Neologisms are words or phrases that are new to the language. As far as I know, there is no specific term that distinguishes neologisms that are derived from existing words from those that are completely newly minted. In the case of medical slang, only about 1% of terms are of the latter variety, not derived from pre-existing words. They include: the Amyoyo syndrome; gork, crumpo, and vedgy; Mudd-Fudd; smeck, smecker, and pisher. ganja, bindle, dujie, and mojo; langer, wazz, and chunder. Muggles and zatch, otherwise completely unrelated, by coincidence create a curious connection between Louis Armstrong and J K Rowling.
Having previously offered a long extensional definition of “pharmacovigilance,” I now offer a shorter, intensional definition: “A scientific activity related to the benefits and harms of any intended therapeutic intervention, primarily involving accurate identification and quantification, mechanistic analysis, continued surveillance, communication, and prevention of its adverse effects, adverse reactions to it, and adverse interactions with other interventions.” A major aspect of pharmacovigilance is continued surveillance for beneficial effects and particularly adverse events, effects, and reactions. Colleagues and I have proposed the following definition of “surveillance”: “a form of non-interventional public health research, consisting of a set of processes for the continued systematic collection, compilation, interrogation, analysis, and interpretation of data on benefits and harms (including relevant spontaneous reports, electronic medical records, and experimental data).” We have also proposed that instead of using qualifiers of surveillance, such as “active” and “passive,” a single definition of “surveillance” is sufficient, and that in any description of a particular method of surveillance the precise way in which the method is used should be detailed.
The UK medical journal The Lancet, established by Thomas Wakley was first published on 5 October 1823 and weekly thereafter. Under his editorship the journal included an eclectic range of topics from both the sciences and arts, including political commentaries, reviews of plays, case reports (particularly reports of events in cases seen in various hospitals), editorials, brief commentaries on pathology and treatments (including quack medicines), extracts from newspapers, comments on various medical societies, and even chess problems. Verbatim accounts of lectures were a major feature and drew criticism from members of the medical establishment. This culminated in an attempt to obtain from the Lord Chancellor, Lord Eldon, an injunction on their publication by the surgeon John Abernethy, which was initially successful and later dissolved. During its first 10 years of publication Wakley defended 10 actions, six of which were for alleged libel, with total claims of damages to the tune of £8000, and awards amounting to £155 and a farthing. However, the journal survived the vicissitudes occasioned by his reforming zeal.
2023 is the 450th anniversary of the birth of the Swiss-born Huguenot physician Théodore de Mayerne on 28 September 1573. After graduating in medicine in Montpelier and making a Grand Tour of Europe, including visits to Queen Elizabeth I in London and James VI in Edinburgh, Mayerne returned to France. However, increasing persecution of the Huguenots in France and an offer of a position as a personal physician in England led Mayerne to return to England in 1611, where he became a physician to King James I and a fellow of the College of Physicians of London. With Henry Atkins he encouraged the publication by the college of the Pharmacopoeia Londinensis in 1618, which came to 11 editions over the next 33 years and laid the foundations for other national pharmacopoeias, including the Edinburgh Pharmacopoeia (1699) and the Dublin Pharmacopoeia (1807). It was eventually replaced by the British Pharmacopoeia (Pharmacopoeia Britannica), recommended and announced in the Medical Acts of 1858 and 1862, respectively, which appeared in 1864 and is still in use today. Mayerne was knighted by James I in 1624.
• Auscultate for a systolic murmur (it can be soft) when patients present with chest pain, breathlessness, presyncope, syncope, palpitations, or unexplained functional deterioration • Clinically relevant aortic stenosis is underdiagnosed—consider transthoracic echocardiography and specialist assessment if there are cardiac or respiratory symptoms associated with an audible murmur • Arrange urgent cardiology assessment (within 2 weeks) or acute admission for syncope and/or rapidly deteriorating symptoms in suspected aortic stenosis • Transcatheter procedures are suitable for many patients who might previously have been deemed unfit for open valve replacement surgery
Billy Palmer, senior fellow at the Nuffield Trust, said it was significant that pay satisfaction among NHS staff overall (26% in 2022) is now 12 percentage points lower than before the pandemic (38% in 2019) and has fallen substantially in the past year—from 33% in 2021. He said, “This is not a surprise—our analysis2 has shown that even before this year’s pay deal, earnings had not kept pace with inflation for over a decade, with average nurse salaries falling 5.9% in real terms since 2010 and typical salaries for all junior doctors falling by 7.9%.”
Chyle is the milky, triglyceride rich lymph formed in the lacteals of the gut lymphatics during fat digestion. Accumulation of this fluid in the pericardial space is rare. It sometimes results from damage to the thoracic duct but more often it’s idiopathic. Cardiac tamponade occurs in a third of cases. Treatments include total parenteral nutrition, a very low fat diet, and octreotide, which increases splanchnic arteriolar resistance and reduces lymphatic flow. If they fail, surgical intervention is required (Heart doi:10.1136/heartjnl-2022-321798).
Abstract Objective To evaluate the quality of evidence, potential biases, and validity of all available studies on dietary sugar consumption and health outcomes. Design Umbrella review of existing meta-analyses. Data sources PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, and hand searching of reference lists. Inclusion criteria Systematic reviews and meta-analyses of randomised controlled trials, cohort studies, case-control studies, or cross sectional studies that evaluated the effect of dietary sugar consumption on any health outcomes in humans free from acute or chronic diseases. Results The search identified 73 meta-analyses and 83 health outcomes from 8601 unique articles, including 74 unique outcomes in meta-analyses of observational studies and nine unique outcomes in meta-analyses of randomised controlled trials. Significant harmful associations between dietary sugar consumption and 18 endocrine/metabolic outcomes, 10 cardiovascular outcomes, seven cancer outcomes, and 10 other outcomes (neuropsychiatric, dental, hepatic, osteal, and allergic) were detected. Moderate quality evidence suggested that the highest versus lowest dietary sugar consumption was associated with increased body weight (sugar sweetened beverages) (class IV evidence) and ectopic fatty accumulation (added sugars) (class IV evidence). Low quality evidence indicated that each serving/week increment of sugar sweetened beverage consumption was associated with a 4% higher risk of gout (class III evidence) and each 250 mL/day increment of sugar sweetened beverage consumption was associated with a 17% and 4% higher risk of coronary heart disease (class II evidence) and all cause mortality (class III evidence), respectively. In addition, low quality evidence suggested that every 25 g/day increment of fructose consumption was associated with a 22% higher risk of pancreatic cancer (class III evidence). Conclusions High dietary sugar consumption is generally more harmful than beneficial for health, especially in cardiometabolic disease. Reducing the consumption of free sugars or added sugars to below 25 g/day (approximately 6 teaspoons/day) and limiting the consumption of sugar sweetened beverages to less than one serving/week (approximately 200-355 mL/week) are recommended to reduce the adverse effect of sugars on health. Systematic review registration PROSPERO CRD42022300982.
Abstract Objective To assess whether an easy-to-use multifaceted intervention for children presenting to primary care with respiratory tract infections would reduce antibiotic dispensing, without increasing hospital admissions for respiratory tract infection. Design Two arm randomised controlled trial clustered by general practice, using routine outcome data, with qualitative and economic evaluations. Setting English primary care practices using the EMIS electronic medical record system. Participants Children aged 0-9 years presenting with respiratory tract infection at 294 general practices, before and during the covid-19 pandemic. Intervention Elicitation of parental concerns during consultation; a clinician focused prognostic algorithm to identify children at very low, normal, or elevated 30 day risk of hospital admission accompanied by antibiotic prescribing guidance; and a leaflet for carers including safety netting advice. Main outcome measures Rate of dispensed amoxicillin and macrolide antibiotics (superiority comparison) and hospital admissions for respiratory tract infection (non-inferiority comparison) for children aged 0-9 years over 12 months (same age practice list size as denominator). Results Of 310 practices needed, 294 (95%) were randomised (144 intervention and 150 controls) representing 5% of all registered 0-9 year olds in England. Of these, 12 (4%) subsequently withdrew (six owing to the pandemic). Median intervention use per practice was 70 (by a median of 9 clinicians). No evidence was found that antibiotic dispensing differed between intervention practices (155 (95% confidence interval 138 to 174) items/year/1000 children) and control practices (157 (140 to 176) items/year/1000 children) (rate ratio 1.011, 95% confidence interval 0.992 to 1.029; P=0.25). Pre-specified subgroup analyses suggested reduced dispensing in intervention practices with fewer prescribing nurses, in single site (compared with multisite) practices, and in practices located in areas of lower socioeconomic deprivation, which may warrant future investigation. Pre-specified sensitivity analysis suggested reduced dispensing among older children in the intervention arm (P=0.03). A post hoc sensitivity analysis suggested less dispensing in intervention practices before the pandemic (rate ratio 0.967, 0.946 to 0.989; P=0.003). The rate of hospital admission for respiratory tract infections in the intervention practices (13 (95% confidence interval 10 to 18) admissions/1000 children) was non-inferior compared with control practices (15 (12 to 20) admissions/1000 children) (rate ratio 0.952, 0.905 to 1.003). Conclusions This multifaceted antibiotic stewardship intervention for children with respiratory tract infections did not reduce overall antibiotic dispensing or increase respiratory tract infection related hospital admissions. Evidence suggested that in some subgroups and situations (for example, under non-pandemic conditions) the intervention slightly reduced prescribing rates but not in a clinically relevant way. Trial registration ISRCTN11405239ISRCTN registry ISRCTN11405239
The politics of health Abeezar Sarela consultant surgeon Salisbury rightly points out that debates about funding theNHSoften comedown to the equitable distribution of healthcare.1 She is also right in implying that health is more valuable than any other commodity, because health is instrumental to almost everything else. But, in advocating for increased funding, Salisbury overlooks that healthcare is only one among many determinants of health. Over and above NHS services, health has many social determinants: housing, education, nutrition, and so on. To advance the equitable distribution of health, attention to every one of the social determinants of health is required. Simply prioritising healthcare and NHS funding, without careful analysis of resource allocation to other health determinants, would not be a meaningful public service.
