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When it comes to medicine, you’d better know your ABCs 📚
A: Always read your weekly medical news, even if you’re at pres, on the bog or watching Netflix
B: Become educated and wow colleagues with your up-to-date clinical prowess
C: Continue indefinitely 🤝
👋 Happy Friday. Here’s what we got:
💊Double it and Pass it on: Adenosine ALS Update
🧟The Rise of the Living Sick
🧠 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
💊 Double it and Pass it on: Adenosine ALS Update
It’s time to take a moment of gratitude if you are currently:
A) breathing through two unobstructed nostrils OR
B) NOT in the pits of med school exam season
If you fall into one or (god forbid) both categories, The Handover sends its deepest condolences 🙏
To the poor souls currently trawling through embryology, physiology or any other cursed -ology, I promise it does eventually get better.
And unlike OSCEs, be reassured that you WILL have a magic device in your pocket to remember 99% of stuff for you.
Forgot the order of draw? …Geeky Medics outside the patient cubicle.
Forgot the cranial nerve exam? …Geeky Medics outside the patient cubicle.
Forgot what comes from ectoderm? Good! Leave that in pre-clin 🤝
But unfortunately, there are a handful of things a quick search can’t save you from.
The dreaded Emergency Algorithms.
There’s just no way around it.
They need to be studied, memorised, then memorised again after the inevitable Great Forgetting post-exams.
Take Supraventricular Tachycardia (SVT)
You need to know what to do when there's a haywire heart rate about.
And the answer is simple: ADENOSINE. 6mg, then 12, then if needs be whack 'em with 18.
Or … is it?
Research published in the Academic Emergency Medicine Journal this week challenged the stepwise approach by questioning why we don’t just jump straight to 12mg?
A trial was done on 142 adults with confirmed, haemodynamically stable SVT.
Patients received either an initial 6mg OR 12mg dose of adenosine, and researchers compared first-dose cardioversion success.
So what happens when you skip the first step?
Turns out, it works even better:
The first-dose conversion was significantly higher with the initial 12 mg adenosine, at 82.7% vs 53.8% (post-adjusting for baseline differences)
Patients given the higher dose had FOUR TIMES greater odds of converting successfully on the first go (adjusted OR: 4.12 (95% CI 1.85-9.14))
And it wasn't just the primary outcome either:
Recurrence during ED stay was lower with 12 mg (1.4% vs 9.9%, though not statistically significant)
Adverse effects were similar between groups - chest tightness, flushing, and impending doom (coincidentally, the same as being quizzed mid-surgery)
And the bottom line: No major increase in serious arrhythmic complications with 12 mg
But before you bin your ALS flashcards, it’s only a small study conducted at a single centre and without long-term follow-up. Plus, not all variables could be controlled, and symptoms were self-reported.
And no … it’s not in our algorithm yet.
But terminating a dangerous arrhythmia will always be core medical knowledge.
And any SVT update that gives us permission to forget a step to improve patient outcomes, I see as an absolute win.
POWERED BY MEDICAL PROTECTION
🎯 Incoming FY1’s - Let’s Get One Thing Straight…
Right.
Let’s get down to brass tacks…
If you join or renew your Medical Protection membership before the end of May, you’ll be entered into their prize draw to win 1 of… 100 gift vouchers. Usable in darn near every store*
Nice.
But don’t just sign up for the dough.
Those first few weeks of FY1? They’re trial by fire.
One minute you’re a medical student.
Next, you’re expected to know where Ward 7B is and why the printer only works when nobody’s looking at it.
There are no stabilisers.
Medical Protection is basically your helmet and elbow pads in case things go sideways.
Their team of medicolegal experts is there to support you through complaints, investigations, legal issues, and the general chaos that occasionally comes with practising medicine.
They’ve been supporting doctors since 1892, which is honestly long enough to have seen medicine evolve from “try leeches on it” to whatever NHS-AI-PALANTIR systems are in the works nowadays.
Supporting over 350,000 clinicians along the way.
Here’s how it works:
Not a member yet? Create your free student membership account.
Set up your £1 Direct Debit. (Already a member? Start here.)
Voila. You’re in.
That’s genuinely it. It should take all of five minutes.
Join or renew before 31st May by using the link below 👇
RESEARCH UPDATE
🧟The Rise of the Living Sick
It’s A&E.
That familiar winter nip is in the air.
It’s been 3 days since you last saw sunlight. That can only mean one thing.
You scramble out to the waiting room and brace yourself.
The horde.
Tiny wheezing humans coughing and spluttering all over their exhausted parents. Rattling chests. Streaming noses. Caregivers clutching Calpol bottles like holy relics.
The coughing begins. Wet. Barking. Productive.
Sats probes chime, and you beeline towards the treatment trolley and grab your weapon (nebulisers) and ammo (oxygen cylinders). You weave through the crowd as snot-crusted fingers thrust out at you and choruses of ‘Give us antibiotics’ echo.
You fire shot after shot, oxygenating each child just enough for discharge.
But for every toddler sent home, ten more take their place.
You look down at the last O2 cylinder and fall to your knees. It’s Empty.
Oxygen sats > 92% have long been one of paediatric A&E’s sacred discharge demands.
But if beds are scarce and the kids are clinically well, why wait?
Enter OxyKids.
Published in The Lancet, this multicentre RCT spanned 10 hospitals and 557 children aged 6 weeks to 12 years admitted with bronchiolitis, viral wheeze, or lower respiratory tract infections.
The kids were split into two groups:
88% Group → Oxygen only started if sats dropped below 88%
92% Group → standard care, with oxygen started below 92%
All other treatments followed local protocols as normal.
The primary outcome?
Time from admission until the child met the pre-defined discharge criteria and could go home.
And here were the cold, hard facts:
Children in the 88% group reached discharge criteria in 27.6 hours VS 46.6 hours in the 92% group.
That’s a whooping 19 hours quicker! (95% CI 0.55-0.74, p<0.0001)
But won’t they just rejoin the horde?
Surprisingly, there were no significant differences in ED revisits, PICU admissions, or readmissions.
Before you let your guard down and get infected, watch out for those pesky limitations:
Most were already on oxygen at randomisation → Threshold mainly used to wean, not start, so less relevant to A&E apocalyptic wastelands
Open-label design → Lack of blinding may have influenced discharge and oxygen restart decisions
Key groups excluded → Such as pre-existing heart/lung conditions, limiting generalisability
Too few darker-skinned children → Oximeters overestimate oxygen in darker skin, so need more data before adjusting thresholds
Sick kids will always be scary.
One subcostal recession here or a tracheal tug there, and we lunge for the oxygen. But this study suggests we may sometimes be overtreating children who are clinically well.
QUICKBIT: OTHER NEWS YOU SHOULD KNOW
🩸PCOS Gets a New Ovary Achiever Name
It’s time polycystic ovarian syndrome got a much-needed rebrand.
Why? PCOS, the current name, just isn't cutting the mustard.
Now called polyendocrine metabolic ovarian syndrome (PMOS), the naming reflects the endocrine and metabolic nature of the disorder, rather than a purely gynaecological one.
PMOS is characterised by an imbalance in LH and FSH, leading to impaired follicular development, chronic anovulation, and hyperandrogenism.
Clinically, this presents with irregular or absent periods, sub-fertility, acne, hirsutism, and androgen-related hair loss. A key driver is insulin resistance, which increases ovarian androgen production and is often exacerbated by weight gain.
The traditional focus on ‘polycystic ovaries’ has proven to be a misleading oversimplification. The so-called cysts are in fact developmentally arrested follicles (Illusions, Micheal), and the condition extends far beyond the ovary itself.
The hope is that the shift to PMOS conveys its multi-system nature to help patients (and doctors) better understand the disease.
Ahh, Wes Streeting.
The former Health Secretary has stepped down from his post. A rather…forgettable stint at the top. I think a tribute to his best moments is in order. Just not this week, though.
Instead, let’s look to the future. James Murray is the new shot caller. Former Deputy Mayor of Housing in London and MP for Ealing North. What can we say about him? Not much.
Classic political pipeline. PPE Oxford => Management Consultancy => Islington Councillor => MP.
Not much in the way of a medical background. Oh, he was treated for myasthenia gravis through the NHS(does that count?) His opinions? Not a fan of strikes, saying the BMA are “haemorrhaging public support” after last summer's industrial action.
Does he have what it takes? Will he last more than 30 days? Will the BMA eat him for breakfast? Time will tell.
The Handover spoke much more about politics before. A return to keep it to research/clinical practice?
Political/BMA Updates?
Everyone loves a good urban myth. MJ is still alive in Cuba. Alligators in the loo. Bloody Mary still scares me to death. To a pregnant woman with depression, it’s that their medication will cause their child to develop autism or ADHD.
Fact or fiction? According to this meta-analysis, published in The Lancet Psychiatry, fiction.
37 case-control and cohort studies were pooled together. Looking at a total of 600,000 pregnant women taking antidepressants and 25 million pregnant women who were not.
Initial findings suggested that usage resulted in a 35% increased risk of ADHD and 69% increased risk of autism. But, after controlling for confounding factors(such as pre-existing mental health conditions), the risk dropped to statistical insignificance. This was true regardless of high and low dosages of antidepressants.
We consume so much medical news to repackage and regurgitate back to you. Sometimes, it’s better to hear it from the source. So, does a love for a JUUL or Triple Mango Lost Mary cause malignancy?
Megan Brooks breaks down the evidence with Medscape. Read the full article 👉 here
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Fun Fact: Antabuse(Disulfuram) was discovered because two Danish scientists unknowingly dosed themselves with an anti-parasitic compound, then attended a cocktail party. Both were violently ill at the same time after drinking. They’d accidentally found one of the first pharmacological treatments for alcohol dependence.
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The Handover is intended for healthcare professionals and does not constitute medical advice.