BMJ - British Medical Journal

Davis and colleagues highlight the critical need for clearer and more accessible information about medicines for patients.1 As an anaesthetist, I often encounter challenges in communicating the risks and benefits of perioperative drugs, particularly as we cannot always predict every medication that might be required during an operation.A key example is sugammadex, a neuromuscular blockade reversal agent that can reduce the efficacy of hormonal contraceptives by binding to steroidal molecules, thus increasing the risk of unintended pregnancy. Patients must be advised to use alternative contraceptive measures for up to seven days after its administration. Such vital information is often overlooked, however, creating a potential gap in patient understanding. This emphasises the need for accessible drug information that can be easily conveyed in time critical scenarios.The unpredictability of anaesthetic practice further complicates the consent process. It is often not possible to foresee every medication that might be given during surgery, such...

Preliminary laboratory findings suggest that a mystery illness in the Democratic Republic of the Congo is a combination of common and seasonal viral respiratory infections and malaria, the World Health Organization (WHO) has said.1WHO described the previously undiagnosed disease as “acute respiratory infections complicated by malaria,” which had led to an increase in severe infections and death when compounded by acute malnutrition.A broad surveillance case definition was established in absence of a diagnosis, which included patients who presented with fever, cough, body weakness, and runny nose. Other signs and symptoms may include chills, headache, difficulty breathing, malnutrition, and body aches.From 24 October to 16 December a total of 891 cases and 48 deaths from the Panzi health zone in the Kwango province met the case definition. More cases occurred in females (58%), especially adults (66%). The disease disproportionately affected children under 5 years old, who made up 47% of all...

The last major hospital in northern Gaza is now out of commission after a raid by Israeli forces left its surgical unit, medical store, and laboratory “burnt and severely damaged.” Staff and critically ill patients have been forced to leave, and the hospital’s director, Hussam Abu Safiya, has been detained.The World Health Organization (WHO) said that it was “appalled” by the raid, which “put the last major health facility in North Gaza out of service,” and was “deeply concerned” for the patients moved to a hospital that cannot care for them, as well as for Abu Safiya. “Kamal Adwan is now empty,” said WHO. “Some people were reportedly stripped and forced to walk toward southern Gaza.”Since early October WHO has confirmed at least 50 attacks on healthcare that took place on or around the hospital. It said, “Attacks on the hospitals and on health workers have occurred almost daily. This...

Davis and colleagues share their concern about the lack of accessible information on both the magnitude and nature of the benefits of new drugs.1 Without such information, it is impossible for patients, or clinicians, to balance the benefits against the adverse effects of the medicine and so arrive at an informed choice.I have been an independent adviser for the UK medicines regulator, the Medicines and Healthcare Products Regulatory Agency, for 40 years and have for many years urged the agency to explore ways of filling this astonishing gap. Almost insurmountable problems exist in two forms: current information for patients is almost entirely with the manufacturers, who would have to be persuaded to invest in the initiative, and many of the clinical rating scales used in the pivotal clinical trials cannot readily be translated into language that means much to patients. These are huge problems, but as the article points out,...

AbstractObjectiveTo identify clusters of women with similar trajectories of breast density change over four longitudinal assessments and to examine the association between these trajectories and the subsequent risk of breast cancer.DesignRetrospective cohort study.SettingData from the national breast cancer screening programme, which is embedded in the National Health Insurance Service database in Korea. Breast density was assessed using the four category Breast Imaging Reporting and Data System (BI-RADS) classification. Group based trajectory modelling was performed to identify the trajectories of breast density.ParticipantsWomen aged ≥40 years who underwent four biennial mammographic screenings between 2009 and 2016.Main outcome measuresBreast cancer development was determined to 31 December 2021. Cox proportional hazard models were used to assess the associations between trajectories and breast cancer outcomes after adjusting for covariates.ResultsAmong a cohort of 1 747 507 women (mean age 61.4 years), five breast density trajectory groups were identified. Group 1 included women with persistently fatty breast tissue, group 2 included women with fatty breast tissue at baseline but increased breast density over time, and groups 3-5 included women with denser breasts, with a slight decrease in density over time. Women in group 2 had a 1.60-fold (95% confidence interval 1.49 to 1.72) increased risk of breast cancer compared with those in group 1. Women in groups 3-5 had higher risks compared with those in group 1, with adjusted hazard ratios of 1.86 (1.74 to 1.98), 2.49 (2.33 to 2.65), and 3.07 (2.87 to 3.28), respectively. Similar results were observed across different age groups, regardless of changes in menopausal status or body mass index.ConclusionsThis study identified five distinct groups of women with similar trajectories of breast density change over time. Future risk of breast cancer was found to vary in these groups. Increasingly dense or persistently dense breasts were associated with a higher risk. Changes in breast density over time should be carefully considered during breast cancer risk stratification and incorporated into future risk models.

AbstractObjectiveTo compare the effectiveness and safety of budesonide-glycopyrrolate-formoterol, a twice daily metered dose inhaler, and fluticasone-umeclidinium-vilanterol, a once daily dry powder inhaler, in patients with chronic obstructive pulmonary disease (COPD) treated in routine clinical practice.DesignNew user cohort study.SettingLongitudinal commercial US claims data.ParticipantsNew initiators of budesonide-glycopyrrolate-formoterol or fluticasone-umeclidinium-vilanterol between 1 January 2021 and 30 September 2023 who had a diagnosis of COPD and were aged 40 years or older.Main outcome measuresIn this 1:1 propensity score matched study, the main outcome measures were first moderate or severe COPD exacerbation (effectiveness) and first admission to hospital with pneumonia (safety) while on treatment. Potential confounders were measured in the 365 days before cohort entry and included in propensity scores. Hazard ratios and 95% confidence intervals (CIs) were estimated using a Cox proportional hazards regression model.ResultsThe study cohort included 20 388 propensity score matched pairs of new users initiating single inhaler triple therapy. Patients who received budesonide-glycopyrrolate-formoterol had a 9% higher incidence of first moderate or severe COPD exacerbation (hazard ratio 1.09 (95% CI 1.04 to 1.14); number needed to harm 38) compared with patients receiving fluticasone-umeclidinium-vilanterol and an identical incidence of first admission to hospital with pneumonia (1.00 (0.91 to 1.10)). The hazard of first moderate COPD exacerbation was 7% higher (1.07 (1.02 to 1.12); number needed to harm 54) and the hazard of first severe COPD exacerbation 29% higher (1.29 (1.12 to 1.48); number needed to harm 97) among those receiving budesonide-glycopyrrolate-formoterol compared to fluticasone-umeclidinium-vilanterol. Prespecified sensitivity analyses yielded similar findings to the primary analysis.ConclusionsBudesonide-glycopyrrolate-formoterol was not associated with improved clinical outcomes compared with fluticasone-umeclidinium-vilanterol. Given the added climate impact of metered dose inhalers, health systems seeking to decrease use of these products may consider steps to promote further prescribing of fluticasone-umeclidinium-vilanterol compared with budesonide-glycopyrrolate-formoterol in people with COPD.Study registrationCenter for Open Science Real World Evidence Registry (https://osf.io/6gdyp/).

The incoming US administration has signalled its intent to make large changes to the federal government’s approach to medicine and public health. With Republicans holding control of both houses of Congress and a conservative Supreme Court, the potential for change is high if the administration can address internal disagreements.Much of that change is likely to centre on health insurance coverage, which for most Americans is provided through Medicaid (the federal and state programme for people on low incomes), Medicare (for people over 65 and those with disabilities), or private insurance, obtained either through employers or through the public marketplaces (exchanges) created under the Affordable Care Act (ACA).Most policies available through Medicaid, Medicare, and ACA exchanges are decided at federal level, but healthcare is mostly administered by states. This means health outcomes may largely depend on how individual states can adjust to likely changes in federal policy or funding.Policy challengesMedicare, Medicaid,...