Medical Journal News

A rise in antibiotic resistant cases of gonorrhoea, including extensively drug resistant (XDR) strains, risks making the sexually transmitted infection (STI) “untreatable” if the problem is not tackled, health officials have said.While most gonorrhoea infections can be treated effectively, increased resistance to ceftriaxone—the most common antibiotic used to treat it in injection or tablet form—poses risks, the UK Health Security Agency (UKHSA) said.Katy Sinka, a consultant epidemiologist and head of the STI section at the UKHSA, called for people to use condoms to protect against STIs and to get tested after unprotected sex, including after having sex abroad.Figures from the UKHSA show that there were 17 cases of ceftriaxone resistant gonorrhoea recorded between January 2024 and 20 March 2025 (13 in 2024 and four in 2025 so far). This compares with 16 during the whole of 2022 and 2023. There were nine cases reported between 2015 (when ceftriaxone resistant gonorrhoea...

by Emma F. Magavern, Maia Megase, Jack Thompson, Gabriel Marengo, Julius Jacobsen, Damian Smedley, Mark J. Caulfield

Background

Adverse drug reactions (ADRs) harm patients and are costly for healthcare systems. Genetic variation contributes to variability in medication response and prospective knowledge of these variants can decrease risk of ADRs, as shown in the PREPARE trial. Reduction in ADRs would affect only those reactions to drugs contained in well-validated pharmacogene–drug pairs. The scope of ADRs represented by these drugs on a population scale is unclear. The objective of this study was to characterize the pharmacogene–drug-associated ADR reporting landscape from a national regulatory pharmacovigilance dataset to elucidate the scale of potential ADR mitigation by pharmacogenomics (PGx) implementation.

Methods and findings

All publicly available Yellow Card ADR reports to the United Kingdom Medicines and Healthcare Products Regulatory Agency, from 1963 to 2024, were compiled using programmatic data extraction. The ADRs were analysed with descriptive statistics, stratified by PGx status and by associated genes. Prescribing prevalence from the literature was compared with age range matched ADR reports for PGx-associated drugs. There were 1,345,712 ADR reports, attributed to 2,499 different substances. 115,789 adverse drug reports (9%) were associated with drugs for which ADR risk can be modified based on pharmacogenomic prescribing guidance. Seventy-five percent of these (n = 87,339) were due to medicines which interact with only three pharmacokinetic pharmacogenes (CYP2C19, CYP2D6, SLCO1B1). Forty-seven percent of all the PGx mitigatable ADRs identified were attributed to psychiatric medications (n = 54,846), followed by 24% attributed to cardiovascular medications (n = 28,279). Those experiencing PGx mitigatable ADRs, as compared with non-PGx mitigatable ADRs, were older and the ADRs more often consisted of severe non-fatal reactions. Many PGx-associated psychiatric drug ADRs were overrepresented as compared with prescribing prevalence, but fatal cardiac arrhythmias were uncommon consequences, comprising only 0.4% of these ADRs (n = 172 of n = 48,315 total ADRs). Limitations of this data source include under reporting of ADRs and reporting bias. These findings are based on analysis of the Yellow Card dataset described and may not represent all ADRs from a generalised patient population.

Conclusions

Nine percent of all reported ADRs are associated with drugs where a genetic variant can cause heightened risk of an ADR and inform prescribing. A panel of only three pharmacogenes could potentially mitigate three in every four PGx modifiable ADRs. Based on our findings, Psychiatry may be the single highest impact specialty to pilot PGx to reduce ADRs and associated morbidity, mortality and costs.

by Xingxing Chen, Enying Gong, Jie Tan, Elizabeth L. Turner, John A. Gallis, Shifeng Sun, Siran Luo, Fei Wu, Bolu Yang, Yutong Long, Yilong Wang, Zixiao Li, Yun Zhou, Shenglan Tang, Janet P. Bettger, Brian Oldenburg, Xiaochen Zhang, Jianfeng Gao, Brian S. Mittman, Valery L. Feigin, Ruitai Shao, Shah Ebrahim, Lijing L. Yan

Background

Despite growing evidence of primary care-based interventions for chronic disease management in resource-limited settings, long-term post-trial effects remain inconclusive. We investigated the association of a 12-month system-integrated technology-enabled model of care (SINEMA) intervention with mortality outcomes among patients experiencing stroke at 6-year post-trial.

Methods and findings

This study (clinicltiral.gov registration number: NCT05792618) is a long-term passive observational follow-up of participants and their spouse of the SINEMA trial (clinicaltrial.gov registration number: NCT03185858). The original SINEMA trial was a cluster-randomized controlled trial conducted in 50 villages (clusters) in rural China among patients experiencing stroke during July 2017–July 2018. Village doctors in the intervention arm received training, incentives, and a customized mobile health application supporting monthly follow-ups to participants who also received daily free automated voice-messages. Vital status and causes of death were ascertained using local death registry, standardized village doctor records, and verbal autopsy. The post-trial observational follow-up spanned from 13- to 70-months post-baseline (up to April 30, 2023), during which no intervention was requested or supported. The primary outcome of this study was all-cause mortality, with cardiovascular and stroke cause-specific mortality also reported. Cox proportional hazards models with cluster-robust standard errors were used to compute hazard ratios (HRs) and 95% confidence intervals (95% CIs), adjusting for town, age, and sex in the main analysis model. Analyses were conducted on an intention-to-treat basis.Of 1,299 patients experiencing stroke (mean age 65.7 years, 42.6% females) followed-up to 6 years, 276 (21.2%) died (median time-to-death 43.0 months [quantile 1–quantile 3: 26.7–56.8]). Cumulative incidence of all-cause mortality was 19.0% (121 among 637) in the intervention arm versus 23.4% (155 among 662) in the control arm (HR 0.73; 95% CI 0.59, 0.90; p = 0.004); 14.4% versus 17.7% (HR 0.73; 95% CI 0.58, 0.94; p = 0.013) for cardiovascular cause-specific mortality; and 6.0% versus 7.9% (HR 0.71; 95% CI 0.44, 1.15; p = 0.16) for stroke cause-specific mortality. Although multisource verification was used to verify the outcomes, limitations exist as the survey- and record-matching-based nature of the study, unavailability of accurate clinical diagnostic records for some cases and the potential confounders that may influence the observed association on mortality.

Conclusions

Despite no observed statistically difference on stroke cause-specific mortality, the 12-month SINEMA intervention, compared with usual care, significantly associated with reduced all-cause and cardiovascular cause-specific mortality during 6 years of follow-up, suggesting potential sustained long-term benefits to patients experiencing stroke.

Decades of improvements in mortality are coming undone as public health funding is eroded and trust in evidence based treatment is undermined. At the same time, commercial interests are pushing people away from healthy lifestyles, as companies work to ensure that government policies don’t undermine their business models (doi:10.1136/bmj.r487).1 And millions of the most powerless people in the world will be harmed in the wake of the US’s sudden withdrawal of foreign aid (doi:10.1136/bmj.r518).2Can some of the new ideas and technological advances discussed in this week’s articles on bmj.com help us turn the tide and progress towards a new age of enlightenment? Should we, for instance, do away with the ancient practice of cadaveric dissection and embrace modern training tools—or will we then miss an essential aspect of the way in which students learn human anatomy (doi:10.1136/bmj.q2829)?3In other areas of medicine, the advantages of new tools and techniques may be...

AbstractClinical questionIn adult patients undergoing colonoscopy for any indication (screening, surveillance, follow-up of positive faecal immunochemical testing, or gastrointestinal symptoms such as blood in the stools) what are the benefits and harms of computer-aided detection (CADe)?Context and current practiceColorectal cancer (CRC), the third most common cancer and the second leading cause of cancer-related death globally, typically arises from adenomatous polyps. Detection and removal of polyps during colonoscopy can reduce the risk of cancer. CADe systems use artificial intelligence (AI) to assist endoscopists by analysing real-time colonoscopy images to detect potential polyps. Despite their increasing use in clinical practice, guideline recommendations that carefully balance all patient-important outcomes remain unavailable. In this first iteration of a living guideline, we address the use of CADe at the level of an individual patient.EvidenceEvidence for this recommendation is drawn from a living systematic review of 44 randomised controlled trials (RCTs) involving more than 30 000 participants and a companion microsimulation study simulating 10 year follow-up for 100 000 individuals aged 60-69 years to assess the impact of CADe on patient-important outcomes. While no direct evidence was found for critical outcomes of colorectal cancer incidence and post-colonoscopy cancer incidence, low certainty data from the trials indicate that CADe may increase positive endoscopy findings. The microsimulation modelling, however, suggests little to no effect on CRC incidence, CRC-related mortality, or colonoscopy-related complications (perforation and bleeding) over the 10 year follow-up period, although low certainty evidence indicates CADe may increase the number of colonoscopies performed per patient. A review of values and preferences identified that patients value mortality reduction and quality of care but worry about increased anxiety, overdiagnosis, and more frequent surveillance.RecommendationFor adults who have agreed to undergo colonoscopy, we suggest against the routine use of CADe (weak recommendation).How this guideline was createdAn international panel, including three patient partners, 11 healthcare providers, and seven methodologists, deemed by MAGIC and The BMJ to have no relevant competing interests, developed this recommendation. For this guideline the panel took an individual patient approach. The panel started by defining the clinical question in PICO format, and prioritised outcomes including CRC incidence and mortality. Based on the linked systematic review and microsimulation study, the panel sought to balance the benefits, harms, and burdens of CADe and assumed patient preferences when making this recommendationUnderstanding the recommendationThe guideline panel found the benefits of CADe on critical outcomes, such as CRC incidence and post-colonoscopy cancer incidence, over a 10 year follow up period to be highly uncertain. Low certainty evidence suggests little to no impact on CRC-related mortality, while the potential burdens—including more frequent surveillance colonoscopies—are likely to affect many patients. Given the small and uncertain benefits and the likelihood of burdens, the panel issued a weak recommendation against routine CADe use.The panel acknowledges the anticipated variability in values and preferences among patients and clinicians when considering these uncertain benefits and potential burdens. In healthcare settings where CADe is available, individual decision making may be appropriate.UpdatesThis is the first iteration of a living practice guideline. The panel will update this living guideline if ongoing evidence surveillance identifies new CADe trial data that substantially alters our conclusions about CRC incidence, mortality, or burdens, or studies that increase our certainty in values and preferences of individual patients. Updates will provide recommendations on the use of CADe from a healthcare systems perspective (including resource use, acceptability, feasibility, and equity), as well as the combined use of CADe and computer aided diagnosis (CADx). Users can access the latest guideline version and supporting evidence on MAGICapp, with updates periodically published in The BMJ.

A new deal for GPs in Scotland which promised to transform their working lives has been a failure, says a damning report from Audit Scotland.A contract agreed with the Scottish government in 2018 envisaged GPs working at the head of expanded primary care teams to deliver improved services.1 It sought to tackle the financial pressures and growing workloads facing family doctors and improve access to care for patients.Audit Scotland analysis found, however, that the contract failed to deliver on several of its commitments.2 Pressures on general practice have increased, investment as a proportion of overall NHS spending has fallen, the number of full time GPs has reduced, patients report finding it more difficult to access care, and proposals to support GPs with more nurses, physiotherapists, and other specialists have not materialised as originally intended.The report says that the Scottish government’s commitment to increase the number of GPs in Scotland by...

The “Hello, my name is” campaign, set up by geriatrician and cancer patient Kate Granger in 2015, encourages all staff to introduce themselves to patients.12 The campaign stemmed from her experience as a patient and the lack of introductions she received from the healthcare staff looking after her.3 It reflected the simple need to know who was providing her care. However, it is now often conflated with use of the first name of healthcare professionals, both in introductions and on name badges, which can cause confusion about names, titles, and roles. The “Hello, my name is” campaign needs updating.Names matter for patients, but introductions using first names alone are insufficient. Introductions and badges should include a healthcare professional’s full name, title, and role. Healthcare delivery has diversified, so role recognition is more difficult and important than ever. Like Kate Granger,1 my usual introduction is “I am Professor Tim Cook, consultant...

Doctors in Gaza have been “abandoned by the world” as they continue to struggle to provide basic healthcare amid renewed Israeli airstrikes, a lack of staff and supplies, and under threat of violence and death, a US doctor working at the recently bombed Nasser Hospital has said.Feroze Sidhwa, US trauma surgeon who is volunteering in Gaza with MedGlobal, told a press conference on 26 March that the horrors he has witnessed since entering Gaza on 6 March far exceed anything he has seen during his humanitarian career, including during his three stints in Ukraine since the Russian invasion.“Doctors feel alone. They feel abandoned by the world, and I think rightly so. When Russia bombs a children’s hospital in Kiev, everybody loses their mind, and rightly so,” Sidhwa said. “But what’s going on here is far more severe and they see that the world, and especially the West, just doesn’t seem...

The treatment of around 800 patients by a now suspended consultant paediatric orthopaedic surgeon at Addenbrooke’s Hospital in Cambridge is to be examined by a panel of expert clinicians, after an initial review of complex hip surgery cases over the past two and a half years found that nine children had received substandard care.The external retrospective review will be chaired by Andrew Kennedy KC, an independent barrister who represented the Countess of Chester Hospital NHS Foundation Trust in the Thirlwall inquiry into the circumstances surrounding the crimes of nurse Lucy Letby.Cambridge University Hospitals NHS Foundation Trust, which runs Addenbrooke’s, has also commissioned an independent investigation by the specialist company Verita into “whether there were any missed opportunities to have identified concerns and acted earlier,” given that concerns were raised as early as 2015 and were the subject of an external review in 2016.Verita has been asked to look into whether...

The timeline for the proposed introduction of assisted dying in England and Wales could be pushed back to four years, raising fears among supporters that its introduction may be abandoned altogether.An amendment approved by the Commons committee scrutinising the bill came as the Isle of Man took its final step to legalise assisted dying, the first area of the British Isles to do so. The Isle of Man Assisted Dying Bill 2023 will now be sent for royal assent before an implementation period begins, with assisted dying potentially available to terminally ill residents from 2027.The deferral in England and Wales was proposed by Kim Leadbeater, the Labour MP behind the private member’s bill. She proposed the amendment to change the maximum implementation period from two to four years after consulting with civil servants, who advised that more time would be needed to set up training and systems for the new...

The NHS is relying too much on recruiting doctors and nurses from countries that have their own significant healthcare workforce shortages instead of training and retaining enough domestic staff, a damning report has concluded.By November 2024 around one in eleven NHS doctors in England (9%) held a nationality from a “red list” country—those listed by the World Health Organization (WHO) as having such a shortage of staff that other countries should not actively recruit from them—found the report from the Nuffield Trust think tank and academics from the University of Sheffield, Queen’s University Belfast, and the University of Michigan.1The report, funded by the Health Foundation, found that since Brexit all UK countries had relied heavily on very high migration of healthcare staff from outside the EU.Mark Dayan, Nuffield Trust policy analyst and Brexit programme lead, told The BMJ, “Yet again, British failure to train enough healthcare staff has been bailed...

As paediatricians working in the US, we view the changes being made to our healthcare and education systems, research enterprise, and regulatory agencies1 as truly dystopian.The damage is clear to us. The breakdown of information from the Centers for Disease Control and Prevention; unjustified firing of workers from the National Science Foundation, US Department of Agriculture, Food and Drug Administration, and Environmental Protection Agency; decreasing the funding of university research through the National Institutes of Health; dismantling the US Agency for International Development; and withdrawal from the World Health Organization and the Paris Climate Agreement have disproportionately adverse effects on children. Children will suffer from diseases and disabilities that otherwise could be prevented and treated, a dire consequence of policies adopted by the very federal government entrusted with promoting and protecting their health, development, and functioning.Dictators have historically used health as a target to destroy the core strength of their...

In this episode of Sharp Scratch, the panel got together to discuss the importance of properly listening to patients.The panel was joined by guest Rageshri Dhairyawan to explore how medical students and doctors can work to improve their listening by increasing their awareness of biases that may lead to some groups of patients being dismissed. The episode highlighted the broader implications of not properly hearing patients, including the impact on health equity. The discussion also covered the challenges of dealing with uncertainty and acknowledging the social factors that can affect healthcare outcomes. The episode emphasised the ways in which becoming a better listener as a medical professional can help us to provide more compassionate and holistic care.Rageshri Dhairyawan is a consultant in sexual health and HIV medicine at Barts Health NHS Trust and deputy director of the SHARE Collaborative for Health Equity, Queen Mary University of London. She is author...

New England Journal of Medicine, Volume 392, Issue 12, Page 1237-1240, March 27, 2025.

New England Journal of Medicine, Volume 392, Issue 12, Page 1203-1214, March 27, 2025.

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New England Journal of Medicine, Volume 392, Issue 12, Page 1245-1246, March 27, 2025.

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