Background Surgical site infection (SSI) is the most common postoperative complication worldwide. WHO guidelines to prevent SSI recommend alcoholic chlorhexidine skin preparation and fascial closure using triclosan-coated sutures, but called for assessment of both interventions in low-resource settings. This study aimed to test both interventions in low-income and middle-income countries. Methods FALCON

Emerging reports of rare neurological complications associated with COVID-19 infection and vaccinations are leading to regulatory, clinical and public health concerns. We undertook a self-controlled case series study to investigate hospital admissions from neurological complications in the 28 days after a first dose of ChAdOx1nCoV-19 (n = 20,417,752) or BNT162b2 (n = 12,134,782), and after a SARS-CoV-2-positive

New England Journal of Medicine, Ahead of Print.

How long do you continue with a course of action that isn’t working? When patients first have high blood pressure or diabetes diagnosed, many are keen to take the problem into their own hands, to solve it by altering their activity levels or eating habits. I’m always delighted when this happens, and I try to empower them with appropriate resources, while arranging follow-up consultations to discuss

The world of Marvel movies and comics involves a whole multiverse where it can be hard to make sense of what’s really happening—which Spider-Man exists in which reality, or which main characters are actually dead or alive. As it’s a fantasy world, we can enjoy the moviemakers’ artistic licence in the spirit intended. A problem arises when that sort of fantastical approach starts to take hold in the

Mendelian randomisation (MR) studies allow a better understanding of the causal effects of modifiable exposures on health outcomes, but the published evidence is often hampered by inadequate reporting. Reporting guidelines help authors effectively communicate all critical information about what was done and what was found. STROBE-MR (strengthening the reporting of observational studies in epidemiology

Rajith Aryan Thirty paediatric health workers from across the UK and their supporters line up in King’s Cross, London, to start the first leg of an 800 km ride to …

During androgen-deprivation therapy, certain bacteria in the gut can synthesize androgens, thereby promoting tumor progression and therapy resistance.

Unprecedented extra demands on healthcare staff during the covid-19 pandemic have made it more difficult than ever for professionals to keep up to date with research. This time of major upheaval has underlined the need for health and social care to be the best and most efficient possible. To ensure that changes represent progress, they need to be based on sound research. With this in mind, The BMJ

Wiles K, Webster P, Seed PT, et al. The impact of chronic kidney disease Stages 3-5 on pregnancy outcomes. Nephrol Dial Transplant 2020;gfaa247. To read the full NIHR Alert go to:

Ford J, Thomas F, Byng R, McCabe R. Asking about self-harm and suicide in primary care: moral and practical dimensions. Patient Educ Couns 2020;104:4. To read the full NIHR Alert go to:

Moscow is imposing Russia’s first major lockdown in over a year as the country seeks to short circuit an autumn surge that has seen cases and deaths climb relentlessly for six weeks. Moscow’s mayor will close businesses, schools, kindergartens, and all shops except groceries and pharmacies for 11 days from 28 October. Bars and restaurants will allow takeout only. Museums and galleries may operate at

The UK has started stockpiling two antiviral drugs as part of a plan to give people who are staying at home with covid-19 a treatment to reduce symptoms and the spread of the virus. The government has purchased 480 000 courses of molnupiravir (made by Merck Sharp and Dohme (MSD)) and 250 000 courses of the combination of PF-07321332 and ritonavir (Pfizer), neither of which have been approved by the

Prominent politicians, as well as the press, have been fanning the flames of public anger towards general practitioners. Health secretary Sajid Javid endorsing thoughtless criticism over face-to-face appointments is deeply unhelpful.1 We need a government that invests in people and systems and supports general practice at a critical time, not one that stokes antagonism leading to violent attacks on

The Brent GP talks to Francesca Robinson about the rewards of working with colleagues to improve population health Achieving change in the NHS can be challenging, especially when people are reluctant to leave their comfort zones, says GP Nigel de Kare-Silver. But the rewards of having a role in influencing care at a population level are gained over time as services improve for patients. De Kare-Silver

Shilu Tong and colleagues describe the health consequences of extreme urban heat and the priorities for action and research to mitigate the harms Cities are a crucial concern in dealing with climate change because an increasing proportion of the global population lives in urban areas. The world’s urban population is expected to grow from 4.2 billion in 2018 to 6.7 billion by 2050, including a burgeoning

40 years ago, Italy saw the birth of a national, universal health-care system (Servizio Sanitario Nazionale [SSN]), which provides a full range of health-care services with a free choice of providers. The SSN is consistently rated within the Organisation for Economic Co-operation and Development among the highest countries for life expectancy and among the lowest in health-care spending as a proportion

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.

Background Agitation is common in people with dementia and negatively affects the quality of life of both people with dementia and carers. Non-drug patient-centred care is the first-line treatment, but there is a need for other treatment when this care is not effective. Current evidence is sparse on safer and effective alternatives to antipsychotics. We assessed the efficacy and safety of mirtazapine

Background Atrial fibrillation is a leading cause of ischaemic stroke. Early detection of atrial fibrillation can enable anticoagulant therapy to reduce ischaemic stroke and mortality. In this randomised study in an older population, we aimed to assess whether systematic screening for atrial fibrillation could reduce mortality and morbidity compared with no screening. Methods STROKESTOP was a multicentre

Background It is unknown whether screening for atrial fibrillation and subsequent treatment with anticoagulants if atrial fibrillation is detected can prevent stroke. Continuous electrocardiographic monitoring using an implantable loop recorder (ILR) can facilitate detection of asymptomatic atrial fibrillation episodes. We aimed to investigate whether atrial fibrillation screening and use of anticoagulants

Borderline personality disorder (BPD) is a mental disorder with a high burden on patients, family members, and health-care systems. The condition was previously regarded as untreatable, but progress in understanding and management has resulted in earlier diagnosis and better treatment outcomes. A coherent syndrome of BPD typically onsets during adolescence (after age 12 years). BPD is often preceded

Current inflammatory bowel disease (IBD) therapies are ineffective in a high proportion of patients. Combining bulk and single-cell transcriptomics, quantitative histopathology and in situ localization across three cohorts of patients with IBD (total n = 376), we identify coexpressed gene modules within the heterogeneous tissular inflammatory response in IBD that map to distinct histopathological and

### What you need to know Bronchiolitis is a viral lower respiratory tract infection occurring mainly in the winter months, most commonly caused by respiratory syncytial virus (RSV). It is seen primarily in infancy but occurs up to 2 years of age and is the most common indication for hospitalisation in this age group. Ninety percent of children are infected with RSV in their first 2 years, and up to

This week, England’s health secretary, Sajid Javid told a Downing Street covid briefing that the government would not “at this point” be implementing its so-called “Plan B” measures to prevent the NHS being overwhelmed—including mandatory face coverings indoors and advising people to work from home. To repurpose a phrase that Javid himself used in July when justifying his decision to remove almost

The NHS is falling over. Not everywhere, but in some places and in some services the signs of extreme stress are manifest. These signs are the result of the irresistible force of rising demand for care meeting the immovable object of constrained capacity. Something has to give. For an increasing number of patients, timely access to acceptable standards of care is no longer possible. For staff the challenge

“What will you do to support nursing research?” I asked. “Well, care is interprofessional, so I don’t think we really need disciplinary research,” they replied. This was the first time I had heard this sentiment expressed directly by a physician, but I had brushed up against it before. I was referred to as coming from the “school” of nursing, rather than the faculty. My conference presentations have

Healthcare in India has long been provided in unconnected silos by individual doctors and in small hospitals. Care is typically initiated by patients who seek treatment in the private sector for which they pay providers an “out-of-pocket” fee.1 Most patients receive either printed or short, hastily handwritten summaries of their care. This serves to tie patients to the provider who knows them, but

In June 2010 the medical journalist Nigel Hawkes, who has died from a heart attack at the age of 78, ran into one of Health Secretary Andrew Lansley’s advisers whom he knew well and whom he greeted warmly since they were old friends. “You’re a troublemaker,” she hissed, “always writing those ghastly articles in The BMJ .” And she turned away. This story, recounted in one of Hawkes’s columns, demonstrates

Gun violence in the United States increased by 30% during 2020-21 from pre-pandemic levels, researchers have reported in Scientific Reports ,1 describing the situation as a public health emergency. The study found that gun related homicides, suicides, and injuries all increased during the period from 1 March 2020 to 31 March 2021 when compared with the same period in 2019-20. The authors compared gun

A Brazilian Senate inquiry into the pandemic has recommended charging the country’s far right president Jair Bolsonaro with nine crimes, including crimes against humanity, for his role in the country’s ineffectual response. The commission’s report also recommended charges against 65 other people, including current and former ministers, officials, legislators, and political staffers. Also named were

The BMA has accused the UK government of being “wilfully negligent” by not immediately implementing additional precautionary measures to reduce the spread of covid-19. At a Downing Street briefing on 20 October, England’s health secretary, Sajid Javid, said that the government would not be bringing in its “plan B” measures to prevent health services being overwhelmed, including mandatory face coverings

The first countrywide study of deaths caused by the delta variant of covid-19 has found that vaccination is 90% effective in preventing people from dying. The research was carried out in Scotland and was based on an analysis of 114 706 cases of SARS-CoV-2 infection detected in the community between April and September this year. Almost all infections were of the delta variant. The study found that

Action is needed to eliminate waste in the health system if the NHS is to make its contribution to global efforts to combat climate change, say health professionals in Scotland. The Academy of Medical Royal Colleges and Faculties in Scotland called for greater efforts to build a greener health system, in a statement published in advance of the COP26 United Nations climate change conference opening

The World Health Organization has chosen 26 scientists from 700 applicants for a new group to investigate the origins of the covid-19 pandemic, as well as future outbreaks. WHO plans to appoint members to the new Scientific Advisory Group for the Origins of Novel Pathogens (SAGO) after a two week review to gather public opinion on the proposed choices, which ends on 27 October.1 Seven of the current

Ambulance services in England are struggling to cope with huge numbers of calls, as crowded hospitals are unable to take patients and queues of ambulances waiting outside emergency departments have become an everyday occurrence. The Association of Ambulance Chief Executives has said that every ambulance service in England is now at the highest level of alert, and paramedics have warned that services

The health and social care workforce is drained of resilience and capacity, from sustained pressure during the pandemic, and this will have consequences for the quality of care if it is not tackled, the Care Quality Commission has warned. “The negative impact of working under this sustained pressure, including anxiety, stress, and burnout, cannot be underestimated,” said the CQC in its annual assessment

The BMA’s England GP committee (GPC) is seeking approval to ballot GPs on industrial action that could constitute a breach of contract. The move comes after the committee formally rejected the health secretary’s rescue package for general practice. Sajid Javid’s plan pledged an extra £250m (€296m; $345m) to increase the proportion of appointments that practices deliver face-to-face, which will require

An estimated 115 000 healthcare workers around the world have died from covid-19 so far, said senior WHO officials on 21 October as they called for governments to better protect such workers.1 If surplus vaccines stored by wealthier nations are not expedited to vulnerable healthcare professionals abroad their death toll will continue to grow by the thousand, WHO warned, adding to a looming healthcare

Glasby argues that current government proposals on adult social care will not improve quality of care or the conditions of an underpaid and demoralised workforce.1 Similarly, Oliver states that older people with conditions like frailty or age related disabilities will continue to be treated as second class citizens compared with those with “healthcare” conditions.23 The pandemic has provided an opportunity

Accredited social health activists are well known for providing healthcare in rural India. However, this essential part of the workforce has long gone unacknowledged, and the situation has become worse in the pandemic, reports Sanket Jain When Netradipa Patil met 9 month old Riya (not her real name) she was perplexed. “Her vaccination card was half empty,” she remembers. Under India’s universal immunisation

No quick fix for the fundamental mismatch between demand for care and available GPs General practice is the foundation of the NHS, but these foundations are creaking. GP consultation numbers are now higher than before the pandemic.1 Yet the number of permanent, fully qualified GPs in England has fallen since 2016.2 The pandemic has created additional work for GPs—including delivering millions of covid-19

In 1967, two toddlers immunized with a formalin-inactivated vaccine against respiratory syncytial virus (FIRSV) in the United States died from enhanced RSV disease (ERD), a severe form of illness resulting from aberrant priming of the antiviral immune response during vaccination. Up to 80% of immunized children subsequently exposed to wild-type virus were hospitalized. These events hampered RSV vaccine

Red blood cells (RBCs) are essential for aerobic respiration through delivery of oxygen to distant tissues. However, RBCs are currently considered immunologically inert, and few, if any, secondary functions of RBCs have been identified. Here, we showed that RBCs serve as critical immune sensors through surface expression of the nucleic acid–sensing Toll-like receptor 9 (TLR9). Mammalian RBCs expressed

Spondyloarthritis (SpA), a type 3 immunity-mediated inflammatory arthritis, is a systemic rheumatic disease that primarily affects the joints, spine, gut, skin, and eyes. Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine, yet MIF’s pathological role in SpA is unknown. Here, we observed that the expression of MIF and its receptor CD74 is increased in blood and tissues of curdlan

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern threatens the efficacy of existing vaccines and therapeutic antibodies and underscores the need for additional antibody-based tools that potently neutralize variants by targeting multiple sites of the spike protein. We isolated 216 monoclonal antibodies targeting SARS-CoV-2 from plasmablasts and memory

Gamma delta T (γδ T) cells are among the most potent cytotoxic lymphocytes. Activating anti–butyrophilin 3A (BTN3A) antibodies prime diverse tumor cell types to be killed by Vγ9Vδ2 T cells, the predominant γδ T cell subset in peripheral circulation, by mechanisms independent of tumor antigen–major histocompatibility complex (MHC) complexes. In this report, we describe the development of a humanized

Noninvasive detection of nonalcoholic steatohepatitis (NASH), the progressive form of nonalcoholic fatty liver disease, promises to improve patient screening, accelerate drug trials, and reduce health care costs. On the basis of protease dysregulation of the biological pathways of fibrotic NASH, we developed the Glympse Bio Test System (GBTS) for multiplexed quantification of liver protease activity

Tetrahydrocannabinol (THC), the primary psychoactive ingredient of cannabis, impairs cognitive and motor function in a concentration-dependent fashion. Drug testing is commonly performed for employment and law enforcement purposes; however, available tests produce low-sensitive binary results (lateral flow assays) or have long turnaround (gas chromatography–mass spectrometry). To enable on-site THC

The COVID-19 pandemic has exacerbated the already substantial burden of depression and anxiety, with tens of millions of additional cases reported globally in 2020.

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.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.