The scariest finding in this paper: the subjects couldn't tell it was happening. UPenn ran this study on 48 healthy adults. One group slept 8 hours. Another slept 6. Another slept 4. For 14 straight days. They tested cognitive performance every 2 hours from 7:30am to 11:30pm. The 6-hour group's reaction times, working memory, and sustained attention deteriorated on a near-linear curve. By day 14 they were performing at the same level as someone who hadn't slept at all in 48 hours. The 4-hour group hit that threshold by day 6. Here's the part that should unsettle everyone who thinks they "do fine" on 6 hours: the subjects' self-reported sleepiness flatlined after the first few days. Their brains kept getting worse. Their perception of how impaired they were stopped updating. The cognitive decline was invisible to the person experiencing it. The researchers found a hard threshold. Any wakefulness beyond 15.84 hours in a day produces cumulative neurobiological cost. That cost compounds every single day you exceed it and does not reset with a weekend of sleeping in. About 35% of American adults sleep less than 7 hours a night. 40% of those get 6 hours or less. In 1942 that number was 11%. We built an entire professional culture around a sleep schedule that this paper says is functionally equivalent to pulling consecutive all-nighters. "I'm fine on 6 hours" is the most common response to sleep research. The first thing chronic sleep debt destroys is your ability to notice chronic sleep debt.

Here are some ways in which the world has gotten better.

Clinical #guidelines are based on population-level evidence and aim to standardize care and improve safety. However, critically ill children in #PedsICU often differ substantially from the “average patient” on which these recommendations are based. #MedEd #EvidenceBasedPICU

"My name's Raymond. I'm 73. I work the parking lot at St. Joseph's Hospital. Minimum wage, orange vest, a whistle I barely use. Most people don't even look at me. I'm just the old man waving cars into spaces. But I see everything. Like the black sedan that circled the lot every morning at 6 a.m. for three weeks. Young man driving, grandmother in the passenger seat. Chemotherapy, I figured. He'd drop her at the entrance, then spend 20 minutes hunting for parking, missing her appointments. One morning, I stopped him. "What time tomorrow?" "6:15," he said, confused. "Space A-7 will be empty. I'll save it." He blinked. "You... you can do that?" "I can now," I said. Next morning, I stood in A-7, holding my ground as cars circled angrily. When his sedan pulled up, I moved. He rolled down his window, speechless. "Why?" "Because she needs you in there with her," I said. "Not out here stressing." He cried. Right there in the parking lot. Word spread quietly. A father with a sick baby asked if I could help. A woman visiting her dying husband. I started arriving at 5 a.m., notebook in hand, tracking who needed what. Saved spots became sacred. People stopped honking. They waited. Because they knew someone else was fighting something bigger than traffic. But here's what changed everything, A businessman in a Mercedes screamed at me one morning. "I'm not sick! I need that spot for a meeting!" "Then walk," I said calmly. "That space is for someone whose hands are shaking too hard to grip a steering wheel." He sped off, furious. But a woman behind him got out of her car and hugged me. "My son has leukemia," she sobbed. "Thank you for seeing us." The hospital tried to stop me. "Liability issues," they said. But then families started writing letters. Dozens. "Raymond made the worst days bearable." "He gave us one less thing to break over." Last month, they made it official. "Reserved Parking for Families in Crisis." Ten spots, marked with blue signs. And they asked me to manage it. But the best part? A man I'd helped two years ago, his mother survived, came back. He's a carpenter. Built a small wooden box, mounted it by the reserved spaces. Inside? Prayer cards, tissues, breath mints, and a note, "Take what you need. You're not alone. -Raymond & Friends" People leave things now. Granola bars. Phone chargers. Yesterday, someone left a hand-knitted blanket. I'm 73. I direct traffic in a hospital parking lot. But I've learned this: Healing doesn't just happen in operating rooms. Sometimes it starts in a parking space. When someone says, "I see your crisis. Let me carry this one small piece." So pay attention. At the grocery checkout, the coffee line, wherever you are. Someone's drowning in the little things while fighting the big ones. Hold a door. Save a spot. Carry the weight no one else sees. It's not glamorous. But it's everything." Let this story reach more hearts.... Credit: Mary Nelson

This is absurd bbc.co.uk/news/articles/cg43…

*me working in pediatrics ER* kid: do u play video games kid’s dad: he’s a doctor of course he doesn’t play video games me:

News | Ethnic minority and poorer children more likely to die in intensive care than White children new study shows. 👉 le.ac.uk/news/2025/july/ethn… #CitizensOfChange | @SarahESeaton @PICANetAudit @HQIP

I often get asked if admitting to ICU for early pressors will clog up beds. My response: 💡 Admit early, stabilise with pressors, and they’re out in 24h once the antibiotics kick in. OR 💣 Wait two days, drown them in fluid, and admit them with multi-organ failure. Now they’re in for a week.

Facilitation skills are not just for change & improvement "experts". Every leader should have them. Organisations that integrate facilitation into their leadership approach report more productive & engaged teams, improved innovation & better decision-making. Facilitative leadership is even more important in the era of AI. AI can analyse trends, detect patterns & generate content, but it can't replicate the trust built through dialogue, or the remarkable outcomes that can emerge when people collaborate to make sense of complex issues together. How we might go about making facilitative leadership the norm: 1) Integrate facilitation into leadership development activities, providing training, coaching, resources & safe spaces to practice. 2) Have senior leaders role model facilitative approaches. 3) Build understanding of situations where we should limit the number/style of decisionmakers & those where we should be facilitative. 4) Make facilitative approaches the leadership norm/expectation & build them into organisational processes. 5) Encourage peer learning so leaders can share experiences, discuss challenges & learn from one another. Inspired by a very good new blog & sketchnote from @tnvora: tanmayvora.com/what-effectiv….

Arrythmias

What is the difference between cooperation, coordination & collaboration? 1) Cooperation - making sure our respective activities don't conflict; doesn't require high levels of trust, we just need to respect each other's space & activity. 2) Coordination - moving together towards a known shared outcome; requires greater trust as we rely on one another to do the work to achieve the common goal. 3) Collaboration - uniting people to create something new together that we couldn't accomplish alone; needs strong interpersonal trust. We need all three in different contexts. When it comes to leading across systems, we get the best outcomes when we invest in the strong trusting relationships that enable us to collaborate: linkedin.com/posts/efmorriso…. By Ed Morrison @Strategic_Doing. Deeper dive: doi.org/10.1177/014920632090…

For better or for worse (worse), MEASLES are back, so here's a #tweetorial on recognizing this once thought eradicated disease. MEASLES: a tutorial! #dermtwitter #dermX #medtwitter #medX #MedEd 1/

Many times when I am in a night shift, I like to read the Humanities' pieces from @JAMA_current and @journal_CHEST This was so beautiful... @medtwitter

What is the data on family presence during resuscitation/CPR? There’s been multiple RCTs performed on this topic with subsequent systematic review’s including a Cochrane review. One cluster RCT even included 1-year follow-up with family that were present during the resuscitation. Here’s the gist of what these studies demonstrate: -There appears to be no impact on patient mortality (IOW it does not degrade the quality of resuscitation) -Family members report lower PTSD, anxiety, and depression (this data is from prehospital setting) -Qualitative data suggests that it helps to ease into cessation of resuscitation -Several studies have highlighted the need for a dedicated team member to address the family during the resuscitation -One study assessing patient survivors found that 9 of them reported awareness of family presence without any negative effects -Assessments of staff members found no increased sense of stress My two cents is that there probably needs to be some preparation including notifying staff that the family will present so they are aware along with a dedicated staff member to prepare the family for what they are about to witness. pmc.ncbi.nlm.nih.gov/article… pubmed.ncbi.nlm.nih.gov/3416… jintensivecare.biomedcentral… #emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #army #armymedicine #armyemdoc #resuscitation #research #data #ems #prehospital #ambulance #family #death #medx #medtwitter

Finally, I’m going to officially be becoming a Paediatric Intensivist in September. #grid

Netflix teases their 2025 slate in new promotional spot including: ‘KNIVES OUT 3’ ‘WEDNESDAY’ Season 2 ‘SQUID GAME’ Season 3 ‘STRANGER THINGS’ Season 5

Playing Monopoly with your family #TheTraitors

Getting a shot of Charlotte reading a Learn Welsh book? Comedy gold. Give them the BAFTA. #TheTraitors

Notice how logos recently all look the same? Not because it makes them look better... But because of THIS psychological trick that manipulates your brain. That's why Google, Microsoft, and Airbnb are all doing it. Here's the full explanation:🧵