iiinova — where your digital self keeps evolving

Cheery Littlebottom @cherrylittlebottom.bsky.social · 22/09/2026

@drjaninaramirez.bsky.social Is there a third book planned in your Viking Mystery series? My child loves the series and is waiting to see the adventures of Alva finding her father!

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 18/09/2026

She's going to track him to a branch of carphone warehouse where he'll buy a burner phone that he'll be leaving in the college library

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 18/09/2026

These were UK hospitals, so probably sticking to the 6h fast. This was also with mitigation allowed (e.g. headup, gastric ultrasound, RSI, prokinetics) so this might have kept the rates down too

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 18/09/2026

Nicely designed study on GLP1 use increasing the risk of perioperative aspiration 11-fold (1.4% rate)

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Tuta @tuta.com · 31/08/2026

If you have a Gmail account, you need to read this. Google's AI now scans your emails and attachments, bank statements, tax files, medical letters, all of it. It turned on by default, and there's a class-action lawsuit over how. Here are 5 moves to shut it off, the switch is hidden in two places:

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 06/09/2026

Also bearing how busy and the culture has moved towards extreme efficiency and do more in less time with fewer resources, this is going to be right at the bottom of priorities for most specialties outside GP and geriatrics anyway

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 06/09/2026

Even at CCT deprescribing is hard! I'm reluctant to do it in areas of medicine that I'm not *extremely* confident about, and medicine is getting ever more subspecialised. Outside of e.g. geriatrics, at best I'll suggest to the GP as they are better generalists and have long term care of the person

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 01/09/2026

I lean pro-TIVA, but cancer recurrence isn't my reason for doing so!

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 01/09/2026

Not a surprise. Despite in vitro effect on natural killer cells, I'm not aware of *any* study showing TIVA superiority on cancer recurrence. It would be a surprise if it did: a 2-3 hour exposure having a noticeable effect over all the other months and treatments they receive

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 28/08/2026

Yes, but they're all anaesthetic problems, the surgery went well

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 23/08/2026

Agreed, a hospital wide policy of call 2222 is often suspended in theatre as the skill mix is different to the wider hospital and you risk having too *many* people which can cause chaos and confusion

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Anaesthesia @anaesjournal.bsky.social · 18/08/2026

Do you routinely discuss the risk of death as a complication of anaesthesia for your paediatric patients? Great Ormond Street have increased the rate of discussion of the risk of death from 4/138 (3%) in 2020 to 131/143 (92%) in their most recent audit. #AnSky #MedSky doi.org/10.1111/anae...

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 07/08/2026

Oof indeed! I would've very much over cooked it

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 07/08/2026

If no significant aspiration risk still propofol. Roughly 5mcg/kg fentanyl, 0.5-1/kg propofol (as little as needed), 1/kg roc as sugammadex is cheap

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 07/08/2026

Antibiotics, fluid resuscitation, rate or rhythm control Team discussion with patient and surgeon of risks and benefits of proceeding vs delay for optimisation If proceeding, awake art line, pressor infusion prior to cautious induction, big drip

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 07/08/2026

Elective or emergency (if emergency why) How long have they been confused, tachycardic and hypotensive? Fluid status, ECG? Signs of infection, MI, PE etc?

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 07/08/2026

Not a clear black and white. Intensive farming is a must in places. We will struggle to feed ourselves with solely organic methods without allocating lots more land (and then we may struggle to house everyone). When we use intensive farming, we should try and make our footprints lighter.

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 06/08/2026

Even can improve productivity! The shade reduces over heating and wilting so means watering is more efficient and improved yields of tomatoes (IIRC in an American trial)

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Royal College of Anaesthetists @rcoanews.bsky.social · 04/08/2026

The latest joint Rapid Sequence Induction (RSI) statement encourages a risk-based approach, careful preparation, and evidence-led practice — empowering anaesthetists to deliver the best care for every patient. Read more and download the statement 👉https://ow.ly/ZKFu50Zwc9q #Ansky #Medsky

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 01/08/2026

If someone has mistakenly asked you to put in a cannula, just use the 24-7 dedicated cannulation service by bleeping the anaesthetic SpR

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Raj LB @rajlb.bsky.social · 01/08/2026

That in the UK we use the start of team brief as a some sort of meaningful measure of theatre efficiency. ANAESTHETISTS HAVE TO SEE PATIENTS THE TIME OF THE BRIEF IS ENTIRELY DEPENDENT ON THE NUMBER AND COMPLEXITY OF PATIENTS #AnSky

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 30/07/2026

I'm the UK it's meant to be a medical decision with input from the family. In practice though, the conversation is done so poorly it ends up being the "would you like your relative to live or die"? (Same as CPR discussion sadly)

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 29/07/2026

To be fair, which of us has never put the decimal point in the wrong place?

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 29/07/2026

Agree completely The ongoing cuts and pay disputes have reduced the goodwill to do unpaid (and even paid) overtime I think there's no fat left to cut, even previous cuts were into muscle, tendons and arteries

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👻madeline bOoOoOoOodent👻 @oldenoughtosay.com · 27/07/2026

the transphobes: 'there's no good medical evidence for trans healthcare' sensible people: 'okay, you've dismissed a number of good studies but fine we'll do another' transphobes: 'and that made me really mad'

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 26/07/2026

Fair point. It's like the big push to reduce use of plastic straws and bags which help but it's massively dwarfed by the environmental impact of industry, fossil fuel power stations and air travel.

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 26/07/2026

Are we comparing like with like here? Does the analysis consider the CO2 cost of desflurane production manufacture (and the metal containers), transport and the Tec6 energy use? I think other analyses ignored them due to the huge direct GWP of desflurane.

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 17/07/2026

I hate that it restricts me from following up patients as that would come under "professional curiosity". The outcomes of my actions are then hidden to me.

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 11/07/2026

How in the name of bloody hell is Badenoch polling well? She talks nonsensical rubbish, amazingly is not racist enough for the Reform wing, and is only possibly good by comparison to the previous Tory leaders!

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 11/07/2026

This is so depressing and also explains a cynical sign I saw once where the business was hectoring customers to tip well because the staff were on a low hourly. I thought: why don't you just pay a better rate? This explains the obvious reason. Damn

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 11/07/2026

I forget how huge the distances are in countries like Australia and the USA! That scuppers my suggestion of having multiple hubs where you can sit the exam

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 11/07/2026

And even if done as a remote exam, some exams have systems where you have to have a webcam pointing on you, software which lets them see what's running on your computer, and you might need to show them your room at any point during the exam Would that not be AI resistant?

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 11/07/2026

Was the reason you said in person assessment wouldn't work due to the asynchronous and remote course? If so, isn't an in person exam still possible as it's a one off day?

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 08/07/2026

Binface vs Farage An unfunny, repetitive joke who has done nothing useful for UK politics will hopefully get destroyed by Count Binface. Let's go!

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 07/07/2026

Counting overtime is generally a bit suspect. It's like saying: Our basic pay is low, but we're so understaffed that if you work loads of extra hours you can make a further 50% over your basic

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 07/07/2026

The extra for overtime ignores the fact this is very much extra! This is done to cover services to make sure things are safe, to reduce waiting lists etc. Generally done because it has to be done. I would rather not have to do any of these extra (far more stress and effort than the pay).

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 07/07/2026

Lazy reporting "Salary range of 113-150k" "Average salary of 152k" The maths here is difficult. The clinical awards for extra pay have been phased out

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 04/07/2026

I had such high hopes for Starmer when he got in, but became massively disappointed with how rightwing his policies were and the lack of vision domestically. But nothing has shocked me as much as this leaving present. Loses money from the NHS to avoid an ineffective tariff. Idiot.

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 03/07/2026

This is a really good post which everyone who has suffered through a PowerPoint presentation should read It's a bugbear of mine that presentation skills are not taught in medical education, so you learn by osmosis how to give a presentation from others who are also terrible at it

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 28/06/2026

They used to be specialised nurses. But in 1990 there came a change called "project 2000" which made direct entry midwives a thing. (As well as staying to sidelines the experiential route to nursing). It sadly has put back the quality of maternity care badly

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 28/06/2026

Most doctors who have worked with midwives who have been nurses first can see such a clear difference. It's not just the experience and skills, they've generally got an approach and attitude that makes them better colleagues and feel safer

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 27/06/2026

Just like someone who proudly boasts they have passed now cognitive exams than any other president

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Gale Sinatra @galesinatra.bsky.social · 27/06/2026

I think we just passed oops.

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 20/06/2026

My similar peeve is the breast surgeons who are still telling patients that they can't have cannulas or BPs in the mastectomy arm despite the extensive evidence against this (in the absence of existing lymphoedema)

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 19/06/2026

That would be inspiring. Zoran Mamdani has done much more noteworthy in a brief spell as NY mayor than Starmer seems to in years as prime minister

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 17/06/2026

Didn't realise that, thanks. Are we still using the specialist, associate specialist and specialty doctor titles too? Because that might get confusing. I'm so grateful they're moving from the complex house officer/SHO/reg/consultant titles that everyone was struggling to understand

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 16/06/2026

I think they've realised the need to have a collective title for these people and have come up with "specialty registrar". No chance of that getting at all confused with "specialist registrar". Great job GMC

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 24/05/2026

The stepping on jabba's tail annoyed me more about this. It also made no sense: Han is in heavy debt to Jabba who is the ultra gangster of that planet and he just treads on him and gets no repercussions?

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Cheery Littlebottom @cherrylittlebottom.bsky.social · 17/05/2026

I've got some excellent bands 7 ODP colleagues but they mainly sit in an office all day

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