Medical Journal News

New England Journal of Medicine, Volume 391, Issue 19, Page 1852-1859, November 14, 2024.

New England Journal of Medicine, Volume 391, Issue 19, November 14, 2024.

New England Journal of Medicine, Volume 391, Issue 19, November 14, 2024.

New England Journal of Medicine, Volume 391, Issue 19, Page 1838-1846, November 14, 2024.

New England Journal of Medicine, Volume 391, Issue 19, November 14, 2024.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

Reducing the risk of metastatic relapse in patients with resectable soft tissue sarcomas is crucial for improving outcomes, because metastasis is the primary cause of mortality in this population. Approximately 40% of patients with localised soft tissue sarcomas develop distant metastases, leading to poor long-term survival. Although chemotherapy has traditionally been used in this setting, its role remains contentious due to inconsistent benefits in overall survival.1,2

Addition of pembrolizumab to preoperative radiotherapy and surgery improves disease-free survival for patients with stage III undifferentiated pleomorphic sarcoma and pleomorphic or dedifferentiated liposarcoma of the extremity, which establishes a promising new treatment option for these patients.

At a recent clinical meeting, I heard that GPs local to me are about to lose the ability to request magnetic resonance imaging (MRI) scans for patients presenting with musculoskeletal symptoms. We’re instead advised to refer our patients to a musculoskeletal clinical assessment and triage service (CATS)—staffed largely by musculoskeletal advanced practitioners, who will assess our patients and determine whether imaging is warranted.The hope is that fewer patients will have unnecessary imaging and that this will reduce the potential harms of overdiagnosis. Radiologists rarely report musculoskeletal MRI scans as entirely normal, and it can be hard to know what to do with abnormal findings on an MRI. More often than not, patients with abnormal scans are referred to orthopaedic teams, even though there may not necessarily be a surgical target.At a population level, this is problematic on two fronts. Firstly, MRI scans are expensive and need to be used judiciously....

Concerns are mounting over whether the NHS can meet key performance targets this winter, NHS Providers has said, after a survey of trust leaders highlighted pressure on hospitals, ambulance services, and community and mental health teams.1Over nine in 10 of the leaders who responded (96%) said that they were extremely or moderately concerned about the effect of winter pressures on their trust and local area. The most common reasons for concerns related to financial constraints and staffing provision. The top three greatest risks to the provision of high quality patient care over winter were identified as delayed discharge (57%), social care capacity (49%), and acute care bed capacity (43%).NHS Providers surveyed 171 trust leaders from 118 trusts in September and October, accounting for 56% of the provider sector.Most trust leaders (79%) were worried or very worried about whether their trusts had capacity to meet demand for services over the next...

I’m often asked if I miss working in the House of Commons. Of course I do; it’s one of the most amazing places in the world and remains the cockpit of our nation.There are obviously days I miss it more than others, usually around the big national moments. Whatever your view of Kim Leadbeater’s private member’s bill—the Terminally Ill Adults (End of Life) Bill—its second reading this month will be one of those big moments.Kim is a friend of mine, and we spoke before she decided to put her bill forward after it topped the private members’ ballot at the start of the new parliament. My advice was to proceed with great care, to remember that this will take over your career in many ways, and to read the report produced earlier this year by the Health and Social Care Committee, which I chaired, on the subject of assisted dying/assisted...

The National Institute for Health and Care Excellence (NICE) has recommended that all women with suspected endometriosis be offered an early transvaginal ultrasound scan, even if the pelvic or abdominal examination is normal.In its updated guideline1 on the diagnosis and management of endometriosis, NICE recommends specialist ultrasound as an alternative to magnetic resonance imaging for investigating suspected cases of the condition in secondary care.The updated guideline follows recent reports from both the National Confidential Enquiry into Patient Outcome and Death2 and Endometriosis UK which highlighted problems with delayed diagnoses, partly owing to a lack of awareness among healthcare professionals of the condition and how it presents. Such delays can result in prolonged suffering, ill health, and risks to fertility, the reports warned.Other new and updated recommendations include asking women with suspected endometriosis if any first degree relatives have a history of the condition, and considering neurodiversity when taking into account...

bmj;387/nov12_10/q2481/FAF1faJulia and Malcolm Donaldsondonaldson20241111.f1Malcolm Donaldson was a distinguished paediatric endocrinologist with a string of research publications to his name—but he was also happy to play second fiddle (almost literally) to his wife Julia, the celebrated author of much loved children’s books, including The Gruffalo and Room on the Broom.Malcolm, a talented musician and performer, accompanied his wife as she toured festivals, schools, and libraries in the UK and around the world. Together they performed the stories, with Malcolm acting characters ranging from an accident prone dragon to a comic cattle thief. His star role, in the words of Julia’s literary agent, was “a particularly suave fox” in The Gruffalo.Malcolm met Julia Shields when they were students at the University of Bristol and they married in 1972. Donaldson went on to work in Brighton, London, and Lyon, France, before moving back to Bristol to be a senior registrar in paediatrics. Six...

Terminally ill adults in England and Wales who are expected to die within six months would be able to get help to end their lives if their applications were approved by two doctors and a High Court judge, under proposed new legislation.1Labour MP Kim Leadbeater, who proposed the bill, said it provided the “strictest safeguards anywhere in the world.” The law would apply only to people who have full mental capacity and are terminally ill. Mental illness and disability are both excluded as eligibility criteria, and a person would need to declare twice in writing that they wanted to be helped to die.A person who wished to end their life would have to administer the medication themselves. It will remain illegal for a doctor or anybody else to end a person’s life. No doctor will be obliged to participate in any part of the process.The bill would also make it...

Donald Trump did not win the 2020 election, but asserting that he did became a prerequisite for Republicans standing for nomination to Congress or the Senate to win their primaries. An entire party became a vehicle for disinformation.1 Trump did win the 2024 presidential election, and key to that victory was building on the success of that lie. If you control enough of the information ecosystem, truth no longer matters.Another telling example: Haitian migrants in Springfield, Ohio, are not eating cats and dogs. US vice president elect, JD Vance, the source of that claim, admitted as much even as he justified it. “If I have to create stories so that the American media actually pays attention to the suffering of the American people, then that’s what I'm going to do,” he said.2Disinformation in politics is nothing new. History is replete with claims that were fabricated to advance political aims. Although...

I agree with Mahase that many challenges exist in endometriosis diagnosis and management, but there has been some progress in this area.1As Mahase mentions, Australia launched the National Action Plan for Endometriosis in 2018.2 This pivotal report focused on three main areas: awareness and education; clinical management and care; and research. It was followed by a series of initiatives in the education sector, medical colleges, and research funding networks that have further strengthened capacity in endometriosis care. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, for example, used clinical evidence and expert recommendations to create the Clinical Practice Guidelines for the Diagnosis and Management of Endometriosis (published in 2021).3 The National Endometriosis Clinical and Scientific Trials Network registry was established in 2018, encouraging collaborative research between clinicians, allied healthcare providers, researchers, and endometriosis advocates.4 Although it will take time to see the fruits of these collaborative efforts,...

An employment judge has cleared the way for Farah Jameel, a former chair of the BMA’s General Practitioners Committee for England (GPCE), to go ahead with claims of discrimination and unfair dismissal against the association over her removal from the post during maternity leave.Jameel, who was elected the first female chair in November 2021, was put on temporary suspension in 2022 after complaints by BMA staff. The BMA told her in August 2023 that her contract was being terminated.The contract described her as a contractor providing consultancy services rather than an employee. But in a preliminary ruling the employment judge Natasha Joffe has held that Jameel was in reality an office holder and an employee, opening the way for her claims to proceed to a full hearing by an employment tribunal.The GPCE passed a vote of no confidence in Jameel in July 2023, as a means of electing a new...

A landmark sex and gender framework for research funders has been launched in the UK to ensure that researchers adequately account for sex and gender when designing studies and conduct more representative research.1The framework has been launched by the George Institute for Global Health’s Medical Science Sex and Gender Equity (Message) project, which is funded by the Wellcome Trust. The team has warned that failure to properly account for and recognise sex and gender differences in research has led to misdiagnoses and substandard or ineffective treatments, and has contributed to the sex and gender health gap.Last year 29 UK medical research organisations and publishers, including The BMJ, pledged their support for the introduction of dedicated policies on sex and gender in biomedical, health, and care research.2 These organisations have been working with the Message project team to co-design the framework over the past two years.Before this publication, the UK lagged...

As an older person living with diabetes, I am apprehensive about the current and future care of older people with diabetes in UK nursing and residential care homes. This is an area that has been neglected over the years.1 It worries me that I may have to rely on untrained carers who may not fully understand my personal diabetes management, especially use of diabetes technology. I fear my diabetes could be poorly managed and controlled because of staff members’ lack of knowledge. There is an urgent need to ensure safe, quality care for older people with diabetes in care homes and to improve carers’ skills in daily diabetes management and the use of diabetes technology.Over a third of the 5.6 million people with diabetes in the UK are over the age of 65.23It is likely that because of the complications of aging they may need to be cared for through...