1. This is an important debate for all FRCPs to attend and vote on. It is your opportunity to impact the how medicine is delivered in the next generation and by whom. Have your say on patient safety.
The 5 motions to be debated are:
1) Physician associates are not doctors. They should not be regarded as replacements for doctors, and they should never replace a doctor on a rota. They are valued healthcare professionals who participate in patient care in addition to the rest of the wider multi-disciplinary team 2. Motion 2: This EGM notes the current legal restrictions on who can prescribe medication or request ionising radiation and reminds all medically qualified membership categories of the College that they remain responsible for any such decisions by others that they may be asked to endorse

1. Medicine is rapidly becoming an expensive hobby- working class people can no longer afford to become doctors given the poor salaries and huge debts on graduation.

I am the son of immigrants - I couldn't speak English until i was 5-i was born/ brought up in longsight, Manchester- in the top 3% of the most deprived areas in England. 2. My father had to work two jobs to support us. I went to a state school. My friend ended up in prison for holding up an off-licence with a gun.

I am the first person / only person in my family that has received an education over the age of 16 and to get into university (oxford)- the only reason I was able to do this was that I received a grant of around 2-3000£ from my council every year.

1. #ConsultantStrikes #NHS
➡️Today the press will be full of stories about fat cats, private practice, made up salaries, gold-plated pensions etc.

➡️ it will say that waiting lists are up and patients are being put at risk.

Please read this 🧵 and make your own minds up. 2. It is true that waiting lists are the highest they have ever been, there are excess deaths.

➡️ waiting lists have been climbing for 13 years - 12 yrs before any NHS strikes were in place

➡️ the increase in waiting lists is a political choice of the conservative government -… https://t.co/0om58ILijktwitter.com/i/web/status/1…

1. Tomorrow i will be supporting the NHS #ConsultantsStrike
About Me:
➡️ I am a cardiology consultant / professor @UHNM_NHS
➡️ i was from a working class background, i went to a state comprehensive. My dad left school at 16, mum at 12. I am the first / only member of my family… twitter.com/i/web/status/1… 2. When I qualified (2000) we had no debt, stayed in hospital accommodation for free

➡️ junior drs leave with 100k of debt
➡️ earn less that i did 20 yrs ago
➡️ have had a real term pay cut of 20% over the past 13 yrs

Many are struggling to afford rent.

We are losing… twitter.com/i/web/status/1…

What happened to HF admissions during #COVID in England? our an analysis led by @DrAhmadShoaib ➡️bit.ly/3c0iEng with @hvanspall @foziaahmedMD @cpgale3 @TheresaMcDonag3 #JohnCleland shows 40%⬇️in HF admissions @GiuseppeGalati_ @DrNasrien @JJheart_doc @ShelleyZieroth 2. This was accompanied by a ⬇️in hospital HF deaths, but ⬆️⬆️ in community and residential home deaths. we estimate 280 excess deaths from heart failure, and an excess of 2,165 heart failure related deaths (HF anywhere on death certificate) @doc_ccc @onco_cardiology @ncurzen

Another day another Hike. This time starting at eigiau dam en.m.wikipedia.org/wiki/Llyn_Eigi… that burst in 1925 and flooded millions of gallons of water - you can see break in 1st pic @DrMarthaGulati @saraceciliamtz @bes502 @DBelardoMD @ShaziaTHussain1 @KTamirisaMD @ncurzen @nolanjimradial Walking up towards the summit of wales 2nd highest mountain Carnedd Llewelyn- didn't make it to top, got to 900m. If you go to Wales come here and don't bother with the Snowden. I literally saw one other couple, rather than hundreds of ppl in snowden @DrRajivsankar @VijayKunadian

1. Hired a cottage in wales For a few days, decided to hike to pen y gaer, An old iron age fort. @DrMarthaGulati @BethFratesMD @bes502 @nolanjimradial @iamritu @CastlDalmunzie @SilCastelletti @mirvatalasnag @djc795 @ErinMichos @RodrigoBagur @ncurzen @DrToniyaSingh @jedicath Further along the climb becomes quite steep. Unfortunately @komoot has taken me nowhere near any dairy products 😜😜 @wordfinga @Libbyextra @Uqayyum123 @billgogas @drercardio @EkateriniL @JGrapsa @Kfarooqi @DrAmirKaki @netta_doc @nishat76 @JSillerMatula @jedicath @DBelardoMD

1. Today is #WorldCancerDay our analysis led by @dr_mosama & @hvanspall academic.oup.com/ehjacc/advance… with @AnaBaracCardio @islamelgendy83 @DLBHATTMD @adnanalkhouli @safinmc @dataevan studies disparities in care & outcomes of cancer pts presenting with STEMI @DrMarthaGulati @ShrillaB 2. #WorldCancerDay It builds on our work published last year led by @adityadoc1 showing pts with cancer less likely to be managed invasively, and when they are have better outcomes. academic.oup.com/eurheartj/arti… @MKIttlesonMD @ovidiogarciav @DrPeterOKane @SukhNijjer @CardioIAN

1. Clickbait title but content worth discussing- my thoughts over the next few tweets
➡️Questions around AMI definition.
Dr Taggart and others were part of the discussions that agreed to AMI definition. I think it was right because- see2.
medscape.com/viewarticle/93… via @medscape 2. an endpoint should have same prognostic impact in each trial arm. EXCEL definition does, UDMI doesnt
however:
➡️Should probably only include spontaneous AMI post procedure (>72 hrs), whatever definition you use, CABG better in long term

1. My talk today at #SHA2020 surgeon session re what #EXCEL really shows. To begin- need to understand importance of endpoints
➡️clinically relevant
➡️related to intervention
➡️relevant to pt
➡️similar prognostic impact in each arm
@SVRaoMD @ajaykirtane @RodrigoBagur @jedicath 2. A significant proportion of LMS wont be suitable for either surgery / CABG. As heart teams we have to do better in stratifying by extent of disease - 1/4 of pts included in #EXCEL didnt meet inclusion criteria (low/ intermediate risk) @ovidiogarciav @aspergian1 @cardioPCImom

1. Our analysis of 144,000 deaths in UK during #COVID19 1st march-12th May published today mayoclinicproceedings.org/article/S0025-… . First national study of causes of death and underlying medical conditions. led by @dr_mosama with @dataevan @cpgale3 @TomLuscher only 25% of deaths due to COVID. 2. Age standardised mortality rates in UK ⬆️⬆️ for non-covid deaths than covid deaths during pandemic for all age groups @TheBHF @amibanerjee1 @DailyMailUK @guardian @ncurzen @ErinMichos @EricSecemskyMD @venkmurthy @DavidLBrownMD @BBCWorld @KeeleComms @AnastasiaSMihai @jcspratt

1. Our analysis of >70,000 pts with rheumatological disease undergoing pci (RA, SLA, SSC) led by @saraceciliamtz and @dr_mosama with collobaration with rheumatologists. 1.4% of pts have rheumaological diseases @DocSavageTJU @adityadoc1 @RodrigoBagur RA increasing over time 2. Patients with SLE have ⬆️ bleeding whilst pts with SSC highest risk, with ⬆️ mortality and stroke. Pts with RA not at increased risk once demographics adjusted. @Hragy @DBelardoMD @purviparwani @aspergian1 @stefan_harb @AnastasiaSMihai @drandrewsharp @billgogas @VijayKunadian

1. Our work led by the v talented @Claire_A_Lawson with @kamleshkhunti et al studying 20 yr trends in outcomes in 88,000 pts with incident HF in UK. thelancet.com/journals/lanpu… Hospitalization rates ⬆️ particularly in areas of deprivation & older pts. @hvanspall @ShelleyZieroth @Claire_A_Lawson @kamleshkhunti @hvanspall @ShelleyZieroth @GiuseppeGalati_ @bogdienache @DrMarthaGulati @purviparwani @AChoiHeart @onco_cardiology @avolgman @gina_lundberg @rwyeh @ErinMichos 2. >70% of Hospitalisations are non-CV. greater risk for those diagnosed in hospital vs community. Of CV causes of hospitalisation, HF related admissions becoming increasingly common. Data for mortality even more interesting ➡️ @iamritu @AnastasiaSMihai @mirvatalasnag @jedicath

1. My Big Data talk in pci at #ICI18 meeting in Tel Aviv. Guidelines tell us to take comorbidity, cancer, frailty into account to guide practice, but not found in contemporary risk scores. Data from EHR can help guide. @DrMauricioCohen @Uqayyum123 @SmithElliotjs @jodiel0ve 2. Cardiologists have narrow view of comorbidity. consider individual conditions & not global comorbid burden. Non-CV death and readmissions more common than CV death following PCI. Driven by comorbidity. @mirvatalasnag @akhojaMD @Dralkutshan @jedicath @MBalghith @DocSavageTJU