PhysioPleb

@AdamStenman @AdamMeakins Loss of fine motor skills by Myelopathic patients is often not voluntarily mentioned. A similar conundrum is documented in the CES literature. Your second scenario appears to support a screening approach IMO.

We could argue the same for cervical myelopathy. Costly if missed. Should we do Hoffmans, Babinski, inverted supinator sign and test clonus in every cervical pain patient? Or maybe we should go there if they mention loss of fine motor skills, have some hyper reflexia during normal exam? I'm more for the second approach. It means I will miss a few surely but I will also not further investigate a ton of patients with incidental findings, which is ofc also harmful.

Should physios screen every patient with back pain for Cauda Equina? What about for tumours, infections, fractures, anky spon, multiple sclerosis, syringomyelia, transverse myelitis, pancreatitis, endometriosis, herpes, aortic aneurysm, pyelonephritis, vasculitis etc etc…?

@AdamMeakins @AdamStenman I'm curious - in a patient with LBP without radicular symptoms, what in the history would increase your index of suspicion that would warrant 'question, screen, test...' for CES? Surely, screening for CES is what raises the index of suspicion in patients with LBP?

@AdamStenman This is my approach as well! Rather than just blanket screening everyone for everything, we should take a thorough history and exam and question, screen, test further if index of suspicion is raised! That’s good clinical reasons and sensible realistic practice!

@RobSetters @physiojack @AdamMeakins Pts with purely LBP can have the above in your statement, and although rare, LBP without sciatica in ces is recognised, and GIRFT does not dismiss this presentation either. Pts will often not volunteer the subtle signs, and screening is easy + allows opportunity to safety net.

@RobSetters @physiojack @AdamMeakins Thanks Rob, these are logical points. I have my thoughts but I just want to clarify- do you not screen pts with purely axial lbp for ces at all? Or would you say you do for the majority/ minority? I also want to distinguish between screening vs detailed questioning

@physiojack @AdamMeakins I think screening by a clinician can certainly be grounded with clinical reason and not purely 'passive' per se. Screening can lead to more detailed questioning. Why would you screen for ces in patients with sciatica but not new patients with back pain (without sciatica)?

@AdamMeakins Is it not clinical reasoning? Screening to me suggests a passive approach - applying a set of questions without reasoning why Clinical reasoning (in this case cauda equina) would be applying a set of questions because of the presentation (sciatica say)

@emily_rj @DrGoblin3 But what actually qualifies the label of 'EDS' in the hypermobility subtypes? Given that there is no clear universal genetic biomarker, and often the EDS label can cause confusion practically in a clinical setting.

@PhysioPleb @DrGoblin3 Many conditions exist on a spectrum, plenty don’t have a gold standard, many routinely update their gold standards because gold standards change None of this is disqualifying for hEDS in comparison HSD was just hEDS before 2017, it was separated out based on no proof

Ehlers-Danlos Syndrome certainly exists, I just don't think many people actually have it. Conflating people whose aortas, lenses and joints give out with people who have chronic pain, unhappiness and a desire for a label is insulting.

@emily_rj @DrGoblin3 By clinical diagnostic tests, i meant a gold standard. Ultimately, the results of the clinical diagnostic tests are variable because pts sit on a spectrum, hence why I think HSD is a more fitting label. Tertiary centres typically do not accept the hypermobilty subtypes

@PhysioPleb @DrGoblin3 Clinical diagnostic tests exist, many conditions are diagnosed the same, that is valid. There are some hEDS genetic biomarkers but like most biomarkers they aren’t universal, and new so not meant for diagnostic use.

@emily_rj @DrGoblin3 Yes, this is the nuance that should be discussed more. I personally think that HSD is a more fitting diagnostic label than hEDS. The former encompasses the constellation and variability of symptoms. The latter implies a diagnostic test- which does not exist.

@DrGoblin3 hEDS and HSD are the same thing, the proof discussed by experts for a while with the EDS Society announcement coming by end of 2026, the 2019 biggest population survey ever found 1 in 500 have hEDS/HSD, it was common before Covid, none of this is a secret

@DrGoblin3 I think the first party regarding the rarity of EDS is valid. The latter part about it being insulting for patients to seek validity to their symptoms, however, is rather abhorrent.

Today the @DailyMail published the findings of my two-year investigation "The Brass Pass" into the hidden epidemic of domestic abuse suffered by military wives and girlfriends. A dossier of 52 cases reveals torture by Army men against their wives.

Can you read 900 words per minute? Try it.

@neilorpen @runningmole @ankitkant @Dr__Sarmy From my understanding, she falsified consultation notes on a patient's records, which brings in a question of data protection breach? :

@runningmole @PhysioPleb @ankitkant @Dr__Sarmy Is purposeful manipulation of the timing so that you leave on time ( not early ) a reason to loose your income for 6 months ?

I want to know why the partners at this practice were more interested in throwing Dr Eisenhauer under the bus with an “internal investigation”,rather than supporting her to work as a GP&pick up kids from school on time. Meaningless statement now that she’s been suspended for 5m.

This excellent blog is well worth a read and raises important points, whilst also recognising the gravity of any dishonesty by a professional

@neilorpen @ankitkant @Dr__Sarmy She did a little than just 'not finish late'. Here is the full judgement: mpts-uk.org/hearings-and-d…

@ankitkant @Dr__Sarmy This is normal in every theatre in the NhS - staff ensure they don’t finish late She did not ensure sure finished early - she only ensured she did not finish late In every NHs hospital this is supported by NHs management for theatre staff

It’s interesting that many right wing commentators have zeroed in on the one aspect of animal welfare that aligns with their worldview & have never spoken out about any of the other manifold abuses & cruelty we mete out to the non-human world. To answer the question posed by Catherine, I would support an investigation into the welfare implications of halal/kosher slaughter *as part of* a wider inquiry into investigate into animal welfare & cruelty & the impacts of animal farming & hunting on nature & the environment. So, let’s have a royal commission to examine the scientific evidence on what causes animal harm & suffering. If the evidence shows that halal slaughter causes unnecessary suffering, I would indeed be in favour of banning it, as I would any unnecessary cruelty. My suspicion, however, is that if we were to apply such standards evenly then we would also need to ban most factory farming too, as well as a host of other practices & industries which cause animal suffering. Would these right wingers support such bans if based on scientific evidence of animal suffering, or are they using animal cruelty as a fig leaf to attack certain religions?

@VeteranGamerUK Au contriare, I believe strongly in the freedom of country folk. Like the freedom to go for a nice walk in the countryside without a jumped up posh person screaming at you to get off ‘his’ land because a random king shagged his mistress 650 years ago.

@GussieGrips @sprolliehouse @The_HCPC @WoodmooseStill Not sure if already aware, but this may (or may not) provide clarity to your point: hcpts-uk.org/aboutus/public…

@sprolliehouse @The_HCPC @WoodmooseStill I am struggling to see why this is a fitness to practice issue. It fits the Hate Crime Bill - he complained about tweets which *might* cause offence to someone with a gender issue if they read the tweets and then went to the bother of establishing who owned the anonymous account

I’m RTing my own thread because I am staggered by the @The_HCPC accommodations made for the complainant in @WoodmooseStill hearing. I expect we’ll hear an explanation of why this grown man needed a screen and why it was initially allowed to conceal him from observers.

Here is what the head of the judiciary had to say about lawyers' use of AI. Any judge who is found to have carelessly relied on AI should not be permitted to keep their job.

🚨There's only one thing we're interested in and that's catching bent coppers🚨 oh, and another series of Line of Duty #LOD7 @BBC @Vicky_McClure @martin_compston #AdrianDunbar

Nvidia invests in OpenAI, OpenAI rents compute from Oracle, Oracle buys Nvidia’s hardware, and Nvidia records huge sales. Everyone in the circle reports rising revenue, rising valuations, and surging share prices, but the cash is largely moving in circles graceblakeley.substack.com/p/the-ai-circu…