Helen MacDonald

What kind of treatments are they looking at?

I think it's still going to be very hard isn't it at this early stage to pick out those cases and I think for now it's going to be the travel history or something peripheral in the story like that that I think is going to arouse your suspicion but I guess once it becomes a bit more established and once people are transmitting it within the UK I think it will become a lot harder.

Okay, kids, time to wash your hands.

I'm Helen MacDonald, UK editor at the BMJ and resting GP.

We can mute him more easily.

So we should wait to hear from our emergency care and acute care colleagues about whether they're convinced by Carl's find.

Yes, what you really need, Carl, is to commission a rapid recommendation.

Yeah.

Well, shall I give you an example of a rapid recommendation?

Our latest rapid recommendation hopefully offers you better evidence to hone prescribing of prophylactic proton pump inhibitors, PPIs, or histamine 2 receptor antagonists, H2RAs, in patients who are in the intensive care unit.

And I thought this one was a good one to talk about.

As Carl said, this one also responded to some emerging evidence, but also is an example of how medicine can be increasingly personalised to hone your offer to the people who are most likely to benefit.

So the background is about one in 20 people on ITU have a clinically important GI bleed, often as a result of a stress ulcer.

And in 2018, there was a trial that was published which suggested that prophylactic drugs didn't make a very meaningful difference to outcomes.

And there was even a suggestion in that study that there could be harms of these medications, in particular,

colostrum difficile infection and pneumonia.

But that was quite uncertain because the number of people with those outcomes was quite low.

So in this rapid recommendation, the team behind it were trying to answer on balance should these drugs be used in this situation?

for all people in intensive care or for specific groups of people in intensive care?

And if so, which drugs should be used?