The safety of antidepressants in pregnancy is controversial, partly because of profound methodological difficulties in separating the fetal effects of antidepressants from those related to maternal depression (confounding by indication). One central concern is the potential impact of these drugs on fetal brain development. Such effects may be subtle and possibly only detectable years after exposure, such as an increased susceptibility to (multifactorial) neurodevelopmental conditions.
Routine use of beta blockers in MI patients without heart failure is questioned
Patients who have had a myocardial infarction (MI) but do not have heart failure or left ventricular systolic dysfunction do not seem to benefit from beta blockers, a large UK study published in the Journal of the American College of Cardiology has found
All emergency departments must have GP led triage by October
Every hospital in England must have a “comprehensive” GP led triage system in emergency departments by October 2017 in a bid to avoid a repeat of the winter crisis that gripped the service this year, NHS leaders have said.
The requirement is one of several “concrete changes” demanded by NHS England’s chief executive, Simon Stevens, and the chief executive of NHS Improvement, Jim Mackey, in a letter sent after the chancellor Philip Hammond’s budget pledge to give the NHS an extra £100m (€115m; $120m) in 2017‑18 to spend on easing pressures in accident and emergency departments.
NICE recommends ixekizumab for persistent severe plaque psoriasis
The National Institute for Health and Care Excellence (NICE), in its final draft guidance issued this week, has recommended ixekizumab, an antibody that inhibits interleukin-17A, as an option for treating adults with severe plaque psoriasis that doesn’t respond to standard therapies.
General practice opening hours to be scrutinised
From October general practices in England will be financially penalised if they close during core working hours during the week, the chief executive of NHS England has said.
Simon Stevens told MPs on the House of Commons Public Accounts Committee that changes to the GP contract, which will be introduced in October, will allow NHS England to scrutinise GP opening hours more closely and take action where necessary.
Anaemia is associated with hearing loss in adults
Iron deficiency anaemia (IDA) has been found to be associated with hearing loss in adults by a study published in JAMA Otolaryngology – Head and Neck Surgery.
Using the electronic medical records of 305 339 adults aged between 21 and 90 years, researchers at Pennsylvania State University College of Medicine examined the association between IDA and sensorineural hearing loss (when there is damage to the cochlea or to the nerve pathways from the inner ear to the brain) and conductive hearing loss (hearing loss because of problems with the bones of the middle ear). IDA was determined by low haemoglobin and ferritin levels for age and sex.
Solanezumab and the amyloid hypothesis for Alzheimer’s disease
Is the amyloid cascade hypothesis of Alzheimer’s disease too big to fail? It proposes that brain deposition of β amyloid protein is the critical early event in the pathogenesis of Alzheimer’s disease and has been the centrepiece of dementia research for decades. The hypothesis suggests that removing β amyloid will reverse or prevent the clinical expression of dementia. However, in all phase III clinical trials to date, treatments targeting β amyloid have failed to improve cognitive outcomes despite reducing brain β amyloid.
End of life care for infants, children and young people with life limiting conditions: summary of NICE guidance
Children and young people can have a wide range of life limiting conditions and may sometimes live with such conditions for many years. This guideline recommends that end of life care be managed as a long term process that begins at the time of diagnosis of a life limiting condition and entails planning for the future. Sometimes it may begin before the child’s birth. It is part of the overall care of the child or young person and runs in parallel with other active treatments for the underlying condition itself. Finally, it includes those aspects related to the care of the dying.
Many children receive no discharge plan after admission for severe asthma
Children admitted to hospital with severe asthma attacks generally receive “very effective and efficient” treatment and care, but more attention must be given to asthma education and review at discharge to help prevent future attacks and readmission, says a national audit by the British Thoracic Society.
The society’s National Paediatric Asthma Audit, published on 29 November, reviewed data on more than 5500 children over the age of 1 admitted with severe asthma attacks to 153 UK hospitals in November 2015 and found that most aspects of discharge from hospital were less than optimal.
Swimming, aerobics, and racquet sports are linked to lowest risk of cardiovascular death
Swimming, racquet sports, and aerobics seem to be the best forms of exercise for reducing the risk of death from heart disease and stroke, research published in the British Journal of Sports Medicine has found.
The researchers said that the small number of events impaired the statistical power in some analyses. There were relatively few deaths from all causes among runners and football players, which may explain the wide confidence intervals. However, they concluded, “These findings demonstrate that participation in specific sports may have significant benefits for public health.”
Cranberry capsules do not reduce urinary tract infections in older women, study finds
Taking cranberry capsules did not reduce urinary tract infections (UTIs) in older women living in nursing homes, a US randomised trial has shown.
UTIs are very common among nursing home residents: bacteriuria is detected in 25-50% of women living in nursing homes, and pyuria is present in 90% of these. Cranberry products have been of interest in preventing UTIs in this group of people, to reduce unnecessary use of antibiotics.
Women are unaware of pregnancy risks linked with sodium valproate
Doctors are being asked to make sure that women and girls with epilepsy know about the risks of taking sodium valproate during pregnancy, after a survey found that half of those questioned were unaware that it could harm the fetus.
The charities Epilepsy Action, Epilepsy Society, and Young Epilepsy conducted a survey earlier this year, in conjunction with the Medicines and Healthcare Products Regulatory Agency (MHRA), of 2788 women aged 16 to 50 with epilepsy.
Reduction in breast cancer deaths is due to treatment not screening, finds study
The fall in breast cancer mortality seen after widespread mammography screening was introduced in the US was mainly due to improved systemic therapy and not earlier detection of tumours, a comparison of national cancer data before and after the introduction of screening programmes has shown.
SSRI exposure in pregnancy linked to speech disorders in offspring
A significant rise in the risk of speech and language disorders was found among children born to mothers prescribed selective serotonin reuptake inhibitors (SSRIs) during pregnancy, a study published in JAMA Psychiatry has found.
Clarity is needed on plans for digital NHS, says think tank
The government and NHS leaders must set out a clear and compelling plan for expanding the use of digital technology to avoid losing the commitment of clinicians, the King’s Fund has said.
Digital technology can transform how patients engage with services, drive improvements in efficiency and care coordination, and help people manage their health and wellbeing, the think tank said in its report, A Digital NHS?
However, it said that expectations might have been set too high amid financial and operational pressures and that there was a lack of clarity about the funding available to support the work.
Burns from e-cigarettes and other electronic nicotine delivery systems
With increasing use of electronic cigarettes (e-cigarettes) and other electronic nicotine delivery systems (ENDS) globally, the debate surrounding the potential harms or benefits may shift to ensuring that the devices are manufactured, marketed, and sold according to standards that reduce harm and promote health. Burns from overheating or explosions of ENDS are an emerging and under-researched concern. In light of the recent ruling that grants the US Food and Drug Administration authority to regulate ENDS1 and as their use becomes widespread worldwide, a clinical, public health, and regulatory framework to reduce ENDS related burns is needed.
Eggs or peanuts in early infant diet may cut allergy risk
Introducing eggs or peanuts early into infants’ diet is associated with a lower risk of developing egg or peanut allergy, says a systematic review of the evidence published in JAMA.
The review found “moderate certainty” evidence that introducing eggs to the infant diet at 4 to 6 months was associated with reduced egg allergy and that introducing peanuts at 4 to 11 months was associated with reduced peanut allergy when compared with later introduction of these foods.
NHS announces new online symptom checker
The BMA has warned that planned new digital NHS services, including an online “symptom checker,” should not replace patients’ direct access to GPs.
Brian Balmer, who chairs the BMA’s General Practitioners Committee, said that any new technology that improved patient care and access was to be welcomed, especially if it made appointment booking easier. But he said, “The proposed symptom checker is not the same as a consultation with a GP and should not be considered as such.”
Deaths from heart disease in UK fall, but prevalence is unchanged
Cardiovascular disease (CVD) mortality in the United Kingdom has decreased significantly over the past 30 years, but its prevalence has shown little change, and major differences exist in the burden of CVD among the four constituent countries and between men and women, a review has found.
Combined HRT may raise breast cancer risk, study finds
Women taking combined hormone replacement therapy (HRT) are 2.7 times more likely to develop breast cancer than non-users, and the risk may increase with longer use, a study published in the British Journal of Cancer has found.
The researchers, from the Institute of Cancer Research in London, said that previous studies may have substantially underestimated the risk of breast cancer from combined HRT, as they did not update information about a woman’s HRT use or analyse accurately to allow for her age at menopause.
The new research was part of the Breast Cancer Now Generations Study, which is following more than 100 000 women for 40 years to investigate the causes of breast cancer.
Paracetamol is no more likely to exacerbate asthma in children than ibuprofen, shows study
Using paracetamol to treat fever or pain is no more likely than ibuprofen to exacerbate asthma in children with mild persistent asthma, a randomised trial has shown (in the New England Journal of Medicine).
Observational data have previously linked paracetamol and asthma symptoms to decreased lung function, so some doctors have recommended avoiding the drug in children with asthma. But data from randomised trials have been limited.
NICE recommends dropping two drugs from Cancer Drugs Fund
Two drugs currently provided under the Cancer Drugs Fund (CDF) should cease to be available because they are not cost effective, the National Institute for Health and Care Excellence (NICE) has concluded.
Everolimus for breast cancer (Afinitor, Novartis) and ibrutinib for mantle cell lymphoma (Imbruvica, Janssen) do not meet the grade, says NICE in draft guidance now open for consultation.
Oily fish intake reduces risk of diabetic retinopathy, study shows
Older patients with type 2 diabetes who consume dietary omega 3 fatty acids equivalent to at least two weekly servings of oily fish have a significantly lower risk of sight threatening diabetic retinopathy than those who eat less, a prospective observational study has shown.1
Diabetic retinopathy is a major cause of vision loss in older people. The pathogenesis is not fully understood, but inflammation, oxidative stress, and microvascular changes play important roles…
General practice should be recognised as speciality in UK, leaders argue
General practice leaders have called on the government and the General Medical Council to correct the “anachronistic anomaly” whereby GP postgraduate training remains unrecognised as a medical specialty in the United Kingdom.
In a joint statement,
GP leaders from the BMA and the Royal College of General Practitioners (RCGP) from across the four UK nations said that this recognition was “long overdue” given the rigorous training and examination that GPs undergo.
Suspected sepsis: summary of NICE guidance
“Think sepsis” in any person with suspected infection
Sepsis may present with non-specific symptoms and signs and without fever
Have a high index of suspicion of sepsis in those who are aged <1 year or >75 years, pregnant, or immunocompromised, and those who have a device or line in situ or have had recent surgery
Use risk factors and any indicators of clinical concern to decide if full assessment is required
Offer people at high risk of sepsis broad spectrum antibiotics and intravenous fluids in hospital