Medical Journal News

New England Journal of Medicine, Volume 392, Issue 12, Page 1148-1151, March 27, 2025.

Overactive bladder is a chronic condition that affects 10–45% of women worldwide;1 however, more than half of women discontinue conservative and medical treatment.2,3 Predicting which women are better served by more invasive, third-line treatments, such as intradetrusor botulinum toxin A (BoNT-A) or sacral neuromodulation, has been elusive. Urodynamic studies have been used to better assess the cause of lower urinary tract symptoms. Expert societies, such as the European Association of Urology and the Canadian Urology Association, recommend conducting urodynamic studies in the event of treatments that did not work, when the diagnosis of overactive bladder is unclear, or if the choice of invasive treatments might change.

In women with refractory overactive bladder or urgency predominant mixed urinary incontinence, the participant-reported success in the urodynamics plus CCA group was not superior to the CCA-only group, and urodynamics was not cost-effective at the £20 000 per QALY gained threshold.

The US Agency for International Development (USAID) is no more. Marco Rubio, the US Secretary of State, has announced that 83% of programmes funded by USAID are to be ended, with the remainder to be absorbed by the State Department. Notwithstanding legal challenges, these decisions signal the end of an organisation that has brought crucial aid to millions globally. The move confirms the worst fears of the international community, coming 6 weeks after a pause on USAID's work that saw 5200 contracts cancelled, classified documents shredded, and life-saving aid halted.

A 2022 review evaluating the global magnitude of encephalitis burden concluded that low-income and middle-income countries (LMICs) had the highest age-standardised incidence rate worldwide (31·63 per 100 000 compared with 6·17 per 100 000 in high-income countries).1 Reported case fatality rates for Neisseria meningitidis were sometimes 3·5 times higher than in high-income countries.2 Accordingly, the Article in The Lancet by Bhagteshwar Singh and colleagues, reporting simple, context-informed interventions to improve the diagnosis and management of brain infections in Brazil, India, and Malawi, addresses a major public health issue.

We would like to express our sincere gratitude to the many dedicated peer reviewers who provided insightful and thoughtful comments on manuscripts submitted to The Lancet in 2024. With the rise in misinformation, together with the challenges posed by paper mills and other research integrity issues,1,2 we depend more than ever on peer reviewers to help uphold the standards of academic research and facilitate The Lancet's goal to publish the best science for better lives. In 2024, more than 1700 peer reviewers from 76 countries volunteered their time to critically assess submissions to the journal.

Kristin Moberg Aakre

After a series of senior departures from NHS England, the UK Prime Minister has caused shockwaves by abolishing the body entirely. Jacqui Thornton reports.

German drugmaker Grünenthal pushed its latest opioid as a safer option. People around the world got hooked. Madlen Davies, Hristio Boytchev, and Rafael Cabrera report.

Why would John Green, a best-selling American novelist, write a book about tuberculosis? The answer can be found in his new book Everything is Tuberculosis: The History and Persistence of Our Deadliest Infection. In this highly readable book, Green writes about how he saw first-hand and learnt that “tuberculosis is both a form and expression of injustice”, and decided to do something about it. The book focuses on the story of Henry Reider, a young tuberculosis patient in Sierra Leone, and his journey to recover from drug-resistant tuberculosis.

“Girls' bodies were fair game”, Sarah Moss writes. “You all knew which were the gropey dads…whom you shouldn't visit when the grandfather was there.” The teenage girls protected each other, she says, until they could not. “Jen's dad's got Cathy in the spare room and we can't get in. Be quiet, Suzy's dad said, the man's a doctor, you could ruin his career saying things like that.” Moss is well admired as a writer of fiction and non-fiction, but My Good Bright Wolf: A Memoir is distinct. Born in Glasgow and brought up in England, the book explores her early life and its adult repercussions.

Former President of the Planned Parenthood Federation of America and defender of sexual and reproductive health and rights. Born on July 15, 1957, in Waco, TX, USA, she died from glioblastoma in New York City, NY, USA, on Jan 20, 2025, aged 67 years.

Bretherton CP, Achten J, Jogarah V, et al. Early versus delayed weight-bearing following operatively treated ankle fracture (WAX): a non-inferiority, multicentre, randomised controlled trial. Lancet 2024; 403: 2787–97—In this Article, the spelling of author Henry Claireaux's name has been corrected. This correction has been made to the online version as of March 20, 2025

Almost 40 years ago, the discovery of the vasoactive neuropeptide calcitonin gene-related peptide (CGRP) and its role in migraine pathophysiology ushered in a new era in migraine treatment. Since 2018, monoclonal antibodies (mAbs) targeting the CGRP pathway are available for migraine prevention. The approval of these drugs marks a pioneering development, as they are the first pharmacological agents specifically tailored for migraine prevention. Introduction of these agents contrasts the historical reliance on traditional preventive medications initially formulated for other indications and later repurposed for migraine therapy.

New England Journal of Medicine, Volume 392, Issue 12, March 27, 2025.

The recent outbreak of Guillain–Barré syndrome in Pune (India) has become a matter of increasing national concern and has warranted the involvement of international agencies.1 As of March 8, 2025, the total number of Guillain–Barré syndrome cases in Pune was 225, with 197 confirmed diagnoses and 28 suspected cases, and can be considered as one of the largest Guillain–Barré syndrome outbreaks.2,3 The death toll has risen to 23 people in India, and Pune continues to be the worst affected with 11 deaths from Guillain–Barré syndrome.

bmj;388/mar21_10/r565/FAF1faAt the height of the Troubles in the early 1980s Ian Bownes, a young trainee psychiatrist in Northern Ireland, was sent into the notorious H blocks in Belfast’s Maze prison to assess if its paramilitary inmates were mentally fit to go on hunger strikes.It would have been an unsettling experience for anyone to go inside the Maze, which mainly housed republican prisoners. For a young Protestant like Bownes, however, it must have been even tougher. That Bownes did so for many years spoke to his “quiet heroism,” how much his professional opinion was valued, and how fully he was trusted to uphold the confidentiality on which his access depended, says friend and former colleague Harry Kennedy, a professor of forensic psychiatry at the University of Dublin.When Bownes first went into the Maze, republican prisoners were escalating a campaign of protest against the British government. This included demands to reinstate special...

by Yulong Ma, Siyuan Liu, Faqiang Zhang, Xuhui Cong, Bingcheng Zhao, Miao Sun, Huikai Yang, Min Liu, Peng Li, Yuxiang Song, Jiangbei Cao, Yingfu Li, Wei Zhang, Kexuan Liu, Jiaqiang Zhang, Weidong Mi

Background

Perioperative stroke is a serious and potentially fatal complication following non-cardiac surgery. Thus, it is important to identify the risk factors and develop an effective prognostic model to predict the incidence of perioperative stroke following non-cardiac surgery.

Methods and findings

We identified potential risk factors and built a model to predict the incidence of perioperative stroke using logistic regression derived from hospital registry data of adult patients that underwent non-cardiac surgery from 2008 to 2019 at The First Medical Center of Chinese PLA General Hospital. Our model was then validated using the records of two additional hospitals to demonstrate its clinical applicability. In our hospital cohorts, 223,415 patients undergoing non-cardiac surgery were included in this study with 525 (0.23%) patients experiencing a perioperative stroke. Thirty-three indicators including several intraoperative variables had been identified as potential risk factors. After multi-variate analysis and stepwise elimination (P < 0.05), 13 variables including age, American Society of Anesthesiologists (ASA) classification, hypertension, previous stroke, valvular heart disease, preoperative steroid hormones, preoperative β-blockers, preoperative mean arterial pressure, preoperative fibrinogen to albumin ratio, preoperative fasting plasma glucose, emergency surgery, surgery type and surgery length were screened as independent risk factors and incorporated to construct the final prediction model. Areas under the curve were 0.893 (95% confidence interval (CI) [0.879, 0.908]; P < 0.001) and 0.878 (95% CI [0.848, 0.909]; P < 0.001) in the development and internal validation cohorts. In the external validation cohorts derived from two other independent hospitals, the areas under the curve were 0.897 and 0.895. In addition, our model outperformed currently available prediction tools in discriminative power and positive net benefits. To increase the accessibility of our predictive model to doctors and patients evaluating perioperative stroke, we published an online prognostic software platform, 301 Perioperative Stroke Risk Calculator (301PSRC). The main limitations of this study included that we excluded surgical patients with an operation duration of less than one hour and that the construction and external validation of our model were from three independent retrospective databases without validation from prospective databases and non-Chinese databases.

Conclusions

In this work, we identified 13 independent risk factors for perioperative stroke and constructed an effective prediction model with well-supported external validation in Chinese patients undergoing non-cardiac surgery. The model may provide potential intervention targets and help to screen high-risk patients for perioperative stroke prevention.

Great British Energy, a new, publicly owned company created by the government, is to invest £200m to fit solar panels to the roofs of 200 NHS hospitals and 200 schools in England. The aim is to cut costs and carbon and make key areas of the public sector less dependent on the uncertain energy market. The programme is expected to save £400m over the lifetime of the panels (30 years), with savings reinvested in the NHS and education. The NHS spends an estimated £1.4bn a year on energy, a figure that has more than doubled since 2019.The programme is expected to last two years, and the first panels should be on NHS sites and schools by the end of summer 2025. The educational component of the programme will focus on schools in deprived areas, particularly in the north east, north west, and west Midlands.Mark Harber, special adviser on healthcare sustainability...