@PhilSmithIsBack

Views entirely my own and do not represent anyone else. RT does not mean agree. Apologies for typos.

Joined March 2024
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Back for a time limited period only.
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🚨 🚨 New article in Frontline Gastroenterology Srinivasa et al linked national cancer registry and HES data for 56,827 people diagnosed with oesophageal cancer in England between 2018 and 2024. They asked how many had their oesophagus dilated for a stricture in the 2 years before the cancer was diagnosed. 🔑 Key findings: 1️⃣ About 1 in 80 (1.2%) had dilatation before diagnosis, and in 36.4% this was more than 3 months before ⚠️ Dilatation was more likely in women, in squamous cell carcinoma and with more comorbidity 💥 3.9% had a perforation, with higher risk in women and after 4 or more dilatations 🔁 51.7% had no endoscopic follow-up after dilatation, and follow-up was linked to less advanced cancer at diagnosis 💡 Characterise strictures with image-enhanced endoscopy and adequate biopsies before dilating. Re-biopsy strictures that respond poorly, and build follow-up into stricture pathways. Read the full paper 🔗 fg.bmj.com/content/early/202… @BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
This image shows a comparison of endoscopic views over time. The upper section displays two images labeled as "Index endoscopy," followed by an arrow pointing right to a single image labeled "Diagnostic endoscopy" with a note of "24 months." The lower section has two images with the same labels, with an arrow pointing to "7 months." The images reveal changes in the appearance of tissue in a medical setting.

ALT This image shows a comparison of endoscopic views over time. The upper section displays two images labeled as "Index endoscopy," followed by an arrow pointing right to a single image labeled "Diagnostic endoscopy" with a note of "24 months." The lower section has two images with the same labels, with an arrow pointing to "7 months." The images reveal changes in the appearance of tissue in a medical setting.

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🚨 🚨 New in Frontline Gastroenterology Machta et al compared diagnostic yield for first diagnostic paediatric endoscopy at a London tertiary centre across three eras: 2014, the COVID-19 restrictions, and 2022–23. COVID-era capacity limits forced stricter patient selection, and that shift persisted afterwards. 🔑 Key findings: 📈 Histological abnormality rose from 36% to 66.4% (194 procedures in 137 children) 🔬 For OGD alone in children with negative coeliac serology, it rose from 16% to 54.9% 🩺 For OGD plus ileocolonoscopy, it rose from 47% to 75% 🛡️ There was no observed evidence of harm from more selective referral 🔎 Endoscopic impression had a PPV of 83.8% but an NPV of only 57.9%, so routine biopsy still matters 💡 The authors propose diagnostic yield as a national benchmark and quality standard for paediatric endoscopy services. Read the full paper 🔗 fg.bmj.com/content/early/202… @BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
Sure! Here's a description: "Four-panel medical data chart. Panel A: Pie chart shows diagnoses distribution with categories including Crohn's disease, gastritis, coeliac disease, and others. Panel B: Bar chart with histological correlation to endoscopic impression, divided into abnormal and normal categories. Panel C: Bar chart of laboratory markers diagnosing performance, illustrating sensitivity and specificity for various markers. Panel D: Bar chart of clinical features diagnosing performance, displaying metrics for symptoms like abdominal pain and anemia.

ALT Sure! Here's a description: "Four-panel medical data chart. Panel A: Pie chart shows diagnoses distribution with categories including Crohn's disease, gastritis, coeliac disease, and others. Panel B: Bar chart with histological correlation to endoscopic impression, divided into abnormal and normal categories. Panel C: Bar chart of laboratory markers diagnosing performance, illustrating sensitivity and specificity for various markers. Panel D: Bar chart of clinical features diagnosing performance, displaying metrics for symptoms like abdominal pain and anemia.

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Response to @RCPhysicians ask re @lengreview clinical protocol done- as a Fellow of RCP. I believe in transparency- so here are my views on some of the key questions. In summary? Needs a rejection on key areas of PAs seeing undifferentiated patients. And certainly not lean on Gen Next to be liability sponge. And let @rcgp make their own decisions regards primary care- no need to interfere. NB: Don't like it, give a counter view. Don't abuse or be snarky. It's a democracy- it's my view. You are welcome to give yours. @mmamas1973 @djnicholl @Mumtaz_Patel_1 @OGMustafa @BDChadwick Link: nhssugardoc.blogspot.com/202…
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He can't handle @kaitlancollins because she is v intelligent, fearless, articulate, holds him to account & crucially, is female. A complete misogynist (as well as many other things). Keep going Kaitlan, I wish your colleagues across the media would hold him much more to account
Kaitlan Collins
@kaitlancollinsOct 21
President Trump is directly tying waiving Russian sanctions to the release of the freed American Stephen Hubbard, despite denying he gave anything to Putin.
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It is hugely frustrating to see the person who was the longest serving SoS for Health @Jeremy_Hunt paraded out on almost every media channel as a bastion of patient safety - from maternity, to pandemic preparedness etc. Many of the issues we currently have started on his watch!
Dr Steve Taylor@DrSteveTaylorOct 21
Unregulated expansion of PAs started in 2015 It took 10 years to finally get the Leng Review 15m after being published it is still not being followed, sadly there are some who are still pushing for undiagnosed (undifferentiated) patients to be seen first by PAs in GP practices0
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Unregulated expansion of PAs started in 2015 It took 10 years to finally get the Leng Review 15m after being published it is still not being followed, sadly there are some who are still pushing for undiagnosed (undifferentiated) patients to be seen first by PAs in GP practices0
Dr Steve Taylor@DrSteveTaylor27 Oct 2025
Physician Assistants were first muted as an idea an concept in the early 2010s as a way of alleviating the workforce shortage in General Practice, helping GPs deal with some of the more simple and mundane tasks to allow GPs more time for patients.  A 🧵 rcp.ac.uk/media/ffdai1fx/com…
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It should be a privilege and honour to do it for free (or poor pay) innit? Oh wait, how much did some in management get for redundancies recently? How much are paid to the management consultancies? Only frontline staff get guilt tripped into poor pay
Louella Vaughan@DrLKVaughanOct 20
It utterly baffles me as to why some think that the NHS doesn't obey the basic laws of economics.
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It utterly baffles me as to why some think that the NHS doesn't obey the basic laws of economics.
Health Service Journal@HSJnewsOct 20
Chemo delays blamed on bank pay cuts ift.tt/YGNDOmw

Chemo delays blamed on bank pay cuts

Patients have been waiting up to a month for chemotherapy appointments because of staffing shortages partly caused by reductions in bank rates.

hsj.co.uk
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Many congratulations to Dr Chris Black @DrCJBlack and Dr Nuru Noor @Y_ECCO_IBD on their #UEGRisingStars2026 @my_ueg awards. Chris and Nuru are exceptional clinical academics and we are very proud that both are excellent @FrontGastro_BMJ Lead Associate Editors! @BritSocGastro @Gut_BMJ @BMJOpen_Gastro @PhilSmithIsBack @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman @alex_ford12399 #UEGweek #UEGWeek2026 #UEG2026
Two people smiling and holding an award together at an event. Both are wearing business attire, and the background has the text "ueg week.

ALT Two people smiling and holding an award together at an event. Both are wearing business attire, and the background has the text "ueg week.

Three individuals in business attire are standing together, smiling. The person in the center is holding an award that says "Accenture." They all have conference name badges. The background is a plain wall.

ALT Three individuals in business attire are standing together, smiling. The person in the center is holding an award that says "Accenture." They all have conference name badges. The background is a plain wall.

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A reminder to @RCPhysicians about what Fellows voted for in an EGM IN 2024 And how data was presented- with it's subsequent fall out due to data manipulation- resulting in resignations Lessons from the past: 1. Don't manipulate responses to suit a narrative. 2. Don't ignore Fellows and their views by use of 'process' Yes- standing by that narrative cost me- yet I haven't budged an inch from that philosophy. Less Chicanery, More Leadership. I repeat: The @lengreview clinical protocols for PAs should be rejected -if nothing else- on grounds of presumed COI by contributors. Also- PAs should NOT be seeing undifferentiated patients. Full stop. @Mumtaz_Patel_1 @OGMustafa @HilaryWMedic
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📰 New article in Frontline Gastroenterology Ngu et al report LivR Well, a randomised controlled trial from Monash Health in Melbourne. It tested a 28-day multidisciplinary, home-based programme for people with hepatic decompensation. The programme included home nursing and physiotherapy, plus hepatologist, dietitian, pharmacist and addiction medicine input. It was compared with enhanced standard ambulatory care. 🔑 Key findings: 👥 105 patients were randomised (54 intervention, 51 control) 🏥 30-day liver-related emergency admissions did not differ: 24% vs 25% (IRR 0.92, 95% CI 0.39 to 2.16) 📉 MELD improved in both groups, by about 3.4 to 3.9 points 💬 Quality of life improved similarly in both groups 💰 The programme wasn't cost-effective (modelled ICER A$145K/QALY vs an A$50K threshold) 💡 Both arms had a liver nurse, a direct mobile line and day-ward access. This enhanced "standard care" may explain why no difference was detected. Read the full paper 🔗 fg.bmj.com/content/early/202… @BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
This flowchart outlines the process of a study with sections labeled Enrolment, Allocation, Follow-Up, and Analysis. It shows the number of participants assessed, excluded, and randomized into two groups: Intervention (n=54) and Control (n=51). Details include reasons for participant exclusion and dropout rates throughout the study phases.

ALT This flowchart outlines the process of a study with sections labeled Enrolment, Allocation, Follow-Up, and Analysis. It shows the number of participants assessed, excluded, and randomized into two groups: Intervention (n=54) and Control (n=51). Details include reasons for participant exclusion and dropout rates throughout the study phases.

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Interesting admission from one of my least favourite accounts. Back when I first heard about ACP, it was the older, battle-hardened nurses who were obtaining extra skills and making a difference. I was shown examples of where this really augmented team working. I kind of /
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You have to love the fact that it's been 18 months since this started @NHSE_WTE And there are still focus groups running on this... While we await a report which will confirm that the Pope is indeed Catholic. And lots of things will be said, asked and pontificated over. But without any funding- thus based on love, vibes and prayers. Incoming...soon. Then again, it comes from the stable of those who categorically stood against Motion 5 of the @RCPhysicians EGM passing. Evans, Powis, McLeod, Dacre, Whitty et al. Reminder of that motion 5: "Demand of a formal pause or slow-down in the deployment and recruitment of PAs until wider medico-legal issues, regulation standards, and exact scopes of practice are legally resolved" History is such a lovely thing. @djnicholl @mmamas1973 @Shr_Nottingham @dieracg @Dr_Done_ @PhilSmithIsBack @G_D_Phillips1
NHS England Workforce, Training and Education@NHSE_WTE19 Feb 2025
Today we have started a review of postgraduate medical training led by @NHSEnglandNMD and @CMO_England Listen to @NavinaEvans explaining more. Find out more at england.nhs.uk/postgraduate-…
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📰 Out now in the November issue of Frontline Gastroenterology Danso et al give a practical guide to managing fatigue in IBD, designed for clinicians without a full multidisciplinary team. 🔑 Fatigue affects 72% of patients with active IBD and 47% in remission. A 5-step algorithm covers screening, reversible causes, sleep and activity, and alerting medications. Modafinil looks promising in refractory cases. 🎧 Listen to the related #FGPodcast via the FG homepage. 🔗 doi.org/10.1136/flgastro-202… @BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
Flowchart for managing IBD fatigue. 1. **Fatigue Screening Measures**: Includes IBD-F Self-Assessment Scale and FACIT-Fatigue assessment, categorizing fatigue levels (No fatigue to Severe). 2. **Exclude Other Causes of Fatigue**: Lists diseases, deficiencies, medication side effects, and lifestyle factors. 3. **Patient-led Measures**: Suggests avoiding alcohol, caffeine, and heavy meals. Recommends a balanced diet and regular exercise. 4. **Sleep Difficulties Present?**: - Focus on sleep routine and exercise. - Morning wake time consistency. 5. **Consider Altering Medication**: Guidance on adjusting treatments, checking for partial or effective remission. 6. **Assess Response After 2-3 Months**: Follow-up recommendations, treatment reviews, and measured outcomes. Includes detailed boxes with quantitative scores and criteria within each category.

ALT Flowchart for managing IBD fatigue. 1. **Fatigue Screening Measures**: Includes IBD-F Self-Assessment Scale and FACIT-Fatigue assessment, categorizing fatigue levels (No fatigue to Severe). 2. **Exclude Other Causes of Fatigue**: Lists diseases, deficiencies, medication side effects, and lifestyle factors. 3. **Patient-led Measures**: Suggests avoiding alcohol, caffeine, and heavy meals. Recommends a balanced diet and regular exercise. 4. **Sleep Difficulties Present?**: - Focus on sleep routine and exercise. - Morning wake time consistency. 5. **Consider Altering Medication**: Guidance on adjusting treatments, checking for partial or effective remission. 6. **Assess Response After 2-3 Months**: Follow-up recommendations, treatment reviews, and measured outcomes. Includes detailed boxes with quantitative scores and criteria within each category.

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Working on the feedback as Fellow to @RCPhysicians - regards the @lengreview protocols for PA working Unless I have read it wrong? The RCP has included a few questions on primary care, whether it’s ok for PAs to see undifferentiated patients, what exceptions should apply - and asking for views of RCP Fellows. In my view? 1. The @rcgp have stated PAs have no role in primary care. It is up to THEM to change that and decide what’s right or wrong in primary care 2. It’s not the business of @RCPhysicians (I think) to interfere in primary care working - we should focus on what we can influence - eg: Should PAs be doing Lumbar Punctures & Peritoneal drains. Or seeing undifferentiated patients with mythical levels of supervision @Mumtaz_Patel_1 @OGMustafa @djnicholl @mmamas1973 @Azeem_Majeed @trishgreenhalgh @VictoriaTzB @BMA_GP
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Phil Smith retweeted
The BMA
@TheBMAOct 19
Cutting doctors’ pay won’t keep them in the NHS. The DDRB must show its independence and recommend what patients and the NHS need, not what the Government is prepared to pay. Full statement: bma.org.uk/bma-media-centre/…
Graphic on blue background, showing scissors making a cut. Text reads: “Doctors in England. 2.4% for doctors. This is a real terms pay cut. At a time when the NHS desperately needs to keep its doctors, the Government is proposing a pay uplift below inflation.”

ALT Graphic on blue background, showing scissors making a cut. Text reads: “Doctors in England. 2.4% for doctors. This is a real terms pay cut. At a time when the NHS desperately needs to keep its doctors, the Government is proposing a pay uplift below inflation.”

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📰 New review in the November issue of Frontline Gastroenterology Abuquteish et al review lower GI toxicity from immune checkpoint inhibitors and targeted cancer therapies, covering clinical, endoscopic and histological features. 🔑 Anti-CTLA-4 causes earlier and more severe colitis than anti-PD-1/PD-L1, and colitis was reported in about 25% of patients on combined ipilimumab and nivolumab. Rituximab was linked to a roughly sixfold increased risk of developing IBD. 🔗 doi.org/10.1136/flgastro-202… @BritSocGastro @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @dtleiberman
The image is an informational chart about medications used in treating inflammatory bowel disease (IBD). It is divided into two sections: "Immune Checkpoint Inhibitors (ICI)" and "Targeted therapies." The ICI section includes anti-PD1/PDL-1 medications such as nivolumab and pembrolizumab, and anti-CTLA-4 medication like ipilimumab. The targeted therapies section lists anti-CD20 drugs like rituximab, and BRAF and MEK inhibitors including dabrafenib and trametinib. Each listing describes the medication's effects, common complications, and their association with IBD.

ALT The image is an informational chart about medications used in treating inflammatory bowel disease (IBD). It is divided into two sections: "Immune Checkpoint Inhibitors (ICI)" and "Targeted therapies." The ICI section includes anti-PD1/PDL-1 medications such as nivolumab and pembrolizumab, and anti-CTLA-4 medication like ipilimumab. The targeted therapies section lists anti-CD20 drugs like rituximab, and BRAF and MEK inhibitors including dabrafenib and trametinib. Each listing describes the medication's effects, common complications, and their association with IBD.

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Phil Smith retweeted
Barack Obama
@BarackObamaOct 18
It is a basic principle of American democracy that the government can’t selectively target individuals simply because of their political beliefs or what they say. But that’s exactly what the Trump Administration is doing to Congresswoman Ilhan Omar of Minnesota. To understand why this is so appalling, it’s important to know the facts. Congresswoman Omar came to this country with her father when she was 12 years old. Five years later, her father became a naturalized citizen. If Ilhan had been 18 at the time, she would have had to apply for citizenship separately. But because she was 17, she became a naturalized citizen automatically. Congresswoman Omar went on to graduate from college, work as a community organizer, become the first Somali-American legislator elected to public office in the U.S., and win a seat in Congress. There, she has been one of the Trump Administration’s fiercest critics, which has led the president to repeatedly single her out as someone who he believes does not belong in this country. Now the Administration is actively trying to deport Congresswoman Omar, seemingly based solely on the unsubstantiated theory that she was actually 18 when her father was naturalized, and therefore is not a citizen. Federal agents have raided her home, confiscated personal records, and seized her phone — all to try and uncover a nonexistent smoking gun from 20 years ago that will somehow make their case. Think about that. The full weight of the federal government is being brought down on a law-abiding elected official because she has dared to criticize the president. And it’s not the first time this has happened. Under President Trump, the Justice Department has repeatedly gone after those he considers his political enemies — from the Attorney General of New York, to the former head of the FBI, to members of the Federal Reserve. In those cases, the prosecutions either stalled or were dismissed for having no basis in law, and the same is likely to happen in this case. But not before Congresswoman Omar’s life has been turned upside down, her legal bills have piled up, and she’s been forced to spend time fighting unsubstantiated charges instead of serving the people of Minnesota. The fact that any president, or any administration, is willing to engage in such transparent efforts to intimidate someone should outrage all Americans, regardless of how they feel about Congresswoman Omar’s political views. Because if this becomes the new normal, there’s no reason to believe it will stop with her — or that future presidents, in either party, won’t do the same.
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Phil Smith retweeted
Mehdi Hasan
@mehdirhasanOct 16
If a US politician made fun of Jewish people like this it would be the end of their careers. But Islamophobia is totally fine and normalized.
Aaron Rupar
@atruparOct 16
Trump: "You have Mohammed, Mohammed, Mohammed, Mohammed, Mohammed. Everybody is basically. If you're in doubt about somebody's name from the Middle East, just say 'Mohammed.' You have about a 65% chance."
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I went to Notts Med school in late 90s, early 00s. A&E dept was always packed. But I understood the powers that be decided workforce substitution (rather than more Drs) was the major solution to the issue? I guess that data looks better when that (ironically) has been "doctored"
Shaun Lintern@ShaunLinternOct 18
🚨 EXCLUSIVE: Leaked emails expose rift at scandal-hit @nottmhospitals as desperate A&E staff whistleblew to CQC over dangerous A&E overcrowding and false reporting of waiting times data. Insiders warn of unsafe care being normalised. ​ Full story: thetimes.com/article/867ac5c…
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