Great article Steve Goodacre @EmergencyMedBMJ Treatment or patient effects may mean that a prediction model is not saying what you think it is! The statement “guidelines should not use clinical prediction scores to direct patient management” should make us all stop and think.

@rbarbosa91 Atrial appendage is a convenient shape to use for this.

EDs often see that prison healthcare is under-resourced. The transition out of prison is also a very noticeable ‘gap’ in healthcare. Very good to see better coordination with the hospital.

RT @RCEMevents: Our @EMTAcommittee Conference lead, @JosephineJYMo, is thrilled to welcome you to #EMTA2025! This year's theme, 'The Art of…

@walsh_joe @RCEMpresident @EddCarlton I would suggest almost all of EM training should be delivered by EM specialists - but should also include others who are great teachers and really ‘get’ what the EM trainees need.

@RCEMpresident @EddCarlton Nice specialist says “I’ve got a special interest in X I could come and teach your teams about X” then get disappointed when I say no. Trouble is there are several hundred of conditions just as important!

@EddCarlton @RCEMpresident GIRFT seems to have lost its way. Maybe time to move on?

@profchrisham @mancunianmedic @sib313 @RCEMpresident John Bache 2005 “A&E consultants are pursuing a course which is diametrically opposite to that of all other specialties in the NHS. Every other specialist is becoming increasingly specialized, whereas A&E practitioners are becoming increasingly diverse.” Now also applied to GIM.

@profchrisham @mancunianmedic @sib313 @RCEMpresident Focus should be right sizing services across the care pathway to match an increasing demand for emergency care, in the context of increased demand for senior doctor delivered care.

@ANDYL0CKEY @American_Heart @TheBHF @ResusCouncilUK @ERC_resus Who they?

I would really appreciate it if you would take 20 mins to fill in this survey. Your opinion counts! We are still really short of volunteers to fill in the survey. I think this project is important as the psychology of antibiotic prescribing is key to controlling resistance.

@LarcombePeter @TandAlates @cmwilliams99 @medicalmodelbri Guidelines / algorithms give the illusion of removing the complexity and uncertainty around applying the evidence to an individualised clinical decision. Hence also give the illusion that anyone can do it and a false dichotomy of right v wrong for legal and governance structures.

@ngonDOTart @JahangirAsgha10 A good example: “Do the CRASH2 results apply to Americans?”. No patients were recruited in the USA (we could not afford the insurance) which is a potential limitation. So clinicians in the USA have to decide if the evidence applies to their patients.

@JahangirAsgha10 @ngonDOTart Pharma would not sponsor any TXA research as it is an old and off-patent medication, so no profit as it costs about $2 per patient. In the UK we would say “cheap as chips”!

@ngonDOTart @JahangirAsgha10 If you are bleeding out after trauma you need a surgeon! But you would be foolish to decline TXA. TXA has a mortality benefit if given early (to fill the gap until the natural antifibrinolytics kick in) - but you still need a good trauma system to do all of the rest.

@Azeem_Majeed 1980s. A senior academic stepped into the RSM library lift at the same time as me. Both carrying an armful of journals, heading for the basement photocopier. To make conversation I said “I wonder what we did before photocopiers”. “We read the papers” Rest of journey in silence.

@PemburyDoc Yup. But our brains seem to have a problem working with a test which is significant if negative but meaningless if positive (see d-dimer!!).