Discover and read the best of Twitter Threads about #primarycare

Most recents (24)

1/
Hi #dermtwitter! Back for another #tweetorial/#medthread on nails! Today we’re learning about:

ONYCHOMYCOSIS- nail fungus!
 
This is THE most common nail condition- so follow along!
Education from @naildisorders
#medstudenttwitter #medtwitter #meded #FOAMed
2/
Onychomycosis is more common in adults than kids.
Trauma, diabetes, immunosuppression, tinea pedis, psoriasis, and family history are some risk factors

Pro tip- check the feet for tinea pedis if you suspect onychomycosis!

@podiatrytoday
3/
Patients with onychomycosis present with nail discoloration (yellow to brown), onycholysis (nail separation), nail brittleness, or nail thickening.

The big toenail is most frequently affected.

Fingernail involvement without also have toenail involvement is uncommon.
Read 14 tweets
BASIL-C19 Trial. Targeting social isolation, loneliness & depression in older people. 🧵on our #UrgentPublicHealth trial during COVID. just published in @PLOSMedicine!
journals.plos.org/plosmedicine/a…
TL:DR COVID has increased social isolation, & risk of depression & toxic loneliness. A behavioural intervention helped older ppl maintain social interaction & networks. strong signal of effect in reducing loneliness. bigger trial underway. NHS is amazing. Image
Our #COVID19 trials programme is called Behavioural Activation in Social Isolation (BASIL), and here is a dodgy video of me:
Read 20 tweets
We have a drug that protects from #HIV. True or False? #ph260720
My friend Steve texted me last year asking how he could convince his partner Ed to see a doctor.

Steve said, “Something weird is happening to him. He can’t walk, his speech is slurred, and his mood changes. He’s a totally different person.” #ph260720 #HIV
I asked him why Ed is reluctant to see doctors. Steve replied, “He has always hated seeing doctors because he feels judged by the health system.”

This is the story of Ed’s experience and how we could have prevented his death from #AIDS 8 weeks later. #ph260720 #providerbias
Read 18 tweets
There is a strong case for Mr Pritchard to publish all income he receives. How that income is spent, what percentage of private work is undertaken and the hours he works? The government needs to call for more transparency & champion taxpayers' interests @Keir_Starmer. /1
I am also tiring of the lambasting of all GPs by Tory’s & their supporting newspapers. I tend to let this stuff wash over me but as @parthaskar has noted this feels sustained & is accusing my staff of being lazy, part time & not seeing patients. It’s time for facts and balance
/2
First fact: primary care sees 95% of patients on 9% of the NHS budget. That’s ~ £19 billion of the £212billion allocated for spending this year by Dept Health and socialcare. You may want to compare this with NHS track and trace back which had double the budget ~£37 billion.
/3
Read 14 tweets
Warm welcome for fellow GPs from @DrMurton. It’s so good to get together with ones people! #gp21 #RNZCGP
Now hearing from @AndrewLittleMP, the Minister of Health, acknowledging the hard work of the last 18 months. “No room for complacency” #gp21
The usual platitudes acknowledging workforce shortages, GP burnout and the important place of #primarycare in our NZ health system. What is going to be done to address this? #gp21
Read 148 tweets
At this watershed moment in the pandemic, the challenge right now is to recalibrate fear — to quiet fear when the facts don’t support it, and to redirect worry to areas where our health and well-being are *actually* at risk.
That said, let’s acknowledge the universality of fear. It’s entirely normal to be afraid when faced with a threat like COVID-19. After all, fear is normal and part of being human. It helps us survive — to run from the proverbial tiger in the wild.
There was (and always is) a time for fear. Anxiety serves us. Fear = survival. But when the proverbial “tiger on the loose” has been caged, it’s time to release ourselves from unnecessary fear. Risk is everywhere; but anxiety out of proportion to facts can make us sick
Read 7 tweets
#primarycare teams are being asked about the effectiveness and risks of the different #CovidVaccine

Here is some helpful information, all in one place.

@NikkiKF @SonaliKinra @DrUrsulaM @KirenCollison @PrimaryCareNHS @rcgp @LondonwideLMCs @BMA_GP

🧵
1/n
How effective is the #PfizerVaccine? What information do people want to know?

Source: ed.ac.uk/files/atoms/fi…

2/n
How effective is the #AstraZeneca vaccine?

Source: ed.ac.uk/files/atoms/fi…

3/n
Read 10 tweets
When you want to know why
-women & minorities leave medicine
-why research lacks data to serve needs of anyone not white & male
and/or
-why different mortality rates in patients by gender, race, SES

this is why

This is #MedBikini#professionalism” again

#MedTwitter
#MedEd
Is insidious
but highly effective
maintains
-segregation
-different access
-barriers

As women, LGBTQ, minorities, disabled enter or advance in medicine, this professor’s public stance will be cited to mislabel having #ethics as “lacking #professionalism

bioethics.net/2020/07/medbik…
#medbikini is not one article
=attitude of many physicians
=drives this

We saw this happen with @ayshakhoury and @uche_blackstock and so many others. It especially happens at midcareer to WOC, especially black. Also if Muslim, LGBTQ, disabled, #mentalhealth

#MedEd
#MedTwitter
Read 52 tweets
1/ When bubbles settle on the surface of the urine it indicates disease of the kidneys-Hippocrates

In the day, urinary exam was so crucial, the urine flask was as much a symbol of a physician as today's white🥼!

🧵Is proteinuria a worthy rival to GFR?
#Nephmadness #primarycare
2/
*⃣Normal urinary protein excretion is <150mg/d and comprises mainly Tamm-Horsfall proteins, with very little albumin (5-10mg/d)

*⃣ We don't understand what happens to albumin in the kidney 💯

*⃣ But overall the degree of albuminuria is a ⚖️of filtration + reabsorption 👇
3/Albuminuria is common in injury to the GBM (GLOMERULAR proteinuria)

But non-albumin proteins sometimes dominate the filtrate.
The classic case is OVERFLOW proteinuria in paraproteinemia
CLUE: Neg dipstick, with⬆️Urine PCR

💡Urine dip +=Albuminuria #renalrules
Read 15 tweets
One neat solution was in @TownofPlacentia. There were independent seniors units (built/helped-along by @lionsclubs) literally next door to the small but mighty @EasternHealthNL Placentia Health Centre. The residents had super easy access to the advanced services at the hosp. 1/
This meant they could stay in their own homes for a lot longer prior to transferring to some type of supportive/long-term care.

Next, I looked after about 25 of these patients. My nurse and I would go to this part of town once per week and do housecalls. The longest .. 2/
anyone went was four weeks between housecalls. They had an open invite to request an earlier housecall if any issue developed, plus I would say "I'd like to see you next week" anytime when appropriate. This meant we probably did 10-15 housecalls a week. Given these houses 3/
Read 12 tweets
1/ Monitoring eGFR in CKD is almost a reflex🦵!

But how did we get here?
What are we trying to assess?
And how does eGFR help?

#NephMadness #primarycare pits GFR vs proteinuria in CKD

In this tweetorial let's take a closer look at GFR

But first, who has your vote?#NephTwitter
2/ The concept of GFR as a marker of kidney function dates way back to the 1950s. (Apologies to the tubules, we do❤️you!)

But how could we measure GFR??

It was suggested that if a solute had certain characteristics its plasma clearance would = GFR

Let's briefly recap🤓
3/ The solution, INULIN, a non-toxic exogenous molecule, came through studies on aglomerular fish! #AnimalHouse

INULIN renal clearance= measured GFR
It is considered the GOLD standard🏆

But it comes with baggage
🧳It's expensive
🧳It's tedious
🧳It's hardly available anymore
Read 16 tweets
🚨Today in West Devon🚨 @NHSDevonCCG & @Devon_LMC approved iCOPE (Integrated Care for Older People), the UK's first #populationhealthmanagement strategy for older people to be implemented.
/1
We will proactively identify older people across West Devon with reduced physiological robustness (aka medical diagnosis of #frailty) and offer evidence-based interventions & #Personcentredcare to support patients to achieve their goals (see plan on page below) 👇
/2 Image
It's based on @ageingwell @nhsrightcare Frailty Toolkit & is our local answer to #anticipatorycare spec in the @NHSEngland #longtermplan. It is:
👉Proactive & goal orientated
👉Community-based
👉Focusses on prevention
👉Identifies mild frailty so we can intervene EARLY
/3
Read 10 tweets
As @Eugenia_South underscores, #HealthEquity isn’t hard, but it does take intentional work to overcome the inequitable inertia of the status quo.

This weekend in Chicago, our @OakStreetHealth team vaccinated 2000 Latinx people in Belmont-Cragin. Here's how we made it work. 🧵
Our first event launched #ProtectChicago Plus, @ChiPublicHealth + @chicagosmayor's bold strategy to get vaccines into the 15 communities hit hardest by #COVID19.

For months, we'd partnered w local CBOs (@NWSHC @gilbert36ward + others) on testing + more. We'd built trust. 2/
Our partners - trusted messengers who know their communities - told us what to seek: a safe, central location for all to congregate, + one that the community trusts. @ChiPubSchools + @SteinmetzCPHS provided that home - one w walkability + great parking (no easy feat here!). 3/
Read 14 tweets
1/3 On Sat 6 Feb, our @ATMedics Whitechapel Health Centre team delivered an excellent #CV19 #vaccination service @elondonmosque. Several patients said they only came for their #COVIDVaccination as it was in the local mosque, being delivered by local GPs.
2/3 A 107 yr old lady attended, her daughter told us she had been hesitant but felt more comfortable since it was being delivered in her local community centre.

Awesome to collaborate with the #Mosque. We hope this will encourage more local people to come forward when invited... Image
Read 3 tweets
@MParshleyMD @adamIMdoc @InduPartha @primarycarechat @ACPinternists Urgent need to provide MORE time for ambulatory visits. Us ambulatory specialists have all felt the time crunch of seeing complex patient w/ 5-10 issues (or more) in 15-20 minutes. NOT good #PatientCare. NOT #PatientSafety. Thread 🧵 1 @ACPinternists #IMProud
@MParshleyMD @adamIMdoc @InduPartha @primarycarechat @ACPinternists We need major payment reform so reimbursements & physician “productivity” is NOT volume-centered based on number of visit encounters. THAT drives ambulatory schedules to have visits that are far too short to maximize numbers of visits. Thread 🧵 2 @ACPinternists #IMProud
@MParshleyMD @adamIMdoc @InduPartha @primarycarechat @ACPinternists Focus on value of care, NOT number of visits. Have flexibility of visit lengths based on appropriateness for care complexity. Get rid of “one size fits all” 15-20 minute visits. Simple 1 issue visit ok for that. Complex multi-problems-NOT ok w/ that. Threads 🧵 3 @ACPinternists
Read 6 tweets
Apologies for inactivity on Twitter. Our #PlymouthCOVIDCollaborative has been hard at work. The task: vaccinate 80 carehomes, 1800 patients, 2700 staff, across 17 GP surgeries, in 5 #primarycarenetworks IN 10 DAYS. What follows is a brief chronology of events /1
Tues 5th Jan: I was asked to join amazing #Plymouth PCN COVID Collaborative team as #COVIDvaccination coordinator for #carehomes.
Thursday 7th Jan: 1st 400 doses of #astrazenecca arrive
Monday 11th Jan: 1st of 80 #carehomes to have AZ vaccines piloted in @PathfieldsMG PCN
/2
Tuesday 12th Jan: 3 other #primarycarenetworks - Drake, Waterside, and Mayflower - also pilot. Our city works well together and, true to Plymouth form, our #vaccteams are a mixture of teams from #primarycare and #communityservices (courtesy of @livewellsw) -thanks Livewell 🙏 /3
Read 14 tweets
1/
Let's kick off the new year with a #dermatology #tweetorial! I put together some tweets on

#MELANOMA

#MedEd #FOAMEd #medtwitter #dermtwitter #onctwitter

Let's start with a poll:

Among BOTH males and females in the US, how common is melanoma?
2/
Melanoma is the 6th most common malignancy (that's tracked) for BOTH men & women. Basal cell carcinoma is actually the MOST common cancer in the US, but we don't track it.

While melanomas are 6th, in certain groups (eg: women age 25-30), it is the #1 cause of cancer death! Image
3/
So melanoma is deadly, especially in certain age groups. But something peculiar is happening too. @AdeAdamson recently spoke at @MassGeneralNews about this interesting finding 👉 melanoma diagnosis is increasing, but melanoma death is decreasing.

Read 18 tweets
1/ This past Thurs, I was honored to ‘emcee’ a grand rounds @HofNorthwellDOM, presenting the Candee Award for Education Excellence in Medicine 2our beloved Ron Rosen of @NorthwellDGIM

Ron is a 50 yr general internist who has taught no less than 40 yrs worth of learners -> 🧵
2/ Ron had so much to tell us about his aunt and uncle, who were early family medicine practitioners in the Bronx/Manhattan. Ambulance drivers would take them to a patient’s home. A beautiful sepia tone showing his aunt going to a call, and another of his uncle in the office
3/ We heard about Dr. Rosen’s medical school yrs @nymedcollege in the early 60s &how he knew the civil rights movement, the movement for reproductive rights, the attempts to mitigate poverty and the birth of Medicaid and Medicare would affect all his future pts &his work ->
Read 15 tweets
Med Schools offer almost no instruction in the world's #1 cause of working-age disability. It'd be like Dental Schools not covering cavities.

7 words diagnose most #migraine: Recurrent #pain w/ hypersensitivity &/or nausea. 60% of patients go undiagnosed. #MedicalTwitter #PCP
#Migraine is PROGRESSIVE. A 40% diagnostic rate condemns some to lifelong #disability: Late diagnosis & ineffective treatment of acute #migraine are leading risks for continuous migraine. #PCP #MedicalTwitter mdedge.com/jcomjournal/ar…
🔴HOW DOES THIS CHILD GO 8 YEARS WITHOUT A DIAGNOSIS? She has textbook ICHD-3 #migraine! 1>sudden hypersensitivity (smell) 2>throbbing #pain 3>nausea 4>need for bedrest

She might've avoided #disability w/ early diagnosis & treatment. #PCP blogs.webmd.com/my-experience/…
Read 10 tweets
1) I lose track of some things I’ve written about so I’ve compiled this #thread of threads. For context
I’m a 60 year old #ActuallyAutistic woman in the U.K. only recognised as being #autistic at 58. This is a purely personal perspective on
#autism
#Neurodiversity
#AutisticJoy
2) A year on from my #autism diagnosis I wrote this thread, with reflections on the process of being assessed as #ActuallyAutistic very late in life.
#autism
#ageing
#OlderAutistics
3) My (autistic) election experience (I keep trying to stay away from politics but failing. It matters far too much).
Read 25 tweets
1/ Curriculum #Medthread about our Global Health Track & Scholars Program!

The OHSU IM Global Health Program endorses a broad definition of #GlobalHealth rooted in interdisciplinary collaboration to promote better health for all

ohsu.edu/school-of-medi…

2/ As the program has grown over the years, one of the highlights of the program was a rotation at Scottish Livingstone Hospital in Molepolole, Botswana through our Harvard/Beth Israel Deaconess partnership

3/ Program alumnus @AdamRodmanMD (host of @BedsideRounds) was a program participant, and then completed a #GlobalHealth fellowship!

Watch him talk about his experience at Scottish Livingstone Hospital here:

Read 10 tweets
0.1% = rate of fatal #OD in the medical use of #opioids acc'g to 2019 research from Kaiser Permanente (link below).

Bwn 2006-2014, 41 of 31,142 died of OD, a rate of 5 per year. Risk stratification did not lower OD rates. Dose reductions were "inconsistent" (VonKorff). /thread
2,887 #vets died by #overdose or #suicide after their #opioid medicine was stopped by the VHA in FY2013 (90 fewer than on 9/11) (Oliva et al 2020).

Patients whose rx opioid was stopped were 3 times MORE likely to die by OD than those whose medicine continued (James 2019).
4.9% of discontinued patients died of OD.
1.7% of continued patients died of OD.

Discontinuation of rx #opioids was associated with 1.35 times the risk of death & 2.94 times the risk of fatal OD compared to patients whose rx continued (James et al 2019).
Read 12 tweets
2019 study in the AMA journal reports that reducing access to rx #opioids has "failed" to reduce overdoses.

OD crisis is projected to become "substantially worse" if public policy continues to wrongly target medical use. (thread) filtermag.org/rate-of-opioid…
Chen et al (JAMA 2019): Analyses of programs designed to reduce overdoses by reducing the medical use of #opioids "have failed to demonstrate a consistent benefit on fatal or nonfatal opioid overdoses." jamanetwork.com/journals/jaman… Image
JAMA> #OD rates are projected to soar 149% above 2015's crisis levels by 2025. Overdose deaths from 2016-25 could reach as high as 1.21 million if the crisis doesn't soon stabilize.

🟡 Continuing prescription restrictions will have a "modest effect, at best" on reducing ODs. Image
Read 13 tweets
"Sustained reductions in antibiotic prescribing [in] viral ARTI visits" found - cluster #RandomisedControlledTrial of online primary care doctor training programme using #ConversationAnalysis #EMCA evidence on communication practices alongside
#AntibioticResis
1/
An accompanying editorial notes that the authors "recognize that clinicians are adult learners, and they combine interventions to implement these adult learning theory tenets to improve appropriate antibiotic prescribing."
pediatrics.aappublications.org/content/early/…
3/
Read 9 tweets

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