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Mashup Score: 7
Objectives To evaluate the clinical effectiveness of long acting progestogens compared with the combined oral contraceptive pill in preventing recurrence of endometriosis related pain. Design The PRE-EMPT (preventing recurrence of endometriosis) pragmatic, parallel group, open label, randomised controlled trial. Setting 34 UK hospitals. Participants 405 women of reproductive age undergoing conservative surgery for endometriosis. Interventions Participants were randomised in a 1:1 ratio using a secure internet facility to a long acting progestogen (depot medroxyprogesterone acetate or levonorgestrel releasing intrauterine system) or the combined oral contraceptive pill. Main outcome measures The primary outcome was pain measured three years after randomisation using the pain domain of the Endometriosis Health Profile 30 (EHP-30) questionnaire. Secondary outcomes (evaluated at six months, one, two, and three years) included the four core and six modular domains of the EHP-30, and treatme
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Mashup Score: 4Mental health: MPs condemn overreliance on pills - 14 hour(s) ago
A group of MPs have called for a radical overhaul of the way poor mental health is managed in the UK to move away from its “overreliance on psychiatric drugs.” The Beyond Pills All Party Parliamentary Group (APPG) says there needs to be a paradigm shift away from “the traditional biomedical model” towards a more holistic approach that tackles the social, economic, and psychological determinants of mental health. In a report1 they point to the impact on mental health of toxic relationships, abuse, and violence as well as the role of wider societal factors such as economic insecurity, poverty, poor housing, inadequate nutrition, and damaged communities. Despite …
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Mashup Score: 13Matt Morgan: Rekindling the NHS’s foundational flame - 16 hour(s) ago
One of the joys of writing this column is receiving emails from readers who work across a wide spectrum of medicine, from students to retired professors. I read one such email from a retired, fellow Cardiff alumnus in response to my last column discussing the new play Nye . After I’d watched the play at the National Theatre1—which dramatises the NHS’s origins through the eyes of Aneurin Bevan, former minister of health and architect of the NHS—a quote from Mark Twain came to my mind: “History doesn’t repeat itself, but it often rhymes.” Bevan’s proposals for a universal healthcare system came at a time …
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Mashup Score: 35Helen Salisbury: Training our replacements - 17 hour(s) ago
Are there limits on what people should be allowed to do in the medical or surgical field when they’re not a doctor and not training to be one? We teach someone our skills so that they may one day exercise them independently, and almost from the moment we qualify as doctors we start training our replacements. The time available for this training is finite, so we should think carefully about how we spend those precious hours and who exactly will replace us. If a medical associate practitioner (anaesthesia associate, surgical care practitioner, or physician associate) should never …
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Mashup Score: 37
Objectives To replicate previous analyses on the effectiveness of the English human papillomavirus (HPV) vaccination programme on incidence of cervical cancer and grade 3 cervical intraepithelial neoplasia (CIN3) using 12 additional months of follow-up, and to investigate effectiveness across levels of socioeconomic deprivation. Design Observational study. Setting England, UK. Participants Women aged 20-64 years resident in England between January 2006 and June 2020 including 29 968 with a diagnosis of cervical cancer and 335 228 with a diagnosis of CIN3. In England, HPV vaccination was introduced nationally in 2008 and was offered routinely to girls aged 12-13 years, with catch-up campaigns during 2008-10 targeting older teenagers aged <19 years. Main outcome measures Incidence of invasive cervical cancer and CIN3. Results In England, 29 968 women aged 20-64 years received a diagnosis of cervical cancer and 335 228 a diagnosis of CIN3 between 1 January 2006 and 30 June 2020. In the bi
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Mashup Score: 2Continuous flow models in urgent and emergency care - 1 day(s) ago
An inadequate response to the deep problems within the NHS? Winter is not yet fully upon us and already emergency departments in the UK are struggling with unprecedented levels of overcrowding. Record numbers of patients are waiting for longer than 12 hours for an inpatient bed, with some spending days in the emergency department. Ambulances are unable to offload patients for want of space, impeding their ability to respond to the most urgent calls.1 So serious is the situation that it has been suggested as the main cause of the spike in excess non-covid deaths seen over the summer.2 One possible solution currently attracting interest is the continuous flow model, first introduced in North America in the late 1990s.3 Also known as full capacity protocols, these effectively mandate that a set number of patients are moved at set times from the emergency department to inpatient wards, regardless of whether a bed is available. This might mean putting an extra patient in a bay or two patien
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Mashup Score: 23
Patients are often the beneficiaries of medicine, but they can be its victims too. Most people in the western world are likely to know by their 60s that they have at least one chronic condition or risk factor, if not several. As they age further the number of these will almost certainly increase, along with regular check-ups, investigations, and an escalating amount of treatment. Some of the effects of this may be positive in terms of a person’s longevity and quality of life, although good nutrition, housing, education, and a decent income are likely to have been more important. Over time, however, their risks of harm will also become greater. These may include …
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Mashup Score: 19Cardiovascular toxicity of immune therapies for cancer - 1 day(s) ago
In addition to conventional chemoradiation and targeted cancer therapy, the use of immune based therapies, specifically immune checkpoint inhibitors (ICIs) and chimeric antigen receptor T cell therapy (CAR-T), has increased exponentially across a wide spectrum of cancers. This has been paralleled by recognition of off-target immune related adverse events that can affect almost any organ system including the cardiovascular system. The use of ICIs has been associated with myocarditis, a less common but highly fatal adverse effect, pericarditis and pericardial effusions, vasculitis, thromboembolism, and potentially accelerated atherosclerosis. CAR-T resulting in a systemic cytokine release syndrome has been associated with myriad cardiovascular consequences including arrhythmias, myocardial infarction, and heart failure. This review summarizes the current state of knowledge regarding adverse cardiovascular effects associated with ICIs and CAR-T.
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Mashup Score: 17
Naloxone, a drug used to reverse the effects of opioid overdose, is to be made more accessible across the UK, after the government announced plans to enable more services and individuals to provide take home supplies.1 Following a six week consultation earlier this year, the Department of Health and Social Care (DHSC) said …
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Mashup Score: 24What do we know about covid-19’s effects on the brain? - 1 day(s) ago
Katharine Lang investigates how SARS-CoV-2 infection can affect the brain, how it might have these effects, and what can be done to minimise the risk Covid may be primarily a respiratory infection, but a common symptom is “brain fog”—problems with memory or concentration—which can persist for weeks or months as part of long covid.1 And it’s not the only neurological effect. Giovanni Schifitto, professor of neurology at the University of Rochester Medical School in New York, explains that neurological symptoms are widespread. “In the acute phase, common things like lack of smell, changes in taste, increase in headaches, cognitive dysfunction, and strokes have been reported, and there are effects on the peripheral nervous system,” he says. Although these complications are more likely in people with severe covid—a 2021 study found that 80% of people admitted to hospital with covid-19 experienced neurological symptoms2—they can also affect people who experience only mild covid symptoms.3 T
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This new research in @bmj_latest evaluates the clinical effectiveness of long acting progestogens compared with the combined oral contraceptive pill in preventing recurrence of #endometriosis related pain https://t.co/qzF95KhMpo