👉 What Happened in Medicine This Week?

👋 Happy Friday. Gaarr. I've been doing med news for 4 long months now. And I swear, if I hear even the whisper of one more med story... I'm going tell you about it. Gladly!

Here’s what we got:

• 🍎 BMA: How’d ya like them apples? NHSE: They’re not bad tbf

• 🤥 Two Lies, One Stroke: Anticoagulation Isn’t the End of the Story

• #TheMoreYouKnow: Other Top Stories of The Week

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

NHS NEWS
BMA: How’d ya like them apples, NHSE: They’re not bad tbf

In order to show the government we mean business, residents up and down the UK went on strike last week. 

5 days aimed to flex our collective muscle and strong-arm the government into full pay restorations. 💪✊

Another triumphant effort in sticking it to the man. Getting what we (rightfully) deserve. How’d ya like them apples?😏

But you see, that’s where there’s a problem… Apparently, the strikes didn’t actually disrupt much :/ 

Apparently, less than a third of residents actually striked (stroke? struck? struketh? idk). 

According the NHS England:

• Turnout was 7.5% (1,243) lower than last year. 

• Care was maintained for 10,000 more patients than before

• 93% of planned operations, tests, and procedures went ahead.

So it would seem the trump card didn't really trump anything. 

Of course, Wes Streeting was quick to comment on this news: 

The BMA, on the other hand, wants VAR called on these stats:  

1. Isn’t NHS England, like… not a thing anymore? (they never said that, but is it not?) 

2. Those numbers are impossible to know:

And here I was thinking we’d left the “he said, she said” games in primary school… 

All the same, the BMA remains steadfast in achieving full pay restorations. 

The Union's resident doctors committee (RDC) co-chairs have said:

Let’s see what comes of it… our money’s on more strikes.

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RESEARCH UPDATE
🤥 Two Lies, One Stroke: Anticoagulation Isn’t the End of The Story

Let’s play a game. Two Lies, One Truth:

1. Random made-up lie 1

2. There’s an uncomfortably high residual risk of recurrent stroke despite anticoagulation in patients with atrial fibrillation.

3. Random made-up lie 2

Whaaaa, how'd you guess that?? Wow, you’re so darn good at this game. You gotta trial for the 2028 Olympics. I mean, they’re anything pass as a sport now. Like breakdancing and skateboarding.

In all seriousness, a new meta-analysis out of JAMA Neurology shows there's more than what meets the eye with stroke management in patients with atrial fibrillation. 

We all know the origin story:

Once upon a time, there was a villain called Atrial Fibrillation (AF). It terrorised the circulatory system, causing clot-triggered chaos and laying claim to a third of all ischaemic strokes.

Then came the heroes: oral anticoagulants. Warfarin and the DOACs reduced the risk of AF-related stroke by 60%. Just like that, peace was restored. AF was tamed. Managed. Under control.

Or so we thought…

Still, even among patients optimally anticoagulated, strokes can recur. And there is little data on how high this residual risk truly is. 

So, these researchers ran a meta-analysis. 

Their goal was to determine the residual risk of recurrent stroke in patients with AF who have already experienced a stroke or transient ischemic attack. Especially focusing on those treated with anticoagulation.

• Study scope: 23 studies, 78,733 patients, nearly all on OACs (median 92%).

• Inclusion Criteria: ≥50 patients with AF and a prior ischaemic stroke or TIA, ≥1 year of follow-up.

• Outcomes: Primary = recurrent ischaemic stroke. Secondary =any stroke and intracerebral haemorrhage.

What did they find?

1. Patients with AF who were started on anticoagulants after a stroke event:
   - These guys had a 3.75% annual risk of recurrent ischaemic stroke.
   - They face a 4.88% annual risk of any recurrent stroke (ischaemic or haemorrhagic)
   - That's a 17.4% 5-year risk of recurrent ischaemic stroke.

2. Patients with AF who stroke events despite already being on an anticoagulant:
   - This group faced a 7.2% annual risk of recurrent ischaemic stroke.
   - An 8.96% annual risk of any stroke.
   - Resulting in a massive 31.2% 5-year risk of recurrent ischaemic stroke. Yikes

So to wrap this all up, it’s clear that the story isn’t a fairy tale. There’s a 17% chance of a sequel stroke within 5 years, and nearly 1 in 3 for those already failed by anticoagulation, the threat of recurrence is very real.

And while clinical trials have long reassured us that anticoagulation works (and it does), this meta-analysis gets you thinking – is anticoagulation alone sufficient?

The authors call for better tools (biologic, predictive and therapeutic) to ensure the threat of recurrent AF-related strokes are thwarted for good.

QUICK BITS: OTHER NEWS

• Dr Google Strikes Again - I know we joke about Dr Google n’ all, but let’s be honest. AI is getting so good. Like Google’s AI just diagnosed the first-ever stroke in the basilar ganglia. Hopefully it’s last too, considering the basilar ganglia doesn’t exist. Somehow, it made it all the way through peer review. It took weeks before some picked it up. Who needs credibility anyway. Fiction is far more entertaining.

• NICE approve Immunotherapy for Endometrial Cancer - Cancer therapy news is always good news. Pembrolizumab(Keytruda) is supposed to be particularly powerful for individuals with advanced stage endometrial cancer. Pitched to reduce risk of death by 26% compared to chemo alone. 2100 people are set to benefit from combination therapy with chemo.

• Whats The Price of Pain? Pregabalin and Heart Failure - Pregabalin might ease chronic pain, but a cohort study of 245,000 patients found it’s linked to higher heart failure risk than gabapentin—possibly due to stronger calcium channel binding. Great for pain, not so great for your ticker. Keep this in mind when dealing with patients with cardiovascular risk.

• Over Half of Gen Z Report Music Linked Hearing Issues - Chat, are we cooked? Honestly, not very suprising. In a poll conducted by the Royal National Institisue for Deaf people(RNID), 58% of respondants have experienced hearing loss or tinnitus related to loud music in social settings. That’s attending festivals, gigs and nightclubs. I would argue TFL(specifically Victoria line) is just as damaging! Avoid noise induced hearing damage and buy some earplugs like these from Redline - They haven’t paid me to plug this, but they should though!

Handover Over 🫡 

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