Vicki Rouse

T1 diabetic since 1979, Addison’s disease since 1998. NHS lover, HCP. Runner. Now on Bluesky

[Vicki Rouse @VickiRouse9]

I’m gradually withdrawing from Twitter (still a blue bird on my devices as I refuse to update). I’m on Bluesky & am trying to find people I follow here, on there. If I unfollow you on here, that’s why. If you want to find me there, I’m https://t.co/lRdp9wveDj

[Duncan Stott 🏗️🔰🇺🇦 @DuncanStott]

Fiscal drag affects all taxpayers, not just pensioners. There's no good reason to treat working-age taxpayers like we're second class.

[Nostalgia @NostalgiaFolder]

Still one of the best videos of all time

[Linsey Marr linseymarr.bsky.social @linseymarr]

It's widely accepted that hantavirus transmits from rodent excreta to humans via inhalation of aerosolized virus, so I don't understand why we're so reluctant to acknowledge the inhalation route for human-to-human transmission.
https://t.co/aGFDKS94Qk

[Dr Dave Triska @dave_dlt]

The obvious consequence is an NHS staffed no longer by doctors, but doctor replacements and the loss of the art of medicine.

There’s always a choice. Always.

[Cat in the Hat 🐈‍⬛ 🎩 🇬🇧 @_CatintheHat]

Did you know that, in the aftermath of the 1918 flu pandemic, deaths from cardiovascular diseases soared and continued to rise for over 40 years?

From 1960 onwards, deaths from heart disease steadily declined as the younger age groups infected during the pandemic gradually died.

[Deb Lyon @debzly]

@barra_mac @GPDrYvetteDoc @Parody_RCGP @DrSteveTaylor I think it's unlikely, once it gets up and running, to be a Doctor who gets the referral.
It's far more likely that the PA or ACP etc will be making the decisions. The one's with only a 2year diploma will be deciding .
The GP with their 10years++training will be over ruled😡

[Becca von Hattifnatt @vonHatti]

Instead of saying “We don’t have enough safe PPE” they changed the threat level of the pandemic so it would match the protective equipment we had.

Gaslighting NHS workers while knowingly infecting them.

[Dr Steve Taylor @DrSteveTaylor]

One Trust £33m deficit

For reference that would fund 20 GP practices (200k patients) for a year

Providing 1.3million appointments and all the other benefits

Just one Trust

And @wesstreeting thinks Trusts can run Neighbourhoods & community services

[Sean Ninan @sean9n]

Fascinating that people who notice that a system runs better with consultants conclude that the solution is to remove a future pipeline of consultants

[Ash Paul @pash22]

Excellent pragmatic comment by David to @HSJEditor 's article ⬇️
What is missing from this analysis is "how" did the consultants who were able to step in during the strikes become confident, competent decision makers?

By several years working as resident doctors including lots of evening and weekend work, rotational training and exams

There will be no pipeline of future consultants and GPs without employing enough resident doctors to become fully trained senior doctors and replace those who retire

Second, it was fine for a few 2-5 day spells to have consultants doing the overnight resident on call work but we could only do so by cancelling lots of other work that would usually be part of a consultant's job plan (and no, i do not mean private practice - which is not available to those of us in urgent and acute care)

Third, if we continue to have nurses and allied health professionals take on advanced clinical practice roles and the type of work resident doctors might traditionally do, that will further deplete the nursing and AHP workforce doing the jobs they originally trained in

Finally, with all respect to my nursing and AHP colleagues who i work with day in day out as part of a multidisciplinary team where we all rely on one another's skills, you cannot compare a 2 year part time Masters for an existing nurse, pharmacist or AHP to become an ACP with a highly competitive entry 5-6 year medical degree (4 years even for graduate entry from other clinical professions) followed by a bare minimum of 5 years for GP and 7-9 years for a consultant rotational postgraduate training with a series of high failure rate professional exams, annual assessment and review, exit exams and final award of CCST. The breadth and the depth of the training is different as is the duration of basic science underpinning the clinical training.

ACPs/ANPs/CNSs are often fantastic at working within their own field of expertise and we doctors work closely with them and learn from them and patients appreciate their input. But that is very different from seeing undifferentiated patients presenting to services and who have multiple simultaneous conditions and where diagnosis and awareness of differential diagnoses and prioritisation of treatment is key.

And doctors tend to stay in clinical practice their whole careers and not move off into pure management roles in order go to up pay bands.

There is a wider agenda here. Although on OECD tables, the UK has low number of doctors per 1000 population and also our GPs are far busier than counterparts in other high income nations. it has been decided that doctors take too long to train, cost too much to train and to pay and are too professionally autonomous, challenging and powerful

So wherever possible let us replace them with less lengthily trained, less professionally autonomous and less well paid groups - who ultimately still need senior doctors as back up and it is those senior doctors who will end up in the coroner's inquest or complaint meeting and carrying the can for decisions.

It is a false economy and it is clearly being driven by economics and a desire to turn senior professionals into controllable employees who can then help hit politically and managerially driven agendas

Carry on down this road and in 10-20 years those experienced senior decision makers won't be around in sufficient number when there are future crises and contingencies for them to cover @DrLKVaughan @DrAsifQasim

[Clinically Vulnerable Families 💙💜💗 @cv_cev]

It turns out that just one BIG share can change *everything* for a petition.

Please help protect vaccine access for Clinically Vulnerable people by tagging people who could amplify.

- ONLY 6 WEEKS LEFT! -
https://t.co/iasq3RQPIy

[chantzy @chantz_y]

Check out these graphics posted this week by the Heart Foundation of Australia - not too mild, is it?

[Dan Neidle @DanNeidle]

Here's a chart of the marginal tax rate for someone with two kids. They pay 53% tax on every £ they earn between £60k and £80k. 62% on every £ they earn between £100k and £125k.

9% more if they've a student loan

(See all the detail in our calculator, pinned to my profile)

[Louella Vaughan @DrLKVaughan]

outcomes HAD been improving with the old GP QOF asthma framework but have deteriorated over the last 5 years needs to be pondered?

Perhaps a link needs to be drawn between that and the introduction of ARRS??

Children and young adults deserve better than tiers and cartoons.
Fin

[Partha S Kar 🇮🇳🇬🇧🏏🎥 @parthaskar]

The perennial question post the pandemic:

Did #COVID19 have an impact around new onset #T1Diabetes?

A piece of work via @kamleshkhunti et al @DiabeticMed

TL:DR?
SARS-CoV-2 infection is associated with subsequent incident #T1Diabetes in the 1–7 months after an acute infection in previously healthy CYP.

Link:

https://t.co/ENFFusTTlc

[Chinook Crew Chick @chinnychick]

Saw this on Linked In…powerful….

We will never forget.

"Dear 77,301,997 Americans who voted for Trump,

Being Canadian has never been about shouting the loudest. We don’t pound our chests or demand attention. We are sometimes like the quiet kid on the playground, just wanting to get along with others. We hold doors, say sorry even when it’s not our fault, and shovel our neighbour’s driveway just because it’s the right thing to do. We believe in fairness, decency, and looking out for one another.

We are the world’s greatest neighbour… and yes, our spelling is the correct one. We show up. In the words of our Prime Minister on Saturday night, “from the beaches of Normandy to the mountains of the Korean Peninsula, from the fields of Flanders to the streets of Kandahar, we have fought and died alongside you during your darkest hours. During the summer of 2005, when Hurricane Katrina ravaged your great city of New Orleans, or mere weeks ago, when we sent water bombers to tackle the wildfires in California, and during the day the world stood still — Sept. 11, 2001 — when we provided refuge to stranded passengers and planes, we were always there, standing with you”.

And yet, here we are – watching your president, a man who built his legacy on bullying, turn his sights on us. He mocks us, belittles us, and treats us like some inconvenience rather than the ally who has stood by you through thick and thin.

It’s easy to mistake our politeness for passivity, or our kindness for weakness. But here’s the thing about the quiet kid on the playground: push that kid far enough, and that kid pushes back.

Canada has never needed to boast about its strength. We just prove it. On battlefields. In boardrooms. On the ice. So, if you think you can push us around and take us for granted – think again. You think we will become your “cherished 51st state” – think again. Underestimate us… that will be fun. Because the quiet kid? The quiet kid remembers. And when the quiet kid finally stands up, the whole playground takes notice.

Now we are pissed.

Sincerely,
Canada"

[Dr Tony Goldstone @goldstone_tony]

1/4 When even @DHSCgovuk are having to point out how useless the #taper tax is, you know its time to review this @TulipSiddiq @RachelReevesMP @wesstreeting

In government's submission to DDRB today they give an example showing a £2 increase in non-pensionable income causing a

[Tom Bacon @TomABacon]

So, I've just spent a bit of time looking into the debate on IHT and farming. I... got a shock. First, a note: I have a friend who runs a family farm. In his view, the whole thing is a something and nothing. 🧵

[UK Health Security Agency @UKHSA]

With the cold weather settling in, now is the time for those eligible to join the millions of other people vaccinated. #GetWinterStrong 💪

If you want even more detail, you can read the full report here. 📄
https://t.co/wYocaV1tKn

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

Despite the historical use of IV antibiotics for the treatment of bone & joint infections, little evidence supports this practice
A systematic review* of RCTs comparing oral(PO)to IV therapy for osteomyelitis found no studies in which IV antibiotics were superior to PO therapy