For a more comprehensive list of everyone involved, please visit AJKDBlog.org; specifically, for 2013: https://ajkdblog.org/2013/04/30/nephmadness-in-review; 2014: https://ajkdblog.org/2014/04/10/nephmadness-2014-%E2%80%A2-thanks; 2015: https://ajkdblog.org/2015/04/09/nephmadness-2015-thanks/; 2016: https://ajkdblog.org/2016/04/13/nephmadness-2016-thanks; and 2017: https://ajkdblog.org/2017/04/12/nephmadness-2017-thank-you.
      Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the policy or position of the US Department of Veterans Affairs or the US government.
      Peer Review: Received October 3, 2017 in response to an invitation from the journal. Direct editorial input from an Associate Editor and a Deputy Editor. Accepted in revised form December 6, 2017.

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      1. Yau T. NephMadness 2017 Interview with Dr. Eleanor Lederer. https://www.youtube.com/watch?v=bvi_sUQPO-4. Accessed April 11, 2017.

      2. Yau T. NephMadness 2017 Interview with Dr. Harold Feldman. https://www.youtube.com/watch?v=kF25-ooFXsk. Accessed April 3, 2017.

      3. Quinlan C. NephMadness 2017: podocytopathy scouting report. https://www.youtube.com/watch?v=U8VNPpo-asg&t=11s. Accessed March 7, 2017.

      4. Quinlan C. NephMadness 2017: ciliopathy scouting report. https://www.youtube.com/watch?v=kxWqcc9ppoE&t=1s. Accessed March 7, 2017.

      5. Quinlan C. What is NephMadness. https://www.youtube.com/watch?v=gnj8V67fwrY. Accessed March 5, 2017.

      6. Quinlan C. NephMadness 2017 summary. https://www.youtube.com/watch?v=iMPutAtGKXw. Accessed April 5, 2017.

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