Reposted by Cameron Gettel MD MHSYour Local Epidemiologist @ylepidemiologist.bsky.social · 13/08/20251/ It’s been a struggle to process what happened at the CDC just a few days ago. The facts are coming in: one officer died, 500 rounds fired, 200 bullets made contact with 6 CDC buildings, hundreds of staff sheltered in place for hours. The intention is undeniable: this was an attempted massacre. 316055
Cameron Gettel MD MHS @camerongettel.bsky.social · 05/08/2025Just out in @agsjournal.bsky.social! We developed and piloted an AI + care coach intervention to support ED-to-home transitions for people with dementia or cognitive impairment + their caregivers. 🧠↑ caregiver self-efficacy 📉↓ caregiver burden Read more: doi.org/10.1111/jgs....doi.org 011
Cameron Gettel MD MHS @camerongettel.bsky.social · 03/07/2025📊 Our new study asks: Will ACGME’s 2025 proposal really boost EM resident experience? @saemonline.bsky.social ✅ 97% of programs already meet the 3000-patient volume ➡️ 3→4 yr shift barely changes volume exposure 🏥 Rural & urban programs look similar Read more: doi.org/10.1002/aet2... #EM #MedEddoi.orgPatient Volume Requirements: Evaluation of the 2025 ACGME Proposal for Emergency Medicine Residency ProgramsObjectives The 2025 ACGME proposed that all EM residency programs must be 4 years and achieve a minimum of 3000 patients per resident. We characterize the current residency program patient volume pe... 032
Reposted by Cameron Gettel MD MHSLiz Goldberg, MD, ScM @lizgoldbergmd.bsky.social · 14/05/2025Congrats to @camerongettel.bsky.social @agem-saem.bsky.social on developing a new care transition measure for older emergency department patients! The PROM-OTED score! #SAEM25 @saemonline.bsky.social 164
Reposted by Cameron Gettel MD MHSLiz Goldberg, MD, ScM @lizgoldbergmd.bsky.social · 06/05/2025There's a trend to adapt #emergencydepartments to better meet the unique needs of our growing population of older adults. Grateful to @ahascience.bsky.social and Mike Merschel for spotlighting this important shift! #EMSky #GeriSky @acepnation.bsky.social www.heart.org/en/news/2025...heart.orgThese emergency rooms adapt to the needs of older adultsNobody wants to have to visit the emergency department, but "age-friendly" care seeks to make the experience safer for older people. 174
Cameron Gettel MD MHS @camerongettel.bsky.social · 22/04/2025I’m sorry for your loss Sarah - she sounds like an incredible woman and accomplished a great deal and positively influenced many lives in too short of a time 110
Cameron Gettel MD MHS @camerongettel.bsky.social · 21/04/20259/ @alzassociation.bsky.social @alzheimerssoc.bsky.social @istaart.bsky.social #emergencydepartment #dementia #Alzheimers #cognitiveimpairment #EndAlz #medsky 010
Cameron Gettel MD MHS @camerongettel.bsky.social · 21/04/20258/ Bottom line: ✅ Screening for CI in the ED can work 🚫 Current diagnostic care transitions often break down 📈 Nearly 80% of those who followed up had confirmed CI Let’s close the gap between detection and diagnosis - the ED can serve as a critical touchpoint. 110
Cameron Gettel MD MHS @camerongettel.bsky.social · 21/04/20257/ We see real promise in pairing cognitive screening with EHR automation. Risk models, auto-referrals, and prompts could lighten ED workload and reduce missed diagnoses. Future work should explore AI and EHR-enhanced pathways. We’re just scratching the surface. 100
Cameron Gettel MD MHS @camerongettel.bsky.social · 21/04/20256/ What could help? • Options like home-based evaluations • Tech support (e.g., EHR-based alerts or automated referral prompts) • Risk stratification to prioritize patients needing urgent follow-up • Public health campaigns to reduce stigma and promote follow-up 100
Cameron Gettel MD MHS @camerongettel.bsky.social · 21/04/20255/ Why the referral and follow-up rates are suboptimal: • Dementia stigma—patients/families may avoid referral • ED teams overwhelmed • Fragmented systems, no clear outpatient path • CI may limit follow-up, esp. without care partner • Unclear who’s responsible for post-discharge follow-up 100
Cameron Gettel MD MHS @camerongettel.bsky.social · 21/04/20254/ The problem: despite effective screening and high follow-up yield, most at-risk patients weren’t referred or didn’t follow up. A huge missed opportunity - EDs are often the first touchpoint for undiagnosed CI. Early detection → timely treatment, caregiver support, better outcomes. 100
Cameron Gettel MD MHS @camerongettel.bsky.social · 21/04/20253/ Of those 100 referred, only 19 completed an outpatient cognitive evaluation – again a big drop. Among them: 🧠 79% were diagnosed with some form of CI 🧠 63% had probable dementia 💊 Many were prescribed meds for CI, dementia, or depression. When the ED refers and patients follow-up…it matters. 100
Cameron Gettel MD MHS @camerongettel.bsky.social · 21/04/20252/ First, we screened 9,359 older adults in the ED for memory/thinking problems. ~5% of patients and 33% of care partners flagged possible CI – 650 in total were eligible for referral. Yet only 100 were actually referred. That’s a big drop – we’ll get to potential reasons for this in a bit. 100
Cameron Gettel MD MHS @camerongettel.bsky.social · 21/04/2025🧵 1/ Check out our team’s new study in @alzdemjournals.bsky.social on ED-based cognitive impairment (CI) screening and referral. What we found highlights both promise and pain points in real-world detection and follow-up for CI and dementia in the acute care setting. bit.ly/4cMO8M0 262
Cameron Gettel MD MHS @camerongettel.bsky.social · 30/03/20256/ This work is directly responsive to efforts from the multidisciplinary Geriatric Emergency care Applied Research (GEAR) network: gearnetwork.org pubmed.ncbi.nlm.nih.gov/34328674/ 000
Cameron Gettel MD MHS @camerongettel.bsky.social · 30/03/20255/ 🏥 By providing insights into patients' perspectives on ED discharge and follow-up care, PROM-OTED can help health providers improve discharge processes and allow researchers to measure what matters to patients in future studies. 120
Cameron Gettel MD MHS @camerongettel.bsky.social · 30/03/20254/ ⏱️ With a mean completion time of just 5 minutes, the PROM-OTED tool can be administered via phone or electronically—making it feasible for diverse patient populations. #GeriatricEmergencyMedicine #GeriEM #EmergencyMedicine #CareTransitions 100
Cameron Gettel MD MHS @camerongettel.bsky.social · 30/03/20253/ ✅ The final 18-item PROM-OTED tool measures critical aspects like understanding discharge instructions, medication management, follow-up care, and quality of life. It’s validated with excellent reliability and a robust factor structure. 100
Cameron Gettel MD MHS @camerongettel.bsky.social · 30/03/20252/ 🧑🔬 Our study involved 290 older adults (65+) discharged from EDs over 3 years, using qualitative interviews, item generation, and psychometric testing to create a reliable measure of care transition outcomes post-ED discharge. #PatientReportedOutcomes #EDCare 100
Cameron Gettel MD MHS @camerongettel.bsky.social · 30/03/20251/ 🚨 ED care transitions are critical for older adults, but no standardized tools have been available to measure patient-reported outcomes. Here we share the development and validation of the PROM-OTED tool to address this gap. Access in @aem-journal.bsky.social: pubmed.ncbi.nlm.nih.gov/40155783/ 152
Reposted by Cameron Gettel MD MHSLiz Goldberg, MD, ScM @lizgoldbergmd.bsky.social · 27/02/2025Grateful to present with @camerongettel.bsky.social @manish-shah.bsky.social & others on how we are improving #dementia care in the #emergencydepartment. #Geriatrics #EMSky @agem-saem.bsky.social Register here: alz-org.zoom.us/webinar/regi... 052
Reposted by Cameron Gettel MD MHSNPR @npr.org · 27/02/2025Sue Bell became one of the first Alzheimer's patients in the U.S. to receive the drug now marketed as Leqembi. Did it make a difference?npr.orgDid a new Alzheimer's Disease drug keep this patient's brain healthier for longer?Sue Bell became one of the first Alzheimer's patients in the U.S. to receive the drug now marketed as Leqembi. Her husband isn't sure if it made a difference. 1026237
Cameron Gettel MD MHS @camerongettel.bsky.social · 30/01/2025#alzsky #dementia #alzheimer #alzheimers #alz #sciencesky 000
Cameron Gettel MD MHS @camerongettel.bsky.social · 30/01/202510/ The big takeaway? Dementia care programs aren’t failing—they’re evolving. We must refine, target, & implement them better. GUIDE is an opportunity to learn from research & build a more effective, scalable system. Let’s get it right. 🚀🧠 120
Cameron Gettel MD MHS @camerongettel.bsky.social · 30/01/20259/ 🔹 D-CARE showed improved caregiver efficacy. GUIDE's focus on caregiver education & respite care may prove critical. 🔹 Hospitalizations & ED visits are modifiable. IN-PEACE showed this. A major reason to keep pushing for dementia-tailored care. 100
Cameron Gettel MD MHS @camerongettel.bsky.social · 30/01/20258/ 🔹 Targeting matters. Broad "one-size-fits-all" approaches may not work. Instead, models should be stepped, with different levels of care for early vs. late-stage dementia. 🔹 Implementation is key. Pragmatic trials are tough, esp. in COVID. GUIDE sites must be flexible & adaptive. 100
Cameron Gettel MD MHS @camerongettel.bsky.social · 30/01/20257/ Enter GUIDE, Medicare's new dementia care payment model launched in July 2024. It funds interdisciplinary teams, caregiver support, and 24/7 access to dementia expertise. What should GUIDE take from D-CARE & IN-PEACE? 📌 100
Cameron Gettel MD MHS @camerongettel.bsky.social · 30/01/20256/ Subgroup findings suggest where dementia care can make an impact: 🔹D-CARE: Hints of benefit in caregiver self-efficacy in both intervention groups. 🔹IN-PEACE: Fewer ED visits/hospitalizations, esp. for African American patients & those with higher symptom burden. 100
Cameron Gettel MD MHS @camerongettel.bsky.social · 30/01/20255/ A key issue brought up in the associated Editorial: Neuropsychiatric symptoms as a primary outcome. These are distressing but highly variable. Should we instead focus on outcomes like hospitalizations or nursing home placement? bit.ly/4aDoHLIbit.lyChallenges and Innovations in Dementia CareDementia, a neurodegenerative disease characterized by progressive cognitive and functional loss, is a devastating illness that requires a complex set of medical and social services for care. It is al... 100
Cameron Gettel MD MHS @camerongettel.bsky.social · 30/01/20254/ So, should we throw in the towel on dementia care programs? Not at all. The trials offer important insights on how to design and target these models. 🏗️ 100
Cameron Gettel MD MHS @camerongettel.bsky.social · 30/01/20253/ IN-PEACE: A smaller RCT (201 dyads) adding palliative care to a dementia care program vs. usual care in a safety-net system. 🔹Primary outcome: Neuropsychiatric symptoms—no difference. 🔹But ED visits/hospitalizations were lower in the intervention group. bit.ly/4hg3o5nbit.lyPalliative Care Program for Community-Dwelling Individuals With DementiaThis randomized clinical trial investigates whether a dementia care management program with integrated palliative care improved the neuropsychiatric symptoms of community-dwelling patients and their c... 110
Cameron Gettel MD MHS @camerongettel.bsky.social · 30/01/20252/ First, D-CARE: A large, pragmatic RCT (2,176 dyads across 4 sites) comparing: 🔹Health system–based dementia care 🔹Community-based dementia care 🔹Usual care Primary outcomes? Neuropsychiatric symptoms & caregiver strain. Unfortunately, no significant benefit vs. usual care. bit.ly/4hg3gmpbit.lyHealth System, Community-Based, or Usual Care for Persons With Dementia and CaregiversThis clinical trial compares the efficacy of health system, community, and usual care delivered to patients with dementia and their caregivers. 100
Cameron Gettel MD MHS @camerongettel.bsky.social · 30/01/20251/ Big week for dementia care research! Two major trials—D-CARE & IN-PEACE—just dropped in @jama.com, testing models to support people living with dementia & their caregivers. What did they find? And what does it mean for the new Medicare GUIDE model? Let’s dig in. 🧵⬇️ 142
Cameron Gettel MD MHS @camerongettel.bsky.social · 29/01/2025🎧 Worth a listen to @arjunvenkatesh.bsky.social on @saemonline.bsky.social Ask-A-Chair podcast - all things clinical practice, boarding, residency training, workforce, mentorship, and "The Big 5" in acute care research. @yale-em.bsky.social @yaleem.bsky.social soundcloud.com/user-7672198...soundcloud.comArjun Venkatesh, MD, MBA, MHS - Yale University School Of MedicineListen to Arjun Venkatesh, MD, MBA, MHS - Yale University School Of Medicine by SAEM #np on #SoundCloud 053
Reposted by Cameron Gettel MD MHSAri B Friedman @abfriedman.com · 27/01/2025A random list of things you can do if a federal agency attempts to cancel your grant (please add suggestions): 1. Organize. Talk to the news about the work that will not happen as a result of this. Explain how promising scientists are now out of a job and their families are affected. 29141
Reposted by Cameron Gettel MD MHSRyan Radecki MD MS @www.evidencetriage.com · 26/01/2025A negative trial for palliative care interventions in the ED – 1) Are ED encounters truly a fertile moment for interventions outside our scope, as many seem to think? 2) Or, is it that "training", "champions", and "alerts" aren't a replacement for resources? #medsky jamanetwork.com/journals/jam... 253
Cameron Gettel MD MHS @camerongettel.bsky.social · 24/01/2025Reminds me of “pizzas for everyone”. Dogs are great…they are not the answer to the record levels of physician burnout and attrition 😔 032
Reposted by Cameron Gettel MD MHSarjunvenkatesh.bsky.social @arjunvenkatesh.bsky.social · 22/01/2025In #nhv that would be IRIS and DESK - if you have a million $ check them out! deskct.org and irisct.orgdeskct.orgDESK | Downtown Evening Soup Kitchen (DESK) 021
Cameron Gettel MD MHS @camerongettel.bsky.social · 21/01/2025#dementia #alzheimer #alzheimers #alz #alzsky #emergencymedicine #geriatricmedicine #emergencydepartment #emergency @agem-saem.bsky.social 100
Cameron Gettel MD MHS @camerongettel.bsky.social · 21/01/20256/ Why does this matter? Well over 50% of older adults with cognitive impairment leave the ED undiagnosed. Many lack follow-up. Early detection through tools like the AD8 can improve care and longer-term outcomes. 110
Cameron Gettel MD MHS @camerongettel.bsky.social · 21/01/20255/ Additionally, one in four older adults without a diagnosis of dementia self-identified as positive on the AD8 and one in five informants indicated that patients were cognitively impaired. 110
Cameron Gettel MD MHS @camerongettel.bsky.social · 21/01/20254/ In our study, we found that self-completed AD8 scores showed moderate agreement with informant-completed scores, suggesting potential utility even when an informant is unavailable, as may be the case in ED encounters. 110
Cameron Gettel MD MHS @camerongettel.bsky.social · 21/01/20253/ While the AD8 test is typically completed by an informant (e.g. family, friend), its agreement with patient self-completion remains unknown. Designed to highlight early functional changes, its brevity and focus make it promising for ED use. 110
Cameron Gettel MD MHS @camerongettel.bsky.social · 21/01/20252/ Historical tests like the MMSE and MoCA, though widely used in outpatient settings, are often too time-intensive to be practical in the ED environment. The AD8 is a briefer dementia screening tool that identifies (if score 2+) changes in memory and daily function. 111
Cameron Gettel MD MHS @camerongettel.bsky.social · 21/01/20251/ Aging patients often visit the ED with undiagnosed cognitive impairment. Spotting cognitive issues here can guide critical care decisions, yet feasible tools remain underused. 🧵 🔎 Check out our latest published work here led by @jamesgalske.bsky.social: bit.ly/4jojfQM 184
Reposted by Cameron Gettel MD MHSThe New York Times @nytimes.com · 18/01/2025By 2060, new dementia cases per year could double to one million because of the growing population of older Americans, a study predicts.nytimes.comDementia Cases in the U.S. Will Surge in the Coming Decades, Researchers SayBy 2060, new dementia cases per year could double to one million because of the growing population of older Americans, a study predicts. 2724860