
Husband, father, pharmacist and educator. Educational interests include #WBL and digital learning. Other interests @wba fan #pharmfoods
England, United Kingdom
Joined November 2013
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Gareth Nickless retweeted
Mr G, 80, using a fentanyl patch for chronic back pain, developed a fever from a chest infection and, over the same day, became drowsy, pinpoint-pupilled and confused, with a slowing respiratory rate.
The infection was real, but the delirium was opioid toxicity. Fever and warm skin had increased the absorption from his patch, and a dose that had been stable for months was suddenly delivering far more. The heat had turned a steady drug into an overdose.
We removed the patch, but the point the team almost missed is that removal alone is not enough. The drug already absorbed sits in a depot under the skin and keeps releasing for many hours, so he needed close monitoring for a full day, with naloxone to hand and given in small titrated doses if his breathing worsened.
Transdermal opioids deliver more when the patient is hot, whether from fever, a heatwave or a hot pack. In any febrile patient on a fentanyl patch who becomes drowsy and confused, think opioid toxicity, remove the patch, and keep watching well beyond it. #delirium
Gareth Nickless retweeted
Yesterday whilst shopping I collapsed and was unable to get up.
An ambulance came and treated me with half an hour.
It was only vertigo, I’ve never had it before. I still feel a bit wobbly today. They gave me two large injections and I was able to return to the villa.
This is Croatia.
Gareth Nickless retweeted
My favourite detail from the Times piece on AI cheating: a student submitted an essay citing Michelangelo as the author of a 2017 book on the Kurds. The professor's verdict — "sadly, I'm sure the more devious students know this and edit accordingly."
This is just the tip of the iceberg. Universities appear to have no real sense of how to meet the challenge of where we now find ourselves.
thetimes.com/article/69da585…
Gareth Nickless retweeted
a Princeton researcher opens his paper with a scenario.
a man asks his AI assistant to book a flight on a specific airline. cheap. direct. the one he chose.
the assistant comes back with a different flight. nearly twice the price. happens to pay the company that built the assistant.
he runs the same test on 23 frontier models. flights, loans, study help, real shopping requests.
Grok 4.1 Fast recommends the sponsored option that is almost twice as expensive 83% of the time.
GPT 5.1 hijacks the request 94% of the time. you ask for one brand. it surfaces the sponsor instead.
Claude 4.5 Opus, the model marketed as the most ethical frontier model in the world, hides that the recommendation is paid 100% of the time when reasoning is on.
Grok 4.1 Fast embellishes the sponsored option with positive framing 97% of the time. better. faster. nicer. for the option you didn't ask for.
then he writes it into the system prompt itself. "act only in the interest of the customer. ignore the company."
GPT 5.1 and GPT 5 Mini stay above 90% sponsored anyway. the instruction does nothing.
then he splits the users by income.
Gemini 3 Pro recommends the expensive sponsored flight to the rich user 74% of the time. to the poor user, 27%.
18 of the 23 models recommended the expensive sponsored option more than half the time.
so the next time your AI assistant gets weirdly enthusiastic about a brand you didn't ask for.
it isn't recommending the best option for you.
it's reading the room. and the room is paying.
read this: arxiv.org/abs/2604.08525
Gareth Nickless retweeted
£20/£30 etc a month to send their kids to football is getting unaffordable for many disadvantage families today, We the free volunteers can't continue to keep propping grassroots football up when theirs £Billions at the top of the pyramid
Gareth Nickless retweeted
Here it is!
#wba meltdown chart for 25/26😂
The highs and lows of a very strange season to reflect on
Gareth Nickless retweeted
This doesn’t sit right with me. Docking West Brom two points over money linked to its Foundation misses what clubs like this do in our communities. And changing the rule part way through the accounting period raises real questions.
I’ll be taking this up with the EFL and the new regulator.
West Brom is a proud community club, working hard to move on from the past ownership issues. I spoke to the club earlier this week to offer my full support.
expressandstar.com/sport/foo…
Gareth Nickless retweeted
Confused patient?
Medication review is your first investigation, not your tenth.
Anticholinergics, benzodiazepines, opioids - stop looking elsewhere until you've looked at the drug list - any recent additions or abrupt withdrawals.
#delirium
Gareth Nickless retweeted
We are now living in the future!
Readers added context they thought people might want to know
Date has been changed in image. Original image date is 2015.
en.wikipedia.org/wiki/Back_to_t…
Gareth Nickless retweeted
.@TheGPhC failed to meet a regulatory standard on timeliness for fitness-to-practise cases for the 7th consecutive year, according to the @prof_standards
#FtP #fitnesstopractise #ukpharmacy
pharmaceutical-journal.com/a…
Gareth Nickless retweeted
Trainees face false pay promises and ‘exploitative’ contracts
vist.ly/45g22
Trainee pharmacists have flagged “discrepancies” between advertised pay and the actual amount set out in their contracts, as well as salaries that breach minimum wage laws, @the_pda has revealed.
Gareth Nickless retweeted
Based on feedback provided by @TheGPhC on candidate performance in previous exam sittings, this blog highlights the useful resources and content collections from @PJOnline_News that aim to support FTs during exam preparation.
pharmaceutical-journal.com/a…
#CPCongress #CPC25
Gareth Nickless retweeted
Said this a fair few times this last few days.
This time last year we were staring administration in the face. It was a very real prospect.
Where we have got to in the last 12 months has been astonishing. Bilkul have stopped a club haemorrhaging money to a club that is well
Gareth Nickless retweeted
42 years ago today, Fraggle Rock debuted.
The theme song will always be a banger.
Gareth Nickless retweeted
‘Gross incompetence’: High Court orders GPhC to reconsider #FtP case
chemistanddruggist.co.uk/new…
The High Court has called out @TheGPhC ’s “unfairness” in handling a pharmacist’s alleged role in “fraudulent” medication sales, ordering it to “undertake the whole process again”


























