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Mashup Score: 3Confusion over emergency pregnancy care is endangering patients: Trump’s actions on EMTALA deepen the problem - 11 hour(s) ago
Trump’s withdrawal of guidance on emergency care has created confusion that will have life and death consequences for patients, say Greer Donley and Kimberly Chernoby Earlier this month, President Trump’s administration rescinded guidance that clarified US hospitals’ legal obligation to provide emergency care to pregnant patients, even in states with strict abortion bans.1 Although expected, this action has led to tremendous confusion about the legality of medically necessary abortions in an already uncertain environment. In 2022, the Supreme Court over-ruled Roe v Wade, the case that first recognised a constitutional right to abortion in the United States. One month later, the Department of Health and Human Services, under President Biden, issued guidance stating that the Emergency Medical Treatment and Active Labour Act (EMTALA), a federal law requiring hospitals to stabilise people with emergency medical conditions, applied to pregnancy related emergencies and included abortion as a
Source: www.bmj.comCategories: General Medicine NewsTweet
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Mashup Score: 38Ticagrelor doubts: inaccuracies uncovered in key studies for AstraZeneca’s billion dollar drug - 13 hour(s) ago
As generic versions of AstraZeneca’s blockbuster drug ticagrelor prepare to enter the market, The BMJ raises fresh concerns over the integrity of the clinical trials that underpinned its approval. Peter Doshi reports ### What we found The multibillion dollar heart drug ticagrelor (Brilinta, Brilique) goes generic this year. Last December, a BMJ investigation found serious data integrity problems in the landmark 18 000 patient PLATO study,1 calling into question the drug’s advantage over cheaper rivals. In this article, The BMJ has expanded its investigation, looking at two key platelet studies that AstraZeneca claimed explained ticagrelor’s ability to treat patients with acute coronary syndrome successfully. We found evidence of serious misreporting, however, raising doubts over the approval and decade long use of ticagrelor. We found: For more than a decade, the multibillion dollar drug ticagrelor (Brilinta in the US and Brilique in Europe) has been recommended in the treatment of pat
Source: www.bmj.comCategories: General Medicine NewsTweet
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Mashup Score: 14
Objective To review evidence from randomised trials assessing the effectiveness of strategies to deprescribe benzodiazepines and closely related sedative hypnotics (BSH). Design Systematic review and meta-analysis of randomised controlled trials. Data sources MEDLINE, Embase, CINAHL, PsycInfo, and CENTRAL, searched from inception to August 2024, and reference lists of included studies and similar systematic reviews. Eligibility criteria for selecting studies Eligible studies randomised adults using BSH for insomnia to interventions aimed at deprescribing BSH, strategies to implement these interventions in healthcare settings, or usual care or placebo. Methods Reviewers worked independently and in duplicate to screen search results, extract data, and assess risk of bias. Similar interventions were grouped together, frequentist random effects meta-analysis was conducted, and the certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Ev
Source: www.bmj.comCategories: General Medicine NewsTweet
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Mashup Score: 14The spending review and the NHS - 17 hour(s) ago
The NHS must reduce demand for healthcare with spending increases nearing their limits News reports that the NHS is one of the main beneficiaries of the spending review conceal some inconvenient truths. The uplift in budgets of around 3 per cent a year is welcome, but below the long term average of 3.6 per cent a year. It also requires the NHS to deliver implausible productivity improvements of 2 per cent a year. These improvements depend in part on investment in new buildings and technology which will be constrained by the government’s decision to hold capital funding flat.1 Over much of the period since the second world war, increases in public spending on health have been possible in part because spending on defence and on funding the national debt have fallen. With debt now at the highest level since the early 1960s and defence spending rising in the face of global insecurities, more of the same is no longer possible. The …
Source: www.bmj.comCategories: General Medicine NewsTweet
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Mashup Score: 14Head injury in older people taking anticoagulants - 19 hour(s) ago
### What you need to know A 73 year old man is brought to the emergency department following a ground level fall a few hours earlier. His physiological observations are normal, but he cannot remember any events for an hour preceding the fall. Examination reveals an occipital scalp haematoma, but no focal neurological deficit. His Glasgow coma scale (GCS) score is 15. His has a history of atrial fibrillation and hypertension, for which he currently takes apixaban at therapeutic dose and several antihypertensives. His renal function was normal on recent blood tests. His partner reports that he took his morning medications as usual, prior to the fall. He undergoes whole body CT imaging, which shows a thin right sided subdural haematoma, occipital skull fracture, and frontal lobe contusion. The report also describes four uncomplicated right sided rib fractures, with no evidence of haemothorax. When trauma to the head results in a disturbance of normal brain function, the resulting conditio
Source: www.bmj.comCategories: General Medicine NewsTweet
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Mashup Score: 38Women bear a disproportionate burden of war - 22 hour(s) ago
Unseen toll of conflicts on sexual and reproductive health and rights Women bear a disproportionate and often overlooked burden of war. In today’s conflict zones, women are not only deliberately targeted through gender based violence but also suffer intensely from the collapse of vital systems that support their health and wellbeing. The consequences for their sexual and reproductive health and rights (SRHR) are catastrophic yet routinely sidelined in humanitarian responses. The complexities of different types of conflicts demand nuanced attention to the layered ways in which war devastates women’s bodies, autonomy, and futures. The most visible manifestations of conflict on SRHR include, for instance, maternal deaths, attacks on health facilities, and the deliberate use of sexual violence as tactics of war. In Gaza over 55 000 pregnant women face urgent need for maternal healthcare, hundreds give birth each day in shelters or unsafe conditions, and neonatal and maternal deaths are cli
Source: www.bmj.comCategories: General Medicine NewsTweet
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Mashup Score: 19“One mistake could cost you everything”: five lessons from teaching clinicians in trouble - 23 hour(s) ago
For the past five years I’ve taught medical ethics to clinicians who are facing disciplinary action. Some are under investigation by their employer or regulator, others are suspended, and a few have been struck off but seek to be restored to the register. Their names may appear in public tribunal decisions or in the press. Their careers and reputation hang in the balance. The teaching is no academic exercise but is an urgent, high stakes effort in moral repair and ethical reflection. Through the Centre for Remedial Ethics, I run bespoke one-to-one courses. After reviewing the case files I meet the clinicians for a day of reflection and analysis. Together we try to make sense of what went wrong, work to understand all the ways in which the conduct was wrong, and discuss how to avoid repeating it. From hundreds of such encounters, I’ve derived five key lessons. They’re worth sharing with clinicians who still have the chance to learn these lessons painlessly. Disheartening …
Source: www.bmj.comCategories: General Medicine NewsTweet
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Mashup Score: 7
The US Supreme Court has ruled that the state of Tennessee can continue to ban transgender care for young people. Although Tennessee is the only state to have brought the issue to court, the ruling sets a precedent that will allow 26 other US states to continue to ban transgender care.12 The 18 June ruling—with a vote that came in 6-3 in favour of Tennessee—affects more than half of the USA’s 50 states and about 40% of transgender young people. Reflecting political division in the US, the states banning transgender care are mostly Republican and most also …
Source: www.bmj.comCategories: General Medicine NewsTweet
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Mashup Score: 13Addictive symptoms more important than time spent on phone in predicting suicidal thoughts in young people, study finds - 1 day(s) ago
Children who develop addictive use of digital technology have up to twice the risk of developing suicidal behaviour within four years compared with those who may spend longer on their phones but don’t develop addictive behaviour, a study has found.1 The research involved regular screening over four years for addictive symptoms, including compulsive use, difficulty in disengaging, and distress when not given access, of 4285 US adolescents who were 10 years old at the start of the study. It is the first to “show that addictive screen use, not total screen time, is linked to suicidal ideation and behaviour and mental health problems in US teens,” said lead author Yunyu Xiao, an assistant professor of psychiatry and population health sciences at Weill Cornell Medical School. The results, published in JAMA , showed that nearly a third of participants had an increasingly addictive use trajectory for social media or mobile phones, which started at age 11. More than four out of 10 (41%) experi
Source: www.bmj.comCategories: General Medicine NewsTweet
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Mashup Score: 6
The price of prescription drugs is too high. This is a global problem on which we can agree with Donald Trump. This week the UK’s National Institute for Health and Care Excellence (NICE) refused to recommend two new drugs for Alzheimer’s disease for use in the NHS (doi:10.1136/bmj.r1270).1 The decision may seem unfair to people seeking fresh treatment options, but NICE’s job is to ration the rollout of new technologies, which is especially important given that we’re digging at the bottom of the national money pit. NICE, an internationally respected organisation for evaluating new technologies, considers both clinical effectiveness and value for money. It has decided that donanemab and lecanemab “do not demonstrate sufficient benefit for their high cost.” Inevitably, such judgments anger drug companies seeking to profit from it, patient groups advocating for availability of breakthrough medicines, and patients …
Source: www.bmj.comCategories: General Medicine NewsTweet
"Trump and the Republican party appears more willing to watch women die than to undermine the most draconian state abortion bans." Greer Donley and Kimberly Chernoby look at how Trump’s withdrawal of guidance on emergency care has created confusion https://t.co/XBgN2trtTA