Medical Journal News

I read with interest the Article by Jürgen Beck and colleagues1 presenting the SWITCH clinical trial, assessing whether decompressive craniectomy added to best medical treatment improves outcomes after spontaneous deep intracerebral haemorrhage. The Article is methodologically important because it presents a confidence distribution for the treatment effect, which is a new and advantageous approach to reporting clinical trial results.2

We thank Roberta Muriel Longo Roepke and Bruno Adler Maccagnan Pinheiro Besen, Jennifer A Frontera and Nicholas A Morris, Nicolas Engrand and Loïc Miry, and Ian C Marschner for their interest in the SWITCH trial.1 A spontaneous severe deep supratentorial intracerebral haemorrhage is a devastating disease: without treatment, more than 50% of victims die or are severely disabled. Decompressive craniectomy tends to reduce mortality without an increase in the number of severely disabled patients recovering from intracerebral haemorrhage (modified Rankin score [mRS] 5).

Watts G. Timothy Danforth Baker. Lancet 2014; 383: 690—In this Obituary, the date of birth has been corrected to July 4, 1925. This correction has been made to the online version as of Jan 2, 2025.

Rydelius J, Hognert H, Kopp-Kallner H, et al. First dose of misoprostol administration at home or in hospital for medical abortion between 12–22 gestational weeks in Sweden (PRIMA): a multicentre, open-label, randomised controlled trial. Lancet 2024; 404: 864–73—In this Article, the definition of 21 gestational weeks and 6 days should have read “153 days” in the Participants section of the Methods. This correction has been made as of Jan 2, 2025.

Werring DJ, Dehbi H-M, Ahmed N, et al. Optimal timing of anticoagulation after acute ischaemic stroke with atrial fibrillation (OPTIMAS): a multicentre, blinded-endpoint, phase 4, randomised controlled trial. Lancet 2024; 404: 1731–41—In the Summary of this Article, the first line should have read “acute ischaemic stroke”. In figure 2 of this Article, the number at risk in the delayed DOAC initiation group at 0 days should have read “1807”. These corrections have been made to the online version as of Jan 2, 2025.

A 26-year-old woman with a 2-month history of postcoital bleeding—which she described as very heavy loss and lasting 2 days—attended our unit.

Osteoarthritis is a heterogeneous disorder that is increasingly prevalent largely due to aging and obesity, resulting in a major disease burden worldwide. Knowledge about the underlying aetiology has improved, with increased understanding of the role of genetic factors, the microbiome, and existence of different pain mechanisms. However, this knowledge has not yet been translated into new treatment options. New evidence has questioned the efficacy of recommended treatments, such as therapeutic exercise programmes and the focus on weight loss, but managing obesity and maintaining activity remain important for the prevention and management of osteoarthritis.

With a sense of inevitability and clear predictability, urgent and emergency care in the UK is rapidly heading into another winter of discontent. We are seeing signs that we will experience another winter of patients facing prolonged waits to access emergency care. The result will be patient harm, corridor care in emergency departments and acute medical units, and delays in ambulance response times.1 Each of these metrics have deteriorated over the past decade, with politicians failing to understand and deliver on the priorities that could reverse this decline.Hospital occupancy levels remain dangerously high.2 This leaves no room in the system to cope with a surge in demand. The “quad-demic” of influenza, respiratory syncytial virus, covid-19, and norovirus will simply be overwhelming. Disturbingly, a measurable increase in any of these conditions would cause hospitals to struggle—with the impact most noticeable in urgent and emergency care.3The discontent is felt and experienced by...

Health officials overseeing the city of Wuhan in China have been forced to stop HIV clinics from uploading results to a new digital system for test sharing after two HIV positive patients were refused hospital treatment.One man was turned away from a dental hospital in the city on 30 November, and another with cold symptoms was rejected from a general hospital on 1 December. In both instances staff told the men that they had seen their positive HIV status in an interhospital test system and were unable to treat people with HIV, said local reports verified by The BMJ.1These incidents highlight the ongoing problem of medical discrimination in China and show how this is complicating a major government effort to curb costs and overtreatment by making hospitals share information such as x ray imaging and blood test results.The orders to HIV clinics to stop uploading results were issued on 4...

I welcome the Medical Protection Society’s report calling for all NHS trust staff who deal with disciplinary procedures to have specialised training.12 As one of the people involved in setting up new guidelines for NHS trusts to follow in respect of human resources disciplinary procedures (outlined on page 3 of the report), I consider that three key things must happen.Firstly, as noted in the report, managers and healthcare staff in management roles need to be properly trained and properly accountable when they are involved in NHS disciplinary procedures. Managers should therefore be regulated just like doctors and nurses. Secondly, there should be a requirement that principles of fairness are imprinted into NHS disciplinary procedures. These are what I have termed PIE principles—plurality, independence, and expertise in panels. Thirdly, there should be an independent body—a “Staff Care Quality Commission”—that has the power to prosecute and fine trusts that abuse NHS disciplinary...

The government has announced the launch of an independent commission into adult social care in England, which will inform the creation of its proposed National Care Service.1The commission, led by the cross bench peer Louise Casey, will be split into two phases and will make “clear recommendations for how to rebuild the adult social care system to meet the current and future needs of the population.”The first phase, expected to report in mid-2026, will identify the main problems with the current care system and set out recommendations for “effective reform and improvement in the medium term.” These recommendations will be aligned with the government’s spring spending review. The second phase, set to report in 2028, will then make longer term recommendations for the transformation of adult social care.The health and social care secretary, Wes Streeting, said, “I have written to opposition parties to invite them to take part in the...

The UK is not a good place to be poor. It is not even a very good place if you are middle income or below. Over the past 14 years, life expectancy has not improved, health inequalities have increased, and reported health has not improved for the poorer half of the population.1 Housing has played an important role in this crisis.A new report from the UCL Institute of Health Equity, Building Health Equity: the Role of the Property Sector in Improving Health, outlines the consequences of housing problems for health equity and details what needs to be done to tackle these.2The report draws attention to three aspects of housing that are important for health: affordability, quality, and supply. Affordability implies some relation between price and ability to pay the price. In the past 15 years income growth in the UK has fallen behind that of other European countries, and income...

Crider and colleagues discuss the availability of personal and private medical records held by the NHS.1 Cybercrime is another area of concern.I recently researched occurrences of cybercrime against medical records.2 It occurs worldwide and is often attached to ransom demands. Intel Security McAfee Laboratories says that cybercriminals are investing more time and resources into exploiting and selling healthcare data.3 On 3 June 2024 the UK firm Synnovis, an NHS pathology testing provider, was hacked, causing massive disruption to multiple London hospitals. The hack disrupted more than 3000 hospital and primary care appointments and operations. Synnovis resisted paying a ransom, and on 24 June 2024, the cybercrime group Qilin shared almost 400 GB of private information on their darknet site. A sample of the data seen by the BBC includes patient names, dates of birth, NHS numbers, and blood test descriptions. It is not known whether test results are also in...

In December 2024, negotiations led by the United Nations to finalise a treaty to end plastic pollution concluded without agreement, pushing discussions into 2025.1 Plastic pollution is now recognised as not only an environmental crisis but also a critical human health crisis. The need for decisive international action to tackle plastic pollution has never been more urgent.The health focus is reflected in the objective of the current treaty draft “to protect human health and the environment from plastic pollution.”2 With the world’s annual plastic production at 400 million tonnes and projected to double by 2040, the scale of plastic pollution is staggering.3 Without intervention on a global scale, this trajectory will worsen.The treaty negotiations have highlighted divisions among countries on critical issues, including the treaty’s scope, limits on plastic production, controls on toxic chemical additives in plastics, and financing for treaty implementation in the regions most affected. These unresolved disagreements...

AbstractCritical illness is a complex condition that can have a devastating impact on health and quality of life. Nutritional support is a crucial component of critical care that aims to maintain or restore nutritional status and muscle function. A one-size-fits-all approach to the components of nutritional support has not proven beneficial. Recent randomized controlled trials challenge the conventional strategy and support the safety and potential benefits of below-usual calorie and protein intakes at the early, acute phase of critical illness. Further research is needed to define optimal nutritional support throughout the intensive care unit stay. Individualized nutritional strategies relying on risk assessment tools or biomarkers deserve further investigation in rigorously designed, large, multicenter, randomized, controlled trials. Importantly, although nutritional support is crucial, it might not be sufficient to enhance the recovery of critically ill patients. Thus, achieving the greatest efficacy may require individualized nutritional support combined with early, prolonged physical rehabilitation within a multimodal, holistic care program throughout the patient's recovery journey.

New England Journal of Medicine, Volume 392, Issue 1, Page 56-71, January 2, 2025.

New England Journal of Medicine, Volume 392, Issue 1, Page 103-104, January 2, 2025.

New England Journal of Medicine, Volume 392, Issue 1, Page 99-101, January 2, 2025.

New England Journal of Medicine, Volume 392, Issue 1, Page 101-102, January 2, 2025.

New England Journal of Medicine, Volume 392, Issue 1, Page 97-99, January 2, 2025.