Consultant in Palliative Medicine (Isle of Wight, UK); Palliative Care Formulary Editor (neuropharmacology sections)
pubmed.ncbi.nlm.nih.gov/40071699/
What I'd add is: consider SC B12 replacement. I don't have easy access to MMA, so offer a trial of treatment if fatigued with a B12<350.
Nothing works every time. But can be spectacular: eg
From housebound to going on a holiday
From bedbound to going out for lunch
Reposted by Paul Howard
Thread [1/9]
Reposted by Smith, Paul Howard
Proposing the concept of misinformation exposure as a social determinant of health.
Read on if you’re interested.
SC metronidazole, ceftazidime, pip-taz are all well tolerated
If you're new to SC ABx, this is an excellent review article
pubmed.ncbi.nlm.nih.gov/32674952/
spcare.bmj.com/content/earl...
SC administration can avoid missed doses if delay cannulating, eg fragile veins
doi.org/10.1093/jac/...
For me, it's "needing to hear patients and families when they recognise deterioration and are asking for symptom focused care"
(As well as hearing the opposite, when frail people want active escalation; palliation should never be imposed)
So there really is no excuse for people to die badly for want of access to medicines.
@iownhs.bsky.social ambulance service identify people in their last days of life wanting symptom focused care, supplement their sch17 ability to give morphine with a PGD for midaz, hyoscine butylbr and levomepromazine, and then call our 24/7 community team to follow-up
This is so wrong.
Reposted by Paul Howard
This is so wrong.
Reposted by Paul Howard
🎥 Watch the video to learn more
🔗 Read the full Guidelines at resus.org.uk/2025-guidelines
journals.lww.com/annals-of-me...
Its also cheaper in UK.
Further, this systematic review found reducing apixaban to 2.5mg BD after 6 months reduced bleeding risk without increasing VTE recurrence
doi.org/10.1016/j.th...
Reposted by Paul Howard
If you have, you'll know what a fantastic opportunity this is to come and listen and engage with Kathryn on "Talking about Dying".
📣 Join us 13th November 6pm GMT
Reposted by David Dunning, Carl T. Bergstrom, Gavin A. Schmidt , and 14 more David Dunning, Carl T. Bergstrom, Gavin A. Schmidt, Jonathan Wolff, Elizabeth Stokoe, Lesley A. Hall, Iikka Korhonen, Smith, Jonathan Hopkin, Alan Richardson, Robert Wolfe, Margot C. Finn, Ben Rosamond, Paul Howard, Christina Pagel, Nicole Guenther Discenza, David Lay Williams
Asking for a friend.....
Reposted by Paul Howard
In which she talks about the importance of the job and the reasons why she was fired
🧪 #CDC #MedSky
@nature.com
www.nature.com/articles/d41...
Found white patients received more analgesia and were admitted less often.
www.nature.com/articles/s41...
Reposted by Paul Howard
So it's interesting that they still found apixaban's non-major bleed risk lower
journals.plos.org/plosmedicine...
pubmed.ncbi.nlm.nih.gov/2384700/
SC would often be a far faster option: fluids, many antibiotics, PPIs, TXA, metoprolol, corticosteroids; the list of drugs given SC grows yearly yet remains little used in UK hospitals
Reposted by Paul Howard
But here's the thing. Moths DON'T fly to flames. And we're just now understanding that.
Let's talk about dorsal light response.
Reposted by Paul Howard
pubmed.ncbi.nlm.nih.gov/2384700/
1."Normal" levels don't exclude deficiency. NICE suggest MMA if B12 180-350 (indeterminate) but our local haem suggests go straight to trial of Rx (MMA also problematic)
2.Many need maintenance more often than 2-3 monthly, so if Sx recur before next injection, shorten interval
E.g studies of "high dose (1mg) B12" are uninterpretable because they use blood levels not symptoms as an outcome (oral replacement can increase blood levels without adequately correcting deficiency).