Steve Granier retweetledi
“What if”: Two words that are breaking emergency medicine
bmj.com/content/390/bm… via @docib
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Steve Granier
474 posts
Steve Granier
@DocSteveG
Family doctor, concerned about overuse of medicines, antibiotics especially; father of 2 boys, cycling addict
Bristol, England Katılım Haziran 2012
304 Takip Edilen118 Takipçiler
Steve Granier retweetledi
ok so where's the real 10y plan caus the one up on NHS England website is a list of things with lots of quite really not at all evidenced things in it?
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Steve Granier retweetledi
13/ I need to end this 🧵by saying no fault is with dedicated hard working staff in the contact centre. This is not their issue.
The fault is with the leadership team who have failed to digitise, failed to keep promises and timescales to transform, and perhaps most importantly
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Steve Granier retweetledi
The review calls for greater accountability, particularly from leaders, institutions and employers, to prevent racism from continuing unchecked and to improve the lives of people who experience racism 6/6
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Steve Granier retweetledi
Our new landmark @MarmotIHE review concludes racism damages health & wellbeing & drives avoidable inequalities between ethnic groups across London @SadiqKhan @DrHNaqvi @LDN_gov @LondonAssembly @UCL 1/6 instituteofhealthequity.org/resources-repo…
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Steve Granier retweetledi
@medmyths Can I prove this? No. I think we would need very long term studies that will not be funded, but the MR evidence of lifetime exposures to low ApoB or LDL is compelling.
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Thanks Steve. Can you define nuance with numbers? How about - in patients without established CVD, does the addition of apo B meaningfully change cardiovascular disease risk estimation compared to standard risk estimates (e.g., age, smoking, SBP, TC, HDL) alone?
Steve Granier@DocSteveG
@medmyths For most LDL-C may be sufficient but some people who have discordant LDL-C and ApoB. For those with uncertainty eg. relatively low LDL C but some FH of CVD who are unsure about starting statin, measuring ApoB and Lp a can give nuance to a discussion about their individual risk.
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@medmyths Hi James, I suspect not on a population level because of the modest impact (most risk is captured with LDL). However a substantial proportion of people in lower risk groups develop CVD. I think using 30 yr QRISK in younger people with ApoB may help inform decisions.
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@medmyths For most LDL-C may be sufficient but some people who have discordant LDL-C and ApoB. For those with uncertainty eg. relatively low LDL C but some FH of CVD who are unsure about starting statin, measuring ApoB and Lp a can give nuance to a discussion about their individual risk.
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@medmyths There is consistent evidence from MR studies that apolipoprotein B is the predominant trait likely to explain how lipids cause CHD. ncbi.nlm.nih.gov/pmc/articles/P…
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I keep reading/hearing that Apo B is a better CVD risk predictor than LDL. However, we use total chol and HDL in CVD risk calculators. Can anyone point me to evidence that shows Apo B adds important value to CVD risk estimations and if so, how do I use it to make risk% estimates?
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Steve Granier retweetledi
1/
REDUCE-AMI Trial
nejm.org/doi/full/10.10…
Beta blocker post-MI and LVEF >50%
Open-label registry-based RCT, N=5020
Power 80%, delta HR 0.75, expected 3% annual rate in control
Median f/u: 3.5y
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Steve Granier retweetledi
Fun fact: one could fund the *entire* flagship NIHR HTA programme (the leading governmental trial funder, arguably, in the world), on what we spend in UK primary care on vitamin D prescription. And have cash to spare.
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Steve Granier retweetledi
GPC England has spoken: the current 24-25 contract offer is woefully inadequate and puts patients and staffing levels at risk.
Watch the video update from @doctor_katie on our next steps, and why GPs should join the BMA to ensure you have your say.
bma.org.uk/bma-media-cent…
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@adamcifu @adamcifu We are still recruiting into panoramic trial. panoramictrial.org @ChrisColButler
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Steve Granier retweetledi
ORBITA-2
nejm.org/doi/full/10.10…
Euskara
@Azeem_Majeed Why should GPs be experts choosing and completing forms? We are all working to deliver best outcomes for patients. Any request for a secondary care assessment should be accepted.
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Rather than rejecting a referral from a GP for a patient with suspected skin cancer & risk delaying their assessment by a dermatology clinic, would it not be more sensible to accept the referral but to remind the referrer that the form has changed & to use the new form in future?
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Steve Granier retweetledi
Can any epidemiologist, anywhere, point me to examples of epidemiological studies that have produced likely correct answers to the question "does circulating HDL cholesterol reduce the risk of CHD?" / cont academic.oup.com/ije/article/49…
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@medmyths RCPsych has these examples of tapering plans. 50% for citalopram and 10% for paroxetine. From experience, smaller reductions seem less likely to be associated with withdrawal symptoms, but depends on drug, duration of treatment and the patient.
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Do you have any studies showing that an initial 25% reduction is a problem? In this NEJM study they started with a 50% reduction in dose. Remember my figure suggested a 10% reduction if symptoms appear - do you have a problem with that recommendation? nejm.org/doi/10.1056/NE…
Kindly #deprescribe -- taper psychiatric drugs@Altostrata
@medmyths Hey, @medmyths the #antidepressant tapering method you've tweeted has no scientific basis, no controlled studies, no retro studies -- it's merely word-of-mouth that has been passed along to doctors for 30 years? PS More gradual tapering than this was advised for TCAs & MAOIs!!
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Steve Granier retweetledi
Great to have such positive response to gpevidence.org yesterday! What's in it? Lots of useful interesting evidence stuff on Rx for long term conditions (a dozen so far). Let's have a look at statins...just because...
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