Every day, we drink from the firehose of the internet.
Gallons of content: watched, skimmed, read, and immediately forgotten.
After a long week of AI baby reels and TikTok Shop ads, our thirst for useless information is finally quenched.
But between you and I, you thirst for something else...your guilty pleasure... it’s medical news.
👋 Happy Friday. Here’s what we got:
🤔 A Case to Convert SEPSIS-6 to SEPSIS-5.2
💆 Therapy: Now With Added Ecstacy 💊
🧠 QuickBits: Other Top Stories of The Week
If you want to read any previous editions of The Handover, you can on our website.
RESEARCH UPDATE
💆 Therapy: Now With Added Ecstacy 💊
“DON’T DO DRUGS, KIDS. YOU’LL DIE”
Ahh yes... The classic nuanced and well-explained proverb universally beloved by PSHE teachers.
Shout it at a bunch of Year 7s, roll the Tea Consent video the week after, and congratulations! You’re now an Ivy-league pastoral teacher.
For many of us, that was the beginning (and end) of our school drug education.
But did it work?🤔
Hard to say, but given that at least 1 in 5 medical students admit to substance misuse, the curriculum might need more than just a single … line.👀
Still, your teacher wasn’t entirely wrong…these are potent compounds. There’s a reason anaesthetists guard the drug cupboard like the crown jewels.
But what if we could harness their powers for good? Not “my mate Dave swears skunk cured his snoring,” but in proper clinical trials, with dosing schedules, ECG monitoring and more therapist hours than I need after a family holiday.
That’s just what a group of researchers in Nature Medicine did. They wanted to see if MDMA could be used to help patients with severe PTSD.
Ideally, the trial would have taken place in the medical tent at Burning Man, but they just couldn’t get the licence agreement in time:
It was a randomised, double-blind trial, where the patients had 3, day-long therapy sessions with a hit of MDMA between them.
The above group was compared to a placebo group only receiving therapy + a placebo.
They monitored PTSD symptom severity using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5).
And the results were actually impressive:
Patients undergoing MDMA plus therapy saw PTSD symptoms decrease significantly vs those on therapy plus placebo.
Mean CAPS-5 scores fell by 24.4 points (s.d. 11.6) in the MDMA group (n=42) versus 13.9 points (s.d. 11.5) in the placebo group (n=37)
But don't get too excited…this isn’t a pill you pop in Berghain before waking in Poland the next day(actually…that’s exactly what it is).
There were constant check-ups and participants were very closely monitored 😑. Even then, it wasn’t perfect:
It was a relatively small study, with just 90 participants.
MDMA was only used in conjunction with therapy, so it’s not validated as a standalone treatment.
MDMA, in case you didn’t know, is really trippy. So chances are, some therapists were maybe, just maybe, able to tell when the patient in front of them was high as a kite (thereby ruining the whole ‘double blind’ nature of the trial).
But despite these limitations, it’s a promising professional breakout role for MDMA. From shady warehouse raves to the pages of Nature Medicine … it could be one hell of a glow up.
So if ‘Class A drug’ really does make the leap to ‘BNF-indexed’, it might be time for a slogan update:
“DO DRUGS KIDS!*”
(*as long as you have PTSD, are undergoing concurrent therapy, and have signed away your legal rights as part of a phase 3 clinical trial. The NHS does not claim responsibility for any side effects, including death)
IN PARTNERSHIP WITH KENHUB
🎯 New Year, New Me?
Dear journal.
A new term has begun.
Last year was... not great. But we made it. Somehow.
This year will be different. This year we’ll get it right.
But… How exactly?
Commit to Passmed? Recommit to Anki?
Some OSCE prep in someone’s kitchen that still smells like Sambuca?
But of course, there is one thing we’re ignoring. The one thing we always regret not starting sooner…
Anatomy.
Oh, the woes of the human body.
The curse of the Brachial Plexus. The unholy diagram that is the Circle of Willis.
Insertion of this. Origin of that.
I’m sick of it already, and terms barely started.
What's the hack?
So what's the cheat?
What's the solution once and for all?
It’s Kenhub.
Kenhub is the GOAT of anatomy and physiology learning. Used by over 6 million medics to actually remember how the body works. It included:
And yes, a ton of it is free.
That includes all articles, anatomy atlas illustrations. They’ve even chucked in a few quizzes, videos and charts to test your knowledge.
Check out Kenhub today.
And to unlock the full experience, use this link for 10% off a premium subscription 👉 https://khub.me/nuy7f2
RESEARCH UPDATE
🤔 A Case to Convert SEPSIS-6 to SEPSIS-5.2?
If medical emergencies were delivery companies, sepsis would be Evri or FedEx.
The second there’s even a hint it might be coming on, you glue yourself to that patient like it’s the last delivery before Christmas. You. Must. Not. Miss it.
One shot is all you’ve got. If you don’t catch it, the patient is gone.
You’ll be left with nothing but a ‘sorry we missed you’ note and a blurry photo of your front porch; the “safe place” they supposedly left it.
…Forgive me, I’m confusing my analogies. Just plotting my revenge on that driver…
In all seriousness, clinically we do a lot to keep sepsis in check. If there was ever propaganda in medicine, it would be the SEPSIS-6.
Oxygen. Fluids. IV antibiotics. Blood cultures. Lactate. Urine output.
Three in. Three out. Job done. Sepsis solved.
But hold on. Easy tiger. Maybe not so fast with those antibiotics.
Of course, it’s better to be safe than sorry, but what about antibiotic resistance?
Previous studies have reported that 20%–40% of patients treated with antibiotics for suspected sepsis are likely non-bacterial causes.
This paper, published in The Journal of Clinical Infectious Disease aimed to not only quantify sepsis antibiotic overtreatment in ED but also assess the possible harms that come with giving it inappropriately.
A retrospective cohort study conducted across 7 US hospitals, reviewed 600 adults treated for suspected sepsis with anti-MRSA and/or antipseudomonal β-lactam antibiotics.
They then had a team of experts(clinical pharmacists, attendings and fellows) retrospectively look over the patient notes and categorise the likelihood of true bacterial infection into:
1. Definite.
2. Probable.
3. Possible but unlikely.
4. Definitely not.
For those with definite or probable bacterial infection, the experts were told to think real hard and consider if a narrower antibiotic would have been sufficient instead.
Here’s the rundown:
Sample Breakdown: Definite = 48%, Probable = 20.5%, Possible = 18.3% and Deffo No = 13.2%
Antibiotic Overtreatment: This means that 1 in 3 (31.5%) patients probably didn’t have bacterial infection. And in those who did, 79.1%(325/411) received antibiotics broader than necessary. Overall 514/600(87.5%) patients were overtreated.
Complications: So 1 in 6 developed antibiotic-associated complications with 90 days of Sepsis treatment. The most common being infection/colonisation with resistant organisms(8%)
Mortality: Deaths were significantly higher in patients with unlikely/no infection (9%) vs. those with definite/probable infection (4.9%).
I know, I know, everyone is a genius in hindsight – facing an increasingly hemodynamically unstable patient is very different to reviewing notes on a treated patient. And in the grand scheme of things, this data set is small – a larger trial is needed to validate the need for policy change.
But when 87.5% of patients were determined to be overtreated, a rethink might be in order.
QUICKBIT: OTHER NEWS YOU SHOULD KNOW
NHS League Table Just Dropped- Where does your trust rank? NHS England released the table to give the public more information on how local NHS services compare. Table toppers will recieve greater funding and lower ranks will get cuts. Nothing like increasing social disparity 😊. Check it out.
A Lesson In Speaking Too Soon… - What’s that saying about counting your eggs before they hatch? Last Friday, The BMA made headlines announcing goverment plans to give full maitainance and tuition loans to students in every year through med school rather than just the formative ones. Well… they completely misinterpreted it, as the Dept of Education embarrassed them publicly. Final year brokeness will continue!
Not Your Average Ultrasound - Researchers from UCL and Oxford have built a helmet with 256 ultrasound emitters that can precisely hit deep brain areas without surgery. In trials, it hit the LGN(a key visual relay) and modulated brain activity with pinpoint accuracy. Just 4 minutes of stimulation had effects lasting 40+ minutes. Could be a game-changer for conditions like Parkinson’s… or at least give DBS a non-invasive rival.
Antipsychotics and Blood Sugar - Impaired glucose tolerance and antipsychotics aren’t a new discovery, but nothing a like a meta-analysis and systematic review to confirm it. Increased fasting glucose, insuline, HbA1c and hyperglycaemia risk compared to placebo. Interestly this was true regardless of the type of antipsychotic or dose. If you weren’t already keeping an eye out…keep an out 👀
Handover Over 🫡
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**Week 3 of The Handover FIGs Scrub giveaway
The top referrer for the Handover at the end of September will get a free pair of FIGs scrubs.
Last weeks leader has now been leap frogged with youmamoh taking the top spot with 25 referral. Impressively, they achieved this in like 48 hours.
Have you got that kinda social pull? There’s still 2 weeks of challenge left.
Give it a shot and share using your personal referral link below.
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Good luck!
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Fun Fact: The antidote for Heparin, Protamine is derived from salmon sperm. Due to risk of seafood anaphylaxis, anaesthetists inject a tiny amount, wait to see the reaction, before injecting the full dose.
If you want to get in contact with The Handover, email us at [email protected]