Medical Journal News

Lawyers for families whose babies the nurse Lucy Letby was convicted of killing or assaulting have cast doubt on the findings by an international panel of experts which appear to exonerate her.1The 14 strong panel revealed its conclusion that the deaths were attributable to natural causes or poor medical care at the Countess of Chester Hospital, where Letby worked, at a press conference organised by her barrister, Mark McDonald, last month.2 Letby is serving 15 life terms after being convicted of murdering seven babies and attempting to murder seven others between June 2015 and June 2016.3 McDonald is asking the Criminal Cases Review Commission to send the case back to the Court of Appeal, after Letby’s previous attempts were turned down.In written submissions to the Thirlwall inquiry, the legal team representing several babies’ families, headed by Richard Baker KC, noted that the panel, assembled by the retired Canadian neonatologist Shoo...

The government has been urged to remove the financial barriers to doctors taking on additional work after a BMA survey showed that many consultants and GPs have cut their hours in the past year because of pension tax rules.The BMA’s poll of more than 5000 senior doctors found that many have reduced their work commitments to such a degree that if replicated across the wider workforce it would equate to the loss of around 5400 full time consultants. The BMA highlighted that this is almost 10% of capacity that could be offered to the NHS in England to tackle waiting lists this year. For GP partners, it estimates that the reduction in hours represents a potential loss of around four million appointments.The long standing problem is related to the tapered annual allowance (AA), introduced in 2016, which imposes a limit on how much senior doctors can put into their pension...

The UK has confirmed a case of H5N1 influenza of avian origin in a sheep in Yorkshire, in a world first.The infection in the animal was identified through routine and repeated milk testing, which was enforced after avian influenza was confirmed in captive birds on the same premises. The sheep has now been “humanely culled” and no other cases of avian influenza have been detected in the remaining sheep, the Department for Environment, Food, and Rural Affairs and the Animal and Plant Health Agency have said.“While this is the first time this virus has been reported in a sheep, it is not the first time influenza of avian origin has been detected in livestock in other countries,” the announcement said. “There is no evidence to suggest an increased risk to the nation’s livestock.”In January the UK confirmed a human case of influenza A (H5N1) in a person in the West...

The growing number of medical students put on a “placeholder” list after applying for foundation year training raises serious concerns about the capacity and foresight of the UK Foundation Programme Office (UKFPO). In 2024, more than a thousand medical school graduates were left without allocated foundation year training posts and faced a prolonged period of uncertainty while emergency posts were created.1 This has left graduates unable to plan the next steps of their careers and personal lives. Early reports suggest that this year hundreds of students have again been given a placeholder allocation.2The shortage of foundation training posts is indicative of a growing problem, as the number of students graduating from UK medical schools is expected to continue rising.3 This is the harbinger of an emerging workforce crisis. Unless there is an adequately planned, sustained expansion in the number of foundation training posts available in the UK, the placeholder list...

A growing tendency in official data to ask a person for their gender identity rather than their sex is having serious consequences in some areas of healthcare such as missed cancer screenings and mistakes in blood testing.An independent, government commissioned report1 into the collection of accurate data and statistics on biological sex concluded that public bodies should collect distinct data on both sex and gender identity to ensure that nationally held data are accurate and clear.The report, published by the Department for Science, Innovation, and Technology, sets out a timeline of how survey data have been collected since the 1960s. It shows how the word “gender” started to replace “sex” in some data collection in the 1990s, and in some survey data, gender was defined as “sex” while in others gender was defined as “identity.”The review authors found that from around 2015 the word “gender” started to be understood in...

bmj;388/mar24_9/r574/FAF1faIn 1983 surgeons across East Africa began to compare notes about a new disease, known colloquially as “slim,” which was prevalent across the region. At the time, Anne Bayley was running a clinic at the University Teaching Hospital in Lusaka, Zambia, for patients with endemic Kaposi’s sarcoma, a relatively indolent skin tumour, found mainly in older men.In 1983, however, the number of new cases of Kaposi’s sarcoma doubled to 23—and 13 of these patients (including three women) presented with unusual, more aggressive disease. Eight patients died in less than a year.1 There was also a rise in reports of Kaposi’s sarcoma in the literature, reflecting the emergence of HIV/AIDS among mainly gay men in the West. Bayley realised that HIV was the underlying problem in her patients with aggressive Kaposi’s sarcoma, which she thought implied heterosexual transmission. Not everyone agreed, convinced that it was spread by sex between men.Keeping an...

Researchers have criticised the UK drug industry trade association’s decision to restore Novo Nordisk’s membership despite the company being subject to ongoing regulatory breaches during its two year suspension period.In March 2023 the Danish pharmaceutical company, which manufactures the high profile weight loss drugs Ozempic, Saxenda, and Wegovy, was suspended as a member of the Association of the British Pharmaceutical Industry (ABPI) for two years because of “serious breaches” of the organisation’s code of practice.1 The company failed to disclose clearly its sponsorship of a weight management training course for healthcare professionals which included positive information on its obesity drug liraglutide (Saxenda).The ABPI, announcing its decision to reinstate Novo Nordisk’s membership on 17 March, said it was satisfied that the company had made “clear, significant, and sustained improvements” to ensure it properly adheres to strict industry standards.2But academics from the University of Bath told The BMJ that the available evidence—including...

Near-infrared spectroscopy (NIRS), originally described in 1977, entered clinical practice as a non-invasive method to assess regional tissue oxygenation.1 This monitoring technique was initially used in high risk surgeries to measure cerebral oxygenation in real time. After encouraging results that linked intraoperative NIRS guided, goal directed treatment to improved neurological outcomes in cardiac surgery, NIRS use quickly expanded.234 This increased use has sparked the development of multiple competing clinically approved NIRS monitoring systems, highlighting the substantial market interest in this technology.5Despite the widespread use of NIRS, negative findings from subsequent trials have raised concerns about whether NIRS monitoring truly improves outcomes.678 These concerns have prompted a debate regarding the surgical populations who might benefit from NIRS and the best practices for its use.9 In a linked research paper (doi:10.1136/bmj-2024-082104), Han and colleagues present noteworthy findings from the Bottomline-CS trial, which examined whether perioperative care guided by cerebral and peripheral tissue...

A love of people and their life stories inspired Raja Badrakalimuthu to specialise in old age psychiatry.“Working with older people, you get to have conversations about their lives,” says Badrakalimuthu, a consultant old age liaison psychiatrist at Royal Surrey County Hospital in Guildford. “Their generation built our society, and we’ve inherited the legacy of their hard work. I find it satisfying to be able to do something for them—to thank them, and show my gratitude.”Old age psychiatry is “the perfect blend of medicine and mental health,” he says. “Older people can have multiple physical conditions and you have to take this into account when diagnosing dementia.”With new dementia drugs becoming incorporated into clinical practice, and new cognitive assessments and scans becoming readily available, “it’s an exciting time to be doing old age psychiatry,” Badrakalimuthu says. Old age psychiatrists also have to be aware of what kind of support is available...

Buse and McKee discuss the potential changes to global health directions, funding, and structures under a second Trump administration.1 They note the risk to funding of organisations supporting sexual and reproductive health rights. These include the reinstatement of such policies as the “global gag rule,” in which the US government refuses to fund global non-government organisations who provide, refer, or promote access to abortion.2 This was very damaging under the first Trump administration.3 But changes in health policy direction and funding could also undermine progress in women’s health in other ways such as increased gender based violence, diminished reproductive autonomy, and shifts in societal norms. We would like to discuss this last aspect.An effect of Trump 2.0 will be the emboldening of men and others who share certain perspectives about the role of women in society. The far right slogan, “Your body, my choice,” tweeted by white nationalist Nick Fuentes...

Data on hospital beds are important1 but must not eclipse upstream priorities for tackling pressures in the NHS. Strengthening general practice is crucial. This calls for medical educators and NHS leaders who value and promote generalist skills—in particular, the art of “holding patient care in general practice.” “Holding” necessitates meeting patients’ health needs as far as possible entirely within the primary care setting and avoiding premature or unnecessary secondary care involvement or specialist investigations. Community presentations such as self-limiting illnesses, mental health issues, and medically unexplained symptoms infrequently follow a linear diagnostic algorithm. They require a “social-psycho-bio” (rather than a “bio-psycho-social”) perspective that tackles social circumstances, psychological wellbeing, and media driven expectations. Here, learners must be comfortable consulting “in the dark”: navigating patient care through history, examination, incremental management, and safety netting rather than defaulting to sequential clinical tests.2 In low risk populations, excessive investigation begets onward referral from ambiguous...

National PPE approach was focused on hospitalsDanny Mortimer, chief executive of NHS Employers and deputy chief executive of the NHS Confederation, told the inquiry that there was a lack of availability of personal protective equipment (PPE) in every part of the health service, but that it was particularly severe in general practices, community settings, and mental health services.1 He said members of the confederation believed that the national approach to PPE was focused on the acute sector. He cited a confederation survey of GPs in early 2020 in which 83% of respondents reported that they didn’t have proper access to masks with filters and 73% reported a lack of access to goggles and visors.Giving evidence on 18 March, Mortimer highlighted problems with the availability of specific equipment such as masks fitted with respirators. “There was particular concern about the availability of equipment that could fit different types of faces, whether...

In healthcare, prediction models or algorithms (hereafter referred to as prediction models) estimate the probability of a health outcome for individuals. In the diagnostic setting—including screening and monitoring—the model typically aims to predict or classify the presence of a particular outcome, such as a disease or disorder. In the prognostic setting the model aims to predict a future outcome—typically health related—in patients with a diagnosis of a particular disease or disorder, or in the general population. The primary use of a prediction model in healthcare is to support individual healthcare counselling and shared decision making on, for example, subsequent medical testing, referral to another healthcare professional or facility, treatment, discharge from hospital, or lifestyle changes. For example, the tool QR4 predicts the probability of developing a cardiovascular event within the next 10 years and informs whether individuals should undergo changes to their lifestyle or be prescribed drugs.1 Prediction models are...

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

New England Journal of Medicine, Volume 392, Issue 12, Page 1151-1153, March 27, 2025.

New England Journal of Medicine, Volume 392, Issue 12, Page 1145-1148, March 27, 2025.

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.