Medical Journal News

Guselkumab was effective and safe as induction and maintenance therapy in patients with moderately to severely active ulcerative colitis.

Almost one in eight phone calls made to NHS hospitals under the Martha’s rule programme have led to a potentially lifesaving change in a person’s treatment, NHS England has said.Early data from hospital pilot sites show that patients have been urgently transferred to intensive care, received antibiotics, or been given oxygen as a result of hospitals adopting the scheme.Martha’s rule allows patients and families to seek an urgent review if their or their family member’s condition deteriorates and they feel that their concerns are not being responded to. The programme is named after Martha Mills, who died in 2021 from sepsis after her family’s concerns about her deterioration were not dealt with.1 An inquest concluded that Martha would probably have survived if she had been moved to intensive care earlier.2The scheme is currently being trialled at 143 hospital sites in England. Data from 136 of these sites show that in...

AbstractObjectiveTo assess the effect of electrically heated mittens on physical hand function in people with osteoarthritis of the hands compared with control mittens.DesignRandomised controlled trial.SettingOsteoarthritis outpatient clinic, Copenhagen, Denmark.Participants200 people with hand osteoarthritis aged 42-90 years. 100 participants were assigned to the intervention group and 100 to the control group.InterventionsElectrically heated mittens or control mittens (heating elements disconnected) worn for at least 15 minutes daily for six weeks.Main outcome measuresThe primary outcome was change in hand function measured on the function subscale of the Australian/Canadian hand osteoarthritis index (AUSCAN; score 0-100 points) at six weeks. Key secondary outcomes included changes in the AUSCAN hand pain subscale (score 0-100 points), global rating of hand osteoarthritis related problems (0-100 visual analogue scale), and grip strength (newtons) at six weeks. Analysis of secondary outcomes was performed using a hierarchical gatekeeping approach.Results91 participants in the intervention group and 95 in the control group completed the trial. The mean age of participants was 71 years, 87% (n=173) were women, and mean body mass index was 24.9 (SD 4.4). Median disease duration was 10 years (interquartile range 5-15 years). The between group difference for change in AUSCAN function at week 6 was 3.0 points (95% confidence interval (CI) −0.4 to 6.3; P=0.09) in favour of heated mittens. For the key secondary outcome, change in AUSCAN hand pain score from baseline, a group difference was observed of 5.9 points (95% CI 2.2 to 9.5) in favour of heated mittens. Changes in global rating of hand osteoarthritis related problems and grip strength did not differ between the groups with an observed difference between groups of 2.8 points (95% CI −3.7 to 9.2) and 2.3 newtons (95% CI −16.3 to 21.0) in favour of heated mittens, respectively.ConclusionUse of electrically heated mittens for six weeks was not related to a positive change in physical hand function compared with control mittens. Heated mittens provided no additional benefits on global rating of hand osteoarthritis related problems and grip strength. A small benefit was detected for hand pain, but this could have been overestimated.Trial registrationClinicalTrials.gov NCT04576403.

Mathew discusses GP access to magnetic resonance imaging (MRI).1Multiple studies have been published in which patients without symptoms underwent MRI of the knee and were found to have abnormalities.23 It follows that the more scanning we perform, the more of these “incidentalomas” will be found, most of which are irrelevant to a patient’s symptoms. The resulting radiology reports then recommend an “orthopaedic opinion” to discuss a harmless finding, for which no intervention is indicated.Often, the most helpful imaging when considering joint replacement surgery is a weight bearing radiograph,45 and it’s frustrating when the patient’s time and taxpayers’ money is wasted on MRI which turns out to be unhelpful. MRI should be approached with the same caution as screening—too many incidental findings lead to health anxiety and over-investigation.Managing patients with chronic pain is challenging, but additional imaging often amplifies anxiety. An incidental finding that appears to be serious enough that a...

AbstractObjectiveTo analyze mortality attributed to Alzheimer’s disease among taxi drivers and ambulance drivers, occupations that demand frequent spatial and navigational processing, compared with other occupations.DesignPopulation based cross-sectional study.SettingUse of death certificates from the National Vital Statistics System in the United States, which were linked to occupation, 1 January 2020-31 December 2022.ParticipantsDeceased adults aged 18 years and older.Main outcomes measuresAmong 443 occupations studied, percentage of deaths attributed to Alzheimer’s disease for taxi drivers and ambulance drivers and each of the remaining 441 occupations, adjusting for age at death and other sociodemographic factors.ResultsOf 8 972 221 people who had died with occupational information, 3.88% (348 328) had Alzheimer’s disease listed as a cause of death. Among taxi drivers, 1.03% (171/16 658) died from Alzheimer’s disease, while among ambulance drivers, the rate was 0.74% (10/1348). After adjustment, ambulance drivers (0.91% (95% confidence interval 0.35% to 1.48%)) and taxi drivers (1.03% (0.87% to 1.18%)) had the lowest proportion of deaths due to Alzheimer’s disease of all occupations examined. This trend was not observed in other transportation related jobs that are less reliant on real time spatial and navigational processing or for other types of dementia. Results were consistent whether Alzheimer’s disease was recorded as an underlying or contributing cause of death.ConclusionsTaxi drivers and ambulance drivers, occupations involving frequent navigational and spatial processing, had the lowest proportions of deaths attributed to Alzheimer’s disease of all occupations.

Women who are survivors of gender based violence in war who flee conflict affected countries and seek refuge in the UK require care that is tailored and sensitive to their specific needs. The health harms of gender based violence and war related trauma are extensive. Healthcare professionals need to be able to recognise the ways that war affects pregnancy related needs and deliver this care effectively. War is a public health issue, and refugee healthcare responses must be sensitive to the sociocultural context in which the violence occurs.Women are often targets of violent tactics in war, with their bodies weaponised through rape, physical violence, and forced impregnation, causing lasting harm to women and their communities. Sexual violence in war is often used as a method of asserting dominance and control over territories,1 especially in interethnic conflicts. Pregnancies resulting from wartime rape underscore the effectiveness of these horrific strategies. War trauma...

“If we build poor quality homes now, we are storing up problems for health in the future,” Michael Marmot has warned in a new report1 that calls for health and wellbeing to be placed centre stage in the government’s housing strategy.The Labour government has pledged to solve the housing crisis with a target of building 1.5 million new homes in England by 2029.2 But the report from the UCL Institute of Health Equity (IHE) calls on the government to prioritise affordable healthy homes.Building Health Equity: The Role of the Property Sector in Improving Health says the housing crisis and the health crisis are inseparable. The homes and neighbourhoods in which people live shape their health in many ways. It points out that inequalities in health have widened and for many years not enough homes, particularly social and affordable homes, have been built where they are needed most.Poor quality housing costs...

Experts have warned that artificial intelligence could lead to extinction of humans.1 In 1973 Ivan Illich, priest, thinker, and critic of industrial society, warned in his book Tools for Conviviality that “a tool can grow out of man’s control, first to become his master and finally to become his executioner.”2Illich argued that widespread industrialism would destroy us. The book foresaw, and describes better than any contemporary book, our current global polycrisis of climate change; destruction of nature; pandemics; multiple wars; the prospect, even likelihood, of nuclear war; gross inequality; growing debt; mass migration; populism; and failing institutions, including health services. Illich writes about subjects that we discuss commonly now: post-industrial society and degrowth or “withdrawal from growth.” 3456There is no disputing that growth, which took off with industrialisation in the 19th century, has brought benefits including increased life expectancy, a profusion of goods, better housing, and increased leisure. A high...

We face a bleak reality. We are in the middle of a mass extinction event driven by human economic activity crossing multiple planetary boundaries.1 Yet it remains business as usual for large transnational corporations engaged in record profiteering,2 especially fossil fuel producers. This dynamic is clear in healthcare as well. Many lives could have been saved during the pandemic if vaccine access had not been locked behind intellectual property rights to protect profits for large pharmaceutical companies.34Our current economic system is clearly willing to sabotage planetary and human health in pursuit of profit, capital accumulation, and economic growth5—as measured by gross domestic product (GDP). Growth in GDP (ie, increased industrial production and consumption) is often incorrectly presented as a proxy for progress, but it represents simply aggregate production. By this metric, producing €1m of bombs is valued the same as producing €1m of medicine. Clearly, it is not aggregate production...

At the heart of the practice of medicine is the tenet “to do good or to do no harm.”1 Fundamental to achieving this objective is continuing professional development (CPD), which should be lifelong and learner-centred, encompassing the clinical domain from consultation room to the bedside and operating room.2 CPD is relevant for all career stages from novice to veteran, although the optimal point for each stage might differ. CPD takes many forms—a long way from the traditional, and now outdated, approach of “see one, do one, teach one”3—including physical and mental rehearsals of clinical skills under laboratory conditions, vicarious experiences through self-guided readings or tutorial and lecture participation, self-reflection, and peer review.4 It involves a variety of media from paper to audiovisual based formats, and a host of digitally based tools that now includes (the soon-to-be ubiquitous) artificial intelligence.From the patient’s perspective, the overarching goals of the clinician’s self-improvement learning...

Fairytales princesses continue to be widely celebrated. The Walt Disney Company has undoubtedly contributed to their popularity by producing movies based on these stories. While these films captivate young viewers, they also raise concerns about stereotyping.1 Unrealistic portrayals of relationships, as well as impossible beauty standards such as unnatural waist-to-hip ratios,2 can negatively impact girls’ self-esteem.3 To date, research has focused on the films’ effects on viewers’ health, neglecting to explore the health risks faced by the princesses themselves. Future research must consider threats to the health of Disney princesses.Disney princesses face serious real world health hazards. Surprisingly, however, despite these risks they seem to live happily ever after. Disney must consider interventions to overcome these health challenges. Strategies to improve princesses’ wellbeing could include mindfulness and psychotherapy, training on cohabitation with animals, and personal protection measures against infectious agents and toxic particles. Only then can Disney princesses start living...

AbstractObjectiveTo assess whether training provided to an inexperienced clinician just before performing a high stakes procedure can improve procedural care quality, measuring the first attempt success rate of trainees performing infant orotracheal intubation.DesignRandomized clinical trial.SettingSingle center, quaternary children’s hospital in Boston, MA, USA.ParticipantsA non-crossover, prospective, parallel group, non-blinded, trial design was used. Volunteer trainees comprised pediatric anesthesia fellows, residents, and student registered nurse anesthetists from 10 regional training programs during their pediatric anesthesiology rotation. Trainees were block randomized by training roles. Inclusion criteria were trainees intubating infants aged ≤12 months with an American Society of Anesthesiology physical status classification of I-III. Exclusion criteria were trainees intubating infants with cyanotic congenital heart disease, known or suspected difficult or critical airways, pre-existing abnormal baseline oxygen saturation <96% on room air, endotracheal or tracheostomy tubes in situ, emergency cases, or covid-19 infection.InterventionsTrainee treatment group received preoperative just-in-time expert intubation coaching on a manikin within one hour of infant intubation; control group carried out standard practice (receiving unstructured intraoperative instruction by attending pediatric anesthesiologists).Main outcome measuresPrimary outcome was the first attempt success rate of intraoperative infant intubation. Modified intention-to-treat analysis used generalized estimating equations to account for multiple intubations per trainee participant. Secondary outcomes were complication rates, cognitive load of intubation, and competency metrics.Results250 trainees were assessed for eligibility; 78 were excluded, 172 were randomized, and 153 were subsequently analyzed. Between 1 August 2020 and 30 April 2022, 153 trainees (83 control, 70 treatment) did 515 intubations (283 control, 232 treatment). In modified intention-to-treat analysis, first attempt success was 91.4% (212/232) in the trainee treatment group and 81.6% (231/283) in the control group (odds ratio 2.42 (95% confidence interval 1.45 to 4.04), P=0.001). Secondary outcomes favored the intervention, showing significance for decreased cognitive load and improved competency. Complications were lower for the intervention than for the control group but the difference was not significant.ConclusionsJust-in-time training among inexperienced clinicians led to increased first attempt success of infant intubation. Integration of a just-in-time approach into airway management could improve patient safety, and these findings could help to improve high stakes procedures more broadly. Randomized evaluation in other settings is warranted.Trial registrationClinicalTrials.gov NCT04472195.

In November, 2024, the UK Parliament voted to support the Terminally Ill Adults (End of Life) Bill.1 The bill would allow terminally ill adults with a prognosis of less than 6 months to request and be provided with assistance to end their lives. This bill is now at the Committee Stage of the parliamentary process and is expected to continue its passage to eventually become law. This change to UK law will have far-reaching impacts for death, dying, and palliative and end-of-life care for UK citizens.

The Italian government has cancelled fines for people who refused to have covid-19 vaccinations.Italy has been severely affected by covid-19, with over 190 000 deaths since the virus was first detected in early 2020, according to the World Health Organization. During his time in office between 2021 and 2022, Italy’s former prime minister Mario Draghi made vaccination mandatory for teachers and healthcare workers and later extended this to everyone aged 50 and over.1 Public employees who refused to be vaccinated were suspended from work without pay. Anyone who refused vaccination received a fine of €100.Italy’s current prime minister, Giorgia Meloni, who criticised Draghi and his predecessor Giuseppe Conte for what she described as an ideological approach to the pandemic, has now reversed the decision. This follows a separate decree from Meloni’s government to suspend compulsory vaccination against covid-19.The new rule applies to all those who have not yet paid the...

We are looking for four students who are studying medicine within the UK or European Union who will spend 16 days with us, remotely, between March and June 2025. There may also be the opportunity to spend time in The BMJ office in London. We welcome students at any stage in their medical school career, including those who want to join us as part of their medical elective.As a Clegg scholar, you will learn more about The BMJ and BMJ Student by meeting members of the team, learning about different article sections, and getting involved in the running of the journal. The content of the placement is flexible, with opportunities to be involved in pitching article ideas, writing, editing and researching content aimed at students. You will also have an opportunity to create social media and multimedia content for our channels. You may virtually attend and report from press conferences...

In early 2022 the World Health Organization (WHO) began drafting an international treaty to tackle the “serious shortcomings” in pandemic preparedness highlighted by the covid-19 pandemic.1 The treaty could improve global health safety, but there are many concerns with the current version, including the inadequate assurance of equity between member states, minimal accounting for human behaviour, and a lack of focus on pandemic recovery.12 Recovery planning is essential to manage the ongoing risks of virus transmission, repair pandemic induced societal damages, and assess response effectiveness to enable preparation for future pandemics.WHO declared an end to the covid-19 public health emergency of international concern in May 2023 but stated “that does not mean covid-19 is over as a global health threat.”3 We are currently in a murky phase of the pandemic where the balance between the ongoing risks of covid-19 and the route to recovery are unclear to many individuals and...

UK doctors who have returned from Gaza have described the situation as “absolutely dire,” recalling blood soaked beds, emaciated colleagues and patients, and doctors forced to perform brain surgery on children without basic surgical equipment.At an event hosted by Healthcare Workers for Palestine UK outside St Thomas’ Hospital, London, on 9 December, doctors told The BMJ they believed they had a duty to speak out for their colleagues in Gaza and to advocate for the health of the people there.Earlier that same day paediatricians delivered a letter addressed to the UK prime minister and signed by more than 800 child health specialists to 10 Downing Street. It called on Kier Starmer to “end all arms export licences to Israel and to impose immediate sanctions upon Israel until it complies with its obligations under international law and until a sustainable ceasefire is in place.”1The letter came as the UN reported further...

How we train future clinicians has the potential to radically and sustainably improve healthcare for everyone. Current medical education has an overt biomedical focus that does not engage enough on wider social determinants of health. This contributes to a clinical culture with rising healthcare costs from polypharmacy and excessive testing, screening, and inappropriate specialist referrals.1 In order to create a health service that is fit for the future, the future health workforce must also be educated on principles of disease prevention, health creation, and patient-partnered biopsychosocial approaches to wellbeing.We need a healthcare workforce that sees individuals dealing with their illnesses within their wider socioeconomic, sociocultural, and environmental contexts. There is clear evidence that taking a holistic approach to healthcare makes economic sense, promotes population wellbeing, and relieves pressure on the healthcare system.23As a group of students and early career professionals representing the future of the NHS workforce, we are calling...

Here, we have the luxury of noticing each symptom and sign. We have the luxury of spending days on scientific pursuits around molecules, processes, and incremental improvements. We consider how we can alleviate a patient’s suffering and, even marginally, protect their quality of life. Using science and our hearts we painstakingly craft elaborate scientific proposals and detailed care plans with each patient. We care for and about all our patients. We advocate for this care to be minimally disruptive, to fit each person’s needs, and to be appropriate to their circumstances. Respect for each person, their human rights, their freedom, and their sacred life enable us to practise our craft.There, is a dark, stark, brutal place where lives don’t matter, obliterated at an industrial scale. Bombs destroy without regard for the victims or their circumstances. Incessant killing technologies systematically fulfil their purpose and reduce existence to numbers. Countless innocent lives...

Thank you for reading the Now@NEJM blog.  As you may have noticed in the past year, content that was previously posted to the blog is now available on other NEJM Group sites such as NEJM Resident 360. To ensure that we do not duplicate content, we will retire the blog at the end of February.

We hope you will remain connected to the New England Journal of Medicine (NEJM.org), the NEJM Group flagship publication. You can see all the ways to stay connected on our Products and Services page, and follow us on our social media channels including Facebook, Twitter, LinkedIn, YouTube, and Instagram. Alternatively, please visit NEJM Group to learn more about the other medical information products in the NEJM Group portfolio.

Karen Buckley, NEJM Resident 360 Product Manager

Jen Zeis, Manager, Communications and Media Relations, NEJM Group