I’ll never forget saying goodbye to my father when I’d first come to the UK to work as a doctor. He came with me from India to help me settle in and to ensure that his son was starting off on the right foot in a foreign country—cold and wet, but with hopes of a bright future. I remember giving him a tearful hug, wondering why I was doing this. My heart ached as he disappeared into the distance on a

The stress-strain curve is a stalwart of orthopaedic exams. Its principles guide how implants behave, but they now seem to be applied increasingly to people working in healthcare. We know that the backlog for elective procedures in the NHS is at a record level. Suddenly, there are whole days when the morning’s operating list spills over into the afternoon clinic. The notion of “just one more” can be

On 29 September the Guardian reported that England’s new health and social care secretary, Thérèse Coffey, was to scrap the long promised government white paper on reducing health inequalities.1 This U turn came only days after the World Health Organization had published a key report on preventing non-communicable diseases (NCDs)2: it estimated that 74% of the world’s deaths each year were caused by

This is pemphigoid on the gingiva of a woman in her 50s (fig 1). Fig 1 The patient presented with a one year history of pain while eating that had worsened acutely over the previous two weeks. She did not smoke, and her …

Beyond discrediting the idea that depression is caused by a deficiency of serotonin amenable to “correction” by antidepressants, the review by Moncrieff et al1 mentioned by Kendrick and Collinson2 goes further in challenging the role of biology in mood disorders. Their dismantling of the serotonin “chemical imbalance” theory and its shameless promotion by the drug industry is justified, but the …

Signed informed consent is “a pragmatic step that can be easily handled and even enforced,”1 but how best to obtain it? Richards says that digital consent forms might improve the process.2 In our time constrained practices, delegating the task of obtaining consent to a digital platform could save precious time and effort, allowing patients to engage with the process at their own pace. …

US government sends a strong signal On 25 August 2022, the Office of Science and Technology Policy of the US White House issued guidance requiring, from 2026, immediate public access to federally funded research publications and the data behind them.1 This is the probably the most consequential in a trajectory of open access policies that have been building pressure for wholesale change. In 2013 President

Objective To evaluate the association between initiation of fluoroquinolones and hospital admission or emergency department visit for suicidality. Design Population based cohort study. Setting IBM MarketScan database, USA. Participants 2 756 268 adults (≥18 years) who initiated an oral fluoroquinolone (ciprofloxacin, levofloxacin, moxifloxacin, gemifloxacin, ofloxacin, gatifloxacin, norfloxacin, lomefloxacin

Vennik J, Hughes S, Smith KA, et al. Patient and practitioner priorities and concerns about primary healthcare interactions for osteoarthritis: a meta-ethnography. Patient Educ Couns 2022;105:1865-77. To read the full NIHR Alert, go to:

Labour Party conferences have been factional and unsettled affairs for some years. Health campaigning in the Corbyn era was largely against fictional NHS privatisation. And fights then between the dominant hard left and the centrists made the annual conference atmospheres tense, if not actually unpleasant. This was not so in Liverpool last week. For the first time in many years Labour actually seemed

This week I learnt that England has the second highest income inequality in Europe, and the recent “fiscal event” and a forecast return to austerity are likely to make things worse for those at the bottom.1 We all know that lower income brings poorer health and earlier death, and while sitting in my consulting room doing my best for the patient in front of me, it often feels as if there’s nothing I

The US needs to plan for what happens if the inactivated polio vaccine and hygiene measures do not stop polio transmission, say Nina Schwalbe and Jay Varma On 13 September 2022, the United States was added to a list compiled by the World Health Organization (WHO) of countries with circulating poliovirus, and joined a group that includes Somalia, Democratic Republic of Congo, and Yemen.1 In late July

Kendrick and Collinson suggest that we overstepped the data in discussion of the relevance of our serotonin paper to antidepressant use.12 The serotonin hypothesis was propagated by drug companies and academics as a rationale for why people should take antidepressants. It is still widely disseminated,3 but the evidence is unconvincing. No other biological hypotheses for depression are proved or accepted

For many people who think that depression is caused by low serotonin, an antidepressant “working” means that it corrects their serotonin system.1 The honest message to such patients is that their serotonin system is likely to be more abnormal after treatment than before.2 This might be a risk worth taking if there were evidence that the drugs saved lives …

Consultant surgeon Bryan Rhodes talks to Kathy Oxtoby about his lifelong love of table tennis and why it’s the perfect sport for surgeons It was the long hot summer of 1976 when Bryan Rhodes’ friend asked him to practise table tennis at the renowned Hermits Table Tennis Club in Bradford. “Up until that time I’d only played it on the kitchen table at home—with books down the middle as a net—so it was

Importance Patients with lower extremity peripheral artery disease (PAD) have reduced lower extremity perfusion, impaired lower extremity skeletal muscle function, and poor walking performance. Telmisartan (an angiotensin receptor blocker) has properties that reverse these abnormalities. Objective To determine whether telmisartan improves 6-minute walk distance, compared with placebo, in patients with

Importance In arthroscopic knee and shoulder surgery, there is growing evidence that opioid-sparing protocols may reduce postoperative opioid consumption while adequately addressing patients' pain. However, there are a lack of prospective, comparative trials evaluating their effectiveness. Objective To evaluate the effect of a multimodal, opioid-sparing approach to postoperative pain management compared

Importance Cefepime/enmetazobactam is a novel β-lactam/β-lactamase inhibitor combination and a potential empirical therapy for resistant gram-negative infections. Objective To evaluate whether cefepime/enmetazobactam was noninferior to piperacillin/tazobactam for the primary outcome of treatment efficacy in patients with complicated urinary tract infections (UTIs) or acute pyelonephritis. Design, Setting

Protease inhibitors are among the most powerful antiviral drugs. Nirmatrelvir is the first protease inhibitor against the SARS-CoV-2 protease 3CL pro that has been licensed for clinical use. To identify mutations that confer resistance to this protease inhibitor, we engineered a chimeric vesicular stomatitis virus (VSV) that expressed a polyprotein composed of the VSV glycoprotein G, the SARS-CoV-2

This article is the American Cancer Society’s update on female breast cancer statistics in the United States, including population-based data on incidence, mortality, survival, and mammography screening. Breast cancer incidence rates have risen in most of the past four decades; during the most recent data years (2010–2019), the rate increased by 0.5% annually, largely driven by localized-stage and

Despite reducing the amount of toxic SOD1 protein, tofersen treatment did not lead to clinical improvements in patients with ALS.

Objective To estimate the effectiveness of mRNA vaccines against moderate and severe covid-19 in adults by time since second, third, or fourth doses, and by age and immunocompromised status. Design Test negative case-control study. Setting Hospitals, emergency departments, and urgent care clinics in 10 US states, 17 January 2021 to 12 July 2022. Participants 893 461 adults (≥18 years) admitted to one

Objective To emulate the GRADE (Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study) trial using real world data before its publication. GRADE directly compared second line glucose lowering drugs for their ability to lower glycated hemoglobin A1c (HbA1c). Design Observational study. Setting OptumLabs® Data Warehouse (OLDW), a nationwide claims database in the US, 25 January

Jarman and colleagues discuss why science and medical advisers must be separate from government decisions and emphasise that the system must be transparent—thank you for addressing the elephant in the room.1 Throughout the covid-19 pandemic, the chief medical officer for England and the UK’s chief scientific adviser stood side by …

All healthcare professionals will find themselves supporting care for a transgender or gender diverse person at some point, and education and research need to be widened, write Guy T’Sjoen and Joz Motmans Population estimates show that transgender and gender diverse identities or experiences can no longer be considered a rarity. The prevalence of transgender identities is cited as 0.3% to 0.5% among

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

Health inequalities across the country have been widening for many years, and if they had ever not been obvious before, the covid-19 pandemic served to shine a spotlight on the health inequalities which are so keenly apparent in so many communities across the UK. A significant and growing gap in life expectancy for people living in areas with the highest and lowest levels of deprivation means there

Politicians need to understand that we need urgent action to protect general practice, writes Martin Marshall There might have been some patients who were pleased to see headlines such as “ An end to the 8am Glastonbury-esque scramble for GP appointments ” that heralded Thérèse Coffey’s first major announcement since taking up the health and social care portfolio in the new Cabinet, but I suspect most

Underconfidence and overconfidence are the Scylla and Charybdis of medical practice. Too much of the former and you will hesitate and overinvestigate; too much of the latter and you will misdiagnose and overtreat. Either way the patient suffers. The Dunning–Kruger effect supposedly predicts how good people are at self-assessment—those with little knowledge or competence overestimate their ability,

Abstract not available

Abstract not available

Abstract not available