👋 Happy Friday. Medical news is like your fingers - something you can count on. But unlike fingers, med news is far far less susceptible to needle-stick injuries or rollerblading accidents(A&E placement… I wish i could unsee it)

Here’s what we got:

• ✊ Strike Mandated. Placards Painted. Let’s Go Again!

•  🧠 🧹 Clean then Flush: A New and Improved Approach To Stroke Care

• 🤖 PANCANAI: Finding Tumours Before You’re Yellow and Doomed

• #TheMoreYouKnow: Other Top Stories of The Week

NHS NEWS

✊Strike Mandated. Placards Painted. Let’s Go Again!

The Word of The Week is Strike. Strike Strike Strike.

The BMA ballot results spelt victory for the majority of readers of The Handover. 78% of you voted yes to industrial action in our most recent poll. In the official ballot, a striking 90% of voters (26,000 doctors) voted in favour of strikes. 

So here we are: the first dates are locked in—five days of industrial action from 7am on Friday 25 July to 7am on Wednesday 30 July. And this isn’t a one-off. This result mandates strike action through to January 2026.

How did we get here? It’s been a whirlwind, but here’s the TLDR:

• From last year’s general election to date residents have got a combined pay rise of 22.3%. Nice start but still 20% less than 2008.

• In March 2025, the DDRB was formally requested to review pay by BMA. Aired for a month.

• BMA were not having it so threatened strike action. Aired for another 3 weeks.

• The BMA doesn't make empty threats. Ballot for Strikes confirmed 2nd May

• Wes offered a “thoroughly deserved” payrise of 5.4%(on average) + £750 consolidation pay for resident doctors. BMA said it was “woefully pitiful”. 

• Ballot was not called off. Results came in on Wednesday. Strike action prevailed. 

Wes Streeting has thrown a verbal tantrum in The Time regarding the results. He said the government “can’t afford” pay rises, that strikes would be a “disaster” for medics and patients alike, and that the public “will not forgive” any strike action from doctors

Weaponsing public opinion isn’t likely to change things. Medics have always been stubborn b*stards. Why do you think we chose this career when every doctor on work experience said run for the high hills?

That said, there will be some real implications for the NHS. The backlog will be a nightmare. During the last 5-day strike, over 200,000 appointments were cancelled. And just as we’d made progress reducing waiting lists to their lowest level since 2023(aggressively slaps knee and clicks fingers).

So the gun has been loaded. Wes is now on his knees. The barrel against his occiput. But the trigger has not been pulled. It may not have to be pulled at all…

The BMA co-chairs have said: “All we need is a credible pay offer and nobody needs to strike, Doctors don’t take industrial action lightly - but they know it is preferable to watching their profession wither away”. “The next move is the Government's"

Number 10 spokesmen: “We aren’t going to reopen negotiations on pay” 😕

Well then. That settles it then. Pull the trigger. Paint the Placards. It’s going to be interesting next 6 months.

RESEARCH UPDATE

🧠🧹Clean Then Flush: A New and Improved Approach To Stroke Care

Droopy Face. Funny Speech. Limb Weakness. It’s a stroke. 

Call the ambulance ASAP. CT shows ischaemic change? Time for a thrombectomy.
Now what?

If the clot’s gone and the vessel’s open, you’d think the worst is over. But for some patients, despite a technically “successful” thrombectomy, the outcome still sucks. The brain doesn’t always bounce back just because the plumbing’s fixed. Which is why the ANGEL-TNK trial asked a deceptively simple question: what if we kept the tPA party going?

Published in JAMA Neurology, this multi-centre RCT took 255 patients from 19 stroke centres in China. All had large vessel occlusion (LVO) strokes in the anterior circulation, 4.5 to 24 hours after symptom onset, and had undergone successful thrombectomy. They were then randomised 1:1 to either:

• Intra-arterial tenecteplase (0.125 mg/kg, max 12.5 mg, infused over 15 minutes), or

• Standard medical management (per Chinese Stroke Association guidelines).

The primary aim was to measure the proportion of patients with excellent neurological outcomes as per the modified Rankin Scale(mRS) – a score of 0-1, which meant either no symptoms, or no significant disabling symptoms – at 90 days. 

Bonus endpoints included broader mRS thresholds (0–2, 0–3), NIHSS score improvement at 36 hours, quality of life (EQ-VAS), and rates of intracranial haemorrhage and death.. 

What did they find?:

• Primary Outcome: 40.5% of patients in the tenecteplase group hit that sweet mRS 0–1 at 90 days, compared to 26.4% in the standard care group (Relative Risk 1.44; 95% CI, 1.06–1.95; P = .02).

• Safety: Rates of symptomatic intracranial haemorrhages within 48hrs were similar between groups (5.6% vs 6.2%). 90-day mortality rates were also similar(21.4% vs 21.7%).

• Subgroup finding: The benefits of tenecteplase were even better in patients with higher admission blood glucose and in those with less complete reperfusion. Neat.

So, is intra-arterial tenecteplase the post-thrombectomy pick-me-up we’ve been waiting for? Maybe. The headline result looks promising: better outcomes, no extra bleeding, same mortality. But every study has its limitations: None of the secondary outcomes hit significance, and this is still a single-country study with a modest sample size.

Plus, when a treatment seems to work best in patients who didn’t reperfuse properly, you have to wonder: is this a fix, or a patch?

Still, the concept is compelling. If thrombectomy is the brute-force route to opening arteries, maybe intra-arterial thrombolysis is the finesse move to finish the job. 

Watch this space. Or better yet, the perfusion scan.

RESEARCH/MEDTECH UPDATE

🤖 PANCANAI: Finding Tumours Before You’re Yellow and Doomed

You see, the problem with pancreatic cancer is that it’s too damn crafty. It hides in your body like a dodgy landlord issue - it goes unnoticed until the plaster gives in and your ceiling introduces itself to the floor. Now you're completely yellow and told there isn’t much anyone can do. That’s why the five-year survival rate is a grim 13%. 

But once again, AI proves it’s more remarkable than just ChatGPT and TikTok AI edits (those cats-at-the-Olympics videos are so convincing). Introducing PANCANAI - an AI model that can detect pancreatic cancer months before a human doctor would even glance at the scan. 

The AI works by looking at two markers radiologists already try to spot: actual tumours and main pancreatic duct (MPD) dilation. MPD tends to appear before a tumour does. It runs this data through some AI statistical wizardry and voila! It spits out a diagnosis.

To prove its worth, researchers ran a retrospective analysis of 1,083 Danish patients with histopathologically confirmed pancreatic cancer, each with at least one suitable CT scan. 1,220 scans in total. The primary performance metric was sensitivity of PANCANAI. In other words, how good is PANCANAI at identifying pancreatic cancer when it was actually there)

Results?:

• At Diagnosis: PANCANCAI had a sensitivity of 91.8%. Not too shabby. By staging: Stage I – 83.1%, Stage II – 85.5%, Stage III – 94.9%, Stage IV – 93%.

• Before Diagnosis: In the prediagnosis scans, PANCANAI had a sensitivity of 68.7%. Which is actually… really good. For scans >1 yr before diagnosis it’s 53.9%

• Also Worth Noting: Dual detection (lesion or MPD dilatation) improved sensitivity compared to lesion-only detection, especially for early-stage and prediagnosis cases.

But of course, PANCANAI isn’t perfect. It won’t catch everything, especially not in scans from years ago when the tumour’s still hiding behind a pixelated pancreas. And let’s be real: most hospitals probably still run Windows 7 and print on thermal paper, so deploying this sort of tech everywhere is going to take a minute.

But it’s hard to overstate how big this is. An early diagnosis using this tool could be the difference between surgery and a sympathy card. More studies and refinements will be needed before adoption, but a step in the right direction.

Anyway, back to TikTok cats.

OTHER NEWS YOU SHOULD KNOW

• NHS Trust League Table Dropped - Where does your trust rank? NHS England released the table to give the public more information on how local NHS services compare. But what if this does more damaged than good? What if Trusts start stat-maxing the 7 variable they chose rather than focusing on hosilistic care?

• MHRA Approves New Non-hormonal option for Menopausal Hot Flushes - In women with cancer histories, stroke history, or who would just rather not a monthly oestrogen top up, there is a new solution for those pesky hot flushes. Sauna sweat no more with elinzanentant.

• Chill on the sick-notes - Wes Streeting has pulled the finger out on sick-notes. Don’t just give them out willy-nilly he advises. Send them to the gym, or job coaches, just please less extended leave. This comes out a little after news of a suspended doctor selling sick-notes on demand. Gotta love medical entrepneurship.

• Do UTI’s increase risk of Strokes and Heart Attacks? - In short yes. Interesting study attached

Handover Over 🫡 

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