There is, to my mind, no justification for the continued use by the UK Government of X as a platform for official comms. There hasn't been for some time, in fact, but if the latest developments around AI-generated image abuse and CSAM don't change the policy I really don't know what will.

Latest UK supply problem to impact drugs used to alleviate distress in the dying: parenteral clonidine. Shortage predicted until start of February (though these estimates are too unreliable to plan with). Options: Import it Use oral tablets sublingually SC dexmedetomidine Clonidine patch (import)

🏆 Its been the biggest honour of my life to win The Lancet 2025 Wakley Prize and have my essay published in the final @thelancet.com of the year 📖 🤩 It was the perfect #Christmas present to receive the paper edition, as a surprise delivery yesterday 🚚 📦 @wolfsonpallcare.bsky.social

In 1800, around one in three children died before their fifth birthday, compared to four deaths per thousand births by 2020 | Amanda Ellison

Registration is now open for #BAP2026 Summer Meeting in Birmingham, 19th - 22nd July. For more information, to register and submit your abstract -

New paper drop! 🧠💊 Our new paper out in Molecular Psychiatry shows that the serotonin 1B receptor is important for the neural and antidepressant/anxiolytic behavioral responses to psilocybin in mice. www.nature.com/articles/s41...

📣Out now in Lancet’s @eclinicalmed.bsky.social 🫁The inverse #PalliativeCare law in advanced lung disease:mixed-methods #SystematicReview & #MetaAnalysis -1st paper from my #PhD provides evidence of #Inqualities in #lung disease @wolfsonpallcare.bsky.social www.sciencedirect.com/science/arti...

Interesting. What I'd add is that being in prominent journals is also no guarantee of quality; I've seen some really poor conclusions in the Lancet and BMJ. Particularly by pharmacoepidemiologists ignoring confounding by indication

This case series describes PCP pneumonia in older people immunocompromised by steroids, anti-cancer treatment etc. Great summary of their clinical presentation (74% dyspnoea, 55% cough, 63% febrile, most tachypnoeic, whereas oxygen sats and neutrophil count mostly normal) doi.org/10.1186/s414...

A study on 1.7 million people in Hong Kong shows superior hybrid immunity to Covid in people who got vaccinated before infection vs. people who got infected first. "Our findings are a direct rebuttal to arguments for natural immunity," the authors write. doi.org/10.1016/j.va...

Delighted to have been invited to speak at @careforthedying.bsky.social webinar. Can we discuss progressive illness & dying without extinguishing hope? I think we can. I think we do. Join us to ponder on Dec 11th, noon -1pm GMT. It's online, & free to attend. Info ⬇️

Sign up to hear about our latest research on improving end-of-life care and future projects and collaboration opportunities. Our research team is part of PELiCam in the Primary Care Unit, University of Cambridge. Sign up here: cambridge.eu.qualtrics.com/jfe/form/SV_...

Here, Dr Takemura and colleagues examined the impact of low dose ("adjuvant") methadone on QT internal. Even in those with cardiac risk factors, there was no increase in QT with these dose regimens. pubmed.ncbi.nlm.nih.gov/40071699/

The overwhelming weight of scientific evidence says that vaccines do NOT cause autism. The link has been studied many many times. Here is just a taste of the mountains of peer-reviewed evidence: Thread [1/9]

I’ve been circling around this idea for awhile but didn’t have the skill to summarize what others have now done extremely eloquently: Proposing the concept of misinformation exposure as a social determinant of health. Read on if you’re interested.

Here, subcutaneous co-amoxiclav becomes the latest ABx with pharmacokinetic information confirming absorption comparable to IV and sufficient to get above MIC SC administration can avoid missed doses if delay cannulating, eg fragile veins doi.org/10.1093/jac/...

Examples of solutions have existed for several years (eg @iownhs.bsky.social ambulance service, @nhswalesexecutive.bsky.social Wales ambulance service) so why are these not being taken up by other areas?

The 2025 Resuscitation Guidelines emphasise the importance of correct defibrillator pad placement - a simple step that gives someone in cardiac arrest the best chance of survival. 🎥 Watch the video to learn more 🔗 Read the full Guidelines at resus.org.uk/2025-guidelines

For cancer-related VTE, unless specific reason for a LMWH (eg drug interactions), apixaban is safer (n=12 011; less major bleeding [RR 0.67; P= 0.0003], more effective (reduced recurrence of PE), kinder (some find LMWH v painful), cheaper, and saves nursing time. journals.lww.com/annals-of-me...

Apixaban is often the DOAC of choice for cancer-related VTE because its safer than rivaroxaban (quoted thread) 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...

If you're invested in high quality palliative care and haven't heard @drkathrynmannix.bsky.social speak, you are missing out! 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

I've decided to stop trusting experts. Really looking forward to my forthcoming surgery being carried out by my mate Dave. He's not an expert surgeon, but he is quite good with a chainsaw and has watched several series of House. Who needs experts?

Read our exclusive interview by @maxkozlov.bsky.social with the ex-CDC director - Susan Monarez - 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...

Important study examining effect of ethnicity on UK ED attendance outcomes in last 3 months of life. Found white patients received more analgesia and were admitted less often. www.nature.com/articles/s41...

@drkathrynmannix.bsky.social Edinburgh is famously accessible from the NE of England, & we are always delighted to welcome palliative care people across the border to our conferences. We have a great line up this year, closer & cheaper than London. www.palliativecarescotland.org.uk/content/annu...

"In cancer-associated VTE, apixaban was associated with similar risks of recurrent VTE and major bleeding, and a lower risk of clinically relevant non-major bleeding compared with rivaroxaban" journals.plos.org/plosmedicine...

The idiom "like a moth to the flame" dates to at least the 12th century, to Persian love poem "Layla and Majnun". Shakespeare references it in "Merchant of Venice." 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.

I agree; in UK hospitals I see administration of fluids and drugs delayed for hours in those with difficult veins. 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

This is a really key point. 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).

B12 deficiency is also really relevant in palliation. I'm seeing people with fatigue and apparently "normal" B12 levels respond really well to SC B12 replacement (i.e. fatigue in advanced illness but in the absence of cachexia/inflammation). So this thread is really interesting

Here, an RCT showing olanzapine improves cancer-related loss of appetite. That said, like other current appetite stimulant options, it's improving enjoyment of food, but not muscle/strength (here, handgrip strength decreased) dx.doi.org/10.6004/jncc...

“We don’t see an epidemic of autism, but we see an ‘epidemic’ of diagnoses” A fresh journalistic look at the rise in autism that brings together perspectives from the researchers & the autism community 🧪 #MedSky @nature.com by @helenpearson.bsky.social www.nature.com/articles/d41...

💡 Midazolam is actually water-soluble in its vial, but becomes lipid-soluble once it enters the body. That’s unusual for a benzodiazepine. The trick lies in its imidazole ring 👇

💊💊ALFENTANIL💊💊 Alfentanil’s pKa ~6.5, much lower than fentanyl (~8.4) or morphine (~8.0) At physiologic pH (7.4), ~90% of alfentanil exists in the unionised, lipid-soluble form → crosses the blood–brain barrier very rapidly This explains why alfentanil has the fastest onset of action of any opioid

Really useful paper. Traditional dosing strategies (200mg IM loading, followed by 800-1200mg/day) don't reflect its half-life. Typical loading doses of around 600mg may not need any follow-on regular dose (or a very-much-less than 800mg/day dose if used)

Did you know, that the half life of phenobarbitone is an average of 4 days?! The way we use it in palliative care needs to be proportionate, specialist-led, and congruent with known pharmacokinetics. @bmj.com Supportive and Palliative Care has more: spcare.bmj.com/content/earl... #palliativecare

Reframing resilience in community healthcare. Our latest piece in BJCN magonlinelibrary.com/doi/abs/10.1...

Elinzanetant, a dual neurokinin 1 and 3 receptor (NK1/NK3) antagonist licenced in UK for peri-menopausal Sx, also now trialed for hot flushes due to endocrine therapy for breastfeeding cancer. Similar trial recruiting for fezolinetant (NK3 antagonist). www.nejm.org/doi/abs/10.1...

A small RCT (n=34) comparing memantine with an active placebo finding a reduction in both pain and PRN opioid consumption. Memantine’s of analgesic interest because of it’s NMDA action (i.e. ketamine-like) doi.org/10.1080/1758...

New evidence just out shows definitive link between mechanisms driving cancer in smoking with those caused by pollution. Common mechanisms included mutations in the TP53 and EGFR genes 🧪

A review of the use of clonidine for agitated delirium from a psychiatry perspective link.springer.com/article/10.1...

Case series describing 112 treatment episodes with subcut antibiotics Very useful out of hospital or where fragile veins hamper reliable IV access Ideal if wanting active treatment but at increased risk of hospital-related harm (eg frailty, cognitive impairment) doi.org/10.1136/spca...

‘Solar-powered’ sea slugs have specialized depots in their cells that store photosynthetic equipment looted from algae https://go.nature.com/4l27lMN

PLEASE SHARE 🧪‼️ Vaccination schedules on the CDC website have already started changing under RFK Jr. Scientific American has published a guide to the EVIDENCE-BASED vaccine recommendations in place BEFORE ACIP members were removed by the administration. www.scientificamerican.com/article/see-...

An amazing resource on anticipatory (just-in-case) prescribing here. List of key references with succinct descriptions of their significance. Ben (@drbenbowers.bsky.social) has done more than anyone else to research and refine this ubiquitous palliative care practice

Here, we looked at just-in-case (JIC) drug use in 80 patients who died in the community and found: 1. High levels of individualised prescribing: 71% were modified (the prescribing template detects CKD, seizures, Parkinson’s, etc and suggests suitable alternatives) spcare.bmj.com/content/earl...

@paulhoward.bsky.social Hi Paul. I'm trying to find the evidence or guidelines around use of the side port for prns when there is an existing syringe driver and drawing a blank. Do you have any ideas?

Nature research paper: Single-cell transcriptomic and chromatin dynamics of the human brain in PTSD https://go.nature.com/44963IH

Daridorexant and delirium. This is review of the literature so far (much of the placebo controlled data relates to suvorexant for prophylaxis of delirium in older people admitted to hospital etc) and a feasibility study for an RCT. www.sciencedirect.com/science/arti...