Paul Howard | Lightnews

Paul Howard @paulhoward.bsky.social · 3h

Yes, I agree with all of that.
There's also a bias I'm struggling to articulate along lines of: demanding far higher level of evidence to adopt potential new option than needed to retain the existing option. Which reinforces "tradition-based medicine"

Paul Howard @paulhoward.bsky.social · 4h

A third blind spot is fitting care into what's convenient for the clinician. E.g. the harm caused by abrupt interruptions to established analgesia at admission to hospital. "Yes, I did tell them! But they said they didn't have any/couldn't prescribe it/had wrong colour socks/other excuse"

Paul Howard @paulhoward.bsky.social · 4h

A second is overestimating how well we understand the patient's experience. E.g. I'm often intrigued at how confidently colleagues pronounce "but that procedure isn't that painful", when I suggest better procedural analgesia after being called afterwards (again) to get their pain back under control

Paul Howard @paulhoward.bsky.social · 4h

I suspect one (of many) barriers is that clinicians often start from a "presumption of knowing best", so lean towards persuading rather than listening.
When I ask hospital inpatients open questions about their goals/aims, I so often find these just aren't aligned with the care being given

North East Bylines @northeastbylines.co.uk · 1d

In 1800, around one in three children died before their fifth birthday, compared to four deaths per thousand births by 2020 | Amanda Ellison

Did Dickens murder Christmas?

In 1800, around one in three children died before their fifth birthday, compared to four deaths per thousand births by 2020

northeastbylines.co.uk

British Association for Psychopharmacology @bapsych.bsky.social · 4d

Registration is now open for #BAP2026 Summer Meeting in Birmingham, 19th - 22nd July. For more information, to register and submit your abstract -

The British Association for Psychopharmacology | 2026 Summer Meeting – Birmingham

The British Association for Psychopharmacology (BAP) promotes research and education in psychopharmacology, and brings together people in academia, health services, and industry

www.bap.org.uk

Kate Nautiyal @katenautiyal.bsky.social · 4d

New paper drop! 🧠💊 Our new paper out in Molecular Psychiatry shows that the serotonin 1B receptor is important for the neural and antidepressant/anxiolytic behavioral responses to psilocybin in mice.

www.nature.com/articles/s41...

The serotonin 1B receptor is required for some of the behavioral effects of psilocybin in mice - Molecular Psychiatry

Molecular Psychiatry - The serotonin 1B receptor is required for some of the behavioral effects of psilocybin in mice

www.nature.com

Paul Howard @paulhoward.bsky.social · 8d

Interesting. What I'd add is that being in prominent journals is also no guarantee of quality; I've seen some really poor conclusions in the Lancet and BMJ. Particularly by pharmacoepidemiologists ignoring confounding by indication

PLOS Biology @plosbiology.org · 8d

Are authors fairly judged by assessing the #journals in which their work is published? @bihutchins.bsky.social &co reveal that most influential papers are published in lower tier journals, and more authors would be better recognized with #ArticleLevelMetrics #ALMs @plosbiology.org 🧪 plos.io/4oV58Ed

Standing on the shoulders of giants. Researchers (nodes) at early (red), mid (blue) and late (grey) career stage who have built on one another's work (edges). Large nodes are researchers whose work would not be recognized with journal level metrics but would be recognized with article level metrics. Credit: B. Ian Hutchins

PLOS Biology @plosbiology.org · 8d

Are authors fairly judged by assessing the #journals in which their work is published? @bihutchins.bsky.social &co reveal that most influential papers are published in lower tier journals, and more authors would be better recognized with #ArticleLevelMetrics #ALMs @plosbiology.org 🧪 plos.io/4oV58Ed

Paul Howard @paulhoward.bsky.social · 8d

It might just be the NHS at the moment, but there are meetings where I long to be Zoom bombed.....where my professional civility hangs by a thread. Maybe you could export it as a service industry? Like, I could click an icon to call in Hawain zoom bombers?

Donna Wakefield @donnawakefield.bsky.social · 9d

📣Out now in Lancet’s @eclinicalmed.bsky.social
🫁The inverse #PalliativeCare law in advanced lung disease:mixed-methods #SystematicReview & #MetaAnalysis -1st paper from my #PhD provides evidence of #Inqualities in #lung disease
@wolfsonpallcare.bsky.social

www.sciencedirect.com/science/arti...

Paul Howard @paulhoward.bsky.social · 17d

This case series describes PCP pneumonia in older people immunocompromised by steroids, anti-cancer treatment etc.
Great summary of their clinical presentation (74% dyspnoea, 55% cough, 63% febrile, most tachypnoeic, whereas oxygen sats and neutrophil count mostly normal)

doi.org/10.1186/s414...

Pneumocystis pneumonia in older non-HIV-infected patients: a French, multicentre, retrospective, cohort study - Pneumonia

Pneumonia - Pneumocystis pneumonia (PCP) is well-described in younger and HIV-infected populations, but limited data are available for older non-HIV-infected patients. The aim was to describe the...

doi.org

Carl Zimmer @carlzimmer.com · 19d

A study on 1.7 million people in Hong Kong shows superior hybrid immunity to Covid in people who got vaccinated before infection vs. people who got infected first. "Our findings are a direct rebuttal to arguments for natural immunity," the authors write. doi.org/10.1016/j.va...

Redirecting

doi.org

International Collaborative for Best Care for the Dying Person @careforthedying.bsky.social · 25d

Join our free webinar on Dec 11 2025 12-1pm GMT (1-2pm CET), as @drkathrynmannix.bsky.social explores the ways in which honest, compassionate conversations can reshape hope at the end of life ⬇️
🔗 www.bestcareforthedying.org/webinars

#eolc #PalliativeCare #hapc #hpm #hpmglobal
@eapcvzw.bsky.social

Dr Ben Bowers @drbenbowers.bsky.social · 29d

Sign up to hear about our latest research on improving end-of-life care and future projects and collaboration opportunities. Our research team is part of PELiCam in the Primary Care Unit, University of Cambridge.

Sign up here: cambridge.eu.qualtrics.com/jfe/form/SV_...

Paul Howard @paulhoward.bsky.social · Nov 26

Here, Dr Takemura and colleagues examined the impact of low dose ("adjuvant") methadone on QT internal. Even in those with cardiac risk factors, there was no increase in QT with these dose regimens.

pubmed.ncbi.nlm.nih.gov/40071699/

Introduction of oral methadone to high-risk patients with prolonged QT interval: A retrospective study - PubMed

Even in patients with heart disease or prolonged QTc at baseline, methadone may be safely administered by initiating low-dose methadone when the dose of other opioids is low and by adjusting the concomitant medications that can interact with methadone.

pubmed.ncbi.nlm.nih.gov

Paul Howard @paulhoward.bsky.social · Nov 23

Really useful summary; thanks

What I'd add is: consider SC B12 replacement. I don't have easy access to MMA, so offer a trial of treatment if fatigued with a B12<350.

Nothing works every time. But can be spectacular: eg
From housebound to going on a holiday
From bedbound to going out for lunch

Raywat Deonandan @deonandan.bsky.social · Nov 21

The overwhelming weight of scientific evidence says that vaccines do NOT cause autism. The link has been studied many many times. Here is just a taste of the mountains of peer-reviewed evidence:

Thread [1/9]

Elizabeth Jacobs, PhD @elizabethjacobs.bsky.social · Nov 15

I’ve been circling around this idea for awhile but didn’t have the skill to summarize what others have now done extremely eloquently:

Proposing the concept of misinformation exposure as a social determinant of health.

Read on if you’re interested.

Paul Howard @paulhoward.bsky.social · Nov 15

Other SC ABx with ph/kin data include: ceftriaxone, ertepenan, meropenam and teicoplanin

SC metronidazole, ceftazidime, pip-taz are all well tolerated

If you're new to SC ABx, this is an excellent review article

pubmed.ncbi.nlm.nih.gov/32674952/

Subcutaneous Antibiotic Therapy: The Why, How, Which Drugs and When - PubMed

SC administration of antibiotics may be useful in various settings such as in hospitalized patients and among those in long-term care facilities or being cared for at home. However, further clinical studies are needed to assess the pharmacokinetic/pharmacodynamic properties, as well as the risks and …

pubmed.ncbi.nlm.nih.gov

Paul Howard @paulhoward.bsky.social · Nov 15

It also makes parenteral antibiotics more feasible outside of hospitals, ideal for those wanting active treatment, but at risk of harm from hospitalisation (eg those with frailty)

spcare.bmj.com/content/earl...

Subcutaneous antibiotics in palliative medicine: Retrospective chart review

Objectives To investigate the use and safety of subcutaneous (SC) antibiotics for infection and symptom control in the palliative setting. Methods We conducted a retrospective chart review of the use...

spcare.bmj.com

Paul Howard @paulhoward.bsky.social · Nov 15

Here, subcutaneous co-amoxiclav becomes the latest ABx with pharmacokinetic information confirming absorption comparable to IV and sufficient to get above MIC

SC administration can avoid missed doses if delay cannulating, eg fragile veins
doi.org/10.1093/jac/...

doi.org