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{"title":"Intra-arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (ATTENTION-IA): multicentre randomised controlled trial","authors":"Wei Hu, Chunrong Tao, Li Wang, Zhongjun Chen, Di Li, Wenhuo Chen, Tingyu Yi, Lihua Xu, Chuanqing Yu, Tao Wang, Xiaoxi Yao, Tao Cui, Guangxiong Yuan, Junfeng Su, Li Chen, Zhiming Zhou, Zhengfei Ma, Junjun Wang, Benxiao Wang, Hongxing Han, Hao Wang, Jie Chen, Peiyang Zhou, Zhihua Cao, Youquan Ren, Xueli Cai, Huaizhang Shi, Guang Zhang, Liping Yu, Xingyun Yuan, Jinglun Li, Guoyong Zeng, Chuyuan Ni, Tong Li, Yingchun Wu, Yuwen Li, Kai Li, Yong Liu, Yao Wang, Yu Jin, Hanwen Liu, Jianshang Wen, Jun Sun, Yuyou Zhu, Rui Li, Chao Zhang, Tianlong Liu, Jianlong Song, Li Wang, Juan Cheng, Adnan I Qureshi, Thanh N Nguyen, Jeffrey L Saver, Raul G Nogueira, Xinfeng Liu","doi":"10.1136/bmj-2024-080489","DOIUrl":"https://doi.org/10.1136/bmj-2024-080489","url":null,"abstract":"Objective To assess whether intra-arterial tenecteplase administered after successful endovascular recanalisation improves outcomes in patients with acute arterial occlusion of the posterior circulation. Design Multicentre randomised controlled trial. Setting 31 hospitals in China, 24 January 2023 to 24 August 2023. Participants 208 patients with successful recanalisation (grade 2b50-3 on the extended thrombolysis in cerebral infarction scale) of an occlusion in the V4 segment of the vertebral artery; proximal, middle, or distal segment of the basilar artery; or P1 segment of the posterior cerebral artery: 104 were randomly allocated to receive tenecteplase and 104 to receive standard care. Interventions Intra-arterial tenecteplase (0.0625 mg/kg, maximum dose 6.25 mg) administered proximal to the residual thrombus (if still present) or distal to the origin of the main pontine perforator branches over 15 seconds, or endovascular treatment only (control group). Main outcome measures The primary outcome was freedom from disability (modified Rankin scale score 0 or 1) at 90 days after randomisation. Primary safety outcomes included symptomatic intracranial haemorrhage within 36 hours and all cause mortality at 90 days. All efficacy and safety analyses were conducted by intention to treat and adjusted for age, pre-stroke modified Rankin scale score, time from onset of moderate to severe stroke (National Institutes of Health stroke scale score ≥6) to randomisation, hypertension, and baseline stroke severity. Results At 90 days, 36 patients (34.6%) in the tenecteplase group and 27 (26.0%) in the control group had a modified Rankin scale score of 0 or 1 (adjusted risk ratio 1.36, 95% confidence interval 0.92 to 2.02; P=0.12). Mortality at 90 days was similar between the tenecteplase and control groups: 29 (27.9%) v 28 (26.9%), adjusted risk ratio 1.13, 0.73 to 1.74. Symptomatic intracranial haemorrhage within 36 hours occurred in eight patients (8.3%) in the tenecteplase group and three (3.1%) in the control group (adjusted risk ratio 3.09, 0.78 to 12.20). Conclusions In patients with acute ischaemic stroke due to acute posterior large or proximal vessel occlusion, intra-arterial tenecteplase administered after successful recanalisation was not associated with a statistically significant reduction in combined disability and mortality at 90 days. Trial registration ClinicalTrials.gov [NCT05684172.][1] Data collected for the study, including deidentified individual participant data and a data dictionary defining each field in the set, can be made available to researchers on reasonable request and after signing appropriate data sharing agreements. Data access requests should be sent to the corresponding author. Such requests must be approved by the respective ethics boards and appropriate data custodians. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05684172.&atom=%2Fbmj%2F388%2Fbmj-2024-080489.atom","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Halting medical doctor degree apprenticeships is a sensible decision","authors":"Rob Tucker","doi":"10.1136/bmj.r66","DOIUrl":"https://doi.org/10.1136/bmj.r66","url":null,"abstract":"Medical apprenticeships were scrapped to avoid creating a two tiered system in medical education, writes Rob Tucker The government has reportedly ceased further funding of the controversial doctor apprenticeship programmes.1 The scheme has faced considerable opposition from the medical community and lobbying by the BMA from the start. Proponents initially argued that these programmes would widen access into medicine, but this argument began to fall apart as further details emerged. Medical doctor apprenticeships would not have delivered on the aim of expanding access into medicine, instead we need effective widening participation schemes in medical education. The timelines to deliver the medical apprenticeships were always tight. In 2022, NHS England set out a tender for medical schools to develop a new programme offering the use of the apprenticeship levy funding for the first time to medical degrees. The pilot medical schools were confirmed in January 2023. NHS England then needed to find willing local employment providers, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does menstrual cycle syncing really help productivity?","authors":"Sangeetha Nadarajah","doi":"10.1136/bmj.q2736","DOIUrl":"https://doi.org/10.1136/bmj.q2736","url":null,"abstract":"“Cycle syncing”—a trend promoted by wellness influencers who claim that aligning work tasks with the menstrual cycle improves productivity—has drawn scepticism from medical experts. Sangeetha Nadarajah reports Advocates of cycle syncing argue that tailoring work tasks to the different menstrual phases can optimise productivity and performance. Some influencers provide paid coaching, including “cycle based” business coaching and workshops on “cycle syncing for feminine leadership.” Proponents such as the podcast host and chiropractor Mindy Pelz and the author Kate Northrup contend that a woman’s decision making abilities fluctuate throughout the cycle, potentially affecting the effectiveness of her work.1 They suggest that women should leverage these fluctuations to their advantage, postponing certain tasks during phases where they feel less confident in making decisions.1 However, medical experts have pointed out that these claims lack evidence and may perpetuate harmful gender stereotypes. Nanette Santoro, an obstetrician and faculty member in the Division of Reproductive Endocrinology and Infertility at the University of Colorado, warns that these claims disregard the complexity of hormonal fluctuations. “The presumption that all women experience predictable variations in performance due to their menstrual cycle is an oversimplification,” says Santoro. Women may feel impaired if they have an underlying medical condition affected by menstruation, such as heavy bleeding, severe pain, hormonal imbalances, polycystic ovary syndrome, postural orthostatic tachycardia syndrome, premenstrual dysphoric disorder, or menstrual migraines. However, there’s no evidence to support claims that women experience significant cognitive impairment or reduced work performance solely due to hormonal changes associated with their menstrual cycle (boxes 1 and 2). Box 1 ### The menstrual cycle The menstrual cycle consists of four distinct phases, each characterised by hormonal fluctuations and physiological changes. Menstrual hormone fluctuations vary widely from cycle to cycle and day to day. Most women have nearly 450 menstrual cycles over 30-40 years.2 During the menstrual … RETURN TO TEXT","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partha Kar: The new storm propagated by poor medical workforce planning is now upon us","authors":"Partha Kar","doi":"10.1136/bmj.r33","DOIUrl":"https://doi.org/10.1136/bmj.r33","url":null,"abstract":"A storm is brewing in the NHS medical workforce. The problem is a lack of jobs for doctors, resulting in questions about competition for jobs between local graduates and international medical graduates (IMGs). An artificial bottleneck has been created by pushing for more medical school places in the NHS long term workforce plan,1 despite not enough jobs being available for those graduating.2 The NHS has also ignored the rising tide of locally employed doctors, mostly IMGs.3 A lack of clear direction for these roles leaves those locally employed doctors without career prospects and increases competition for jobs. Additionally, poor planning around the Professional and Linguistic Assessments Board (PLAB) exams has resulted in a growing number of IMGs being available for jobs.4 PLAB exams run regularly and admit more IMGs into the system, contributing to the bottleneck. This cocktail of problems could threaten the fabric of NHS medical teams. We risk a resurgence of rhetoric, seen previously in heated debates …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rupert Fawdry: obstetrician whose fascination with computerised medical records soon turned to disappointment","authors":"John Illman","doi":"10.1136/bmj.r24","DOIUrl":"https://doi.org/10.1136/bmj.r24","url":null,"abstract":"Obstetrician and gynaecologist Rupert Fawdry was an original thinker, dismissed by some as a Luddite and acclaimed by others as a maverick genius. If computers had been invented first, he suggested, paper and pen might have been considered the greatest IT breakthrough since the dawn of civilisation. This may seem an odd and even illogical observation by a charming eccentric who had an “affair” with the computer, according to his Canadian born first wife Judy. This passionate, obsessive affair reflected a love of structure and an overwhelming desire to organise the world—in particular, medical records. Fawdry highlighted dozens of inconsistencies in some 70 maternity datasets. The Körner model, for example, lacked an option for a breech birth by caesarean, he said, while the “place of birth” option seemed to differ in each dataset. Perhaps it was the depth of his knowledge and experience that ultimately made him appreciate the limitations of computerised medical records in obstetrics and care of the elderly. He was, despite boundless zeal, a pragmatist. He told a parliamentary committee in 2003: “Sadly, time and again, I have found myself helplessly watching the almost …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142968224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"I’ve been asked to do something that falls outside my role, what should I do?","authors":"Abi Rimmer","doi":"10.1136/bmj.q2869","DOIUrl":"https://doi.org/10.1136/bmj.q2869","url":null,"abstract":"It can be hard to know how to respond when asked to undertake a task that isn’t part of your role, but there are ways to deal with it, Abi Rimmer hears Ashley Simpson, medical education fellow, NHS Lothian, says, “Being asked to undertake a task you believe is outside your role can be challenging. Navigating these situations is often context dependent, requiring a balance between your professional responsibilities, team working, and patient safety. “Delivering healthcare is a team effort, with each professional holding specific responsibilities. There is often overlap in competencies, however, meaning that some tasks can be undertaken by multiple team members. “As a resident doctor rotating though departments, it’s important to clarify the typical responsibilities of team members in each setting. A task outside your role in one department may fall within it in another. Establishing role boundaries can empower you to handle situations like this more effectively. “Occasionally you may be asked to complete tasks typically assigned to others—for example, phlebotomy—because of workload or staffing pressures. In these instances, working collaboratively may be the best approach for patient care. If this becomes a frequent occurrence, impacting your own clinical responsibilities or professional development, you should escalate this to your clinical or educational supervisor. “The General Medical Council requires doctors to work within their competence. If you are asked to perform a task that you are not trained to undertake, you must voice this. While that might feel difficult in hierarchical teams, patient safety is your priority. Politely explain—for example, ‘I’m sorry, I’m not competent to perform this task safely. I think it …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142968221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blackout deaths: the grim toll of Ecuador’s energy crisis","authors":"Andersson Boscán, freelance journalist","doi":"10.1136/bmj.r32","DOIUrl":"https://doi.org/10.1136/bmj.r32","url":null,"abstract":"An energy crisis has seen regular power blackouts throughout South America. Andersson Boscán reports from Ecuador where the situation is costing lives in both hospitals and homes Gabriela Alvaro’s blood was flowing through a dialysis machine when the power in Ecuador went out nationwide. “Generators can take up to a minute and a half to start,” says Alvaro, 31, whose kidneys stopped functioning eight years ago. She relies on dialysis three times a week. “That minute and a half felt eternal. I remember being afraid that my blood would clot and they wouldn’t be able to return it to my body. That would kill me, of course. I don’t remember much else—I fainted.” It was 5 August 2024, and the latest in a series of scheduled blackouts that left the country in darkness for at least 70 days, with some outages lasting 14 hours. Every Friday the government announces the power outages scheduled for the following week. Life is planned around the affected areas and times. By government mandate, public healthcare facilities are exempt from power cuts, although private hospitals are left to keep running on their own. The Ecuadorian Ministry of Public Health told The BMJ , “Patient care is guaranteed, especially in critical areas such as intensive care units and emergency rooms. Additionally, the safety of patients and the continuity of essential services like …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142968219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We need to focus on local solutions for health inequalities","authors":"Ara Darzi, Tetiana Lunova, Peter Howitt","doi":"10.1136/bmj.r55","DOIUrl":"https://doi.org/10.1136/bmj.r55","url":null,"abstract":"The covid-19 pandemic and the recent cost-of-living crisis have substantially exacerbated pre-existing inequalities in health and social care in the UK.1 Marginalised populations are disproportionately affected, for example by experiencing higher rates of childhood obesity, depression, and maternal and neonatal mortality.2 Paradoxically, those who are most in need of medical care—disadvantaged populations—often face the greatest barriers to accessing it. In England, people living in the most deprived areas are twice as likely to wait over a year for non-urgent treatment compared to others.3 For the NHS to make a real difference to health equity, local organisations should not be waiting for a solution to emerge nationally. Instead, they should be looking to, and working with, the local populations they serve. For instance, there is a critical need for better data on …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"118 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142939945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When I use a word . . . Medical anniversaries in 2025","authors":"Jeffrey K Aronson","doi":"10.1136/bmj.r61","DOIUrl":"https://doi.org/10.1136/bmj.r61","url":null,"abstract":"My list of 110 medically related anniversaries for 2025 (events in years ending ’25 and’75) includes: ● Fifty two births: Charles Rochemont Aikin, surgeon; William Aitken, pathologist; Sir John Baber, physician; Helen Rae Bamber née Balmuth, human rights advocate and psychotherapist; Charles Cassidy Bass, American physician; Norman Bier, optometrist and contact lens specialist; Baruch Samuel “Barry” Blumberg, American scientist; Henry Edmund Gaskin Boyle, anaesthetist; Leslie Baruch Brent, transplantation immunologist; Fred Brown, virologist; Alfred John Carpenter, physician; Jean-Martin Charcot, French physician and neurologist; Joseph Thomas Clover, anaesthetist and surgeon; Barry Albert Cross, physiologist; Henry Hallett Dale, pharmacologist and physiologist; William Bill Davison, geriatrician; John Dossetor, Canadian physician; Robert Geoffrey Edwards, physiologist; John Richard Farre, physician; Robert Jackson Fletcher, optometrist; Paul Greengard, American neuroscientist; Wendy Elsa Greengross, general practitioner and broadcaster; David Gregorie, Scottish physician; Samuel Osborne Habershon, physician; Daniel Hanbury, pharmacologist; Henry Harris, cell biologist; Andrew Herxheimer, physician and clinical pharmacologist; Henry Tristram Holland, missionary and eye surgeon; Timothy Holmes, surgeon; Thomas Henry Huxley, biologist; John Kidd, physician; Homer Terril Lane, educationist and psychoanalyst; John Charles Grant Ledingham, bacteriologist; Mary Frances Lyon, geneticist; Johann Baptist Malfatti, Count of Monteregio, Italian born physician; John Marks, chairman of the BMA; Thomas Morson, pharmaceutical manufacturer; Autar Singh Paintal, Indian scientist, discoverer of sensory receptors; Edward William Pritchard, surgeon and poisoner; Reginald Crundall Punnett, experimental geneticist; Richard Reece, physician; J Murdoch Ritchie, neuroscientist, biophysicist, and pharmacologist; William Tindal Robertson, physician; Martin Rodbell, American scientist; Oliver Smithies, biochemist and geneticist; Henry Sessions Souttar, surgeon; Keith Sykes, professor of clinical anaesthesia; Alexander Cuthbert Turnbull, professor of obstetrics and gynaecology; Hubert Maitland Turnbull, pathologist; Patrick David Pat Wall, neuroscientist; John Wood, surgeon; Oliver Murray Wrong, physician and nephrologist; ● Twenty four deaths: Charles Cassidy Bass, American physician; Thomas Bowdler, English physician and expurgator; George Calvert, surgeon; Colin Chisholm, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142961718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute painful crisis in sickle cell disease: transfusion is not a benign treatment","authors":"Sonia N Wolf","doi":"10.1136/bmj.r37","DOIUrl":"https://doi.org/10.1136/bmj.r37","url":null,"abstract":"Charles and colleagues’ overview of management of acute pain crisis in sickle cell disease is welcome,1 especially as patients move away from city centres to areas that typically have a less ethnically diverse demographic. As a consultant haematologist specialising …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142939947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}