John Digman

Infographic

New living clinical practice guideline: Cardiovascular, kidney related, and weight loss effects of therapeutics for type 2 diabetes

See our #BMJInfographic for a visual summary of the recommendations
www.bmj.com/content/390/...

Portrait of Edward Jenner leaning against a tree

Happy 276th birthday Edward Jenner! What a time for vaccination: 154 million lives saved in the last 50 years, tempered with an increase in vaccine preventable diseases across the world, vaccine sceptics in charge in the US, and cuts to overseas aid threatening global immunisation programmes.

Exceptionally clear and informative resource.

Contemporary Hormonal Contraception and Risk of Venous Thromboembolism This study assesses the risk of venous thromboembolism of different forms of hormonal contraception, including pills with estrogen and progestin, vaginal rings, patches, progestin-only pills, intrauterine devices, implants, and injections.

The risk of venous thromboembolism (VTE) varies across contemporary hormonal contraceptives, with the highest risk associated with combined pills.

#MedSky https://ja.ma/3Y5WQPf

Terminally Ill Adults (End of Life) Bill: call for evidence Terminally Ill Adults (End of Life) Bill: call for evidence

Terminally Ill Adults (End of Life) Bill: call for evidence
here's mine

margaretmccartney.substack.com/p/terminally...

www.parliament.uk/business/new...

Paper in this week's NEJM shows that in patients with atrial fibrillation and stable coronary artery disease, edoxaban monotherapy is superior to the combination of edoxaban plus an antiplatelet drug. Major difference was in bleeding rather than reduction in ischaemic events.

Oral HRT increases venous thrombotic risk (VTE). Tibolone increases arterial but not VTE risk. Topical HRT showed no increase in either. Huge prospective Swedish study: 919,614 women of whom 77,512 started HRT. tinyurl.com/85jxatux #HRT

Disagree. It’s not the NICE decision that’s disappointing , it’s the drug

https://www.ft.com/content/7762094c-a86d-43ac-9ed7-fc74ead4c5c5

Excellently articulated opinion piece from former PM Gordon Brown.

Antibiotic-resistant infections at highest level since COVID-19 pandemic, finds report An estimated 66,730 serious antibiotic-resistant infections were reported in 2023, surpassing pre-pandemic levels of 62,314 infections in 2019, a report published by the UK Health Security Agency (UKH...

Trending in the wrong direction...

#AMR #WAAW24 #PharmSky

pharmaceutical-journal.com/article/news...

MEGA PDF on Incretin therapies by the one and only @drkevinfernando.bsky.social
Very topical at the moment for CRM world
#PharmSky #Medsky #GPsky #CRM #CardioSky
img.medscapestatic.com/vim/live/pro...

Excited to share our recent publication exploring a path forward to retire Cockroft Gault and move towards universal eGFR-based medication dosing decisions, a monumental effort led by Wendy St. Peter and the @nkf-professionals.bsky.social

doi.org/10.1093/ajhp...

Routine Spironolactone in Acute Myocardial Infarction | NEJM Mineralocorticoid receptor antagonists have been shown to reduce mortality in patients after myocardial infarction with congestive heart failure. Whether routine use of spironolactone is beneficial...

CLEAR trial: Should we routinely use Spironolactone after Acute Myocardial Infarction?

No!

#AHA2024

www.nejm.org/doi/full/10....

Yes I've had that thought before too. If no pre-ICS FBC, but eosinophils normal on ICS/LABA, pt stable and no other Hx of inflam resp disease then probably reasonable to try switch. Can always recheck FBC again at later date to check eosinophil trend 👍.

Not a resp expert...

But my understanding is if eosinophils normal + no PMH asthma, then ideally to remove ICS as can inc risk of pneumonia in COPD pts. So yes - switch to LABA/LAMA.

Totally agree - hard to get patients on board when they feel strongly about their existing txt!

GOLD 2025 guidance now available.

No dramatic changes to pharmacological management of COPD from my reading.

#PharmSky #COPD

goldcopd.org/2025-gold-re...

Interesting conclusion from Cochrane. Are we currently over treating BP in this cohort?

Thoughts?

#PharmSky #Pharmacy

Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity | NEJM Obesity increases the risk of heart failure with preserved ejection fraction. Tirzepatide, a long-acting agonist of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor...

SUMMIT trial: “Treatment with tirzepatide led to a lower risk of a composite of death from cardiovascular causes or worsening heart failure than placebo and improved health status in patients with heart failure with preserved ejection fraction and obesity”
www.nejm.org/doi/full/10....

Intensive Blood-Pressure Control in Patients with Type 2 Diabetes | NEJM Effective targets for systolic blood-pressure control in patients with type 2 diabetes are unclear. We enrolled patients 50 years of age or older with type 2 diabetes, elevated systolic blood press...

BPROAD trial: “Among patients with T2 diabetes, the incidence of major CVD events was significantly lower with intensive treatment targeting a systolic blood pressure of <120 mm Hg than with standard treatment targeting a systolic blood pressure of <140 mm Hg”

www.nejm.org/doi/full/10....

Useful paper. Fesoterodine's DT price hugely reduced in recent months, so no excuse to prescribe oxybutynin any more based on cost. Fesoterodine now included as 1st line on Somerset Prescribing Formulary

The painful truth about assisted suicide

Good piece on the problems around drug choice in assisted suicide unherd.com/2024/11/the-...

Partisan prophecy: God warning powerless people of their fate if they do not support and defend the cause of the right people in power.

Biblical prophecy: God warning those in power of their fate if they do not support and defend the cause of powerless people.

I understood that BlueSky was supposed to be a 'safer' space than X... On browsing feeds on Christianity/religion, perhaps this is not a safe space after all!

Is there space for people of faith to encourage each other here, or should we move elsewhere?!

#christianity #religion #christian

Year 2 medics are still early on in programme of study... Maybe keep simple? Prescribing - perhaps consider various factors that affect prescription choice (ease of use, availability, cost effectiveness, clinician "favourites"). Deprescribing - lots of good resources such as STOPP/START