Steve Granier

Family doctor, concerned about overuse of medicines, antibiotics especially; father of 2 boys, cycling addict

[Ash Paul @pash22]

“What if”: Two words that are breaking emergency medicine
https://t.co/fHVCVADAUH via @docib

[Margaret McCartney @mgtmccartney]

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?

[Dr Tony Goldstone @goldstone_tony]

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

[Sir Michael Marmot @MichaelMarmot]

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

[Sir Michael Marmot @MichaelMarmot]

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 https://t.co/XrPaWPLyJ3

[Adam Cifu @adamcifu]

There are days that I feel like my role as a primary care general internist is to be the receptacle of other people’s intolerance of risk and uncertainty.

[Steve Granier @DocSteveG]

@medmyths This is compelling

[Steve Granier @DocSteveG]

@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.

[Steve Granier @DocSteveG]

@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.

[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.

[Steve Granier @DocSteveG]

@medmyths There is consistent evidence from MR studies that apolipoprotein B is the predominant trait likely to explain how lipids cause CHD. https://t.co/Zn2PvqWr3E

[Sanjay Kaul @kaulcsmc]

1/
REDUCE-AMI Trial

https://t.co/fIY5U8PanS

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

[Gus Hamilton @gushamilton]

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.

[General Practice @BMA_GP]

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.
https://t.co/1i2Os1Gbsu

[Steve Granier @DocSteveG]

@adamcifu @adamcifu We are still recruiting into panoramic trial. https://t.co/WG7bV85IEf @ChrisColButler

[Prof Darrel Francis ☺ Mk CardioFellows Great Again @ProfDFrancis]

ORBITA-2

https://t.co/3wbEQIwmJs

[Steve Granier @DocSteveG]

@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.

[george davey smith @mendel_random]

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 https://t.co/aZzPr8oYmC

[Steve Granier @DocSteveG]

@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.

[Julian Treadwell @JulianTreadwel1]

Great to have such positive response to https://t.co/CQ7uCRvG8H 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...