🌶️ The Drama in Medicine This Week

A hot new batch of medical news has entered the villa 🥵

So ‘scuse us while we pull you for a chat, as we've got the goss on who's been dumped from the guidelines, which study's already causing a stir and even more …

👋 Happy Friday. Here’s what we got:

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

Think of the age-old question. Is a hot dog a sandwich? … Obviously not. 

Here’s a better one: Is blood a soup?
Think about it. It’s a liquid with a bunch of components inside 🍲

But … you could argue it’s viscous enough to be gravy instead?

Or maybe a nice broth?
It has been simmering in your body heat since birth, tbf.

The answer realistically depends on the bleeding risk 🩸

Higher bleeding risk = watery soup. 
Average patient = A nice thick gravy. 

But if you leave gravy out for ages, it clumps up.
And blood clumping up is the last thing we want post-ACS. 

Therefore, we give them dual antiplatelets. Up to a whole year in some cases.

That sounds fine for your average gravy patient.
But if someone’s watery soup already, is that much thinning really necessary?

A systematic review published this week in JAMA set out to answer that question.

Researchers pooled 14 RCTs, encompassing 11,398 patients at high bleeding risk (HBR) undergoing PCI. 

How did they test it?

And the primary outcomes?

So did the soup patients need thinning for as long as the gravy patients?
Turns out, no:

So less thinning, same clot protection.
Turns out the soup was never at much risk of clumping anyway. 

But before you go about changing the recipe, here are some things to consider:

ESC Guidelines already give leeway in the recipe for thinner soup by allowing just 3 months of DAPT in some HBR patients.

Either way, don't forget the single agent afterwards. Yes, we don’t want it too watery, but that doesn’t mean we want it clumpy.

So next time you're writing up a DAPT plan for an ACS patient at high bleeding risk, ask yourself: soup or gravy?

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 👇

Every speciality gets a stereotype.
It's how we cope with the crushing reality of how tough medicine is.
And bully playfully tease each other.

Anaesthetists? The sit-down sudoku (or TikTok) masters.
Emergency med? The ADHD-buzzed adrenaline junkies.
And ortho? Ortho gets unga bunga. Big bone, big man, small vocabulary.

So this week’s research is an apology to the ortho bros.
We’ve teased you endlessly, but turns out these guys just might know ball (balls and sockets, at least)

Anyone who's clerked a hip fracture knows the (bone) drill:
Elderly patient + fall = straight to theatre for a hip replacement. 

What you might not clock is that the thing most likely to go wrong afterwards isn't infection, it's not a leaky wound, it’s the joint straight up popping out 😬

AKA Dislocation.
Usually occurs while the patient is doing something thrilling, like standing up off the commode.

And the ortho bros weren’t happy with this.
They invented the ‘dual mobility cup’  hip replacement upgrade to replace the standard acetabular cup. See the helpful Nature diagram below:

And to test it out, the bros did DUALITY.
Not the duality of being both medicine’s dumb jock and elite engineer, but a multicentre RCT across 44 Swedish and British hospitals. 

The results published in The Lancet this week are a testament to the research power of ortho:

The primary outcome: dislocation within 1 year (requiring closed reduction or a return to theatre) 

And the outcome?

Of the 1,566 patients in the final analysis:

Basically, patients who got the dual mobility cup were about 73% less likely to dislocate. 

And why does this matter?

Hip fracture patients aren't an ortho-only problem.
ED clerks them, geris look after them, anaesthetists put them to sleep, physio gets them walking again …

We’ve all got a vested interest in keeping dear Doris on her feet. 

But bear in mind, the trial only looked at these fancy cups for hip fractures, not your standard arthritic replacement.
And surprise, surprise, the fancy cups are more expensive. 

Plus, with the whole double ball-cool design of the fancy cups, there’s double the chance that the mechanism could fail.

But still, maybe the ortho bros aren't just big biceps and bigger hammers. 

They may look like jocks, but we mustn’t forget they’re doctors too.
Nerds just like the rest of us.
(The muscles overcompensate for their failed rugby careers.)

✅ The Deal Is Done, Now What?

The doctors have spoken.
Well … the 57% of us who could be bothered to vote, anyway.

The government’s offer to resident doctors has been accepted.

After divisive opinions, fierce online debates and a group that seemed torn, BMA members had 53% vote in favour of the deal.

What does this mean?

No more strikes for now.
So sorry to all you incoming F1 extra holiday hopefuls, you’ll have to kiss your dreams of last-minute getaways goodbye. 

The deal also outlines standard 2016 contract terms for locally employed doctors, an average pay uplift and 4,500 new speciality training posts over three years.

But in terms of how these will actually be implemented?
We’ll have to wait and see 👀

📋 PMOS (PCOS 2.0) To Have Annual Review 

The recent rebrand of PCOS to polyendocrine metabolic ovarian syndrome, or PMOS, isn’t all that’s new for this endocrine star syndrome 💅

A new draft guideline published by NICE this week outlines plans to introduce yearly reviews for PMOS patients. Think your classic hypertension or diabetes check-ins. 

This annual check-up would go beyond just symptom control, and touch on more traditionally overlooked aspects of the disease - from fertility, to mental and menstrual health.

Considering PMOS is estimated to affect 1 in 8 women and a good few body systems, a yearly MOT seems like a pretty sensible idea. 

The hope is also that complications of the disease can be regularly screened for and caught earlier. 

The guidance is still under development, with the final version coming later this year.
Stay tuned endo enthusiasts …

🦀 Contraceptives and the Cancer Controversy 

As if the contraception side effects leaflet wasn’t already long enough to qualify as a novel (or a mega blanket), there might now be yet another addition to the list.

A wave of reporting this week has focused on a potential link between Depo-Provera (medroxyprogesterone acetate) and intracranial meningiomas, alongside ongoing discussions of legal action against the manufacturer, Pfizer.

Concern in part comes from a 2024 French case-control study published in the BMJ, which found that the risk of developing an intracranial meningioma was 5.6 times more likely for women with prolonged (>1 year) use of Depo-Provera compared to controls.

However, correlation is not causation. Only 20 participants in the study were exposed to Depo-Provera, so the risk is difficult to gauge. Meningiomas are more common generally in women, too. 

So whilst mention of brain tumours causes understandable public concern, we need to interpret with caution.

Like so much of medicine, it’s all about balancing risk ⚖️

💉The Handover’s Read of the Week

In true Love Island fashion, the focus this week is romance ❤️‍🔥

It’s safe to say in 2026, navigating the dating scene is a bit like trying to make it unscathed through a minefield …

And if there wasn’t enough to get right already, now even more mandatory conversations are being introduced.

This week’s read is one of 3 new articles from lifestyle magazine Cosmopolitan on navigating dating in the GLP-1 World

Interested in the advice?
Curious as to what on earth GLPs have to do with romance?
Why not give it a read?

You’re all up to date with the research, what’s a bit of tabloid tea to spice things up 🌶️ Check it out 👉 here

Handover Over 🫡

If you liked it, tell your mates
(forward along, please. It only takes 15 seconds, making this took 15 hours.)
If you hated it, tell your enemies.

FINAL WEEK: The Handover FIGs Scrub Giveaway Part 2

The top referrer for the Handover will get a free pair of FIGs scrubs.

Our top referrer has 60 referrals so far… they’ve kinda run away with it. But you’re a medic. I know you’ve got that dog in you. Competition is in your DNA. Don’t run away from the challenge. Rise to it!

Start Referring: Use your personal referral link below 👇

N.B. Referral gotta be nhs.net, doctors.net or a university email address. Referral requires double opt-in verification, so tell your mates to check their email after they sign up!

Good luck

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