Medical Journal News

Cytisine, a pill that reduces cravings for nicotine, should be considered as a treatment option to help people stop smoking, the National Institute for Health and Care Excellence has proposed.1 NICE is consulting on a change to the current guidance after new evidence showed that people who took cytisine were 30% more likely not to smoke for six months or longer than those taking a placebo or no medication.Cytisine, also known as cytisinicline, was approved by the Medicines and Healthcare Products Regulatory Agency (MHRA) in 2019 but has been available in the UK only since January 2024. It has been used widely in eastern Europe since the 1970s.The drug works in a similar way to varenicline, by reducing the urge to smoke by attaching to some of the same neuronal receptors in the brain that nicotine does.In July 2021 varenicline (marketed as Champix) was removed from the market as a...

Women with serious gynaecological conditions are being forced to wait months or years for specialist care because of lack of capacity in the system, clinicians have warned.An “urgent” package of care or support is now needed, with a commitment to long term, sustained funding, the Royal College of Obstetricians and Gynaecologists (RCOG) said. Since 2022 an already expanding waiting list has grown by a third. Waiting lists across the UK now number almost 764 000 women—enough to fill Wembley stadium more than eight times over, a detailed RCOG report said.1In England, almost half of the 593 000 women referred for treatment have now been waiting more than 18 weeks for care, a 482% increase since before the pandemic, the report noted. More than 27 000 women in England have been waiting for more than a year. The other UK nations have reported similar trends, with patients in deprived areas faring...

The number of serious antibiotic resistant infections in England rose to an estimated 66 730 in 2023, up 7% from 62 314 in 2019 and an increase of 14.6% from the 58 224 identified in 2022, show figures from the UK Health Security Agency (UKHSA).1The figures signal a return to levels of activity in antibiotic resistant bacterial infections seen before the covid pandemic, after a dip to 55 792 in 2021.2Antibiotic use also rose in 2023 to 17.6 daily defined doses per 1000 inhabitants each day, a 2.4% rise on the 2022 figure. The rise was seen in all primary and secondary care settings except dental practices, and prescribing levels are now in line with those seen in 2019. The increases were across the majority of antibiotic groups, with penicillins accounting for the most frequently prescribed antibiotic group in primary and secondary care. In 2023 antibiotic consumption continued to be...

Katie Bramall-Stainer’s name was misspelt in this editorial (BMJ 2024;387:q2494; doi:10.1136/bmj.q2494). The online version has been updated.

Up to 80% of women experience vasomotor symptoms, including hot flushes and night sweats, during menopausal transition.1234567 These symptoms can persist for years before and after menopause, substantially impacting quality of life by impairing sleep, mood, and cognitive functioning.23456789101112 Approximately 32-46% of women describe their vasomotor symptoms as moderate to severe and would warrant treatment; studies suggest that the median total length of vasomotor symptoms is 7.4 years.4569 An effective treatment of vasomotor symptoms is hormonal therapy, but this treatment is not appropriate for everyone and only about 10% of women worldwide with vasomotor symptoms report using hormonal therapy.23561011131415 Contraindications to hormonal therapy and concerns for adverse effects with prolonged hormonal therapy use may contribute to its low use.2345679 Non-hormonal alternatives to manage vasomotor symptoms are available but these alternatives are generally considered less efficacious than hormonal therapy.6910111314 Furthermore, before 2023, paroxetine was the only non-hormonal treatment approved by the...

AbstractObjectivesTo assess the efficacy and safety of the non-hormonal, neurokinin 3 receptor antagonist, fezolinetant, to treat moderate-severe vasomotor symptoms associated with menopause in individuals unsuitable for hormone therapy.DesignPhase 3b randomised controlled trial.Setting16 countries.Participants453 individuals aged 40-65 years with moderate-severe vasomotor symptoms associated with menopause who were considered unsuitable candidates for hormone therapy (contraindicated, caution (based on medical history), stoppers (previous discontinuation of hormone therapy), or averse (informed choice not to use hormone therapy)) were randomised to receive fezolinetant (n=227) or placebo (n=226).InterventionFezolinetant 45 mg or placebo once daily for 24 weeks.Main outcome measuresThe primary endpoint was mean change in daily frequency of moderate-severe vasomotor symptoms from baseline to week 24. Secondary endpoints were mean change in symptom severity, sleep disturbance using the Patient-Reported Outcome Measurement Information System Sleep Disturbance Short Form (PROMIS SD-SF) 8b total score, and safety.Results370 (81.7%) participants completed the study (fezolinetant=195, placebo group=175). The safety and full analysis sets comprised 452 participants who received at least one dose of study drug. Mean age was 54.5 (standard deviation 4.7) years and most of the participants (435 (96.7%) were white and categorised as either hormone therapy averse (168 (37.2%)) or caution (165 (36.5%)). At week 24, fezolinetant significantly reduced the frequency (least squares mean difference –1.93, 95% confidence interval (CI) –2.64 to –1.22; P<0.001) and severity of vasomotor symptoms (–0.39, –0.57 to –0.21; P<0.001). At week 24, the fezolinetant group had a greater reduction in sleep disturbance (PROMIS SD-SF 8b total score) compared with placebo (–2.5, –3.9 to –1.1; P<0.001). Improvements over placebo were observed as early as week 1. Both groups showed similar incidences of treatment emergent adverse events (TEAEs, 147 (65.0%) in the fezolinetant group, 138 (61.1%) in the placebo group) and serious TEAEs (10 (4.4%) and 8 (3.5%), respectively). The most common TEAEs in the fezolinetant group were covid-19 (30 (13.3%)), headache (20 (8.8%)), and fatigue (13 (5.8%)).ConclusionsFezolinetant was efficacious and well tolerated over a six month period for treating moderate-severe vasomotor symptoms in individuals considered unsuitable for hormone therapy. These results highlight the utility of fezolinetant as an effective treatment option for those who have contraindications to or choose not to use hormone therapy.Trial registrationClinicalTrials.gov NCT05033886; EudraCT 2021-001685-38.

Explore why you feel this wayKirsty Shires, salaried GP, GP appraiser, coach, and mentor, West Midlands, says, “For many of us, fitting in at work is important to our sense of self, identity, and belonging. When this is lacking, it can affect our confidence and ability to perform well—which in healthcare could affect patient care as well as our own wellbeing.“There could be many factors involved in that sense of fitting in, but if we notice this feeling then it is worth taking stock and exploring it. This might mean asking questions about the situation we find ourselves in, the organisation we’re working for, the people we’re working with, and, perhaps most pertinently, ourselves.“From my own experience of working in different organisations, and from listening to others who are having qualms about fitting in, the difficulty can arise from a mismatch between your own values and those of the wider...

bmj;387/nov18_5/q2532/FAF1faJean Carruthers, an ophthalmologist, came home from work one evening and told her dermatologist husband Alastair about a conversation she had had with a patient. As part of a clinical trial1 she was using botulinum toxin to treat patients with dystonia, an involuntary spasm of the eyelids. One of her patients had asked to be treated between her eyes. When Jean told the patient that she had not thought she was spasming there, the patient replied that she was not, but every time Jean injected her there, her frown lines disappeared.Alastair was intrigued and the couple, working in private practice in Canada, decided to see if botulinum toxin had the same effect on others. Their receptionist, Cathy Bickerton Swann, then aged 30, had deep frown lines and agreed to the experiment. Carruthers administered the injections and in a few days they had almost disappeared.The couple’s first peer reviewed study of...

New England Journal of Medicine, Ahead of Print.

The editorial on children’s right to oral health mentions that 514 million children have untreated carious lesions in their primary teeth.1 It emphasises the importance of upstream policies such as reducing sugar consumption but makes no mention of water fluoridation.As Niger Carter, chief executive officer of the Oral Health Foundation, said in a policy paper prepared for the Health and Care Bill in 2022: “We believe that water fluoridation is the single most effective public health measure there is for reducing oral health inequalities and tooth decay rates, especially amongst children.”2The British Fluoridation Society has been collecting evidence for years and finds that only 10% of water supplies in the UK are currently adequately fluoridated by natural or artificial means despite numerous reports of the effectiveness (including cost) of this measure.3Despite this low percentage, the National Institute for Health and Care Research funded data study of 6.4 million UK adults...

Mollet and colleagues call for a rights based approach to children’s oral health.1 There is an established link between poor oral health and lower socioeconomic status. Poor paediatric oral health is associated with education delay and increased morbidity in adulthood.2 Unfortunately, these associations are not new and have been known for at least 150 years.In 1905, James Kerr, a medical doctor, and Charles Edward Wallis, one of the earliest known dually qualified doctor-dentists, worked with the London County Council to establish the London School Dental Service to combat poor oral and dental health among schoolchildren.3 Meanwhile, legislation was enacted to ensure the provision of food with nutritional value (including fruits high in vitamin C essential for gum health) and mandatory check-ups for schoolchildren by clinical professionals.45The work of Kerr and Wallis highlights two things: the necessity of input from the state and the power of collaboration and allyship between clinical...

In 1994, the International Conference on Population and Development established a groundbreaking framework recognising reproductive rights as human rights.1 This framework prioritised people and human rights in development—rather than population control. Thirty years on, stark inequalities in sexual and reproductive health and rights persist across national, regional, and global levels. Poor access and restrictions on abortion are contributing to maternal mortality in Latin America and the Caribbean.In many contexts, women have limited autonomy and decision making power over their health, exacerbating poor health outcomes. Unsafe abortion is a serious public health problem and poses a particular risk to women’s health—especially in countries where abortion is clandestine and often dangerous. The impact of unsafe abortion is particularly severe in young, impoverished, and less educated women. Studies on clandestine abortions in places where abortion is highly restricted show that women with higher incomes have a greater chance of accessing safer abortion methods...

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Volume 391, Issue 20, Page 1936-1936, November 21, 2024.

New England Journal of Medicine, Volume 391, Issue 20, Page 1872-1875, November 21, 2024.

New England Journal of Medicine, Volume 391, Issue 20, Page 1868-1870, November 21, 2024.