🙊 What Doctors Yapped About This Week

December is upon us.
Cue the winter festivities and total cash loss.
Spotify Wrapped dropped, and everyone rushed to Instagram to declare they definitely aren’t basic.

Yes, Drake may have found his way into your top 5(again), but you actually listen to lowkey, up-and-coming artists like Olivia Dean or Playboi Carti.

Whilst I can’t comment on your music taste, I can compliment you on your choice in medical news outlets. A truly refined taste indeed.

👋 Happy Friday. Here’s what we got:

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

Dear Cardiology,

What happened to us?
You were everything to me.
The yin to my yang. The lub to my dub. The suture to my scalpel. 

After all these years, this is how you betray me?

You’d hear the murmur I’d miss.
You’d manage the breathless, the dizzy, the pre-syncopal.
You’d hold their hand when I couldn’t even hold eye contact.

But treating them? That's my territory

It was my time to shine. Surgery is supposed to be my thing. I’d open up that chest. I’d replace that valve. I would get the flowers. I would get the glory.

But I guess going unsung isn’t really your thing, huh?

You’ve replaced my CABG with your angioplasty and stents. 
You’ve robbed me of closing septal defects.
Now, you want to take my valve replacements, too?

Yes! I saw that trial you and your cardiac cronies published in NEJM.

You wanted to prove that your not-so-surgical transcatheter aortic valve replacement(TAVR) was just as good as my open-heart valve replacement. 

You recruited 1000 patients with severe symptomatic aortic stenosis and low surgical risk. Then randomised them, 1:1, to either receive tranfemoral TAVR or surgery. 

You followed them over 7 years to measure a composite of death, stroke, or rehospitalisation related to the procedure, the valve, or heart failure. 

And you found… no significant difference 🥀

The primary endpoint occurred in 34.6% of TAVR patients vs 37.2% of surgery patients (−2.6%; HR 0.87; 95% CI 0.70–1.08) at 7 years

Individually:

And safety findings: 

I’m sure you're sitting in your office, all smug about the results, But you cherry-picked, didn’t you?

You chose low-risk patients and excluded anyone remotely complex.
You conducted the trial in top-tier centres with pristine outcomes, not in the real world where variability is… let’s say, wider.
And let’s not ignore the follow-up dropouts…patients who vanished, their outcomes lost in the ether. Dead? Alive? We’ll never know.

Look. I know the above limitation a damning, but I think we can make up. Just go back to being medical, and I can go back to being surgical.

Pretty please.
You're actually scaring me now. 

Stay in your lane.
Yours truly,
Cardiothoracic Surgery

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The irony. The sweet irony. Every 16-year-old's favourite class C drug might actually have efficacy in treating every 16-year-old's go-to mental health condition.

A meta-analysis systematic review, published in The Lancet, took 7 trials investigating Nitrous Oxide against various placebos. Studies showed it consistently produced “rapid, reproducible antidepressant effects”. That’s pretty unsurprising if you ask me. But imagine a world where you could get NOS on the NHS. It’d be an ADHD x Ritalin crisis all over again. Though I’m sure local dealers would be very, very pleased.

Read the full paper here

You know the drill. This time, the BMA didn’t dilly dally. Another round of strikes has been confirmed from the 17th-22nd December. I’m sure you get the gist by now. Pay restorations haven’t happened + Training crisis is ongoing + Little progress from the government = return to the picket lines. 

Wes went on a 9-minute rant to Sky News, complaining about all things doctor. Striking residents are “juvenile delinquents”, and the BMA are “moaning minnies” – I sure hope he doesn’t kiss his mother with that mouth.   

Read the discourse between doctors and the public on X(fka Twitter) here

Yes, we’ve(largely) moved past the woes of warfarin. But even the DOACs we have can be improved. A new class of anticoagulants (Factor XI inhibitors) have been progressing through clinical trials. Reducing pathological clotting risk and reduced bleeding risk(this is like haematological dirty talk). Big Pharma's Regeneron and Bayer both have trials published demonstrating their efficacy in post-surgery VTE and AF. 

Read the paper here

Contrary to popular belief, massive guideline changes don’t happen as much as you’d think. For those in Med School, GP, Paeds or A&E, there’s been a minor update to the guidelines of child maltreatment guidelines. 

The key addition was the definition of independent mobility. You should be suspicious of any bruise, laceration or thermal injury to any child that's not independently mobile. This is a child who cannot meet their normal developmental milestones (crawl, shuffle, pull to stand etc.)

Seems kind of obvious to me, but clearly it wasn’t obvious to others(or it wouldn’t have been updated). #nowyouknow 🤝

Handover Over 🫡

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