In an @NEJM Case Record, a 64-year-old woman presented with fatigue, memory changes, and falls. "This case is chock-full of striking images that I encourage you to see for yourself," says @ClementLeeMD. Read the full summary and comment: https://t.co/9dGvzQZtem
"It's just the dementia progressing."
A very dangerous phrase in clinical care.
Acute change in someone with dementia? That's #delirium until proven otherwise.
↳ Don't put the stick in the patient's wheel.
#Delirium#Dementia
What's my take on VIP medicine?
Find out here, in my new NEJM Voices piece.
You can sign up for email alerts so you never miss a piece, and access is FREE (you don't need a subscription to NEJM)!
https://t.co/4RLFV0XHtH
Patients at EOL often say they want to go home.
But they are usually already debilitated, in which case, "going home" means lots of burden on families.
If we keep expectations of going home high, family has to tell the patient, "I'm sorry Dad, we cannot take care of you". 1/
1/14
Why can't you use direct oral anticoagulants (DOACs) in patients with mechanical valves (MVs)?
DOACs have been one of the most important advances in my career. And yet, the presence of a MV is one of the few contraindications.
The reason highlights the unique nature of thrombus formation in those with a MV and provides insights into the evolution of human hemostasis.
Quick thread: "How do SSRI's work" 🧵
I've had a few patients ask me how SSRI's work.
To be clear, my first answer is "well we know they are supposed to block serotonin reuptake, but it's not that simple and we don't really know."
But, if you want the best 2026 science...
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A MUST-READ!
This is probably one of my most important papers where I try to teach how to fish rather than offer fish.
How I Read a Clinical Trial Report?
BG’s primer for Busy Clinicians.
Thank you @JCOOP_ASCO@EthicsdoctorP for the kind invitation. I hope the readers will find this useful.
https://t.co/HJhZlsBpU2
"Age is often treated as a proxy for variables that may not be measured, including functional decline, physiological resilience, accumulated biologic injury, and potential for recovery after illness"
Among individuals with severe, treatment-resistant #Schizophrenia, #dementia was common and showed a distinct clinical and genetic profile not explained by #Alzheimer disease, cardiovascular risk, or medication effects.
https://t.co/hkz7MoIENa
Who loves teaching? 🙋🏻♀️
During feedback session today with one of my trainees I get feedback too- turns out they found probing ❓to be valuable- the art of Socratic method
Reminded me of paper we did in 2021 showing student + faculty perspectives
��️ https://t.co/WBgovxerkA
Check out our brand new @SCCM guidelines addressing the care of older adults in the ICU.
Recommendations address: geriatric models of care, post-ICU followup, MAP targets and antipsychotics for delirium prevention or treatment.
https://t.co/30PnI0eyVT
Between 1812 and 1819, Francisco Goya painted "Casa de Locos" (The Madhouse).
He had visited the asylum in Zaragoza. He painted what he saw.
The scene is dark, lit only by a barred window high on the wall. Figures are naked, fighting, gesturing to invisible audiences. One wears a feathered headdress. Another makes a blessing gesture to no one.
Goya was recovering from his own serious illness at the time. He wrote that he found himself "sometimes raving with a mood that I myself cannot stand."
We can see reflections of the suffering that delirium can cause in this painting.
The patient talking to someone who isn't there. The one who can't explain what they're seeing. The one who is fighting off imaginary enemies.
These kinds of experiences are happening to millions of patients around the world with delirium every year.
And yet we often don't fully acknowledge this, articulate it, or try to help with professional, technical diagnosis, and skilled help.
We may look back in horror at the way that mental health disorders were managed in the past, but in fact versions of Case de Locos still exist in our hospitals today.
#elderlycare #dementia #delirium #acuteconfusion #mentalhealth