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Medical Journal News
Medical and political paternalism and the end of life
The BMJ widely discussed the assisted dying bill that is currently at the committee stage in the UK parliament.1Having worked for many years now for a health system that gives people more agency and dignity, I thought I had already come across all the arguments of medical paternalism. But I was wrong.What I wasn’t prepared for in the discussion about the assisted dying bill was that the current state of palliative care would be used as an argument for why we shouldn’t have agency. According to some politicians and leaders of the medical profession, it should be palliative care that is fixed, rather than giving choices to patients.2 As if we couldn’t have both.For now, no mainstream politician in the UK is proposing to turn back the tide on women’s right to choose just because maternity services are far too often unsafe.3 No one is saying that women cannot safely...
Categories: Medical Journal News
John Launer: Losing touch with NHS reality
A wonderfully absurdist NHS fantasy has been doing the rounds on social media. It stemmed from a case vignette in a government document, Reforming Elective Care for Patients,1 in a text box illustrating how patients can be empowered by accessing their results on the NHS App. I’m a great fan of patient empowerment and have nothing against the NHS App. But the illustrative story (which has since been removed) was so hilarious that it deserves to be widely shared.The heroine of the story is Sarah, a patient with sinus pain and hearing loss who goes to her GP surgery and sees a nurse practitioner. You’d reasonably expect that the nurse might recommend steam inhalations or possibly follow NICE guidelines by prescribing a decongestant nasal spray.2 But alas, she seems to be a devotee of expensive, privately financed high tech, so she refers the patient immediately to the local community diagnostic...
Categories: Medical Journal News
Adult social care reform cannot afford to wait
The UK government has announced its approach for social care—establishing yet another commission.1 In its 2024 election manifesto Labour pledged to create a “national care service” (without explaining what this means), tackle low pay for care workers, and “build consensus for the longer term reform needed.”2Meanwhile, social care is in crisis. Analysis suggests that age adjusted spending per person will be at least 5% lower in 2024-25 than in 2009-10, and that an additional £8.3bn a year could be needed by 2032-33 to keep up with rising demand.3 Age UK estimates that two million people aged ≥65 have unmet needs for care and support,4 and analysis by Healthwatch suggests that up to 1.5 million disabled adults of working age could be eligible for social care support but are not receiving it.5 There are 131 000 staff vacancies,6 and some 81% of councils are due to overspend their adult social care...
Categories: Medical Journal News
Short term complications of conisation and long term effects on fertility related outcomes in Denmark: register based nationwide cohort study
AbstractObjectiveTo report on complications of conisation and its effects on fertility and stenosis.DesignRegister based nationwide cohort study on routinely collected data using several linked databases.SettingPrimary and secondary care in Denmark, 2006-18.PopulationThe conisation cohort comprised 48 048 conisations on women aged 23-65 who had undergone conisation within 120 days of a cervical biopsy. The biopsy cohort comprised 48 048 biopsies on women who had undergone a cervical biopsy but not conisation who were matched by age and time of procedure. Women were excluded from the conisation cohort before long term outcome analyses if they had undergone hysterectomy, resection of the uterus, or had cervical cancer or any long term outcomes within the 10 years before their conisation.Main outcome measuresBleeding, infection, and gynaecological operations within 30 days of conisation (stratified by age, year of conisation, and number of previous conisations) and long term risk of fertility treatment, fertility consultation, stenosis, cervical dilatation, infertility diagnoses, and death at any point after conisation. Long term outcomes were followed up until death, emigration, diagnosis of cervical cancer, hysterectomy or resection of uterus, or the end of 2018. Long term outcomes were analysed with incidence rate ratios from Cox regression models.ResultsBleeding, infection, and gynaecological operations were registered for 2.81% (n=1351), 0.48% (n=231), and 3.95% (n=1897) of all conisations within 30 days of the procedure, respectively. Women in the conisation cohort had increased risk of stenosis (incidence rate ratio 14.81, 95% confidence interval 7.55 to 29.05, 0.41% v 0.03% (n=176 v 12)) and cervical dilatation (2.68, 2.41 to 2.97, 4.01% v 1.58% (n=1735 v 668)) compared with women in the biopsy cohort. No significant differences were observed for the other outcomes when adjusting for baseline covariates (such as age and region of residence). Cervical suturing after bleeding was associated with a substantial increase in the risk of stenosis and cervical dilatation.ConclusionThis study found higher rates of complications within 30 days of conisation than previous studies with comparable outcome definitions, and a substantially increased risk of stenosis and cervical dilatation for women who had cervical suturing to treat bleeding after conisation. However, these results were based on few events in a small subgroup, and are therefore associated with major uncertainty. This study supports previous findings that conisation does not generally increase rates of infertility treatment or infertility diagnoses.
Categories: Medical Journal News
Investigation shows how private equity firms have “infected” US healthcare system, says senator
Private equity’s ownership of US hospitals has led to patient suffering, understaffing, reduced care quality, and health and safety violations, while investors have earned millions, a year long Senate Budget Committee investigation has found.1The bipartisan committee looked at more than a million pages of documents, including emails, board meeting minutes, financial reports, spreadsheets, and loan agreements, relating to two major private equity firms, Apollo Global Management and Leonard Green & Partners.Through studying these documents the committee “uncovered troubling patterns of prioritising profits over patients and of unfulfilled promises.” It identified “systemic issues” such as underinvestment in critical hospital infrastructure and the “pursuit of financial gains through leveraged buyouts and dividend extractions—often to the detriment of patients and hospital operations.”Apollo owns around 220 hospitals through the rural hospital operator Lifepoint Health and a second operator ScionHealth, and Leonard Green & Partners held a majority stake in Prospect Medical Holdings from 2010...
Categories: Medical Journal News
Survival with Trastuzumab Emtansine in Residual HER2-Positive Breast Cancer
New England Journal of Medicine, Volume 392, Issue 3, Page 249-257, January 16, 2025.
Categories: Medical Journal News
Fracture Prevention with Infrequent Zoledronate in Women 50 to 60 Years of Age
New England Journal of Medicine, Volume 392, Issue 3, Page 239-248, January 16, 2025.
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Challenges to the Future of a Robust Physician Workforce in the United States
New England Journal of Medicine, Volume 392, Issue 3, Page 286-295, January 16, 2025.
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KRAS Oncoprotein Signaling in Cancer
New England Journal of Medicine, Volume 392, Issue 3, Page 296-298, January 16, 2025.
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Identification and Treatment of Alcohol Use Disorder
New England Journal of Medicine, Volume 392, Issue 3, Page 258-266, January 16, 2025.
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Finerenone in Heart Failure with Preserved Ejection Fraction
New England Journal of Medicine, Volume 392, Issue 3, Page 308-310, January 16, 2025.
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Inavolisib Therapy in Advanced Breast Cancer
New England Journal of Medicine, Volume 392, Issue 3, Page 310-311, January 16, 2025.
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Burnout, Depression, and Diminished Well-Being among Physicians
New England Journal of Medicine, Volume 392, Issue 3, Page 311-312, January 16, 2025.
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Influenza Vaccination Strategies in Patients with Hematologic Cancer
New England Journal of Medicine, Volume 392, Issue 3, Page 306-308, January 16, 2025.
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Infrequent Zoledronate — Small Individual Gain, Larger Population Gain
New England Journal of Medicine, Volume 392, Issue 3, Page 281-283, January 16, 2025.
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APOL1 Kidney Disease Variants — Information from West Africa at Last
New England Journal of Medicine, Volume 392, Issue 3, Page 279-281, January 16, 2025.
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Asymptomatic Severe Aortic-Valve Stenosis — To Wait or Not to Wait
New England Journal of Medicine, Volume 392, Issue 3, Page 278-279, January 16, 2025.
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Livedo Racemosa
New England Journal of Medicine, Volume 392, Issue 3, Page 267-267, January 16, 2025.
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Case 2-2025: A 21-Year-Old Man with Loss of Consciousness and a Fall
New England Journal of Medicine, Volume 392, Issue 3, Page 268-276, January 16, 2025.
Categories: Medical Journal News
Sex, Gender, and Sexuality in the Journal
New England Journal of Medicine, Volume 392, Issue 3, January 16, 2025.
Categories: Medical Journal News