👀 8 Medical Stories You Missed This Week

I cracked open a fortune cookie last night, and for once it actually had a good fortune. None of that, words of wisdom, “trust the journey”, “drink more water” nonsense.
A real, honest-to-God fortune…

And it told me… 💆 🔮This Friday, you will spawn into the inbox of tens of thousands of clinicians to warn them of the latest research affecting their clinical practice.

I cannot believe they got it so right.

👋 Happy Friday. Here’s what we got:

If you want to read any previous editions of The Handover, you can on our website.

Working out whether a patient has a drug allergy has 4 clear steps:

Step 1: Ask the patient: “Do you have any drug allergies?”
Step 2: Receive response:  “Ummm, penicillin, I think”
Step 3: Raise eyebrow. Stroke chin inquisitively.
Step 4: Ask again: “What actually happens when you take penicillin?”

Maybe a rash, some vomiting or that sleep paralysis demon of Michael Jackson they reported 27 years ago…
Somewhere in that vague, hazy history, a label gets cemented on their drug chart: Penicillin Allergic. 

No further testing. No more questions.
But… that’s not how medicine usually works.

We don’t diagnose asthma solely from having chest tightness.
We don’t diagnose Crohn's solely on an incredible frequency of diarrhoea.

And yet, for drug allergies, the boat stops there. This has resulted in an estimated 10% of the hospitalised patients reporting a penicillin allergy when they might not have one. 

This leads to suboptimal antibiotic regimes, inferior health outcomes and the uprising of the big bad antibiotic resistance.

Luckily, it's a simple fix: A direct oral challenge (DOC) - i.e. let’s call bs on the allergy and put it to the test by giving it to you anyway

Published in the Journal of Clinical Infectious Diseases, these researchers put it to the test.

This study is a prospective, multicenter international type 2 hybrid effectiveness-implementation study… which is a fancy way of saying it’s an international trial seeking to see if this works in practice and if hospitals can actually adopt it. 

They enrolled 5121 adults with a reported penicillin allergy from 40 different hospitals. For ethical reasons, a filter was applied to determine whether a patient was high risk or low risk. 

A PEN-FAST score(penicillin allergy answer to CHADsVASc) <3, filtered the 5121 candidates down to 1573 (30.7%) to receive a DOC. They were given a dose of penicillin, then monitored for:

If nothing happened, good news! The patient's penicillin allergy was removed. 

So what did they find? 

Of 1573 (30.7%) who received DOC, 95.5% (1502) had the penicillin allergy removed.

They also wanted to see what changes removing the label had on real practice. They took a 892 pt who had the challenge and 960 who didn’t(but were a look-alike demographic). Then looked to see what antibiotics were prescribed over the next 90 days. They found that:

It’s not exactly the time to prescribe amoxicillin to any old Joe who says they react badly to it(you can’t cite The Handover in your tribunal case!). But the study does provide evidence that there could be a pretty simple way to curb the overuse of resistance-driving antibiotics.

Truth be told, we couldn’t find a sponsor for this week's Handover 💔
So we made our own…

You get the gist of speciality application… a couple of poster presentations, an audit and a teaching series on the anatomy of the earlobe. 

But what’s enough? What scores? What doesn’t? 
Where do you actually even stand in this crazily competitive climate? 

Introducing Docfolio - The definitive scoring engine for speciality training.

Docfolio uses the exact scoring matrix your interviewer will use… and shows exactly where you sit.

Think of it like this:

You’re playing a game.
Every audit, poster, and teaching session = points.

Aim of the game? Max out your score 

And when you’ve maxed out your score, you can export your full portfolio, exactly the way your interviewer will want to read it. 

There is no need for a speciality application to be a stressful process when Docfolio shows exactly what to do, when to do it, and how to do it.
Anddddd it’s completely free

So… how do you stack up?
See your score in just 60 seconds using the link below 👇

P.S. We want to actually make this good(and stop the site from breaking), so we’re limiting the first batch to just 50 test users. You can see how many people have signed in the link above. Good luck!

Meet Mrs Dosset.
Lovely 67-year-old lady.
Next on your patient list.
You glance at her notes before calling her in.
And then… her medication list.

It just keeps going. And going. And going.

Mate, this lady’s on more pills than a season 2 Jesse Pinkman…

Atorvastatin. Metformin. Ramipril
And of course.

Levothyroxine

On her chart since 1976…
Since then, we’ve had 10 prime ministers, 2 monarchs and 10,267 episodes of Corrie…

You pause for a sec and think…
Does poor Mrs Dosset really need that mini white pill in her blister pack?

Well, turns out…this study published in JAMA had the same idea…

Do older adults taking levothyroxine actually need it for life?

Researchers set out to discover what proportion of adults aged 60 years or older could discontinue levothyroxine successfully by performing an open-label, single-group, prospective study. 

They recruited 370 participants whose TSH was below 10 mIU/L, and taking a dose of 150 μg/day or less. 

The primary outcome was whether participants could remain off levothyroxine for 1 year while maintaining a TSH below 10 mIU/L and free T4 within the reference range.

The dose was reduced stepwise every 6 weeks or more, with thyroid function tests after each reduction. 

Thyroid-related quality of life and general health were also measured by the researchers. 

Huh..well, de-prescribing might actually be the move for some…

There are, of course, some limitations: 

So no…this is not a call to empty Mrs Dosset’s box overnight. But perhaps, when you next see an OAP in clinic, squint an eye at that LT4 on the chart and ask if it still belongs there.

NICE Approves Ozempic for CVD Risk

In today's episode of “What can’t GLP-1 RAs do?”, NICE have approved a fresh new use case for the wonder drug. Get your QRISK calculators ready… the regulator recommends a once-weekly injection up to 2.4 mg for adults with established cardiovascular disease AND have a BMI >= 27.

NICE cites the SELECT trial, published in the NEJM, as the source of its regulation inspiration. This RCT looked at 17,000+ with established CVD & BMI >= 27. Then split them 1:1 into a semaglutide group and a control group. Next, they monitored to see how many actually died from their CVD over the next 48 months. 

And lo and behold, they found semaglutide actually did help; they were about 20% less likely to reach the primary endpoint. 

And lucky for the patients, it’s just about cheap enough that the NHS can justify dishing it out. Good stuff. Publication is expected for 7th May 2026 🫡

AI Scribes Scratch The Surface

The AI Scribe tools are everywhere! For those who aren’t indoctrinated(haven’t seen a Heidi Health ig ad), these are kinda like dictation apps, except they're approved to listen to your clinician consultations. The promise to revolutionise clinical documentation by autofilling forms, saving you precious time.

They’ve been around a hot minute now… but I’ve hardly seen anyone raving about them in practice. 

It would seem these researchers thought the same. This study, published in JAMA, asked if the adoption of AI scribes is actually associated with changes in EHR time expenditure and weekly visit volume.

And the results were… pretty unwhelming 🫤, in those who adopted the tech, around 13 minutes were saved on EHR systems, and 16 minutes were saved on documentation for every 8 hours of patient care. 

But hey, do you know what you can do with a whole extra 29 minutes? Yeahh, idk either.

Medicine and Personal Beliefs: GMC Want Your Opinion

The light of a Kent-based GP told a young patient seeking mental health treatment to “reconnect with God” first, the GMC have proposed some changes on it’s personal beliefs and medical practice guidance, last amended in 2013.

The major recommendations are really around making the implicit, explicit:

It's still in consultation. This is a guideline you can actually have a say in.
Have your opinion heard using the link here

Reversing Cellular Ageing in Humans

Who needs the Holy Grail, the Fountain of Youth or whatever Bryan Johnson is on, when you have modern-day science to keep you #foreveryoung. 

Scientists are testing whether partially reprogramming cells(essentially dialling back their biological age) can safely restore function in humans.

The approach uses Yamanaka factors, proteins that can revert cells to a younger state without fully resetting their identity. The first clinical trial, happening later this year, will deliver three of these factors into the eyes of glaucoma patients to attempt to regenerate damaged retinal nerve cells. Science never fails to amaze.

New Lanyard Alert!

If you’ve anything from The Pitt, you’d notice the massive f-off DOCTOR sign beneath their ID lanyards. Whilst we’re ever so lucky to have our “Hello, my name is…” and doctor written in subtext, the BMA decided it’s time for an upgrade. 

Taking a leaf out of the Yanks' book, they created this super slick new DOCTOR lanyard to differentiate doctors from other staff. It's been handed out to doctors on the picket lines during the ongoing strike. 

It’s the little things 💆

Handover Over 🫡

If you liked it, tell your mates
(forward along, please. It only takes 14.66 seconds, making this took 14.66 hours.)
If you hated it, tell your enemies.

Before you depart(if you haven’t voted already), please let us know your role in the poll below - It means the world when you do 🫶