NHS Consultant in Cardiothoracic Anaesthesia & Critical Care. Interested in ❤️ & 🫁 Transplant, MCS, Echo, Regional Anaesthesia & Med Ed

London
Joined January 2013
On Friday 31st October we are hosting a short online seminar as part of the AOP ICU Leaders Program. If you are a UK based healthcare professional interested in critical care sign up by emailing [email protected] @RBHHEducation #icu #ecmo #MedTwitter #FOAMed
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Sachin Mehta retweeted
Consultants don’t want to strike, but after 18 months without formal negotiations, they cannot wait any longer. These strikes are planned to take place on 25 and 26 November, with Christmas Day levels of cover provided. There is still time for the Government to make progress.
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Replying to @DrNovinoTailor
Anticoagulants are used for venous thrombosis because venous clots are rich in fibrin formed by slow blood flow (stasis) and the coagulation cascade, whereas antiplatelets are used for arterial thrombosis because arterial clots are driven by platelet aggregation triggered by high-shear stress and ruptured atherosclerotic plaques.
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Please retweet...
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Is it a surprise that there are so many concerns with LAST with continuous SPIP blockade? Fig 1. Blue dot: ribs Large white dot: major arterial perforators Fig 2. Black dot = ITA perforators Fig 3. Coronal section Br J Plast Surg. 1986; 39: 287-99
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This is a disaster for the human race and I’ve really lost patience with the useless morons who can’t see that. An AI video chat that passes for human has no necessary legitimate applications. It will be used to scam old people out of their life savings. Lonely, mentally vulnerable people are going to form romantic attachments to people who aren’t real. Isolation will increase. Mental illness will skyrocket even more than it already has. Kids in grade school will have AI boyfriends and girlfriends. All of this will happen. And worse things we can’t even conceive at this point. People are already forming unhealthy emotional attachments to text-based LLMs. Once there’s an audio and visual component, it’s over. Millions of brains will be broken irreparably. The benefits of this technology, whatever they are exactly, are so vastly outweighed by the societal catastrophe it will cause, and is already causing, that you can’t even measure the two categories on the same scale. But at least this is the best thing that ever happened to third world scammers. So if you’re in that community, congratulations.
Introducing Griffin, the first model to pass the video Turing test. 48% of people who talked to it live thought it was a real human. Previous systems have had a pass rate <3%. It is #1 on NVIDIA's benchmark for full-duplex AI video. It’s the first Human Interaction Model (HIM).
Readers added context they thought people might want to know
The 48% figure and "video Turing test" claim are from Tavus's own study of 54 one-minute calls, not independently verified or using a standard protocol. Griffin-Lite leads NVIDIA's VideoFDB benchmark on their public leaderboard. cellcog.ai/blog/tavus-gri… research.nvidia.com/labs/amri/proj… tech-ish.com/2026/10/02/tav…
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It’s Organ Donation Week. We were honoured to welcome transplant recipient Dave Webb, who shared how a donor heart and the expertise of our Harefield Hospital transplant team transformed and extended his life. Find out more about organ donation: organdonation.nhs.uk/about-o…
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An important update with implications for surgical and perioperative care: Jehovah’s Witnesses have announced that accepting red cells, white cells, plasma, or platelets from another person’s blood is now a matter of individual conscience. Their position on whole-blood transfusion remains unchanged. For those involved in surgical care, this development highlights the importance of individualized conversations. Patients who identify as Jehovah’s Witnesses may have different preferences regarding each blood component, and previously documented choices may not necessarily reflect their current wishes. Thoughtful discussion and clear documentation help ensure that each patient’s informed preferences are understood and respected. Official announcement: jw.org/finder?wtlocale=E&doc… #PatientAutonomy #InformedConsent #JehovahsWitnesses #PatientBloodManagement #PerioperativeCare #BloodTransfusion @AmCollSurgeons @ASCRS_1
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Daily reminder that the more unwilling you are to deviate from guidelines & protocols, the more readily replaceable you are.
In modern psychiatric practice, many psychiatrists--MDs or DOs who have completed a year of internship, and three years of psychiatric residency--are being replaced by PMHNPs (psychiatric mental health nurse practitioners) with markedly less training requirements, and much lower salaries. But given the limited breadth of knowledge that's required to diagnose patients (checklists of superficial signs and symptoms), and to select medications accordingly, I doubt that treatment varies much between these two disciplines. I think that psychiatrists might have dumbed down their practice so much that their own professional credentials are unnecessary in practice. Not that I think patients are actually that simple to treat. I just believe that psychiatry has stripped away the depths and demands of our job--drunk on a simplistic illusion of mastering what is the most complicated object in the known universe, the human brain/mind.
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Doctors’ London Weighting hasn't moved since 2005. Since then: 🏠Rent is up 128% 🚇Tube prices are up 82% 👶and Childcare is up by 133% London doctors deserve a fair turn. Join the @BMALondon campaign bma.doctor/londonweighting
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We're proud of the lifesaving work our volunteers do in the Channel – we make no apology for it. Those we rescue are vulnerable people in danger & distress. Each of them is someone’s father, mother, son or daughter - every life is precious. This is why we launch:
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In a difficult and dangerous world, a decade on from Brexit, there is a risk that Britain loses the confidence to lead and stand up for its values. I’m not prepared to let that happen. It is more important than ever that Britain stands for something. We have called for years for a two-state solution in the Middle East, but we must recognise that those words are meaningless unless we back them up with action. For too long, we have been hesitant to act, fearful of being accused of being anti-Israel. Today we are announcing carefully judged, targeted steps that are not aimed at the Israeli people, but at the unacceptable policies of the current Israeli government. The suffering of the Palestinian people is a scar on the conscience of the world. Innocent Palestinians, including children, continue to be killed in Gaza. And there is still a humanitarian crisis, with far too little aid getting in. The scale of destruction is hard to comprehend. More than 70,000 people lie dead - at least 20,000 of them children. Families and communities have been torn apart. Millions displaced. And the population of Gaza is now penned into just one third of the territory. I know that people across the UK feel very deeply about this issue - and so do I. Before I became Prime Minister, I said our country’s response had been too slow and simply not good enough. That’s why I committed to changing the government’s approach. I will not stand by as the horrific suffering continues to grow and the prospect of a two-state solution - the best hope for peace and stability in the region - comes under attack. More settlements have been approved under the four years of this Israeli government than in the previous 20 years. The UN has reported more than 1,500 incidents of settler violence so far this year, aimed at driving out Palestinians. And the situation is growing worse, fast. The Israeli government has now approved 104 new settlements since it took office in December 2022, and ahead of the October elections in Israel, it is allowing tenders for the construction of the E1 mega settlement to go ahead. This would cut a swathe through the heart of the West Bank - snuffing out the hope of realising a two-state solution. It cannot be allowed to happen. That’s why we are announcing a new package of tough measures to put pressure on the Israeli government: First, we will ban the trade in goods with illegal settlements in Palestine. Second, we have formally changed the view of the British government to say for the first time that the Israeli occupation of Palestinian territory is unlawful - independent of, but in line with, the conclusion of the international court of justice. And third, we will sanction individuals and companies that support, facilitate or profit from illegal settlements. That includes any businesses or investors that take part in the construction of the E1 settlement. In addition, we are announcing a new package of desperately needed humanitarian aid to Gaza. We are taking these steps because it is the right thing to do. I have condemned the monstrous terrorist attack on Israel on 7 October 2023 in the strongest possible terms - and continue to condemn Hamas. However, it does not justify the Israeli government’s actions in Gaza or the West Bank. The measures we are taking are about targeting illegal settlements and increasing the pressure on the Israeli government to change course. We are not imposing sanctions on Israel as a whole, which would punish the Israeli people, many of whom disagree with their government’s position. The Israeli people are not responsible for the actions of their government. And nor is the Jewish community in the UK. Blaming British Jews for the actions of Benjamin Netanyahu’s government is wrong, plain and simple. And it is antisemitism, plain and simple. I met the representatives of the Jewish community just last week. I know the fear they live with day by day. My government will stop at nothing to ensure they are safe and to stamp out antisemitism in every part of our society. The measures we are announcing today are about protecting the only solution that could see the Israeli and Palestinian people living side by side in peace and security - something that people up and down the UK desperately want to see. The government I lead will keep working with our partners around the world to keep that hope alive.
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People keep trying to make metoprolol & COPD a thing. They're not. They don't love each other, they don't hate each other - they're just indifferent to one another. A few years ago there was an overblown trial in NEJM which tried implying that metoprolol *increased* mortality in COPD. I debunked the concept of metoprolol killing people on the blog here: emcrit.org/pulmcrit/metoprol… This new trial will hopefully clarify this topic once and for all. The bottom line on metoprolol & COPD: 🔑 COPD isn't an indication for metoprolol 🔑 COPD isn't a contraindication for metoprolol 🔑 COPD doesn't affect the risk/benefit ratio of metoprolol 🔑 Use metoprolol as indicated for cardiac indications based on the cardiology literature This is actually really simple.
𝐉𝐮𝐬𝐭 𝐩𝐮𝐛𝐥𝐢𝐬𝐡𝐞𝐝! Original Article by J. Sundh et al.: Metoprolol in Chronic Obstructive Pulmonary Disease without Cardiovascular Disease eviden.cc/4ctWTvo #ERSCongress | @EuroRespSoc @SundhJosefin @FrobertOle
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Pain after sternotomy still undertreated. Our new study: bilateral intercostal cryoanalgesia works after CABG. Less pain. Fewer opioids. Faster recovery. The article is available at: doi.org/10.3390/medsci140505…
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In case you missed it: A study of more than 236,000 patients found no consistent evidence that NHS virtual wards reduce hospital admissions, length of stay or readmission rates. eu1.hubs.ly/H0xLfzQ0
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A study with almost 74,000 subjects ages 50-85. Conclusion: -The wealthiest Americans had approximately the same survival rates as the poorest people in Europe. Wealth helps enormously within the United States, but even high wealth does not completely overcome the US–European mortality disadvantage. Wealthy Americans presumably have much greater ability to buy excellent medical care, better housing, healthier food, gyms, preventive testing and so forth. Yet their survival remained roughly comparable to the poorest group in Northern/Western Europe. The study doesn’t provide direct answers to why this happens. However, maybe wealth cannot outperform lifestyle, strong social safety net, great food around friends and family, lower stress, walking significantly more everyday to your bakery (yes, believe it or not, Europeans are big on bread), local food stores, coffee shops, affording to retire when it is time without worrying about paying bills especially when you get sick… As both an American and European citizen, I believe it may be time for Americans to recalibrate how we think about longevity. We are increasingly chasing the latest intervention such as rapamycin, peptides, cold plunges, red-light therapy…hoping that targeting a single enzyme or metabolic pathway will move the needle. As a systems physiologist, I struggle with that view. Human physiology is not a collection of isolated pathways. Trillions of cells communicate across metabolic, vascular, endocrine, immune and neurological systems. Health emerges from their integration. Perhaps longevity is less about hacking individual pathways and more about creating the environment in which the whole organism can thrive.
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EXCLUSIVE: Jason Arday was targeted in a coordinated campaign by an anti-black race science network with ties to Cambridge and pro-Trump billionaire Peter Thiel, whipping up a catalogue of systemic misinformation across the British press 🧵/1 bylinetimes.com/2026/08/18/t…
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ICU Pharmacology Secrets: If you work in an ICU of a hospital with busy cardiology and cardiothoracic programs, keep this on your radar: Ticagrelor (Brilinta) can cause false-negative results in functional laboratory tests for heparin-induced thrombocytopenia (HIT), such as the serotonin release assay (SRA) and heparin-induced platelet activation (HIPA) test Why this happens Ticagrelor is a reversible P2Y12 receptor antagonist commonly used after coronary interventions or acute coronary syndrome. Unlike clopidogrel, prasugrel, or aspirin, its reversible binding leaves active drug circulating in the blood sample. HIT antibodies activate platelets through the FcγRIIA receptor, but this pathway relies heavily on P2Y12 co-signaling. Because ticagrelor blocks that receptor, it inadvertently shuts down the lab assay, giving you a clean result on a patient who actually has HIT Clinical significance While HIT isn’t everyday occurrence, it carries massive risk, especially in cardiac patients. The incidence of HIT after cardiac surgery is 1-2%, and it is ∼0.5% after transcatheter aortic valve replacement. Even if ticagrelor is held pre-op, we routinely restart it shortly after surgery in high-risk patients Another high-stakes scenario is managing surgical patients with a recent history of HIT. Heparin remains the standard for cardiopulmonary bypass. Guidelines allow us to use heparin intra-operatively, once functional tests turn negative -even if the antibody ELISA stays positive- while keeping them on non-heparin agents before and after. If ticagrelor is masking that functional test, you could re-expose a patient to heparin under a false sense of security Take-home messages 1. Never rule out HIT on a negative functional assay alone if the patient is taking ticagrelor 2. Trust the full clinical picture: Re-evaluate the 4Ts score and look closely at the anti-PF4/heparin ELISA. A strongly positive optical density (e.g., OD > 1.5) should raise red flags regardless of a negative SRA 3. Consider workarounds: Send alternative testing like the PF4-dependent P-selectin expression assay (PEA), if available 4. Stay the course: If clinical suspicion remains high, maintain non-heparin anticoagulation (bivalirudin is our go-to), remove all heparin from the lines, and re-test once the drug clears or alternative panels are back Useful reference: Blood (2020); 135(11): 875-8
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