B✚DRBOATMEDIC NOTES

LEARN. UNDERSTAND. SHARE.

Medical knowledge.
Clearly explained.

Visual notes and thoughtful explanations that bring medicine closer to students, healthcare professionals and the communities they serve.

Explore the notes
By Dr E. Adjei Boateng
THE FEATURED NOTE   /   01

Two cancers.
Different warning signs.

Understanding ovarian and cervical cancer.

DRBOAT MEDIC NOTES comparison of ovarian and cervical cancer, including warning signs, screening and assessment
OBSTETRICS & GYNAECOLOGYACUTE & EMERGENCY CAREPUBLIC HEALTH & AWARENESS

THE NOTEBOOK

A little clarity goes a long way.

Explore clear explainers and clinical learning notes.
Read, save and return when you need them.

ACUTE & EMERGENCY CARE · WEEKLY EVIDENCE BRIEFING

DKA and delirium: a marker of higher-risk illness

Published 9 October 2026 · By Dr E. Adjei Boateng

EMERGING EVIDENCE

Clinical headline: No new NICE, NHS England or UK specialty-body guidance this week changes emergency management of sepsis, ACS, stroke, anaphylaxis, acute severe asthma, PE, DKA or hyperkalaemia. One large observational DKA study is worth noting, but it does not alter the UK treatment pathway.

What is new?

An analysis of 578,204 adult DKA hospitalisations in the US National Inpatient Sample found coded delirium in 1.1%. Patients with delirium had longer median admission (8 versus 3 days) and higher in-hospital mortality (6.4% versus 3.2%). Delirium was also associated with older age, multimorbidity and complications such as sepsis, stroke, pulmonary embolism, acute myocardial infarction and acute kidney injury.

Practical clinical implication

New confusion in an adult with DKA should be treated as a warning sign, not automatically attributed to acidosis. Reassess ABCDE, glucose and osmolality; review fluid, sodium and potassium trends; and actively consider infection, hypoxia, AKI, stroke, substance withdrawal, medication effects and—where clinically plausible— cerebral oedema. Escalate monitoring and senior review when mental status is abnormal or deteriorating.

Important caveats

This was retrospective US administrative data. Delirium and DKA were identified through coding, timing could not establish causation, and the apparent rise in delirium may partly reflect improved recognition. The findings support vigilance and a search for complications; they do not justify a new drug, investigation bundle or departure from current UK DKA protocols.

Source & publication note

No other worthwhile new developments identified this week: sepsis, ACS, stroke, anaphylaxis, acute severe asthma, PE or hyperkalaemia.

OBSTETRICS & GYNAECOLOGY · WEEKLY EVIDENCE BRIEFING

Menopause treatment and continuity after birth

Published 9 October 2026 · By Dr E. Adjei Boateng

GUIDANCE + TRIAL

Clinical headline: No new NICE, RCOG, NHS or MHRA recommendation this week requires an immediate UK protocol change. New ACP guidance reinforces hormone therapy as the most effective first-line treatment for troublesome menopausal vasomotor symptoms, while a randomised trial suggests that year-long patient navigation can improve several—though not all—elements of postpartum care.

1. Menopausal vasomotor symptoms: hormone therapy remains first line

Type: American College of Physicians clinical guideline with a supporting systematic review and meta-analysis of 90 randomised trials, published 6 October.

ACP strongly recommends oestrogen plus a progestogen for people with a uterus, or oestrogen alone after hysterectomy, when pharmacological treatment is sought for hot flushes or night sweats and there is no contraindication. If hormone therapy is unsuitable or not tolerated, ACP places venlafaxine or desvenlafaxine second line, followed by escitalopram, paroxetine, gabapentin or a neurokinin-receptor antagonist such as fezolinetant or elinzanetant.

Why it matters: The review found that oestrogen reduced both symptom frequency and severity and improved quality of life. Non-hormonal agents generally reduced frequency, but evidence for reducing severity was weaker. Hormone therapy was judged high economic value; fezolinetant low value in the US analysis.

UK take-home: This broadly reinforces NICE rather than changing UK practice: offer individualised HRT for vasomotor symptoms after assessing contraindications and discussing benefits and risks. NICE permits fezolinetant for moderate-to-severe symptoms when HRT is unsuitable, but the ACP sequence should not override NICE commissioning or product monitoring requirements. Comparative evidence is limited, and most trials were too short to define uncommon or long-term harms.

2. Postpartum patient navigation improves several care processes

Type: Single-centre US randomised trial of 405 predominantly Black or Hispanic Medicaid-insured participants, published 2 October. A trained lay navigator addressed social barriers, coordinated appointments and supported transition to primary care for one year.

The prespecified composite of receiving all six essential care elements by 12 weeks was not improved (9.4% versus 7.9%). Nevertheless, navigation increased postpartum-visit completion (96% versus 80%), depression screening and linkage (86% versus 72%), and receipt of anticipatory guidance (65% versus 51%). At 11–13 months, primary-care attendance was 57% versus 30%.

Practice take-home: For UK services with high postnatal attrition or marked inequalities, this supports testing named navigators or link workers who can schedule care, address social barriers and ensure handover to primary care. Measure individual outcomes rather than relying on an all-or-none composite. Generalisability is uncertain: the intervention was resource-intensive, context-dependent and not powered for maternal morbidity or mortality.

UK counselling update: birth after caesarean

RCOG released refreshed patient information on 6 October, aligned with NICE NG192. It supports balanced, individualised discussion of VBAC and planned repeat caesarean: about three in four women with one previous caesarean who enter spontaneous labour achieve vaginal birth; uterine rupture occurs in up to 1 in 200 planned VBACs and rises approximately two- to three-fold with induction. This is an updated counselling resource, not a new Green-top management guideline.

Most worth reading
  1. ACP clinical guideline: pharmacological treatment of menopausal vasomotor symptoms
  2. Supporting systematic review and meta-analysis
  3. Randomised trial of postpartum patient navigation
  4. RCOG: birth options after previous caesarean birth

OCTOBER · BREAST CANCER AWARENESS

Explore the breast cancer series

Public explanations, clinical learning notes and downloadable infographics.

DRBOAT MEDIC NOTES Episode 1: It starts with knowing your normal. The infographic’s educational content is also provided in the text alongside it.Download infographicView full-size image
BREAST CANCER AWARENESS · EPISODE 1

It starts with knowing your normal

Episode released 1 October 2026 · Added to website 8 October 2026
By Dr E. Adjei Boateng

Breast awareness starts with knowing how your breasts or chest normally look and feel. Anyone can develop breast cancer, including men.

Look, feel and act

  • Look: notice changes in size or shape, skin dimpling, colour changes or a new nipple change.
  • Feel: get familiar with your breasts or chest, including your armpits. Check regularly—about once a month.
  • Act: book a GP appointment for a new lump, unusual nipple discharge or another unexplained change. Persistent breast or armpit pain should also be checked.

Most breast changes are not cancer, but assessment matters. You do not need to wait for pain before seeking help.

Clinical learning notes

Symptoms extend beyond a lump: skin tethering or dimpling, a newly inverted nipple, nipple rash and abnormal discharge warrant assessment. Symptoms may be painless.

Consider skin tone: colour changes may appear as darkening on brown or black skin rather than obvious redness.

Assessment: establish symptom history, previous screening and family history; examine with consent and offer a chaperone. Refer for specialist assessment when indicated. A referral does not itself mean cancer.

Awareness and screening have different roles: mammography can detect cancers too small to feel. Knowing your normal does not replace screening.

Sources & further reading
Back to the series
DRBOAT MEDIC NOTES Episode 2: Warning signs beyond a lump. The infographic’s educational content is also provided in the text alongside it.Download infographicView full-size image
BREAST CANCER AWARENESS · EPISODE 2

Warning signs beyond a lump

Episode released 3 October 2026 · Added to website 8 October 2026
By Dr E. Adjei Boateng

A lump is only one possible warning sign. Look out for changes that are new or unusual for you:

  • Skin dimpling, puckering or an orange-peel appearance.
  • New redness or unusual darkening.
  • A change in breast size or shape, or swelling.
  • A nipple that has newly turned inward.
  • A new or persistent nipple rash or crusting.
  • Unexpected nipple discharge, especially if blood-stained.

Also check for a new breast or armpit lump. These changes can have non-cancerous causes, but appearance alone cannot establish the cause. Book a GP appointment even if the change is painless.

Clinical learning notes

Pain: breast pain alone is usually not a sign of cancer; absence of pain does not exclude it.

NICE NG12 referral guidance:

  • Age 30 or over with an unexplained breast lump, with or without pain: refer through the suspected cancer pathway.
  • Age 50 or over with discharge, retraction or another concerning change in one nipple: refer through the suspected cancer pathway.
  • Skin changes suggesting breast cancer, at any age: consider a suspected cancer pathway referral.
  • Age 30 or over with an unexplained axillary lump: consider a suspected cancer pathway referral.
  • Age under 30 with an unexplained breast lump: consider non-urgent referral; seek specialist advice if clinical concern remains.

These thresholds guide referral pathways and should not be used to dismiss concerning symptoms in younger people.

Sources & further reading
Back to the series
DRBOAT MEDIC NOTES Episode 3: Breast awareness: how to know your normal. The infographic’s educational content is also provided in the text alongside it.Download infographicView full-size image
BREAST CANCER AWARENESS · EPISODE 3

Breast awareness: how to know your normal

Episode released 6 October 2026 · Added to website 8 October 2026
By Dr E. Adjei Boateng

  1. Look: use a mirror with your arms down, then raised. Notice changes in shape, skin or nipples.
  2. Feel: use circular movements and light to firmer pressure. Cover each breast or side of your chest, up to the collarbone and into the armpit. Include the nipples and avoid painful pressure.
  3. Make it a habit: check about once a month. Learn how your breasts change through your cycle and life stages.
  4. Act on a change: contact your GP about a new lump, unusual change or pain that does not go away.

Breast awareness does not replace mammograms. Do not wait for your next screening appointment if you develop symptoms.

Clinical learning notes

Normal variation: breasts may differ in size and change with menstruation, pregnancy, breastfeeding and menopause. Focus on changes from the person’s usual pattern.

Awareness complements screening: mammograms can detect abnormalities too small to feel; checking at home does not replace them.

Safety-net clearly: new symptoms need clinical assessment even after a recent normal mammogram. Patients should not wait for their next screening invitation.

Sources & further reading
Back to the series
DRBOAT MEDIC NOTES Episode 4: Risk factors and common myths. The infographic’s educational content is also provided in the text alongside it.Download infographicView full-size image
BREAST CANCER AWARENESS · EPISODE 4

Risk factors and common myths

Episode released 7 October 2026 · Added to website 8 October 2026
By Dr E. Adjei Boateng

Understanding risk should empower us, without fear or blame. Some factors, such as age, inherited gene changes and dense breast tissue, are beyond our control.

Reducing alcohol, staying physically active and maintaining a healthy weight—particularly after menopause—can help lower risk, but cannot eliminate it.

Three myths, explained

  • “No family history means no risk.” Breast cancer can develop without a family history.
  • “Underwired bras cause breast cancer.” Evidence does not support this.
  • “Deodorants cause breast cancer.” Good-quality studies have found no link.

Discuss concerns about hormonal contraception or HRT with your clinician to weigh your individual benefits and risks. Anyone diagnosed deserves care and support, not blame.

Clinical learning notes

Risk is multifactorial: include age, breast density, reproductive history, previous breast disease and prior chest radiotherapy when assessing risk. Excess body weight is particularly relevant to postmenopausal breast cancer.

Family history requires detail: record affected relatives, cancer types and ages at diagnosis; consider specialist risk assessment where indicated. Absence of family history does not exclude breast cancer.

Avoid treating all HRT alike: combined HRT increases breast cancer risk, with risk increasing with duration. NICE describes very little or no increase with oestrogen-only HRT in people without previous breast cancer. Discuss absolute risk alongside symptom benefits and other health outcomes.

Sources & further reading
Back to the series
Breast cancer awareness Episode 5: family history, BRCA and genetic assessment. Both parental sides count; each child of a carrier has a 1 in 2 chance of inheriting the harmful gene change, not a 1 in 2 cancer risk.Download infographicView full-size image
BREAST CANCER AWARENESS · EPISODE 5

Family history, BRCA & genetic assessment

Published 8 October 2026 · Reviewed 8 October 2026
By Dr E. Adjei Boateng

Your father’s side matters too.

Harmful BRCA changes can be inherited from either parent. Higher genetic risk does not mean cancer is inevitable.

What your family history can tell you

Everyone has BRCA1 and BRCA2 genes. Certain harmful changes in these genes increase the risk of cancers including breast and ovarian cancer. Men can also inherit and pass on these changes.

If a parent carries a harmful BRCA change, each child has a 50% chance of inheriting it. This is the inheritance chance—not the chance of developing cancer.

When to ask about your risk

  • A close relative developed breast cancer at a young age.
  • Several relatives had breast or ovarian cancer.
  • A male relative had breast cancer.
  • Your family has a known inherited cancer-risk gene change.

Record who was affected, which cancer they had and their age at diagnosis, on both sides of your family. Discuss your concerns with your GP. These are reasons to ask for assessment, not a complete list of genetic-testing eligibility criteria.

A genetic counsellor or specialist can assess your risk, explain whether testing is appropriate and discuss what the results could mean for you and your relatives.

Clinical learning notes

Assess both parental lineages: BRCA-related predisposition affects men as well as women. Referral for risk assessment and eligibility for genetic testing are separate decisions.

Test an affected relative first where possible: identifying a pathogenic familial variant allows targeted predictive testing in relatives. Discuss possible results and family implications before testing.

Interpret results carefully: a variant of uncertain significance is not a confirmed harmful variant and should not itself drive changes in clinical management.

Individualise care: a confirmed harmful variant may lead to enhanced surveillance and discussion of risk-reducing treatment. It does not automatically mean surgery is required.

Sources & further reading
WOMEN’S HEALTH

Ovarian vs
cervical cancer

Know the differences.
Recognise the warning signs.

4 October 2026 · Quick learning note

Download infographicView full-size image
01

Ovarian cancer

Persistent bloating, abdominal or pelvic pain, feeling full quickly and needing to pass urine more often are symptoms worth checking. Risk increases with age, and some inherited gene changes increase risk.

Assessment may include a CA125 blood test and pelvic ultrasound. Further investigations are needed to confirm a diagnosis.

02

Cervical cancer

Nearly all cases are linked to high-risk HPV infection. Warning signs include bleeding after sex, between periods or after menopause, changes in vaginal discharge and pelvic pain.

HPV vaccination and cervical screening help prevent cervical cancer. Screening checks for high-risk HPV first, with cell changes checked if HPV is detected.

Sources & further reading
O&G CLINICAL REASONING · DRILL 6

Pathological CTG + tachysystole

Published 3 October 2026 · Physician-level UK practice drill

TIME-CRITICAL

THE SCENARIO

A 30-year-old woman, G1P0 at 39+2 weeks, is undergoing induction of labour for reduced fetal movements. Her membranes ruptured 22 hours ago. She has an epidural and is receiving an oxytocin infusion.

  • Cervix 7 cm; fetal head at −1 station
  • Temperature 38.3°C, HR 122 bpm, BP 108/66 mmHg, RR 22/min
  • Offensive liquor with thick meconium
  • Six contractions in 10 minutes, several lasting longer than 90 seconds

The CTG over 40 minutes shows a baseline of 175 bpm, variability of 3 bpm, recurrent late decelerations with more than half of contractions, and no accelerations.

Answer all sections together
  1. Classify and interpret the CTG.
  2. Identify the likely causes and time-critical features.
  3. Give your immediate actions and investigations.
  4. State the medication, escalation and definitive delivery plan.
  5. Explain whether fetal scalp stimulation or blood sampling has a role.
  6. Include neonatal care, postpartum monitoring and safety-netting.
DRBOAT MEDIC NOTES: pathological CTG and tachysystole emergency managementDownload infographic
Reveal the ideal approach

Interpretation

This is a pathological CTG: baseline above 160 bpm and recurrent late decelerations are red features; variability below 5 bpm for 40 minutes is amber. Six contractions in 10 minutes indicate tachysystole. The pattern suggests evolving or established fetal hypoxia.

The likely mechanism is multifactorial: oxytocin-related uterine hyperstimulation plus suspected intra-amniotic infection. Fever, prolonged rupture of membranes, offensive liquor and maternal and fetal tachycardia strongly support infection. Maternal sepsis remains a concern and requires assessment for organ dysfunction.

Immediate actions

  1. Call the senior obstetrician, coordinating midwife, anaesthetist, theatre and neonatal team.
  2. Stop oxytocin immediately.
  3. Place the mother left lateral, continue CTG and complete an ABCDE assessment.
  4. Confirm the trace is fetal, review maternal observations and assess reversible causes.
  5. If tachysystole persists, consider terbutaline 0.25 mg subcutaneously according to local protocol and contraindications.
  6. Start locally recommended broad-spectrum IV antibiotics promptly when infection or sepsis is suspected.

Give IV crystalloid according to haemodynamics, lactate and clinical assessment. Do not give routine oxygen when maternal oxygen saturation is normal; reserve it for maternal hypoxaemia or anaesthetic preoxygenation.

Investigations

Request FBC, CRP, U&E/creatinine, LFTs, coagulation screen, glucose, venous blood gas and lactate. Obtain blood cultures if this does not delay antibiotics, plus group and save, urine output monitoring, urine culture and appropriate genital or placental microbiology.

Birth and aftercare

Do not delay delivery for fetal scalp stimulation or blood sampling. At 7 cm with the head at −1, birth is not imminent and operative vaginal delivery is inappropriate. Correct reversible causes while preparing for emergency caesarean birth; if the CTG does not recover rapidly, this is likely a category 1 caesarean.

After birth, obtain paired cord gases. The neonatal team should assess for hypoxia, meconium exposure and early-onset infection. Continue maternal observations, fluid balance, urine output, lactate and blood-result review; reassess antibiotics against cultures and clinical response.

Memorable learning point: Pathological CTG + tachysystole = stop oxytocin immediately while treating reversible causes and preparing for birth.

Guidance and further reading
DRBOAT MEDIC NOTES infographic: plague in Russia, what is known as of 7 October 2026Download infographic
PUBLIC HEALTH & AWARENESS

Plague in Russia? What we know

Published 7 October 2026 · Reviewed 7 October 2026

Current status: unconfirmed

A laboratory worker in Irkutsk died after developing pneumonia of unknown cause. Plague has not been confirmed as the cause. The WHO says it does not yet have the full picture and has requested more information. ECDC reported no secondary cases and no evidence of sustained person-to-person transmission in the information available on 6 October 2026.

Public explainer

Plague is a bacterial infection caused by Yersinia pestis. It can spread through infected flea bites or contact with infected animal tissues. Pneumonic plague affects the lungs and can spread through respiratory droplets during close contact.

The current reports do not establish a confirmed plague outbreak in Russia. The ECDC assessed the risk to people in the EU as very low based on the limited information available. Follow reliable public health updates and avoid sharing unverified claims.

If you become seriously unwell after possible exposure in an affected area, seek urgent medical advice and explain your travel and exposure history.

Clinical notes

Recognise: bubonic disease may present with fever and a painful, swollen lymph node; pneumonic disease with rapidly progressive fever, cough and breathlessness; septicaemic disease with severe systemic infection or shock.

If plague is a credible possibility: isolate a patient with suspected pneumonic disease and use appropriate respiratory precautions. Urgently involve local infectious disease and microbiology specialists. In the UK, contact UKHSA’s Imported Fever Service and notify the local Health Protection Team as advised; plague is an urgent notifiable disease in England.

Testing and treatment: coordinate specimen collection and testing through specialist services. Do not delay specialist-directed empirical treatment while awaiting confirmation when clinical suspicion is credible.

These notes support learning; follow current local protocols and specialist advice. They are not a treatment protocol.

Sources & further reading
Dr E. Adjei Boateng in a navy suit and burgundy tie

BEHIND THE NOTES

Dr E.
Adjei Boateng

Medicine. Education. Understanding.

“Making medical knowledge easier to understand, one note at a time.”

DRBOAT MEDIC NOTES is an educational brand created by Dr E. Adjei Boateng, a physician with clinical experience in Ghana and a particular interest in obstetrics and gynaecology.

The notes bring together medical learning and public health awareness, using illustrations and clear explanations to make complex topics more approachable.

For learnersA clear starting point for study and revision.
For communitiesHealth information that starts useful conversations.

KEEP LEARNING

Go to the source.

Use original guidance alongside educational notes.

01 / HEALTH INFORMATION

NHS

Conditions, symptoms and when to seek help.

02 / CLINICAL GUIDANCE

NICE

Evidence-based recommendations for care.

03 / WOMEN’S HEALTH

RCOG

Obstetrics and gynaecology guidance.
A note on using these resources

For education and awareness. These notes do not replace individual medical assessment, current clinical guidance or local protocols. If you are concerned about symptoms, contact a healthcare professional.