Arvind Singhal

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Arvind Singhal

Arvind Singhal

@arvsinghal

Consultant Cardiologist at Frimley Park Hospital | Here to learn - views my own

London Katılım Eylül 2019
704 Takip Edilen311 Takipçiler
Arvind Singhal
Arvind Singhal@arvsinghal·
@valhumphreys51 Conscious sedation by a trained professional (which can be a sedation trained nurse) is perfectly safe, and I think a lot of health professionals here are massively overreacting, and it allows patients to get sedation more readily
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Valerie (Val) Humphreys
Valerie (Val) Humphreys@valhumphreys51·
For clarity: I understand that many people on here think that sedation is risky, too risky for an AA to be allowed to give it, too risky to have in outpts, more dangerous than GA etc. I’m not suggesting you are wrong - after all, you are the professionals. All I am asking 1/2
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Arvind Singhal
Arvind Singhal@arvsinghal·
@dnunan79 @BoussageonR Would a reasonable analogy be: I flip a coin 10 times, 6 heads, 4 tails. Were there more heads than tails? Yes Does the coin tend to land heads? Inconclusive. I think the sampled clinicians are interpreting the question as the latter which is more relevant
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David Nunan
David Nunan@dnunan79·
@BoussageonR @arvsinghal If the set alpha value (typically 5%) is not met, this is interpreted as 'The data do not provide sufficient evidence against the null at the 5% level'. But not as 'there is no effect'.
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David Nunan
David Nunan@dnunan79·
Wait till you find out that the 1 out of 5 still probably interprets a confidence interval wrongly as a credible interval. And then wait until you find out no one can really show why that error matters to decision making, so you can carry on as you were.
Beatriz Gros@Bealoquebea

I have seen this error so many times A confidence interval crossing the null does not mean “no effect”. It means uncertainty around the estimate. Yet in this survey, fewer than 1 in 5 clinicians correctly identified an effect when the point estimate suggested benefit or harm but the CI crossed the null Time to move beyond dichotomous thinking sciencedirect.com/science/articl…

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Arvind Singhal
Arvind Singhal@arvsinghal·
@daisychristo I think an obvious area for a national exit exam and university comparisons is medical schools, and yet there's been massive resistance to this (despite I think a strong public interest argument)
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Daisy Christodoulou
Daisy Christodoulou@daisychristo·
The great thing about a system like this is that less prestigious universities would be able to prove they taught maths as well as more prestigious ones. And people could copy what the best universities do, or try and improve on what they do, and learn from each other in a way that just isn't possible now.
Tom Forth@thomasforth

@daisychristo We had something very similar when I was an undergrad in Paris for a year. It eroded the privilege of the Elite institutions. The concours system did the same. So I completely understand why the elite Unis in the UK oppose it. But it would be better for actually learning maths.

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Zack Ferguson
Zack Ferguson@zackferguson·
And now his watch is ended. Seven years, hundreds of shifts, thousands of bleeps and one pandemic later… I’m the Med Reg no more. It was the best of jobs. It was the worst of jobs. But most of all, it’s over. ✌️
Zack Ferguson tweet media
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Arvind Singhal
Arvind Singhal@arvsinghal·
@residentadviser The supposed victims of most "cultural appropriation" are usually delighted about said appropriation. Eg if someone wore an Indian inspired dress, most actual Indian women would love it
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Arvind Singhal
Arvind Singhal@arvsinghal·
@jo3hill @restate_thinks @BeaconRosie @AliceKSemark A big factual error - you write that doctors choose a specialty eg Cardiology after 2 years, but that's not correct, you can only do a medical speciality such as Cardiology after 5 years of general training, and it is mandatory to also do internal medicine at the same time
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Joe Hill
Joe Hill@jo3hill·
Everybody wants to talk about Our NHS. But nobody wants to talk about R NHS, where R stands for “Rate of flow through hospitals”! Our new paper @restate_thinks explores how to fix hospital gridlock. Great to see it written up in the Times, well done @BeaconRosie @AliceKSemark
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Arvind Singhal
Arvind Singhal@arvsinghal·
@DrWillWatson Completely agree. I feel like cardiometabolic is in vogue right now, but I can't imagine obesity treatments helping slim, elderly HFpEF patients (who I think are probably the majority of HFpEF in clinic)
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Will Watson
Will Watson@DrWillWatson·
2. This creates a circular argument whereby HFpEF and the effects of obesity on the heart are synonymous. 3. Therefore HFpEF collapses into being an extension of obesity and obesity treatments become HFpEF treatments.
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Will Watson
Will Watson@DrWillWatson·
1. The reason obesity/dietary excess is the major driver of experimental HFpEF is that this is the preclinical model which has been honed in on. It ignores other contributions (aging/hypertension/valve dysfunction/atrial disease)
Andrew J Sauer MD@AndrewJSauer

The vast majority of patients with HFpEF have cardiometabolic disease driven by adipose tissue at the core. Lines of evidence continue to support this adipokine hypothesis. The inimitable Milton Packer provides a deeper understanding of the evidence in this timely perspective piece in JACC. jacc.org/doi/10.1016/j.…

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Arvind Singhal
Arvind Singhal@arvsinghal·
@botzarelli While I was there my comp changed from blazers (which you could buy from anywhere as long as you stitched on the school badge) to jumpers you could only buy from one place that looked tacky, were way too warm in summer and had no storage
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AB
AB@botzarelli·
At my local comprehensive schools the “posh” blazer is the same price as the alternative of a jumper but unlike the jumpers you only need one if you’re trying to avoid being stinky. Blazers also give you somewhere to keep your pens so you never “forget” to bring one.
Michael Winstanley@Winstamike

Why does a blazer have to be "posh" .I went to a state comprehensive school in Wigan, and a blazer was part of the uniform policy. That uniform policy was enforced. Because standards matter and it breeds an ethos in standards and behaviour.

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Arvind Singhal
Arvind Singhal@arvsinghal·
@adb0wen So yes I agree RPI is very misleading but so is your graph, where the base pay rise is mostly just the 2016 contract increasing base pay and reducing out of hours pay. It's a silly comparison
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Arvind Singhal
Arvind Singhal@arvsinghal·
@adb0wen Not when the method of how pay is calculated has changed so dramatically though, eg FY1 base pay went up circa 15% but total remuneration was roughly the same after the contract (it was pay neutral). Almost no one works just 40h and gets only base pay
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Arvind Singhal
Arvind Singhal@arvsinghal·
@adb0wen Base pay is misleading too because the contract changed in 2016. Base pay on the pre 2016 contract was low, but had high pay for additional hours (usually 40 or 50% extra). They increased base pay and reduced on call supplements for out of hours in 2016
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Arvind Singhal
Arvind Singhal@arvsinghal·
@portraitinflesh Existing residents have a vote but potential residents don't. Furthermore some non owners see new builds (though they are a drop in the ocean) and prices rising and so wrongly assume building does not help affordability
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Arvind Singhal
Arvind Singhal@arvsinghal·
@portraitinflesh My pet theory on this is that right NIMBYs and older generations want house prices to go up and don't want new people moving into their towns. Left NIMBYs believe that gentrification and private development is always inherently bad
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Tomos Doran 🏴󠁧󠁢󠁷󠁬󠁳󠁿 🇬🇧 🇺🇦 🇮🇱 🇵🇸
Tomos Doran 🏴󠁧󠁢󠁷󠁬󠁳󠁿 🇬🇧 🇺🇦 🇮🇱 🇵🇸@portraitinflesh·
There's now near-universal consensus that Britain's failure to build enough housing is not just a huge problem, but also an ur-problem that makes all other problems worse. But has anyone attempted a proper explanation of *why* the UK has failed so spectacularly, in this regard?
Sam Dumitriu@Sam_Dumitriu

Every year for the last 40 years, France has built more homes per person than England. If England built at French levels, it would have almost 3 million more homes. French homes are, on average, a fifth bigger that English homes.

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Arvind Singhal
Arvind Singhal@arvsinghal·
@1689Freeman @BernoulliDefect The paper you linked shows it did decline in absolute terms and they specifically say it was because of deindustrialisation during the 18th and 19th centuries
Arvind Singhal tweet media
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bernoulli_defect
bernoulli_defect@BernoulliDefect·
It’s a shame that historians aren’t expected to know historical gdp per capita estimates as they clear up sloppy thinking in a similar way knowing modern day estimates helps.
Nicholas Decker@captgouda24

This is total nonsense, to be clear. No part of India was ever even close to as wealthy on a per capita basis as the more developed parts of Europe before the Industrial Revolution. Colonialism should be seen as largely a consequence, not a cause, of divergence.

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Arvind Singhal
Arvind Singhal@arvsinghal·
@BernoulliDefect But it didn't just not rise, gdp per capita actually fell during the 18th and 19th centuries in India during colonial rule. Yes it's not as simple as just empire and wealth extraction, and yes it didn't industrialise but also it was already colonised by the industrial revolution
Arvind Singhal tweet media
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bernoulli_defect
bernoulli_defect@BernoulliDefect·
@arvsinghal It simply didn’t grow as quickly as it didn’t industrialise, similar to other regions like China, Central Asia, etc
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Keşfet

@valhumphreys51 @dnunan79 @BoussageonR @daisychristo @zackferguson @residentadviser @jo3hill @restate_thinks