Medical Journal News

New England Journal of Medicine, Volume 392, Issue 3, Page 310-311, January 16, 2025.

New England Journal of Medicine, Volume 392, Issue 3, Page 311-312, January 16, 2025.

New England Journal of Medicine, Volume 392, Issue 3, Page 306-308, January 16, 2025.

New England Journal of Medicine, Volume 392, Issue 3, Page 281-283, January 16, 2025.

New England Journal of Medicine, Volume 392, Issue 3, Page 279-281, January 16, 2025.

New England Journal of Medicine, Volume 392, Issue 3, Page 278-279, January 16, 2025.

New England Journal of Medicine, Volume 392, Issue 3, Page 267-267, January 16, 2025.

New England Journal of Medicine, Volume 392, Issue 3, Page 268-276, January 16, 2025.

New England Journal of Medicine, Volume 392, Issue 3, January 16, 2025.

New England Journal of Medicine, Volume 392, Issue 3, January 16, 2025.

New England Journal of Medicine, Ahead of Print.

A controversial scheme in which midwives paid by a leading formula milk company have been providing infant feeding advice to new parents has been axed after an outcry.The initiative, hosted by the supermarket giant Tesco and revealed by The BMJ last week,1 drew criticism for its parallels to disgraced activities by formula milk companies that took place many decades ago.Midwives hired by Danone, which owns the UK’s leading formula brand, were being paid nearly double NHS rates to work at Tesco offering infant feeding advice. The service breached the International Code of Marketing of Breast-Milk Substitutes, established by WHO and Unicef, which clearly advises against marketing personnel seeking direct or indirect contact with pregnant women or mothers. As the midwives were working for Danone they are seen as marketing personnel.Tesco originally said it intended to continue the pilot in its flagship Hertfordshire store and roll out the service to two...

In recent years, the NHS has faced numerous drug shortages, with serious consequences for both patients and healthcare professionals.12 These ongoing shortages have affected a wide range of drugs, including antibiotics, diabetes medicines, ADHD medications and hormone replacement therapy.34 As the NHS grapples with drug scarcity, it is necessary to understand the causes and prioritise solutions to tackle this recurrent problem.Medicine shortages doubled between 2022 and 2024, with 101 drug supply disruption notifications in February 2024 compared to 52 in the same month in 2022.567 In 2023, healthcare providers received an average of 137 monthly notifications about supply disruptions, signalling a worsening crisis which is affecting patient care.7The current drug shortages in the UK arise from global and local factors.2 Disruptions in worldwide supply chains—triggered by events such as the covid-19 pandemic, the Ukraine war and increased energy costs—have impacted the manufacturing and transport of essential pharmaceutical ingredients.8 Manufacturing problems...

The current approach to global vaccine research and development (R&D), manufacturing, and distribution has greatly expanded routine immunisation, achieving substantial reductions in disease burden over recent decades and helping to save lives and protect economies. Yet this approach has limitations in a world where new pathogens emerge unpredictably and regional needs are increasingly diverging from global priorities.1

The UK's COVID-19 Inquiry is undertaking the biggest public engagement exercise in a public inquiry, hearing from more than 53 000 people. Jacqui Thornton reports.

A 44 year old man with epilepsy who died following a fall had been left without his anti-epileptic medication carbamazepine (Tegretol) after his pharmacy could not supply the drug, a prevention of future deaths report has said.1The coroner’s report was addressed to both the Midway Pharmacy, Pudsey, and the General Pharmaceutical Council (GPC). It said that David Joseph Crompton had not received his medication twice last year, first for 10 days in April and then again in December, when his pharmacy left him an “IOU” for Tegretol when delivering his other medications to his home.According to the report, Crompton and his family were then left to “contact other pharmacies to see if they could obtain it.”The coroner said, “Without his medication his epileptic condition was likely to destabilise and give rise to fits. His falls both in April and December 2024 occurred when he was left without his essential medication....

by Raphaele Houlbracq, Camille Le Ray, Béatrice Blondel, Nathalie Lelong, Anne Alice Chantry, Thomas Desplanches, ENP2021 Study Group

Background

The French guidelines have recommended a restrictive policy of episiotomy since 2005. We aimed to assess variations in the prevalence of both episiotomy and obstetric anal sphincter injury (OASI) from the 2010, 2016, and 2021 National Perinatal Surveys.

Methods and findings

A total of 29,750 women who had given birth to a live infant by vaginal delivery were included. For instance, in 2021, 22.3% of women were over 35 years old, 17.7% were born outside of France, 11.3% had a body mass index (BMI) of 30 kg/m2 or higher, and 39.9% were primiparous. Episiotomy and OASI (third- and fourth-degree tears) were identified from medical records. We described the overall prevalence of outcomes, and then by obstetrical clinical contexts using a seven-group obstetric classification of women. Variations between 2010 (reference), 2016, and 2021 were analyzed by Cochran–Armitage tests and using Poisson regression models adjusted for maternal age, BMI, country of birth, antenatal classes, suspicion of fetal macrosomia, and neuroaxial analgesia during labor, the professional who attended the birth, the annual number of deliveries, and the maternity unit status to account for changes in women’s characteristics and obstetric practices.The overall prevalence of episiotomy decreased significantly from 25.8% (95% confidence interval (CI) 25.0 to 26.7) in 2010, to 20.1% (95% CI 19.3 to 20.9) in 2016, and 8.3% (95% CI 7.8 to 8.9) in 2021 (adjusted risk ratio (aRR) 0.33, 95% CI 0.30 to 0.35). This reduction was observed in all groups of the classification (Cochran–Armitage tests P < 0.001), ranging from −33.0% in Group 2a [nulliparous term cephalic singleton with forceps delivery] to −94.0% in Group 7 [multiple pregnancy]. The difference in overall prevalence of OASI between 2010 (0.7%) and 2021 (1.0%) was not statistically significant after adjustment (aRR 1.24, 95% CI 0.91 to 1.68). By groups of classification, the prevalence of OASI increased significantly only in Group 2b [nulliparous term cephalic singleton with spatula delivery] from 2.6% (95% CI 1.2 to 5.6) in 2010 to 9.6% (95% CI 6.2 to 14.7) in 2021 (aRR 3.69, 95% CI 1.50 to 9.09), and did not differ statistically significantly in Group 2a [nulliparous term cephalic singleton with forceps delivery] from 3.2% (95% CI 1.8 to 5.7) in 2010 to 5.7% (95% CI 3.4 to 9.5) in 2021 (aRR 1.78, 95% CI 0.81 to 3.90).The main limitations of this study include the failure to take into account some potential confounding factors and the inability to analyze some groups of the studied population (8.5% of the sample) because of the very small number of events in these groups.

Conclusions

The significant overall reduction in the prevalence of episiotomy in France has not been followed by an overall increase in OASI. However, subgroup analyses revealed a significant rise in OASI among nulliparous women giving birth by spatula (Group 2b), and a clinically relevant but statistically nonsignificant rise among nulliparous women delivering by forceps (Group 2a), while the prevalence of episiotomy significantly decreased. These results should be interpreted with caution given the low prevalence of OASI in some subgroups. Further research is needed to predict the optimal rate of episiotomy for instrumental deliveries. In hospitals with high episiotomy rates, our findings suggest that episiotomy could be safely reduced for spontaneous vaginal deliveries to comply with international guidelines and women’s requests.

New roles in healthcare provision, such as physician associates (PAs), have been introduced too quickly and without proper preparation, a review has found.The review of new staff roles in the NHS in England,1 carried out by the health think tank the Nuffield Trust, found that too often they had been introduced before agreement on issues such as regulation, training, supervision, and communication.The study, commissioned by NHS Employers, looked at the history of how different roles have been introduced, how the mix of staff skills in the NHS compares with other countries, and what needs to be tackled if the government’s plans to expand the workforce and invest in new roles are to succeed.The NHS has a long history of introducing new roles, said the authors—recently including PAs, nursing associates, and advanced nurse practitioners to tackle staff shortages, financial constraints, and changing health needs.The report drew on published data throughout England...

An employment tribunal has ordered an NHS trust to pay just over £100 000 to a trauma surgeon with post-traumatic stress disorder (PTSD) after deciding that he was unfairly dismissed.1The Cambridge tribunal found a “wholesale failure” by East and North Hertfordshire NHS Trust to follow its own illness policy when it decided to dismiss Vladimir Filipovich, who worked at the Lister Hospital in Stevenage, at the age of 60.Filipovich, who represented himself at the tribunal, had worked for the trust for nearly 20 years when he was sacked in July 2019. He had conducted over 25 000 operations without any deaths. Before coming to the UK he had been a trauma surgeon in the Bosnian war, exposed to severely injured and dying patients.He experienced an inability to concentrate, memory loss, exhaustion, and flashbacks. In November 2016 a psychiatrist made a preliminary diagnosis of PTSD.In January 2017 Filipovich turned up for...

Reports that a “mysterious” covid-like virus is overwhelming Chinese hospitals have made international headlines. Is human metapneumovirus (HMPV) a common winter bug that is following an expected seasonal outbreak pattern or something more serious?Could it be the next pandemic?That is extremely unlikely. HMPV is not a new virus like SARS-CoV-2 and has been circulating in its current form for decades.12 The Dutch researchers who first isolated it in 2001 found antibodies in almost all of the children they tested aged 5 and older.3Unlike respiratory syncytial virus (RSV), from which it is almost clinically indistinguishable, there is no vaccine against HMPV. But patients usually recover after a few days of mild illness. Immune treatment and antivirals are occasionally used, but bed rest and fluids are the primary treatment.HMPV can be more serious in infants, elderly people, and people who are immunocompromised, who may develop bronchiolitis or pneumonia. It kills at about...