Previous studies reported lower rates of recurrent venous thromboembolism (rVTE) among statin users, but this association could be influenced by concurrent anticoagulation and confounding by statin indication. This study aimed to confirm the beneficial association between statins and rVTE, stratified according to periods with and without anticoagulation, and additionally employ propensity score weighted approach to reduce risk of confounding by indication. The setting was a prospective multicentre cohort study and the outcome was time to first rVTE in statin vs. non-statin users. 980 participants with acute VTE were enrolled (mean age 75.0 years, 47% women), with median follow-up of 2.5 years. Of 241 (24.3%) statin users, 21 (8.7%) suffered rVTE vs. 99 (13.4%) among 739 non-users. The overall adjusted sub-hazard ratio (aSHR) for rVTE comparing statin users to non-users was 0.72 (95%CI 0.44 to 1.19, p = 0.20). This association was only apparent during periods without anticoagulation (aSHR 0.50, 95%CI 0.27 to 0.92, p = 0.03; vs. with anticoagulation: aSHR 1.34, 95%CI 0.54 to 3.35, p = 0.53). Using propensity scores, the rVTE risk during periods without anticoagulation fell further (aSHR 0.20, 95%CI 0.08 to 0.49, p < 0.001). In conclusion, statin use is associated with a more pronounced risk reduction for rVTE than previously estimated, but only during periods without anticoagulation.

BackgroundFuture and practising GPs encounter various stressors, which can potentially impair mental wellbeing and develop into mental illnesses.AimTo assess mental wellbeing of young and future GPs by their level of training.Design & settingA cross-sectional anonymous survey of members of the Swiss Young General Practitioners Association (JHaS) was undertaken.MethodBasic characteristics and the current mental wellbeing were assessed using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Specific stressors that can influence wellbeing were focused on. Participants were asked for ideas on how to improve wellbeing via open questions.ResultsResponse rate was 57% (n = 503). Mean value for mental wellbeing (WEMWBS) was 52.4 (maximum 70, standard deviation [SD] 7.2). Residents had a significantly lower level of mental health (51.0, SD 7.6) compared with GPs (54.2, SD 6.2). Overall, stress level was reported as high or very high by almost half of participants (49%). Forty-five per cent indicated a lack of private time; the highest proportion was among residents. Fifteen per cent (20% among residents) were at risk of burnout. Most frequent stressors were administrative tasks, high workload, and work demands. Support requests included improvement of work–life balance and reduction of administrative workload.ConclusionResidents had the lowest mental wellbeing, at a stress level similarly high to that of GPs. They most often indicated not having enough time for a private life and were most at risk of burnout. Improvement suggestions should be implemented to maintain mental health of young and future GPs. Particular attention should be paid to GPs in training, as owing to their reduced mental health, they may benefit most.

We describe a patient with a 35-year history of a severe chronic pelvic pain syndrome (CPPS) that failed to adequately respond to various drug therapies and other treatments by different specialists. In addition to the ongoing chronic pain, he suffered from week-long episodes of increased pain with no discernible trigger. At the first consultation with us the patient was in a particularly severe pain phase. He was taking four different analgesically effective drugs. In terms of therapeutic local anesthesia (neural therapy), we performed suprapubic injection of procaine 1% with infiltration of the vesicoprostatic plexus. Just a few minutes later, the pain decreased significantly. To maintain and further increase the effect, we performed the injection six more times. The patient gradually reduced and stopped all drugs and remained free of pain and discomfort ever since. This is the first report of a successful therapeutic infiltration of the vesicoprostatic plexus using a local anesthetic (LA) in a patient with CPPS that has been refractory to different treatments for many years. A possible explanation may be that the positive feedback loops maintaining pain and neurogenic inflammation are disrupted by LA infiltration. This can lead to a new organisation (self-organisation) of the pain-processing systems.