👀 PPI's, Ozempic Pills and Sperm Racing?

Congratulations to Dua Lipa and Callum Turner, who tied the knot in London the other week. The newest “it” couple first bonded over having both finished the first chapter of Hernan Diaz’s novel Trust.

Just goes to show that even a little reading can put you on the path to love and eternal happiness. So we recommend continuing until you get to the bottom of today’s newsletter, just in case you meet the love of your life in the hospital canteen.

Nothing gets spells seduction quite like a randomised controlled trial.

👋 Happy Friday. Here’s what we got:

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

The humble toothbrush.
Fighting the daily battle against tooth decay, gum disease, and halitosis.

You might brush once a day or twice a day.
You might do it before breakfast or after breakfast (FYI, before is actually better).
You might even actually floss alongside brushing. You performative freak.

Now think of Pneumonia. A classic infection known for long hospital stays, patient distress, and death.

You’ve got CAP (Community-Acquired Pneumonia).
You’ve got HAP (Hospital-Acquired Pneumonia).
In that, you got VAP(Ventilator) and NV-HAP(Non-Ventilator).
Say all of those in a freestyle, and you’ve got a Pneumo Rap.

Now, you might be wondering, ‘What’s the link between toothbrushes and Pneumonia?’ 

Well, a toothbrush may actually prevent more than just plaque; it may also prevent NV-HAP.

You’re probably starting to get suspicious. Did a dentist sneak his way into a doctor's newsletter? But, fear not, this is not just propaganda from Big Dental.

This link was studied in the HAPPEN trial. Published in The Lancet Infectious Diseases, this multicentre stepped‑wedge cluster RCT ran across nine medical and stroke wards in three Australian hospitals. It included 8,870 adults who stayed in the hospital for at least 48 hours.

How did they test it?

What was the primary outcome?

Incidence of NV‑HAP >48 hours after ward admission, using strict ECDC criteria

The Big Question: Would 9 out of 10 Resp Consultants recommend this intervention?

Apparently so:

But here’s some info from that pesky last consultant who doesn’t agree:

The £1 toothbrush may be humble, but it definitely ain’t weak. Yes, drugs like Tazocin are more expensive heavy-hitters, but stopping Pneumo from getting into the ring is what we want.

Make sure to start brushing up on your toothbrush brands.
Pretty soon, you could be deciding whether to prescribe soft-bristle or hard-bristle brushes.

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 👇

For the sake of argument, let’s say you're not a masochist. 

It stands to reason that if you’re experiencing pain somewhere in your body, you’ll probably reach for pain relief.

Maybe some ibuprofen. Maybe naproxen. 
That mystery pill in your kitchen cabinet, chilling since March 2020. 

The problem is that while NSAIDs are great at calming inflammation, they’re also remarkably talented at irritating the stomach lining. And seeing as that’s the case, it’s in your best interest to make sure your stomach lining is protected from its harmful effects

Which is where proton pump inhibitors (PPIs) come in.

Omeprazole. Lansoprazole. Pantoprazole. The NHS hands these things out like participation trophies. Reduced Acid = Reduced Irritation. 

Wonderful. But what’s the catch?
Increased osteoporosis risk.
Potential for the world’s most stinky case of the shits(courtesy of C.difficile).

And now, according to this paper in CHEST, worsening of obstructive lung disorders. 

So, everyone but our orthopaedic brethren knows what an obstructive lung condition is. FEV1/FVC < 0.7. It’s our asthma, COPD and Bronchiectasis. These conditions are prone to exacerbations – periods when respiratory control takes a turn for the worse.

As we’ve established, every co-morbid person and their gran take PPIs. No doubt, there are a load of people on PPIs who also have obstructive lung conditions.

The question these researchers wanted to figure out was whether long-term PPI use is associated with a high risk of respiratory exacerbations in adults with obstructive lung conditions. Additionally:

The study type chosen to explore this big question was an observational cohort study. 

They looked through Belgian healthcare records and looked for patients who had been prescribed at least two medications for treating obstructive lung diseases(think salbutamol, patropium bromide, etc). 

This search yielded 932,135 patients, of whom 44.6% used PPIs. What did they find?

Headline Finding: PPI use was associated with a high risk of exacerbation 

Interesting… but before we bundle PPI’s in the ⚠️ DO NOT GIVE ASTHMATICS⚠️  category alongside beta-blockers. The study does have some standout limitations.

This isn’t quite a practice-changing paper. A randomised controlled trial on the same association would be nice… 

But in the meantime, it might be worth thinking about de-prescribing in people popping the pill since Mrs May was in office.

WeGovy Pill = Approved ✅

As of yesterday, for the very first time, Wegovy has been approved to be taken as a pill.

Forget needle fears and pesky injection site rotation. The Medicines and Healthcare products Regulatory Agency(MHRA) has vetted the pill and determined it’s good to go. The final step before it’s given out to patients is NICE approval.

A little on dosing: A 2.4 mg semaglutide injection weekly injection can be transitioned to a 25mg tablet. The MHRA suggests starting on the 1.5mg tablet, then stepping up 4mg => 9mg => 25mg as needed

So there it is. Semaglutide OD, PO FTW!

👨‍⚕ Dr House is Coming To The UK

I mean… the show's been streaming on Netflix for years now. What I mean is his role is coming to the UK hospital. House is the definition of a “Little bit of this, little bit of that” doctor. No real specialist role. Kinda just diagnosing whatever springs up. Not quite a GP, but not ED either. The role is called “general hospitalists” 

The NHS will bring in a new class of generalist hospital doctors, inspired by the American “hospitalist” role, by the end of the decade. This is according to a leak of the government's upcoming workforce planning, uncovered by the HSJ 

Draft plans seen by HSJ propose the introduction of hospitalists to help care for complex patients who do not neatly fit into a single speciality. What to make of this new role? Not much yet… just curious to see what the competition ratios would look like for such a role. Considering 1 in 4 of us were probably inspired by a Medical Drama(just admit it)

🪖 Palantir For Good?

This weeks eyebrow raising headline: “Palatnir software halves sepsis deaths at US hospital” by The Times. 

According to the article, a hospital in Tampa, Florida, integrated a Sepsis Hub system in partnership with Palatir - The US Military's favourite Silicon Valley tech company. 

The system monitors the vitals of patients 24 hours a day(an always-on, NEWS score typa thing), then “alerting a rapid response team” any time there is a mild scent of sepsis. 

According to analysis, the hospital's death rate from sepsis has reduced by 68% over the 4 years it's been integrated. 

This is interesting as the NHS and Palantir seem to be getting quite cosy. Deals are in place for the Tech company to assist with waiting list times, but it is yet to be integrated into clinical decision-making.  

The BMA, LibDems and Green Party stand strongly against NHS x Palantir due to its links to Israel and the US military. But they are 2 years into a 7-year contract. Time will tell how the relationship develops. 

More Job Security For Locally Employed Doctors

One of the more low-key NHS changes this week could affect thousands of doctors on local contracts.

From September, many Locally Employed Doctors (LEDs) who have spent at least two years working at a level equivalent to a Speciality and Specialist (SAS) doctor will be able to transfer onto permanent SAS contracts.

The move comes from a framework agreed as part of the 2024 SAS pay deal.

Why does this matter? Because LE doctors often work under locally negotiated contracts rather than national terms and conditions, many have less job security, fewer protections, and less clear career progression. The BMA has long described parts of the system as a "wild west" of contracts.

The union says the change will improve recognition, stability and opportunities for thousands of doctors, many of whom trained overseas.

Considering LEDs have spent years plugging rota gaps and keeping services afloat, it seems only fair they finally get some of the security that comes with it.

🌍 The Sperm Racing World Cup

Y’know, I heard about this months ago, but I thought it was just too ridiculous to report on. So, I’m sooo happy the BMJ did it first, so now we can get away with it.

Yes, you heard that right. Sperm racing. Semen samples from participants across 128 countries will be tested and “raced” on tracks mimicking the reproductive system to compete to win $100,000. Race will be recorded using “advanced imaging, with high-resolution cameras to track every move”

Anyone over the age of 18 years old, free of STIs, is eligible to apply to compete in the sperm-meets-F1 context.

What’s the end goal? Seems like no net benefit to society. Just an absolutely ridiculous use of free will. 

Handover Over 🫡

If you liked it, tell your mates**
If you hated it, tell your enemies.

Urgghhh, fine! I guess we could do another giveaway to sweeten the deal. Let’s upgrade your hospital swag. Figs make these really well-fitting, but really expensive scrubs.

We’re offering you this. The Figs Scrubs minus the expense. It’s completely free for our Top Referrer for the next month.

All you have to do is share The Handover using your custom referral link below.

Tell your medical buddy to sign up(and confirm their subscription so we know they're not a bot).

The person with the most shares will win! Simple as that. Every week, we’ll share who has the most shares, so you know if you have a fighting chance(you probably do. Way fewer people actually take the effort to enter than you’d think)

So get to sharing using your custom link above. Good Luck!

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