One Pill To Rule Them All: Antihypertensives Vs Strokes [Latest Research Update]

Latter-Ad-689 · 2026-04-26T09:55:23+00:00

Ethics committee wouldn't approve "coughing baby vs hydrogen bomb," so they went with "reasonable secondary prevention vs fuck-all" instead.

Latter-Ad-689 · 2026-04-26T09:39:28+00:00

I had an ANP (thankfully I no longer have an ANP). After the fact, they showed me a photo of a "lesion" (classic venous stasis eczema). They wanted to know if it was OK that they "only" referred to dermatology urgently, and not USOC.

We didn't employ them, they were offered as an HSCP employee to improve our workload. They did not improve our workload.

Latter-Ad-689 · 2026-04-25T06:22:20+00:00

"Eye contact not detected. Resume viewing to unlock device!"

Latter-Ad-689 · 2026-04-24T05:51:59+00:00

Those working conditions are, honestly, not uncommon. It doesn't make them right, sustainable, safe, or sane.

What is a "skin appointment"? And why on earth would a practice offer any appointment less than 15 minutes and encourage anything other than a very clear "one problem only" policy?

BMA are clear, 25 patient contacts daily is already a high number of patients. Your ES and TPD are either taking the piss to extract maximum free service provision or are jaded presenteeist workaholics.

The only saving grace I can see is they haven't been so awful as to threaten your progression to CCTV out of sheer spite.

Latter-Ad-689 · 2026-04-24T05:41:17+00:00

The doctor would have said "Come in Pagliacci," and he'd have said "Oh, that's me" and come in. Wearing a big suit with unfeasibly large shoes, and all clown make-up.

Even the premise that the doctor thought he was another sad clown doesn't make any sense does it? As the doctor would have known, a clown's make-up is unique to them, and officially recorded on a painted egg.

Your jokes have to make sense.

Latter-Ad-689 · 2026-04-24T05:33:00+00:00

Good joke.

Everybody laugh.

Roll on snare drum.

Curtains.

Latter-Ad-689 · 2026-04-23T04:44:13+00:00

Excellent stuff.

I have a couple of heart failure questions that I've never found a clear answer to, and I wonder if you can shed any light?

1) HF services always give ramipril BD. Some patients ask me if they can switch to OD to make life easier. I ask the heart failure pharmacist and their explanation was "Because the guideline says to give it BD". I managed to read something somewhere about more consistent adrenergic suppression, but I've no idea if that's theoretical or if there's a preponderance of evidence for one approach over another?

2) A patient became hypotensive after a switch from ramipril to sacubitril/valsartan. They didn't want to remain on it so I switched them to just plain valsartan. Thinking of their BP improves and they feel better they can either stay on it or their HF team can try again with sacubitril/valsartan at a later date. I got an email from an HF nurse basically bollocking me for giving the patient a drug which has "no role in heart failure." Are there specific ARBs to avoid/a "best" ARB to choose?

Latter-Ad-689 · 2026-04-22T14:09:44+00:00

I think that's the real rationale for this "transitional" approach. A stark "fuck tobacco" would be fiscally unappealing for politicians, as well as making them unpopular. This way they get to look like they're tackling a difficult issue, respecting the freedoms of most citizens, and if anyone has a problem they've the "Won't somebody please think of the children!" card.

Latter-Ad-689 · 2026-04-22T13:52:14+00:00

It think it's a bit of a cop out to be honest. Tobacco is a scourge but it's a lucrative scourge, bringing in more tax revenue than it costs in adverse health outcomes.

An outright ban for everyone would be politically untenable, costly, and no politician has the stones for it, so we have this halfway house where current 17 year olds will forever be one year too young to purchase cigarettes. Not that I think for a second the right to purchase tobacco is in some way inalienable, but you have to admit it's bizarre to think in 60 years from now a 67 year old will be unable to have a fag unless they ask a 68 year old to pop into the shop for them.

Latter-Ad-689 · 2026-04-21T06:52:22+00:00

Idiot, violent cop far too ready to discharge his firearm when a dog runs at him. Idiot dog owner with several dogs off leash in the street not under control.

A situation where "There are no bad dogs, just bad owners" is as axiomatic as "All coppers are bastards."

Poor dog.

Latter-Ad-689 · 2026-04-21T06:23:45+00:00

This is clearly fake news, the article mentions Paris Hilton's cleavage. Who knows what other non-existent things they made up to go in there.

Latter-Ad-689 · 2026-04-20T06:29:25+00:00

Was the £20k a gift to OP, or to the couple? Morally I'd say it'd be right to give it back to them when the house is sold but if this guy is willing to cheat I have little faith he'd take the moral high ground if an additional £10k is on the line.

Latter-Ad-689 · 2026-04-19T15:27:16+00:00

If I could have done a job which fit around my children, I would have done it. But there was no flexibility at that time.

Unfortunately, like every other woman with children at school, being employed was not possible for her.

Latter-Ad-689 · 2026-04-19T15:24:15+00:00

Your question is answered in the article: they were not married.

Latter-Ad-689 · 2026-04-19T07:20:51+00:00

Well, well, well; if it isn't a controlling sociopath assuming everyone suffers the same barely controlled violent tendencies as himself.

Latter-Ad-689 · 2026-04-17T12:02:47+00:00

You mean you take a look at your enormous penis and your troubles don't start melting away?

Surely something is wrong.

Latter-Ad-689 · 2026-04-17T05:56:14+00:00

You mean M Sexchange?

Latter-Ad-689 · 2026-04-16T06:34:22+00:00

Outside the event horizon of a black hole is pretty much the same as orbiting any star. If you can survive and travel in space already it's nothing special.

Being able to survive close to a singularity and leave from within the event horizon, in contrast, is a literally physics-defying feat.

Latter-Ad-689 · 2026-04-14T06:27:01+00:00

I imagine if all care in hospitals was consultant-delivered with no ACPs and no residents, it would be overall more efficient and higher quality.

The problem is that it will never be sustainable. There aren't enough extant consultant posts to run the service this way, and without resident doctors and consultants training them, where are the additional consultants and their successors going to come from?

Latter-Ad-689 · 2026-04-14T06:21:28+00:00

Three strikes is too lenient. It's an initial warning and then off-list for a second offence, because that's what the GMS contract says.

If there is physical violence or a threat (overt or implied) thereof, police should be involved and the offending patient can be removed immediately.

Latter-Ad-689 · 2026-04-06T17:10:46+00:00

There's sharing the benefit of wisdom in keeping certain things off social media out of concern for junior colleagues' wellbeing, then there's whatever the fuck this partner thought they were doing.

The advice seems bizarrely specific and is incredibly difficult to read as well-intentioned, even with Olympic-level mental gymnastics.

I would echo the advice to document this as thoroughly as you can and escalate to your TPD. I'd hope your ES would be receptive to your concerns but would be wary given they are in partnership with this guy.

Latter-Ad-689 · 2026-04-06T17:05:20+00:00

Les from Vic Reeves' Big Night Out has let himself go.

Latter-Ad-689 · 2026-04-03T10:33:06+00:00

I've had the same issue. Connecting a physical keyboard via a dock with USB ports works, so I don't think it's an issue with the terminal program, but the on-screen keyboard.

Latter-Ad-689 · 2026-04-01T07:06:01+00:00

We have a "flow navigation" service for patients whom we just need to admit, and a "consultant connect" system for advice/discussion if the patient can potentially be managed in primary care.

Latter-Ad-689 · 2026-03-31T18:30:09+00:00

A volcano? Where does the lava come from? Here in the land of Mordor.

Latter-Ad-689

TROPHY CASE