WARNING: THIS POST CONTAINS INFO LIKELY TO MAKE STEAM COME OUT YOUR EARS
Personally, I don't use but I gotta ask b/as long time SA Counselor & Clinical Neuropsychologist,
What ARE these people so on re weed about? Theres NOTHING abt weed comes anywhere close to t/individual, 1/

@KEBrightbill Since 1980-90s WS successful ongoing intentional strategy to blend w/fundamentalist W Christian & infiltrate/integrate/take over these spaces; emerging in homeschooling tied to natural CB, attachment style parenting, Le Leche League, Natural child rearing & ecological mov'nts

Theres not a lot 1 can do abt this either. There are SOME divisions but not as many as one might like to think & there are an infinite number of fuzzy boundaries ie., as in vaccinations. This is a highly fluid & often volatile life stage to navigate married or single & 2/

things are muddy as hell (this is an area I've researched tracked, and personally experienced as part of that natural child birth community). Women are isolated by society and thats a problem on both the right and the left. Women are vilified & looked down on when they do 3/

have kids, and are pilloried if they stay home, go to work, if they breastfeed, for how long or not and are essentially cut off from an elder community that might help them navigate the enormous shift in their lives not to mention having to put up with petulant manbaby 4/

husbands who drag them via their own negative ideals, expections, insecurities fears angers hurts at the sudden usurping of their position as number 1 in a womans life when she has a baby, & especially the first baby. BOTH WHITE SUPREMACY AND FUNDAMENTALIST WHITE CHRISTIANITY 5/

@KathyGrants @slomoshun1966 @kk131066 @foe_us @nature_org @jane__eden @impakterdotcom @sillymickel @vegix @how_sustainable @JamesrossrJames @climatemessages @sustainableuni1 @LolaGayleC @ResisterForever @mmpadellan @AdamParkhomenko @glennkirschner2 @morethanmySLE All the clinical Neuropsychological and forensic testing manuals that match the clinical measures we use...
Then made cheat sheets. (ok geek comment alert) the reason to do this is because if you don't understand the base rates and how they were derived, the populations 1/

@slomoshun1966 @kk131066 @foe_us @nature_org @jane__eden @impakterdotcom @sillymickel @vegix @how_sustainable @JamesrossrJames @climatemessages @sustainableuni1 @LolaGayleC @ResisterForever @mmpadellan @AdamParkhomenko @glennkirschner2 @morethanmySLE sampled to gain those "norms" and the year in which this was done, your interpretation of testing data will be significantly "off". If you can't assess the accurate diagnosis (meaning you misdiagnose) you end up causing pain and suffering not to mention treatment especially 2/

@slomoshun1966 @kk131066 @foe_us @nature_org @jane__eden @impakterdotcom @sillymickel @vegix @how_sustainable @JamesrossrJames @climatemessages @sustainableuni1 @LolaGayleC @ResisterForever @mmpadellan @AdamParkhomenko @glennkirschner2 @morethanmySLE if it involves psychopharm (meds)doesn't treat what actually ails the patient. When this happens, at best no one's treated for the actual illness they have which causes undue pain & suffering, at worst symptoms are exacerbated and or meds cause adverse reactions that can 3/

@slomoshun1966 @kk131066 @foe_us @nature_org @jane__eden @impakterdotcom @sillymickel @vegix @how_sustainable @JamesrossrJames @climatemessages @sustainableuni1 @LolaGayleC @ResisterForever @mmpadellan @AdamParkhomenko @glennkirschner2 @morethanmySLE have lasting effects (more pain and suffering) not to mention totally messing with the outcomes of legal cases
In short an inaccurate Diagnosis totally messed with people's lives.
. ..... So, if I use a measure you can bet Ive read the manual and understand the cautions, and 4/

@slomoshun1966 @kk131066 @foe_us @nature_org @jane__eden @impakterdotcom @sillymickel @vegix @how_sustainable @JamesrossrJames @climatemessages @sustainableuni1 @LolaGayleC @ResisterForever @mmpadellan @AdamParkhomenko @glennkirschner2 @morethanmySLE when to augment via clinical judgement. That often puts me at odds with folks in terms of opinions but I can back it all up via research and what's written in the manuals which often have caveats re use and application that people miss. More, as I went along it became obvious 5/

“Should I give them more fluid?”

Extremely common question during AKI referrals from junior docs.

⛔️ Fluid management is tricky, often misunderstood, & can cause huge iatrogenic harm ⛔️

We try to convey important principles in THREAD 👇

#tipsfornewdocs #medtwitter #tweetorial

Currently too often patients with high creatinine are given too much IV fluid, driven by an AKI ➡️ fluid reflex

We’ve seen 7 litres be given in one shift.

Medics & surgeons, juniors & seniors, it seems everyone loves to reach for extra IV fluid (especially if urine output poor)

Why does huge volume IV fluid ‘resuscitation’ consistently occur?

Lots of reasons, including FALSE beliefs:
🛑 IV fluid always “treats AKI”
🛑 Hypotension = hypovolaemia
🛑 Lactate >2 means fluid deficiency
🛑 Septic patients are very hypovolaemic

The rule with IV fluids and AKI is to remember this 5 word phrase:

💥 💥 Aim for euvolaemia, then stop💥 💥

Fluid status is like Goldilocks - hypovolaemia is bad for the kidneys BUT excess volume is also harmful for renal function and will cause other complications too.

It is easy to say “target euvolaemia” - but we agree it is more difficult to do!

Fluid status assessment is certainly made harder by a belief that we must only rely on a snapshot assessment of examination features which are NOT specific / sensitive / reliable to elicit like.…

I think that, in the face of an ongoing global health emergency and a pressing need to reopen safely, some form of health pass is a reasonable option to consider. But debate is a good thing, so here are some brief thoughts on various concerns I've heard about them... [thread]

"A health pass discriminates against people who have refused the vaccine." No. A health pass should also support proof of test result for people who haven't been vaccinated, and exemptions for people who cannot be vaccinated (get vaccinated if you can though, for heaven's sake).

"A health pass is an invasion of privacy." No. A health pass should be privacy preserving, allowing you to prove your status to third parties without giving away personal data or letting them track you without your permission.

"A health pass is unfair to people without smartphones." No. A health pass should accommodate people without a smartphone, e.g. with a printable option as a fall-back (though for most of us, carrying a digital pass on our phone will be much more convenient).

"A health pass will become obsolete as the virus mutates." No. A health pass should actually give us more insight and flexibility to adjust our response as our knowledge of the virus, and the ways we test / treat / vaccinate for it, increases.

New NHS reforms announced today. Seems to be a story of two parts, plus a missing character. Quick thoughts (1/):

Part 1 of the story is a set of technical fixes wanted by NHS leaders to encourage collaboration in the health system. The direction here makes sense—and fits with what the NHS has been doing for ages. Competition is (mostly) out; collaboration is in: good (2/)

And the need for legal changes to tidy the mess left by Lansley’s 2012 Act has long been recognized. But... (3/)

The benefits of integration are often way overstated, and the risk of reorganizations underplayed. In its first 30 years, the NHS’s structure was relatively stable. But over the past 30, the NHS in England has been on an almost constant treadmill of reform and reorganization (4/)

Overall, evidence suggests that previous reorganizations have delivered little measurable benefit. They can also distract and disrupt, depending on how they’re done. The list of other things for the NHS to be doing during and after the pandemic is very long. So be cautious (5/)