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Start / Medicine and Science from The BMJ
Medicine and Science from The BMJ
Leading the debate on health to engage, inform, and stimulate doctors, researchers, and other health professionals.
993 avsnitt • Längd: 25 min • Veckovis: Fredag
Om podden
Leading the debate on health to engage, inform, and stimulate doctors, researchers, and other health professionals.
The podcast Medicine and Science from The BMJ is created by The BMJ. The podcast and the artwork on this page are embedded on this page using the public podcast feed (RSS).
Avsnitt
How MSF maintains neutrality in conflict zones
20 november 2024 |
32 min
This week we’re at the World Innovation Summit for Health, where we’re a media partner - the meeting is focussing on conflict, equity and resilience.
In that vein, we’re joined by Christos Christou, international president of Médecins Sans Frontières (MSF) to talk about attacks on healthcare staff, and the difficulty and importance of maintaining neutrality in conflict zones.
Ara Darzi, surgeon, executive chair of the conference, and author of the recent NHS review, joins us to talk about antimicrobial resistance, and how diagnostics and a small funding commitment could head off the problem.
And finally, we change our focus to the US, and hear about new research into adverse events during surgery with authors Antoine Duclos and David Bates from Harvard Medical School.
Reading list.
We need to do more to keep antibiotics working
WISH report - Tackling Antimicrobial Resistance: How to Keep Antibiotics Working for the Next Century
Conflict zones, women’s health research, and reimagining palliative care
2 november 2024 |
38 min
In this episode, we speak to the doctor overseeing the WHO’s emergency response for the eastern mediterranean region - including Gaza, Lebanon, Sudan and Yemen. Richard Brennan joins us to talk about protecting health services, and workers, in the escalating armed conflicts that are affecting the region.
Menaka Paranathala and Emma Rourke, from The BMJ, are on to talk about improving research into women’s health. A new UK project, MESSAGE, aims to give consideration to sex and gender in life science research.
Palliative care is not just for end-of-life, and rethinking how it’s integrated into every speciality is the key to improving care for patients, argue Richard Harding, Anna Peeler, and Oladayo Afolabi from the Cicely Saunders Institute.
Links
Climate leadership - knowledge is power
19 oktober 2024 |
41 min
It’s an often cited statistic that if healthcare was a country, it would be the fifth largest carbon emitter. At The BMJ we want to change that, and move healthcare towards a more sustainable future.
In this week’s episode, we’ll hear about our annual climate edition from two of The BMJ’s editors, Sophie Cook and Juliet Dobson.
We’ll be diving into Cli-Fi and asking how climate fiction can galvanise our collective response to climate change. Our panel includes Howard Frumkin, professor emeritus at University of Washington. Lakshmi Krishnan, internist and Director of Medical Humanities at Georgetown university, and Sarah Grossman, journalist and author of Fire So Wild.
And Finally, Tereza Kasaeva, director of the WHO’s Global Tuberculosis Programme, explains how migration and food insecurity, exacerbated by climate change, are affecting TB - and why, despite effective treatment, there are still over a million deaths from the disease annually.
Our panel's cli-fi book recommendations
- A Fire So Wild - Sarah Grossman
- The Last Man - Mary W. Shelly
- The Broken Earth - NK Jemisin
- Oryx and Crake - Margaret Attwood
- The Ministry for the Future - Kim Stanley Robinson
- Olga Dies Dreaming - Xóchitl González
- Land of Milk and Honey - C Pam Zhang
- Day of the Triffids - John Wyndham
Links
- The BMJ’s annual climate issue
- Cli-Fi—helping us manage a crisis
- Writing towards a healthier future amid climate disaster
- WISH report - Tuberculosis
Lakshmi’s references
- Fundamental Role of Arts and Humanities in Medical Education
- Capable of being in uncertainties’: applied medical humanities in undergraduate medical education
- The introduction of medical humanities in the undergraduate curriculum of Greek medical schools: challenge and necessity
- The medical humanities at United States medical schools
Getting science into policy for gun control and NHS reform
12 oktober 2024 |
22 min
How science can be transformed into policy?
One of the seemingly intractable issues when it comes to legislative change in the US is gun control. One reason policy change is so difficult, is the US specific evidence vacuum, but that’s beginning to change.
We're joined by Louis Klarevas, an academic at the University of Colombia and author of the book “Rampage Nation, securing america from gun violence" and Shannon Watts, from Moms Demand Action which is a grassroots movement of Americans fighting for public safety measures that can protect people from gun violence.
Even when there is evidence, the trade-offs needed for legislative change can still paralyse policy makers. Citizen assemblies, a form of democratic participation that asks the public for their views, has helped clarify some key healthcare issues, from assisted dying in Jersey, to abortion access in Ireland.
Rebecca McKee from the Institute of Government argues they could be used to fix the NHS, and joins us to explain how.
Reading list
More gun regulation, less firearm harm
Citizens’ assemblies, health, and health policy
Nutrition for health and conflicts of interests
27 september 2024 |
22 min
Under-nutrition harms health, but so does over-nutrition.
The Bill and Melinda Gate’s foundation has just released their Goalkeepers' report - highlighting the detrimental impact that poor nutrition is having on children’s health. Rasa Izadnegahdar, director of Maternal, Newborn, Child Nutrition & Health at the foundation joins us to explain how they are targeting nutritional interventions.
Also this week, a new investigation in The BMJ has found that the UK government’s Scientific Advisory Committee on Nutrition - the people who help guide the UK’s nutrition policy - have competing interests with the food industry. We hear from Chris van Tulleken, University College London; Rob Percival, the Soil Association; and Alison Tedstone, chair of the Association for Nutrition.
Reading list:
UK government’s nutrition advisers are paid by world’s largest food companies, BMJ analysis reveals
Improving data for quality care when resources are stretched
17 september 2024 |
23 min
There's a real drive to strengthen quality of care in facilities around the world. However, no matter where you are, improving healthcare depends on quality data—and collecting and using that data can be challenging without the time and expertise. In this podcast, we explore how different healthcare systems, especially those with limited resources, are tackling the challenge of data collection and use head-on.
The BMJ has partnered with the World Health Organization and the World Bank on a Collection on Quality of Care. This podcast, the second in a series exploring themes from the Collection, features researchers and implementers from Ghana, Qatar, and the US. They share insights on improving and using data in resource-constrained environments, offering valuable perspectives relevant to healthcare systems worldwide facing similar challenges.
Provenance statement:
This podcast is part of a Collection on Quality of Care proposed and funded by the World Health Organization and the World Bank. The BMJ commissioned, edited, and published the podcast. Emma Veitch, Rachael Hinton and Duncan Jarvis were the lead editors for The BMJ.
GPs' industrial action, and the olympians after the games
9 september 2024 |
29 min
The news that GPs in England have voted for industrial action has spooked the healthcare system - Katie Bramall-Stainer, the chair of the BMA's General Practice Committee explains what's lead to this, and why trust in the government has gone.
After the games, olympians and paralympians return to their normal lives - but what does that mean for their healthcare, especially in the US where insurance is expensive? Jonathan Finnoff, chief medical officer for the US Olympic and Paralympic committee joins us to explain how athletes are supported outside the games.
Reading list;
GP leader: “If general practice is the bedrock of the NHS, then the NHS is collapsing”
Multi-cancer detection and NHS HIT Lists
14 augusti 2024 |
26 min
This week we're questioning the effectiveness of the Galleri Test for early cancer detection with investigation authors Margaret McCartney and Deborah Cohen. They delve into the decision-making and politics behind this test's introduction in the UK.
The episode also covers the growing NHS waiting list crisis and how Imran Ahmed and his team at Guy's and St. Thomas' NHS Trust are using high intensity theatre (HIT) lists to increase surgical throughput - and what other teams need to know, if a national rollout of this model is to happen.
Reading list
Are surgical HIT lists the answer to bringing down NHS waiting times?
Ensuring an Olympic legacy, and fixing primary care
26 juli 2024 |
39 min
The Paris games have just started - and France has made a concerted effort to ensure that this year's Olympics will have a legacy of physical activity for the whole population.
However, mega sporting events don't always have that effect, and Fiona Bull, head of physical activity for the WHO, joins us to explain why it's increasingly important that they do.
We'll also hear from Professor Sir Denis Perera Gray about how a lifetime of general practice, and why continuity needs to be at the heart of any improvement to primary care.
Finally, Harry Brunjes went from being a village GP to the chair of English National Opera, and explains what the two careers have in common.
Reading list
Olympic Games: linking sports mega events to population physical activity
The patient issue
13 juli 2024 |
43 min
We celebrate 10 years of patient and public partnership strategy at The BMJ with a patient-centred podcast.
We ask how should the new Labour government engage patients in shaping the future of the NHS. We also dive into the concepts of social care and peer support, and learn from Brazil's experience in social participation.
Highlights:
01:52 - The Patient "takeover"
05:43 - Social care with Charlotte Augst
19:53 - Peer support groups with Claire Reid and Partha Kar
31:48 - WHO’s resolution on social participation with Mark Barone
Reading:
Editor's Choice - Listening to patients at all levels of healthcare, Emma Doble, patient editor
Extending access for breast cancer, and epidural outcomes
1 juli 2024 |
30 min
Women's Health, breast cancer screening, epidurals, and GP voices
New U.S. guideline on breast cancer screening have been extended to women in their 40s - Katy Bell, from the University of Sydney, and Stacy Carter, from the University of Wollongong explain why the good intention of that change wont be mirrored in outcomes - and may even induce harm.
Research in The BMJ shows epidurals during labour can reduce severe maternal morbidity Rachael Kearns describes why analgesia may improve those outcomes, and why some myths about epidurals may be reducing their usage.
Lastly, a GP confronts the Prime Minister on the disintegration of the NHS and its effects on general practitioners.
02:23 Breast cancer screening guidelines
14:00 Epidurals and maternal morbidity
26:42 A GP confronts the Prime Minister
Reading list:
Breast cancer screening from age 40 in the US
Epidural analgesia during labour and severe maternal morbidity: population based study
GP who confronted Rishi Sunak received “hundreds” of supportive messages from doctors
Large, plausible and imminent - time to take H5N1 seriously
14 juni 2024 |
32 min
As increasing numbers of mammalian, and human, cases of H5N1 are documented we askShould we worry about a growing threat from “bird flu”? Wendy Barclay, from Imperial college London, and Christopher Dye, from Oxford University join us to explain why they think we should.
Our commission on the future of the NHS has released a manifesto for a sustainable NHS that still meets it's founding principles. Helen Salisbury, GP and BMJ columnist, joins the podcast to lay it out.
Finally, a musical interlude from the World Doctor's Orchestra.
00:18 H5N1 Bird Flu: Rising Threat 15:35 The manifesto for a better NHS 27:46 World Doctors' Orchestra Reading list; BMJ Editorial - Should we worry about a growing threat from “bird flu”? BMJ Opinion - A manifesto for a healthier NHS, a healthier UKhttps://www.world-doctors-orchestra.org Stay up to date with our daily email alert - https://www.bmj.com/today
Elections and health in India, the UK, and the USA
31 maj 2024 |
30 min
In the UK, a general election has been called - and around the world, ½ the global population will be voting this year; so in this episode we’ll be talking about how elections and health intersect.
Firstly, what are the UK parties’ plans for health? Abi Rimmer, The BMJ's UK features editor joins us with the latest information.
The world’s largest democracy is polling, so how are Indian politicians talking about health? Sanjay Nagral, surgeon and director of the Department of Surgical Gastroenterology at Jaslok Hospital & Research Centre in Mumbai takes us through the campaign promises.
And finally, Jody Heymann is founding director of the WORLD Policy Analysis Center at UCLA and explains why this is the most consequential US election for woman's health in a generation.
01:30 Election Fever and NHS Plans 07:35 Impact of Elections on Health in India 21:20 Women's Health in the US Elections Reading list Feature: The untold health toll of voting Editorial: Workplace rights around pregnancy and childbirth
The prospect of unemployed GPs
10 maj 2024 |
34 min
With the anticipation of a new government in the UK, shadow health secretary Wes Streeting will hit the ground running - with a winter season (and it's inevitable crisis) and ongoing industrial desputes with junior doctors. Elisabeth Mahase ask him about his plans to handle these challenges if elected.
We also find our selves in the puzzling situation of potential GP unemployment in the UK despite a high demand for primary care doctors, Helen Salisbury, GP and columnist for The BMJ explains how we've got into this situation.
Finally, Peter Doshi has been looking at the financial entanglement of FDA heads with the companies they are regulating - 9 of the previous 10 FDA heads have gone on to work for industry in some respect. He has also investigated how complex financial instruments can make these conflicts more opaque.
02:03 Anticipating a New Government and the NHS Winter Crisis
10:50 The Kafkaesque Dilemma of GP Unemployment
23:10 FDA Leaders' Financial Entanglements: A Deep Dive
Reading list
Workforce and winter under Labour: Wes Streeting on his plan for the NHS
Helen Salisbury: No jobs for GPs—we’ll be missed when we’re gone
Fixing healthcare's workforce problems
26 april 2024 |
37 min
Where next for psychological safety? Amy Edmundson is professor of Leadership and Management at the Harvard Business School. Her work on psychological safety has underpinned so much quality improvement, and she joins us fresh of the stage at the International Forum on Quality and safety in healthcare to talk about the next steps in creating a safe work place.
The BMJ has published two new investigations, looking at the alcohol and tobacco industry funding of public health and education - we’ll hear how the companies who create the problems, are now styling themselves as the solution. Rebecca Coombes joins us to explain what The BMJ has found, and May van Schalkwyk, a researcher from the London School of Hygiene & Tropical Medicine, explains how commercial conflicts are shaping the wrong education tactics.
And finally, our NHS commissioners have more recommendations - this time on workforce issues. Mary Dixon-Woods, director of THIS institute at the University of Cambridge, and Matt Morgan, intensive care consultant in Cardiff, tell the NHS to get serious about staffing.
02:03 Amy Edmondson on Future Health and Psychological Safety
10:24 The Impact of Corporate Funding on Public Health
19:57 Addressing NHS Workforce Challenges: Insights and Solutions
Reading list;
Our new podcast - Future Health
International forum keynote - Medscape caves in on courses funded by tobacco giant Philip Morris, while medics fear global push into medical education
Investigation - Big alcohol: Universities and schools urged to throw out industry-funded public health advice
Commission on the future of the NHS - The future of the NHS depends on its workforce
Improving NHS gender identity services - Hilary Cass
12 april 2024 |
38 min
Hilary Cass, the former president of the Royal College of Paediatrics, has spent the last 3 years collating the evidence for treatment of gender questioning young people; engaging with those young people, their families and their clinicians - all with the aim of improving NHS treatment of this complex and vulnerable group.
In this interview, Kamran Abbasi, editor in chief of The BMJ, speaks in depth to Cass about her review - about evidence base for transitioning, but also about the way in which the siloing of care for young trans people has failed them.
They discuss the need to support young people in their journey - Cass is clear that the NHS should allow young people to explore their gender, but that ultimately, that may not mean medical intervention at all.
Reading list
The Cass Review - final report
The systematic review and meta-analyses published in Archives of Disease in Childhood
BMJ Opinion: Gender medicine for children and young people is built on shaky foundations
Derogation, an ultra processed food system, and catch up pay for the NHS
29 mars 2024 |
30 min
Derogation, the way in which striking doctors can be recalled to the ward to protect patient safety, was agreed by NHS England and the BMA. Now, new data The BMJ has uncovered shows that the mechanism was rarely used - and when it was tried, was often rejected. Gareth Iacobucci explains what that means about relations between the government, the NHS, and doctors.
Felice Jacka, director of the Food & Mood Centre at Deakin University, is one of the authors of our recent ultra-processed foods umbrella review - and joins the podcast to talk about the link between diet and health; and why goverments need to pay more attention to the food system.
Finally, John Appleby, senior associate at the Nuffield Trust, and Gillian Leng, dean and president elect of the Royal Society of medicine, have been thinking about healthcare funding, and how more stability is essential in securing the service's future.
Reading list
Ultra-processed food exposure and adverse health outcomes
NHS funding for a secure future
Chapters
00:31 Derogation and doctor strikes 06:59 Ultra processed food producers and health 13:59 Rethinking NHS fundingThe future of the clinical relationship, code sharing, and a Nye-t at the theatre
15 mars 2024 |
37 min
In this week's podcast:
How AI will affect the clinician-patient relationship? Our annual Nuffield Summit roundtable asks how the promise of tech tools stacks up against reality, and how the future of the therapeutic relationship can be protected (participants below).
Your code is as important as your methods, which is why The BMJ now requires you to share it - Ben Goldacre and Nick De Vito, from the Bennett Institute for Applied Data Science at the University of Oxford, explain why it's so important, and how The BMJ's new data and code sharing policy could change research transparency.
Nye Bevin set up the NHS when the UK was in the economic doldrums, and the public's need for care was becoming an emergency - BMJ columnist Matt Morgan has helped turn that story into a play, currently showing at the National Theatre; and reflects on the parallels between now and then.
1:58 Nuffield Summit roundtable
17:32 New BMJ rules on data and code sharing
29:03 Aneurin "Nye" Bevan play
Taking part in our roundtable were:
-
Rebecca Rosen, Senior Fellow at the Nuffield Trust and GP
-
Juliet Bouverie, CEO of The Stroke Association
-
Daniel Elkeles, CEO of London Ambulance Service
- Neil Sebire, Professor and Chief Research Information Officer at Great Ormond Street Hospital
How is technology changing clinician-patient relationships?
Mandatory data and code sharing for research published by The BMJ
Retracting abortion papers, deafness in the clinic, and 70 years of a medical orchestra
1 mars 2024 |
39 min
The U.S. Supreme Court is hearing a case on the approval of mifepristone for medical abortion - a case which could change the availability of the drug in the US, and which hinges on papers linking abortion to mental distress. However, those papers are contested (including a paper published by BMJ), and some have been retracted already - Julia Littell and Antonia Biggs tell us how that science is being used in court, and why retraction is essential.
Awakening from anaesthetic is difficult enough, but imagine you're three and only communicate through sign language - which no one can understand. We hear from Kirsten, a mother who thinks everyone should learn at least a few key sign language phrases.
Finally, the London Medical Orchestra is turning 70 - having had their start in The BMJ's letters pages. Stuart Delve and Peter Gough help explain the orchestra's longevity.
01:00 The Supreme Court Case on Medical Abortion
10:27 The Role of Journal Editors in Scientific Integrity
19:54 The Impact of Deafness on Patient Experience
30:57 The Joy of Music in a Medical Career: London Medical Orchestra
References
Analysis: Correcting the scientific record on abortion and mental health outcomes
WYPIT: The importance of British Sign Language
London Medical Orchestra's 70th anniversary concert - 6:30pm, Sun, 10 Mar 2024
Heidi Larson on misinformation, the right exercise to reduce depression, and Breathtaking TV
16 februari 2024 |
35 min
Social media, and the rate at which the online world is changing, is worrying - especially the speed at which health disinformation can speed around the globe. We look to tech companies for a solution to the problems of their own making - but Heidi Larson, director of the Vaccine Confidence Project, and professor of anthropology, risk and decision science at LSHTM, joins us to explain why we should be cautious about focussing our attention there.
Next on the podcast, research just published in The BMJ looks at the efficacy of exercise at controlling depressive symptoms - but helps finally answer the key question - which exercise works best. Lead author, Michael Noetel, senior lecturer in psychology at the University of Queensland, joins us to explain the research, and how well exercise stacks up against pharmacological treatments.
Finally, while it’s tempting to try and put the pandemic behind us, its effects linger - and many healthcare staff are still dealing with their experience of that time. Rachel Clarke, a palliative care doctor in the UK, joins us to explain why she has felt the need to document the pandemic, first in a book and now in a new TV drama set to air in the UK next week.
06:15 Heidi Larson on vaccine confidence and social media
15:31 Exploring the effectiveness of exercise for depression
26:56 Rachel Clark on seeing her experiences reflected on screen
Reading list
BMJ Collection: How are social media influencing vaccination
Feature: Medical misinformation on social media—are the platforms equipped to be the judge?
Research: Effect of exercise for depression
A health and care emergency, the US constitutional weakness for pandemic response, ActionAid in conflict zones
2 februari 2024 |
40 min
With a new logo, and new music, comes a revamped The BMJ Podcast.
Every two weeks we’ll be bringing you a magazine style show, more variety and perspectives on medicine, health, and wellbeing.
In this episode:- Former chief executive of the NHS, Nigel Crisp, explaining why the UK is facing a national health and care emergency (01:22)
- The guest editors of our US covid series, Gavin Yamey and Ana Diez Roux, discuss the US pandemic response, and how problems are built into the US constitution (19:48)
- How The BMJ’s ActionAid appeal will help people in Gaza, Syria and Somalia (33:06)
Christmas 2023 - performing medicine, and prescribing nature
22 december 2023 |
34 min
In this festive edition of the BMJ podcast, we hear about what medicine can learn from music, when it comes to giving a convincing performance, and how we can grow an evidence base for nature prescribing.
Professors Roger Kneebone and Aaron William of the Centre for Performance Science raise the curtain on the performance of medicine, and we hear what your consultation technique could learn from a hairstylist.
Ruth Garside, Professor of Evidence Synthesis, Kerryn Husk, Associate Professor of Health Sciences and Edward Chapman from the Health and Environment Public Engagement Group then discuss 'nature prescribing', and wonder about how to balance maintaining the joy derived from nature and yet create an evidence base for the medicinal benefits associated with it.
Reading list
00:13 Introduction to the BMJ Podcast
00:36 Exploring the Themes of the Christmas Edition
01:38 The Intersection of Medicine and Performance
02:33 The Art and Science of Performance in Medicine
05:04 The Role of Performance in Music
06:29 The Similarities Between Medicine and Music
08:06 The Role of Experiential Learning in Performance
14:11 The Impact of Audience on Performance
19:04 The Benefits of Nature and Green Prescribing
24:52 The Challenges of Measuring the Impact of Nature Prescribing
30:37 The Community's Engagement with Nature Prescribing
33:01 Conclusion and Farewell
Oxytocin, clinical outcomes, and patient choice, in resource constrained settings
21 december 2023 |
40 min
There’s an inherent tension between creating quality standards that are very clinically focussed, and standards which are very patient centred - especially in settings where clinical outcomes can be compromised by basic lack of resources.
The use of oxytocin to prevent bleeding after birth is an example of this - WHO quality guidelines clearly measure and incentivise use of the drug, but in more wealthy healthcare systems, adherence patient preference is the key measure.
How can we ensure that less wealthy healthcare systems are also patient centred?
Our guests for this discussion;
Nana Twum-Danso, senior vice president, Institute for Healthcare Improvement (IHI)
Paul Dsane-Aidoo, health specialist, UNICEF Ghana
Keith Cloete, head of department at Western Cape Government: Health
Hosted by Emma Veitch, Collections editor for The BMJ
This podcast is part of The BMJ Quality of Care collection, in collaboration with the World Health Organization and the World Bank, which offers critical thinking on both the unfinished agenda and emerging priorities for improving quality of care in low- and middle-income countries.
00:00 Introduction to the podcast
00:48 Introduction of experts and their backgrounds
02:54 Challenges in healthcare systems: south africa's perspective
04:15 The importance of patient-centred care
04:56 The role of data in improving quality of care
06:11 Community engagement and feedback in healthcare
07:58 Tackling global disparities in healthcare
08:41 Balancing clinical outcomes and patient-centred care
10:58 Addressing inequities in healthcare
22:43 The role of governance in improving quality of care
32:56 Overcoming resource constraints in healthcare
36:22 The need for system redesign in healthcare
37:18 Adapting to changing times in healthcare
Social connection is essential for health; supporting adolescent health and wellbeing
14 december 2023 |
48 min
In this specially curated three-part podcast series from The BMJ, we explore the importance of community and connection to foster adolescent wellbeing.
The discussion covers athe wide array of issues young people face, with a particular focus on the unique challenges of adolescence from a social perspective. The episode unpacks the significance of having supportive relationships within families, schools, and communities and the influence of these relationships on the mental and behavioural health outcomes of adolescents.
It also explores the impact of digitalization on adolescent connection, with discussions on how to balance online interactions with offline engagements. Importantly, it highlights the need for further research into understanding digital and social media interactions and their influence on the health and wellbeing of adolescents in a rapidly evolving digital landscape.
Our guests:
Ulises Ariel Vélez Gauna, Transmitiendo Diversidad
Flavia Bustreo, Fondation Botnar
Richard Dzikunu, YIELD Hub
Shelani Palihawadana, Young Experts Tech for Health.
Joanna Lai, United Nations International Children’s Emergency Fund (UNICEFUnicef)
Hosted by Adam Levy
Supported by the Fondation Botnar and PMNCH, the Partnership for Maternal, Newborn, and Child Health. Read the full cCollection of articles showing the importance of investing in adolescent wellbeing.
00:04 Introduction to the podcast series
00:36 Understanding adolescence from a social perspective
01:00 The impact of community and connection on adolescents
01:07 Personal experiences: growing up as an LGBT+ teenager
01:38 The role of supportive relationships in adolescents' lives
02:05 The importance of connectedness in adolescence and beyond
03:27 Treating safe spaces for LGBT+ adolescents
05:23 The unique role of community during adolescence
07:02 The impact of political landscape on LGBT+ community
07:54 The importance of community and connectedness: expert opinions
08:56 The interconnection of social, health, and educational well-being
12:14 The role of digital technology in adolescents' lives
16:56 The importance of investing in adolescents' well-being
43:18 The role of schools in fostering connectedness
45:41 Conclusion: personal reflections on connectedness
Give children control; supporting adolescent health and wellbeing
14 december 2023 |
45 min
This is the second episode of a special three-part podcast series that delves into adolescent health and wellbeing, focusing on creating a positive trajectory of health from a young age.
The podcast explores physical and mental health issues affecting young people globally, particularly in sexual and reproductive health. We hear how young people are excluded from decisions about their own health, and how grassroots groups around the world are empowering them to take responsibility for their own wellbeing.
We also hear how young people are becoming leaders in social movements, from tackling structural racism to improving nutrition in schools, and how their unique perspectives are vital in making those changes.
Our guests:
Natasha Salifyanji Kaoma, Copper Rose Zambia
Alaa Murabit, The Bill and Melinda Gates Foundation
Donald Bundy, London School of Hygiene and Tropical Medicine
Anshu Banerjee, World Health Organisation
Dev Sharma, Bite Back 2030
Hosted by Adam Levy
Supported by the Fondation Botnar and PMNCH, the Partnership for Maternal, Newborn, and Child Health. Read the full cCollection of articles showing the importance of investing in adolescent wellbeing.
00:05 Introduction to adolescent health
01:00 Young womens’ menstrual health
02:11 Discussion on candid pride project
03:29 Importance of sexual and reproductive health
04:49 The role of young people in health advocacy
06:17 The epidemiology of early health and lifecourse
10:08 Impact of adolescent health on future generations
18:29 How young people become activists
28:51 Advocacy for women in Libya
28:54 Global forum for adolescents
40:15 Success stories
44:54 Conclusion and preview of next episode
It’s time for an educational revolution; supporting adolescent health and wellbeing
14 december 2023 |
46 min
In the final episode of this three-part podcast series from The BMJ, we dive into the vital topic of education for adolescents and how it influences the course of life.
This podcast explores barriers, burdens and possibilities of change in the educational system to better support young people, and how the traditional system of schooling is failing to equip young people with the skills and knowledge to lead healthy lives.
We also hear how the value of informal education and its impact on subjects ranging from health to gender equality, and that learning isn’t limited to young people, and the intergenerational benefits of education and its role in shaping societal norms and individual health.
Our guests;
Maziko Matemvu, Uwale
Joanna Herat, UNESCO
Janani Vijayaraghavan, Plan Canada
Atika Ajra Ayon, Plan International
Stefan Germann, Fondation Botnar
Hosted by Adam Levy
Supported by the Fondation Botnar and PMNCH, the Partnership for Maternal, Newborn, and Child Health. Read the full cCollection of articles showing the importance of investing in adolescent wellbeing.
00:03 Introduction to the podcast
00:11 The importance of education for adolescents
03:26 The role of education in health and wellbeing
04:43 The impact of education on society
10:21 The power of peer education
11:15 The role of media in education
12:31 The importance of meaningful engagement in education
14:45 The impact of education on health
17:48 The challenges in access to education
26:25 The role of education in combating child marriage
36:37 The impact of climate change on education
44:53 The role of education in mental wellbeing
45:59 Conclusion of the podcast
Insulin without refrigeration and the complexities of consent
12 december 2023 |
41 min
The December edition of the Talk Evidence podcast discusses the complexities of seeking consent from patients who are part of large data sets, and some new research to help patients living with diabetes in places without certain power supplies.
First patient consent and data - in the UK, two stories that have made the public worry about the use of their health data. Firstly the news that UK biobank, who hold a lot of genomic and health data, allowed research by an insurance company, and second that the NHS has entered a contract with Palentir to do analysis on NHS data.
Natalie Banner, director of ethics at Genomics England has been thinking hard about putting patients at the centre of decision making about their data, and explains why she thinks a sole reliance on a consent model falls short.
Next, uncertain power supplies, such as in conflict or disaster zones, means uncertain refrigeration. Hard enough for most people to survive, but if you need to keep your insulin cold, it can be lifethreatening. However a new cochrane review has found good news about the thermostability of insulin at room temperature.
We ask Phillipa Boulle, MSF Intersectional NCD Working Group Leader and Cyrine Farhat,is a global diabetes advocate based in Lebanon, how this will affect care for patients around the world.
Reading list
Thermal stability and storage of human insulin
Outline
00:06 introduction and overview
00:24 the challenge of seeking consent in big data sets
01:34 understanding consent issues in large datasets
01:52 the role of participant panels in data accountability
02:44 the complexity of public attitudes towards data use
04:54 the importance of transparency and engagement in data use
05:48 the impact of external factors on public trust in data use
07:49 the ethical challenges of using health data
09:17 the limitations of consent in ethical discussions
09:23 the need for more conversation about group benefits, risks, and harms
10:41 the role of governance in ethical decision making
12:05 discussion on the interview with natalie banner
14:59 the challenge of managing chronic conditions in disaster zones
15:15 the impact of temperature and storage conditions on insulin
17:32 interview with Philippa Boulle from medecins sans frontieres
29:10 interview with Cyrine Farhat, a person living with diabetes in lebanon
36:18 discussion on the interviews and the challenges of diabetes management
The future of the winter ’flu season
1 december 2023 |
39 min
We were accepting of an increase in deaths every winter 'flu season, but Ashish Jha thinks that is not longer a tenable position.
Lessons he learned during his time as the White House Covid-19 coordinator have convinced him we should be taking a different approach to the winter season.
In this interview with Mun-Keat Looi, The BMJ's international features editor, we hear about living with COVID, the future of antivirals, vaccines, and surveillance. They talk about long COVID, the investment required to fight future outbreaks effectively, and the role of the US in the global health response.
Low carb and cancer screening
6 november 2023 |
33 min
Each episode of Talk Evidence we take a dive into an issue or paper which is in the news, with a little help from some knowledgeable guests to help us to understand what it all means for clinical care, policy, or research.
In this episode:
Helen Macdonald take a deep dive into cancer screening tests, prompted by a paper in JAMA which showed most have no effect on all cause mortality, and news that the NHS is evaluating a single test which screens for 50 common cancers - we ask Barry Kramer, former director of the Division of Cancer Prevention, at the U.S. National Cancer Institute to help explain how to hold those two pieces of knowledge.
Juan Franco has been looking into diet and obesity, prompted by new research in The BMJ and a new Cochrane review, looking at the role of low glycemic index foods in weightloss - we ask Khadidja Chekima, nutritional researcher at Taylor’s University in Malaysia, to define low GI foods, and why it’s so hard to research their role in diet and weightloss
Reading list;
JAMA research - Estimated Lifetime Gained With Cancer Screening Tests; A Meta-Analysis of Randomized Clinical Trials
The BMJ news - Clinicians raise concerns over pilot of blood test for multiple cancers
The BMJ research - Association between changes in carbohydrate intake and long term weight changes: prospective cohort study
Cochrane review - Low glycaemic index or low glycaemic load diets for people with overweight or obesity
Decolonising health and medicine: Episode 5 - Getting our house in order: Decolonising the British Medical Association
17 oktober 2023 |
46 min
Organisational and student leaders explore the responsibilities of the British Medical Association and The BMJ to understand and respond to its colonial history.
Our panel
- Kamran Abassi, editor in chief, The BMJ, London, UK
- Omolara Akinnawonu, Foundation year doctor, Essex, UK, and outgoing co-chair of the BMA medical students committee
- Latifa Patel, elected chair of the UK BMA's Representative Body and BMA EDI lead
- Host - Navjoyt Ladher, clinical editor for The BMJ
Decolonising health and medicine: Episode 4 - How to transform global health institutions born of colonial eras
17 oktober 2023 |
54 min
Leaders from academic and funding organisations discuss the transformative change required to overcome extractive and inequitable research practices in global health, and the need for examining power and privilege within traditional research institutions.
Our panel
- Samuel Oti, senior program specialist, International Development Research Centre, Ottawa, Canada, and member of the Global Health Decolonization Movement in Africa (GHDM-Africa)
- Muneera Rasheed, clinical psychologist and behaviour scientist and former faculty, Aga Khan University, Karachi, Pakistan
- Liam Smeeth, professor of clinical epidemiology and director of the London School of Hygiene and Tropical Medicine, London, UK
- Angela Obasi, senior clinical lecturer, Liverpool School of Tropical Medicine, UK
- Seye Abimbola, editor of BMJ Global Health, and health systems researcher from Nigeria currently based at the University of Sydney, Australia
- Jocalyn Clark, international editor, The BMJ, London, UK
- Host - Navjoyt Ladher, clinical editor for The BMJ
Decolonising health and medicine: Episode 3 - Common terrains of anti-colonial and feminist approaches to the politics of health
17 oktober 2023 |
50 min
International health leaders discuss how feminist and decolonial advocates in health face similar resistance and attempts to sow divisiveness, and how they can join forces to promote health equity and justice for all.
Our panel
- Raewyn Connell, sociologist and professor emerita at the University of Sydney, Australia
- Sarah Hawkes, professor of global public health and director of the Centre for Gender and Global Health, University College London, UK
- Sanjoy Bhattacharya, head of the school of history and professor of medical and global health histories, University of Leeds, UK
- Asha George, professor and South African research chair in health systems, complexity, and social change, University of the Western Cape, South Africa
- Host - Navjoyt Ladher, clinical editor for The BMJ
Decolonising health and medicine: Episode 2 - Looking back to move forward: missing histories of the decolonisation agenda
17 oktober 2023 |
54 min
Experts discuss how failing to confront colonial pasts is linked to present lack of progress in global health equity, why health leaders need historical educations, and how, for Indigenous peoples, it’s not just a colonial history but a colonial present.
Our panel
- Seye Abimbola, editor of BMJ Global Health, and health systems researcher from Nigeria currently based at the University of Sydney, Australia
- Catherine Kyobutungi, Ugandan epidemiologist and executive director of the African Population and Health Research Center, Nairobi, Kenya
- Sanjoy Bhattacharya, head of the school of history and professor of medical and global health histories, University of Leeds, UK
- Chelsea Watego, professor of Indigenous Health at Queensland University of Technology, Australia
- Host - Navjoyt Ladher, clinical editor for The BMJ
Decolonising health and medicine: Episode 1 - The colonial legacy in clinical medicine
17 oktober 2023 |
52 min
Healthcare leaders discuss the ways in which colonial-era bias and eugenics persist in today’s medical education and clinical practice in the UK and beyond, and what meaningful change is required to overcome racial and other healthcare inequalities
Our panel
- Annabel Sowemimo, sexual and reproductive health registrar and part-time PhD student and Harold Moody Scholar at King’s College London, UK
- Thirusha Naidu, head of clinical psychology, King Dinuzulu Hospital, and associate professor, Department of Behavioural Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Subhadra Das, UK based researcher and storyteller who specialises in the history and philosophy of science, particularly scientific racism and eugenics
- Amali Lokugamage, honorary associate professor, Institute of Women's Health, University College London, and consultant obstetrician and gynaecologist, Whittington Hospital, London, UK
- Host - Richard Hurley, collections editor at The BMJ
Planet centred care - How to talk about this stuff
14 oktober 2023 |
53 min
We’ve heard throughout the series from people who have a passion for sustainability, and have successfully made changes in their organisations to reduce the planetary impact of their work. In doing so, they will have recruited other people who have a similar outlook - but they will have also convinced people who aren’t prioritising sustainability.
In this last podcast of the series, we’re delving into that - how to talk to colleagues and patients, in ways which connect with their own needs and preferences.
To help with that, we’re joined by David Pencheon, director of the Sustainable Development Unit for NHS England, who’s been successfully talking about these issues for years, and Kate Wylie, executive director of Doctors for the Environment Australia.
Planet centred care - Why doing less can be hard
6 oktober 2023 |
50 min
One element of sustainable healthcare is simply reducing the amount of healthcare you’re doing by not doing the things that are of no value to patients. However, how do we do this in practice? And why is it often so hard? What is the role of fear in this discussion? These are all questions we will discuss in this episode.
To help us with this we’ll be joined by Prof Ben Newell (cognitive psychologist from University of New South Wales, whose research interest includes judgement and decision making). and Dr Lucas Chartier, emergency medicine physician at the University Health Network in Toronto.
Ben Newell also has also recently released a book, Open Minded, co-authored with David Shanks on the role of the unconscious mind in our decisions making
Planet centred care - Sustainable healthcare is better for patients
2 oktober 2023 |
38 min
Acting on climate change is often framed as having to give stuff up, to cost more money, to make sacrifices. Yet in healthcare we find the opposite can often be true: there are many actions we can take which reduce the carbon footprint of healthcare which actually end up with better outcomes for our patients. In this episode, we hear from two examples of that.
Singing for breathing is a type of social prescribing to help people with chronic lung disease manage their breathlessness, reducing their need to be reliant on healthcare to do this, while also finding joy and a sense of community. Stephen is one patient who has benefited from this service, and will tell us more about the impact it had on his life.
In another example, Lynn Riddell, an HIV consultant will tell us how a change in their clinical pathway helped a cohort of patients reduce the amount of travelling to and from the clinic, still manage their condition safely and give them back precious time and control.
https://www.bartscharity.org.uk/our-news/singing-sessions-to-improve-patients-lung-health/
Planet centred care - Sustainable healthcare is good for staff
22 september 2023 |
55 min
Ooops! If you listened to episode 3 when it first came out you may have realised that the title didn't quite match the content. We've just updated the title and the show notes below, and stay tuned for when we'll be soon releasing an episode on how sustainable healthcare can be good for patients.
In a system where healthcare workers are continually described as overworked and burnt out, how can we expect them to find the time to act on the climate? In this episode we turn that assumption on its head, and, in fact, show how acting to reduce the environmental impact of healthcare can help staff find joy in their work again. Our two guests today are Tracy Lyons, founder of Pharmacy Declares and medicines optimisation pharmacist in Dorset, UK, and David Smith, general surgeon at North York General Hospital in Toronto, Canada.
The very worst thing is sometimes to have a problem you feel you can’t solve, and action mitigates anxiety: these are two of the many lessons that came out of today’s episode. We also touch on the different levels that you can start to take action at: from the small and tangible to influencing change at a system level.
Related links:
Talking overdiagnosis
16 september 2023 |
36 min
In this month's Talk Evidence, Helen and Juan are reporting from Preventing Overdiagnosis - the conference that raises issues of diagnostic accuracy, and asks if starting the process of medicalisation is always the right thing to do for patients.
In this episode, they talk about home testing, sustainability and screening. They're also joined by two guests to talk about the overdiagnosis of obesity - when that label is stigmatising and there seem to be few successful treatments that medicine can offer, and the need to educate students in the concepts of overdiagnosis and too much medicine, to create a culture change in medicine.
Links;
The Preventing Overdiagnosis conference
The BMJ EBM papers on choosing wisely.
Planet centred care - Greening the gaze
31 augusti 2023 |
45 min
Planet centred care is new podcast series for the BMJ exploring issues related to environmentally sustainable healthcare, aimed at all clinicians, and anyone working in healthcare, who want to make sure they can continue to help patients while not harming the planet.
In this episode we’ll discuss that first radicalising moment. That moment where you start to see all the things you can do to make healthcare more sustainable and how it is hard to un-see that. For everyone, that moment may come from a different place, or different perspective.
Our guests for this episode:
Gareth Murcutt who was at first reluctant until he saw the size of the impact he could make; Gwen Sims whose eyes were opened by moving health systems (and continents) and Alifia Chakera who didn’t expect to find a huge sustainability saving so close to home when she took up a new clinical role before the pandemic.
Hosts:
Loren De Freitas and Florence Wedmore, the BMJ
Planet centred care - It’s all about working together
31 augusti 2023 |
43 min
Healthcare is a complex system, and if we want to make changes such as those needed for sustainable healthcare, we need to work across multiple teams, and make sure we hear everyone’s voice, including our patients’. In this episode we’ll discuss how we can communicate and work with those different groups, and some novel ways of getting the message across from T-rexes worth of plastic gloves to art made out of surgical waste.
Guests for this episode:
Nicola Wilson, lead clinical educator, Great Ormond Street Children’s hospital, and Maria Koijck, artist and former patient. You can read more about the Gloves are Off project here https://www.gosh.nhs.uk/news/gloves-are-off/
You can see Maria’s film here: https://www.mariakoijck.com/
The problem with trainees - The GMC’s National Training Survey results data
17 augusti 2023 |
50 min
In our final episode of this season, we're going quantitative, with the newly released data on how trainees in the UK are faring.
Each year the UK's General Medical Council, the doctor's regulator, surveys trainees in the NHS to ask them questions about stress and burnout, harassment and discrimination, and how well supported they feel in their training. They also ask trainers about the same things.
Unsurprisingly, the year the results look bad - with increasing levels of burnout across the board, but particularly in new trainees. At the same time trainers are feeling unable to use their time supporting learning, and instead are propping up the system.
To discuss this, Clara Munro and Ayisha Ashmore are joined by Colin Melville, medical director, and director of education and standards, at the GMC.
All the data discussed, and the interactive tool that Colin mentions, are available on the GMC's National training survey 2023 results page.
Ensuring the integrity of research, and the future of AI as authors
5 augusti 2023 |
45 min
In this month's Talk Evidence, we're getting a little meta - how do we keep an eye on research to make sure it's done with integrity. Helen Macdonald is BMJ's Publication ethics and content integrity editor - and we quiz her about what that actually means on a day to day basis.
Ensuring the integrity of research could be made both easier, and harder, by the ascendance of large language models, Ian Mulvany, BMJ's chief technology officer joins us to talk about how we can harness the power of this new technology.
Taking on the van Tullekens; how Margaret McCartney changed their minds about COIs
28 juli 2023 |
54 min
They're the trusted public figures of the medical profession, but many of the most famous medics in the UK will have been approached by, and accepted money from, companies wishing to promote their products - and the public will never know.
To talk about conflicts of interest in media doctors, we’re joined by two of the most recognisable medics on our screens - Chris and Xand van Tulleken, and the GP who persuaded them to think about what they receive cash for, Margaret McCartney.
Read our investigation into how the UK's medical royal colleges receive millions from drug and medical devices companies and Margaret McCartney's plea that “You have to be above reproach”: why doctors need to get better at managing their conflicts of interest
Talk Evidence - post pandemic pruning, breast cancer screening, and orphan drugs
30 juni 2023 |
37 min
In this episode of Talk Evidence, Helen Macdonald, Joe Ross, and Juan Franco are back to update us on what's happening in the world of medical evidence.
Firstly, the news about the end of the covid-19 pandemic was trumpeted, but the changes to research funding have been more quite - and the team discuss what this means for ongoing work to understand the effects of covid, but also in terms of preparedness for the next pandemic.
Next, breast cancer screening recommendations, in the USA, have been reduced from women over the age of 50, to those over the age of 40. We discuss the modelling study which lead to that recommendation change, and what the consequence may be in terms of overdiagnosis.
Finally, 40 years ago, the U.S. Orphan Drug act was passed to encourage the development of treatments for rare conditions - but new research looks at how many clinically useful drugs have come onto market, and an analysis examines the way in which the system could be gamed by narrowing disease definitions to create small populations of patients.
Reading list
Is the UK losing its world leading covid surveillance network just when it needs it most?
Breast cancer: US recommends women start screening at 40
Pride in healthcare
18 juni 2023 |
48 min
We're in pride month, and this year the celebration of LGBT+ people seems to be increasingly contentious. Healthcare's treatment of queer people has improved hugely since the days when being gay was considered a mental disorder, and would end a doctor's career - but that doesn't mean that everything is equal.
In this episode of Doctor Informed, we're hearing from two doctors who are out and proud at work, about what it's been like to be queer in medicine, and what good allyship looks like.
Our Guests
Michael Farqhuar is consultant in sleep medicine at the Evelina London Children's Hospital, he also helped set up the NHS Rainbow badge scheme.
Greta McLachlan is a general surgical trainee, and member of the Royal College of Surgeon's Pride in Surgery Forum
Doctor Informed - surviving in scrubs
26 maj 2023 |
60 min
The culture which allows sexism to perpetuate in healthcare is no better illustrated than by The BMJ's investigation into sexual abuse in the NHS.
However, The BMJ are not the first organisation to highlight the problems - Surviving in Scrubs have been collating stories of sexism in healthcare, and making waves about the issues for a while.
In this episode of Doctor Informed, Clara Munro is joined by the founders of Surviving in Scrubs, to discuss their campaign, how to create a culture of zero tolerance for sexism at the ward level, and why they think sexism should be a professional issue.
Our guests;
Becky Cox is an academic GP researching domestic abuse and GP specialist in gynaecology in Oxford.
Chelcie Jewitt is an emergency medicine trainee in Liverpool.
Bron Biddle, founder of Ambulance Voices, and an employee in the ambulance service.
Links;
https://www.bmj.com/me-too-investigation
Previous Doctor Informed interview with Baroness Helena Kennedy
Talk Evidence - cloning, reporting, and disseminating
5 maj 2023 |
47 min
Helen Macdonald, Juan Franco, and Joe Ross are back with our monthly update on the world of evidence based medicine.
This episode delves into new methodologies which can use observational data to emulate trial data. We discuss a new systematic review and meta-analysis of RCTs for surgical treatment of sciatica. There is elaboration and explanation of the CONSORT Harms 2022 statement - and we'll be asking if it goes far enough. Finally, the old chestnut of surrogate endpoints in cancer treatment trials - are benefits communicated to patients accurately?
Reading list;
Nirmatrelvir and risk of hospital admission or death in adults with covid-19: emulation of a randomized target trial using electronic health records - https://www.bmj.com/content/381/bmj-2022-073312
Surgical versus non-surgical treatment for sciatica
https://www.bmj.com/content/381/bmj-2022-070730
CONSORT Harms 2022 statement, explanation, and elaboration
https://www.bmj.com/content/381/bmj-2022-073725
Funders crack down on unpublished clinical trials—but is it enough?
https://www.bmj.com/content/381/bmj.p840
Communication of anticancer drug benefits and related uncertainties to patients and clinicians
https://www.bmj.com/content/380/bmj-2022-073711
Addiction in doctors
21 april 2023 |
59 min
Everyone has coping mechanisms, but sometimes those ways of coping become problem behaviours - addictions.
In this episode of Doctor Informed, we're focussing on how to spot the signs that you may be sliding into addiction, how to have conversations with friends and colleagues if you worry about their behaviour, and how seeking treatment is the best way to avoid GMC scrutiny.
Joining Clara Munro are Liz Croton and Zaid Al-Najjar, GPs who work for NHS Practitioner health - a mental health and addiction service specifically for health professionals. They are also joined by Ruth Mayall, a retired consultant anaesthetist who has experienced addiction herself, and has contributed to the Association of Anaesthetists guidance on drug and alcohol abuse.
Some resources mentioned in the podcast;
NHS Practitioner Health
https://www.practitionerhealth.nhs.uk/
The Sick Doctor's Trust
http://sick-doctors-trust.co.uk/
British Doctors & Dentists Group
https://www.bddg.org/
Substance use disorder in the anaesthetist
https://anaesthetists.org/Home/Resources-publications/Guidelines/Substance-use-disorder-in-the-anaesthetist
Substance abuse in anaesthetists
https://academic.oup.com/bjaed/article/16/7/236/2196385?login=false
Talk Evidence - automatic approval, evidence apps, and pay for performance data
30 mars 2023 |
40 min
In this month’s Talk Evidence, Helen Macdonald, Juan Franco and Joseph Ross are back to talk us through some of the latest research,
They’ll talk about pay-for-perfomance schemes, and whether the data they routinely collect is measuring outcomes or tickboxes. They’ll also talk about a new analysis published on bmj.com which suggests ways in which that data could be better.
We’re also by Huseyin Naci, associate professor of health policy at the London School of Economics and Political Science, who will tell us about proposed changes to drug regulation in the UK - and we discuss research which has linked speedier regulatory approval to more adverse advents in post marketing studies.
Finally, we talk about point of care apps. The availability of medical information in the clinic has changed practice, but how good is that information? We hear about research which has evaluated those point of care apps (including BMJ’s Best Practice app) and rates them against different criteria.
Reading list
Estimated impact from the withdrawal of primary care financial incentives on selected indicators of quality of care in Scotland
https://www.bmj.com/content/380/bmj-2022-072098
How can we improve the quality of data collected in general practice?
https://www.bmj.com/content/380/bmj-2022-071950#
UK to give “near automatic sign off” for treatments approved by “trusted” regulators
https://www.bmj.com/content/380/bmj.p633
Smartphone apps for point-of-care information summaries
https://ebm.bmj.com/content/early/2023/03/14/bmjebm-2022-112146
Nappuccinos and circadian rhythms
24 mars 2023 |
53 min
Fatigue can have as much of an affect in your ability to function as alcohol, and yet while you would be chastised for drinking before appearing on the ward, hospitals have systematically removed the spaces where tired clinicians can rest and recover.
The Royal College of Anaesthetists have been campaigning to raise awareness of the dangers of fatigue, and it seems that anaesthetic trainees have benefitted from that, with sleep pods and flexible schedules - but other specialties are lagging behind.
In this podcast, Roo McCrossan, a consultant anaesthetist joins our host Clara Munro, a surgical trainee, and Ayesha Ashmore, obstetric trainee, to talk about how to fight fatigue. They discuss circadian rhythms, what to eat, nappuccinos, and why trusts should make more sleeping spaces.
For more information about fighting fatigue;
https://anaesthetists.org/Home/Wellbeing-support/Fatigue/-Fight-Fatigue-download-our-information-packs
Why guideline authors need to pay attention to doctor’s time
10 mars 2023 |
45 min
We're bringing you an episode of the BMJ's podcast for primary care, Deep Breath In, which we think you'll enjoy.
How long would it take GPs to enact all of the guideline recommendations that they might be expected too? Far more GP hours than exist in any healthcare system; but as medicine has turned its attention to primary prevention, and expanded the populations whose health we seek to improve, those guidelines are taking up more and more time.
A recent analysis in The BMJ has proposed the concept of “Time Needed to Treat” - and implores guideline makers to take account consultation time as a precious, finite, resource when thinking about their recommendations.
In this episode of Deep Breath In, we’re joined by Minna Johansson, family doctor and director Global Center for Sustainable Healthcare, who co-authored that analysis to talk about how the concept has gone down, and what it might mean for rethinking what primary care is supposed to do.
Reading list:
Guidelines should consider clinicians’ time needed to treat
https://www.bmj.com/content/380/bmj-2022-072953
Nuffield Summit 2023 - healthcare needs flexible working
3 mars 2023 |
44 min
As workforce gaps in the NHS, and other healthcare systems around the world widen, the need to improve staff retention has become an ever more pressing concern. Yet work-life balance issues continue to drive staff away from the service.
What is the imperative to get flexible working right, and what can be done to remove the barriers facing healthcare workers seeking to change the way they work?
Joining us in the discussion are;
Kamran Abbasi, editor in chief of The BMJ
Rachel Hutchings, fellow at the Nuffield Trust
Sarah Sweeney, interim chief executive, National Voices
Farzana Hussain, a GP in Newham, London
Thea Stein, chief executive of Leeds Community Healthcare NHS Trust
The report that Rachel Hutchings has authors is summaried in a BMJ feature - Challenges of combining a career in surgery with parenting https://www.bmj.com/content/380/bmj.p449
Talk Evidence - masks, chronic pain, and baby milk formulae claims
24 februari 2023 |
38 min
In this episode of Talk Evidence, Helen Macdonald is joined by Juan Franco and Joe Ross, to bring you the newest evidence in The BMJ.
First, chronic pain. As prescribers move away from opioids, Juan finds an overview of systematic reviews asking whether anti-depressants might help.
Joe finds new research on the link between six healthy lifestyle markers and cognitive decline.
Helen looks at a trial to reduce prescribing among older people with suspected urinary tract infection or UTI.
Juan has a nuanced take on the updated evidence on masks to reduce the spread of respiratory viruses.
Finally, an international group of researchers traced the health claims made about infant formula milk back to the evidence or lack of it
Reading list:
Efficacy, safety, and tolerability of antidepressants for pain in adults
https://www.bmj.com/content/380/bmj-2022-072415
Association between healthy lifestyle and memory decline in older adults
https://www.bmj.com/content/380/bmj-2022-072691
Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults
https://www.bmj.com/content/380/bmj-2022-072319
Physical interventions to interrupt or reduce the spread of respiratory viruses
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full
Health and nutrition claims for infant formula
https://www.bmj.com/content/380/bmj-2022-071075
Got grit?
10 februari 2023 |
54 min
Grit is one of those concepts (like the dreaded resilience) that has a specific meaning, but has become a buzzword in healthcare.
It’s the ability to persevere in the pursuit of a goal, in the face of obstacles - and it’s something all doctors have.
However that trait has benefits and drawbacks. It’s not necessarily fixed, but will depend on context, and it is measurable but not a very helpful measure in isolation.
In this episode, Clara Munro is joined by Declan Murphy and Ayisha Ashmore - and they sit down with neurourgeon and researcher Simone Betchen, who has measured grit in women surgeons, and helps them understand their grit scores.
Reading list
Grit in surgeons
https://pubmed.ncbi.nlm.nih.gov/34218313/
Is it time for the Beano to drop the junk food brands?
4 februari 2023 |
18 min
Claire Mulrenan, specialist registrar in public health, and Mark Petticrew, professor of public health evaluation, both working at the London School of Hygiene and Tropical medicine were surprised to see high-fat, high-salt fast food brands being featured heavily on the website of one of the UK's most beloved children's comics.
In this podcast, they describe why they think that is harmful, and why the Beano should think again about its editorial policies, to protect children's health.
To read the full investigation: www.bmj.com/content/380/bmj.p197
Talk Evidence - excess deaths, the ONS, and the healthcare crisis
27 januari 2023 |
52 min
In this week's episode, we're focusing on covid and the ongoing crisis in the NHS.
Helen Macdonald, Juan Franco and Joseph Ross cast their evidence seeking eyes over research into outcomes as well as the workload of doctors.
Firstly, Joe tells us about a new big data study into longer term outcomes after mild covid-19, how those ongoing symptoms relate to long covid, and how often they resolve themselves.
Juan looks back to his homeland to see what Argentina which was very early to offer children vaccinations against covid-19. He tells us how a new study design can help understand how effective different combinations of vaccines were.
Joe has a Danish registry paper, which links people's employment status after a MI, explains how that gives us an insight into morbidity following that event.
Helen looks at a new analysis which outlines the concept of "time needed to treat" - a measure of how much time it would take a clinician to actually carry out a guideline - and you'd be surprised how much GP time would be swallowed by a "brief" intervention to reduce inactivity in their patients.
Finally, the data on excess mortality in the UK has been up for debate recently - our health minister calling into question the Office of National Statistic's data. We hear from Nazrul Islam, Associate professor of medical statistics, advisor to the ONS and BMJ research editor, who has some bad news for him.
Reading list:
Long covid outcomes at one year after mild SARS-CoV-2 infection
https://www.bmj.com/content/380/bmj-2022-072529
Effectiveness of mRNA-1273, BNT162b2, and BBIBP-CorV vaccines against infection and mortality in children in Argentina, during predominance of delta and omicron covid-19 variants
https://www.bmj.com/content/379/bmj-2022-073070
Guidelines should consider clinicians’ time needed to treat
https://www.bmj.com/content/380/bmj-2022-072953
Expanding the measurement of overdiagnosis in the context of disease precursors and risk factors
https://ebm.bmj.com/content/early/2023/01/10/bmjebm-2022-112117
Excess deaths associated with covid-19 pandemic in 2020
https://www.bmj.com/content/373/bmj.n1137.abstract
Formal Training Pathways, are they really all that?
6 januari 2023 |
59 min
One size doesn’t fit all - so what are the alternative career paths of doctors in the NHS? The treadmill of medical school, to foundation training, to specialist training, to a consultant position takes years and is not very trainee-centric in it’s design.
So are there other ways for doctors to be able to work in the NHS, still progress their career, but also tailor the job to themselves? And what are the drawbacks of trying to do that?
In this podcast, Clara Munro is joined by Flo Wedmore and new panelist Jason Ramsingh, a surgical trainee in Newcastle. They speak to Rob Fleming an SAS (speciality and associate specialist) doctor in anaesthetics.
Conflict and food global food insecurity
31 december 2022 |
45 min
As we gear up for the winter in the northern hemisphere, the need to stay warm and eat well is pressing - but in 2022, there are global pressures working against us.
Russia invaded Ukraine, and the subsequent restrictions on exports from both of those countries is being felt in terms of fuel costs - but also food costs. At the same time, this year has seen droughts and flooding which have affected global food production, as well as continuing restrictions around covid and economic activity.
All of these factors are working together to increase food insecurity.
Our Guests;
Sheryl Hendricks, professor of food security at the University of Pretoria
Renzo Guinto, chief planetary doctor at PH Lab
Tim Benton, director of the Environment and Society Programme at Chatham House.
Talking evidence at Christmas
21 december 2022 |
34 min
It's almost time for the Christmas edition of the BMJ to hit your doormats, and in this festive edition of Talk Evidence we're going to be talking Christmas research.
Joining Helen and Juan, we have Tim Feeney, BMJ research editor and researcher into Surgical outcomes at Boston University.
In this episode we'll be hearing about the health of footballers, and if a career in the sport predisposes Swedish players to substance use disorders. We'll hear about the performance of BMJ’s editors, when it comes to assessing the impact of a paper. We'll find out if AI algorithms can pass UK radiology exams, misinformation and a belief that everything causes cancer, and finally, some tips from BMJ’s statisticians to set the world right
DNACPR
14 december 2022 |
61 min
In this episode of the Dr. Informed podcast, the topic of discussion is death and dying, and how to involve patients in DNACPR decisions.
The panel discuss the importance of doctors having discussions with patients about end-of-life care as a way of creating the best possible death for patients. The conversation also touches on the challenges that doctors may face when having these difficult discussions and they give some advice on how they to overcome them.
Joining Clara are;
Mark Taubert, palliative care consultant, and national chair of future care planning for the Welsh Government
Kat Shelley, an anaesthetics trainee, who has stage four breast cancer, and is receiving palliative care
Lucy-Anne Frank, an elderly care consultant.
The article "Do not resuscitate me in Barbados" is published by BMJ Supportive and Palliative Care, and is free to access at;
https://spcare.bmj.com/content/11/3/310
Talk Evidence - endometriosis, falling, and better EBM
2 december 2022 |
48 min
In this month's episode, Helen Juan and Joe delve into the clinical - with a new review of endometriosis, and why the difficulty in diagnosis has lead to a dearth of evidence and attention on the condition.
Joe tells us about a risk prediction tool that could be useful in helping to mitigate some of the problems of antihypertensive treatments.
We're also having a geek out about a group of papers we've published lately, on how well evidence is created, maintained, and diseminated.
Reading list;
Development and external validation of a risk prediction model for falls in patients with an indication for antihypertensive treatment: retrospective cohort study
https://www.bmj.com/content/379/bmj-2022-070918
Pathophysiology, diagnosis, and management of endometriosis
https://www.bmj.com/content/379/bmj-2022-070750
Effective knowledge mobilisation: creating environments for quick generation, dissemination, and use of evidence
https://www.bmj.com/content/379/bmj-2022-070195
Consistency of covid-19 trial preprints with published reports and impact for decision making: retrospective review
https://bmjmedicine.bmj.com/content/1/1/e000309
Changing patterns in reporting and sharing of review data in systematic reviews with meta-analysis of the effects of interventions: a meta-research study from the REPRISE project
https://www.medrxiv.org/content/10.1101/2022.04.11.22273688v2
#MedTwitter - a force for good or evil?
22 november 2022 |
53 min
#MedTwitter consists of an online community of researchers, health practitioners and students who have created an open source decentralised forum for information sharing, medical education and professional networking. #MedTwitter also provides a space for publications to be shared and promoted. While many will credit Twitter with giving a voice to clinicians, it also comes with challenges, the potential for abuse, or the spread of misinformation.
Joining Clara to discuss are;
Jonathan Guckian, a dermatology registrar in Leeds, and director of social media and communications at the Association for the Study of Medical Education (ASMI).
Flo Wedmore, a medical registrar and NHS sustainability fellow
Declan Murphy, an academic medical fellow S2 in ophthalmology in Newcastle, and former Sharp Scratch panelist.
WISH 2022 - Antimicrobial resistance, and workforce wellbeing
11 november 2022 |
43 min
Last month, saw the WISH 2022 - the World Innovation Summit for Health, where experts from around the world came and presented their ideas.
In this podcast we'll hear from Dame Sally Davies, the UK’s Special Envoy on Antimicrobial Resistance - she explains how covid, and treatment uncertainty, put paid to conservative prescribing; and what innovations in microbial treatment are on the horizon.
Following that, James Campbell, director of the health workforce department at the WHO, who joins us to talk about new data they have on the wellbeing, and why the international market for healthcare staff is no longer the simple solution for vacancies.
The BMJ's collections we mentioned are on empowering and engaging patients (https://www.bmj.com/empowering-and-engaging-patients) and food security and health in a changing environment (https://www.bmj.com/food-security-and-health-in-a-changing-environment)
Talk Evidence - Diabetes data, colonoscopies, and researchers behaving badly
2 november 2022 |
46 min
In this month's Talk Evidence, Helen Macdonald, The BMJ's research integrity editor, is joined again by Juan Franco, editor in chief of BMJ EBM, and Joe Ross, US research editor.
They're straying beyond the pages of The BMJ, and discussing an NEJM paper about colonoscopy for colorectal cancer screening.
We have a listener request, asking about evidence for England's " NHS Diabetes Prevention Programme" - what do we know about how lifestyle interventions work at a population level? Juan puts on his Cochrane hat to answer the query.
We stay with diabetes, and Joe tells us about his research trying to see if routinely collected observational data could be used to match the outcomes of an RCT into drug treatments.
Finally, Helen updates us about what she's been doing about a case of plagiarism in one of BMJ's journals - and what that means for researchers who are writing in multiple journals about their work.
Reading list
Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
https://www.nejm.org/doi/full/10.1056/NEJMoa2208375
Emulating the GRADE trial using real world data: retrospective comparative effectiveness study
https://www.bmj.com/content/379/bmj-2022-070717
Expression of concern about content of which Dr Paul McCrory is a single author
https://bjsm.bmj.com/content/early/2022/10/11/bjsports-2022-106408eoc
Doctor informed - sustainability isn’t just waste management
26 oktober 2022 |
56 min
In this episode of Doctor Informed, we're talking sustainability. The BMJ has a special edition on the climate crisis, and finding hope amid dispair - and we want to help our listeners with some of that. Clara is joined by three of the NHS's sustainability fellows, Florence, Who is a medical registrar, Emily a paedatrics trainee, and Li, an anaesthetics trainee
For more on the climate crisis, read The BMJ's special edition
https://www.bmj.com/content/379/8356
Talk Evidence - Inquiring about covid, burnout, and marginal data
12 oktober 2022 |
37 min
It's October's Talk Evidence, and that means the autumn is upon us including those autumnal viruses. Here in the UK covid is on the rise, and Joe Ross is looking at some research on how good those elusive lateral flows are at detecting infection among people with symptoms of covid.
Juan will give us an update on the covid inquiry, the collection of analysis articles The BMJ is publishing looking at the interface of evidence and policy in our decisions about how to handle the pandemic.
Since the pandemic moral among clinicians in many health systems has fallen even further, workloads have spiralled. Coupled with other problems with workforce planning and investment in health and healthcare, this is increasing burnout - with a consequential impact on patient care. Helen will tell us about new research which is trying to put some numbers to how much clinican burnout effects patient outcomes
Finally, we're turning to a very clinical topic that we don't often cover in Talk Evidence - oncology, and some interesting insights into clearance margins in cancer surgery.
Reading list
Diagnostic accuracy of covid-19 rapid antigen tests with unsupervised self-sampling in people with symptoms in the omicron period
https://www.bmj.com/content/378/bmj-2022-071215
Guided by the science? Questions for the UK’s covid-19 public inquiry
https://www.bmj.com/content/378/bmj.o2066
Associations of physician burnout with career engagement and quality of patient care
https://www.bmj.com/content/378/bmj-2022-070442
Margin status and survival outcomes after breast cancer conservation surgery
https://www.bmj.com/content/378/bmj-2022-070346
Doctor Informed - the generational divide
27 september 2022 |
54 min
It's zoomers vs boomers on this week's Doctor Informed, as we assemble a multigenerational team to talk about the "good old days" and if the youth of today are really snowflakes.
Clara Munro is joined by Nikki Nabavi, a medical student at Manchester University and a regular on Sharp Scratch (The BMJ's student podcast); Ayisha Ashmoore, an trainee in obstetrics and gynaecology, in the East Midlands; and Alastair Munro, a retired professor of oncology (and Clara's dad).
Doctor Informed - what to expect from an inquest
12 september 2022 |
56 min
In our new season of Doctor Important, we'll be discussing topics that are not always talked about, and today, by popular request of our listners, we're talking about Coroner's Court and inquests - two things that strike terror into doctors, but are often not as bad as you may fear.
Our panel;
Clara Munro is a surgical trainee in the North East Deanery.
She's joined by her colleage Katie Strong, another surgical trainee. We also have returning to Doctor Informed Ayisha Ashmore, an Obs and Gynae registrar in the East Midlands.
Our Expert guest this week is Beth Walker, a former palliative care registrar who now works as an advisor for Medical Protection.
Series 1 wrap up
5 september 2022 |
41 min
This is our last episode of series 1 of Doctor Informed, and with it we're coming full circle. Clara will be talking to our first two guests, Mary Dixon-Woods and Bill Kirkup, having now heard from all of our other experts over this series.
In this first series, we've learned about speaking out, team work, compassionate leadership - all the things that are needed to help clinicians challenge the status quo, So in this episode, we'll be asking Mary how much she thinks things have changed, and Bill how he manages a career challenging the healthcare system.
Our guests
Mary Dixon-Woods is director of THIS Institute, and a Health Foundation Professor of Healthcare Improvement Studies in the Department of Public Health and Primary Care at the University of Cambridge. Her work is concerned with generating a high quality evidence-base to support the organisation, quality and safety of care delivered to patients.
For links to the work that Mary talked about visit https://www.thisinstitute.cam.ac.uk/
Bill Kirkup is a clinician turned investigator - he led investigations into failings at a maternity and neonatal unit in Morcambe Bay, into the Oxford paediatric cardiac surgery unit and into Jimmy Savile’s involvement with Broadmoor Hospital. He was also a member of the Hillsborough Independent Panel
Talk Evidence - a new way of understanding antidepressant effectiveness
24 augusti 2022 |
42 min
In this week's episode, Joe Ross, professor of medicine at Yale, and The BMJ's US research editor, and Juan Franco, researcher at Heinrich-Heine-Universität and editor in chief of BMJ EBM are in the hot-seat.
They will discuss new research on the effectiveness of antidepressants - based on all the individual patient data submitted to the FDA between 1979 and now.
We'll take a look at a study of industry sponsorship of cost effectiveness analysis, and seeing similar patters of publication bias to RCTs.
And finally we'll be talking about new research on the ongoing, and emergent pandemics - covid and monkeypox.
Reading listResponse to acute monotherapy for major depressive disorder in randomized, placebo controlled trials submitted to the US Food and Drug Administration: individual participant data analysis
https://www.bmj.com/content/378/bmj-2021-067606)
Using individual participant data to improve network meta-analysis projects
https://ebm.bmj.com/content/early/2022/08/10/bmjebm-2022-111931
Industry sponsorship bias in cost effectiveness analysis: registry based analysis
https://www.bmj.com/content/377/bmj-2021-069573
Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak https://www.bmj.com/content/378/bmj-2022-072410
Effectiveness of a fourth dose of covid-19 mRNA vaccine against the omicron variant among long term care residents in Ontario, Canada:
https://www.bmj.com/content/378/bmj-2022-071502
Reflecting on a crisis
9 augusti 2022 |
54 min
Previous Doctor Informed episodes have discussed how to prevent patient safety issues from occurring, but sometimes situations are beyond anyone's control - like COVID.
It can be hard to look back, especially if difficult decisions and compromises were made, including ones we did not completely agree with, or if there could be criticism of the way we responded. We ask how individual doctors, teams, and organisations could respond to and recover from major problems?
In this episode, we're joined by Annelieke Driessen, a THIS Institute fellow and medical anthropologist. She is a research fellow at the University of Oxford and honorary assistant professor in medical anthropology at the London School of Hygiene and Tropical Medicine, who has spent hours listening to and understanding patient experiences of ICU during the pandemic. We'll also hear from Dominque Allwood, Chief Medical Officer at UCL Partners, and Director of Population Health at Imperial College Healthcare NHS Trust, who focuses on creating positive change in healthcare.
The research Annelieke Driessen discussed, and the full versions of the patient interviews that are included in the podcast are available at https://healthtalk.org/Experiences-of-Covid-19-and-Intensive-Care/overview
Talk Evidence - shoulders, knees, and woes
31 juli 2022 |
38 min
In this episode, Juan Franco, editor in chief of BMJ EBM, and Helen Macdonald, The BMJ's research integrity editor, sit down to discuss what's new in the world of evidence.
Firstly, last week they went to the first EBM Live conference for two years - and report back on what happened when the evidence community got back together.
We have two research papers looking at knees and shoulders, and finding out about the balance of risks and benefits.
In covid news, we're still finding new symptoms associated with infection, 2.5 years after the pandemic started. We'll also hear how complex it is to research vaccine efficacy now.
Reading list:
Smell and taste dysfunction after covid-19 https://www.bmj.com/content/378/bmj.o1653
Serious adverse event rates and reoperation after arthroscopic shoulder surgery
https://www.bmj.com/content/378/bmj-2021-069901
Viscosupplementation for knee osteoarthritis
https://www.bmj.com/content/378/bmj-2022-069722
Waning effectiveness of BNT162b2 and ChAdOx1 covid-19 vaccines over six months since second dose
https://www.bmj.com/content/378/bmj-2022-071249
Diabetes in Ukraine - supporting NCDs in a conflict zone
18 juli 2022 |
42 min
As the Russian invasion of Ukraine continues, living under the uncertainty has become the new normal for thousands of patients with diabetes who are dependant on insulin.
Supporting patients with non-communicable disease is the reality of all disaster situations now, and that added layer of complexity makes coordinating responses even harder.
In this podcast, we'll hear how people with diabetes are being supported in Ukraine, and what is being done to improve things, despite the continued fighting.
Our guests;
Iryna Vlasenko, Vice President of the International Diabetes Federation
Slim Slama, unit head for NCD management at the WHO
Yaroslav Diakunchak, family physician in Brovary, Kyiv.
Talk Evidence - political persuasion and mortality, too much medicine
17 juni 2022 |
41 min
In this week's episode, Helen Macdonald is joined by Joseph Ross, US research editor for The BMJ, and Juan Franco, editor of BMJ EBM.
They begin by discussing a review of obesity interventions in primary care, and Joe wonders if GPs are really the best people to tackle the issue.
https://www.bmj.com/content/377/bmj-2021-069719
Cervical screening in the UK now includes HPV testing, and they look at research which examines whether this could mean longer periods between screening tests.
https://www.bmj.com/content/377/bmj-2021-068776
They all enjoy a new State of the Art Review into Revascularization in stable coronary artery disease.
https://www.bmj.com/content/377/bmj-2021-067085
Juan and Joe look at a review into combinations of covid-19 vaccinations - and wonder whether we'll ever see more trials to fit into this meta-analysis.
https://www.bmj.com/content/377/bmj-2022-069989
Finally, they find out how your political persuasion has affected mortality in the US, with new research that links Republican and Democrat voters with differential changes in mortality.
https://www.bmj.com/content/377/bmj-2021-069308
Violence against GPs with Adam Janjua, Marcela Schilderman, and Anita Bignell
13 juni 2022 |
53 min
A recent investigation, by The BMJ, showed a worrying increase in incidence of violence, directed to wards GPs, and reported to the police. In this episode of Deep Breath in, Tom and Jenny are joined by Gareth Iacobucci, assistant news editor for The BMJ who broke the story.
They'll hear from a GP affected, and get some advice on preventing violence, and deescalation, from two mental health experts, who deal with the most agitated patients.
Our guests:
Adam Janjua, a GP in Fleetwood, Lancashire.
Marcela Schilderman, a consultant psychiatrist at South London and the Maudsley NHS Foundation Trust
and Anita Bignell, a mental health nurse, at South London and the Maudsley NHS Foundation Trust
Reading list
Violent incidents at GP surgeries double in five years, BMJ investigation finds
https://www.bmj.com/content/377/bmj.o1333
”But it’s always been done that way”
30 maj 2022 |
51 min
In Doctor Informed, we've been hearing a lot about the problems of healthcare, but we also want to talk about solutions. Whatever we're going to do to fix healthcare, whether that's bullying, or burnout, or patient safety - it's going to require change. And change is hard.
In this episode Clara Munro is joined by Graham Martin, director of research at THIS Institute. They discuss the dreaded phrase "But it's always been done this way", and why failing is the path to success, and the true importance of listening.
Our guests;
Penny Pereira, Q managing director at the Health Foundation. Q helps promote improvement within the health and care system, encouraging and supporting a wide range of people to effectively lead improvement. https://www.health.org.uk/about-the-health-foundation/our-people/q-and-q-labs-team
Moira Durbridge, director of safety and risk at University Hospitals of Leicester NHS Trust. Moira trained as a nurse, and continues to work clinically, as well as her role in leading her Trust's change.
Talk Evidence - evidence in Roe vs Wade, MI treatment variation, and tribal methodologies
23 maj 2022 |
46 min
Helen Macdonald, The BMJ's research integrity editor is back with another episode, and this week is joined by Joe Ross, professor of medicine and public health at Yale, and US research editor for The BMJ, and Juan Franco, editor in chief of BMJ EBM, and Professor at the Instituto Universitario Hospital Italiano de Buenos Aires
In this episode they discuss;
The US supreme court looks set to overturn Roe v Wade, creating a patchwork of abortion provision across the U.S. We consider the role which evidence might play in documenting how health is affected by that decision, and whether medical evidence is being used at all in the debate.
We'll give you a quick update on treatment for Covid-19
We know that trials are needed for new treatments, but in the face of an exponentially growing amount of observational data, is it time for a shift in that certainty? Joe tells us about his research into whether trials and observational studies of three drugs in covid produce the same answer?
And finally, treatment variation - it's one of the things that helped kick-start the EBM revolution, but there's still much to learn. Juan describes some new research which examines how countries stack up when you compare their handling of and outcomes of a common condition such as a myocardial infarction.
Reading list;
Navigating Loss of Abortion Services — A Large Academic Medical Center Prepares for the Overturn of Roe v. Wade
https://www.nejm.org/doi/full/10.1056/NEJMp2206246.
A living WHO guideline on drugs for covid-19
https://www.bmj.com/content/370/bmj.m3379
Agreement of treatment effects from observational studies and randomized controlled trials evaluating hydroxychloroquine, lopinavir-ritonavir, or dexamethasone for covid-19
https://www.bmj.com/content/377/bmj-2021-069400
Variation in revascularisation use and outcomes of patients in hospital with acute myocardial infarction across six high income countries
https://www.bmj.com/content/377/bmj-2021-069164
Get political, for health’s sake
13 maj 2022 |
38 min
The influence of public health on politics, at least at the beginning of the pandemic, had never been stronger - but now it seems as hard to persuade politicians to pay attention as ever, yet political will is essential in making different sectors work together to create a healthier world.
In this podcast, The BMJ's editor in chief, Kamran Abbasi is joined by Shyama Kuruvilla, senior strategic adviser at World Health Organization, and Kent Buse, director of the global healthier societies program at The George Institute for Global Health.
They discuss examples of where multisectoral working has managed to bridge the gaps between sectors, and how healthcare needs to get political to make that success more widespread.
This is part of the collection "The world we want: Actions towards a sustainable, fairer and healthier society" - https://www.bmj.com/pmac-2022
Deep Breath In - what’s in store for general practice in the UK
30 april 2022 |
44 min
This is a special episode of our podcast for GP's, Deep Breath In, where we tackle the everyday challenges of being a GP.
With the focus on covid, and the pressure on hospitals, it may be easy to overlook what’s happening in general practice in the UK - but changes are afoot. Our new health secretary Sajid Javid doesn’t seem to like our long standing GP practice arrangement, NHS England has imposed new weekend working arrangements on the already stretched service, and the workforce pressures continue.
In this episode of Deep Breath In, our GP panel of Tom Nolan, Navjoyt Ladher, and Jenny Rasanathan are joined by Gareth Iacobucci, The BMJ’s assistant news editor, to give them the lowdown on what’s happening around primary care, who some of the key players are, and what his predictions for 2022.
You can find Deep Breath In on all major podcast apps
https://www.bmj.com/podcasts/deepbreathin
Creativity and wellbeing
22 april 2022 |
36 min
Paula Redmond, clinical psychologist who supports healthcare workers experiencing burnout and other difficulties related to their job. Before this, she worked for the NHS until she experienced bullying, and a lack of support from her organisation, which made her strike out on her own.
In this wellbeing podcast, she describes the way in which her experience of bullying affected her, and how she used the creative process to help her move on.
She and Cat Chatfield discuss what creativity actually is, and why small projects can be just as useful as big complex ones - depending upon what you need at the time.
Futher reading:
a Blog series on bullying in healthcare: https://drpaularedmond.com/category/bullying_in_healthcare/page/2/
a mindful embroidery craftivism project ("Do no harm but take no shit") https://drpaularedmond.com/donoharm/
Quality improvement and wellbeing are inextricably linked
15 april 2022 |
28 min
Over the course of the last few years, the BMJ has published a series of articles in our Quality Improvement series - aiming to give those new to improvement science a good grasp of how to think about changing things in healthcare.
Then covid-19 came along, and it seemed like all of healthcare was now aimed at just surviving in the face of the pandemic, and all thoughts of quality improvement projects went out the window... But did they?
Cat Chatfield, is joined by Will Warburton, former director of quality improvement at the Health Foundation, and advisor on the series.
To read all of the open access articles mentioned in the discussion, visit https://www.bmj.com/quality-improvement
Doctor Informed - Medicine’s me too moments
4 april 2022 |
43 min
In this episode we’re going to be talking about misogyny in surgery, recent revelations about sexual harassment in the theatre have emerged - but these behaviours have been endemic for a while, even as the profession seemed to ignore them.
Joining Clara Munro is Baroness Helena Kenned, the author of a recent report into diversity in medicine, who, as a barrister, has long worked on discrimination cases.
The reports mentioned in the episode are from the Royal College of Surgeons;
https://www.rcseng.ac.uk/about-the-rcs/about-our-mission/diversity-review-2021/
Covid vaccine safety, Methenamine hippurate, and intersectionality
30 mars 2022 |
38 min
In this episode of Talk Evidence, Helen Macdonald, the BMJ’s research integrity editor is joined by Joe Ross, US research editor, and Juan Franco, editor in chief of BMJEBM, to talk about all things evidence.
Joe gives us an update about covid, including new research on safety of the vaccine Association between covid-19 vaccination, SARS-CoV-2 infection, and risk of immune mediated neurological events
https://www.bmj.com/content/376/bmj-2021-068373
Juan updates us on a potential new prophylactic for recurrent UTIs, Methenamine hippurate, which could be an alternative to antibiotics.
Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women
https://www.bmj.com/content/376/bmj-2021-0068229
Helen tells us about some research which evaluates the way in which intersecting identities combine to make students experience of medical school more difficult.
Marginalized identities, mistreatment, discrimination, and burnout among US medical students
https://www.bmj.com/content/376/bmj-2021-065984
Wellbeing - hot food on a night shift
24 mars 2022 |
23 min
The issue of food on nightshifts is a perennial grumble in the NHS, and though it might seem trivial, what does it say of an organisation if they demand their staff work when they're hungry, and what is the onward implication for that on patient care?
To discuss all of these issues, we're joined by Neely Mozawala, a community specialist diabetes podiatrist, and Sahlia Saliha Mahmood-Ahmed, a gastroenterologist who have started the #24hrhotfoodfortheNHS campaign.
Everyone’s going to make a mistake
17 mars 2022 |
52 min
Medicine is complex, and as a doctor you won't always do the right thing - but you can prepare yourself for when mistakes happen, both emotionally and logistically.
In this episode of Doctor Informed, Clara Munro is joined by Susanna Stamford, a patient who was on the receiving end of a mistake, which catalysed her interest in patient safety. We're also joined by Anthea Martin, from Medical Protection, who dispels some myths about saying sorry. Ayisha Ashmore returns to the pod to digest the lessons from our experts.
Futher reading:
The video that Susanna mentioned is available to watch on youtube
bitly.com/ManagingAdverseEvents
Solving retention to support workforce recovery
11 mars 2022 |
59 min
The covid-19 pandemic has stretched healthcare staff like never before. As part of the 2022 Nuffield Trust summit, The BMJ hosted a roundtable discussion looking at why workers leave the NHS and how staff wellbeing and retention can be improved.
Joining us to discuss are:
Kamran Abbasi, editor in chief, The BMJ
Billy Palmer, senior fellow, Nuffield Trust
Lucina Rolewicz, researcher, Nuffield Trust
Mark Britnell, global healthcare expert and senior partner, KPMG International
Neil Greenburg, consultant occupational and forensic psychiatrist, King's College London's centre for military health research
Rose Penfold, National Institute for Clinical Research academic clinical fellow in geriatrics
Rammya Mathew, GP and quality improvement lead for Islington GP Federation
Partha Kar, diabetes consultant and NHS England's national advisor for diabetes
Danny Mortimer, chief executive of NHS Employers
The Nuffield Trust report, "The Long Goodbye" which was discussed in this roundtable is available here - https://www.nuffieldtrust.org.uk/resource/the-long-goodbye-exploring-rates-of-staff-leaving-the-nhs-and-social-care
Rural healthcare in a pandemic
7 mars 2022 |
28 min
In this episode of the podcast we’re going to be talking about rural healthcare - and specifically the difficulties that distance, demographics, and funding have introduced into the world’s covid-19 response.
Rural regions made vulnerable by limited healthcare infrastructure, lower rates of vaccination, and opposition to government policies are the new frontlines in the pandemic, but support systems have not adjusted to the growing rural needs for health education, testing, vaccination, and treatment.
Michael Forster Rothbart, Kata Karáth, and Lungelo Ndhlovu report from the US, Ecuador, and Zimbabwe
The blame game
25 februari 2022 |
52 min
In previous episodes of Doctor Informed, we've talked about the importance of speaking out, but the culture in your organisation might not always make that easy, especially if you feel something has gone wrong and you might be blamed for it.
Blame culture, no blame culture, just culture - there are many terms which are used to describe the environment in which individuals and teams work, the feel within a team and an organisation. In this episode we'll explore what they mean, why blame can be detrimental to patient safety, and give some tips on how to investigate problems without throwing blame around.
Our guests in this episode;
Joselle Wright - Deputy Director of Midwifery, Gynaecology and Sexual Health at Walsall Healthcare NHS Trust
Susanna Stanford, who became involved in patient safety after experience of a spinal anaesthetic failing during a c-section in 2010. She is an ambassador for the Clinical Human Factors Group.
Learning to listen
4 februari 2022 |
47 min
In previous episodes of Doctor Informed, we've talked about the importance of speaking out, and how to do that better, but as you progress through your medical career, you will become the person to whom those with problems will turn.
In this episode we will explore listening. As a senior clinician, how can you make the space in your work to be a good listener, when what you hear might not be what you want to hear?
Our guests;
Megan Reitz is a professor of Leadership and Dialogue at Hult Business School.
John Higgins is research director at The Right Conversation.
Reading
Speaking truth to power: why leaders cannot hear what they need to hear
https://bmjleader.bmj.com/content/5/4/270
Talk Evidence - isolation periods, openness, and environmental impacts
28 januari 2022 |
35 min
In the first Talk Evidence of 2022, we'll be asking about the evidence for isolation - now that isolation periods are being reduced, or even stopped in the event of a negative lateral flow test, we'll find out what data that's based on, and if it's appropriate.
Vaccinations and treatments for covid-19 have been the one major success story of the pandemic, but that doesn't mean we should abandon the principles of openness and transparency when it comes to scrutinising the data - we'll hear what access to the data which underlies regulatory approval could do now.
Finally, the impacts of climate change were set out in a WHO report in November last year - and recent weather seems to underline their conclusions. We'll discuss new evidence linking the environment and health, and ask what clinicians can do with that.
Reading list:
Mitigating isolation: The use of rapid antigen testing to reduce the impact of self-isolation periods
https://www.medrxiv.org/content/10.1101/2021.12.23.21268326v1.full.pdf
Covid-19 vaccines and treatments: we must have raw data, now
https://www.bmj.com/content/376/bmj.o102
WHO report: Climate change and health
https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health
Ambient heat and risks of emergency department visits among adults in the United States: time stratified case crossover study
https://www.bmj.com/content/375/bmj-2021-065653
Residential exposure to transportation noise in Denmark and incidence of dementia: national cohort study
https://www.bmj.com/content/374/bmj.n1954
Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project: pooled analysis
https://www.bmj.com/content/374/bmj.n1904
Why is it so hard to speak out about patient safety?
21 januari 2022 |
37 min
In the previous episodes of Doctor Informed, we've heard why it's so important to talk about patient safety concerns, and some of the mechanisms that allow hospital staff to raise them, but knowing why and how doesn't always make it easier to speak out.
In this episode we're exploring the concept of a voiceable concern – identifying what counts as a concern, and what counts as an occasion for voice by an individual, is not a straightforward matter of applying objective criteria- for example how do you tell if you're witnessing poor practice, or just something that lies outside your area of understanding? Or how do you know if the common practice in this particular ward is actually an outlier when looking at other hospitals?
Our guests this week;
Mary Dixon-Woods is director of THIS Institute, and a Health Foundation Professor of Healthcare Improvement Studies in the Department of Public Health and Primary Care at the University of Cambridge. Her work is concerned with generating a high quality evidence-base to support the organisation, quality and safety of care delivered to patients.
Zoe Fritz is a consultant in acute medicine at Cambridge University Hospitals NHS Foundation Trust, she is also a Wellcome Fellow in society and ethics at THIS Institute, investigating how we communicate and record uncertainty around diagnosis.
Reading:
https://pubmed.ncbi.nlm.nih.gov/34978470/
www.bmj.com/podcasts/doctorinformed/
https://www.thisinstitute.cam.ac.uk/podcast/
US Assistant Secretary of Health, Rachel Levine
15 januari 2022 |
25 min
Rachel Levine Trained as a paediatrician, before becoming firstly the state of Pennsylvania's Physician General, then its Health Secretary.
During president Joe Biden's administration, she was nominated to become the U.S.'s assistant secretary of health. That lead to her becoming a four-star admiral in the U.S. Public Health Service Commissioned Corps, and thus the first openly transgender four-star officer in the US.
In this podcast, we discussed the pandemic - but also wider problems affecting Americans' health, notably climate change, inequality and the opioid crisis. We also discuss the health and care of LGBT+ people, in the U.S, and around the world.
This interview was recorded on the 16th of December 2021.
Talking Christmas Evidence 2021
22 december 2021 |
34 min
The BMJ has special criteria for considering Christmas research: first it should make you laugh, and then it should make you think.
In this festive episode of the Talk Evidence podcast, our regular panel of Helen Macdonald and Joe Ross are again joined by Juan Franco,
editor in chief of BMJ Evidence Based Medicine.
They’ll give you a peek into what makes for good Christmas research, and why what may seem silly on the surface has a deeper meaning.
Who is responsible for patient safety?
16 december 2021 |
42 min
As clinicians, we're all taught that patient safety is everyone's responsibility - but on the ground it can be hard to know how to most effectively report concerns, especially if you're not sure how those concerns will be received.
In this episode of Doctor Informed, Clara Munro is joined by Ayisha Ashmore, and they ask "who is actually responsible for patient safety?"
To answer that we're joined by 2 guests
Bill Kirkup, independent investigator who has worked on the reports into failings in Mid-Staffordshire, and Gosport.
Henrietta Hughes - GP, and the NHS's first guardian, Henrietta championed the creation of freedom-to-speak-up guardians in the English NHS, to ensure that clinicians are able to freely speak out.
Exit interview with Fiona Godlee
15 december 2021 |
44 min
Fiona Godlee is stepping down as Editor-in-Chief of The BMJ after 16 years in the position.
She was the first female editor of the journal, and over her tenure has seen a lot of changes - both to the publication she's run, and to the wider world of medicine.
To mark her departure, Helen Macdonald sat down with Fiona to ask her a bit about those early days at the journal, on her view of women taking leadership roles in medicine, on her thoughts about some of the big issues facing science, and what is coming next.
Note from the editor; apologies for the audio quality in the first half.
Covid and conflict In South Asia
10 december 2021 |
39 min
In this second podcast focussing on the covid response in South Asia, we’re focussing on the intersection of conflict and covid in the region. The pandemic has highlighted the underlying weaknesses in many health systems - but could it also be used as a catalyst for change, and be a step towards easing tensions?
To discuss this, Kamran Abbasi, executive editor of The BMJ, is joined by Zulfiqar Bhutta, head of the Institute for Global Health and Development, Aga Khan University, and Arun Mitra senior vice president of Indian Doctors for Peace & Development.
To read more;
Conflict, extremism, resilience and peace in South Asia; can covid-19 provide a bridge for peace and rapprochement?
https://www.bmj.com/content/375/BMJ-2021-067384
Life Support - Being a compassionate colleague
30 november 2021 |
49 min
In this episode of Doctor Informed, Clara Munro is joined by Ayisha Ashmore - and they're getting to grips with being a compassionate colleague.
While the topic might seem warm and fuzzy, there's some good hard science to suggest that compassionate leadership at every level of healthcare can make a huge difference to staff, and improve patient outcomes.
Most people innately have the skills need to be compassionate colleagues - but often the pressures of the job can make it the lowest of priorities in our everyday interactions.
Our two guests this week think that's wrong though - and say that compassionate leadership is one of the most important things to get right.
Joining us are, Michael West, senior fellow at The King's Fund and professor of Work and Organisational Psychology at Lancaster, and Bob Klaber, consultant general paediatrician and director of strategy, research and innovation at Imperial College Healthcare NHS Trust
Michael has written the book on compassionate leadership in health and social care - https://tinyurl.com/vh55mker.
You can read more about Bob's work in his blog - https://www.imperial.nhs.uk/about-us/blog/how-acts-of-kindness-can-improve-care-and-strengthen-teams
Ayisha has written about putting some of this all into practice in a maternity setting - https://bmjleader.bmj.com/content/early/2021/11/25/leader-2021-000449
Wellbeing - feeling addicted to your phone?
26 november 2021 |
36 min
In the wellbeing podcast, the dread topic of phone usage has come up again - how social media, and an "always on" culture can affect our wellbeing.
But knowing that, and changing our behaviour are two different things - so to give some advice on reducing our reliance on phones, Abi and Cat are joined by Nidhi Gupta, assistant professor of pediatrics at Vanderbilt University Medical Center, who's been using techniques from behavioural addiction to help with device usage.
For more from Nidhi, visit https://phreedom.net/
Some of the research that Nidhi mentions
https://publications.aap.org/pediatrics/article/138/5/e20162591/60503/Media-and-Young-Minds
A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children
https://pubmed.ncbi.nlm.nih.gov/18316661/
Distraction: an assessment of smartphone usage in health care work settings
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437811/
Treatment Considerations in Internet and Video Game Addiction
https://pubmed.ncbi.nlm.nih.gov/29502754/
The Smartphone Addiction Scale: Development and Validation of a Short Version for Adolescents
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0083558
Doctor Informed - The patterns which emerge
16 november 2021 |
31 min
When you hear the reports from a major patient safety issue, it will be shocking to hear how they have played out - but the patterns in behaviour, of people and institutions which have gone disastrously wrong, can be seen throughout healthcare.
As this first series of Doctor Informed unfolds, we'll be exploring these patterns, and bring you evidence and expertise on tackling them - Doctor Informed is about going beyond medical knowledge to make you the best doctor you can be.
In this first episode we're talking to experts who have seen these patterns firsthand, and whose work is all about tackling them;
Bill Kirkup is a clinician turned investigator - he's led investigations into failings at a maternity and neonatal unit in Morcambe Bay, into the Oxford paediatric cardiac surgery unit and into Jimmy Savile’s involvement with Broadmoor Hospital. He was also a member of the Hillsborough Independent Panel
Mary Dixon-Woods is director of THIS Insitute, and a Health Foundation Professor of Healthcare Improvement Studies in the Department of Public Health and Primary Care at the University of Cambridge. Her work is concerned with generating a high quality evidence-base to support the organisation, quality and safety of care delivered to patients.
Talk Evidence - Bones, nutrition, pain relief, and overdiagnosis.
5 november 2021 |
46 min
In this month’s Talk evidence, we’re going back to our roots and avoiding covid - so sit back and listen to Helen Macdonald and Joe Ross discuss a new nutrition study to prevent fractures in older adults by eating dairy, and a meta-analysis which helps you choose pain relief medications for management of osteoarthritis.
We’ll hear from Steven Woloshin about the virtual Overdiagnosis conference, and why he’s so excited about a new category in the National Library of Medicine.
Finally, we have a study on urinary retention and risk of cancer that has been over 25 years in the making.
Reading list;
Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care
https://www.bmj.com/content/375/bmj.n2364
Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis
https://www.bmj.com/content/375/bmj.n2321
To access the webinars Steven was talking about.
https://www.preventingoverdiagnosis.net/
Acute urinary retention and risk of cancer
https://www.bmj.com/content/375/bmj.n2305
Podcast listener survey. Please let us know how we could improve the podcasts for you, and your specialty - https://linktr.ee/BMJsurvey
Introducing Doctor Informed
24 oktober 2021 |
14 min
Doctor Informed is a new podcast for hospital doctors, from The BMJ - created in collaboration with THIS Institute, and sponsored by Medical Protection.
Medical expertise is fundamental to the practice of medicine. But other skills and knowledge are important too. Doctor Informed gives the inside story on the evidence about giving the best care and having positive relationships with patients and colleagues.
In this trailer, meet two of the hosts of Doctor Informed - Clara Munro, a surgical trainee in the North East Deanery, and Jenni Burt, senior social scientist at THIS Institute.
www.bmj.com/podcasts/doctorinformed
Wellbeing - QI approach to improving your wellbeing
24 oktober 2021 |
43 min
It's easy to decide to do something like exercise, or a hobby to improve your wellbeing, but actually following through and make that a regular part of your week can be much harder.
In this podcast, Pedro Delgado, vice president of the Institute for Healthcare Improvement, joins Abi and Cat to explain how he turned some of the QI methodology he's been taught over the years on himself, and improved his wellbeing during the pandemic.
www.bmj.com/wellbeing
Covid in south Asia - India and Nepal
17 oktober 2021 |
54 min
In this podcast series, Kamran Abbasi, executive editor of The BMJ will convene experts from South Asia to discuss how the pandemic has affected the region, how measures like lock-down and vaccination have been handled, and the impact of the pandemic on the social determinants of health.
In this first podcast, we're focussing on India and Nepal, and are joined by;
Srinath Reddy, president of the Public Health Foundation of India.
Biraj Swain, who works in global development in Asia and East Africa, is a senior media critic
and Buddha Basnyat, director of the Oxford University Clinical Research Unit in Nepal.
For more covid coverage
www.bmj.com/coronavirus
Talk Evidence - testing for respiratory tract infections, cannabis for pain, & covid outcomes
29 september 2021 |
29 min
This week our regular panelists, Helen Macdonald and Joe Ross, are joined by Juan Franco, editor in chief of BMJ Evidence Based Medicine - to take a primary care focussed look at what's been happening in the world of evidence.
On this week’s episode.
As kids go back to school, winter bugs surge and pressure mounts on health services we look at two trials which aimed to use reduce antibiotic prescribing for respiratory tract infections in nursing homes and primary care
Juan brings us an update on prescribing medicinal cannabis for pain, based on a recent BMJ rapid recommendation article and linked systematic review and meta-analysis
And finally, in covid news, how likely are you to be admitted or die from covid after one or two SARS-CoV 2 vaccinations?
Reading list
Effect of C reactive protein point-of-care testing on antibiotic prescribing for lower respiratory tract infections in nursing home residents - https://www.bmj.com/content/374/bmj.n2198
Procalcitonin and lung ultrasonography point-of-care testing to determine antibiotic prescription in patients with lower respiratory tract infection in primary care - https://www.bmj.com/content/374/bmj.n2132
Medical cannabis or cannabinoids for chronic pain - https://www.bmj.com/content/374/bmj.n2040
Risk prediction of covid-19 related death and hospital admission in adults after covid-19 vaccination - https://www.bmj.com/content/374/bmj.n2244
Wellbeing - tired or fatigued, and why the difference might matter
24 september 2021 |
42 min
There has been a lot of work on the way in which surgeon's are affected by tiredness - and the whole medical workforce can probably relate to their experience.
But there's a difference between tiredness and fatigue, and that difference might be important in understanding what's happening in your own life.
Dale Whelehan is a physiotherapist, and PhD candidate at Trinity college Dublin, where he is investigating behavioural psychology and the effect of tiredness and fatigue on surgeons - in this podcast he describes how he thinks about those two things, what we know about the effect on wellbeing, and some strategies which might help manage them.
The future of Afghan healthcare
18 september 2021 |
20 min
The infrastructure of Afghanistan healthcare is under threat, as international agencies who run clinics withdraw from the country. At the same time, some of the healthcare workforce are leaving the country, while those who remain face the prospect of their wages drying up as the economy of the country collapses.
But there remain people dedicated to providing healthcare, and in this podcast we hear from, Wais Mohammad Qarani, president of the Afghanistan Midwifery and Nurses Council, about what changes might be seen under the new regime, and what needs to be done to support care in the country.
Healthcare In Afghanistan Now
9 september 2021 |
27 min
The final evacuation planes have left Kabul airport, and Afghanistan’s government have ceded power to the Taliban.
Amongst the international community, worries about what that transition of power means for the people of Afghanistan have centred around the rights of women, access to education for the whole population, and the continuing prosperity of the country… However what this means for health is still uncertain.
Nadia Akseer is an Afghan scientist and epidemiologist, now working at John's Hopkins Bloomberg School of Public Health and who has published extensively the health of her home country
Reading list;
Achieving maternal and child health gains in Afghanistan
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30002-X/fulltext
Association of Exposure to Civil Conflict With Maternal Resilience and Maternal and Child Health and Health System Performance in Afghanistan
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2754253
Coverage and inequalities in maternal and child health interventions in Afghanistan
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3406-1
Geospatial inequalities and determinants of nutritional status among women and children in Afghanistan
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30025-1/fulltext
Talk Evidence - real world vaccine data, GP records and CVD
3 september 2021 |
44 min
In this month's Talk Evidence, Helen Macdonald and Joe Ross are back with a wry look at the world of Evidence Based Medicine.
They give us a round up of real world data emerging to address various uncertainties about vaccinations against covid
Helen has an update on NHS Digital’s project to extract GP coding for planning of healthcare and research, and talks to Natalie Banner from Understanding Patient Data, to find out what the public really cares about.
Finally, as routine care must go on a clinical review on cardiovascular disease in older adults introduces us to geroscience.
Reading list
Vaccines;
Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study - https://doi.org/10.1136/bmj.n1943
Effectiveness of the CoronaVac vaccine in older adults during a gamma variant associated epidemic of covid-19 in Brazil: test negative case-control study - https://doi.org/10.1136/bmj.n2015
Associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission and death with covid-19 in nursing homes and healthcare workers in Catalonia: prospective cohort study
https://doi.org/10.1136/bmj.n1868
Risk of thrombocytopenia and thromboembolism after covid-19 vaccination and SARS-CoV-2 positive testing: self-controlled case series study - https://doi.org/10.1136/bmj.n1931
CVD
Cardiovascular care of older adults - https://doi.org/10.1136/bmj.n1593
Junior doctors improving hospital wellbeing
27 augusti 2021 |
39 min
The Midlands Charter, is a set of principles that hospitals in the midlands region of England have signed up to, to improve the health and wellbeing of trainees working in the area. It was created in a huge collaboration of trainees, NHS England, Health Education England and the GMC.
Dan Smith is a junior doctor at Nottingham University Hospitals NHS Trust, and one of the authors of that charter. He joins us to explain how they're QI thinking to improve doctors wellbeing, and how other areas can follow their lead.
Read the full charter:
https://www.england.nhs.uk/midlands/information-for-professionals/nhs-midlands-charter/
To join the collaborative
https://future.nhs.uk/MidlandsCharter/grouphome
Wellbeing - scheduling and burnout
13 augusti 2021 |
33 min
Rota gaps are a big problem when it comes to loading stress on the medical workforce, and there is big pressure to spread the workforce as evenly as possible across wards and shifts.
However the tyranny of the rota - especially when changing rotations or working across multiple sites, means that often doctors personal wishes, or big life events are not taken into account.
The dehumanising status of becoming just a number in the system is not helping people have the kind of fulfilling careers that encourages people to stay within the workforce, and helps guard them from burnout.
So how do we square that circle? Anas Nader, CEO of Patchwork Health, joins us to talk about why his own burnout lead him to try and fix the rota problem - and where he has got to now.
Findout more at: https://www.patchwork.health/
Note - BMJ company has invested in patchwork health
Women’s health and gender inequalities - Legislating for change
5 augusti 2021 |
46 min
It's been 25 years since the declaration on the rights of women, was signed in Beijing - and in that time the landscape of health car inequity has changed. To celebrate we created 3 podcasts, in collaboration with The WHO and UN University, as part of the collection on Women’s Health and Gender Inequalities
www.bmj.com/gender
In these podcasts we'll be hosting conversations between women early in, and some who are more advanced in, their careers - doctors, researchers, legislators and campaigners, all working towards building a future in which women can thrive.
As well as these in depth discussions, you will hear some shorter interviews from experts who have written for the collection. These give you a flavour of the bigger discussions going on in global health when it comes to gender equity - so keep an ear out for those during the discussions.
In this podcast, we're joined by lawyer and activist Hina Jilani, who has been campaigning for women's rights in her native Pakistan for her whole life.
She and her sister set up the first female law firm in the country, she established a refuge for women who were fleeing violence and abuse, she was one of the founders of the Human Rights Commission of Pakistan, and is now an advocate on the country's Supreme Court. She is also one of The Elders.
Hina talks about her career, how she has pulled the various levers of change - lobbying for legislation, legal challenge, and protest - to improve the lives of women in Pakistan.
The additional interviews are from; Lia Quatrapella, Asha George, and Veloshnee Govender
Wellbeing - surveying the mental health of NHS staff
30 juli 2021 |
33 min
In the wellbeing podcast, we have had a lot of personal experience of the pandemic, and schemes to support staff - but always we've wanted to know if there's research which can tell us how universal those experiences have been.
In this podcast, Abi and Cat are joined by Danielle Lamb, senior research fellow at University College London, and Sam Gnanapragasam, clinical fellow in psychiatry at South London and the Maudsley NHS Trust. Danielle and Sam are both investigators on NHS Check - a representative survey of NHS staff about their mental wellbeing during covid-19.
https://nhscheck.org/
Talk Evidence - Freedom Day
21 juli 2021 |
48 min
The 19th of July in the UK saw the relaxation of covid rules that have been in place for 18 months - social distancing requirements in venues, mask wearing in public will no longer be legally mandated.
There are a lot of questions about what this will mean for the pandemic, and in this episode of Talk Evidence Helen MacDonald, Joe Ross and Duncan Jarvies are joined by Iain Buchan, professor of public health in Liverpool, who has been involved in 2 key studies on covid transmission.
Firstly, lateral flow tests - the big questions has been how well do they work in the wild - and how well do they have to work, to be useful in test trace and isolate? Iain tells us about new research into the innova test.
Secondly, events - the football has shown that events can still be a big source of transmission, and the UK government put in place a number of trial events, all carefully monitored by public health researchers - Iain tells us about one nightclub test in Liverpool, and what we can glean from it.
Reading list;
Performance of the Innova SARS-CoV-2 antigen rapid lateral flow test in the Liverpool asymptomatic testing pilot: population based cohort study
https://www.bmj.com/content/374/bmj.n1637
The UK government's events programme
https://www.gov.uk/government/publications/events-research-programme-phase-i-findings/events-research-programme-phase-i-findings#findings
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/979461/S1195_Science_framework_for_opening_up_group_events.pdf
Effect of the covid-19 pandemic in 2020 on life expectancy across populations in the USA and other high income countries: simulations of provisional mortality data
https://www.bmj.com/content/373/bmj.n1343
Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM): cluster randomised controlled trial
https://www.bmj.com/content/374/bmj.n1585
Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis
https://www.bmj.com/content/374/bmj.n1446
Women’s health and gender inequalities - The science of women’s health
15 juli 2021 |
51 min
It's been 25 years since the declaration on the rights of women, was signed in Beijing - and in that time the landscape of health car inequity has changed. To celebrate we created 3 podcasts, in collaboration with The WHO and UN University, as part of the collection on Women’s Health and Gender Inequalities
www.bmj.com/gender
In these podcasts we'll be hosting conversations between women early in, and some who are more advanced in, their careers - doctors, researchers, legislators and campaigners, all working towards building a future in which women can thrive.
As well as these in depth discussions, you will hear some shorter interviews from experts who have written for the collection. These give you a flavour of the bigger discussions going on in global health when it comes to gender equity - so keep an ear out for those during the discussions.
In this first podcast, Lulit Yonas Mengesha talks to Cara Tannenbaum
Lulit Yonas Mengesha is right at the beginning of her medical career, she's a medical student in Ethiopia, but has already become passionate about woman's health
Cara Tannenbaum is is Scientific Director of the Institute of Gender and Health at the Canadian Institutes of Health Research.
Lulit and Cara discuss how women have been excluded from healthcare research - and how that affects practice today, how there are gaps in our understanding of basic biology, as well as how different life experiences affect outcomes.
The additional interviews are from; Lavanya Vijayasingham, Claudia Lopes, and Claire Wenham
Wellbeing - the need for culturally aware support
8 juli 2021 |
22 min
We know the pandemic has disproportionately affected the NHS workers who come from a ethnic minorities, we also know that doctors from an ethnic minority face additional barriers to accessing support - so how well have the various support schemes put in place during the pandemic helped those doctors from ethnic minorities?
Dammie Olubawale, medical student and grants and partnerships manager at Melanin Medics, joins us to talk about a fund they've created specifically to help doctors of black African and Caribbean heritage, to access support tailored to them.
Dammie explains some of the reasons which doctors, particularly from that heritage, may be more reluctant to access support - and how organisations large and small need to think about tailoring their wellbeing initiatives to include all staff.
To access the melanin medics wellbeing fund visit
https://www.melaninmedics.com/wellbeing-fund
Women’s health and gender inequalities - Campaigning for change
28 juni 2021 |
48 min
It's been 25 years since the declaration on the rights of women, was signed in Beijing - and in that time the landscape of health car inequity has changed. To celebrate we created 3 podcasts, in collaboration with The WHO and UN University, as part of the collection on Women’s Health and Gender Inequalities
https://www.bmj.com/gender
In these podcasts we'll be hosting conversations between women early in, and some who are more advanced in, their careers - doctors, researchers, legislators and campaigners, all working towards building a future in which women can thrive.
As well as these in depth discussions, you will hear some shorter interviews from experts who have written for the collection. These give you a flavour of the bigger discussions going on in global health when it comes to gender equity - so keep an ear out for those during the discussions.
In this first podcast, Adrienne Germaine talks to Fila Magnus.
Adrienne starter her career as an activist for women's health in the 1970s, and went on to become president of the International Women's Health Coalition
Fila Magnus is Director of Communications at the International Youth Alliance for Family Planning, and was born in the same year as the Declaration was signed.
Fila and Adrienne discuss campaigning, now and then, and how the work that led to the declaration can be built on, but is never over...
The additional interviews are from; Emma Fulu, Sheena Hadi, Oswaldo Montoya, and Claudia Garcia-Moreno.
Talk Evidence - GP data, excess mortality and FDA approval
20 juni 2021 |
52 min
In this Talk Evidence, Helen Macdonald, Joe Ross and Duncan Jarvies discuss what's going on in the world of EBM.
Firstly, a while ago on the podcast, we concluded that excess mortality would be the best way to measure the impact of the pandemic - and now a new paper looks at different country's excess mortalitites over the past year. We're joined by author Nazrul Islam Physician-Epidemiologist at the University of Oxford (and a research editor for The BMJ) to talk about why comparisons may still not be sensible.
Read the full research here - https://www.bmj.com/content/373/bmj.n1137
The Delta variant is dominating headlines, and infections in the UK now - but until recently the Alpha one was ascendent, and new research has helped characterise how the mortality rate of that variant differed from previous viruses. We discuss how that research was done.
Read the full research - https://www.bmj.com/content/372/bmj.n579
GP data in the UK - the planned cut-off for granting access to your GP data for researchers has been extended, but there are still a lot of questions remaining. Helen has tried to find out some basic answers, and is still confused.
Finally, the FDA has approved a new drug for treatment of dementia - and researchers (and the FDA's own panel of experts) are up in arms. Joe Ross tells us why he thinks the decision was the wrong one, and why patients may be harmed because of it.
https://edition.cnn.com/2021/06/17/opinions/biogen-alzheimers-drug-opinion-ramachandra-ross/index.html
Wellbeing - are men worse at sounding the alarm about their mental health?
4 juni 2021 |
34 min
We've been bringing you stories of doctors wellbeing for a while in the podcast, but we noticed a pattern. Woman would come on and talk about their own difficulties, men would talk about other peoples - so we wanted to dive into that a bit, and called out on twitter for men who would be willing to open up to our listeners about their own mental health.
This interview is with Zeshan Quereshi - registrar in paediatrics, author and TedX talker. In this conversation we talk about why it is that men are particularly disinclined to open up about their difficulties at work, and what Zeshan has done to try and support his own.
Zeshan's TedX talk
https://www.youtube.com/watch?v=uctoTk64GVM
Coronavirus Second Wave - wrapping up the UK’s response
28 maj 2021 |
53 min
Finally it seems that life might return to normal in the UK, as the vaccination efforts continue apace, and despite concern about increasingly spreading variants, our hospitals are not being overwhelmed.
Because of this, we are changing our approach to covering the pandemic - and taking this second wave podcast to pastures new, but before that, in this last episode we’re going to look backwards and forwards, at the UK’s response.
On the panel today are
Matt Morgan, consultant in critical care, Nisreen Alwan, associate professor in public health, Partha Kar, consultant in diabetes, and Helen Salisbury, GP.
www.bmj.com/coronavirus
Wellbeing - Questions to ask yourself, if you think medicine may no longer be for you
21 maj 2021 |
42 min
The pandemic has wrought a lot of change, not least to doctors relationship to their careers. While still loving the patient interaction, we're increasingly hearing that doctors are disillusioned with the other aspects of medicine.
If you're feeling that way, there are ways to structure your thinking to help you make sense of your career. In this podcast Claire Kaye, former portfolio GP and now coach, explains how she went about deciding medicine wasn't for her, and how she helps doctors go through that process too.
You can find Claire at
https://www.drclairekaye.com/
https://www.instagram.com/drclairekaye_executivecoaching/
Talk Evidence covid-19 update - Research on vaccine safety, treatment for dementia
14 maj 2021 |
47 min
In this week's Talk Evidence, Joe Ross, BMJ editor and professor at Yale again joins Helen Macdonald to talk about emerging evidence on Covid-19.
They also welcome to the podcast Juan Franco, family physician in Buenos Aires, and professor at the Instituto Universitario Hospital Italiano, and new editor-in-chief of BMJ Evidence Based Medicine.
This week, the team bring you updates on;
Post-covid syndrome in individuals admitted to hospital with covid-19 - how are people with long covid faring.
Finally published research from Scandinavia on the risk of thrombotic events after administration of the Oxford-AstraZeneca vaccine - how big is the risk, and what does that mean for the overall benefit of that vaccine.
How difficult the UK population found it to understand and stick to the rules with our test, trace and isolate system - and some of the questions that this raises for this public health approach.
and finally, research that showed non-drug interventions are as good as pharmaceuticals at treating people with depression and dementia - and the holistic effect that alleviating depression can have.
Full reading list
Ayoubkhani, Daniel, Kamlesh Khunti, Vahé Nafilyan, Thomas Maddox, Ben Humberstone, Ian Diamond, and Amitava Banerjee. 2021. “Post-Covid Syndrome in Individuals Admitted to Hospital with Covid-19: Retrospective Cohort Study.” BMJ 372 (March): n693.
https://www.bmj.com/content/372/bmj.n693
Pottegård, Anton, Lars Christian Lund, Øystein Karlstad, Jesper Dahl, Morten Andersen, Jesper Hallas, Øjvind Lidegaard, et al. 2021. “Arterial Events, Venous Thromboembolism, Thrombocytopenia, and Bleeding after Vaccination with Oxford-AstraZeneca ChAdOx1-S in Denmark and Norway: Population Based Cohort Study.” BMJ 373 (May): n1114.
https://www.bmj.com/content/373/bmj.n1114
Smith, Louise E., Henry W. W. Potts, Richard Amlôt, Nicola T. Fear, Susan Michie, and G. James Rubin. 2021. “Adherence to the Test, Trace, and Isolate System in the UK: Results from 37 Nationally Representative Surveys.” BMJ 372 (March): n608.
https://www.bmj.com/content/372/bmj.n608
Watt, Jennifer A., Zahra Goodarzi, Areti Angeliki Veroniki, Vera Nincic, Paul A. Khan, Marco Ghassemi, Yonda Lai, et al. 2021. “Comparative Efficacy of Interventions for Reducing Symptoms of Depression in People with Dementia: Systematic Review and Network Meta-Analysis.” BMJ 372 (March): n532.
https://www.bmj.com/content/372/bmj.n532
Roopa Dhatt - Getting woman into leadership positions in healthcare
7 maj 2021 |
38 min
This interview is part of our BMJ interview series, where we talk to the people who are changing medicine. The series thus far has been a bit male dominated - reflecting the leadership in medicine at the moment, if not the actual workforce.
One woman who's planning to change that is Roopa Dhatt, executive director of Woman in Global Health - a new grassroots organistion which is making waves with its demand for equality of representation for woman in global health decision making.
In this interview, we talk to Dr Dhatt about the genesis of Woman in Global Health, and how they've managed to cement real commitment from the WHO. We also discuss how her experience of being Indian and American has shaped her understanding of equality in medicine, and how the covid-19 pandemic has highlighted the way in which women are discounted.
Wellbeing - Humanising medicine
29 april 2021 |
26 min
In medicine, a lot of work has been done to encourage person centred care - but can that maxim be extended to the people working within the healthcare system?
Subodh Dave has just been elected as dean of the Royal College of Psychiatrists, and joins us fresh from talking at the International conference on physician health to speak about his ambition to humanise medicine.
In this podcast, Subodh, Abi and Cat discuss what lessons from the pandemic need to remain, why at this time it's really important to look out for your colleague with family overseas, and how ice cream trucks meant much more than a cold treat.
www.bmj.com/wellbeing
Wellbeing - After shielding
22 april 2021 |
45 min
On this wellbeing podcast, Abi and Cat are joined by Emma Lishman, a clinical psychologist and part of the North Bristol NHS Trust's staff wellbeing team.Emma helps doctors return to training after a break - be that for maternity leave, or covid-19.
Emma describes some of the fears that doctors who have been shielding have expressed coming back onto the ward, the ways in which teams may inadvertently make those worse, and the problems with complying with risk assessments in the face of staffing pressures.
Wellbeing podcasts have focused a lot on the importance of openness about mental health in the NHS, but in this podcast, you'll also hear how reluctant clinicians are to discuss physical health problems - and why the taboo around all aspects of illhealth needs to be tackled.
For more wellbeing
https://www.bmj.com/wellbeing
Coronavirus second wave - headaches abound
14 april 2021 |
44 min
Recorded on Tuesday 13th of April, as the shops open in the UK, and England is heading to the beer gardens. The roll out of the vaccination programme has completed its first phase, and second doses have been given to the most vulnerable people - and now the under 50s are starting to get their first doses.
In this podcast, Duncan Jarvies, multimedia editor for The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire.
The genomicc trial Matt mentions is still recruiting - if you're interested more detail is available here https://genomicc.org/
Measure the broader impacts of healthcare
10 april 2021 |
38 min
The synergistic linking of increasing health and wealth is broadly accepted - it's an integral part of the thinking between the Sustainable Development Goals, and the World Bank's call for universal healthcare as a way of boosting a country's economy.
But the quantification of that link - the extent to which a particular health intervention, has broader economic impacts, is actually pretty poorly understood.
In this podcast, we hear from some economists, who have an idea about how we could - fairly easily - measure those impacts at the same time we measure clinical efficacy.
Joining us are, Dean Jamison, professor emeritus of global health at the University of Washington
Osondu Ogbuoji, assistant research professor at Duke Global Health Insitute.
Till Bärnighausen, director of the Heidelberg Institute of Global Health
Sebastian Vollmer, professor of development economics at the University of Göttingen
The collection that prompted this discussion is "Health, Wealth and Profits" - https://www.bmj.com/health-wealth-profits
Talk Evidence - children and covid, varients of concern, ivormectin update
2 april 2021 |
33 min
The evidence geekery continues, and this week Helen Macdonald and Duncan Jarvies are joined again by Joe Ross, The BMJ's US research editor, and professor of medicine and public health at Yale.
This week we update you on treatment - the WHO's guidelines for covid and ivermectin, and why they're not ready to recommend it's use in treatment, and prophylactic anticoagulation treatment.
We hear about two papers from the UK and Switzerland which look at children and covid, and we pick up on varients of concern and long covid.
Reading list.
Association between living with children and outcomes from covid-19: OpenSAFELY cohort study of 12 million adults in England
https://www.bmj.com/content/372/bmj.n628
Clustering and longitudinal change in SARS-CoV-2 seroprevalence in school children in the canton of Zurich, Switzerland: prospective cohort study of 55 schools
https://www.bmj.com/content/372/bmj.n616
Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: matched cohort study
https://www.bmj.com/content/372/bmj.n579
Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study
https://www.bmj.com/content/372/bmj.n311
Editorial - Prophylactic anticoagulation for patients in hospital with covid-19
https://www.bmj.com/content/372/bmj.n487
Living with Covid19 – Second review - Informative and accessible health and care research
https://evidence.nihr.ac.uk/themedreview/living-with-covid19-second-review/
Coronavirus second wave - vaccination roll out changes, uncertainty about long covid
25 mars 2021 |
49 min
In the UK, phase 2 of our coronavirus vaccination strategy may be delayed by supply problems, at the same time many GPs, who carried out the majority of the first vaccination phases, are declining to take on the addition burden and are trying to return to normal clinical work.
In this podcast, Duncan Jarvies, multimedia editor for The BMJ, talks to the full panel; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton.
Wellbeing - Put yourself first
18 mars 2021 |
43 min
In this Wellbeing podcast, sponsored by medical protection, Abi Rimmer and Cat Chatfield talk to Susanna Petche and Reina Popat, GPs and members of First You - an organisation of healthcare workers, promoting wellbeing in the NHS.
They discuss why it is that clinicians learn to subjugate their own wellbeing to their patients', and the ways in which working in the healthcare system perpetuate that. They discuss how systemic change can come through individual action, and how peers can band together to support each other.
What should ”following the science” mean for government policy?
15 mars 2021 |
59 min
This round table, recorded at the nuffield summit 2021, asks what does following the science actually mean - do ministers understand the nuance of the science in the pandemic, and how does uncertainty get interpreted through the lens of ideology and the power of compelling stories.
Taking part are:
Kamran Abassi, executive editor of The BMJ
Partha Kar, consultant in diabetes and endocrinology
Deborah Cohen, health correspondent for BBC Newsnight
Tom Sasse, associate director at the Institute for Government
Christina Pagel, professor of Operational Research at University College London
Matt Morgan, intensive care consultant
Andy McKeon, chair of the Nuffield Trust
Isobel Hardman, assistant editor of The Spectator
Mary Dixon-Woods, director of This Institute
Ben Page, chief executive of Ipsos MORI
Alexandra Freeman, executive director of the Winton Centre for Risk & Evidence Communication
Will Moy, chief executive of Full Fact
Nigel Edwards, chief executive of the Nuffield Trust
Talk Evidence - Inside the JCVI, and the key to grading evidence
12 mars 2021 |
56 min
In a slightly different talk evidence, Helen Macdonald and Duncan Jarvies are bringing you a couple, of in depth interviews,
Firstly, Anthony Harnden, GP, academic and member of the UK's Joint Committee on Vaccination and Immunisation takes us inside their decision making, and explains what evidence they look at, how they assess it, and what the next year of vaccination may look like.
Also in this episode, Gordon Guyatt, one of the founders of EBM, joins us to talk about Grade - the framework in which evidence for guidelines can be assessed - and explains why the most important thing is not the RCTs, but being very clear about what the guideline is supposed to achieve.
https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation
https://www.gradeworkinggroup.org/
Stephen Thomas - Behind the scenes in the Pfizer vaccine trial
8 mars 2021 |
33 min
Never has the spotlight been as strong on a clinical trial as that on the Pfizer BioNTech vaccine, the first approved for covid-19.
In this interview, Joanne Silberner spoke to its lead principal investigator, Stephen Thomas chief of infectious diseases at SUNY Upstate Medical University, New York, became the lead principal investigator for one of the most closely watched clinical trials in history.
They discuss the moment the positive results came through, what will happen to the people who are still enrolled in the trial, but got a placebo dose, and why the trial was designed in the way it was.
www.bmj.com/coronavirus
Coronavirus second wave - cancelled surgery, increasing waiting lists
3 mars 2021 |
43 min
Many surgeries have been cancelled during the pandemic, with good reason, as early data showed the increase in mortality associated with a coronavirus infection, but now waiting lists grow, and there are questions about how the NHS will pick up the slack.
In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to the full panel; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton.
They are joined by Mary Venn, research fellow, and honorary surgical registrar in London, who's been looking into the pandemic's effect on surgery. For more on that research:
http://nihrglobalsurgery.org/surgeryduringcovid
To register for our covid known unknowns webinar - https://www.bmj.com/covid-19-webinars
Wellbeing - speaking out about mental health in the NHS
26 februari 2021 |
45 min
Ashling Lillis is a now consultant in acute medicine at Whittington Health NHS Trust, but she was almost a consultant in intensive care medicine - but a mental health crisis just 6 months before she qualified made her reassess her career, and choose a different path.
In this podcast, Ash talks to Abi and Cat about the difficulty many doctors have when discussing their mental health - and how speaking out about her own experiences, has encouraged others to talk to her privately - and opened her eyes to the extent of the problem in the NHS.
www.bmj.com/wellbeing
The BMJ Interview - Jeremy Farrar; sharing the vaccine is enlightened self interest
19 februari 2021 |
33 min
Jeremy Farrar, is director of the Wellcome Trust, as well as advisor to the government on SAGE. Trained as a medic and with a PhD in neuro-immunology, he was a professor of Tropical Medicine and Global health at the University of Oxford.
In this podcast, he tells us why he thinks that vaccine nationalism is a very short-termist response the pandemic, and why he's bullish about new variants of the SARS-CoV-2 virus.
www.bmj.com/coronavirus
Corona virus second wave - Palliative care, and online abuse
17 februari 2021 |
43 min
In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton. This week our special guest is Rachel Clarke, author and palliative care specialist.
The panel discuss how end of life care has changed in the pandemic, and how clinicians have become targets of abuse on social media, for speaking out about things like masks and hospital capacity.
Wellbeing special - A post vaccination mindfullness moment
12 februari 2021 |
11 min
The observation period, after receiving a covid-19 vaccination may be the only 15 minutes someone in the NHS might get all day.
In this podcast, we're joined again by Chris Bu, psychiatry trainee who has previously spoken to us about how Burmese Buddhism helped him in his training.
He takes us through a guided mindfullness meditation, tailored to that post-vaccination period, to help you make the most of your observation time.
www.bmj.com/wellbeing
Talk Evidence - re-hospitalistion for covid-19, remote hypertension intervention
12 februari 2021 |
41 min
The evidence geekery continues, and this week Helen Macdonald and Duncan Jarvies are joined by Joe Ross, The BMJ's US research editor, and professor of medicine and public health at Yale.
This week we pick up on a preprint in medRxiv, which has been attracting attention on social media - it tries to look at the longer term effects of covid hospitalisation.
Joe explains why he thinks propensity matching can be summarised as "doing your best".
Finally, as more and more care moves remotely, we discuss a trial on a digital intervention to help manage poorly controlled hypertension remotely.
Reading list:
Epidemiology of post-COVID syndrome following hospitalisation with
coronavirus: a retrospective cohort study
https://www.medrxiv.org/content/10.1101/2021.01.15.21249885v1.full.pdf
Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial
https://www.bmj.com/content/372/bmj.m4858
Neil Greenberg on tackling PTSD in the NHS
9 februari 2021 |
39 min
Neil Greenberg is a psychiatrist, and professor of Defence Mental Health at King's College London. He spent 23 in the military, and now continues to work with them on things like peer led traumatic stress support packages.
A recent survey of NHS staff showed disturbing signs that covid-19 has caused a widespread trauma in staff, so in this podcast we talked to Neil about trauma and moral injury, what some of the warning signs are, and what individuals and organisations can do to help their colleagues.
www.bmj.com/wellbeing
The BMJ interview - Jeremy Hunt MP
8 februari 2021 |
43 min
Jeremy Hunt probably needs no introduction to our audience - the UK's longest serving health minister, he now chairs Westminster's Health and Social Care Committee - the powerful committee that holds the government to account for its policy choices.
In this interview Gareth Iacobucci asks Hunt if he regrets his decision to impose the contract on junior doctors which lead to their industrial action, how workforce issues have left the NHS in a poor state to deal with a health emergency. They also talk about the potential for a public enquiry into the government's handling of the pandemic, and what an upcoming committee report into the same issue might find.
Coronavirus second wave - The NHS one year on
4 februari 2021 |
41 min
The "public health emergency of international concern" was issued by the WHO a year and a lifetime ago. As the UK ramps up testing for the South African virus variant, and is full steam ahead on vaccination, we look back at what we've learned in that time.
In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire.
They talk about working in the NHS at the moment, the utility of international comparisons, and their remaining questions about vaccination regimes.
www.bmj.com/coronavirus
The BMJ interview - Tom Frieden, former CDC director on why we thought we were prepared
2 februari 2021 |
37 min
It’s been just over a year since the WHO declared the pandemic a “Public Health Emergency of International Concern” - if you cast your mind back to then, the news was full of reassurances about how prepared the UK and the USA were for a pandemic.
Now a year later, with the benefit of hindsight, that confidence was wildly overstated - but why was that, what is the gap between that theoretical readiness, and reality.
In this podcast we're joined by talking to Tom Frieden - former director of the Centres for Disease Control and Prevention, under President Obama, and who has a long history of public health leadership.
He talks about the gap between the apparatus to do something, the the political will to do that. Why data have been lacking, and the interaction between a infectious and non-infectious diseases.
www.bmj.com/coronavirus
Coronavirus second wave - 100,000 deaths
27 januari 2021 |
42 min
Recorded on the 26th January 2021
The UK has become, officially, the worst performing country in terms of Covid-19 deaths, per head of population - and the number of people in hospital is still higher than at any point in the pandemic.
In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire.
They talk about working in the NHS at the moment, and the challenges in things like oxygen and vaccine supplies. How the pandemic has exposed a gap in general medicine, and the importance of challenging poor responses at all levels.
Coronavirus second wave - The view from the front line
20 januari 2021 |
52 min
In the UK, over 37,000 people are in hospital with covid-19, and the NHS comes closer than ever to being overwhelmed - though 4 million people have received their first dose of the vaccine, we are warned that things will get worse before they get better.
In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton, about the pressure on hospitals, why GPs are questioning the need for max vaccination centres, and why the public health approach can't be just lockdown and vaccinations.
www.bmj.com/coronavirus
The BMJ interview: Fixing America’s covid response in the Biden era
19 januari 2021 |
29 min
US president elect Joe Biden wasted no time in appointing a special advisory board of experts to guide America out of its coronavirus crisis.
One of those experts is Celine Gounder, an infectious diseases epidemiologist who has worked on Ebola, tuberculosis, and HIV in Africa and South America. She’s a clinical assistant professor of medicine and infectious diseases at New York University’s School of Medicine, as well as an active writer and podcast host, including of Epidemic
In this podcast she talks to Joanne Silberner about the ways in which the taskforce is helping prepare for action immediately after the inauguration, what the big challenges they need to tackle are, and how they plan to rebuild trust in the U.S. covid response.
https://www.bmj.com/content/372/bmj.n33
Talk Evidence - Lateral flow tests update, not the best public health approach
16 januari 2021 |
42 min
In this episode of Talk Evidence, Jon Deeks, professor of biostatistics at the University of Birmingham, returns to the pod with an update on lateral flow tests - and why the government plan for using them in asymptomatic screening for covid-19 doesn't follow the science.
We're also joined by Allyson Pollock, clinical professor of public health at Newcastle University, and author of a recent editorial in The BMJ about asymptomatic transmission of SARS-CoV-2. She explains why she thinks supporting social isolation is the missing piece of our approach to tackling the pandemic.
Covid-19 INNOVA testing in schools: don’t just test, evaluate
https://blogs.bmj.com/bmj/2021/01/12/covid-19-innova-testing-in-schools-dont-just-test-evaluate/
Asymptomatic transmission of covid-19
https://www.bmj.com/content/371/bmj.m4851
The BMJ Interview - Andrew Pollard on the Oxford/Astra Zeneca vaccine
14 januari 2021 |
45 min
Andrew Pollard is Director of the Oxford Vaccines Group - who, along with Astra Zeneca, have developed an modified adenovirus vaccine for SARS-CoV-2.
In this interview we talk to him about the development of that vaccine - what he thinks about the UK government's plan to increase the interval between doses; if he worries about a mutating virus and vaccine escape; and how the university came to make a deal with a commercial company to provide cost-price vaccinations for the world.
www.bmj.com/coronavirus
Wellbeing - where to turn for emotional support during the pandemic
12 januari 2021 |
27 min
The Samaritans have traditionally been there for people in a crisis, those who are on the verge of ending their life by suicide - but during this pandemic, with the personal toll of caring for covid-19 patients, they are also here to provide emotional support for NHS staff however they are feeling.
In this podcast, Ben Phillips, head of service programmes for Samaritans joins us to explain how being listened to can help - and how to tactfully point your colleagues towards that emotional help if you feel they need it.
If you need support at this time you can call 0800 069 6222
or visit https://www.samaritans.org/how-we-can-help/health-and-care/
Food aid - helping providers support the health of their users
8 januari 2021 |
18 min
The growth in the need for food aid, in the UK, has been staggering. That's why The BMJ has chosen the Independent Food Aid Network (IFAN) as its annual charity appeal.
Nutritional guidelines which work for everyone is difficult, even harder for food aid providers who have to factor in things like long term storage, reduced access to fresh produce and in some cases the inability to afford the electricity to cook with.
In this podcast, Sabine Goodwin, IFAN's coordinator is joined by Isabel Rice, dietician at the charity Centrepoint, and Dee Woods, co-chair of IFAN and who co-runs Granville Community Kitchen, a food aid provider in London.
Please time the time to donate at;
https://www.foodaidnetwork.org.uk/bmj
Coronavirus second wave - The UK’s fourth lockdown
6 januari 2021 |
50 min
Recorded Tuesday 5th Jan 2021
As the UK enters lockdown, again, schools are closed, the NHS struggles under the surge of cases, new variants of SARS-COV-2 virus stalk the world, and vaccination programmes make a faltering start.
In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton, about the pressure on critical care, England's vaccination roll out, the closure of schools and why communication is undermining trust in the vaccines.
All the BMJ's corona virus coverage is currently free to access
www.bmj.com/coronavirus
Listening is the first part of research
5 januari 2021 |
27 min
The BMJ has long campaigned for better patient and public participation in research, making the case that it leads to better outcomes for patients and for society - but an article published in the Christmas edition of The BMJ goes further than that - and talks about the insights that participants in research provide- insights that the academic team would never be able to have themselves.
In this podcast, Seb Crutch a professor of neuropsychology, and Martin Rossor, national director for dementia research - who have been involved in neurological research as academics, and also by Valerie Mansfield, who’s a member of a patient support group, discuss how the scientific establishment can recognise those invaluable insights.
Read the full article:
https://www.bmj.com/content/371/bmj.m4478
A (non-systematic) evidence review of 2020
3 januari 2021 |
36 min
As 2021 hoves into view, we look back at a year of extraordinary evidence.
Helen Macdonald is joined by Joe Ross, one of The BMJ's research editors, as well as a researcher at Yale.
They discuss the way in which clinical pre-prints have become an important part of the research ecosystem, especially during the pandemic, and pick up on some of the non-coronavirus things you might have missed in the deluge of data.
The Deep Breath talking wellbeing evidence round-up of the year.
1 januari 2021 |
65 min
In this end-of-year podcast from Deep Breath In, we're bringing you a light hearted look back at 2020, and trying to remember some of the non-covid-19 medicine that has crossed our desks.
This festive quiz features the deep breath in gang, as well as Cat Chatfield from the Wellbeing podcast, and Helen Macdonald from our Talk Evidence podcasts.
Reading list;
Thyroid disease assessment and management: summary of NICE guidance
https://www.bmj.com/content/368/bmj.m41
Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline
https://www.bmj.com/content/365/bmj.l2006
Judd Brewer's advice for coping with burnout
https://drjud.com/
Talking Christmas evidence - how Christmas research is chosen
28 december 2020 |
40 min
If you've had time to digest this year's Christmas edition of The BMJ, you might have wondered how those papers get into The BMJ.
Well in this Talk Evidence podcast, Helen Macdonald, UK research editor at The BMJ talks to two of her research team colleagues, John Fletcher and Tim Feeney, as they talk through why they chose their favourite papers.
Toxicological analysis of George’s marvellous medicine
https://www.bmj.com/content/371/bmj.m4467
Does medicine run in the family—evidence from three generations of physicians in Sweden
https://www.bmj.com/content/371/bmj.m4453
The time to act is now
https://www.bmj.com/content/371/bmj.m4143
Wellbeing - Human factors, and Christmas Logistics
24 december 2020 |
43 min
How do human behaviours affect patient outcomes? And what has that got to do with Christmas?
Graham Shaw, director of Critical Factors, and Peter Brennan, a maxillofacial surgeon in Portsmouth, join us to explain what human factors are, why they’re not a bigger part of medical training, and talk about their importance as the NHS comes under greater and greater pressure because of the surge in covid-19 cases.
They also offer a word of advice to Santa, about making sure a festive never-event never happens.
www.bmj.com/wellbeing
Food insecurity in the 6th largest economy
23 december 2020 |
28 min
Every year, the BMJ has a charity appeal - we’ve regularly focused on organisations like MSF, or Lifebox - providing support to areas of the world which don’t have good healthcare provision… This year though, covid-19 has changed everything - and we’re focussed inwards, on the UK.
With growing unemployment, sections of the population being laid off, and with the well documented delays in receiving universal credit - food insecurity has become a major issue in the sixth largest economy in the world.
In this podcast Martin Caraher, emeritus professor of food and health policy at City University of London, explains how this crisis is a long time coming, and the result of the inattention of successive governments to the issue of hunger.
We also hear from Sabine Goodwin, coordinator of the Independent Food Aid Network, the recipients of this years award funds, about how the their network is being affected by the covid-19 pandemic, and how your money will be used to supports food banks, and advocate for their obsolescence
Donate the the Independent Food Aid Network here:
https://www.foodaidnetwork.org.uk/bmj
The soundscape of a hospital
22 december 2020 |
46 min
Until hear death in 2019, Annabel and her husband James Weaver, spent a lot of time together in hospitals - in patient and outpatient wards, waiting in makeshift waiting rooms in corridors and atriums. And while you or I might notice things about the way in which the hospital looks - James and Annabel noticed the way in which is sounded.
James is perusing a PhD at Queen Mary University of London into acoustics and the intelligibility of sound - and in this podcast we delve into the sound of a hospital, and why it can make communication between staff and patients so hard.
Read James's Christmas article, The sound of medicine
https://www.bmj.com/content/371/bmj.m4682
Rob Poynton wants you to pause
18 december 2020 |
39 min
Robert Poynton is an associate fellow of the Saïd Business School at the University of Oxford, and author of books designed to help people work in ways which help both their career and wellbeing.
In this wellbeing podcast, we focus on "Do Pause; you are not a to do list" - a book that Cat has had on her to do list for months.
Rob explain to us what the concept of "pausing" is, and why he thinks a small gesture can have a significant effect on our ability to deal with the stresses of day to day work life.
Rob's books are available on Bookshop
Do Pause
https://uk.bookshop.org/a/98/9781907974632
Do Improvise
https://uk.bookshop.org/a/98/9781907974014
Coronavirus second wave - Should we cancel Christmas?
16 december 2020 |
48 min
As London and some neighbouring counties move up to tier 3, and Germany, Italy and The Netherlands impose tighter restrictions over over the coming days of Christmas, in this podcast we ask - should Christmas gatherings be cancelled?
In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire.
They're joined by Mike Tildesley, reader in mathematics at Warwick School of Life Sciences, who models infectious disease spread.
They discuss why the key to controlling is pruning network connections - but why that concept hasn't been well explained to the public, what's happening in Cardiff, where ICU is running at 120% capacity, and how the vaccine roll out is being coordinated in primary care.
For more on the pandemic
www.bmj.com/coronavirus
Inside a vaccine trial
14 december 2020 |
30 min
The last few weeks we’ve been feverish in our coverage of vaccines - the evidence base for them is, how they’ve been evaluated and licensed, and who’s going to get them first.
But what we’ve not covered much is what it’s like to do, and take part in, a vaccine trial.
In this special podcast, we’re going to hear from John Wright, director of the Bradford Institute of Health Research. He’s been keeping a “doctors diary” for BBC radio, and in this podcast we’re doing a deeper dive into that - and finding out about the people working on, and volunteering to test, a corona virus vaccine.
Talk evidence covid-19 update - poor public messaging, and vaccine approval data
11 december 2020 |
47 min
The vaccines are being rolled out - but approval is still on an emergency basis, and the evidence underpinning those decisions is only just becoming available for scrutiny.
In this podcast we talk to Baruch Fischhoff, professor at Carnegie Mellon University and expert on public health communication about how that messaging should be done.
Peter Doshi, associate editor at The BMJ, and vaccine regulation researcher also joins us to talk about the data now released on the vaccine trials - what questions does it raise, and what are the next steps for researching safety.
For more on The BMJ's covid-19 coverage www.bmj.com/coronavirus
Coronavirus second wave - the vaccine’s here, but the pandemic isn’t over
8 december 2020 |
52 min
As the first people outside of a trial have started receiving Pfizer's sars-cov-2 vaccine, including Matt, but that's not the end of the story for the pandemic, there are still logistics of rollout, plus treating those who have already contracted the disease.
In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire.
They discuss why it's impossible to get the vaccine into care homes, because of the need for very low temperature storage, why the survival rate in ICU has gone down, and how messaging on the non-vaccine ways of preventing spread need to be tightened up, especially now.
For more of The BMJ’s covid-19 coverage.
www.bmj.com/coronavirus
Lockdown lessons from an Antarctic winter
4 december 2020 |
34 min
Anne Hicks, is an emergency medicine consultant in Plymouth, and for 16 years was the medical director for the British Antarctic Survey (she stepped down last year).
The British Antarctic Survey operates all through the antarctic winter - where for 90 days, the sun sets and plunges their base into cold and darkness. So who better to give us some advice on coping with the strict covid-19 rules during our winter period.
Anne talks to Cat Chatfield about the ways in which structure, even the seemingly small and arbitrary, can help, how to spot signs of someone struggling, and how the lack of daylight affects teams working at the bottom of the world.
https://www.bmj.com/wellbeing
Corona virus second wave - Fears for tiers
2 december 2020 |
46 min
As the first vaccine for corona virus is approved, and England joins the other nations of the UK outside of full lockdown, we are all entering tiers of restrictions - variable across the country, which will continue until that vaccine coverage is enough to slow transmission in the community.
In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire, and are re-joined by Karl Friston, neurologist and member of iSAGE.
They discuss what we know about the efficacy of these tiers, and how they interact with things like track and trace, and the mass testing taking place in Liverpool.
For more of The BMJ’s covid-19 coverage.
www.bmj.com/coronavirus
Calum Semple - the efficacy of mass testing in Liverpool
1 december 2020 |
40 min
The government has decided to pursue a strategy of mass-testing in Liverpool, in a pilot to see what effect that has on containment of corona virus.
A lot of criticism has been levelled at the scheme, from the sensitivity of the lateral flow test used, to whether this is screening and should be referred to the national screening committee to be evaluated.
Calum Semple, professor of child health and outbreak medicine at the University of Liverpool is evaluating the project, and joins us to explain what we can understand from this - how initial data shows the new testing regime is reaching more of the population, and why he thinks this is a public health intervention, not a personal screening test.
www.bmj.com/coronavirus
Why the government is being sued over PPE contracts
26 november 2020 |
48 min
The BMJ is a champion of openness and transparency in research, in clinical practice and in health policy.
However, if you’ve kept and eye on the journals recently, you’ll have seen that governments have been less diligent about keeping an eye on competing interests than they should be.
In this podcast we’re joined by Jolyon Maugham QC - one of the founding members of the Good Law Project, who have successfully litigated against the government on Brexit, and are now turning their eyes to procurement during the pandemic.
Jo talks to Kamran Abbasi about how big the contracts have been, how the UK’s system lacks the checks and balances to prevent a government from forging ahead, and if cronyism and corruption have damaged the pandemic response
www.bmj.com/coronavirus
Coronavirus second wave - recentring patients in our covid-19 response
24 november 2020 |
51 min
As further promising news emerges of vaccine effectiveness, although still with no data published, and as plans emerge for the return home of university students and limited festive winter celebrations.
But as we talked about in the last podcast, there needs to be a concerted effort to re-centre patients and the public within the decisions made about how the NHS will treat covid patients and those with continuing healthcare conditions impacted by the pandemic.
National Voices, a coalition of charities that stands for patient centred care, have been talking to patients about what matters to people during COVID-19 and beyond, and have written a report with some clear recommendations to health and care leaders and professionals.
In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton.
They are joined by Charlotte Augst, Chief Executive of national voices to talk about that report; why some patients have felt abandoned; how covid has accelerated the conversation about rationing; and why now is the time to rebuild services around patient needs.
www.bmj.com/coronavirus
Talk evidence covid-19 update - uncertainty in treatment, uncertainty in prevention
21 november 2020 |
34 min
Uncertainty abounds - even as we get better data on treatments, with the big RCTs beginning to report, and new trials on masks, the evidence remains uncertain, in both the statistical realm (confidence intervals crossing 0) and in what to do in the face of that continuing lack of clear effect.
As always Helen Macdonald and Duncan Jarvies are looking at the evidence, and this week are joined by John Brodersen, professor of general practice at the University of Copenhagen.
Helen talks to Bram Rochwerg, methodology lead on the WHO treatment guidelines for covid, about why their latest review has stopped recommending remdesivir for covid-19 treatment.
John tells us about the Danmask study - what question it was actually trying to answer.
We also discuss the ways in which there is a tendency to express certainty where there is none, and why distrusting simple solutions to complex problems is a good rule of thumb.
Reading list:
A living WHO guideline on drugs for covid-19
https://www.bmj.com/content/370/bmj.m3379
Covid-19’s known unknowns
https://www.bmj.com/content/371/bmj.m3979
Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers
https://www.acpjournals.org/doi/10.7326/M20-6817
Wellbeing - What we’ve learned from treating doctors
20 november 2020 |
30 min
Clare Gerada and Zaid Al-Najjar have been treating doctors for a while now, through the NHS Practitioner Programme.
In that time they have noticed some themes in the issues that bring doctors to them, from isolation to stress.
In this podcast they reflect on what they've learned about the problems that affect doctors, and how covid-19 has exacerbated some, and surprisingly reduced others.
Their book Beneath the White Coat: Doctors, Their Minds and Mental Health is out now
https://www.routledge.com/Beneath-the-White-Coat-Doctors-Their-Minds-and-Mental-Health/Gerada/p/book/9781138499737
Coronavirus second wave - vaccines, how ready is the needle to hit the arm?
17 november 2020 |
58 min
Covid-19 continues its grip on the Northern Hemisphere alongside news of a vaccine trial showing real success at first glance. In this second wave update, we explore the latest issues with healthcare professionals from primary care, secondary care, and public health, and discuss what is happening in their field, and put their questions to experts.
In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton.
They are joined by Katrina Pollock, senior clinical research fellow in vaccinology at Imperial College London, to talk about: the three vaccines in the news; why different groups may require different vaccines; and how to choose who to get the vaccination first.
www.bmj.com/coronavirus
How well did hospitals perform for their staff during covid?
13 november 2020 |
34 min
In the first wave of covid-19, hospitals started to reconfigure space and services, to provide rest areas and food for staff, to help them cope with the surge in patients.
Michael West, professor professor of work and organisational psychology at Lancaster University Management School, returns to the podcast to talk about how well those changes helped staff - and what needs to be done, now that a second wave is hitting, to make sure those essential services don't disappear.
www.bmj.com/wellbeing
Coronavirus second wave - viral transmission and a vaccine announcement
11 november 2020 |
51 min
Covid-19 continues its grip on the Northern Hemisphere alongside news of a vaccine trial showing real success at first glance. In this second wave update, we explore the latest issues with healthcare professionals from primary care, secondary care, and public health, and discuss what is happening in their field, and put their questions to experts.
In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Alison Pittard, a consultant in anaesthesia and intensive care medicine in Leeds, and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton.
They are joined by Müge Çevik, an infectious diseases researcher at the University of St Andrews, to talk about: what’s happening with track and trace and how to make it work better; transmission and asymptomatic spread, in particular hospital-acquired infections; views on the news of Pfizer’s vaccine; and reaction to US presidential election.
www.bmj.com/coronavirus
A lump in the throat with Nick Hamilton, Deonne Dersch-Mills and Bonnie Kaplan
5 november 2020 |
59 min
A lump in the throat is a classic GP presentation, but one that often causes a lot of worry. Many people are struggling with high levels of anxiety anyway at the moment, and this may manifest physical symptoms, such as fatigue, insomnia and dysphagia.
In this week’s episode, we discuss how to differentiate between causes of a lump in the throat: is my patient experiencing laryngopharyngeal reflux, or could it be cancer? How do we reassure distressed patients when we need to refer them on for imaging, or a consultation with a specialist, before we can rule out a malignant cause?
We also talk about how to manage a patient who has difficulty swallowing pills, and the challenges of getting children, in particular, to take medication.
Our guests:
Nick Hamilton is a clinical lecturer in otorhinolaryngology at UCL, and also works as a specialist registrar in otorhinolaryngology head and neck surgery at North Thames Deanery, London.
Deonne Dersch-Mills is the clinical practice leader for pharmacy for paediatrics & neonatology with Alberta Health Services. She is based at Alberta Children’s Hospital, Calgary.
Bonnie J. Kaplan is a semi-retired research psychologist, and professor emerita from the Cumming School of Medicine, Calgary.
Coronavirus second wave - Making the lockdown work
3 november 2020 |
58 min
As the second spike in covid-19 cases grows, we want to take stock of what's happening in the NHS. In these second wave updates, clinicians from primary care, secondary care, and public health, discuss what is happening in their field, and put questions to experts.
In this podcast, Fiona Godlee, editor in chief of The BMJ talks to Matt Morgan, consultant in intensive care medicine in Cardiff and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton.
They are joined by Andrew Hayward, professor of infectious disease epidemiology and inclusion health research, to talk about the lockdown in England, why the message should be clearer, what needs to be done to make the lockdown work, and how doctors are braced for the upcoming surge in cases.
https://www.bmj.com/coronavirus
Talk evidence covid-19 update - talking risk, remdesivir, and relevant research
30 oktober 2020 |
41 min
In this talk evidence covid-19 update, we’re taking on risk - how do you figure out your individual risk of dying from the disease? Try QCovid, but remember that it’s figuring out your risk back in April.
When it comes to talking about risk, very few people actually engage with the number, so Alex Freeman from the Winton Centre for Risk and Evidence Communication at the University of Cambridge joins us to describe their research into more effective ways of presenting it.
Huseyin Naci, from the London School of Economics, returns to the podcast to talk to us about the problems of pulling all the trial data together, and where covid-19 has made people work together most effectively in tackling that issue.
Reading list;
Living risk prediction algorithm (QCOVID) for risk of hospital admission and mortality from coronavirus 19 in adults
https://www.bmj.com/content/371/bmj.m3731
Repurposed antiviral drugs for COVID-19 –interim WHO SOLIDARITY trial results
https://www.medrxiv.org/content/10.1101/2020.10.15.20209817v1
Producing and using timely comparative evidence on drugs: lessons from clinical trials for covid-19
https://www.bmj.com/content/371/bmj.m3869.full
Chris Whitty on the challenge of winter, lockdown, and following the science
29 oktober 2020 |
39 min
Chris Whitty probably needs no introduction to our UK audience - he's the chief medical advisor to the UK government, has played a pivotal role in shaping the country's response to Covid-19.
He rarely does interviews - so in this conversation we wanted to ask him the questions that matter to clinicians, about how the pandemic will impact them over the winter.
This was recorded yesterday, just before the announcement of the strict lockdowns in France and Germany.
For more covid-19 coverage
www.bmj.com/coronavirus
Coronavirus second wave - what the modelling say about slowing transmission
27 oktober 2020 |
46 min
As the world sees an upsurge in infections, this "second wave" feels different to the first - we have a much better understanding of the biology of the virus, in hospitals, guidelines for treatment have been rapidly developed... and the pipeline of research to improve that has been created.
But a lot of questions remain - particularly about the dynamics of the spread of respiratory viruses.
Which brings us onto this episode - in these weekly discussions, clinicians from across the healthservice and I will be joined by experts, so we can find out more about the issues that really matter to frontline staff.
Joining us today are BMJ columnists, Matt Morgan, consultant in intensive care medicine in Cardiff and Helen Salisbury, GP in Oxfordshire. We also have The BMJ authors, Nisreen Alwan, consultant in public health, in Southampton and Karl Friston, neurologist and member of iSAGE
For more of The BMJ’s covid-19 coverage.
www.bmj.com/coronavirus
Deep Breath In - EUPD with Leisha Davies, Soumitra Burman-Roy and Marie Stella McClure
22 oktober 2020 |
59 min
Personality disorder is often referred to as the “Cinderella” diagnosis of mental health. Around 1 in 20 people is estimated to have a personality disorder, and it is a neglected and under-resourced area of our healthcare system. In this week’s episode, we discuss the stigma surrounding personality disorder, which can often manifest itself in high levels of anxiety for both patients and GPs, when it comes to diagnosing and managing it, and how to help a patient come to terms with their diagnosis.
With suicidal ideation being experienced by many people with a personality disorder on a regular basis, we also talk about how we may best manage a situation of a patient in crisis presenting in primary care.
Our guests:
Leisha Davies is a clinical psychologist, originally from South Africa, who currently works in private practice.
Soumitra Burman-Roy is a consultant psychiatrist at the South London and Maudsley NHS Foundation Trust. He also works for Maudsley Learning, an organisation which provides mental health training for primary care.
Marie Stella McClure, who was diagnosed with borderline personality disorder at the age of 38, is the author of ‘Borderline: a Memoir’, a book about her life and experiences of BPD.
Second wave updates - How it’s affecting practice now
21 oktober 2020 |
32 min
As the second spike in covid-19 cases grows, we want to take stock of what's happening in the NHS. In these second wave updates, clinicians from primary care, secondary care, and public health, discuss what is happening in their field, and put questions to experts.
In this podcast, Fiona Godlee, editor in chief of The BMJ talks to Matt Morgan, consultant in intensive care medicine in Cardiff and Helen Salisbury, GP in Oxfordshire - they discuss how full hospitals are getting, how many covid-19 cases are presenting in primary care, and how treating patients has fared as the pandemic hots up.
For more on covid-19 visit https://www.bmj.com/coronavirus
Wellbeing - Dreading the second wave
20 oktober 2020 |
32 min
The "second wave" of covid is hitting the UK, and clinicians are anticipating a spike in demand in the NHS. The inevitability of that is weighing on NHS staff's minds.
In this podcast, Cormac Doyle, a retired senior army officer, who specialises in military mental health/ veterans and support other with psychological trauma, returns to the podcast to talk about his experience of deployment in the military, and how individuals and their employers can make the inevitability of a second wave less daunting.
For more wellbeing from The BMJ - https://www.bmj.com/wellbeing
Economics for Drs - what you need to know to understand UBI and a jobs guarantee
16 oktober 2020 |
33 min
As the economic fall out of covid-19 starts to bite, attention is turning to how the state can support everyone - especially if the pandemic turns into a depression.
Universal basic income, and a jobs guarantee are two of the potential mechanisms a country could deploy, both with different effects on people's health and wellbeing.
In this podcast, Martin Hensher, associate professor of health system financing and organisation at Deakin university in Australia, and author of the new analysis "Covid-19, unemployment, and health: time for deeper solutions?" joins us to get you up to speed on the economic thought behind these two schemes.
Read the full analysis;
https://www.bmj.com/content/371/bmj.m3687
Coughing kids with Tim Spector and Edward Snelson
8 oktober 2020 |
43 min
Persistent coughing in children is always a challenge, both for parents trying to describe and measure the cough, and for doctors making a diagnosis. In the current climate, this is all the more difficult, seeing as a continual cough is one of the major symptoms of COVID-19. UK Government guidance advises that anyone with a persistent cough should get a coronavirus test. But with the reopening of schools and the beginning of the cold & flu season both coinciding with a national shortage of tests available, should we all err on the side of caution and try to get a test at the first sign of a cough or sniffle, or can the data on cold virus symptoms help parents and GPs make an informed judgement on the likelihood that their child’s cough indicates COVID?
Our guests:
Tim Spector is a professor of Genetic Epidemiology, and director of the TwinsUK Registry, at King’s College London.
Edward Snelson is a paediatrician in the paediatric emergency department at Sheffield Children’s Hospital.
Talk Evidence covid-19 update - antigen testing and developing non drug evidence
5 oktober 2020 |
46 min
In this Talk Evidence covid-19 update, Jon Deeks, professor of biostatistics at the University of Birmingham gives us an update on testing technology. Will the point of care tests make a different to big live events, and how research and regulation need to change to tame the testing wild west.
Paul Glasziou, professor of evidence based practice at at Bond University has set up a new collaboration to try and get better at creating evidence for non-drug/vaccine control of pandemics - and ponders why we're good at drug research, but terrible at other kinds.
A way for healthcare to become net-zero for carbon
2 oktober 2020 |
40 min
David Pencheon, Renee Salas and Ed Maibach join us to talk about how healthcare can, and should, take leadership on climate change.
With a few exceptions, the healthcare industry lags behind in efforts to reduce carbon emissions - in this podcast, we'll discuss why that is, why now is the time to take decarbonisation seriously, and why Covid-19 is a hindrance, but also a potential pivot point for change.
A pathway to net zero emissions for healthcare
https://www.bmj.com/content/371/bmj.m3785
For more on health and climate change
https://www.bmj.com/campaign/climate-change
’Flu vaccine season - with Nikki Turner and Jeff Kwong
24 september 2020 |
58 min
With the annual flu season looming, GPs are anticipating a frenzy of vaccinations, perhaps more so than ever this year.
As so many 'flu and respiratory viruses circulate every year, and as the 'flu vaccine is for one strain of influenza only, is the vaccine worth getting, and what are the risks associated with vaccinating vs. not vaccinating?
In this week’s episode, we discuss the high vaccine uptake in New Zealand, and the role that social distancing for COVID-19 may have played in their low numbers of seasonal flu.
We also talk about whether or not the message we give to patients about the benefits and risks of vaccination is transparent enough, and how we might communicate better with them to allow them to make an informed decision.
We feel pressure to increase vaccination rates, because we believe we are protecting people, but does the evidence support that?
Our guests:
Nikki Turner is the director of the Immunisation Advisory Centre (IMAC) at the university of Auckland. She is an academic general practitioner, and a professor at the university.
Jeff Kwong is a professor at the University of Toronto, and the interim director of the Centre for Vaccine Preventable Diseases at the university’s Dalla Lana School of Public Health.
Talk evidence covid-19 update - covid in kids, and the winter cold season
23 september 2020 |
27 min
This episode was recorded on 18 September - just before the news came out about the new lockdown measures. We’ll hear Carl and Helen’s thoughts, but we also want to hear a broad range of views - so get in touch at bmj.com/podcasts.
(1.15) The kids are back in school, and people are worried about the infection spreading. Helen takes us through the ISCARIC data on children's symptoms and outcomes from covid-19.
(5.50) David Ludwig, professor of pediatrics at Harvard Medical School and BMJ editor, joins us to give an overview of paediatric covid.
(15.30) Carl has thoughts about the spread of covid, and how it seems to be mirroring other respiratory illnesses.
(18.00) We wonder about the evidence for the "rule of six"
Nudge it
21 september 2020 |
27 min
Nudging seemed to be all the rage a few years ago - a way of changing individual behaviours to help people make better choices, about their diet, exercise and other habits.
A lot of hype ensued, the UK government under Tony Blair even set up a “nudge unit” - but questions were asked about the efficacy of the approaches used, confusion about what a nudge actually was, and how to turn it into actual scalable change have followed the discipline.
In this podcast Craig Fox, behavioural scientist at UCLA, and author of a new analysis “Details matter: predicting when nudging clinicians will succeed or fail” joins us to explain why he thinks nudging could work in medicine.
https://www.bmj.com/content/370/bmj.m3256
To register for your free online place at BMJ Live 2020 visit
https://live.bmj.com/
Anthony Fauci - on changing science, long-covid, and political intrusion into health agencies
18 september 2020 |
33 min
Dr Anthony Fauci needs no introduction, as head of the NIAID for almost four decades, and the U.S. government's leading advisor on infectious diseases, and leader in the country's response to Covid-19.
In this interview with The BMJ, Dr Fauci covers parallels in his experience in the HIV/AIDS crisis with this latest public health emergency. He talks about how his understanding of Covid-19 has changed.
We also tackle the reports of political intrusion into the CDC and, address worries about the rush toward a vaccine in time for the November elections.
For more from The BMJ's covid coverage, all available for free
https://www.bmj.com/coronavirus
Talking about obesity with Stephanie deGiorgio and Naveed Sattar
10 september 2020 |
59 min
Fatphobia has been described as society’s last ‘ism’. Whilst our understanding of weight and health has changed over time, there is still a stigma towards people who are overweight or obese, and an assumption that they must be unhealthy, and unhealthy by choice. However, the correlation between weight and health may not be as clear cut as our societal biases would lead us to believe, and, therefore, the challenge for GPs is to make a conscious efforts to overcome our preconceptions so that they may provide the best support for our obese patients. This week, we discuss the need for a zero tolerance towards fat shaming at an organisational level, and how we can make GP practices more accessible for this group of patients. We also talk about retraining the palette in order to sustain weight loss, and our duty to lobby for better community-based weight management services.
Our guests:
Stephanie deGiorgio is a GP, and the clinical lead in the UTC at Queen Elizabeth The Queen Mother Hospital, Margate. She has a special interest in obesity.
Naveed Sattar is a professor of Metabolic Medicine at the University of Glasgow. His main research concerns investigating the prevention, causes and management of diabetes, heart disease and obesity.
Wellbeing - Mask shaming
5 september 2020 |
30 min
The social norms that guide our behaviour in the world aren’t often quick to change - but the imperative to wear a mask in public has rapidly taken hold, establish by law, but policed by the public.
Mask shaming is a new phenomenon, but in this podcast, Brandy Schillace, author, historian and editor in chief of Medical Humanities (a BMJ journal) joins Cat and Abi to discuss how ineffective shaming is as a tool for behaviour change, and what mask-shaming reveals about the ways in which society treats those who are seen as non-conforming.
For more on The BMJ’s wellbeing campaign
www.bmj.com/wellbeing
Talk Evidence Covid-19 Update - Lockdown, a spoonful of honey, and weight loss
28 augusti 2020 |
33 min
There are have been local lockdowns in the UK, in places such as Oldham, Birmingham, Manchester – but what is the criteria for making that decision?
In the non-Covid world: does honey alleviate symptoms in upper-respiratory tract infections? When does unexpected weight-loss warrant further investigation for cancer in primary care?
Plus, in the light of findings from the Cumberlege review of safety in medical devices, the team discuss the issue of doctors’ declaration of interests.
Time For A Pill Check With Anne McGregor And Tara Stein
28 augusti 2020 |
59 min
Contraceptive pill check-up appointments used to be simple and straightforward for GPs, and frequently felt like a welcome reprieve from more complex consultations. However, there’s often more to them these days, especially given the rise in tailored regimens, with more and more women moving away from the standard of 21 pills followed by a 7-day break.
In this week’s episode, we discuss common misconceptions around the pill cycle compared with a woman’s natural cycle, the various side effects caused by taking an oestrogen-dominant versus a progesterone-dominant pill, and the purely arbitrary nature of the standard regimen. How do we ensure that our patients are able to make an informed choice on their method of contraception, and how do we avoid the risk of contraceptive coercion?
Our guests:
Anne MacGregor is a professor, working in Secual ans Reproductive Healthcare at Barts Health NHS Trust. She is a specialist in women’s health, and also in headaches and migraines.
Tara Stein is a Family Medicine doctor at Montefiore Medical Center, and the Clinical Curriculum Manager for RHEDI – Reproductive Health Education in Family Medicine.
Wellbeing – The joy of socks
21 augusti 2020 |
30 min
In Australia, a staggering 25% of doctors have had thoughts of suicide in the past 12 months, a recent survey said. Mental health problems are higher in medicine than any other job – and yet healthcare professionals are still stigmatised for seeking help. Partly in response to his own struggles, Geoff Toogood, a cardiologist in Melbourne, started an ingenious campaign called CrazySocks4Docs to highlight the issue.
https://www.crazysocks4docs.com.au/
What Do We Know About Long Covid
20 augusti 2020 |
29 min
Trisha Greenhalgh, professor of primary care health sciences at the University of Oxford has been a powerhouse of covid-19 evidence synthesis. She pulled together advice on doing remote consultations, on wearing masks to prevent spread, and a host of other information.
She’s now turning her attention to “long-covid” - as we learn more about the disease, it’s becoming apparent that it’s not just an acute infection, patients are reporting chronic long term consequences of having the virus.
In this podcast, she describes what we know about long-covid, where the uncertainty lies, and what clinicians should be doing to help patients who are experiencing the symptoms.
Management of post-acute covid-19 in primary care
https://www.bmj.com/content/370/bmj.m3026
Talk evidence covid-19 update - Living meta-analysis and covid uncertainty
15 augusti 2020 |
43 min
1.00) Carl has been looking at PCR testing, and explains why it picks up both viable SARS-cov-2, but also fragments of it’s RNA - leading to potential over diagnosis.
(8.50 ) What did the Living systematic review and accompanying guidelines say about treatment options for covid-19
(14.35) Helen talks to Reed Siemieniuk, general internist from McMaster University, about creating a living network meta-analysis, to try and synthesis all the evidence on covid-19
(22.48) Helen also talks to Bram Rochwerg, associate professor at McMaster University and
consultant intensivist at Hamilton Health Sciences, about turning the outcomes of a meta-analysis into guidelines, and why at the moment they’re still calling for more evidence on Remdesivir
(30.08) Finally, there are worries about the uncertainty expressed in the living review - and in the way in which we communicate that. Helen goes back to Reed to find out how the review might evolve in the future.
(33.50) Covid isn’t just an acute disease, there is emerging consensus that it’s systemic effects lead to long term problems for some patients - but there’s a lot of uncertainty there.
(38.40) Carl talks about the IMMDS review and his involvement in it - and what recommendations we’ll be covering in future Talk Evidence programmes.
Reading list:
Drug treatments for covid-19: living systematic review and network meta-analysis -https://www.bmj.com/content/370/bmj.m2980
Remdesivir for severe covid-19: a clinical practice guideline - https://www.bmj.com/content/370/bmj.m2924
Management of post-acute covid-19 in primary care - https://www.bmj.com/content/370/bmj.m3026
Thinking about vitamin D with Andrew Grey and Tom Chatfield
13 augusti 2020 |
61 min
Interest in vitamin D, and it’s association with a range of health outcomes continues - at least if the regular flurry of papers on the subject that are submitted to The BMJ are anything to go by, and with Covid-19, interest has piqued again.
GPs are regularly asked to prescribe it, and to test for deficiencies. Low levels of vitamin D are associated with a large number of health outcomes, but, given the high costs and low accuracy of tests, would it be easier just to recommend taking supplements without testing vitamin levels first, taking a “won’t hurt but might help” approach? If so, should we all be taking them, and would doing so help to prevent against COVID-19?
Our guests:
Andrew Grey is an endocrinologist and an associate professor of Medicine at the University of Auckland.
Tom Chatfield is a philosopher, author and broadcaster, whose work looks at humans and technology, as well as cognitive biases.
Talk Evidence covid-19 update - How well have physical distancing measures worked?
31 juli 2020 |
41 min
Fresh outbreaks of covid in Europe and a wave of infections in the United States have been in the news this week, highlighting the renewed need for social distancing – but to what extent?
In this edition, we explore the real-world evidence for physical distancing measures as well as the research into whether or not facemasks make us behave more recklessly.
We also discuss the non-covid themes of research transparency and a BMJ investigation into the lucrative business of orphan drugs.
“Trust me, I’m a GP” with Karen Praeter and Rhea Boyd
31 juli 2020 |
49 min
In light of the publication of the Independent Medicines and Medical Devices Safety Review (the Cumberlege report) in early July, which assessed the use of vaginal mesh, sodium valproate and Primodos and their associated under-acknowledged complications, this week we discuss trust between patients and doctors, and how that relationship of trust can break down when patients feel that their concerns and their pain are not being recognised and supported. We talk about the influence of racial inequalities on trust and healthcare outcomes, GPs being an advocate for their patients, and we ask what structural changes to the healthcare system need to happen to allow us to spend more time with our patients and build up that trusting relationship with them?
Our guests:
Karen Praeter works on the admin team of Sling the Mesh, a campaign which raises awareness of the risks of having a vaginal mesh implant, having joined two years after her own mesh implant operation in 2015 which led to painful complications.
Rhea Boyd is a paediatrician at the Palo Alto Medical Foundation in California, and she is also a public health advocate and scholar.
Wellbeing – addiction during lockdown
30 juli 2020 |
26 min
Lockdown has been such a stressful period that many healthcare professionals developed abnormal behaviours to cope. Addiction is one such behaviour, be it to a substance – alcohol for example – or any other obsessive activity like exercise. Dr Caroline Walker, an NHS psychiatrist and therapist who has personal experience of addiction discusses the harmful behaviours to look out for and what to do about them.
Marian Knight - Improving obstetric outcomes with a single dose of antibiotics
25 juli 2020 |
21 min
This time of year we would usually be doing some podcasts from the BMJ awards - but the pandemic has delayed our plans.
We’re still working on acknowledging some of the best medicine from around the UK, but in the meantime we’ve decided to give out the awards for outstanding contribution to health, and research paper of the year.
In the following interview, Fiona Godlee - the BMJ’s editor in chief, talks to Marian Knight, lead author of the ANODE trial - The BMJ's research paper of the year.
For more about The BMJ Awards categories and previous winners; https://thebmjawards.bmj.com/
David Pencheon - measuring the climate impact of the NHS
25 juli 2020 |
31 min
This time of year we would usually be doing some podcasts from the BMJ awards - but the pandemic has delayed our plans.
We’re still working on acknowledging some of the best medicine from around the UK, but in the meantime we’ve decided to give out the awards for outstanding contribution to health, and research paper of the year.
In the following interview, Fiona Godlee - the BMJ’s editor in chief, talks to David Pencheon, director of the NHS sustainability unit about his work.
For more about The BMJ Awards categories and previous winners; https://thebmjawards.bmj.com/
Covid public health - Data is fundamental
22 juli 2020 |
31 min
As the pandemic play out, we’ve seen ways in which the collection of covid data - and it’s sharing, has been flawed, with reports in the UK that local authorities haven't got granular data, and in the US that the CDC is being circumvented for data reporting.
Kathleen Bachynski, assistant professor of public health at Muhlenburgh College, and Sridhar Venkatapuram, director of global health education & training at King's College London join us to discuss why data is fundamental to the social contract between the public and their government, and why undermining it is so dangerous.
Talk Evidence covid-19 update - How will we know if a vaccine works?
17 juli 2020 |
37 min
Vaccines have been in the news this week - but when you dig into the stories, it turns out that the hype is about phase 1 trials. We're a long way from being sure any of the 150 possible vaccines being developed actually work.
In this talk evidence we're talking to a researcher, a regulator, and a manufacturer about the way in covid-19 is upending normal vaccine development, which hurdles they'll have to reach to get onto the market, and how we'll know which one to choose when they are there.
This week
(1.10) We said that covid would have a knock-on effect on other treatments, and Helen looks at some research into acute coronary syndrome admissions in the UK.
(6.53) Peter Doshi, assistant professor of pharmaceutical health services research at the University of Maryland School of Pharmacy and an editor for The BMJ, tells us what to watch out for in the PICO for a vaccine study.
(15.20) Marco Cavaleri, head of Biological Health Threats and Vaccines Strategy at the European Medicines Agency, explains what regulators are looking for when thinking about licencing a vaccine - and how covid has made different agencies around the world align their requirements.
(22.22) Philip Cruz, UK head of vaccines at GSK, explains how a manufacturer tests their vaccines, and how they use adaptive study design to past regulatory hurdles and provide information for those choosing which vaccine to use.
Reading list
Lancet paper - COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31356-8/fulltext
ONS Data - Deaths registered weekly in England and Wales, provisional: week ending 3 July 2020
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/latest
The BMJ editorial - Vaccines, convalescent plasma, and monoclonal antibodies for covid-19
https://www.bmj.com/content/370/bmj.m2722
WHO report - Draft landscape of COVID-19 candidate vaccines
https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines
Research Methods & Reporting
The Adaptive designs CONSORT Extension (ACE) statement: a checklist with explanation and elaboration guideline for reporting randomised trials that use an adaptive design
https://www.bmj.com/content/369/bmj.m115
Tackling racism with Annabel Sowemimo, Shani Scott and Joan Saddler OBE
16 juli 2020 |
63 min
The signs and symptoms of racism have long permeated our society, and are embedded in our clinical practice and medical education. Recent events in the US, including the murder of George Floyd, have brought the Black Lives Matter movement to the fore of public consciousness, and have sparked outrage and protests in countries around the world. COVID-19 has exposed the inequalities in our healthcare systems, as the virus has had a disproportionate impact on some ethnic minority communities. In this week’s episode, we discuss colonial undertones to contraception policy-making, how doctors remaining silent on racial issues are seen as complicit, and the lack of diversity in learning resources used in medical schools. How can we use the current climate as a teaching moment to engage with people, clinicians and patients, about their experiences of healthcare? And how do we begin to make reparations in medicine for centuries of institutionalised racism?
Our guests:
Annabel Sowemimo is a community Sexual & Reproductive Health registrar, working in Leicester. She is also the founder of Decolonising Contraception and a trustee for Medact charity.
Shani Scott works as a general internist at Montefiore Medical Center in the Bronx. She is an associate program director for the Moses-Weiler Internal Medicine Residency Program, and is also the co-director of Diversity & Inclusion for the Department of Medicine at Montefiore Medical Center.
Joan Saddler OBE is the director of partnerships and equality at the NHS Confederation, and the co-chair of the NHS Equality & Diversity Council. She was awarded an OBE in 2007 for services to health and diversity.
Resources mentioned by Jenny:
NEJM Perspective, "How Medical Education is Missing the Bull's-eye" by LaShyra Nolen
https://www.nejm.org/doi/full/10.1056/NEJMp1915891
America Did What?! Podcast with Blair Imani & Kate Robards
Episode 1: Redlining and the GI Bill
https://www.stitcher.com/podcast/america-did-what
Making the drug and device system fit for patients
15 juli 2020 |
29 min
A series of medical scandals prompted Jeremy Hunt, former UK health secretary to launch the Independent Medicines and Medical Devices Safety Review - with the explicit aim of strengthening the patient voice in order to help build a "system that listens, hears and acts – with speed, compassion and proportionality"
That report is out, and describes a system that does anything but.
In this podcast, Sir Cyril Chantler, the review's vice chair discusses their recommendations, for better regulation, transparency and patient advocacy in the use of medicines and medical devices.
Read the full report:
https://www.immdsreview.org.uk/
The BMJ report into what we must learn from mesh
https://www.bmj.com/content/363/bmj.k4254
What are the chances of an American vaccine?
10 juli 2020 |
37 min
US President Donald Trump has been pushing hard for an American vaccine against Covid-19. He's named the program Operation Warp Speed, which has many people worried that safety tests will be rushed.
What are the prospects for an American vaccine against Covid-19? If the US is first, will it make its vaccines available to other countries? And what if it's not first?
Three American vaccine experts talk with the BMJ about prospects for an American vaccine against the new coronavirus.
Joining us are;
Nicole Lurrie - senior lecturer at Harvard Medical School and a strategic adviser to the foundation working on global vaccines, CEPI.
Paul Offit - professor at the University of Pennsylvania, and co inventor of a rotavirus vaccine.
Prashant Yadav - senior fellow at the Centre for Global Development and a lecturer at Harvard Medical School.
Wellbeing – how to say no
8 juli 2020 |
35 min
We all know that healthcare professionals are stretching themselves to provide the care that’s needed right now. But there are instances when you might find yourself out of your comfort zone or being pushed too hard or fast. When is it ok to say no to these demands?
We spoke to Kate Burnett who educates NHS staff on empowerment about how to voice your position clearly and how to reconcile the guilt you might feel of letting the side down.
www.bmj.com/wellbeing
Talk Evidence covid-19 update - drop in excess deaths, HIV drugs, academic promotion
3 juli 2020 |
45 min
In this week's Talk Evidence we're hearing about how the death rate has dropped below average, disappointment about HIV drugs for covid-19 treatment, a trial to reduce polypharmacy, and why academic promotions matter to everyone else.
1.35 - Carl gives us one of his death updates
3.30 - Helen asks if it’s finally time to be able to do the international comparisons we’ve been waiting for?
16.10 - New research suggests that extreme PPE prevents transmission - but PPE came with a whole range of other viral suppression measures, and they all work together.
21.30 - The Recovery trial has said that lopinavir-ritonavir isn’t effective against covid - enough for them to stop the arm of that trial. We talk about this and more treatment evidence.
24.00 - Can a digital intervention reduce poly pharmacy? A new trial on bmj.com says no, but we talk about the composite endpoint and the way the trial is powered.
36.25 - Why academic promotion matters to non academics
Lowering the shield with Julia Marcus and Carol Liddle
2 juli 2020 |
54 min
The relaxation of the COVID-19 lockdown regulations is raising a lot of questions, both for doctors and for patients. This week, we discuss how the lack of clarity and coherence in public health messages over the past few months has caused anxiety and confusion for our patients, especially those who have been told to shield. We talk about GPs tailoring shielding advice to suit the individuals they treat, the politicisation of mask wearing, and the flaws of ‘abstinence-only’ health messaging. How do we balance prompting overall health, rather than just working to prevent disease, and how do we start taking baby steps towards returning to normality?
Our guests:
Julia Marcus is an infectious disease epidemiologist and Assistant Professor at Harvard Medical School’s Department of Population Medicine . She is also an HIV researcher.
Carol Liddle, a COPD patient, is a patient advocate on the panel for NACAP (National asthma and COPD audit), as well as a patient representative for the Taskforce for Lung Health, which is run by the British Lung Foundation.
Tom, Navjoyt and Jenny mentioned some resources they have found useful while looking at racism in medicine - which we have compiled into this document https://bit.ly/DBIRacismResources
David Michaels - Doubt is an industry tactic
1 juli 2020 |
38 min
For a long time, the BMJ has been interested in conflicts of interest and how that skews the research base.
We also heard in our podcast on "Big Tan" that science is being used to sow seeds of doubt into the association between sunbeds and skin cancer, by scrutinizing the minutiae of a research paper, but ignoring it's bigger message.
Now it's all just happening in medicine. This is an industry tactic. And to talk about that we're joined by David Michaels - who was the longest serving head of the Occupational Safety and Health Administration, and an epidemiologist and professor at the George Washington University School of Public Health.
Read The BMJ's collection - Commercial influence in health: from transparency to independence
https://www.bmj.com/commercial-influence
To find out more from David, plus his two books on the influence of industry
https://www.drdavidmichaels.com/
Covid-19 in the U.S. - returning to work in a pandemic
26 juni 2020 |
18 min
In the third part of our series of podcasts “Corona Virus as Seen Through a US Lens,” features editor for The BMJ, Joanne Silberner, talks to Dr. Adeline Goss about the experience of being a new mom and a hospital resident during the crisis.
In The BMJ, Dr Goss recently wrote about the challenges facing medical residents as they deal with working during the virus.
When she went on maternity leave a few months ago, nothing seemed amiss, beyond the normal stress of being a new mom. But when she returned to full time work on June 1, everything had changed. Goss kept an audio diary of her experience preparing and going back to work and we hear some of that during the podcast.
For more of The BMJ's covid-19 coverage www.bmj.com/coronavirus
Talk Evidence covid-19 update - dexamethosone, testing, rehabilitation after covid.
25 juni 2020 |
39 min
This week we're looking beyond the press release for dexamethasone, the long awaited review of antibody testing, and how well people are recovering after surviving acute covid-19.
(2.36) The preprint for dexamethasone is finally out - considerably after the press release. Carl digs into it to find out how good the news actually is.
(8.49) There are a couple of newly published systematic reviews on antibody testing, so we return to our testing guru Jon Deeks - professor of biostatistics at the University of Birmingham to give us an update.
(23.52)Covid-19, it became apparent as the pandemic grew, was more than a respiratory disease - there are systemic effects on almost all organs. As people are recovering from the worst ravages of the disease, the long term consequences of those effects are becoming more clear - Lynne Turner-Stokes, professor of rehabilitation medicine at King's College London.
Reading list;
Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report
https://www.medrxiv.org/content/10.1101/2020.06.22.20137273v1
Cochrane review of antibody tests for covid-19
DOI: 10.1002/14651858.CD013652
British society of rehabilitation medicine guidelines for rehab after covid-19.
https://www.bsrm.org.uk/downloads/covid-19bsrmissue1-published-27-4-2020.pdf
Mala Rao on the UK’s new race in health observatory
17 juni 2020 |
24 min
Earlier this year, the bmj published a racism in medicine issue - the issue was guest edited by Lord Victor Adebowale, chief executive of the NHS Confederation and Professor Mala Rao, professor of public health at Imperial College London.
At the event to launch the issue, they managed to persuade Simon Stephens , chief executive of the NHS, to put money into a “race in health observatory”
Mala joins us to talk about what that observatory is going to do, how it will maintain independence, it's role in synthesising, commissioning and implementing research, and where the organisation might begin in tackling the issue.
Reading list
NHS launches Race and Health Observatory after BMJ’s call to end inequalities
https://www.bmj.com/content/369/bmj.m2191
The BMJ's racism in medicine issue (free to access)
https://www.bmj.com/racism-in-medicine
Interview with Yvonne Coghill
https://podcasts.apple.com/us/podcast/yvonne-coghill-is-trying-to-fix-racism-in-the-nhs/id283916558?i=1000466962555
Interview with David Williams
https://podcasts.apple.com/tr/podcast/david-williams-everyday-discrimination-is-independent/id283916558?i=1000465493980
Resetting General Practice with Martin Marshall, Jenny Doust and Toyin Ajayi
17 juni 2020 |
66 min
In this week’s episode, our focus is on what the post-COVID world of general practice might look like. The pandemic has exposed the inequalities in our social and healthcare systems, but has also given GPs some much-needed headspace to reflect on changes to make going forward. Will we be able to turn general practice off and on again, like a faulty computer? Will we just drift back to the status quo, or will we seize this opportunity to shake up the old routines in order to redefine the role of the GP and to benefit the ever-evolving needs of our patients?
Our guests:
Martin Marshall is Chair of the Royal College of General Practitioners, a professor of Healthcare Improvement at UCL, and a GP practising in East London.
Jenny Doust is a Clinical Professorial Research Fellow at the School of Public Health at the University of Queensland, and practises as a GP in Brisbane.
Toyin Ajayi is Chief Health Officer, and co-founder, of Cityblock Health, which is a New York-based health and social services company delivering personalised healthcare to marginalised communities.
Tom, Navjoyt and Jenny mentioned some resources they have found useful while looking at racism in medicine - which we have compiled into this document https://bit.ly/DBIRacismResources
The corona virus pandemic in South America
15 juni 2020 |
20 min
At the end of May, the WHO said that South America has become the new epicentre of the covid-19 pandemic.
The majority of those with covid are in Brazil - not entirely surprising given it is the most populous - but in neighbouring Peru, numbers are growing too.
And it’s to Peru that we turn to talk to our guest today, Valerie Paz-Soldan is a social scientist and director of the Tulane Health Office for Latin America - part of the university’s school of public health and tropical medicine.
She joins us to talk about the pattern of the virus in Peru in particular, but elsewhere in the region, and how the pandemic is overwhelming an already stressed healthcare system.
https://www.bmj.com/coronavirus
Wellbeing - the art of the staycation
15 juni 2020 |
21 min
n normal times, around this time we’d start thinking about weekend breaks and summer holidays abroad. More than most healthcare staff and other key workers are in dire need of time out. Given the uncertainties around foreign travel, how can we recreate in some way that holiday feeling. Simon Calder, travel correspondent for The Independent newspaper, offers his staycation tips and alternative travel advice.
Talk Evidence covid-19 update - surgisphere data, and protests in a pandemic
12 juni 2020 |
50 min
This week, we’re asking questions about surgisphere data, and how it might have got into such high impact journals, we’re also talking about the protests around the world about structural racism - and how they intersect with the covid pandemic.
(1.39) Helen and Carl talk about the data underlying the newly retracted papers on hydroxychloroquine and ace-inhibitors or ARBs and covid.
(7.45) Fiona Godlee, the BMJ’s editor in chief, comes onto the pod to talk about retractions, and why they’re often called for, an rarely done.
(25.10) We talk about the protests, and Carl gives us his opinion on the risk of covid transmission during them (spoiler; he thinks it’s low)
(37.40) Sonia Saxena, professor of primary care at Imperial College London gives her verdict on the Public Health England report into this disproportionate effect of covid on ethnic minorities in the UK, and pushes back against it being a biological instead of a sociological determination.
Reading list:
Sonia’s analysis into transforming the health system for the UK’s multiethnic population https://www.bmj.com/content/368/bmj.m268
News Analysis - Covid-19: PHE review has failed ethnic minorities, leaders tell BMJ
https://www.bmj.com/content/369/bmj.m2264
The PHE report into the disparate risk of covid to ethnic minorities
https://www.gov.uk/government/publications/covid-19-review-of-disparities-in-risks-and-outcomes
Wellbeing - how Burmese Buddhism can help
10 juni 2020 |
28 min
How might Burmese Buddhism help deal with pandemic stress? Christopher Bu drew on his familial heritage and the tradition of practicing mindfulness to cope with the stresses of studying to be a doctor. He invites us to consider how the same techniques might be useful psychological tool for all healthcare workers during this challenging time.
Talk evidence covid-19 update - second wave and care home failings
8 juni 2020 |
45 min
In this episode of Talk Evidence, we'll be finding out if second waves are inevitable (or even a thing), how the UK's failure to protect it's care homes is symbolic of a neglected part of public life, and why those papers on hydroxychloroquine were retracted.
This is Talk Evidence - the podcast for evidence based medicine, where research, guidance and practice are debated and demystified.
Helen Macdonald, UK research editor for The BMJ, and Carl Heneghan, professor of EBM at the University of Oxford and editor of BMJ EBM, talk about some of the latest developments in the world of evidence, and what they mean.
This week:
2.00 - Helen looking into a second wave - and finds out from Tom Jefferson, an epidemiologist with the Cochrane Collaboration's acute respiratory infections group, that a "wave" might be a misnomer.
12.00 - Mary Daly, professor of sociology and social policy at the University of Oxford, tells us where the UK went wrong with care homes, and what we’d need to do to stop it happening again.
31.20 - Carl and Helen discuss those hydroxy chloroquine papers, now retracted. This was recorded before that happened, but we decided to keep this section in, because they talk about the reasons the papers should be viewed with caution, and the importance of scrutiny of the data.
Reading list:
The talk from Mary Daly at Green Templeton College.
https://www.gtc.ox.ac.uk/news-and-events/event/covid-19-and-care-homes-what-went-wrong-and-why/
Counting the ways Donald Trump failed in the pandemic
5 juni 2020 |
32 min
The Trump administration was left a playbook for pandemics when they entered the Whitehouse, but even before covid-19 was a threat systematically dismantled the public health protections put in place to follow that playbook.
In this podcast, Nicole Lurie, Gavin Yamey and Gregg Gonsalves talk about how the US response to public health was mismanaged, how it has become politicized, and what that playbook suggested should have been done. They also talk about rebuilding public health in the US after this is all over.
Our guests;
Nicole Lurie, former Assistant Secretary for Preparedness and Response under the Obama administration, senior clinical lecturer at Harvard Medical School and advisor to the Coalition for Epidemic Preparedness Innovation
Gavin Yamey, professor of global health and public policy at Duke University
Gregg Gonsalves, assistant professor of epidemiology at Yale School of Public Health.
This podcast is hosted by Joanne Silberner.
Testing times with James McCormack and Jess Watson
4 juni 2020 |
52 min
For GPs, testing patients is their “bread and butter”. This week, we discuss the “better safe than sorry” attitude towards testing, which is so common among doctors – are we guilty of over-testing purely out of force of habit, or are we worried about missing something vital, and therefore find reassurance in doing them? How should we interpret test results, and how do these results affect the way we manage our patients? And, with the huge focus on COVID-19 testing in the media, how do we communicate the current risks and uncertainties surrounding it to our patients?
Our guests:
James McCormack is a professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia, and the co-host of a popular weekly podcast called Best Science (BS) Medicine podcast. His work focuses on helping healthcare professionals to understand medical data, by taking the best available evidence and making it as simple and practical as possible.
Jess Watson is a GP, working in Bristol, and an expert on medical testing. She is a researcher with an interest in the use of diagnostic tests in primary care, specifically inflammatory marker blood tests.
Reading list:
James's BS Medicine Podcast
https://therapeuticseducation.org/
Jess's Practice Pointer - Interpreting a covid-19 test result
https://www.bmj.com/content/369/bmj.m1808
Talk evidence covid-19 update - remdesivir redux, the overwhelming volume of research
3 juni 2020 |
31 min
That remdesivir study has finally been published - what does it say and is it as independant as claimed. Also, as the world's focus turned to covid, so have researchers - and they've produced over 15000 papers. How can we sift through the flood of research and know what's any good?
(2.30) Helen Macdonald talks to Elizabeth Loder about the volume of research we're seeing, and why journals and peer reviewers are struggling to check it all.
(8.15) The study on remdesivir has been published - the trial was stopped early, and the primary outcome switched - we talk about how that increases uncertainty over the results, and could actually delay the treatment.
(26.50) We hear from a couple fo readers who wanted to correct us about averages, means, medians.
Reading list:
The US NIH AID study on remdesivir, published 22nd May in the New England Journal of Medicine
Research - preliminary report https://www.nejm.org/doi/full/10.1056/NEJMoa2007764
NEJM - looking at the dose duration https://www.nejm.org/doi/full/10.1056/NEJMoa2015301
Editorial - an important first step https://www.nejm.org/doi/full/10.1056/NEJMe2018715
Ray Moynihan - Declarations of interest in healthcare leaders
29 maj 2020 |
22 min
*Non covid content alert*
While the last couple of months have been covid-19 focused, the work of the beforetimes carries on - including a topic the BMJ is perennially interested in, industry funding of medics.
Ray Moynihan, researcher at Bond University, has been looking at financial ties between some healthcare association leaders, and industry, in the US, and reports that in new research published this week in The BMJ.
Read the full open access research;
Financial ties between leaders of influential US professional medical associations and industry: cross sectional study - https://www.bmj.com/content/369/bmj.m1505
Wellbeing – how to write a wellbeing prescription
27 maj 2020 |
28 min
How might stress affect your performance as a healthcare worker?
That’s the question that Mark Stacey, a consultant obstetric anaesthetist in Cardiff, has been interested in for the past 10 years. He saw similarities in the aviation industry, which uses a theory of human factors to explain why things go wrong when humans interact with complex systems.
Stress was a major culprit, in both aerospace and medicine, so he began to explore wellbeing as a way to reduce stress and, in turn, reduce adverse events. He has developed the idea of writing yourself a wellbeing prescription, which includes practical techniques such as the Baker’s Dozen and a gratitude diary.
Useful tools
Bakers Dozen https://www.cardiff.ac.uk/__data/assets/pdf_file/0003/808950/Bakers-Dozen-Toolkit.pdf
A 30 day plan that Mark has put together http://www.cardiffandvaleuhb.wales.nhs.uk/improving-resilience-in-anaesthesia
Public health response to covid-19 - data integrity and the importance of international comparison
26 maj 2020 |
45 min
This last week has seen questions raised about the integrity of some of the epidemiological data being produced by US states, and as rates continue to grow in some countries international comparisons are being questioned.
To discuss the implication of that are;
Sridhar Venkatapuram
associate professor global health & philosophy at King's College London
Kathleen Bachynski
Assistant professor of public health at Muhlenberg College
Martin Mckee
Professor of European health at the London School of Hygiene and Tropical Medicine
Talk Evidence covid-19 update - strategies to end lockdown, more testing
22 maj 2020 |
46 min
This week we're focussing on what kind of information we need to be able to collect and use as the country transitions out of lockdown - and why local lockdowns may be here for some time.
We also hear about the new antibody tests which are available in the UK - are they actually a game changer?
(2.00) Helen explains what some new evidence says about hydroxychloroquine (spoiler; don’t take it for covid-19)
(6.40) *Non covid alert* - Carl tells us about new research on compressions stockings for thromboprophylaxis, and the importance of doing research on non-pharmacological interventions
(10.30) David Nabarro, Special Envoy of WHO Director-General on COVID19,
(28.00) Helen goes back to Jon Deeks, professor of biostatistics at Birmingham, to find out more about these “accurate” tests for covid, endorsed by the government this week.
Reading list:
Clinical efficacy of hydroxychloroquine in patients with covid-19
https://www.bmj.com/content/369/bmj.m1844
Hydroxychloroquine in patients with mainly mild to moderate covid-19
https://www.bmj.com/content/369/bmj.m1849
David Nabarro’s website, with daily briefings
https://www.4sd.info/
News Covid-19: Two antibody tests are “highly specific” but vary in sensitivity, evaluations find
https://www.bmj.com/content/369/bmj.m2066
Talking about dying from covid with Scott Murray and Katherine Shear
21 maj 2020 |
55 min
With COVID-19 still ongoing, and at the forefront of the minds of doctors, patients and members of the public alike, difficult conversations are taking place - GPs are encouraged to talk about death with those who might not be ready to discuss it, and families are losing loved ones without being able to say goodbye. In this episode, we also look at survivor guilt, the range of emotions that grieving encompasses, and how to address the potentially thorny subject of advance care planning with COVID-19 patients.
Our guests:
Katherine Shear, internist and psychiatrist, is Director of The Center for Complicated Grief at Columbia University’s School of Social Work. She has been involved in research into treatments for grief for over 20 years.
Scott Murray, a recently retired GP, has key interests in disease trajectory and advance care planning. He led the first Primary Palliative Care Research Group and he chairs the International Primary Palliative Care Network. He advocates high-quality palliative care for everyone.
This week's deep breath out is the Viral Counterpoint of the Coronavirus Spike Protein (2019-nCoV) - https://soundcloud.com/user-275864738/viral-counterpoint-of-the-coronavirus-spike-protein-2019-ncov
Pandemics from history - how they inform our response now
21 maj 2020 |
23 min
Does history count as a non-pharmaceutical intervention? Much of our view on what to do in this pandemic has been influenced by the 1917 Spanish 'flu outbreak - even though covid-19 seems to be acting differently.
In this podcast, we talk to Howard Markel, a professor of pediatrics at Michigan, as well as professor in the history of medicine. He's written books on quarantines and epidemics, and was part of a team that did the medical and historical work that first showed the value of flattening the curve.
This is the first of 4 podcasts from our US colleagues, looking at the disease in that country, which will be published over the next 2 months.
For more on covid-19
www.bmj.com/coronavirus
Adam Kucharski, using viral epidemiology to combat fake news
19 maj 2020 |
16 min
Hydroxychloroquine is in the news again - as Trump and some news organisations are pushing it as a treatment, despite evidence (published in The BMJ) showing it lacks efficacy, and has a load of potential negative effects - including arrhythmias.
We know that kind of information spreads online - particularly through social media, but how does it do that?
In this podcast we talk to Adam Kucharski, and epidemiologist from the London School of Hygiene and Tropical Medicine, who has used disease modelling tools to look at fake news spread, and has some ideas about creating an online social distance.
For more covid coverage www.bmj.com/coronavirus
Talk evidence covid-19 update - answering questions with big data
17 maj 2020 |
38 min
Big data is being crunched to help us tackle some of the enormous amount of uncertainty about covid-19, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.
In these podcasts, we're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
This week.
(3.10) Calum Semple, professor of outbreak medicine at the University of Liverpool talks about the ISARIC project - predesigned research brought off the shelf and deployed during a pandemic.
(14.20) Ben Goldacre, doctor, researcher and director of the EBM datalab at the University of Oxford, joins us to talk about how his team have managed to pull together records from 40% of NHS patients to look for patterns in covid-19 morbidity and mortality.
Reading list
OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients.
https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1
Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol
https://www.medrxiv.org/content/10.1101/2020.04.23.20076042v1
Soumya Swaminathan - WHO’s chief scientist is trying to fix research during a pandemic
14 maj 2020 |
30 min
If you’re a regular listener to our podcasts, you’ll have heard how Covid is exposing the cracks in our systems of healthcare - from showing how poorly provisioned elderly social care is, to how antibody testing issues have exposing how innovation is uncoordinated and driven by the worst bits of the free market.
In this podcast we talked to Soumya Swaminathan, the WHO’s first Chief scientist, and ask about how the world’s foremost normative body for health tackle some of this issues.
We talk about agenda setting - and how the WHO is trying to prioritise neglected areas of research, how they’re starting to set standards for evidence driven by public rather than commercial priorities, and how, if and when a vaccine for corona virus is finally created - they can help it be distributed equitably, rather than to those with the most money to spend.
Wellbeing – how to deal with the post-emergency crash
13 maj 2020 |
28 min
The first peak of the pandemic has passed, the situation in hospitals is more manageable. While healthcare workers are preparing for the long haul, Abi and Cat discuss how to deal with this period of post-crisis crash.
In this podcast, we speak to Ali Milani, a former Labour politician who ran against Prime Minister Boris Johnson in his London constituency during the 2019 election. How might Milani’s experience of a year-long campaign and fallout compare to the current post-emergency stage of Covid-19?
www.bmj.com/wellbeing
www.bmj.com/coronavirus
Public health response - Lifting thelockdown
12 maj 2020 |
36 min
We’re at the point in the pandemic that restrictions on the way people live and work are being relaxed around the world, but how that changes safety for the population is very different depending on your demographic - will you have to work with other people, will you have to take public transport to work, and can you wear a mask in public safely?
To talk about the importance of not neglecting those most affected by covid-19 we’re joined by Kathleen Bachynski, assistant professor of public health at Muhlenberg College and Sridhar Venkatapuram, associate professor global Health & philosophy at King's College London
For all The BMJ's covid coverage
www.bmj.com/coronavirus
Talk evidence covid-19 update - natural history of covid, include patients in guidelines
9 maj 2020 |
33 min
For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.
We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
This week:
(1.20) Carl gives us an update on the England and Wales admission data.
(3.00) Helen talks about ways in which spread and severity of infection amongst household contacts.
(8.20) We talk natural history of covid-19, and Harlan Krumholz, cardiologist at Yale, tells us what we know, and why it's difficult to have a full picture at the moment.
(15.10) Helen picks up on a study from Tim Spectre and colleagues using an app to track cases.
(20.00) Henry Scowcroft, one of The BMJ's patient editor, who also works for Cancer Research UK, joins us to talk about patients who are taking part in clinical trials, and how this is affecting them. He also touches on the thin patient participation in the design of covid treatment guidelines.
(24.10) Carl talks rapidity of publishing, and where researchers should most target their evidence outreach.
Reading list:
Reducing risks from coronavirus transmission in the home
https://www.bmj.com/content/369/bmj.m1728
Rapid implementation of mobile technology for real-time
epidemiology of COVID-19
https://science.sciencemag.org/content/sci/early/2020/05/04/science.abc0473.full.pdf
The BMJ Public and Patient participation twitter chat
https://twitter.com/hashtag/BMJdebate
Wellbeing – coping with Covid fatigue
8 maj 2020 |
24 min
We are more than six weeks into the lockdown and if you were to gauge the mood of the nation, it would be one of fatigue. It started as an all-hands-on-deck emergency situation, but it now transpires that the current work situation for healthcare professionals is not going to change any time soon.
This is a marathon rather than a sprint. So how can we better look after ourselves to cope with this new realisation? In this podcast we speak to Dr Caroline Walker, an NHS-based psychiatrist and therapist.
Wait til the end for Caroline's simple technique she uses to help when feeling overwhelmed.
Read Caroline and Clare Gerada's opinion piece
https://blogs.bmj.com/bmj/2020/03/31/extraordinary-times-coping-psychologically-through-the-impact-of-covid-19/
Coping with Covid with Monica Schoch-Spana and Jud Brewer
6 maj 2020 |
49 min
In this week’s episode, we discuss bystander guilt, convergence, brain hacks and “how you can sneeze on someone’s brain from anywhere in the world”. How can GPs cope with the myriad worries around treating patients during the current pandemic, both on the frontline and in general practice? How do we recognise and break unhelpful anxious behaviour habits and stop fixating on the news?
Our guests:
Monica Schoch-Spana is a medical anthropologist and a Senior Scholar at Johns Hopkins Center for Public Health. She specialises in crisis and risk communication, community resilience to disaster, public engagement in policy-making and public health emergency preparedness.
Jud Brewer is an addiction psychiatrist and neuroscientist, specialising in anxiety and habit change. He is the Director of Research and Innovation at Brown University’s Mindfulness Center, an associate professor of behavioural and social sciences at the School of Public Health at Brown, as well as of psychiatry at the university’s medical school.
Reading list:
Monica's blog on the psychological impacts of covid-19
https://blogs.scientificamerican.com/observations/covid-19s-psychosocial-impacts/
Jud's article in the New York Times
https://www.nytimes.com/2020/03/13/well/mind/a-brain-hack-to-break-the-coronavirus-anxiety-cycle.html
GP course: https://drjud.com/health-care-provider-course/
Youtube animation of the NYTimes article: https://www.youtube.com/watch?v=900cOKCADIk&feature=youtu.be
Youtube coronavirus daily videos: https://www.youtube.com/watch?v=w4NwsyXRbNw&list=PL6sRqjtLfiTTni7oXKpSj2cQ9290lkpKH
Frontline stories - caring for non-covid patients
5 maj 2020 |
20 min
As the pandemic plays out - hospitals are reconfigured to increase critical care capacity, outpatient clinics become virtual, and elective procedures delayed.
How are these affecting care for those who are in hospital but don't have covid-19?
In this podcast, Matt Morgan,honorary senior research fellow at Cardiff University, consultant in intensive care medicine and Partha Kar, consultant in diabetes and endocrinology in Portsmouth, join us to discuss how their working week is changing.
Read the BMJ's columns
https://www.bmj.com/uk/news/views%20%26amp%3B%20reviews
Talk Evidence covid-19 update - lack of testing transparency, how to give good debate
4 maj 2020 |
44 min
For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.
We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
This week:
(1.10) Carl gives us an update on the UK's figures, and how deaths outside are now being counted.
(2.10) When the pandemic slows down, and normal services resume - what should we start doing first? Helen picks up some evidence on what they might be.
(6.05) There's a signal that covid-19 may be causing coagulopathies in some patients, and Helen picks up on a listeners request for more information.
(11.22) John Deeks, professor of Biostatistics at the University of Birmingham, is leading a Cochrane initiative into examining the evidence around testing, and rivals Carl's rant when he explains how some research is being done behind a veil of confidentiality.
(35.27) When there's a lot of uncertainty, and the stakes are very high, then tempers can flare. Vinay Prasad, hematologist-oncologist in the US, and host of Plenary Sessions podcast, joins us to talk about having a good, respectful, scientific debate.
Wellbeing – how one junior doctor found a way to support frontline staff
29 april 2020 |
32 min
How can we help frontline clinicians? Sometimes medics may feel uneasy or even guilty and that they could be doing more. That was what a junior doctor in Abergavenny in Wales felt and she did something about it.
In this podcast, we speak to Josie Cheetham about how she started her initiative to provide support boxes in hospitals for her colleagues working at the frontline, and how that initiative inspired others and mushroomed across the UK.
Public Health Vs The Economy
28 april 2020 |
49 min
Around the world, as the covid pandemic plays out, and some countries are starting to ease their restrictions, this narrative of the economy and public health being opposing weights on a set of scales keeps returning - they need to be balanced.
But before this, a healthy population is very much seen as being supportive of the economy. So is a pandemic different, or is that dichotomy false.
Joining us to discuss are;
Martin Mckee, professor of european health at LSHTM
Kathleen Bachynski, assistant professor of public health at Muhlenberg College
Sridhar Venkatapuram, associate professor global Health & philosophy at King's College London
Frontline stories - working as a GP during covid
27 april 2020 |
21 min
As the pandemic plays out - the way in which doctors in the UK practice is changing, hospitals are reconfigured to increase critical care capacity, GPs are working from home and doing their day to day work remotely.
Some of the changes have come at the detriment of staff and patient wellbeing but covid-19 has also helped cut through some of the inertia to get welcome changes done.
In this podcast, Helen Salisbury, GP in Oxfordshire, and Clare Gerada, GP in south London, join us to talk about the way in which general practice has changed, and how they and their teams are experiencing that.
Talk Evidence covid-19 update - covid ethics, waste and a minimum RCT size
24 april 2020 |
47 min
For the next few months Talk Evidence is going to focus on the new corona virus pandemic.
There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.
We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
This week:
(1.00) Carl gives us an update on the UK’s covid-19 related mortality
(7.40) When the evidence is uncertain, and the outcomes so massive, then the ethical dimensions of decisions become even more apparent. Helen talks ethics in guidelines with Julian Sheather, advisor on ethics and human rights to the BMA and MSF.
(25.37) Update on covid-19 research, looking at viral particle shedding.
(29.24) We’ve mentioned the potential wasted effort in covid-19 research, and Helen speaks to Paul Glaziou, director of the Institute for Evidence Based Research at Bond University, about the waste he’s already seen, and ways in which it could be avoided.
Teleconsulting with Trish Greenhalgh and Fiona Stevenson
22 april 2020 |
46 min
A new podcast from The BMJ, to help GP's feel more connected, heard, and supported.
Subscribe on;
Apple podcasts - https://bit.ly/applepodsDBI
Spotify - https://bit.ly/spotifyDBI
Google podcasts - https://bit.ly/googlepodsDBI
In our first episode, we discuss the highs and lows of video consultations, and how coronavirus has altered the landscape of business as usual for GPs. How will this change affect our relationships with our patients? How do we cope with frustrating technical issues? Are we more likely to miss a crucial diagnosis if we can’t rely on physical examinations? And, finally, are teleconsultations the future of GP practice?
Our guests:
Trish Greenhalgh is a former GP of 30 years who is now Professor of Primary Care Health Sciences at the University of Oxford. Trish is a leading researcher on video consultations.
Fiona Stevenson is a medical sociologist and researcher based at UCL. She is the co-director of their e-health unit.
Deep Breath Out - the Rob Auton Daily Podcast https://play.acast.com/s/robautonpodcast
https://www.bmj.com/podcasts/deepbreathin
Feeling the fear with Iona Heath and Danielle Ofri
22 april 2020 |
50 min
A new podcast from The BMJ, to help GP's feel more connected, heard, and supported.
Subscribe on;
Apple podcasts - https://bit.ly/applepodsDBI
Spotify - https://bit.ly/spotifyDBI
Google podcasts - https://bit.ly/googlepodsDBI
This week, our topic is fear: we try to get a better understanding of fear, how it affects all of us as clinicians for better or for worse, and the impact that fear has on the ways in which we approach our patients & practice. Does fear distort our judgement, and increase the likelihood of blundering, or does a healthy dose of fear help to keep us grounded?
Our guests:
Iona Heath is a former GP and president of the Royal College of GPs.
Danielle Ofri is an internist at Bellevue Hospital in New York, and Clinical Professor of Medicine at NYU School of Medicine. She has written several books on topics such as medical error and how doctors’ emotions affect their practice.
The Deep Breath Out - The bees of Brockwell Park Surgery
https://www.bmj.com/podcasts/deepbreathin
Wellbeing – advice from a military medic to frontline clinicians
22 april 2020 |
35 min
There is no doubt that anxiety levels that clinicians are feeling during this pandemic are high.
One military medic believes the current situation is comparable to his experience when posted during British campaigns in Afghanistan and Iraq. Cormac Doyle offers advice on how to deal with high-stress conditions, both in a work and at home, as well as how to negate the future effects of post-traumatic stress disorder.
One strategy he supports is using Bilatural Stimulation using music, one example of which called “Strength Within” can be found here shorturl.at/fgrSW.
Talk Evidence covid-19 update - Remdesivir, care homes, and death data
17 april 2020 |
52 min
For the next few months Talk Evidence is going to focus on the new corona virus pandemic.
There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.
We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
This week:
(3.14) Jeff Aronson from Oxford University explains why remdesivir is a potential therapeutic, but is pessimistic about the quality of the studies being done on it
(13.22) Carl explains why smoking cessation is still a key public health priority under covid-19
(16.30) Helen talks care homes, and interviews Mona Koshkouei, from Oxford University, about the research which shows staff are the main vector of infection.
(27.20) David Spiegelhalter, professor of public understanding of risk, looks at the new data on excess deaths in the UK - and the difficulties with reporting that underlie it. Carl explains how deaths track infections, and why uncertainty there makes it hard to calcuate the case fatality rate (And why that is not a good measure to use in a pandemic)
Reading list.
Compassionate Use of Remdesivir for Patients with Severe Covid-19
https://www.nejm.org/doi/full/10.1056/NEJMoa2007016
How can pandemic spreads be contained in care homes?
https://www.cebm.net/covid-19/how-can-pandemic-spreads-be-contained-in-care-homes/
Covid-19: Death rate in England and Wales reaches record high because of covid-19
https://www.bmj.com/node/1024784.full
Wellbeing - some advice for telehealth in secondary care
16 april 2020 |
24 min
We’ve published info on Telehealth in primary care - and have been overwhelmed by the response from GPs who are finding it useful.
But it’s not only primary care that is dramatically shifting to remote care - routine hospital care is moving online too, so we’ve asked Rowena McCash - GP and out of hours triage trainer joins us to give some tips on how to change your communication for the situation.
She explains safety netting in telephone triage, note taking, and why there are some advantages to working that way.
www.bmj.com/coronavirus
www.bmj.com/wellbeing
Front line stories - How corona is changing acute care
14 april 2020 |
36 min
As we cover the covid-19 outbreak, we want to hear some of the stories from the frontline - And who better to heart of what this pandemic is doing to the profession in the UK, than some of the people who write regularly for The BMJ?
In this first one, we wanted to look specifically at acute care - those at the sharp end of the response, so we're joined by David Oliver, consultant in geriatrics and internal medicine, and Matt Morgan, consultant in intensive care medicine.
Read the columns
https://blogs.bmj.com/bmj/category/columnists/matt-morgan/
https://blogs.bmj.com/bmj/category/columnists/david-oliver/
For more free information on covid-19
www.bmj.com/coronavirus
Talk Evidence covid-19 update - hydroxy/chloroquinine, prognostic models and facemaskss
13 april 2020 |
37 min
For the next few months Talk Evidence is going to focus on the new corona virus pandemic.
There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.
We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
This week:
(2.24) - Hydroxychloroquinine/chloroquinine - Robin Ferner, honorary professor of clinical pharmacology at the University of Birmingham explains why is it a potential therapeutic for covid-19, and why is it being hyped.
(12.45) - We use prognostic models to make treatment decisions, but they have to be well conducted. Lots of them are being created for covid-19, but their quality isn’t great. Statisticians Laure Wynants Maastricht University and Maarten van Smeden from Utrecht University have done a systematic review of these models, and explain what’s needed for them to be useful.
(26.30) PPE - specifically facemasks. What does the evidence say about their use by the public, and does the precautionary principle hold
Reading list:
COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community
https://www.nice.org.uk/guidance/ng165/chapter/4-Managing-suspected-or-confirmed-pneumonia
Chloroquine and hydroxychloroquine in covid-19
https://www.bmj.com/content/369/bmj.m1432
Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal
https://www.bmj.com/content/369/bmj.m1328
What is the efficacy of standard face masks compared to respirator masks in preventing COVID-type respiratory illnesses in primary care staff?
https://www.cebm.net/covid-19/what-is-the-efficacy-of-standard-face-masks-compared-to-respirator-masks-in-preventing-covid-type-respiratory-illnesses-in-primary-care-staff/
The public health response to covid - 19
12 april 2020 |
39 min
As part of our response to the covid-19 pandemic, we’re going to be running a series of discussions with experts about some of the big issues arising from the virus.
In this one, we’re asking about the public health response to an outbreak - what’s necessary, and is it possible to go to far.
Joining us are
Martin Mckee - professor of european health at the London Schoole fo Hygiene and Tropical Medicine
Kathleen Bachynski - assistant professor of public health at Muhlenberg College
Sridhar Venkatapura - associate professor global health & philosophy at
King's College London
www.bmj.com/podcasts
www.bmj.com/coronavirus
Talk Evidence covid-19 update - pneumonia, guidelines, preprints and testing
9 april 2020 |
43 min
For the next few months Talk Evidence is going to focus on the new corona virus pandemic.
There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.
We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
This week
5.00 - Carl gives us an update about pneumonia in primary care, should you give antibiotics when you're not sure if it's bacterial or viral
10.00 - The importance and difficulty of making guidelines now
15.00 - We hear from guideline maker Per Vandvik, about making guidance.
21.40 - Preprint servers for medicine are showing their use in this fast changing situation. Joseph Ross from Yale School of Medicine, and one of The BMJ's research editors, talks to us about the kind of information we're seeing on medRxiv.
31.10 - Testing. What are the tests, and when do we want specificity, and when do we want sensitivity. Nick Beeching from the Liverpool School of Tropical Medicine joins us to explain.
Reading list:
www.bmj.com/coronavirus
Rapidly managing pneumonia in older people during a pandemic
https://www.cebm.net/covid-19/rapidly-managing-pneumonia-in-older-people-during-a-pandemic/
https://www.medrxiv.org/
Covid-19: testing times
https://www.bmj.com/content/369/bmj.m1403
Wellbeing - Some advice on working in PPE
8 april 2020 |
34 min
Wellbeing might not seem the obvious place to talk about PPE - but lack of appropriate PPE is causing healthcare staff a great deal of stress now.
Mary Brindle is a pediatric surgeon and the director of The EQuIS (Efficiency Quality Innovation and Safety) Research platform at Alberta Children’s hospital.
In this podcast she reflects on the use of PPE, talks a little about the culture of it - and how overuse by one person can amply the concerns of others, the effect on patients of seeing their carers in protective equipment (especially children), and the importance of communication when you can't see colleagues faces anymore.
www.bmj.com/wellbeing
www.bmj.com/coronavirus
Look after yourself during covid-19
7 april 2020 |
35 min
Continuing our series on wellbeing during the pandemic, in this podcast we speak to Occupational Psychologist Roxane Gervais about how doctors can look after themselves during the covid-19 pandemic.
We discuss the importance of reaching out to friends and family during this difficult time, how to deal with the loss of control, as well how to tackle feelings of guilt when you are unable to work clinically.
For more wellbeing content
www.bmj.com/wellbeing
For more on covid-19
www.bmj.com/coronavirus
WHO’s response to covid-19
5 april 2020 |
33 min
We knew a pandemic was coming at some point - it’s kind of why we have the WHO. We have had various smaller scale tests of the international response to an infectious disease outbreak - Ebola in west africa being the most recent.
After that, reports criticised the WHO's response - citing problems around the swiftness of their action, the lack of coordination between countries, and the platforms for knowledge sharing. Is the agency doing any better in Covid-19?
Suerie Moon is co-director of the Global Health Centre at the Graduate Institute of International and Development studies in Geneva, and author of one of those critical reports which was published in The BMJ. She joins us to assess how the WHO is responding.
Talk Evidence covid-19 update - Confused symptoms, fatality rate uncertainty, Iceland’s testing
27 mars 2020 |
40 min
For the next few months Talk Evidence is going to focus on the new corona virus pandemic.
There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.
We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
This week
3.50 - There is a lot of confusion around symptoms, we hear what Carl's review of the case studies has found, and why he thinks fever and persistent dry cough may not be a sign of all cases.
10.30 - where are we with research into antiviral treatment
17.30 - John Ioannidis has expressed concerns about the quality data used in modelling and therefore our pandemic response. We hear what his concerns are, and what needs to be done to answer them.
29.10 - Iceland is the only country attempting to do population level screening, we hear from Kári Stefánsson, CEO of deCODE genetics which is working with the Icelandic government to allow everyone to access testing for the virus.
Organisational kindness during covid-19
26 mars 2020 |
26 min
Reports from Italy, and more recently from the U.S. show the strain the healthcare system is under during this pandemic.
We know that staff will step up in an emergency, but this isn’t a fire or a bombing, this is going to last for months. So how can organisations be proactive in supporting staff, and how can leaders try to mitigate the inevitable burnout.
In this podcast, Michael West, professor of organisational psychology at Lancaster university, and author of the GMC report “Caring for doctors, caring for patients” joins us to talk about what compassionate leadership looks like in a time of covid-19.
Resources
www.bmj.com/coronavirus
www.bmj.com/wellbeing
www.bmj.com/podcasts
https://www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-patients_pdf-80706341.pdf
Talk Evidence - testing under the microscope and opioid prescription
20 mars 2020 |
55 min
This edition of talk evidence was recorded before the big increase in covid-19 infections in the UK, and then delayed by some self isolation. We'll be back with more evidence on the pandemic very soon.
As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence).
in this episode
(1.01) Helen talks about variation in prescription of opioids - do 1% of clinician really prescribe the vast majority of the drug?
(8.45) Carl tells us that its time papers (in this case a lung screening one) really present absolute numbers.
(17.30) Carl explains how a spoonfull (less) of salt helps the blood pressure go down
(21.25) Helen puts test results under a microscope, and finds out that they may vary.
(33.20) What do conflicts of interest in tanning papers mean for wider science?
(48.05) Carl has a "super-rant" about smartphone apps for skin cancer - and a sensitivity of 0.
Reading list:
Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study
https://www.bmj.com/content/368/bmj.l6968
Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial
https://www.nejm.org/doi/full/10.1056/NEJMoa1911793
Effect of dose and duration of reduction in dietary sodium on blood pressure levels
https://www.bmj.com/content/368/bmj.m315
Your results may vary: the imprecision of medical measurements
https://www.bmj.com/content/368/bmj.m149
Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning: systematic review
https://www.bmj.com/content/368/bmj.m7
Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studies
https://www.bmj.com/content/368/bmj.m127
For a greener NHS - a call for evidence
14 mars 2020 |
17 min
The NHS is a world leader in sustainable healthcare - and it's the staff who have have been leading the charge.
The For A Greener NHS campaign is asking everyone who has made a change to the way they work, to submit evidence and help shape the whole organisation's response to the climate emergency.
In this podcast, Isobel Braithwaite, public health registrar & academic clinical fellow at UCL, and Sandy Robertson, LTFT Emergency Medicine Trainee and Chair of RCEM environmental specialist interest group, join us to explain what they're doing, and what kind of evidence is needed.
For more on the For A Greener NHS campaign
https://www.england.nhs.uk/greenernhs/
To submit evidence
https://www.engage.england.nhs.uk/survey/nhs-net-zero/
Cycling - Does the health benefit outweigh the accident risk (in the UK)
12 mars 2020 |
23 min
We all know we should be doing more exercise, and one way to do that is by active commuting - journeying to work on foot or by bike.
One thing preventing people from taking up cycling is the fear of being involved in road traffic accidents, and that the risk isn't worth the benefit of the extra exercise. It’s even more confusing when air pollution has to be taken into account.
Joining us to discuss new research into that risk/benefit calculation are
Paul Welsh, a Senior Lecturer, and Carlos Celis, a research fellow, both Institute of Cardiovascular & Medical Sciences at the University of Glasgow.
Read their open access research - Association of injury related hospital admissions with commuting by bicycle in the UK: prospective population based study
https://www.bmj.com/content/368/bmj.m336
Why we are failing patients with multimorbidity
5 mars 2020 |
60 min
We know that the number of people living with multiple health conditions is rising year on year, and yet training, guidelines, organisations and physical spaces in healthcare still largely focus on single diseases or organ systems.
The means that patients in the NHS are often treated as if their conditions exist in isolation, and that their care lacks coordination, and isn't as good as it should be.
To look at why patients with multiple conditions pose a challenge to the NHS, and what we can do to improve the care they receive, we’re joined by
Louella Vaughan, acute physician and senior clinical fellow at the Nuffield Trust
Jihad Malasi, GP and clinical chair of Thanet CCG
Rammya Mathew, GP and a quality improvement lead and columnist for The BMJ
and David Oliver, consultant in geriatrics, clinical vice president of the RCP and columnist for The BMJ
Yvonne Coghill is trying to fix racism in the NHS
28 februari 2020 |
49 min
In this week's special episode of Sharp Scratch, we've got something a little different for you! Last week the panel talked microaggressions, so this week we're hearing from an expert guest who is leading the work the NHS is doing to combat inequality in healthcare.
If you like this special edition, let us know on Facebook, Instagram or Twitter using #SharpScratch
This week's special guest:
Yvonne Coghill, CBE is the director of Workforce Race Equality Standard (WRES) at NHS England and NHS Improvement. Yvonne has over 20 years’ experience in nursing, before taking up operational and strategic leadership posts.
During her 40 plus years career, she has held a wide variety of clinical and managerial roles at the Department for Health and NHS Leadership Academy. In 2013 she was voted by colleagues in the NHS as one of the top 50 most inspirational women, one of the top 50 most inspirational nurse leaders and one of the top 50 black and minority ethnic (BME) pioneers, two years in a row.
In July 2015 Yvonne joined NHS England as director for WRES Implementation. She was awarded an Order of the British Empire for services to healthcare in 2010 and Commander of the British Empire in 2018. Yvonne was elected deputy president of the Royal College of Nursing (RCN) in November 2018.
Some of the resources Yvonne mentions during the interview:
https://www.england.nhs.uk/2020/02/nhs-publishes-new-workforce-race-equality-data-ahead-of-nhs-and-race-summit/
https://www.england.nhs.uk/about/equality/equality-hub/equality-standard/resources/
https://www.england.nhs.uk/2019/01/race-equality/
Born equal - the launch of The BMJ special issue on race in medicine
21 februari 2020 |
28 min
Last week the BMJ published it’s first special edition into Racism in Medicine. The issues tacked ranged from differential attainment in medical school, to the physiological effects that experiencing everyday discrimination has.
The issue was guest edited by Victor Adebowale, the Chief Executive of the social care enterprise Turning Point, and Mala Rao, Professor of Public Health, at Imperial College London - and they, along with Simon Stevens, chief executive of the NHS, Chand Nagpul Chair of council of the BMA, and the Olalade Obedare, medical student from Nottingham University Medical School, talked at the event.
www.bmj.com/racism-in-health.
Talk Evidence - Building an evidence base for covid-19
17 februari 2020 |
45 min
We're taking a break from the usual Talk Evidence to focus on the new corona virus that has emerged in China.
With a brand new disease, we have to build our evidence base from scratch - basic virology, epidemiology, pathogenicity, transmissibility, and ultimately treatment are all unknowns.
In this episode of Talk Evidence, we're trying to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
(8.00) Peter Openshaw, professor of experimental medicine at Imperial College London, talks to us about the pathogenicity of covid-19
(17.30) Wendy Barclay, head of the Department of Infectious Disease at Imperial College London, describes what can change the R0 of a viral disease.
(20.50) Raina MacIntyre, professor of biosecurity at the Kirby Institute at the University of New South Wales, talks to us about how effective masks are at preventing spread of viruses.
(30.00) We discuss treatment options in the face of massive uncertainty.
To read more about covid-19 and to keep up to date with the disease visit https://www.bmj.com/coronavirus where all of the information on the disease if freely available.
David Williams - everyday discrimination is an independent predictor of mortality
13 februari 2020 |
53 min
There comes a tipping point in all campaigns when the evidence is overwhelming and the only way to proceed is with action. According to David Williams, it’s time to tackle the disproportionate effects of race on patients in the UK.
David Williams, from Harvard University, developed the Everyday Discrimination Scale that, in 1997, launched a new scientific approach to assessing social influences, such as racism, on health.
He’s shown that people who experience every day acts of discrimination— like getting poorer service in a bank or a restaurant, or being treated with less courtesy—will over time have worse health outcomes, including higher rates of heart disease, lower life expectancy, and greater infant mortality.
In this podcast he is interviewed by Lilian Anekwe, assistant news editor
for New Scientist.
Read Lilian's article on tackling racism in the NHS
https://www.bmj.com/content/368/bmj.m341
And all of the special issue on racism in medicine
https://www.bmj.com/racism-in-medicine
Big Tan - Is the sunbed industry targeting research?
10 februari 2020 |
29 min
In 2012, Eleni Linos, professor of dermatology at Stanford university, published a systematic review and meta-analysis of the link between non-melanoma cancer and sun-beds.
That bit of pretty standard research, and a particular rapid response to it, has kicked of years of work - and in this podcast I talk to Eleni and her colleagues Stanton Glantz, and Yogi Hendlin about what they’ve uncovered.
Reading list:
Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning
https://www.bmj.com/content/368/bmj.m7
Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis
https://www.bmj.com/content/345/bmj.e5909
Writing a good outpatient letter means addressing it to the patient
7 februari 2020 |
25 min
In many countries (including the UK and Australia) it is still common practice for hospital doctors to write letters to patients’ general practitioners (GPs) following outpatient consultations, and for patients to receive copies of these letters.
However, Hugh Rayner, consultant nephrologist, and Peter Rees, former Chair of the Academy of Medical Royal Colleges' lay patient committee, suggest that hospital doctors who have changed their practice to include writing letters directly to patients have more patient centred consultations and experience smoother handovers with other members of their multidisciplinary teams.
Read their article explaining what makes for a good outpatient letter; https://www.bmj.com/content/368/bmj.m24
QI and improvement are not synonyms
31 januari 2020 |
45 min
In October 2019, Mary Dixon-Woods, director of the THIS Institute, dedicated to healthcare improvement. In that she explained how she believed healthcare improvement could be improved.
The essay took the position that "Quality Improvement" isn't necessarily the best way to improve healthcare, and that more rigour needs to be brought to the field.
That paper has created a great deal of discussion, so in this podcast we wanted to go back to Mary and ask her what she thinks about improvement, and how we can practically put into place some of the things she calls for.
Read the full essay:
https://www.bmj.com/content/367/bmj.l5514
And the rest of our healthcare improvement series:
https://www.bmj.com/quality-improvement
Prevalence and treatment of precocious puberty
28 januari 2020 |
34 min
Precocious puberty, that is puberty that starts before age 8 in girls and 9 in boys seems to be on the rise, but whether that’s because of an increase in incidence, or greater attention is unknown - what we do know that precocious puberty in girls is commonly idiopathic, while in boys is a red flag for pathology. But either way ther first point of call is the GP.
In this podcast, Steven Bradley GP, and Neil Lawrence, paediatric trainee join us to discuss how common precocious puberty is, how GPs should respond to a family presenting with it, and if intimate examination is actually warranted in primary care.
Read the full practice pointer:
https://www.bmj.com/content/368/bmj.l6597
Talk Evidence - Sepsis, talc and blindsided by blinding
22 januari 2020 |
41 min
Welcome to the festive talk evidence, giving you a little EBM to take you into the new year. As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence)*
This month:
(1.20) Carl tells us about new research on treating sepsis with steroids that might inform practice.
(4.58)Proscribing of prophylactic PPIs or H2-blockers for intensive care patients.
(11.00) Carl wonders if we can actually rule out an increased risk of ovarian cancer with the use of talc.
(17.46) Helen drops and EBM bombshell - is all the work needed to blind participants in a double blind randomised control trial actually worth it?
(33.00) Helen is annoyed about a press release from the department of health, and kicks of 2020 by stealing Carl's rant spot.
Reading list:
Corticosteroids for Treating Sepsis in Children and Adults
https://pubmed.ncbi.nlm.nih.gov/31808551-corticosteroids-for-treating-sepsis-in-children-and-adults/?dopt=Abstract
Gastrointestinal bleeding prophylaxis for critically ill patients: a clinical practice guideline
https://www.bmj.com/content/368/bmj.l6722
Association of Powder Use in the Genital Area With Risk of Ovarian Cancer.
https://www.ncbi.nlm.nih.gov/pubmed/31910280
Blinding
Fool’s gold? Why blinded trials are not always best
https://www.bmj.com/content/368/bmj.l6228
Impact of blinding on estimated treatment effects in randomised clinical trials
https://www.bmj.com/content/368/bmj.l6802
*quick note to say sorry about the sound quality on Duncan's microphone - we had a technical glitch (he was left alone to record).
Surviving childhood cancer treatment
21 januari 2020 |
25 min
In a British cohort, 30% of patients who had survived childhood cancer had died within 45 years of diagnosis; only 6% were expected to have died.
51% had developed a new primary cancer, but a 26% died of cardiovascular disease - thought to be caused by their treatment. Consequently, efforts to reduce long term mortality have focused on reducing exposure to the most toxic aspects of anticancer treatment, including radiotherapy.
In this podcast we’re joined by Daniel Mulrooney, associate professor in the Division of Cancer Survivorship, at St Jude Children’s Research Hospital and one of the authors of the paper Major cardiac events for adult survivors of childhood cancer diagnosed between 1970 and 1999: report from the Childhood Cancer Survivor Study cohort
Read the full research:
https://www.bmj.com/content/368/bmj.l6794
Is it possible to have fair pricing for medicines
17 januari 2020 |
26 min
Is it possible to have a fair price for medicines? Yes, according to a new collection just published on bmj.com.
The authors set out to evaluate how we could improve the functioning of the market for medicines, to honestly compensate industry for innovation, whilst allowing the poorest to afford them.
Suerie Moon, co-director of global health at the Graduate Institute of Geneva joins us to explain what's wrong with how we decided what to pay for medicine's now, and how we could change that.
Read the full collection:
https://www.bmj.com/fair-pricing
Michael West - GMC Report On Wellbeing
10 januari 2020 |
39 min
Michael West is professor of organisational psychology, at Lancaster University, and co-author of a new GMC report into the wellbeing of NHS staff.
The review he led together with the clinical psychiatrist Denise Coia, focused on primary interventions related to workplace factors and the systems that doctors work in, rather than secondary interventions such as resilience training.
In this podcast interview, he describes what he found - and talks about how low wellbeing is amongst doctors, why the command and control nature of some management teams has increased the problem, and why he has hope because of some of the good practice he sees in NHS organisations.
Read the full report:
https://www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-patients_pdf-80706341.pdf
From dance class to social prescription - starting and evaluating an idea
7 januari 2020 |
42 min
If you read the Christmas BMJ in the last few weeks, you might have noticed a lot around art and health - the way in which engagement in arts can help in prevention and treatment, but can also affect those more nebulous things which really matter to patients - loneliness, self expression, being connected to the wider community.
That obviously links to social prescribing, which looks like it’s going to be one of the big changes to medicine which will happen in near future.
In this podcast we hear from Simon Opher, a GP in gloucestershire who has had artists and poets in residence in his surgery, and has experience of setting up services which link art and health - and we discuss how to do that practically. SImon makes it sound easy, but also has a few tips for GPs out there who have an idea about a non-medical service that could help their patients, but doesn’t yet exist.
We’ll also be talking to Helen Stokes Lampard, former chair of the Royal College of Surgeons and head of the new National Academy for Social Prescribing - as services bloom, how do we know what actually works?
Helen is sceptical that our current ways of evaluating an intervention are going to be inadequate to look at the much more messy world of social prescribing, with it’s localisation, multitude of influences, and difficult to measure outcomes.
Reading list:
Previous BMJ podcast on social prescribing
https://podcasts.apple.com/no/podcast/social-prescribing/id283916558?i=1000446265663
Clinical update on social prescribing
https://www.bmj.com/content/364/bmj.l1285
Editors pick of education in 2019
3 januari 2020 |
30 min
If you’re lucky enough to not be back at work, you might be feeling like you need to quickly refresh your medical knowledge - and this podcast the BMJ’s education editors take you on a whistlestop tour through the BMJ’s education articles of 2019.
Tom Nolan (GP in London) is joined by Navjoyt Ladher (GP in London), Anita Jain (GP in India) and Jenny Rasanathan (GP in Phnom Penh).
Our reading list:
Please don’t call me mum
https://www.bmj.com/content/367/bmj.l5373
Which emollients are effective and acceptable for eczema in children?
https://www.bmj.com/content/367/bmj.l5882
Pre-eclampsia: pathophysiology and clinical implications
https://www.bmj.com/content/366/bmj.l2381
A borderline HbA1c result
https://www.bmj.com/content/365/bmj.l1361
Talk Xmas Evidence
31 december 2019 |
44 min
Welcome to the festive talk evidence, giving you a little EBM to take you into the new year. As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence)
This month:
(2.00) Helen look back at a Christmas article, which investigates a very common superstition in hospitals.
(7.55) Carl has his pick of the top 100 altimetric most influential papers of the year.
(12.40) We find out all about the preventing overdiagnosis conference which happened earlier in December.
(34.15) Helen has her annual rant about misogeny in medicine.
Reading list:
Q fever—the superstition of avoiding the word “quiet” as a coping mechanism
https://www.bmj.com/content/367/bmj.l6446
Altimetric Top 100
https://www.altmetric.com/top100/2019/
Fiona Godlee’s keynote at Preventing Overdiagnosis
https://www.preventingoverdiagnosis.net/
Gender differences in how scientists present the importance of their research: observational study
https://www.bmj.com/content/367/bmj.l6573
The need for (psychiatrists’) speed
20 december 2019 |
16 min
The internecine takes on medical specialty are a common thread in the Christmas BMJ, and this year we're doing it through the lens of driving. Which speciality speeds the most, who has the nicest cars?
André Zimerman, soon to be cardiologist, and researcher lets us know - and also why you can't rely on being a doctor to get off a speeding ticket. At least in Florida.
Read the full article:
https://www.bmj.com/content/367/bmj.l6354
Talking up your research - Sex makes a difference
20 december 2019 |
23 min
As editors, we feel like we’re spending a lot of time taking the superlatives out from articles - amazing, novel, important… But new research on BMJ.com suggests that we might not be doing that great a job, and that for some reason, papers authored by men tend to have more of them - because men put more in, or maybe a bias against woman writing in that way.
Marc Lerchenmueller, assistant professor at the University of Mannheim joins us to talk about how they did the research, and what it means for women's careers.
Read the full article
https://www.bmj.com/content/367/bmj.l6573
Talk Evidence - digital clubbing, osteoarthritis & sustainable EBM
16 december 2019 |
44 min
We’re back for the December Talk Evidence, and this month we’re being very digital
Firstly,(1.20) Helen tells us about arthritic fingers - should we be using prednisolone for treatment when people have painful osteoarthritis of the hand
Then (13.30) Carl gets us all to check our fingers for clubbing, and we find out how useful it is as a test for lung cancer
(23.10) Minna Johansson GP and Cochrane Sweden researcher explains why EBM needs to take into account sustainability, and why that isn’t just carbon footprint.
(33.50) We talk AF and the Apple Watch - and why drop out is going to be a massive problem for the kind of big studies that they’re attempting to do with new consumer smart devices.
This month's reading:
Results of a 6-week treatment with 10 mg prednisolone in patients with hand osteoarthritis (HOPE)
https://www.sciencedirect.com/science/article/pii/S0140673619324894?via%3Dihub
Cancer research UK - finger clubbing and mesothelioma
https://www.cancerresearchuk.org/about-cancer/mesothelioma/symptoms/finger-clubbing
Cochrane launches new Sustainable Healthcare Field, in Lund
https://sweden.cochrane.org/news/cochrane-launches-new-sustainable-healthcare-field-lund
Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation
https://www.nejm.org/doi/full/10.1056/NEJMoa1901183
Talk Evidence - Talking about harms
13 december 2019 |
35 min
In this special edition of talk evidence, Helen Macdonald and Carl Henneghan talk about creating an evidence base from harms.
We hear from a member of the pubic who experienced harm from a drug, and now advises the FDA. A former regulator who explains why reporting harms is so important. And finally, an investigative journalist who explains what "ghost management" is.
Behind the campaign promises - Doctors in parliament
9 december 2019 |
33 min
The UK general election is happening this week, and you’ve probably made your mind up which MP you’re voting for already - and maybe the NHS has influenced that decision.
This year has seen an increase in the number of doctors running for parliament, and in this podcast we find out what motivates doctors to step away from clinical practice, and why their voice on national issues is important to guide the health of their patients.
We’re joined by Louise Irving, gp and former parliamentary candidate for the NHS action party, and Andy Cowper, editor of Health Policy Insight
Behind the campaign promises - what the NHS means for the election
5 december 2019 |
35 min
UK general election has been called - polling day is on the 12th of December, and from now until then we’re going to be bringing you a weekly election-themed podcast.
We want to help you make sense of the promises and pledges, claims and counter-claims, that are being made around healthcare and the NHS out on the campaign trail.
This week we're focussing on what the NHS means to the election, from people who have been inside the political process and know about how campaign promises are made. We talk about retail pledges, and why spending claims which don't cause real change might come back to bite politicians.
Joining us are Sally Warren, director of policy at The King's Fund,
Siva Anandaciva, chief analyst at The King's Fund and Bill Morgan, former policy advisor and founding partner of Incisive Health
www.kingsfund.org.uk/Podcast
https://www.kingsfund.org.uk/topics/general-election-2019
Behind the campaign promises - Health beyond the NHS
30 november 2019 |
39 min
A UK general election has been called - polling day is on the 12th of December, and from now until then we’re going to be bringing you a weekly election-themed podcast.
We want to help you make sense of the promises and pledges, claims and counter-claims, that are being made around healthcare and the NHS out on the campaign trail.
This week we're focussing on health beyond the NHS - public health spending, and pledges to tackle air pollution and climate change. To discuss we're joined by Jennifer Dixon, chief executive of the Health Foundation, and Nicky Philpott, director of the UK Health Alliance on Climate Change.
Reading list
The BMJ's 2019 election coverage
https://www.bmj.com/content/general-election-2019
Health Foundation report: Mortality and life expectancy trends in the UK
https://www.health.org.uk/publications/reports/mortality-and-life-expectancy-trends-in-the-uk
UK Health Alliance on Climate Change general election briefing
http://www.ukhealthalliance.org/general-election-briefing/
Behind the campaign promises - Health and social care spending
22 november 2019 |
28 min
A UK general election has been called - polling day is on the 12th of December, and from now until then we’re going to be bringing you a weekly election-themed podcast.
We want to help you make sense of the promises and pledges, claims and counter-claims, that are being made around healthcare and the NHS out on the campaign trail.
This week we're focussing on spending pledges. NHS budgets have not been keeping up with healthcare demand, and social care is in dire financial straits. David Oliver, consultant physician in Berkshire and author of the weekly BMJ “Acute perspective” column, and Hugh Alderwick, assistant director of policy at the Health Foundation.
Reading list
Acute perspective column
https://blogs.bmj.com/bmj/category/columnists/david-oliver/
Health Foundations analysis of spending
https://www.health.org.uk/news-and-comment/blogsf
talk through what the parties are promising
Behind the campaign promises - GP numbers, and appointment slots
15 november 2019 |
31 min
A UK general election has been called - polling day is on the 12th of December, and from now until then we’re going to be bringing you a weekly election-themed podcast.
We want to help you make sense of the promises and pledges, claims and counter-claims, that are being made around healthcare and the NHS out on the campaign trail.
This week has seen pledges about GP numbers, so we're focussing on primary care - and are joined by two GPs, Clare Gerada, co chair of the NHS Assembly, and former chair of the Royal College of GPs, and Rebecca Rosen, who is also a senior fellow at the Nuffield Trust.
Reading list:
Health, wellbeing, and care should be top of everyone’s political agenda
https://www.bmj.com/content/367/bmj.l6503
Labour pledges to outspend Conservatives on health with £26bn NHS “rescue plan”
https://www.bmj.com/content/367/bmj.l6537
Tories promise 6000 extra GPs by 2024
https://www.bmj.com/content/367/bmj.l6463
Is the number of GPs falling across the UK?
https://www.nuffieldtrust.org.uk/news-item/is-the-number-of-gps-falling-across-the-uk
Reversing our preconceptions about where innovation comes from
14 november 2019 |
23 min
Reverse innovation may sound like some attempt to return to the dark ages - but it has a specific meaning, especially when it comes to med-tech. It’s about where we look for innovation - and overturning our preconceived ideas of where new ideas come from.
Mark Skopec, and Matthew Harris - both from Imperial College London are two of the authors of a new analysis, setting out to highlight those preconceptions, and creating new routes to bring innovation into the NHS.
Read the analysis:
https://www.bmj.com/content/367/bmj.l6205
Talk Evidence - aggravating acronyms, a time to prescribe, and screening (again)
11 november 2019 |
40 min
Talk Evidence is back, with your monthly take on the world of EBM with Duncan Jarvies and GPs Carl Heneghan (also director for the Centre of Evidence Based Medicine at the University of Oxford) and Helen Macdonald (also The BMJ's UK research Editor).
This month Helen talks about the messy business of colon cancer screening - which modality is best, and in what population is it actually effective (1.40)
Carl talks about how the Netherlands did the right research at the right time to stop a new pregnancy scan before it became routine (10.35)
The Rant: acronyms in research papers (17.45)
Mini Rant: politicisation of the NHS, and Carl pitches for yet another job (25.15)
Research in the news has talked about the importance of when drugs are taken, to maximise efficacy. Melvin Lobo, cardiologist specialising in hypertension joins us to explain that research and why we seem to have forgotten about that effect.
Reading list:
Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a clinical practice guideline
https://www.bmj.com/content/367/bmj.l5515
Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study): nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial
https://www.bmj.com/content/367/bmj.l5517
Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/5602478
Creating a speak out culture
7 november 2019 |
28 min
Giving staff the confidence to speak out is important in healthcare - It's a key aspect of the WHO patient safety checklist, decreasing incidence of medical error, but it's also important to stop incidents of harassment and abuse which undermine staff and increase burnout.
Creating that culture is a difficult task, but two hospitals in the southern hemisphere have been trying to do do that by putting in place ways which support staff in making complaints when they wouldn't normally feel confident to do so.
In this podcast we hear from Alex Sia, CEO of KK hospital Singapore, Jeanette Conley, medical executive at Adventist Healthcare in Sydney and Mark O”Brien, medical director of the Cognitive Institute, who talk about their challenges and successes in changing the way they work.
For more on burnout;
https://podcasts.apple.com/co/podcast/burnout-dont-try-to-make-canary-in-coal-mine-more-resilient/id283916558?i=1000446459269
http://www.bmj.com/wellbeing
Creating support for doctors in the NHS
5 november 2019 |
18 min
The NHS Practitioner Health Programme - once only for doctors in London, now it’s being rolled out across the NHS to provide the largest, publicly funded, comprehensive physician health service, in the world.
However, while helping the individual is essential, systemic change needs to be made to support doctors in our healthcare system.
Clare Gerada, GP and medical director of NHS PHP joins us to talk about how the expanded service will work, and what role regulation and inspections should play in wellbeing.
For more on the NHS PHP
https://blogs.bmj.com/bmj/2019/10/31/clare-gerada-protecting-practitioners-health/
020 3049 4505
https://php.nhs.uk/
Nudging the calories off your order
31 oktober 2019 |
26 min
There has been a lot of noise made about calorie counts on labels - the idea being it’s one of those things that might nudge people to make healthier choices.
So much so that in 2018, in the USA, it became mandatory for food chains with more than 20 outlets to label the calories in their food.
But the effectiveness of that is hard to gauge - it’s relied on reporting from customers, which leads to an incomplete picture. The really killer data would be from the chains themselves, but they’re reluctant to share that widely.
That's where new research comes in - and we're joined in the podcast by Joshua Petimar, postdoctoral researcher at the Harvard T.H. Chan School of Public Health, and Jason Block, associate professor at Harvard Pilgrim Healthcare Institute & Harvard Medical School, to discuss what they've done.
Read the full research:
https://www.bmj.com/content/367/bmj.l5837
Testing for TB is only skin deep
25 oktober 2019 |
30 min
A TB infection can take two forms, active and latent. Active disease is transmissible, and causes the damage to the lungs which makes TB one of the biggest killers in the world.
In the latent form, the bacteria Mycobacterium tuberculosis is quiescent and can stay that way for years until it becomes active and causes those clinical signs.
Testing for the active version of the disease is done directly, but when it comes to latency, we use the tuberculin skin test to see if someone has an immunological response - and when that happens we consider them to have latent disease.
However, in this podcast Lalita Ramakrishnan, professor of immunology and infectious diseases at the University of Cambridge; Paul Edelstein, professor of pathology and laboratory medicine at the University of Pennsylvania; and Marcel Behr, professor of medicine at McGill University question that conclusion.
Read their full analysis:
https://www.bmj.com/content/367/bmj.l5770/
Their previous analysis:
https://www.bmj.com/content/362/bmj.k2738.abstract
And search for their previous podcast - "Have we misunderstood TB's timeline?"
20 Arnav Agarwal
22 oktober 2019 |
34 min
This week, Dr Arnav Agarwal joins Ray to share the perspective and experiences of a young, recently graduated doctor working in a busy, metropolitan hospital. Despite the long shifts and demanding environment, Arnav makes time and space to reflect on work, life and mortality through his thought-provoking poetry and volunteer work.
19 Marion Nestle
22 oktober 2019 |
28 min
This week, Ray ventures into the notoriously complex field of nutrition with special guest, Professor Marion Nestle. Named by Forbes as one of the world's most powerful foodies, Marion’s stellar career spans five decades of research, teaching, advocacy work and the publication of countless prize-winning books.
Statins for primary prevention - How good is the evidence
21 oktober 2019 |
21 min
Statins are now the most commonly used drug in the UK and one of the most commonly used medicines in the world, but debate remains about their use for primary prevention for people without cardiovascular disease.
Paula Byrne from the National University of Ireland Galway, joins us to talk about the evidence of benefit for low risk individuals, and what needs to be done to finally answer the questions about efficacy and harms.
Read the full analysis:
https://www.bmj.com/content/367/bmj.l5674
Ancestry DNA tests can over or under estimate genetic disease risk
17 oktober 2019 |
36 min
Direct-to-consumer genetic tests are sold online and in shops as a way to “find out what your DNA says".
They insights into ancestry or disease risks; others claim to provide information on personality, athletic ability, and child talent. However, interpretation of genetic data is complex and context dependent, and DTC genetic tests may produce false positive and false negative results.
Rachel Horton, clinical training fellow, Anneke Lucassen, chair of British Society of Genetic Medicine, and Jude Hayward the RCGP clinical champion for genomics join us to discuss how this deluge of genetic data is affecting patients, GPs and clinical geneticists in the NHS.
Read the full article:
https://www.bmj.com/content/367/bmj.l5688
How Blockchain could improve clinical trial transparency
12 oktober 2019 |
23 min
Blockchain is the digital technology that underpins cryptocurrencies such as bitcoin, and has been proposed as the digital panacea of our times.
But Leeza Osipenko, from the London School of Economics, has thought about how it could actually be used in clinical trials, and what else would need to change in our regulatory environment to make that work.
Read her full essay:
https://www.bmj.com/content/367/bmj.l5561
A new way to look at behaviour change in UK GPs
8 oktober 2019 |
31 min
In quality improvement, measurement is seen as a key driver of change - how well do you know you’re doing, if you can’t actually measure it.
So, when something changes in the NHS (say a new guideline) how can you tell how quickly that’s filtering down to the front line.
Ben goldacre, from the Nuffield Department of Primary Care Health Sciences at the University of Oxford, joins us to talk about a new proof of concept published on bmj.com, which uses NHS prescribing data to analyse how change propagated through GP practices.
Read the full open access research:
https://www.bmj.com/content/367/bmj.l5205
https://openprescribing.net/
17 Liam Mannix
8 oktober 2019 |
31 min
Our latest series kicks off with Australia’s multi-award-winning health and science reporter, Liam Mannix. He joins Ray to share his insights into the role and impact of evidence, advocacy and investigative reporting in today’s ever-changing media landscape.
Talk Evidence - eating less, drinking less, drug approval data
4 oktober 2019 |
37 min
Talk Evidence is back, with your monthly take on the world of EBM with Duncan Jarvies and GPs Carl Heneghan (also director for the Centre of Evidence Based Medicine at the University of Oxford) and Helen Macdonald (also The BMJ's UK research Editor).
This month Carl talks about evidence that restricting your diet might improve health at a population level (1.50)
Helen talks about the data on a drop in alcohol consumption amongst Scots (7.04)
A listener questions the team about their take on Tramadol (13.45)
Helen talks about the problems with the trials we use to regulate drugs (18.00)
And Carl explains why drug shortages aren't just a Brexit problem (31.30)
Reading list:
two years of calorie restriction and cardiometabolic risk (CALERIE): exploratory outcomes of a multicentre, phase 2, randomised controlled trial
https://www.sciencedirect.com/science/article/pii/S2213858719301512?via%3Dihub
Immediate impact of minimum unit pricing on alcohol purchases in Scotland: controlled interrupted time series analysis for 2015-18
https://www.bmj.com/content/366/bmj.l5274
Design characteristics, risk of bias, and reporting of randomised controlled trials supporting approvals of cancer drugs by European Medicines Agency, 2014-16: cross sectional analysis
https://www.bmj.com/content/366/bmj.l5221
Crisis in the supply of medicines
https://www.bmj.com/content/367/bmj.l5841
18 David Tovey
2 oktober 2019 |
29 min
After ten years at the helm of the Cochrane Library, Dr David Tovey recently stepped down as Editor-in-Chief. This week he joins Ray to reflect on Cochrane’s past, present and future and share some of the challenges and rewards of leading one of the world’s largest and most trusted health research networks.
Minimum unit pricing in Scotland
26 september 2019 |
17 min
On the 1st of May, 2018 Scotland was the first country to try a new way of reducing alcohol consumption in its population. It introduced a minimum unit prices for alcohol.
Now new research just published on BMJ.com is looking at the effect of that price increase - and measuring how well it has achieved the goal of reducing drinking in Scots.
Peter Anderson, professor of alcohol studies at Newcastle University explains how well the result matched the expectation, and if the result targeted just lower earners, or all high volume drinkers.
Read the full research:
https://www.bmj.com/content/366/bmj.l5274
Climate change will make universal health coverage precarious
24 september 2019 |
41 min
The BMJ in partnership with The Harvard Global Health Institute has launched a collection of articles exploring how to achieve effective universal health coverage (UHC). The collection highlights the importance of quality in UHC, potential finance models, how best to incentivise stakeholders, and some of the barriers to true UHC.
One of those barriers, and it’s a big one, is climate change - patterns of disease will change, both communicable and non-communicable, cataclysmic weather will disrupt systems, and the economic impact is going to challenge our ability to pay for healthcare.
But even against that backdrop, Ashish Jha, and Rene Salas - aren't totally pessimistic. They join us to talk about the intersection between climate and health, and where effective change can be made.
Climate change threatens the achievement of effective universal healthcare
https://www.bmj.com/content/366/bmj.l5302
Universal health coverage collection
https://www.bmj.com/universal-health-coverage
Talk Evidence - Recurrent VTE, CRP testing for COPD, CMO report, and a consultation
23 september 2019 |
42 min
Helen talks about new research on prevention of recurrent VTE - and Carl things the evidence goes further, and we can extend prophylaxis for a year.
13.00 - CRP testing for antibiotic prescription in COPD exacerbations, should we start doing it in primary care settings - and what will that mean. We also hear from Chris Butler, one of the trialists, who explains why being very clear about what you actually want to measure is important in study design.
26.50 - Carl wants you to read the Chief Medical Officer’s report, and we hear from Cathrine Falconer, who edited it, about how they put the recommendations together.
32.50 - Helen thinks that a new consultation from the UK government is collecting evidence in an unsystematic way, and that it’s an opportunity for listeners to submit some good evidence.
Reading list:
Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event
https://www.bmj.com/content/366/bmj.l4363
C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations
https://www.nejm.org/doi/10.1056/NEJMoa1803185
Chief Medical Officer annual report 2019: partnering for progress
https://www.gov.uk/government/publications/chief-medical-officer-annual-report-2019-partnering-for-progress
Advancing our health: prevention in the 2020s – consultation document
https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document
Cancer drug trials used for regulatory approval are at risk of bias
19 september 2019 |
27 min
Around half of trials that supported new cancer drug approvals in Europe between 2014 and 2016 were judged to be at high risk of bias, in a new study.
Huseyin Naci,assistant professor of health policy a the London School of Economics joins us to talk about why potential bias may mean potential exaggeration of treatment effects, and could be costing our health systems a great deal of money.
Read the full research:
https://www.bmj.com/content/366/bmj.l5221
Listen on apple podcasts:
https://podcasts.apple.com/gb/podcast/the-bmj-podcast/id283916558?mt=2&app=podcast
Brexit - Planning for medicine shortages
13 september 2019 |
32 min
This week we saw the release of the much awaited Yellowhammer documents from the government, documents which outline some of the risks involved with Britain’s sudden departure from the EU. The documents themselves outline that there are risks to the supply of medicines - but do not set out the detail of how those risks have been mitigated, and what doctors and patients should do to plan for the possibility.
In this podcast we hear from Andrew Goddard , president of the Royal College of Physicians, and Sandra Gidley, president of the Royal Pharmaceutical Society. We also have a statement from the Royal College of Radiologists.
Vaping deaths - does this change what we think about public health messages
12 september 2019 |
13 min
This week the Trump administration has banned the sale of flavoured vapes in the USA.
The reason for that is the sudden rash of cases of pulmonary disease, including deaths, linked to vaping. The mechanism by which vaping may be causing damage to the lungs is as yet unclear, and our understanding is hampered by the heterogeneous nature of the compounds involved and the mechanisms of delivery.
David Hammond, professor in the school of public health and health systems at the University of Waterloo in Canada, is author of a recent editorial about vaping and joins us to discuss what this means for public health.
Outbreak of pulmonary diseases linked to vaping
https://www.bmj.com/content/366/bmj.l5445
Extending the UK’s sugar tax to snacks
6 september 2019 |
25 min
In the UK, for just over a year, we've been paying the "Soft Drinks Industry Levy" - a tax on sugary beverages intended to reduce our consumption of free sugars.
That was based on taxes that had happened in other countries, however, in the UK high sugar snacks, such as confectionery, cakes, and biscuits make a greater contribution to intakes of free sugars as well as energy than sugar sweetened beverages.
Now new research models what extending the sugar tax to those snacks would do to our energy intake, and then onto the BMI of the nation.
Pauline Scheelbeek, assistant professor in nutritional and environmental epidemiology at the London School of Hygiene and Tropical Medicine joins us to explain how they modelled that, and what the outcome might be
Read the full open access research:
https://www.bmj.com/content/366/bmj.l4786
The government is lacking detail over Brexit planning
4 september 2019 |
37 min
Brexit.
Who knows what’s going to happen in the next few weeks, months, years - the uncertainty is high.
In the face of that, you’d hope that the government was doing all it could to plan for any eventuality - let alone for a massive, country altering one like suddenly crashing out without a deal - but Martin McKee, professor of public health at the London School of Hygiene and Tropical Medicine, and David Nicholl, Consultant Neurologist, don’t think that’s the case.
In the debate about Brexit, increasingly we’re hearing about the impact on health in the UK - and in increasingly doomed ways. But what about across the rest of Europe? Natasha Azzopardi Muscat, president of the European Public Health Association, explains a little about what Brexit means for the whole of European public health.
Assessing the health effects of a “no deal” Brexit:
https://www.bmj.com/content/366/bmj.l5300
Tackling burnout in The Netherlands
30 augusti 2019 |
24 min
We heard a few podcasts ago about burnout - what it is, and why it should be thought of as a systems issue. Now a project in the Netherlands is trying to investigate who it is that is particularly at risk of burnout, and hopes to test whether individually tailored coaching and counselling can help those who are experiencing the symptoms change the way they’re working.
Karel Scheepstra is a psychiatrist and researcher in the Amsterdam University Medical Centre, and joins us to discuss what we know about burnout in Dutch doctors, and what this new research hopes to uncover.
For more from our wellbeing campaign;
www.bmj.com/wellbeing
Physical activity and mortality - ”The least active quartile did less than 5 minute per day”
23 augusti 2019 |
22 min
We know that exercise is good for you - the WHO recommends at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity aerobic physical activity each week.
That recommendation is built on evidence that relied on self reporting that may underestimate the amount of lower intensity exercise those people were doing, and at the sometime overestimate the overall amount.
That makes new research, published on bmj.com particularly interesting - it pulls together the published data on outcomes for measured activity, where study participants were given an accelerometer to wear.
Ulf Ekelund, from the Department of Sports Medicine at the Norwegian School of Sport Sciences, joins us to discuss what they found, and what that means for those recommendations.
Read the open access research:
https://www.bmj.com/content/366/bmj.l4570
Talk Evidence - Tramadol, medical harm, and alexa
21 augusti 2019 |
41 min
Welcome back to Talk Evidence - where Helen Macdonald and Carl Heneghan take you through what's happening in the world of Evidence.
This month we'll be discussing tramadol being prescripted postoperatively, and a new EBM verdict says that should change(1.36). How much preventable harm does healthcare causes (11.20. A canadian project to help policy makers get the evidence they need (16.55)
One of our listeners thinks "Simple" GPs are anything but (28.30) - and we'll be asking Alexa about our health queries.
Reading list
Treating postoperative pain? Avoid tramadol, long-acting opioid analgesics and long-term use
https://ebm.bmj.com/content/early/2019/08/16/bmjebm-2019-111236
Prevalence, severity, and nature of preventable patient harm across medical care settings
https://www.bmj.com/content/366/bmj.l4185
Helen Salisbury: “Alexa, can you do my job for me?”
https://www.bmj.com/content/366/bmj.l4719
Gottfried Hirnschall is optimistic about ending the HIV epidemic
15 augusti 2019 |
47 min
In 2001, Gottfried Hirnschall joined the WHO to work on the global response to HIV/AIDs, 18 years later he just retired as the director of WHO’s department for HIV and Hepatitis.
The intervening period, almost half the time we’ve been aware of the disease the fight against the infection has been characterised by scientific breakthroughs, and disappointments - but the people mobilised against the virus have changed the way the world funds global health, the way patients are included in research agendas, and saved lives.
Gottfried spoke to us during his post retirement holiday in France, and talked about his experiences, and what the legacy of HIV/AIDs will be.
Burnout - Don’t try to make the canary in the coal mine more resilient
8 augusti 2019 |
52 min
Burnout is a problem in healthcare - it’s a problem for individuals, those who experience it and decide to leave a career they formerly loved, but it’s also a problem for our healthcare system. Burnout is associated with an increase in medical errors, and poor quality of care. Fundamentally it’s a patient safety issue.
But, unlike other patient safety issues we tend to think about it, and try to prevent it, at an individual not systems level.
However, Anthony Montgomery from the University of Macedonia, and Christina Maslach, from the University of California, Berkeley, urge us to start treating burnout as a systems issue. We hear about how we can spot burnout, and what can be done to try and mitigate it.
Read their full analysis
Burnout in healthcare: the case for organisational change
https://www.bmj.com/content/366/bmj.l4774
Sustainable health
2 augusti 2019 |
34 min
The UK has just seen it’s hottest July on record, including the highest ever temperature recorded. With climate change in the forefront of our minds, it’s timely that we have two editorials on the sustainability and health.
Michael Depledge, emeritus professor of environment and human health at University of Exeter Medical School, and author of the editorial Time and Tide, explains how closely the oceans and seas are linked to human health.
Also Gillian Leng, deputy chief executive and director of health and social care at NICE has ideas about what the NHS can do to become more sustainable, and how we could evaluate the impact treatments have on the planet.
Read the two editorials
Time and tide - https://www.bmj.com/content/366/bmj.l4671
A more sustainable NHS - https://www.bmj.com/content/366/bmj.l4930
Patient’s rights in research - moving beyond participation
25 juli 2019 |
31 min
At EBM live recently, we ran a workshop with researchers, patients and clinicians to talk about patient rights in research - should patients be setting the full research agenda? Should they be full participants and authors?
Helen Macdonald, BMJ’s UK research editor and co-host of our talk evidence podcast sat down to Paul Wicks, researcher and patient, and Emma Cartwright, The BMJ's What your patient is thinking editor, to reflect on what the workshop uncovered - and where we should be moving to next.
Read more about the BMJ's patient and public partnership: https://www.bmj.com/campaign/patient-partnership
Go to EBM live in Toronto in 2020
https://ebmlive.org/ebmlive-2020/
Cannabinoid Hyperemesis Syndrome
19 juli 2019 |
18 min
Cannabinoid hyperemesis syndrome is a relatively newly recognised condition - but, according to one study, can account for up to 6% of patients presenting to emergency departments.
The causal mechanism is as yet unclear - but currently the only known way to prevent the syndrome is for the patient to stop their cannabis use.
Yaniv Chocron, chief resident at Lausanne University Hospital, Lausanne, Switzerland talks us through spotting the condition, and what we think might be the mechanism of action.
Read the full easily missed article:
https://www.bmj.com/content/366/bmj.l4336
Fighting bad science in Austria
17 juli 2019 |
16 min
Cochrane Austria have been asking the public what they'd like to know about health. Not whether the latest drug is more efficacious, but whether glacier stone power cures hangovers.
Gerald Gartlehner, director of the Cochrane Austria Centre joins us to explain what they do, and how their evidence has been received.
Read more about the project (in German):
https://www.medizin-transparent.at/
Fertility awareness based methods for pregnancy prevention
13 juli 2019 |
38 min
Fertility awareness based methods of contraception are increasingly being used for pregnancy prevention. In the US, the proportion of contraceptive users who choose such methods has grown from 1% in 2008 to approximately 3% in 2014.
Relative to other methods of pregnancy prevention, however, substantial misinformation exists around fertility awareness based methods of contraception, particularly about the effectiveness of specific methods and how to use them.
Rachel Urrutia, assistant professor of Obstetrics and Gynecology at the, University of North Carolina, and Chelsea Polis, senior research scientist at the Guttmacher Institute join us to describe the various fertility awareness based methods, and the evidence base behind all the options available.
Read the full clinical update
https://www.bmj.com/content/366/bmj.l4245
Talk Evidence - smoking, gloves and transparency
10 juli 2019 |
47 min
This month we have some more feedback from our listeners (2.20)
Carl says it's time to start smoking cessation (or stop the reduction in funding for smoking reduction) (11.40) and marvels at how pretty Richard Doll's seminal smoking paper is.
It's gloves off for infection control (22.20)
Andrew George, a non-executive director of the Health Research Authority joins us to talk about their consultation on research transparency, and explains how you can get involved (27.04)
And we talk about a new tool for rating the transparency of pharma companies (37.40)
Reading list:
Impact of the WHO Framework Convention on Tobacco Control on global cigarette consumption
https://www.bmj.com/content/365/bmj.l2287
Sixty seconds on . . . gloves off
https://www.bmj.com/content/366/bmj.l4498
HRA transparency consultation
https://www.hra.nhs.uk/about-us/consultations/make-it-public/our-vision-research-transparency/
Sharing of clinical trial data and results reporting practices among large pharmaceutical companies
https://www.bmj.com/content/366/bmj.l4217
I have never encountered an organisation as vicious in its treatment of whistleblowers as the NHS
4 juli 2019 |
29 min
Margaret Heffernan has thought a lot about whistleblowing, and why companies don't respond well to it. She wrote the "Book Wilful Blindness: Why We Ignore the Obvious at our Peril".
In this podcast she talks about how culture, and groupthink, leads to a culture where whistleblowers are ignored, and why the NHS needs to change the way it treats people who try and call out poor care.
This was recorded at Risky Business - https://www.riskybusiness.events/ where you can find our more about the conference and watch previous talks.
After Grenfell
1 juli 2019 |
21 min
It's been just over two years since a fire broke out in Grenfell tower, in west London, claiming the lives of 72 residents. 223 people survived, thanks to the work of the fire brigade and health care.
In this podcast we hear from Andrew Roe, assistant commissioner at London Fire Brigade, and Anu Mitra, consultant emergency physician at St Mary's hospital - they talk about the support which has been provided, and where more needs to be done to help frontline staff cope with the horrors of the job.
The interviews were recorded at Risky Business - https://www.riskybusiness.events/ - where you can find out more about the Risk in healthcare.
Talk Evidence - Z drugs, subclinical hypothyroidism and Drazen’s dozen
25 juni 2019 |
45 min
This week on the podcast, (2.02) a listener asks, when we suggest something to stop, should we suggest an alternative instead?
(8.24) Helen tells us to stop putting people on treatment for subclinical hypothyroidism, but what does that mean for people who are already receiving thyroxine?
(20.55) Carl has a black box warning about z drugs, and wonders what the alternative for sleep are.
(30.11) Finally the NEJM has published Jeff Drazen's dozen most influential papers - but not a systematic review amongst them. Cue the rant.
Reading list:
Rapid rec on subclinical hypothyroidism
https://www.bmj.com/content/365/bmj.l2006
Temporal trends in use of tests in UK primary care, 2000-15
https://www.bmj.com/content/363/bmj.k4666
Black box warning for z-drugs
https://www.bmj.com/content/365/bmj.l2165
Drazen's dozen
https://cdn.nejm.org/pdf/Drazens-Dozen.pdf
Did international accord on tobacco reduce smoking?
20 juni 2019 |
35 min
WHO Director-General Dr. Tedros recently said “Since it came into force 13 years ago, the Framework Convention on Tobacco Control remains one of the world’s most powerful tools for promoting public health,”.
But is it?
That’s what a to studies just published on bmj.com try and investigate - one of which pulls together all the data we have on smoking rates, from 1970 to 2015, and then a quasi-experimental study which tries to model what the effect of the FCTC has had.
Steven Hoffman, and Matthieu Poirier from the Global Strategy Lab at York University join us to explain what their research means, and why it’s time to double down on our attempts to reduce smoking.
Read the open access research:
https://www.bmj.com/content/365/bmj.l2287
https://www.bmj.com/content/365/bmj.l2231
Working as a team, and combating stress, in space
18 juni 2019 |
16 min
Nicole Stott is an engineer, aquanaut and one of the 220 astronauts to have lived and worked on the International Space Station.
In a confined space, under huge pressure, with no way out, it's important that teams maintain healthy dynamics, and individuals can manage their stress adequately, and in this podcast Nicole explains a little about living on the ISS and how she coped for 91 days.
Read more about the Space Art Foundation:
https://www.bmj.com/content/365/bmj.l4244
More from Risky Business
https://www.riskybusiness.events/
Thoroughly and deliberately targeted; Doctors in Syria
14 juni 2019 |
17 min
As Syria enters its ninth year of conflict, doctors are struggling to provide health care to a badly damaged country.
While dealing with medicine shortages, mass casualties and everything that comes with working in a warzone, healthcare facilities and their staff are also facing an unprecedented number of targeted and often repeated attacks.
According to a new report, there were 257 recorded attacks on hospitals, medical transportation and healthcare workers in Syria in 2018. And despite these attacks being illegal under international law, they are becoming the new normal.
In this podcast, Elisabeth Mahase talks to Feras Fares, a gynaecologist from Syria, Len Rubenstein, chair of the Safeguarding Health in Conflict Coalition, and Declan Barry, an Irish pediatrician who worked with MSF in Syria in 2013.
Planning for the unplannable
11 juni 2019 |
25 min
Hi impact, low probability events are a planners nightmare. You know that you need to think about them, but how can you prioritise which event - terrorist attack, natural disaster, disease outbreak, deserves attention - and how can you sell the risks of that, but not oversell them?
Risky business is a conference where some of these kind of things can be discussed - how do we think about risk, how do we plan for it - at this year’s conference we heard from one of the men who rescued the boys from a cave in Thailand, the fireman in charge of Grenfell, and the medical teams responding to the three latest terrorist attacks in the UK.
In this podcast we talk to Amy Pope, former advisor to the Whitehouse during president Obama’s tenure. There she was charged with thinking about these high impact, low probability events.
More from Risky Business
https://www.riskybusiness.events/
What Matters To You Day
6 juni 2019 |
37 min
It's What Matters To You day - #wmty - and in this podcast Anya de Iongh, The BMJ's patient editor, and Joe Fraser, author of Joe's Diabetes who works at NHS England on personalised care, get together to discuss what personalised care actually means, how it changes the ways in which patients and health professionals interact, and how it can be practically done.
We also hear from three people who are making personalised care actually happen
Jo McGoldrick is a health coach who works at Lions Health GP Practice in Dudley.
Joanne Appleton is a Commissioning Manager for Personalised Care at Gloucester CCG
Jono Broad lives with long term health conditions and is involved in regional and QI work around personalised care.
Tech and the NHS - A tale of two cultures
3 juni 2019 |
33 min
The NHS is about caring for people, free at the point of care, creating a safety net which catches the most vulnerable. Tech has been defined by the facebook maxim "move fast, break things" - looking to disrupt a sector, get investment and move on.
We want to be able to harness the potential utility of digital tech in the NHS - but how can those two cultures be reconciled, and what salutary lessons should we learn from other industries (pharmaceuticals, devices) before we embark on these new ventures.
In this podcast we hear from;
Neil Sebire, Chief Research Information Officer and Director, Great Ormond Street Hospital Digital Research, Informatics and Virtual Environments (DRIVE) Unit
Dr Ramani Moonesinghe, Professor and Head of Centre for Perioperative Medicine, University College London
Indra Joshi, Digital Health and Artificial Intelligence Clinical Lead at the newly formed NHS X
Finding out who funds patient groups
29 maj 2019 |
21 min
We’ve been banging the drum about transparency of payment to doctors for years - we’ve even put a moratorium on financial conflicts of interest in the authors of any of our education articles. Not because we think that all doctors who receive money from industry are being influenced to push their agenda - but because we have no way of telling when that’s happening…
At the same time, and rightly, patient groups are becoming more involved in setting things like research priorities, and in guideline development - and we’re campaigning to increase that involvement. but as that involvement increases, it’s also important to make sure that potential industry influence is made transparent.
Piotr Ozieranski, is an assistant professor at the Department of Social and Policy Sciences at the University of Bath and one of the authors of a new analysis which attempts to build a picture of industry funding of UK patient groups.
Read the full analysis:
https://www.bmj.com/content/365/bmj.l1806
Talk Evidence - cancer causing food, prostate cancer and disease definitions
25 maj 2019 |
35 min
Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month.
(1.05) Carl rants about bacon causing cancer
(7.10) Helen talks about prostate cancer, and we hear from the author of the research paper which won Research Paper Of The Year at the BMJ awards.
We also cover disease definition and a call to have GPs more involved in that process, (24.12)and a new call for papers into conflicts of interest (29.40)
Reading list:
MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis.
https://www.ncbi.nlm.nih.gov/pubmed/29552975?dopt=Abstract
Reforming disease definitions: a new primary care led, people-centred approach
https://ebm.bmj.com/content/early/2019/04/11/bmjebm-2018-111148
Commercial interests, transparency, and independence: a call for submissions
https://www.bmj.com/content/365/bmj.l1706
What caused the drop in stroke mortality in the UK
23 maj 2019 |
23 min
Stroke mortality rates have been declining in almost every country, and that reduction could result from a decline in disease occurrence or a decline in case fatality, or both. Broadly - is that decline down to better treatment or better prevention.
Olena Seminog, a researcher, and and Mike Rayner, professor of population health, both from the Nuffield Department of Population Health at the University of Oxford, join us to discuss their study which has used a large database to try and determine what has most affected stroke mortality.
Read the full open access research paper:
https://www.bmj.com/content/365/bmj.l1778
Helping parents with children who display challenging behaviour
17 maj 2019 |
45 min
Looking after a young child is hard enough, but when that child has learning difficulties and displays challenging behaviour - the burden on parents can be extreme.
That behaviour may prompt a visit to the doctor, and in this podcast we’re talking about how parents can be supported in that - what services are available. We’ll also be discussing what is normal behaviour, and what might prompt a referral to a specialist team for further assessment.
In this podcast we're joined by 2 of the authors of a recent practice pointer - Managing challenging behaviour in children with possible learning disability. Angela Hassiotis - professor of psychiatry of intellectual disability at University College London and Michael Absoud - consultant in paediatric neurodisability at the Evelina London Children’s Hospital.
We also have Rebecca - mother of a child who displayed some of these behaviours, and is actually a parent/carer case worker supporting families of children with disabilities.
Read the full practice article:
https://www.bmj.com/content/365/bmj.l1663
Tackling gambling
10 maj 2019 |
21 min
In the UK we have a complex relationship with gambling, the government licences the national lottery, and uses profit from that to fund our art and museum sector - horse racing is a national TV event, and we've seen a proliferation of betting shops on our high streets.
At the same time, there's increasing acceptance that gambling causes problems for some people - to the extent that it's been termed a "hidden epidemic" and a public health problem. And it's to that point that the authors of a new analysis have written in the BMJ - if we see gambling as a public health problem, why aren't we treating it as such.
To talk about that, we're joined in the studio by Heather Wardle - Wellcome humanities and social science research fellow at the LSHTM.
Read the full analysis:
https://www.bmj.com/content/365/bmj.l1807
The sex lives of married Brits
9 maj 2019 |
25 min
The National Surveys of Sexual Attitudes and Lifestyles is a deep look into the sex lives of us brits - and has been running now for 30 years, giving us some longitudinal data about the way in which those sex lives have changed. The latest paper to be published, based on that data, looks at the frequency of sex - how often different groups are having sex on a weekly basis, and has reported a drop in that frequency for some groups.
Joining us to talk about the research, and why we're having less sex, is Kaye Wellings, Professor of Sexual and Reproductive Health at the London School of Hygiene and Tropical Medicine.
Read the full open access research:
https://www.bmj.com/content/365/bmj.l1525
Doctors and extinction rebellion
3 maj 2019 |
34 min
Starting in the middle of April, the group “Extinction Rebellion” have organised a series of non-violent direct action protests. Most notably bringing central London to a standstill - but these events are now continuing around the country.
Predictably, they have received a lot of criticism - they have also received a lot of support - amongst those arrested at the protests have been a few doctors, despite reservations that some may have for the impact on their careers.
In this podcast, we'll hear from three people who have decided to support extinction rebellion, about why they do, and what the medical community's support might mean for climate change.
We're joined by Rowan Williams, Master of Magdalene College, Cambridge and former Archbishop of Canterbury - the principle leader of the church of England. Robin Stott, retired physician and campaigner, and Alex Armitage, paediatric trainee.
Schoolchildren’s activism is a lesson for health professionals
https://www.bmj.com/content/365/bmj.l1938
Just 11 years to avert disaster
https://www.bmj.com/content/365/bmj.l1801
Introducing Sharp Scratch - our new podcast for students and junior doctors
26 april 2019 |
43 min
Here's a taster for our new student podcast - Sharp Scratch. We're talking about the hidden curriculum, things you need to know to function as a doctor, but are rarely formally taught.
This is a taster - if you enjoy, subscribe! https://podcasts.apple.com/gb/podcast/student-bmj-podcast/id331561304
Sharp Scratch episode 1: Surviving the night shift.
Why nights shifts mess with your brain, how astronauts will cope with the time difference on Mars, and the power of frozen grapes when you need a boost.
Join medical students Laura, Ryhan, Declan, and newly qualified doctor Chidera as we figure out how to survive the night shift. Featuring a guest interview with NASA researcher Erin, leader of the Fatigue Countermeasures Group.
https://www.bmj.com/sharpscratch
Gypsy and Traveller health
24 april 2019 |
28 min
In the UK, there's an ethnic group that is surprisingly large, but often overlooked by society, and formal healthcare services. The gypsy traveller community have poorer health outcomes because of systemic issues around access to health and education.
In this podcast we're joined by Michelle Gavin and Samson Rattigan, who both work for Friend's Families and Travellers - and who have have been working hard in East Sussex to bridge the gap between the healthcare system and those who identify as gypsies or travellers, and explain some of the simple ways in which GPs and hospitals can support this neglected group.
https://www.gypsy-traveller.org/
Could open access have unintended consequences?
19 april 2019 |
23 min
An “author pays” publishing model is the only fair way to make biomedical research findings accessible to all, say David Sanders, professor of gastroenterology at Sheffield University, but James Ashton and worries that it can lead to bias in the evidence base towards commercially driven results - as those are the researchers who can pay for open access fees. Dave deBronkart just wants patients to have access to key research.
Read the full head to head:
https://www.bmj.com/content/365/bmj.l1544
Talk Evidence - health checks, abx courses and p-values
17 april 2019 |
48 min
Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month.
(1.20) Carl grinds his gears over general health checks, with an update in the Cochrane Library.
(9.15) Helen is surprised by new research which looks at over prescription of antibiotics - but this time because the courses prescribed are far longer than guidelines suggest.
(22.30) What is the true 99th centile of high sensitivity cardiac troponin in hospital patients?
(29.02) Is it time to abandon statistical significance and be aware of the problem of the transposed conditional.
Reading list:
General health checks in adults for reducing morbidity and mortality from disease - https://www.ncbi.nlm.nih.gov/pubmed/30699470?dopt=Abstract
Duration of antibiotic treatment for common infections in English primary care -https://www.bmj.com/content/364/bmj.l440
True 99th centile of high sensitivity cardiac troponin for hospital patients - https://www.bmj.com/content/364/bmj.l440
Significant debate - https://www.nature.com/magazine-assets/d41586-019-00874-8/d41586-019-00874-8.pdf
The false positive risk: a proposal concerning what to do about p-values - https://www.youtube.com/watch?v=jZWgijUnIxI
http://www.onemol.org.uk/?page_id=456
Capital punishment, my sixth great grandfather, and me
9 april 2019 |
20 min
On the 7th of June, 1753, Dr Archibald Cameron was executed at Tyburn. "The body, after hanging twenty minutes, was cut down: it was not quartered; but the heart was taken out and burnt. "
250 years later, his sixth great grandson, Robert Syned found himself deeply involved in the process of execution, as an expert witness in a case about the use of a new drug for lethal injection in the USA.
In this podcast, Robert joins us to talk about the dearth of evidence, and massive variation in the use of drugs used to execute someone, and reflects on how finding out about his ancestor meant to him in this process.
How to have joy at work
5 april 2019 |
19 min
Jessica Perlo is the Director for Joy at Work at the Institute for Healthcare Improverment, and James Mountford is direct or of quality at the Royal Free London NHS Foundation Trust.
Together they joined us at the International Forum on Quality and Safety in Healthcare to discuss joy at work - what that concept actually means, and practically, how hospitals can start implementing it.
Watch Jessica’s session at the forum
https://internationalforum.bmj.com/glasgow/2018/09/20/a1-leadership-models-for-co-producing-a-joyful-workforce/
BMJ's wellbeing campaign
https://www.bmj.com/wellbeing
https://www.facebook.com/groups/569230966796440/
Social prescribing
4 april 2019 |
20 min
Non-medical interventions are increasingly being proposed to address wider determinants of health and to help patients improve health behaviours and better manage their conditions - this is known as social prescribing. In England, the NHS Long Term Plan states that nearly one million people will qualify for referral to social prescribing schemes by 2024.
In this podcast, Chris Drinkwater, emeritus professor of primary care and Louise Cook, a link worker, both at Newcastle University's Ways to Wellness - who provide social prescribing support.
They describe the evidence base for the service, how they work with patients to coordinate their non-medical interventions, and how they measure success.
Read the full clinical update:
https://www.bmj.com/content/364/bmj.l1285
Applying new power in medicine
1 april 2019 |
37 min
Change requires the application of power - the way in which individuals can accrue power has shifted in our digitally connected world. Traditional ways of influencing change in healthcare (getting the chief executive on side, having a quiet chat with the medical director) are not the only way to build a momentum.
Henry Timms - author of “New Power” the internationally best selling book joins us to talk about about how much of his thinking on these power structures has come from healthcare.
https://thisisnewpower.com/
https://twitter.com/hashtag/newpower
Henry Timms onstage at the International Forum on Quality and Safety in Healthcare
https://livestream.com/IFQSH/Glasgow2019/videos/189271449
Talk Evidence - Shoulders, statins and doctors messes
28 mars 2019 |
42 min
Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month.
They start by talking about shoulders - what does the evidence say about treating subacromial pain, and why the potential for a subgroup effect shouldn't change our views about stop surgery (for now, more research needed).
(16.00) Statins - more uncertainty about statins, this is now looking at older people. Age is a big risk factor for cardiovascular disease - at what point does that risk overwhelm any potential benefit from taking statins?
(20.30)Carl explains his rule-of-thumb for turning relative risks into absolute risks, in a way can help doctors talk to patients about new evidence.
(25.46)What's the evidence for doctors messes? Carl's rant of the week focuses on the calls (including the BMJ's campaign) to have spaces for doctors to relax in hospitals. He asks, is that better than putting in a gym? What's the evidence for that.
Reading list:
Subacromial decompression surgery for adults with shoulder pain
https://www.bmj.com/content/364/bmj.l294
Efficacy and safety of statin therapy in older people
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31942-1/fulltext
The future of doctor's messes
https://www.bmj.com/content/364/bmj.k5367.abstract
Is opt-out the best way to increase organ donation?
22 mars 2019 |
25 min
As England’s presumed consent law for 2020 clears parliament, Veronica English, head of medical ethics and human rights at the BMA, say that evidence from Wales and other countries shows that it could increase transplantation rates. But Blair L Sadler, physician and senior adviser to California State University, consider such legal changes a distraction lacking strong evidence: they say that public education and trained staff would have a proven impact.
We also hear from Erin Walker, the recipient of 2 liver transplants, about her concerns on families over-ruling donor's wishes.
Read the full debate, and Erin's commentary:
https://www.bmj.com/content/364/bmj.l967
An acutely disturbed person in the community
21 mars 2019 |
26 min
It can be difficult to know what to do when a person in severe psychological distress presents to a general practice or community clinic, particularly if they are behaving aggressively, or if they are refusing help.
Most patients who are acutely disturbed present no danger to others, however situations can evolve rapidly. Frontline staff need to know how to call for help, how to assess and manage physical risk, and how to de-escalate such situations.
In this podcast Aileen O’Brien, reader in psychiatry and education at St George’s University of London joins us to give some advice on what to do in that situation - why deescalation is useful, and who else to involve.
We also hear from someone who lives with bipolar disorder, and has had experiences of being acutely unwell in a public places, which have lead to police and psychiatric intervention.
Read the full practice article:
https://www.bmj.com/content/364/bmj.l578
Passing on the secret knowledge of loop diuretics
15 mars 2019 |
26 min
In every generation there are a few that know the secret; the counterintuitive effects of loop diuretics.
In this podcast Steven Anisman, cardiologist at the Dartmouth Hitchcock Department of Cardiovascular Medicine, joins us to explain about the threshold effects of these drugs, and why that might change the way in which you think about prescribing them.
Read the full article on treatment of oedema with loop diuretics, and contribute to the discussion: https://www.bmj.com/content/364/bmj.l359
#talkaboutcomplications
14 mars 2019 |
28 min
Renza Scibilia and Chris Aldred have diabetes, and their introduction to the idea of complications arising from the condition were terrifying.
Because of this early experience, and Chris's later development of complications, they have campaigned to make doctors really think about the way in which they talk about complications with patients. Challenging the use of "non-compliant" and other stigmatising language.
Chris has also documented his experience of developing an ulcer, and having it successfully treated, on social media, to open up the conversation and make us all #talkaboutcomplications.
Chris Aldred is @grumpy_pumper on twitter, and blogs at http://www.the-grumpy-pumper.com. Renza Scibilia is @RenzaS on twitter and blogs at https://diabetogenic.wordpress.com/
Ebola - Stepping up in Sierre Leone
8 mars 2019 |
31 min
In 2014, Oliver Johnson was a 28 year old British doctor, working on health policy in Sierre Leone after finishing medical school. Also working in Freetown was Sinead Walsh, then the Irish Ambassador to the country.
Then the biggest outbreak of Ebola on record happened in West Africa, starting in Guinea and quickly spreading to Liberia, Sierre Leone and Nigeria.
Oliver and Sinead have co-authored a book about the change that wrought on their lives, how they stepped into roles coordinating the international response to the disease and running a treatment centre. They join us today to talk about their experiences there.
For more information about Ebola, including the current outbreak in the Democratic Republic of Congo visit https://www.bmj.com/ebola.
For Sinead and Oliver's book - Getting to Zero: A Doctor and a Diplomat on the Ebola Frontline is available now.
https://www.amazon.co.uk/dp/B07DFLFF9P/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1
Signals from the NIHR
7 mars 2019 |
14 min
If you've been keeping up to day with The BMJ - online on in print, you might have noticed that we've got a new type of article - NIHR Signals - and they are here to give busy clinicians a quick overview of practice changing research that has come out of the UK's National Institute for Health Research.
Tara Lamont, director of the NIHR dissemination centre, joins us to talk a bit more about the research underpinning these articles.
You can find the full list of articles:
https://www.bmj.com/NIHR-signals
Nuffield 2019 - How can the NHS provide a fulfilling lifelong career
6 mars 2019 |
47 min
More doctors are choosing to retire early, doctors who take career breaks find it hard to return to practice, and doctors at all stages of their careers are frustrated by the lack of support given to training and development in today’s NHS.
Each year the BMJ holds a roundtable discussion at the Nuffield Summit - where health leaders come together to talk about the NHS. We wanted to know what more the NHS can do to provide fulfilling careers for staff and to improve support for doctors who want to keep working and those seeking to return to practice.
Taking part in the discussion were:
Tom Moberly - UK editor for The BMJ
Rahkee Shah - paediatric registrar
Ronny Cheung - consultant general paedatrician
Claire Lemer - consultant paediatrician
Candace Imison - Director of Workforce Strategy at the Nuffield Trust
James Morrow - GP partner
Diabetes Insipidus - the danger of misunderstanding diabetes
1 mars 2019 |
44 min
Diabetes is synonymous with sugar, but diabetes insipidus, "water diabetes", can't be forgotten. Between 2009 and 2016, 4 people died in hospital in England, when lifesaving treatment for the condition was not given.
In this podcast, we hear some practical tips for non-specialists to aid diagnosis, and how patients should be managed during hospital admission.
On the podcast are
Miles Levy, consultant endocrinologist from Leicester Royal Infirmary
Pat McBride, head of family services at the Pituitary Foundation
John Wass, professor of endocrinology at Oxford University
Malcolm Prentice, consultant endocrinologist at Croydon University Hospital.
Read the full practice article:
https://www.bmj.com/content/364/bmj.l321
Talk Evidence - Radiation, fertility, and pneumonia
27 februari 2019 |
32 min
Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month.
They start by talking about how difficult a task it is to find evidence that's definitely practice changing, what GPs can learn from Malawian children with nonsevere fast-breathing pneumonia, how radiation dosage varies substantially - and consultant radiologist Amy Davies what that means for patients.
They also rail against add-on tests for fertility, and the lack of evidence underpinning their use - will the traffic light system suggested help patients make treatment choices.
Carl's rant this week is based on a new study by Steve Woloshin and Lisa Schwartz which documented 20 years of medical marketing in the USA.
Reading list:
Pneumonia in Malawi - https://www.ncbi.nlm.nih.gov/pubmed/30419120
Variation in radiation dose - https://www.bmj.com/content/364/bmj.k4931
Traffic light fertility tests - https://www.bmj.com/content/364/bmj.l226
Medical marketing - https://jamanetwork.com/journals/jama/fullarticle/2720029
Sorry for the interruption in service
22 februari 2019 |
1 min
The problem we had publishing our feed has been fixed, and normal service has resumed.
Thank you for subscribing to the podcast, if you have thoughts you'd like to express, we'd love to hear them.
https://www.bmj.com/podcasts
Safeguarding LGBT+ young people
15 februari 2019 |
29 min
Recent years have seen political and social progress for people who identify as LGBT+ (lesbian, gay, bisexual, and transgender; the “+” indicating inclusion of other minority sexual and gender identities).
Yet international evidence shows ongoing health and social inequalities in this group, many of which emerge during adolescence and represent unique safeguarding risks.
In this podcast, Kate Addlington, psychiatry trainee and associate editor at The BMJ is joined by Ginger Drage, expert patient educator at University College London, Jessica Salkind, academic clinical fellow in paediatrics & teaching lead for LGBT+, at Imperial College London and Rosanna Bevan, psychiatry trainee from East London Foundation Trust
They discuss the the risks faced by LGBT+ young people, which include increased rates of self harm, suicide, and family rejection or abuse, and what steps clinicians can take to support and intervene if necessary.
Read the full practice article:
https://www.bmj.com/content/364/bmj.l245
Should we be screening for AF?
14 februari 2019 |
21 min
Current evidence is sufficient to justify a national screening programme, argues Mark Lown clinical lecturer at the University of Southampton, but Patrick Moran, senior research fellow in health economics at Trinity College Dublin, thinks there are too many unanswered questions and evidence from randomised trials is needed to avoid overdiagnosis
Read the full debate:
https://www.bmj.com/content/364/bmj.l43
Chronic Rhinosinusitis
8 februari 2019 |
36 min
Patients who experience chronic rhinosinusitis may way for a considerable period of time before presenting, because they believe the condition to be trivial.
In this podcast, Alam Hannan, ENT Consultant at the Royal Throat Nose and Ear Hospital in London, explains why that belief is not founded, and describes which treatments can be effective at providing relief.
Assisted dying: should doctors help patients to die?
4 februari 2019 |
29 min
The Royal College of Physicians will survey all its members in February on this most controversial question. It says that it will move from opposition to neutrality on assisted dying unless 60% vote otherwise.
The BMJ explores several conflicting views. From Canada, palliative care doctor Sandy Buchman explains why he sees medical aid in dying as a compassionate treatment that fully respects patient autonomy. The Canadian Medical Association is neutral on the issue, and Jeff Blackmer, its vice president for international health, shares how that stance enabled it to represent all its members, including doctors with conscientious objections.
But many are unconvinced to say the least. Rob George, a UK palliative care doctor and professor at King's College London, says assisted suicide has no place in medicine. Tony Baldwinson, from the UK campaign group Not Dead Yet, worries for disabled people were society to endorse doctors actively ending lives. And Zoe Fritz, a consultant physician in acute medicine at Addenbrooke’s Hospital, Cambridge, has a proposal that she says would protect the doctor-patient relationship.
Read all our content at https://www.bmj.com/assisted-dying
"Why I decided to provide assisted dying: it is truly patient centred care" by Sandy Buchman https://www.bmj.com/content/364/bmj.l412
"How the Canadian Medical Association found a third way to support all its members on assisted dying" by Jeff Blackmer https://www.bmj.com/content/364/bmj.l415
"Religious and non-religious people share objections to assisted suicide" by Mark Pickering https://blogs.bmj.com/bmj/2019/01/30/religious-and-non-religious-people-share-objections-to-assisted-suicide/
"The courts should judge applications for assisted suicide, sparing the doctor-patient relationship" by Zoe Fritz https://blogs.bmj.com/bmj/2019/01/30/the-courts-should-judge-applications-for-assisted-suicide-sparing-the-doctor-patient-relationship/
Goran Henriks - How an 80 year old woman called Esther shaped Swedish Healthcare
25 januari 2019 |
16 min
Jönköping has been at the centre of the healthcare quality improvement movement for years - but how did a forested region of Sweden, situated between it's main cities, come to embrace the philosophy of improvement so fervently? Goran Henriks, chief executive of learning and innovation at Qulturum in Jönköping joins us to explain. He also tells us about Esther, and why she figures so centrally in their planning.
Talk evidence - TIAs, aging in Japan and women in medicine
23 januari 2019 |
36 min
In this EBM round-up, Carl Heneghan, Helen Macdonald and Duncan Jarvies are back to give you an update
Dual vs single therapy for prevention of TIA or minor stroke - how does the advice that dual work better translate in the UK?
Carl explains why Japan can teach us to get active and, how GPs can use that information to "drop a decade" in aging.
Finally, Helen took some time to relax over Christmas - until she read a story in the Christmas edition about gender discrimination in medicine, and it reminded her of her time on the ward.
Reading list:
The BMJ Practice: Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke
https://www.bmj.com/content/363/bmj.k4169
Delaying and reversing frailty: a systematic review of primary care interventions
https://bjgp.org/content/early/2018/11/30/bjgp18X700241
HIV - everything you wanted to know about PeP and PreP
15 januari 2019 |
67 min
We have had two articles published recently on bmj.com, looking at drug prevention of HIV; PeP - Post-exposure Prophylaxis and PreP - Pre-exposure Prophylaxis, neither prevent the virus from entering the body, but they do prevent the infection from taking hold.
There are lots of questions that doctors have about these - what are the risk profiles of patients who should be offered the treatments? How can they be prescribed? What are the side effects? And if you're in England, where PreP is not yet available on the NHS, can doctors advise their patients to buy it online?
Michael Brady, Sexual health and HIV consultant at Kings College Hospital and Medical Director of the Terrence Higgins Trust, joins us to help answer those questions.
Further reading
BMJ article on PeP https://www.bmj.com/content/363/bmj.k4928
BMJ article on PreP
BASHH guidelines on PreP - https://www.bashhguidelines.org/media/1189/prep-2018.pdf
https://iwantprepnow.co.uk
http://www.aidsmap.com/
HbA1c - when it might not be accurately measuring glycemic control
15 januari 2019 |
18 min
HbA1c concentration is used as the biomarker for long term glycaemic control, however if the lifespan of red blood cells is altered, that may lead to an over, or under estimation of that control.
In this podcast Ravinder Sodi, consultant clinical biochemist at University Hospitals of Morecambe Bay NHS Foundation Trust, explains when to suspect HbA1c is not an accurate measure of glycemic control, and what alternative tests are available.
Read the full article:
https://www.bmj.com/content/363/bmj.k4723
Terence Stephenson - looking back at chairing the GMC
15 januari 2019 |
23 min
Terence Stephenson is a consultant paediatrician who became been chair of the General Medical Council in 2015.
His 4 year tenure has now come to an end, but during his time with the regulator the medical profession faced a number of challenges - the case of Hadiza Bawa Garba and a growing recruitment crisis in the NHS - the GMC is the gatekeeper for foreign doctors who who wish to work here. As the rules on EU doctors change, the GMC’s regulatory practice may have to change too.
In this podcast, Abi Rimmer, a report and editor for The BMJ, went to Terrence’s office to talk to him about his career at the GMC, and his perspective on how the organisation has responded to those challenges.
Read the related article:
https://www.bmj.com/content/363/bmj.k5402
How Coca-Cola shaped obesity science and policy in China
9 januari 2019 |
25 min
Susan Greenhalg is a research professor of chinese society in Harvard’s department of anthropology - not a natural fit for a medical journal you may think, but recently she has been looking at the influence of Coca Cola on obesity policy in China.
She has written up her investigation in an article published on bmj.com this week, and joins us in the podcast to talk about why a communist country would embrace a message from an icon of capitalism, and what attitudes toward financial conflicts of interest exist in the country.
Read the full feature:
https://www.bmj.com/content/364/bmj.k5050
Accompanying editorial:
https://www.bmj.com/content/364/bmj.l4
Coding at Christmas
4 januari 2019 |
36 min
For many of you Christmas is over and, you’re back to work. Admin piled up over christmas? Feeling resentful for all those forms, and the weird codes they make you put in them?
In this podcast I hope we can explain why that’s important, with 17th century death, the esoteria of reed codes, and why the WHO cares about spaceship accidents.
Consumption, flux, and dropsy: counting deaths in 17th century London
https://www.bmj.com/content/363/bmj.k5014
Christmas guide to clinical coding
https://www.bmj.com/content/363/bmj.k5209
Women in medicine at Christmas
21 december 2018 |
42 min
2018 will go down in history as a year of reckoning as the year that that some men’s behaviour came back to bite them. The continuing impact of #MeToo across the world has prompted another round of thinking about women’s experiences in medicine, which can be seen this year’s christmas journal
In this podcast, Esther Choo and Eleni Lenos, join us to discuss their research into mother's experiences of being doctors - and how discrimination is still rife against them.
Also Sarah Lowry, from the Royal College of Physicians brings us some other women's voices - this time from the RCP exhibition "This vexed Question: 500 years of women in medicine"
Visit the exhibition:
https://www.rcplondon.ac.uk/events/vexed-question-500-years-women-medicine
Physician mothers’ experience of workplace discrimination: a qualitative analysis
https://www.bmj.com/content/363/bmj.k4926
A lexicon for gender bias in academia and medicine
https://www.bmj.com/content/363/bmj.k5218
Christmas Food 2018
16 december 2018 |
35 min
the Christmas BMJ season is upon us - if you’re to go to our website now, you’ll see that it’s been a bumper year. In the podcast, we’re going to be bringing you a select few - we’ll be looking at motherhood. Trying to figure out what 17th Century causes of death were, and - as it’s christmas - in this pod we’ll be looking at food.
We talk to Frances Mason and Amanda Farley, from the University of Birmingham, about their RCT examining the “Effectiveness of a brief behavioural intervention to prevent weight gain over the Christmas holiday period"
https://www.bmj.com/content/363/bmj.k4867
We also have Eric Robinson from the University of Liverpool explains how calorific restaurant food from his observational study,
"(Over)eating out at major UK restaurant chains"
https://www.bmj.com/content/363/bmj.k4982
Talk Evidence - Devices and facebook vaccines
12 december 2018 |
36 min
In the second of our EBM round-ups, Carl Heneghan, Helen Macdonald and Duncan Jarvies are joined by Deborah Cohen, investigative journalist and scourge of device manufacturers.
We're giving our verdict on the sensitivity and specificity of ketone testing for hyperemesis, and the advice to drinking more water to prevent recurrent UTIs in women.
Deb joins us to talk about the massive, international, investigation into failing regulation for implantable devices - and shares some of the stories where these have harmed patients.
Finally, Carl is excised about antivaxer ads on facebook - but Helen has seen some pro-vaccine ones which are poor science too.
Reading list:
Diagnostic markers for hyperemesis gravidarum
https://www.ncbi.nlm.nih.gov/pubmed/24530975
Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2705079
The great implant scandle
https://www.bbc.co.uk/iplayer/episode/b0btjr55/panorama-the-great-implant-scandal
Facebook antivaccine ads
https://www.independent.co.uk/news/uk/home-news/anti-vaccination-antivaxxers-uk-advert-banned-facebook-post-vaccines-kill-babies-a8620831.html
Making multisectoral collaboration work
7 december 2018 |
46 min
A new collection of articles published by The BMJ includes twelve country case studies, each an evaluation of multisectoral collaboration in action at scale on women’s, children’s, and adolescent’s health.
Collectively these twelve studies inform an overarching synthesis and accompanying commentaries, drawing together lessons learned in achieving effective multisectoral collaboration.
In this podcast, Wendy Graham, professor of obstetric epidemiology at the London School of Hygiene and Tropical Medicine, and Shyama Kuruvilla, senior strategic advisor to the World Health Organisation, join us to discuss what can be learned from those case studies.
Read all the case studies:
https://www.bmj.com/multisectoral-collaboration
Trojan Milk
5 december 2018 |
32 min
Infant formula manufacturers were made pariah in the 70s, because of their marketing practices - this lead to “The Code”, adopted by the WHO, which set out clear guidelines about what those practices should be.
Now an investigation on bmj.com by Chris Van Tulleken, honorary senior lecturer at University College London, examines the practices associated with the marketing of specialist milk formula for children with cow’s milk protein allergy, and asks whether doctors organisations should be receiving money from that industry.
Read the full investigation:
https://www.bmj.com/content/363/bmj.k5056
The bone crushing nausea of hyperemesis
1 december 2018 |
49 min
Nausea and vomiting in pregnancy affects around 70% of pregnancies. It is mild for around 40% of women, moderate for 46%, and severe for 14%.
By contrast, hyperemesis gravidarum is a complication of pregnancy rather than a normal part of it and occurs in around 1.5% of pregnancies. The psychosocial burden of HG can be heavy for women and their families.
In this podcast, Caitlin Dean Phd Candidate, Gillian Ostrowski, general practitioner, Rebecca C Painter, consultant obstetrician join us to explain what hyperemesis is like for those who experience it, and discuss what treatment options are available.
Read the full article:
https://www.bmj.com/content/363/bmj.k5000
God is in Operating Room 4
27 november 2018 |
46 min
Healthy self confidence has an important role in surgery, but what came first - the surgeon or the ego?
In this conversation, Christopher Myers, Yemeng Lu-Myers, and Amir Ghaferi join us to talk about the (very few) surgeons who behave badly in theatre, and why that behaviour has persisted, and can be detrimental.
Read their full analysis:
https://www.bmj.com/content/363/bmj.k4537
Carers need a voice in the NHS
22 november 2018 |
28 min
Until recently, The BMJ had a campaign of patient partnership - now we have a patient and public partnership campaign. The reason for that change is that medicine has an effect beyond the individual being treated - and this podcast interview is a very good example of that.
Anya De Iong, patient editor for The BMJ, talks to Christine Morgan - independent chair of the Greater Manchester Carers Strategic Group. Christine has a mission to bring the needs of carers into thinking and planning about the NHS - and explains how the needs of patients and carers may be similar, and different.
Acceptable, tolerable, manageable - but not to patients. How drug trials report harms.
19 november 2018 |
26 min
You’ll have read in a clinical trial “Most patients had an acceptable adverse-event profile.” Or that a drug “has a manageable and mostly reversible safety profile.” And that “the tolerability was good overall.”
In this podcast, Bishal Gyawali (@oncology_bg) joins us to describe what events those terms were actually describing in cancer drug trials, and how they reduce the readers appreciation of the adverse effects of these novel drugs.
Read the full analysis:
https://www.bmj.com/content/363/bmj.k4383
Talk evidence - Vitamin D, Oxygen and ethics
16 november 2018 |
41 min
Welcome to this, trial run, of a new kind of BMJ podcast - here we’re going to be focusing on all things EBM.
Duncan Jarvies, Helen Macdonald and Carl Heneghan - and occasional guests- will be back every month to discuss what's been happening in the world of evidence.
We'll bring you our Verdict on what you should start or stop doing, geek out about stats, and rant about the unevidence based world in which we live.
This week we talk about:
Vitamin D
https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30265-1/fulltext
Oxygen
https://www.bmj.com/content/363/bmj.k4169
The UK parliament's report on clinical trial transparency
https://publications.parliament.uk/pa/cm201719/cmselect/cmsctech/1480/1480.pdf
Adverse drug reactions
6 november 2018 |
31 min
Clinical trials for regulatory approval are designed to test efficacy, but new drugs might have adverse reactions - reactions those trials aren’t designed to spot.
To talk about those adverse reactions - how to spot them, how to report them and what to do about them, we're joined by Robin Ferner, from the West Midlands Centre for Adverse Drug Reactions.
Read the full practice article:
https://www.bmj.com/content/363/bmj.k4051
HAL will see you now
5 november 2018 |
33 min
Machines that can learn and correct themselves already perform better than doctors at some tasks, but not all medicine is task based - but will AI doctors ever be able to have a therapeutic relationship with their patients?
In this debate, Jörg Goldhahn, deputy head of the Institute for Translational Medicine at ETH Zurich thinks that the future belongs to robot doctors - but Vanessa Rampton, Branco Weiss fellow at McGill Institute for Health and Social Policy, says they'll never be able to emulate the empathy required.
We're also joined by Michael Mittelman, executive director of the American Living Organ Donor Fund, who has had complex healthcare needs for his whole life - to explain what he feels about the prospect of his care delivered by machine.
Read the full debate:
https://www.bmj.com/content/363/bmj.k4669
How much oxygen is too much oxygen?
1 november 2018 |
32 min
As the accompanying editorial to this article says, "oxygen has long been a friend of the medical profession Even old friendships require reappraisal in the light of new information."
And that’s what a new rapid reccomendation - Oxygen therapy for acutely ill medical patients - does.
To discuss we're joined by two of the authors, Reed Simieniuk, general internist at McMaster University and Gordon Guyatt, distinguished professor at McMaster University.
Read the full recommendation:
https://www.bmj.com/content/363/bmj.k4169
How does lifestyle affect genetic risk of stroke?
30 oktober 2018 |
17 min
Cardiovascular factors are associated with risk of stroke - and those factors can be mediated by lifestyle and by genetic make up.
New research published by The BMJ sets out to explore how these risks combine, and we're joined on the podcast by two of the authors - Loes Rutten-Jacobs, senior postdoctoral researcher at the German Center for Neurodegenerative diseases, and Susanna Larsson, associate professor at the Karolinska Institutet.
Read the full open access research:
https://www.bmj.com/content/363/bmj.k4168
Talking honestly about intensive care
26 oktober 2018 |
33 min
On the podcast, we’ve talked a lot about the limits of medicine - where treatment doesn’t work, or potentially harms. But in that conversation, we’ve mainly focused on specific treatments.
Now a new analysis, broadens that to talk about patients being admitted to a whole ward - intensive care. The authors of that article contend that, often, patients or their families don’t fully understand the implication of that admission.
To discuss, we're joined by Jamie Gross, consultant in intensive care medicine at London North West University Healthcare NHS Trust, and by Barry Williams, patient representative at the Intensive Care Society.
Read the full analysis:
https://www.bmj.com/content/363/bmj.k4135
Nasal symptoms of the common cold
14 oktober 2018 |
22 min
The common cold is usually mild and self limiting - but they’re very annoying, especially the runny nose and bunged up feeling that form the nasal symptoms.
A new practice article, published on BMJ.com looks at the available evidence for treatment of those nasal symptoms - both pharmacological and alternative.
In this podcast we're joined by Mieke van Driel - GP in Australia and a professor of primary care at The University of Queensland, and An De Sutter - GP in Belgium and professor of family medicine at Ghent University.
Read the full article, and play with the interactive infographic:
https://www.bmj.com/content/363/bmj.k3786
What’s it like to live with a vaginal mesh?
12 oktober 2018 |
30 min
What can we learn from the shameful story of vaginal mesh? That thousands of women have been irreversibly harmed; that implants were approved on the flimsiest of evidence; that surgeons weren’t adequately trained and patients weren’t properly informed; that the dash for mesh, fuelled by its manufacturers, stopped the development of alternatives; that surgeons failed to set up mesh registries that would have identified complications sooner; and that the National Institute for Health and Clinical Excellence and the UK regulators let them off the hook.
The BMJ has a published an investigation into vaginal mesh, which charts some of the issues above.
In this podcast The BMJ talked to three women who have had a vaginal mesh implanted, and all suffered the negative consequences that have prompted these investigations.
We bring you these stories to underline how life altering the situation has been for these woman, and to highlight the need for fully informed consent before anyone else has a mesh implanted.
What we must learn from mesh:
https://www.bmj.com/content/363/bmj.k4254
How to taper opioids
11 oktober 2018 |
30 min
There is very little guidance on withdrawing or tapering opioids in chronic pain (not caused by cancer). People can fear pain, withdrawal symptoms, a lack of social and healthcare support, and they may also distrust non-opioid methods of pain management.
This can mean that patients receive repeat opioid prescriptions for extended periods of time.
In this podcast, Harbinder Sandhu, health psychologist in pain management at Warwick Medical School, Andrea Furlan, associate professor of medicine at University of Toronto, and Sam Eldabe, consultant in pain medicine at The James Cook University Hospital join us to set out the evidence on tapering opioids - and give practical advice on how to support patients. We're also joined by Colin, who was prescribed opioids for a decade, before he decided to reduce his usage.
What you need to know:
For people with chronic pain and who do not have cancer, the benefits of long term opioids are outweighed by the issues of tolerance, dependence, and the requirement for higher doses
Tapering is the gradual reduction of opioids with the aim of limiting withdrawal symptoms; it may target complete discontinuation of the opioid, or on occasion a reduction of the dose
It is not clear how best to support people to taper their opioids; whether it is best done by interdisciplinary pain management programmes, buprenorphine substitution, or behavioural interventions
Read the full uncertainties paper:
https://www.bmj.com/content/362/bmj.k2990
The counter intuitive effect of open label placebo
6 oktober 2018 |
28 min
Ted Kaptchuk, professor of medicine at Harvard Medical school - and leading placebo researcher, has just published an analysis on bmj.com describing the effect of open label placebo - placebos that patient's know are placebos, but still seem to have some clinical effect.
Ted joins us to speculate about what's going on in the body, what this means for designing a more effective placebo, and asking whether it's time to start honestly prescribing placebos in the clinic.
Read his full analysis:
https://www.bmj.com/content/363/bmj.k3889
Vinay Prasad - there is overdiagnosis in clinical trials
3 oktober 2018 |
29 min
We want clinical trials to be thorough - but Vinay Prasad, assistant professor of medicine at Oregon Health Science University, argues that the problem of overdiagnosis may be as prevalent, in the way we measure disease in our research, as our practice.
In this podcast he joins us to discuss the problem, and why he thinks what qualifies as disease in clinical trials may be getting so broad that outcomes are becoming less meaningful and harder to interpret.
Read the full analysis:
https://www.bmj.com/content/362/bmj.k3783
UK children are drinking less and the importance of a publicly provided NHS
28 september 2018 |
35 min
Brits have a reputation as Europe’s boozers - and for good reason, with alcohol consumption higher than much of the rest of the continent. That reputation is extended to our young people too - but is it still deserved? Joanna Inchley, senior research fellow at the University of St Andrews, explains new research on decreasing drinking - http://www.hbsc.org/
Also this week, as part of our coverage of the 70th anniversary of the founding of the NHS, we’ve been running a series of articles exploring this unique institution’s future. Neena Modi, professor of neonatal health, and Jonathan Clarke, clinical research fellow, from Imperial College London, passionately believe that the NHS needs to be publicly financed - and importantly, publicly provided.
https://www.bmj.com/content/362/bmj.k3580
Don’t save on transport at the cost of the NHS
24 september 2018 |
19 min
Last week we heard about how evidence in policy making is imperilled - but today we’re hearing about a plan to make evidence about health central to all aspects of government.
Laura Webber, director of public health modelling at the UK Health Forum, Susie Morrow, chair of the Wandsworth Living Streets Group and Brian Ferguson, chief economist at Public Health England join us to discuss a “health in all policies” approach, with protected funding for preventive interventions.
Read their full analysis:
https://www.bmj.com/content/362/bmj.k3377
15 Iona Heath
18 september 2018 |
25 min
This week a very different kind of conversation on the Recommended Dose – one that considers the art of medicine more than the science. Iona Heath is a long-time family doctor who has worked in a London GP clinic for over 30 years, and at one time became President of the Royal College of General Practitioners. With an international profile, gained in part through her much-loved writing in the BMJ, Iona is unlike many of our previous guests. For a start, she loves words more than numbers, and literature more than clinical guidelines. Host Ray Moynihan caught up with Iona at a recent conference in Helsinki – where she'd just presented little data but much food for thought from the likes of novelists EM Forster and James Baldwin. Here, she shares more of her love of literature and thoughtful commitment to the best kind of patient care.
Defending evidence informed policy making from ideological attack
17 september 2018 |
28 min
If you’re of a scientific persuasion, watching policy debates around Brexit, or climate change, or drug prohibition are likely to cause feelings of intense frustration about the dearth of evidence in those discussions.
In this podcast we're joined by Chris Bonell, professor of public health sociology - in this podcast he airs those frustrations, and worries that the rise of populism is pushing evidence even further out of policy decision.
Read the accompanying essay:
https://www.bmj.com/content/362/bmj.k3827
How often do hospital doctors change long term medication during an inpatient stay?
14 september 2018 |
27 min
More than ½ of patients leave hospital with changes to four or more of their long-term medications - but how appropriate are those changes?
New research published on bmj.com looks at antihypertensive medication prescription changes to try and model that - and found that more than half of intensifications occurred in patients with previously well controlled outpatient blood pressure.
To discuss what they found, we're joined by Timothy Anderson, primary care research fellow, and Michael Steinman, professor of medicine, both from UCSF.
Read the open access research:
https://www.bmj.com/content/362/bmj.k3503
Nutritional science - Is quality more important than quantity?
7 september 2018 |
36 min
We at The BMJ care about food, and if our listener stats are to be believed, so do you.
In this podcast we’re looking at quality as an important driver of a good diet. At our recent food conference - Food For Thought - hosted in Zurich by Swiss Re we brought researchers in many fields of nutritional science together. We asked people with competing ideas to write articles to elucidate where there’s agreement, and where there is still contention.
There was lots of disagreement - but one thing that was widely agreed on was that, quality of food matters. Quality is as, if not more, important than quantity.
In this podcast we’ll be exploring what quality is, how industrial food production affects it, and how we conceptualise quality. Joining us are Martin White, Mathilde Touvier, Jean Adams, Nicola Guess and Alan Levinovitz.
For the last podcast in the food series:
https://soundcloud.com/bmjpodcasts/nutritional-science-why-studying-what-we-eat-is-so-difficult?
For more on the Food for Thought series
https://www.bmj.com/food-for-thought
Preventing Overdiagnosis 2018 - part 2: What opened your eyes to overdiagnosis?
31 augusti 2018 |
34 min
The concept of overdiagnosis is pretty hard to get - especially if you’ve been educated in a paradigm where medicine has the answers, and it’s only every a positive intervention in someone’s life - the journey to understanding the flip side - that sometimes medicine can harm often takes what Stacey Carter director of Research for Social Change at Wollongong university described in an preventing overdiagnosis podcast last year as a “moral shock” - https://soundcloud.com/bmjpodcasts/preventing-overdiagnosis-2017-stacy-carter-on-the-culture-of-overmedicalisation
This year, we asked some of the leaders in the field to describe what it was that opened their eyes to overdiagnosis and overtreatment - and recorded the session for you.
You’ll hear from Fiona Godlee, editor in Chief of The BMJ, Steve Woloshin and Lisa Schwartz, directors of the Center for Medicine and Media at The Dartmouth Institute, John Brodersen - professor of general practice at the University of Copenhagen, and Barry Kramer - director of the Division of Cancer Prevention at the U.S. National cancer institute.
The
Preventing overdiagnosis 2018 - Part 1
24 augusti 2018 |
31 min
This week saw the latest Preventing Overdiagnosis conference - this time in Copenhagen.
The conference is a is a forum where researchers and practitioners can present examples of overdiagnosis - and we heard about the various ways which disease definitions are being subtly widened, and diagnostic thresholds lowered.
In this podcast we talk to Allen Frances, psychiatrist and former chair of the Diagnostic and Statistical Manual of Mental Disorders. We also hear from friends of the podcast, Steve Woloshin and Lisa Schwartz about the way in which some disease awareness campaigns fuel inappropriate diagnosis.
https://www.preventingoverdiagnosis.net/
https://www.bmj.com/too-much-medicine
Have we misunderstood TB’s timeline?
23 augusti 2018 |
32 min
The number of people estimated to be latently infected with TB - that is infected with TB, which has not yet manifested symptoms - is around 2 billion. That is 1 in 3 people on the planet are infected by the bacteria. The World Health Organization’s website notes that on average 5-10% of those infected with TB will develop active TB.
That number is terrifying, but a new analysis published in the BMJ, suggests that the assumption that latent TB often has a very long incubation period of many years may be wrong - and that may change how we calculate the number of people affected, and our whole approach to tackling the disease.
This podcast features Lalita Ramakrishnan, professor of immunology and infectious diseases at Cambridge University, Paul Edelstein, professor of pathology and laboratory medicine at the University of Pennsylvania, and Marcel Behr, professor of medicine at McGill university.
Together they discuss the analysis article "Revisiting the timetable of tuberculosis" - https://www.bmj.com/content/362/bmj.k2738
13 Iain Chalmers
22 augusti 2018 |
31 min
This week, a very special conversation with a maverick British medico who set up a tiny research centre in Oxford and watched it grow into a global collaboration of over 40,000 people across 130 countries. Three decades on, the Cochrane Collaboration now produces the world's most trusted health evidence that's used by patients, health professionals, researchers and policy makers around the world every day.
Cochrane co-founder Iain Chalmers joins Ray to look back on the origins of the organisation and the extraordinary life of its namesake, Archie Cochrane. Iain also reflects on his work beyond the collaboration - from working in refugee camps in Gaza to teaching children in Uganda how to detect ‘bullshit’ health claims and more recently, establishing the James Lind Alliance. It's no surprise he's received the BMJ’s most prestigious award for a lifetime of achievement in healthcare, along with a knighthood from the Queen.
The diagnosis and treatment of dyspareunia
13 augusti 2018 |
34 min
Dyspareunia is a common but poorly understood problem affecting around 7.5% of sexually active women. It is an important and neglected area of female health, associated with substantial morbidity and distress.
Women may be seen by several clinicians before a diagnosis is reached, There are also specialist psychosexual clinics, where men and women can be referred for sexual problems. Little has been written on the holistic approach to care for women with dyspareunia, therefore, some of the advice here is based on expert experience.
Joining us to talk about care are Leila Frodsham, consultant gynaecologist and lead for psychosexual medicine, and Nikki Lee, speciality trainee in obstetrics & gynaecology, both at King’s College London. We’re also joined by Poppy, who experienced dyspareunia and has undergone treatment.
Read the full education article:
https://www.bmj.com/content/361/bmj.k2341
Patient information is key to the therapeutic relationship
10 augusti 2018 |
26 min
Sue Farrington is chair of the Patient Information Forum, a member organisation which promotes best practice in anyone who produces information for patients.
In this podcast, she discusses what makes good patient information, why doctors should be pleased when patients arrive at an appointment with a long list of questions, and why patients are savvy about believing "doctor google".
https://www.pifonline.org.uk/
15 seconds to improve your workplace
27 juli 2018 |
24 min
15s30m is a social movement to reduce frustration & increase joy - the idea is to spend 15 seconds of your time now, and save someone else 30 minutes down the line.
To talk about their movement we're joined by the founders, Rachel Pilling, consultant ophthalmologist, and Dan Wadsworth, transformation manager - both from Bradford Teaching Hospitals NHS Trust.
They explain why this is quality improvement, but doesn't require a lot of theory or permission to put in place, and why empowering staff to make small changes increases joy and reduces frustration.
Follow them on twitter - https://twitter.com/15s30m
See some of their missions on youtube - https://www.youtube.com/channel/UCg6ECK8oq_-pYMTgAR6pt7w
Mendelian Randomisation - for the moderately intelligent
16 juli 2018 |
34 min
Mendelian randomisation - it’s a technique that uses the chance distribution of genes in a population, combined with big data sets, to investigate causative relationships.
But there are a lot of questions we have in The BMJ about how the technique works - the association between genes and apparently non-biologically mediated behaviours, how much the strict rule of not claiming causation based on observational data has actually been overturned, and general confusion about how the non-methodologists amongst us can read these studies.
Neil Davies and George Davey Smith from University of Bristol, and Michael Holmes from the University of Oxford, join us to explain how the technique works, where it can be applied, and what readers should look out for when they're trying to assess the quality of a mendelian randomisation study.
Read their full research methods and reporting paper:
https://www.bmj.com/content/362/bmj.k601
What does the public think of the NHS?
12 juli 2018 |
18 min
It’s been quite a year for the NHS - it just turned 70, had a winter crisis like never before, got over junior doctor strikes, but then was hit by a series of scandals about breast screening, and now opiate prescriptions.
At the same time, we’ve seen demonstrations in favour of the service and even widespread public backing for more money. So how do all of these things mix into the way in which the British public view the NHS?
In this podcast, Ben Page - chief exec of Ipsos MORI, the polling company, joins us to discuss the fluctuations in public opinion.
Read the provocation:
https://www.bmj.com/content/361/bmj.k2663
More NHS at 70 coverage:
https://www.bmj.com/nhs-at-70
10 Rita Redberg
12 juli 2018 |
33 min
This week influential Editor-in-Chief of JAMA Internal Medicine Dr Rita Redberg joins Ray for a wide ranging conversation on all things health. A Professor at the University of California San Francisco and high profile contributor to The Washington Post and New York Times, Rita is also a practising cardiologist who loves to see patients. She says that ‘being a doctor is really a privilege’.
Together, Ray and Rita canvas many topics including shared decision making between doctors and patients, the tricky territory of medical device approvals, the controversy surrounding both statins and CT scans, and the implications of not including enough women in clinical trials.
Doctors and vets working together for antibiotic stewardship
11 juli 2018 |
63 min
Doctors and the farming industry are often blamed for overuse of antibiotics that spurs the growing problem of antimicrobial resistance - but the professions are using different methods to combat resistance and reduce overuse.
In this roundtable, we bring medics and vets together to discuss the problem - where antibiotic resistance arises, how resistance genes propagate through the environment and between countries, and what non-drug approaches can be used to reduce the need for antibiotics.
Sandy Trees, Vet Record editor in chief, and retired veterinary surgeon
Stuart Reid, principal of the Royal Veterinary College
Jenny Bellini, cattle and dairy vet, Friars Moor Livestock Health in Dorset
Peter Hawkey, professor of clinical and public health bacteriology, University of Birmingham
Tim McHugh, professor of medical microbiology at University College London
Emmanuel Wey, consultant in infection, Royal Free Hospital, London
James Munro cares about patients opinions.
5 juli 2018 |
19 min
Getting feedback from people who use NHS services is essential to
assessing their value - and improving their quality. Hospitals and general practices widely post information about patient's satisfaction with their services on their websites, but approach tells us little about how feedback changes things on the ground .
In this podcast, James Munro, former doctor and academic and current CEO of Care Opinion, explains how their online platform works, how Trusts are using it as a quality improvement tool, and how health systems can capitalise on the learning potential of this large scale data collection.
This is part of the series of interviews with people who are making partnership between health professional and patients work in the real world. Listen to Katherine Cowen, from the James Lind Alliance, talk about how to broker an agreement about research priorities. https://soundcloud.com/bmjpodcasts/katherine-cowan-reaching-a-priority
Prof. Wendy Burn - the changing focus of psychiatry.
29 juni 2018 |
27 min
Wendy Burn is a consultant old age psychiatrist, and new president of the Royal College of Psychiatrists. Her work on dementia has given her an affinity for the neurobiological basis of psychiatry - and her tenure at the college is seeing a move to wards this neurobiological model in the teaching of the profession.
In this interview she talks about her work, how the profession is changing, and why she thinks Kanye can be a model for mental health.
Your recommended dose of Ray Moynihan
28 juni 2018 |
16 min
Ray Moynihan is a senior research assistant at Bond University, a journalist, champion of rolling back too much medicine, and host of a new series “The Recommended Dose” from Cochrane Australia.
In the series, Ray has talked to some of the people who shape the medical evidence that underpin healthcare around the world - the series aim is to elucidating their worldview, and how their thinking shapes their work.
Over the next couple of months, we’ll be co-publishing the series - so keep an ear out for those interviews in your podcast feed.
Evidence in a humanitarian emergency
25 juni 2018 |
29 min
At evidence live this year, one of the sessions was about the work of Evidence Aid - and their attempt to bring high quality evidence to the frontline of a humanitarian crisis.
In that situation, it’s very difficult to know what will work - a conflict, or even immediately post-conflict situation is characterised by chaos - and merely doing something is vital. But though each situation is unique, sharing what’s worked elsewhere can be key to maximising the help given to vulnerable people.
When an investigative journalist calls
22 juni 2018 |
32 min
At Evidence Live this year, the focus of the conference was on communication of evidence - both academically, and to the public. And part of that is the role that investigative journalism has to play in that.
At the BMJ we’ve used investigative journalistic techniques to try and expose wrong doing on the part of government and industry - always in collaboration with clinicians and researchers.
To explain a bit more about the world of journalism and campaigning, we're joined by to Shelley Jofre - from the BBC, Jet Schouten - from Radar, Kath Sansom - who started the online sling the mesh campaign & Deb Cohen, former investigations editor at The BMJ.
Don Berwick - you can break the rules to help patients
15 juni 2018 |
27 min
Don Berwick, president emeritus of the Institute of Healthcare Improvement, and former Administrator of the Centers for Medicare and Medicaid Services.
In this conversation he discusses how he went from being a paediatrician to running Medicare for Obama, how we can create headroom in stressed systems, and breaking the rules to make things better for patients and staff.
Quality improvement series:
Darknet Opioids
15 juni 2018 |
29 min
When tackling societal problems - like the opioid epidemic in the US - there are two ways of approaching it. One is to reduce demand - by organising treatment programmes, or reducing the underlying reasons why people may become addicted in the first place - but that’s hard. So governments often turn to the other route - reducing supply - and that’s what the US government did in 2014 when it rescheduled oxycodone combination products from schedule 3 to schedual 2 - essentially making it harder for people to obtain a prescription.
Now reducing that legal supply, without in hand reducing the demand, led to fears that those people with an opioid addiction would just turn to illicit routes to obtain their drugs - and new research published on bmj.com has attempted to find out if that happened.
We're joined by 3 of the authors, James Martin, associate professor of criminology at Swinburne University; Judith Aldridge, professor of criminology at the University of Manchester; and Jack Cunliffe, lecturer in quantitative methods and criminology at the University of Kent.
Read the full research:
https://www.bmj.com/content/361/bmj.k2480
09 John Ioannidis
15 juni 2018 |
62 min
Series two of The Recommended Dose kicks off with polymath and poet, Dr John Ioannidis. Recognised by The Atlantic as one the most influential scientists alive today, he’s a global authority on genetics, medical research and the nature of scientific inquiry itself – among many other things.
A professor at Stanford University, John has authored close to 1,000 academic papers and served on the editorial boards of 30 of the world's top journals. He is best known for seriously challenging the status quo. His trailblazing 2005 paper 'Why Most Published Research Findings Are False' has been viewed over 2.5 million times and is the most cited article in the history of PLoS Medicine. In it, he argues that most medical research is biased, overblown or simply wrong. Here, he talks to Ray about the far-reaching implications of these findings for people both inside and outside the world of health.
While most closely associated with exploring cutting-edge conundrums across science, genomics and even economics, John is also something of a humanist. He’d be right at home with the philosophers of ancient Greece, seeking as he does to find answers to the big questions of the day in science and medicine, as well as in nature and narratives.
A voracious reader himself, John has a lifelong love of ‘swimming in books’ and has penned seven literary works of his own in Greek – two of which have been nominated for prestigious literary prizes. And fittingly, he finds inspiration for his myriad of multi-disciplinary pursuits on Antipaxi, one of Greece’s most beautiful and secluded islands.
He shares some of his distinctive logic, reason - and even a little of his poetry - on this very special episode of The Recommended Dose, produced by Cochrane Australia and co-published with the BMJ.
You'll find our show notes and a full transcript of the show at http://australia.cochrane.org/trd
Ashish Jha tries to see the world as it is.
8 juni 2018 |
48 min
There’s a lot going on in the world at the moment - Ebola’s back, Puerto Rico is without power and the official estimations of death following the hurricane are being challenged. The WHO’s just met to decide what to do about it all, as well as sorting out universal healthcare, access to medicines, eradicating polio, etc etc.
To make sense of that a little, we grabbed Ashish Jha - Director of the Harvard Global Health Institute to shed some light into how decisions about global health are made, and why he tries to see the world as it actually is - not how he wishes it would be.
Reading list:
Mortality in Puerto Rico after Hurricane Maria
https://www.nejm.org/doi/full/10.1056/NEJMsa1803972
https://www.bmj.com/universal-health-coverage
Nutritional science - why studying what we eat is so difficult.
8 juni 2018 |
52 min
We at The BMJ care about food, and if our listener stats are to be believed, so do you.
In this podcast we talk to a few of the authors of a new series, published next week on bmj.com, which tries to provide some insight into the current state of nutritional science - where the controversies lie, where there’s broad agreement, and the journey of our understanding of nutrition.
The open access fees for those articles has been paid for by Swiss Re - a wholesale provider of reinsurance, insurance and other insurance-based forms of risk transfer - they have not had any input into the editorial process, which has gone through the same peer review as any of our other analysis articles. Swiss Re are also co-hosting a conference where we’ll be bringing together a lot of these researchers - and which will be live streamed next week - you’ll be able to access that for free on bmj.com
For more on the conference:
http://institute.swissre.com/events/food_for_thought_bmj.html
The misunderstanding of overdiagnosis
31 maj 2018 |
28 min
In December 2017, the NEJM’s national corespondent, Lisa Rosenbaum, published an article “The Less-Is-More Crusade — Are We Overmedicalizing or Oversimplifying?”
The article aimed a broadside against those who are campaigning against the overuse of medicine, and the over diagnosis of treatment.
This week in the BMJ we’ve published a rebuttal to that article, and in this podcast we talk to Steve Woloshin and Lisa Schwartz - both professors at the Dartmouth Institute for Health Policy and Clinical Practice.
Steve and Lisa’s article carefully deconstructs some of the ideas advanced by Rosenbaum, but in this podcast we discuss how much separate camps are forming in this debate - and how to have a constructive dialogue across that divide.
Read Steve and Lisa's essay
https://www.bmj.com/content/361/bmj.k2035
Iona Heath's essay - The role of fear in overdiagnosis
https://www.bmj.com/content/349/bmj.g6123
Stacy Carter's interview about moral shocks
https://soundcloud.com/bmjpodcasts/preventing-overdiagnosis-2017-stacy-carter-on-the-culture-of-overmedicalisation
Biochem for kids
25 maj 2018 |
23 min
Each time you order a test for a child, do you think the population that makes up the baseline against which the results are measured? It turns out that that historically those reference intervals have been based on adults - but children, especially neonates and adolescents, are undergoing physiological changes that mean those reference intervals may not be appropriate.
To get around this Khosrow Adeli, head and professor of clinical biochemistry at the Hospital for Sick Children, and the University of Toronto, and colleagues have undertaken a mission to recruit children and young people into a study of their test results.
Read the full practice article:
https://www.bmj.com/content/361/bmj.k1950
Antidepressants and weight gain
25 maj 2018 |
17 min
Patients who are depressed and prescribed antidepressants may report weight gain, but there has been limited research into the association between the two. However new observational research published on bmj.com aims to identify that association.
Rafael Gafoor, a psychiatrist and researcher at Kings College London, and one of the authors of that research joins us to talk about the potential mechanism of action - is it a physiological response to the drug, is it to do with the underlying reason for the prescription; how they studied the association; and what this might mean for individual prescriptions.
You can read the full research on bmj.com;
https://www.bmj.com/content/361/bmj.k1951
Think of healthcare is an ecosystem, not a machine
19 maj 2018 |
37 min
Complexity science offers ways to change our collective mindset about healthcare systems, enabling us to improve performance that is otherwise stagnant, argues Jeffrey Braithwaite, professor of health systems research and president elect of the International Society for Quality in Health Care.
Read the full analysis:
https://www.bmj.com/content/361/bmj.k2014
Quality improvement series:
https://www.bmj.com/quality-improvement
The BMJ in partnership with and funded by The Health Foundation are launching a joint series of papers exploring how to improve the quality of healthcare delivery. The series aims to discuss the evidence for systematic quality improvement, provide knowledge and support to clinicians and ultimately to help improve care for patients.
New antivirals for Hepatitis C - what does the evidence prove?
12 maj 2018 |
17 min
There’s been a lot of attention given to the new antirviral drugs which target Hepatitis C - partly because of the burden of infection of the disease, and the lack of a treatment that can be made easily accessible to around the world, and partly because of the incredible cost of a course of treatment.
But a new article on BMJ talks about the uncertainly of that treatment - do we know that the drugs actually clear a HepC infection, and that this will lead to a corresponding decrease in mortality and morbidity?
Janus Jakobsen from the Copenhagen Clinical Trial Unit joins us to discuss what the literature proves.
Read the full article:
https://www.bmj.com/content/361/bmj.k1382
What forced migration can tell us about diabetes
8 maj 2018 |
23 min
Worldwide, the rate of type II diabetes is estimated to be around 1 in 11 people - about 9%. For the Pima people of Arizona, 38% of the adult population have the condition - but across the border in Mexico, the rate drops down to 7%.
The difference between the groups is their life experience - one side displaced, the other on their traditional lands - and their experience is being replicated elsewhere.
Lauren Carruth, assistant professor at The American University, joins us to talk about the Pima people, where else displacement is changing patterns of non-communicable disease, and what this might tell us about economic migrations effect on health.
Read the full editorial:
https://www.bmj.com/content/361/bmj.k1795
Big Metadata
4 maj 2018 |
20 min
We’re in an era of big data - and hospitals and GPs are generating an inordinate amount of it that has potential to improve everyone’s health. But only if it’s used properly. New research published on www.bmj.com this week describes another set of information, about that data, that the authors believe could be just as important as the data itself.
Griffin weber, and Isaac Kohane, from the Department of Biomedical informatics at Harvard medical school join us to discuss.
Read the full research:
https://www.bmj.com/content/361/bmj.k1479
WHO can tackle pharma advertising
3 maj 2018 |
26 min
The array of options available to pharmaceutical companies, to advertise their drugs, is incredibly broad - and the amount that they spend is increasing, with some reports saying it’s up 60% in the last five years. In most countries, there are pretty strict rules to limit the ways in which Pharma can spend their advertising dollars - but the WHO guidelines which have informed many of those rules are now 30 years out of date.
A new analysis on bmj.com “Ethical drug marketing criteria for the 21st century“ proposes some ways in which those guidelines should be updated, we're joined two of the authors - Lisa Parker and Lisa Bero - from the Charles Perkins centre at the faculty of pharmacy at the university of Sydney to discuss.
Read the full analysis:
https://www.bmj.com/content/361/bmj.k1809
The complexities of depression in cancer
26 april 2018 |
38 min
For many people, cancer is now survivable and has become a long term condition, and depression and anxiety are more common in cancer survivors than in the general population. Despite this, 73% of patients don't receive effective psychiatric treatment.
Alexandra Pitman, consultant liaison psychiatrist at St George’s University Hospitals NHS Foundation Trust, and Andrew Hodgkiss, consultant liaison psychiatrist, at the Institute of Psychiatry, Psychology & Neuroscience join us to dispel some of the concern clinicians may have about the complexities of diagnosing depression in cancer - what is biopsychosocial, what is the organic result of the cancer or treatment - and some of the concern about treatment interactions.
Read the two education articles:
https://www.bmj.com/content/361/bmj.k1415
https://www.bmj.com/content/361/bmj.k1488
E-cigarettes - debating the evidence
23 april 2018 |
33 min
Smokers want to vape, it can help them quit, and it’s less harmful than smoking, say Paul Aveyard professor of behavioural medicine at the University of Oxford.
But Kenneth C Johnson, adjunct professor at the University of Ottawa, argues that smokers who vape are generally less likely to quit and is concerned about youth vaping as a gateway to smoking, dual use, and potential harms from long term use.
Read the debate:
https://www.bmj.com/content/361/bmj.k1759
Harry Burns - the social determinants of Scotland
20 april 2018 |
43 min
Harry Burns was a surgeon, who gave up his career in that discipline to become a public health doctor. Eventually that lead to him being the last Chief Medical Officer of Scotland, and now he’s professor of global public health at the University of Strathclyde.
Scotland has always had a separate NHS, but since devolution, the parliament there has had much more autonomy in running the country - and Harry has seemed to manage to convince them that improving health means improving the social determinants of health.
In this conversation we talk about that link, how his philosophy has affected policy up there, some of the experiments which are going on in the country, and what he thinks is the most exciting change.
Read the editorial on GDP and wellness:
https://www.bmj.com/content/360/bmj.k1239
Can we regulate intellectual interests like financial ones?
13 april 2018 |
35 min
We talk about financial conflicts of interest a lot atThe BMJ - and have take taken the decision that our educational content should be without them.
We also talk a lot about non-financial conflicts of interest, but the choppy waters of those are much more difficult to navigate.
In this podcast, we discuss whether we should, or if we could even could, make people’s intellectual positions transparent.
Arguing that it’s important to tackle this issue, are Wendy Lipworth and Ian Kerridge from Sydney health Ethics at the University of Sydney - and arguing that it’s not as easy as we think is Marc Rodwin, from Suffolk University Law School in Boston.
Read the full head to head:
https://www.bmj.com/content/361/bmj.k1240
Civilians under siege in Eastern Ghouta
3 april 2018 |
15 min
In 2016, from an estimated pre-war population of 22 million, the United Nations (UN) identified 13.5 million Syrians requiring humanitarian assistance, of which more than 6 million are internally displaced within Syria, and around 5 million are refugees outside of Syria.
In this podcast, Aula Abarra, consultant in infectious disease from London, joins us to discuss what's happening now in Eastern Ghouta, and area of Damascus, where civilians are being held under siege, where humanitarian aid is unable to reach.
Read the full editorial:
https://www.bmj.com/content/360/bmj.k1368
Online Consultations - general practice is primed for a fight
28 mars 2018 |
21 min
The first digital banking in the UK was launched in 1983, Skype turns 15 this year, but 2017 finally saw panic over the impact that online consultations may have on general practices.
In this podcast Martin Marshall, professor of healthcare improvement at University College London joins us to discuss whether video conference actually is a disruptor, or whether it’s actually the whole business model of general practice that needs to change.
Read the full analysis:
https://www.bmj.com/content/360/bmj.k1195
Evidence for off label prescribing - explore less, confirm more
23 mars 2018 |
24 min
When a new drug reaches market, the race is on to find more indications for its use - exploratory trials are set up, and positive results can lead to the off label prescriptions (eg Pregabalin for lower back pain. However, these initial indications are rarely confirmed with further, better quality, evidence.
Jonathan Kimmelman is an associate professor at MCgill University in Canada, thinks it's time to explore less, and confirm more - and joins us to explain why.
Read the full analysis:
http://www.bmj.com/content/360/bmj.k959
How to stop generic drug price hikes (or at least reduce them)
23 mars 2018 |
19 min
Ravi Gupta, is a resident in internal medicine at Johns Hopkins in Baltimore - and as he said has seen the influence of sudden price hikes on his patients - between 2010 and 2015 more than 300 drugs in the U.S. have seen sudden increases of over %100.
Ravi and his co-authors have suggested, and tested the feasibility of, a possible answer to those price hikes - a small tweak that should protect patients from the possibility that they’ll suddenly be unable to afford their essential medication.
Read the full research:
http://www.bmj.com/content/360/bmj.k831
Dorling on decreasing life expectancy - ”the DOH have lost their credibility”
16 mars 2018 |
20 min
”An additional person died every seven minutes during the first 49 days of 2018 compared with what had been usual in the previous five years. Why?
In this podcast, Danny Dorling, Halford Mackinder professor of geography at the university of Oxford, talks about the spike in mortality, what that means for overall life expectancy in the UK (spoiler, it’s not great) and what he thinks could be fuelling the change.
Read the full editorial
http://www.bmj.com/content/360/bmj.k1090
For more information, this article by Dorling and Hiam has further analysis:
https://theconversation.com/rapid-rise-in-mortality-in-england-and-wales-in-early-2018-an-investigation-is-needed-93311
Unprofessionalism - ”blaming other people, I put that at the top of the impact list”
12 mars 2018 |
48 min
That’s Jo Shapiro is a surgeon and manager in Brigham and Women’s hospital, she’s also director of the Center for Professionalism and Peer Support, and has written an editorial for The BMJ on tackling unprofessional behaviour.
In this discussion, she and I talked about what she thinks (beyond the illegal) are the most damaging behaviours seen around a hospital, what needs to be done to set up an environment that allows the victims of unprofessional behaviour to speak out about senior members of staff, and how she goes about confronting perpetrators about their behaviour.
Read the full editorial:
http://www.bmj.com/content/360/bmj.k1025
Should doctors prescribe acupuncture for pain?
8 mars 2018 |
27 min
Our latest debate asks, should doctors recommend acupuncture for pain? Asbjørn Hróbjartsson from the Center for Evidence-based Medicine at University of Southern Denmark argues no - evidence show's it's no worse than placebo. Mike Cummings, medical director of the British Medical Acupuncture Society argues yes - that there is evidence of efficacy, and trials haven't been designed to accurately measure that.
We also hear from Kumari Manickasamy, a GP in north London, and someone who used acupuncture to control her pain during pregnancy despite knowing the lack of evidence.
Read the debate and commentary:
http://www.bmj.com/content/360/bmj.k970
http://www.bmj.com/content/360/bmj.k990
Nuffield Summit 2018 - HR in all policies, how the NHS can become a good employer
7 mars 2018 |
43 min
In this year's Nuffield Summit round table we're asking, how can the NHS become a good employer?
At the moment, there is a recruitment and retention crisis across the workforce, doctors and nurses are leaving the NHS in droves, rota gaps are prevalent. A recent BMA survey showed that the majority of junior doctors are now planning to take a career break.
So against this backdrop, what can the NHS do to nurture it's employees, and make medicine an exciting proposition for the millennial, and subsequent, generations.
Taking part are:
Fiona Godlee (Chair), editor-in-chief, The BMJ
Candace Imison, director of policy, The Nuffield Trust
Bob Klaber, consultant paediatrician and associate medical director, Imperial College Healthcare NHS Trust
Claire Lemer, consultant in general paediatrics and service transformation, Guys and St Thomas’s NHS Foundation Trust
Nishma Manek, GP trainee in London, national medical director’s clinical fellow
Clifford Mann, consultant in Emergency Medicine, Taunton and Somerset NHS Foundation Trust, national clinical advisor for NHS England’s Accident and Emergency Improvement Plan
Katherine Cowan - Reaching A Priority
2 mars 2018 |
28 min
Its now widely agreed that one of the key ways of reducing the current high level of "waste " in biomedical research is to focus it more squarely on addressing the questions that matter to patients - and the people and medical staff that care for them.
In this interview, Tessa Richards - the BMJ's patient partnership editor, talks to Katherine Cowan, independent consultant and a senior advisor the the James Lind Alliance, which has pioneered patient involvement with their research priority setting partnerships.
In this conversation they talk about how these work, the challenge of navigating between different groups with what are often very different views and agendas, and why she thinks healthy debate on divergent views is no bad thing
Should universal distribution of high dose vitamin A to children cease?
1 mars 2018 |
18 min
Up to $500m a year could be put to better use by stopping ineffective and potentially harmful supplementation programmes in poorer countries, argues John Mason, professor emeritus at Tulane University School of Public Health and Tropical Medicine.
However Keith West, professor of infant and child nutrition at Johns Hopkins Bloomberg School of Public Health disagrees, saying that such programmes have been proved to save millions of lives and should be withdrawn only when robust evidence permits.
Read the full head to head debate:
http://www.bmj.com/content/360/bmj.k927
Fever in the returning traveller
20 februari 2018 |
32 min
International travel is increasingly common. Between 10% and 42% of travellers to any destination, and 15%-70% of travellers to tropical settings experience ill health, either while abroad or on returning home,
Malaria is the commonest specific diagnosis, accounting for 5%-29% of all individuals presenting to specialist clinic, followed by dengue, enteric fever, and rickettsial infections .
In this podcast Doug Fink specialist registrar, and Victoria Johnston consultant, in infectious diseases at The Hospital for Tropical Diseases join us to discuss diagnosis, and treatment - and why the clinically most interesting diagnosis is rarely the right one.
Read the full practice article:
http://www.bmj.com/content/360/bmj.j5773
SDGs - How many lives are at stake?
17 februari 2018 |
44 min
In a new analysis John McArthur and Krista Rasmussen, from the Global Economy and Development Program at the Brookings Institution, and Gavin Yamey from Duke University, have set out to analyse the potential for lives saved by the goals set in the Sustainable Development Goals
In this conversation I talked to Gavin and John about the numbers, which countries have to accelerate their development to meet those goals - and we also address some of the criticisms of the SDGs - that they’re too wide ranging, that they lack a political dimension, and that they are unrealistic.
Read the full analysis and more on the SDGs:
http://www.bmj.com/content/360/bmj.k373
http://www.bmj.com/content/sustainable-development-goals
”We don’t really know the impact of these products on our health”: Ultraprocessed food & cancer risk
15 februari 2018 |
22 min
A study published by The BMJ today reports a possible association between intake of highly processed (“ultra-processed”) food in the diet and cancer.
Ultra-processed foods include packaged baked goods and snacks, fizzy drinks, sugary cereals, ready meals and reconstituted meat products - often containing high levels of sugar, fat, and salt, but lacking in vitamins and fibre. They are thought to account for up to 50% of total daily energy intake in several developed countries.
Mathilde Touvier, senior researcher in nutritional epidemiology and Bernard Srour, pharmacist and PhD Candidate, both at INSERM, join us to discuss what ultra processed foods actually are, why it is they could be leading to cancer, and what their cohort study tells us about that potential risk.
Read the full open access research:
http://www.bmj.com/content/360/bmj.k322
How does it feel, to help your patient die?
8 februari 2018 |
27 min
Sabine Netters is an oncologist in The Netherlands - where assisted dying is legal. There doctors actually administer the drugs to help their patients die (unlike proposed legislation in the UK).
In this moving interview, Sabine explains what was going through her head, the first time she helped her patient die - and how in the subsequent years, the emotional toll hasn't lessened. She explains why she believes that in certain circumstances, euthanasia can be the ultimate caring act.
Read her essay:
http://www.bmj.com/content/360/bmj.k116
The tone of the debate around assisted dying
8 februari 2018 |
21 min
Bobbie Farsides is professor of clinical and biomedical ethics at Brighton and Sussex Medical School. She’s been described as one of the few people that is acceptable to “both sides” of the assisted dying debate.
This week she joins us to talk about the way in which the debate on euthanasia has played out in the UK - and hear why she thinks it’s now time for all individual doctors to make up their own mind, and not let either camp own the argument for them.
Read her commentary on the debate:
http://www.bmj.com/content/360/bmj.k544
Torture - What declassified guidelines tell us about medical complicity
5 februari 2018 |
18 min
The UN Convention against Torture defines torture as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person” by someone acting in an official capacity for purposes such as obtaining a confession or punishing or intimidating that person.
It is unethical for healthcare professionals to participate in torture, including any use of medical knowledge or skill to facilitate torture or allow it to continue, or to be present during torture. Yet medical participation in torture has taken place throughout the world and was a prominent feature of the US interrogation practice in military and Central Intelligence Agency (CIA) detention facilities in the years after the attacks of 11 September 2001. Little attention has been paid, however, to how a regime of torture affects the ability of health professionals to meet their obligations regarding routine clinical care for detainees.
The 2016 release of previously classified portions of guidelines from the CIA regarding medical practice in its secret detention facilities sheds light on that question. These show that the CIA instructed healthcare professions to subordinate their fundamental ethical obligations regarding professional standards of care to further the objectives of the torturers.
In this podcast, Zackary Berger, associate professor at Johns Hopkins School of Medicine, joins us to discuss what those guidelines have revealed.
Read the full analysis:
http://www.bmj.com/content/360/bmj.k449
We must not get to the stage of thinking that [homelessness] is normal
2 februari 2018 |
17 min
The number of people officially recorded as sleeping on the streets of England rose from 1768 in 2010 to 4751 in autumn 2017.1 Charities estimate the true figure to be more than double this.
Danny Dorling, Halford Mackinder professor of geography at the University of Oxford joins us to explain what's fuelling that rise, why the true extent of the problem is far larger, and what steps need to be taken to tackle the epidemic.
Read the editorial:
http://www.bmj.com/content/360/bmj.k214
Public health - time for pragmatism or knowledge production?
1 februari 2018 |
22 min
We have evidence on which to act, and inaction costs lives, argues Simon Capewell, Professor of Public Health and Policy, at the University of Liverpool. But Aileen Clarke, professor of public health and health services research at Warwick Medical School, says our understanding of the human behaviour that leads to unhealthy choices is still lacking
Read the head to head
http://www.bmj.com/content/360/bmj.k292
Smoking one a day can’t hurt, can it?
25 januari 2018 |
14 min
We know that smoking 20 cigarettes a day increases your risk of CHD and stroke - but what happens if you cut down to 1, do you have 1/20th of that risk?
Allan Hackshaw, professor of epidemiology at UCL joins us to discuss a new systematic review and meta analysis published on bmj.com, examining the risk of smoking just one or two cigarettes a day.
Read the full review:
http://www.bmj.com/content/360/bmj.j5855
Virginia Murray - the science of disaster risk reduction
24 januari 2018 |
25 min
Virginia Murray, public health consultant in global disaster risk reduction at Public Health England, was instrumental in putting together the Sendai Framework for Disaster Risk Reduction - an international agreement which aims to move the world from reacting to disasters, to proactively preventing them.
In this podcast, she explains what they learned in the process, and why science had to become storytelling, in order to make politicians pay attention.
Read the editorial on creating a set of indicators for disaster preparedness.
http://www.bmj.com/content/359/bmj.j5279
Education round-up - January 2018
22 januari 2018 |
39 min
The BMJ publishes a variety of education articles, to help doctors improve their practice. Often authors join us in our podcast to give tips on putting their recommendations into practice.
In this audio round-up The BMJ’s clinical editors discuss what they have learned, and how they may alter their practice. Kate Addlington, associate editor and trainee psychiatrist is joined by Cat Chatfield, quality editor and GP.
They discuss acute respiratory distress syndrome:
http://www.bmj.com/content/359/bmj.j5055
Why it’s important to have early diagnosis of psychotic symptoms, and the evidence for improved outcomes:
http://www.bmj.com/content/357/bmj.j4578
And finally, why it’s important to consider hearing-loss on the ward:
http://www.bmj.com/content/360/bmj.k21
They can’t hear you - how hearing loss can affect care.
19 januari 2018 |
16 min
Many older adults have difficulty understanding speech in acute healthcare settings owing to hearing loss, but the effect on patient care is often overlooked.
Jan Blustein professor of health policy and medicine at New York University, and who has also experienced the affects of hearing loss, joins us to explain what that's like, and gives some tips on making it easier to communicate.
Read the full analysis:
http://www.bmj.com/content/360/bmj.k21
Full transcript of the interview:
https://docs.google.com/document/d/1Rp7zvRlnTG5KRVLgmR-PFt-0fVRLBqINU5EmOrT5RDU/edit?usp=sharing
MVA85A trial investigation - press conference.
11 januari 2018 |
49 min
Trial MVA85A - monkey trials for a booster vaccine for BCG, developed by researchers at Oxford University, is the subject of an investigation published on bmj.com.
Experts warn that today’s investigation is just one example of “a systematic failure” afflicting preclinical research and call for urgent action “to make animal research more fit for purpose as a valuable and reliable forerunner to clinical research in humans.”
The press conference is led by Dr Fiona Godlee, the editor-in-chief of the BMJ, who provides a background to the investigation. The panel members are:
Dr Deborah Cohen, author of the investigation and associate editor at the BMJ, talking about carrying out the investigation and the difficulty to obtain basic information
Professor Paul Garner from the Liverpool School of Tropical Medicine, addressing the ineffectiveness of the current TB vaccine and also talking about the backlash he experienced after publishing a systematic review concluding that the animal studies results had been overstated
Malcolm Macleod, from the University of Edinburgh, talking about the broader public health aspect
Merel Ritskes-Hoitinga from the Department for Health Evidence in The Netherlands, addressing the quality of animal studies and the need for systematic reviews
and Jonathan Kimmelman, from McGill University in Canada analysing the story from the perspective of biomedical ethics.
neoadjuvant treatment for breast cancer - not living up to the promise
11 januari 2018 |
19 min
Neoadjuvant chemotherapy for breast cancer is a new strategy that was introduced towards the end of the 20th century with the aim of reducing tumour size - rendering an otherwise inoperable tumour operable, allowing more conservative surgery, and hopefully improving overall survival.
Although data indicate that the first rationale remains valid, the others have not led to the desired outcomes. More conservative surgery after neoadjuvant chemotherapy can result in a higher rate of local recurrence, and, despite the earlier initiation of systemic treatment, no improvement in survival has been seen.
Jayant Vaidya, professor of surgery and oncology and consultant breast cancer surgeon at University College London, joins us to explain why he is rethinking the use of neoadjuvant chemotherapy for breast cancer.
Read the full analysis:
http://www.bmj.com/content/360/bmj.j5913
Winter pressures - ”You run the risk of dropping the ball”
10 januari 2018 |
39 min
Winter pressures on NHS services have kicked in a little bit earlier than usual. So here to discuss that, and also the issue of how local NHS leaders can support staff in times of extreme pressure.
Discussing that with Rebecca Coombes, The BMJ’s head of news and views, are Matthew Inada-Kim, a consultant in acute and general medicine at Hampshire Hospitals NHS Foundation Trust, and Joe Harrison, CEO of Milton Keynes Hospital NHS Foundation Trust.
Suspect, investigate, and diagnose acute respiratory distress syndrome
3 januari 2018 |
44 min
Acute respiratory distress syndrome was first described in 1967 and has become a defining condition in critical care. Around 40% of patients with ARDS will die, and survivors experience long term sequelae. No drug treatments exist for ARDS, however good supportive management reduces harm and improves outcome.
In this podcast, John Laffey, professor of anaesthesiology at St Michael’s Hospital, Toronto and Brian Kavanagh, clinician-scientist, intensive care medicine at the University of Toronto take us through the background to diagnosis and treatment of ARDS.
Cheryl Misak, professor of philosophy at the University of Toronto, and survivor of ARDS, also joins us to explain how she has faired in recovery.
Read the full easily missed article:
http://www.bmj.com/content/359/bmj.j5055
Hope is important - early psychosis for the non-specialist doctor
31 december 2017 |
42 min
Psychosis often emerges for the first time in adolescence and young adulthood. In around four out of five patients symptoms remit, but most experience relapses and further difficulties.
Psychosis can be a frightening and bewildering experience for both patients and families. Early proactive support and intervention improves clinical outcomes, avoids costly and traumatic hospital admissions, and is preferred by patients and their families
In this podcast,Sagnik Bhattacharyya, consultant psychiatrist at the Lambeth Hospital South London and Maudsley NHS Foundation Trust, and David Shiers, former GP, honorary reader in early psychosis at at Manchester University, join us to discuss early treatment - and why hope is important for both GPs and patients.
Read the full practice article:
http://www.bmj.com/content/357/bmj.j4578
And see the infographic on identification and management of psychotic disorders.
http://www.bmj.com/content/bmj/suppl/2017/11/08/bmj.j4578.DC1/psychosis_v28.pdf
Cats, dogs, and biomarkers of ageing.
15 december 2017 |
21 min
The notion that animal companionship might be linked to human health can be traced to ancient writings and, with the first population based study conducted at least four decades ago.
Although some empirical evidence links animal companionship with apparent protection against a series of important health outcomes in middle aged populations, including premature mortality, obesity, hypertension, and hyperlipidaemia, systematic reviews and position statements suggest that these associations are not universal.
To investigate this further, the authors of this observational study, looked at the prospective link between pet ownership and a selected range of objective biomarkers of ageing proposed for use in large scale population based studies of older people.
Richard Watt, professor of dental public health at University College London joins us to discuss their results.
http://www.bmj.com/content/359/bmj.j5558
Small, medium, or a pint of wine?
14 december 2017 |
33 min
Wine glasses come in a range of sizes, but the average wine glass in the UK today can hold almost ½ a litre.
That wasn’t always the case - and a new analysis, on bmj.com takes a look at the changing size of wineglasses from 1700 until now.
To discuss how the size of glass affects consumption we're joined by Theresa Marteau, director of the Behaviour and Health Research Unit at the University of Cambridge and Zorana Zupan, a research associate in the Unit.
We're also joined by Matthew Winterbottom, curator of decorative arts at the Ashmolean Museum in Oxford, to tell us about the history of wine drinking in the UK.
Read the full analysis:
http://www.bmj.com/content/359/bmj.j5623
Taking the temperature of 37°C
13 december 2017 |
25 min
Average body temperature is 37°C, right?
That was the conclusion of Carl Wunderlich in his magnum opus, The Course of Temperature in Diseases - Wunderlich published that in 1868, following his extensive collection of body temperature readings - and 37°C stuck. But, it’s not as simple as that
Philip Mackowiak, emeritus professor of medicine, and now history of medicine scholar in residence, at the University of Maryland School of Medicine, has been interested in temperature for a long time. He joins us to explain how Wunderlich measured temperature, and what he actually found.
Read his editorial:
http://www.bmj.com/content/359/bmj.j5697
Manflu - are men immunologically inferior?
12 december 2017 |
21 min
Manflu, the phenomenon that men experience the symptoms of viral illness more than woman, is usually used with derision - but a new review, published in the Christmas edition, is asking - is there a plausible biological basis for this sex difference?
Kyle Sue is a clinical assistant professor in family medicine at Memorial University of Newfoundland, and a GP in northern Canada - and has been looking at the research on sex difference in immune response.
Read the full article:
http://www.bmj.com/content/359/bmj.j5560
I thought I wasn’t thin enough to be anorexic
10 december 2017 |
43 min
Assessing young people with possible eating disorders can be complex for a variety of reasons. Building a therapeutic relationship with a young person with a possible eating disorder and their family is key to enabling a thorough assessment and ongoing management, but it introduces difficult issues regarding confidentiality and risk.
In this podcast we speak to the mother and daughter authors of a What you patient is thinking article, who describe what it's like for a family to experience a child with an eating disorder.
In a linked podcast, we talk with the authors of two practice articles, which give advice on spotting and treating eating disorders in young people.
Read the articles:
http://www.bmj.com/content/359/bmj.j5328
http://www.bmj.com/content/359/bmj.j5378
http://www.bmj.com/content/359/bmj.j5245
Early detection of eating disorders
10 december 2017 |
43 min
Assessing young people with possible eating disorders can be complex for a variety of reasons. Building a therapeutic relationship with a young person with a possible eating disorder and their family is key to enabling a thorough assessment and ongoing management, but it introduces difficult issues regarding confidentiality and risk.
In this podcast we talk with the authors of two practice articles, which give advice on spotting and treating eating disorders in young people.
In a linked podcast, we speak to the mother and daughter authors of a What you patient is thinking article, who describe what it's like for a family to experience a child with an eating disorder.
Read the articles:
http://www.bmj.com/content/359/bmj.j5328
http://www.bmj.com/content/359/bmj.j5378
http://www.bmj.com/content/359/bmj.j5245
Should all fetuses be monitored electronically during birth?
7 december 2017 |
29 min
Our latest H2H debate asks: Is continuous electronic fetal monitoring useful for all women in labour?
Peter Brocklehurst is professor of women’s health at the University of Birmingham. He argues that continuous electronic fetal monitoring during labour can lead to harm and increase the risk of caesarean section.
Christoph Lees is reader in obstetrics and fetal medicine at Imperial College London. He argues that continuous electronic fetal monitoring is useful for all women in labour as it helps avoid fetal and neonatal morbidity
”Obesity is the last thing it’s OK to discriminate on the basis of”
24 november 2017 |
20 min
We have a problem in obesity research — clinical trials continue to prioritise weight loss as a primary outcome and rarely consider patients’ experience, quality of life, or adverse events - and now a new analysis article, "Challenging assumptions in obesity research" questions that focus on weight.
Navjoyt Ladher discusses this thorny topic with Liz Sturgiss, GP, obesity researcher at Australian National University Medical School, and one of the authors of that paper.
Read the full analysis:
http://www.bmj.com/content/359/bmj.j5303
Dieting, cardiovascular disease, cancer, and mortality
21 november 2017 |
26 min
We know that adults with obesity have an increased risk of premature mortality, cardiovascular disease, some cancers, type 2 diabetes, and many other diseases.
However, the effect of dieting on 3 of those outcomes (cancer, cvd, and mortality) is surprisingly little studied.
However a new systematic review and meta-analysis does bring together what we know of that effect, and to explain the evidence we're joined by Alison Avenell, professor in the Health Services Research Unit, University of Aberdeen.
Read the full systematic review and meta-analysis: http://www.bmj.com/content/359/bmj.j4849
Antibiotic prescription course - an update
17 november 2017 |
30 min
In July, The BMJ published an analysis article called “The Antibiotic Course has had it’s day” - a provocative title that turned out the garner a lot of debate on our site. The article said that the convention for the length of a course of antibiotics was set by Flemming, in his Nobel Prize acceptance speech - “If you use penicillin, use enough!” - and that the evidence base hasn’t moved on since then.
The article has had over 40 substantive responses, both agreeing and vehemently not - and so we thought it worth revisiting that argument, now the dust has settled.
Discussing that are Martin Llewellyn, professor of infectious disease at Brighton and Sussex Medical School, and Paul Little, professor of primary care at the University of Southampton.
Read the original analysis:
http://www.bmj.com/content/358/bmj.j3418
Is it time to scrap the UK’s mental health act?
17 november 2017 |
26 min
Unjust discrimination against people with mental ill health should be replaced with universal rules based on decision making ability, argues George Szmukler, emeritus professor of psychiatry and society at King’s College, London.
However Scott Weich, professor of mental health at the University of Sheffield, worries about legal distractions that won’t improve outcomes while services are so thinly stretched.
Read the full debate:
http://www.bmj.com/content/359/bmj.j5248
Three talks to good decision making
10 november 2017 |
24 min
The Three Talk Model of shared decision is a framework to help clinicians to think about how to structure their consultation to ensure that shared decision making can most usefully take place.
The model is based around 3 concepts - option talk, decision talk, and team talk - with active listening at the centre.
Three Talk was first proposed in 2012, now new research published on bmj.com updates that model. Professor Glynn Elwyn, from The Dartmouth Institute for Health Policy and Clinical Practice, joins us to explain how that was done, and what it's creators learned from the process.
Read the full research:
http://www.bmj.com/content/359/bmj.j4891
Education round up October 2017
31 oktober 2017 |
48 min
The BMJ publishes a variety of education articles, to help doctors improve their practice. Often authors join us in our podcast to give tips on putting their recommendations into practice.
In this new monthly audio round-up The BMJ’s clinical editors discuss what they have learned, and how they may alter their practice.
In this edition, GP Cat Chatfield, psychiatric trainee Kate Addlington and Gastrology trainee Robin Baddeley discuss the articles;
Diagnosis and management of postpartum haemorrhage
http://www.bmj.com/content/358/bmj.j3875
Indications for anticoagulant and antiplatelet combined therapy
http://www.bmj.com/content/356/bmj.j1128
Safe Handover
http://www.bmj.com/content/359/bmj.j4328
and why fixing the broken medical ward round is in everyone’s interests
http://blogs.bmj.com/bmj/2017/10/13/robin-baddeley-fixing-the-broken-medical-ward-round-is-in-everyones-interests/
Money for editors
27 oktober 2017 |
16 min
As journal editors, we’re aware of the fact that we have a role to play in scientific discourse - that’s why The BMJ has been so keen to talk about the way in which scientific knowledge is constructed, through our Evidence Manifesto.
We also know that money has influence in the scientific literature - which is why we have a zero tolerance policy for financial conflicts of interest in our educational content.
Where do journal editors fit into this?
The first step into investigating that is to find out if journal editors receive payments from pharma and device companies - and new research, published on bmj.com does that.
Jessica Liu - internist and assistant professor at the university of Toronto, and one of the authors of that study joins us to discuss.
Read the full research:
http://www.bmj.com/content/359/bmj.j4619
The death of QOF?
26 oktober 2017 |
21 min
The Quality and Outcomes Framework (QOF) is one of the most ambitious pay-for-performance schemes introduced into any health system. It's now being scrapped by bits of the NHS, and is under reform elsewhere.
Martin Marshall, GP and professor of Health Improvement at University College London, thinks it's time to rethink the experiment. He joins us to discuss how we got here, what we've learned, and what will replace QOF.
Read the editorial:
http://www.bmj.com/content/359/bmj.j4681
70% rise in incidence of self harm in teenagers
19 oktober 2017 |
24 min
Half of adolescents who die by suicide have a history of self harm. And in the UK, the rates of adolescents who commit suicide jumped from 3.2, to 5.4 per 100 000 between 2010 and 2015. The national suicide prevention strategy recently expanded its scope by aiming to reduce self harm rates as a common precursor to suicide.
Therefore it's important that we have an accurate measure of rates of self harm in the population, and new research published on bmj.com aims to do that.
To discuss we're joined by one of the authors of that paper - Navneet Kapur, professor of psychiatry and population health at the University of Manchester.
Read the full research:
http://www.bmj.com/content/359/bmj.j4351
Exercise in old age - ”we need kendo classes in Huddersfield”
18 oktober 2017 |
31 min
There's a crisis in old age care - not just in the UK, around the world, as population demographics shift, and the proportion of older people increase - there's a worry about who's going to look after them, and how much is it going to cost?
However, a new analysis on bmj.com says this picture need not be so gloomy - they say that encouraging exercise in older people could save billions - by keeping frailty at bay and increasing healthy life expectancy.
We're joined by two of the authors of that analysis - Scarlett McNally, consultant orthopedic surgeon at Eastbourne District General Hospital, and Muir Gray, public health doctor.
Read the full analysis:
http://www.bmj.com/content/359/bmj.j4609
Sex in surgery
13 oktober 2017 |
37 min
New research published on bmj.com has evaluated how well women surgeons operate, when compared to their male colleagues - and shows that there is a marginal improvement in patient outcomes.
To discuss how that was studied, and what the findings mean, we're joined by Chris Wallis, a resident at the University of Toronto, and Raj Satkunasivam, a urologic-surgeon and assistant professor at the Houston methodist hospital in Texas.
Also joining us, to contextualise that research, is Clare Marx - associate medical director of Ipswich Hospital NHS Ttrust, and former president of the Royal College of Surgeons.
Read the open access research:
http://www.bmj.com/content/359/bmj.j4366
and editorial:
http://www.bmj.com/content/359/bmj.j4580
Vinay Prasad - Cancer drugs from an oncologist point of view
13 oktober 2017 |
24 min
Last week we published some new research which showed that 2/3 of new cancer drugs approved by the European Medicines Agency - the drug regulator for Europe - didn’t have any evidence of improved life expectancy or quality of life.
In this interview, Vinau Prasad, ematologist-oncologist and Assistant Professor of Medicine at the Oregon Health and Sciences University, explains how we came to accept surrogate measures in oncology trials, and how he tries to navigate the evidence for his patients.
Read his editorial:
http://www.bmj.com/content/359/bmj.j4528
There’s no clear evidence that most new cancer drugs extend or improve life
5 oktober 2017 |
24 min
The majority of cancer drugs approved in Europe between 2009 and 2013 entered the market without clear evidence that they improved survival or quality of life for patients, finds a study published by The BMJ today.
Even where drugs did show survival gains over existing treatments, these were often marginal.
To discuss that, we're joined by Huseyin Naci, assistant professor of health policy at the London School of Economics.
Read the open access study: http://www.bmj.com/content/359/bmj.j4530
Telephone consultations - no cost savings, but increased GP workload
28 september 2017 |
23 min
If you're a patient in the UK, increasingly, your first interaction with the healthcare system won't be the traditional face to fact chat with your doctor - instead you'll have a telephone consultation.
The prevalence of these telephone consultations is increasing, and being promoted by CCGs and private companies who administer them - usually as a cost saving measure.
Now new research published on bmj.com looks at these phone consultation - how often they happen, how patients feel about them, and how much money they actually save.
In this podcast we're joined by Martin Roland, emeritus professor of health services research at Cambridge University, to find out more.
Read the full research:
http://www.bmj.com/content/358/bmj.j4197
Selling off NHS silver?
27 september 2017 |
15 min
Should we welcome plans to sell off NHS land?
The government seems likely to back the recommendations of Robert Naylor (national adviser on NHS property and estates) to raise capital by selling off inefficiently used assets, but Kailash Chand (GP) worries that services could be threatened and that public consultation is lacking.
Read the Head To Head article: https://www.bmj.com/content/358/bmj.j4290
What Choosing Wisely looks like in the UK
27 september 2017 |
40 min
Choosing Wisely was launched in the US, to much fanfare. Since then the movement has spread around the world, with successful chapters set up in Canada, Australia Brazil, Italy, Japan, new Zealand - and most recently the UK.
The campaigns have not been without criticism – from how individual recommendations were chosen, to the way in which patients have been involved.
In this podcast, we're joined by joined by 3 of Choosing Wisely UK’s steering group, professor Sue Bailey, head of the steering committee, Ramai Santhirapala, honorary consultant in anaesthesia and perioperative medicine, and, Richard Lehman, GP.
http://www.choosingwisely.co.uk/
Diabetes remission - ”treating blood glucose, when the disease process is to do with body fat”
22 september 2017 |
24 min
In the UK - type 2 diabetes now affects between 5-10% of the population - and accounts for around 10% of our total NHS budget. For the individuals affected, treatments are effective at helping control glucose levels - however, the sequela associated with the disease - vascular problems, and a life expectancy that’s 6 years shorter - are still an issue.
However, for some, remission seems to be a possibility.
To discuss we're joined by Mike Lean, professor of human nutrition at the university if Glasgow, and co-author of an analysis, published on bmj.com, which impels doctors to make sure that type to diabetes remission is coded properly.
Read the full analysis:
http://www.bmj.com/content/358/bmj.j4030
The problems with peer review
19 september 2017 |
14 min
One of the hurdles that anyone who submits research or analysis to The BMJ has to deal with is peer review.
The problems of the process, and some of the potential solutions, was a big part of the Peer Review Congress which took place last week.
In this interview, Sophie Cook, The BMJ's UK research editor, talks to Lisa Bero, who’s a professor of evidence based medicine at Sydney University, and spends a lot of time investigating the integrity of health research.
HIV in pregnancy - ”without the big picture, people aren’t going to be able to take the medication”
15 september 2017 |
26 min
A new Rapid Recommendation from The BMJ suggests that for pregnant women, they may wish to avoid certain antiviral treatments for HIV.
This recommendation differs from the WHO's, and to discuss why that is, and what makes that difference important, we're joined by Reed Siemieniuk, a physician and methodologist from McMaster University, and Alice Welbourn, campaigner for gender and sexual and reproductive health rights, in the context of HIV and violence against women.
Read the full rapid recommendation:
http://www.bmj.com/content/358/bmj.j3961
And Alice Welborn's opinion article:
http://blogs.bmj.com/bmj/2017/09/11/alice-welbourn-who-and-the-rights-of-women-living-with-hiv/
Googling depression
11 september 2017 |
35 min
In the USA, when googling "depression" patients will be presented with a link to the PHQ-9 screening test.
Google has developed this in collaboration with the National Alliance on Mental Illness - and Ken Duckworth, the alliance's medical director, debates the merits of this approach with Simon Gilbody, from the Department of Health Sciences at the University of York.
Also joining this podcast is David Gilbert, mental health services user and director of InHealth Associates, who argues that it's only through patient involvement that real improvements to mental health can be obtained.
Read the debate and commentary:
http://www.bmj.com/content/358/bmj.j4144
http://www.bmj.com/content/358/bmj.j4207
Nigel Crisp - The NHS isn’t just a cost to society, it’s a benefit
8 september 2017 |
26 min
If you google "The NHS" you'll see screaming headlines from the Daily Mail about cost and waste - debate in parliament is about how much of our GDP we should be spending - and each year, hospital trusts go cap in hand to ask for more funding.
Against this backdrop, a new analysis, and a first in a series, published on bmj.com, looks at what it takes to have sustainable healthcare - and cruically, talks about this from the point of view of benefit, not cost.
I'm Duncan Jarvies, and I'm Navjoyt Ladher, and today we've come to the House of Lords to speak to Baron Nigel Crisp - cross-bench peer, former NHS trust executive, and health system guru.
The World Bank - creating a market in pandemic risk
1 september 2017 |
22 min
The world bank was set up in 1944. In the aftermath of the second world war, the institution was there to give loans to countries rebuilding after the conflict. Their first loan went to France - but with stipulations about repayment that set a tone for future funds.
A new series, authored by Devi Sridhar, and her team from the University of Edinburgh, and published on bmj.com, looks at where the World Bank has come. The series is , and the articles will cover;
Why the World Bank matters to global health
The World Bank’s turn to Universal health coverage
How the Bank’s trust funds are being used to fund specific projects - and why it’s hard to know what those are
The Global Financing Facility - grants and loans supplied together,
and finally, creating a market out of pandemic risk
In this final interview, Felix Stein a postdoctoral research fellow at the University of Edinburgh describes the bank's move to create a market for pandemic insurance.
Read the full analysis:
http://www.bmj.com/content/358/bmj.j3397
The World Bank - the Global Financing Facility
1 september 2017 |
13 min
The world bank was set up in 1944. In the aftermath of the second world war, the institution was there to give loans to countries rebuilding after the conflict. Their first loan went to France - but with stipulations about repayment that set a tone for future funds.
A new series, authored by Devi Sridhar, and her team from the University of Edinburgh, and published on bmj.com, looks at where the World Bank has come. The series is , and the articles will cover;
Why the World Bank matters to global health
The World Bank’s turn to Universal health coverage
How the Bank’s trust funds are being used to fund specific projects - and why it’s hard to know what those are
The Global Financing Facility - grants and loans supplied together,
and finally, creating a market out of pandemic risk
In this fourth interview, Genevie Fernandes a PhD student at the University of Edinburgh discusses a new model of combing grants and loans in the Global Financing Facility.
Read the full analysis:
http://www.bmj.com/content/358/bmj.j3395
The World Bank - trust funds
1 september 2017 |
19 min
The world bank was set up in 1944. In the aftermath of the second world war, the institution was there to give loans to countries rebuilding after the conflict. Their first loan went to France - but with stipulations about repayment that set a tone for future funds.
A new series, authored by Devi Sridhar, and her team from the University of Edinburgh, and published on bmj.com, looks at where the World Bank has come. The series is , and the articles will cover;
Why the World Bank matters to global health
The World Bank’s turn to Universal health coverage
How the Bank’s trust funds are being used to fund specific projects - and why it’s hard to know what those are
The Global Financing Facility - grants and loans supplied together,
and finally, creating a market out of pandemic risk
In this third interview, Janelle Winters a PhD student at the University of Edinburgh explains what the bank's trust funds are, and why it can be hard to tell what they're funding.
Read the full analysis:
http://www.bmj.com/content/358/bmj.j3394
The World Bank - Universal Healthcare
1 september 2017 |
17 min
The world bank was set up in 1944. In the aftermath of the second world war, the institution was there to give loans to countries rebuilding after the conflict. Their first loan went to France - but with stipulations about repayment that set a tone for future funds.
A new series, authored by Devi Sridhar, and her team from the University of Edinburgh, and published on bmj.com, looks at where the World Bank has come. The series is , and the articles will cover;
Why the World Bank matters to global health
The World Bank’s turn to Universal health coverage
How the Bank’s trust funds are being used to fund specific projects - and why it’s hard to know what those are
The Global Financing Facility - grants and loans supplied together,
and finally, creating a market out of pandemic risk
In this second interview, Marlee Tichenor, postdoctoral research fellow at the University of Edinburgh explains why the bank has embraced universal healthcare.
Read the full analysis:
http://www.bmj.com/content/358/bmj.j3347
The World Bank - why it matters for global health
1 september 2017 |
17 min
The world bank was set up in 1944. In the aftermath of the second world war, the institution was there to give loans to countries rebuilding after the conflict. Their first loan went to France - but with stipulations about repayment that set a tone for future funds.
A new series, authored by Devi Sridhar, and her team from the University of Edinburgh, and published on bmj.com, looks at where the World Bank has come. The series is , and the articles will cover;
Why the World Bank matters to global health
The World Bank’s turn to Universal health coverage
How the Bank’s trust funds are being used to fund specific projects - and why it’s hard to know what those are
The Global Financing Facility - grants and loans supplied together,
and finally, creating a market out of pandemic risk
In this first interview, Devi Sridhar, professor of global health at the University of Edinburgh explains why the bank matters for global health.
Read the full analysis:
http://www.bmj.com/content/358/bmj.j3339
Preventing Overdiagnosis 2017 - from theory to practice
24 augusti 2017 |
24 min
In our last podcast from Preventing Overdiagnosis 2017, we convened an impromptu roundtable of clinicians who are attending the conference to see how some of the big themes that were discussed at the conference are going to impact their everyday practice.
Joining us were;
Jessica Otte - Family physician from Canada
David Warriner - Cardiologist from the UK.
Jack O’Sullivan - Junior doctor from Australia
Imran Sajid - GP from the UK
To read more, have a look at our Too much medicine campaign - bmj.com/too-much-medicine.
Preventing Overdiagnosis 2017 - Citizen juries
19 augusti 2017 |
15 min
This week we’re at the over diagnosis conference in Quebec Canada, Preventing overdiangosis is a forum to discuss the harms associated with using uncertain methods to look for disease in apparently healthy people - and is part of the BMJ’s too much medicine campaign.
One of the ways in which the public’s attitudes and wishes around health is measured are citizen or community juries - set up in a similar way to a criminal jury - with an information gathering, and a deliberation phase - recently one of these citizen juries discussed, whether abortion should be allowed in Ireland (they decided “yes”).
We're joined by Rae Thomas, from Bond University and Chris Degeling, from the University of Sydney, who have both been using citizen juries to look at over diagnosis.
Preventing Overdiagnosis 2017 - Vinay Prasad
19 augusti 2017 |
32 min
The Preventing overdiagnosis conference covers how physicians, researchers and patients can implement solutions to the problems of over diagnosis and overuse in healthcare.
If you’re a doctor on twitter, you’ve probably come across our guest - Vinay Prasad, assistant prof. of medicine at Oregon Health and Science University, and author of the book Ending Medical Reversal.
Preventing Overdiagnosis 2017 - Rita Redberg
18 augusti 2017 |
22 min
This week we’re at the Preventing Overdiagnosis conference in Quebec Canada, The conference is a forum to discuss the harms associated with using uncertain methods to look for disease in apparently healthy people - and is part of the BMJ’s too much medicine campaign.
The literature on overdiagnosis has mostly been published since 2013 - partly because of The BMJ, but in large part because of the work of Rita Redberg, professor of clinical medicine, and a working cardiologist, at UCSF, and editor of JAMA internal medicine who joins us to discuss why less is more.
Preventing Overdiagnosis 2017 - Stacy Carter on the culture of overmedicalisation
17 augusti 2017 |
24 min
In this interview from Preventing Overdiagnosis 2017 (preventingoverdiagnosis.net) Stacy Carter, associate professor at Sydney Health Ethics - and the author of a recently written BMJ essay the ethical aspects of overdiagnosis, joins us to talk about how the cultural context of medicine seeps into our decision making processes and affects how people conceptualise the risks of too much medicine.
Read Stacy's full essay:
http://www.bmj.com/content/358/bmj.j3872
What’s driving overdiagnosis?
16 augusti 2017 |
18 min
This week the annual Preventing over diagnosis conference is happening in Quebec, Canada. The conference is put together with a wide range of partners, including The BMJ, and aims to tackle the some of the problems of Too Much Medicine.
To kick off our content for the conference, this week we’ve published an article looking at some of the drivers - and hence potential solutions for over diagnosis.
Two of the authors of that paper. Thanya Pathirana, and Ray Moynihan, both from Bond University’s Centre fro Research in Evidence Based Practice, join us to discuss.
Helping Bereaved people
3 augusti 2017 |
26 min
Loss of a loved one can be very painful. When seeking support, some people turn to their doctor. Because of their pivotal role in the community, physicians can provide excellent support for bereaved people and can often direct them to additional resources.
Katherine Shear, a physician, and Stephanie Muldberg, a bereaved mother, join us to discuss how grief can play out in the consultation, and explain the importance of doctors acknowledging the death of a patient's loved one.
Read their full practice article:
http://www.bmj.com/content/358/bmj.j2854
Auditing the transparency policies of pharma
28 juli 2017 |
32 min
If you’ve listened to more than one of our podcasts, you’ll probably be aware of the problem of the opacity of clinical trial data - trials which are conducted by never see the light of day, or results within those trials which are never published.
Pharmaceutical companies have their own policies on what they are willing to make public, when, and for the first time a new audit, published on bmj.com, collates and analyses those policies.
To discuss that study I’m joined by two of the authors - Ben Goldacre, senior clinical research fellow at, and Carl Heneghan, director of, Oxford's Centre for Evidence Based Medicine.
Read the full audit:
http://www.bmj.com/content/358/bmj.j3334
Mike Richards has ”never been politically interfered with”
28 juli 2017 |
20 min
Mike Richards is well known in the UK - former Cancer Tzar, he now heads up the Care Quality Commission - regulator of all health and social care services, and therefore the body responsible for inspecting hospitals and GP practices.
In this interview, BMJ’s head of news and views, Rebecca Coombes went to the CQC’s headquarters in London, and spoke to Mike Richards - who defends the record of hospital inspection on his watch.
This is an edited version of the interview - read the full write up:
http://www.bmj.com/content/358/bmj.j3567
”For the first time in 15 years the quitting rate has gone up” - ecigarettes smoking cessation
27 juli 2017 |
25 min
It’s been 10 years since electronic cigarettes hit the shelves in a big way - and since there controversy has reigned about their health effects - are they less unhealthy than smoking traditional tobacco cigarettes, and will they increase nicotine dependence?
Its to that last point that new research, published on BMJ.com is looking into - specifically, do e-cigarettes help people quit tobacco?
Professor Shu-Hong Zhu, Director of the Center for Research & Intervention in Tobacco Control at the university of California San Diego joins us to discuss what effect ecigarettes have had, at a population level, on smoking cessation rates.
Read the open access research:
http://www.bmj.com/content/358/bmj.j3262
What’s going on with life expectancy?
21 juli 2017 |
30 min
The increase in life expectancy in England has almost “ground to a halt” since 2010 and austerity measures are likely to be a significant contributor.
In this podcast Michael Marmot, director at University College London’s Institute of Health Equity, joins us to discuss what might be causing that drop off, and why a decrease in early life chances is particularly problematic.
Read more about the report:
http://www.bmj.com/content/358/bmj.j3473
Biomarkers - miracle or marketing?
18 juli 2017 |
18 min
The BMJ has been campaigning for an end to “too much medicine” - the pernicious effect of marketing on the range of tests and treatments that doctors offer patients - tests and treatments which are motivated by the financial reward to the system, than the health of the individual.
A new analysis on BMJ.com takes a look at what’s happening in the the first part of that - testing. New biomarkers for disease, and new ways of monitoring, have the potential to diagnose disease more quickly, but is the hype backed by science?
Bjorn Hoffman professor of medical ethics at Norwegian University of Science and Technology and one of the authors of that article doesn’t think so - and joins us on the podcast to discuss.
Read the full analysis:
http://www.bmj.com/content/358/bmj.j3314
James Kinross and Chris Hankin WannCry about NHS IT
14 juli 2017 |
37 min
Earlier this year, the WannaCry ransomeware attack took control of computers in 40 NHS trusts, blocking access to the data held on them.
This wasn’t the first time that NHS computers had been infected by malware, but it brought the danger of cyber attack into the consciousness of doctors and patients.
In this podcast we hear from two people who have been thinking hard about cyber security in the NHS - James Kinross, a surgeon and lecturer at Imperial College London, and Chris Hankin, director of Imperial’s Institute for Security Science and Technology.
Read the analysis:
http://www.bmj.com/content/358/bmj.j3179
Is the FDA really too slow?
11 juli 2017 |
22 min
The FDA faces perpetual criticism that it is too slow in it’s approval process for getting drugs to market, but one former FDA employee Tom Marciniak, and one professor, Victor Serebruany from Johns Hopkins University have analysed that process and disagree.
Tom Marciniak has been a commentator on the approval process, both critical of industry and the FDA in The BMJ - and in this interview he talks about that process, his new analysis, and how he thinks we could be more sure about the safety and efficacy of drugs coming onto the market.
Read this full analysis:
http://www.bmj.com/content/357/bmj.j2867
”For the public good, not for careers” - Iain Chalmers and Doug Altman on research waste
7 juli 2017 |
27 min
Twenty years ago the statistician Doug Altman railed against, “The Scandal of Poor Medical Research,” in an editorial in The BMJ.
10 years later, Iain Chalmers and Paul Glaziou calculated that costs $170 billion annually in wasted research grants.
In this podcast, recorded at Evidence Live, we spoke to Altman and Chalmers about their campaigns to improve the design, conduct, and reporting of clinical trials, and why that level of waste still occurs.
Reward Alliance - http://rewardalliance.net/
Equator Network - http://www.equator-network.org/
Research publication audit "Getting our house in order" - http://bmjopen.bmj.com/content/6/3/e009285
Dementia prevalance in 2040
5 juli 2017 |
20 min
The Alzheimer’s society, in the UK, predicts that if the rates of dementia remain constant there’ll be 1.7 million people in the country living with the condition by 2050. We also know that things like improvements in cardiovascular health are changing those rates.
New research published on bmj.com attempts to model what the outcomes of those changing factors might be, and Sara Ahmadi - Abhari, a research associate in the Department of Epidemiology and Public Health at the University College London, joins us to discuss that model.
Read the open access research:
http://www.bmj.com/content/358/bmj.j2856
Transhealth - how to talk to patients about pronouns
30 juni 2017 |
31 min
Two articles published on the bmj.com aim to help doctors treat patients who request support with their gender identity.
Firstly a practice pointer on how to refer to gender clinic, and secondly a What Your Patient Is Thinking article about trans people's experiences in the healthcare system.
In this podcast, two of the authors of that patient experience article, Emma-Ben and Reubs, join us to discuss identity, pronouns and what genderqueer means.
I am your trans patient
http://www.bmj.com/content/357/bmj.j2963
Gender dysphoria: assessment and management for non-specialists
http://www.bmj.com/content/357/bmj.j2866
Childhood IQ and cause of death
29 juni 2017 |
19 min
Findings from a range of prospective cohort studies based around the world indicate that higher intelligence in children is related to a lower risk of all cause mortality in adulthood - and now a new study, published on bmj.com, is trying to dig into that association further, with a whole population cohort and data on cause specific mortality.
Ian J Deary, professor of differential psychology at the University of Edinburgh and one of the authors of that study, joins us to discuss what this tells us, and what might be causing that association.
Read the full open access study:
http://www.bmj.com/content/357/bmj.j2708
The Evidence Manifesto - it’s time to fix the E in EBM
23 juni 2017 |
42 min
"Too many research studies are poorly designed or executed. Too much of the resulting research evidence is withheld or disseminated piecemeal. As the volume of clinical research activity has grown the quality of evidence has often worsened, which has compromised the ability of all health professionals to provide affordable, effective, high value care for patients.”
Evidence is in crisis, and Carl Heneghan, director for the Centre for Evidence Based Medicine, and Fiona Godlee, editor in chief of The BMJ set out the 9 points of the Evidence manifesto, which tries to set a road map for strengthening the evidence base.
1) Expand the role of patients, health professionals and policy makers in research
2) Increase the systematic use of existing evidence
3) Make research evidence relevant, replicable and accessible to end users.
4) Reduce questionable research practices, bias, and conflicts of interests
5) Ensure drug and device regulation is robust, transparent and independent
6) Produce better usable clinical guidelines.
7) Support innovation, quality improvement, and safety through the better use of real world data.
8) Educate professionals, policy makers and the public in evidence-based healthcare to make informed choices.
9) Encourage the next generation of leaders in evidence-based medicine.
http://www.bmj.com/content/357/bmj.j2973
Stress at work
16 juni 2017 |
17 min
Stress is one of the leading causes of work absence, recently overtaking back-pain, and an increasing part of a GPs workload. However good quality evidence about how to deal with stress is hard to come by.
Alexis Descatha, an occupational/emergency practitioner, at the University hospital of Poincaré, gives some practical advice on what to do when you suspect stress is the underlying cause of a consultation, and what to do once you have confirmed that.
Read the full practice article:
http://www.bmj.com/content/357/bmj.j2489
”The interest of diesel drivers over the interest of the public” - tackling air pollution
15 juni 2017 |
14 min
Air pollution is a truly damaging environmental insult to the human body. The numbers of premature deaths, in the UK alone, that can be attributed to it are calculated to be 40,000 a year.
Yet despite this, action to tackle the problem - as with the other huge environmental issue of our time, climate change - is distinctly lacking.
Robin Russel-Jones dermatologist and chair of Help Rescue the Planet - joins us to discuss what should be done to tackle the problem.
Read the full analysis:
http://www.bmj.com/content/357/bmj.j2713
How to build a resillient health system
8 juni 2017 |
27 min
The 2014 west African Ebola epidemic shone a harsh light on the health systems of Guinea, Liberia, and Sierra Leone. While decades of domestic and international investment had contributed to substantial progress on the Millennium Development Goals, national health systems remained weak and were unable to cope with the epidemic.
Margaret Kruk associate professor of global health at the Harvard TH Chan School of Public Health, joins us to discuss what makes a health system resilient, and how Liberia in particular has learned lessons from Ebola.
Read the full analysis:
http://www.bmj.com/content/357/bmj.j2323
Your brain on booze
7 juni 2017 |
15 min
A new study on BMJ.com, examines the effect of moderate drinking on brain structure. We know that heavy drinking has a deleterious effect on our brains, and is linked to dementias. However, for sometime it’s been thought that moderate drinking is actually protective.
Anya Topiwala, clinical lecturer in old age psychiatry at the University of Oxford, joins us to discuss the association between alcohol consumption and those structural elements.
Read the full research:
http://www.bmj.com/content/357/bmj.j2353
Future Earth - linking health and environmental research
2 juni 2017 |
18 min
The rapid changes in the global environment have led many scientists to conclude that we are living in a new geological epoch—the Anthropocene—in which human activities have become the dominant driving force transforming the Earth’s natural systems.
A recent joint publication by the World Health Organization and Convention on Biological Diversity articulated the myriad connections between biodiversity and health and the threats to both posed by environmental change.
Andy Haines, professor of public health and primary care, at the London School of Hygiene and Tropical Medicine joins us to talk about a new research platforms present an opportunity to advance understanding of how to safeguard health in the face of global environmental change.
Read more:
http://www.bmj.com/content/357/bmj.j2358
Government and evidence
2 juni 2017 |
34 min
We're creating a manifesto for better evidence. The centre for Evidence Based Medicine at the University of Oxford, and the BMJ, are asking what are the problem with medical evidence, and how can we fix them?
In this third discussion we went to Scotland, to find out what the people who create policy think about the issues with evidence synthesis, and how the information they create is being used in practice.
evidencelive.org/manifesto/ - join the discussion, read, and comment on our manifesto.
50% of delirium is hypoactive - how to spot it
26 maj 2017 |
23 min
Available data suggest about 50% of delirium is hypoactive; this and the mixed motor subtype account for 80% of all cases of delirium.
It can be more difficult to recognise, and is associated with worse outcomes, than hyperactive delirium.
In this podcast, Christian Hosker, consultant liaison psychiatrist at the Leeds Liaison Psychiatry Service outlines when to suspect hypoactive delirium, how to assess, and appropriately manage patients.
Infographic explaining diagnosis:
http://www.bmj.com/content/bmj/suppl/2017/05/25/bmj.j2047.DC1/hosc038261.wi.pdf
Read the full article:
http://www.bmj.com/content/357/bmj.j2047
Helping patients with complex grief
18 maj 2017 |
19 min
Each individual’s grief process is unique, when confronted with the death of a loved one, most people experience transient rather than persistent distress - however 10% of bereaved individuals, with an increased risk following the death of a partner or child and loss to unnatural or violent circumstances, experience prolonged grief disorder.
In this podcast, Paul Boelen, a professor of psychiatry at Utrecht University, and Geert Smid, psychiatrist and senior researcher from the Dutch National Psychotrauma Centre, join us to discuss what constitutes complex grief, how to recognise it, and some strategies for helping patients cope.
Read the full practice pointer:
http://www.bmj.com/content/357/bmj.j2016
NHS must “get its act together” to secure cash for new buildings
15 maj 2017 |
23 min
NHS hospitals must be willing to dispose of surplus land to help convince the Treasury to invest in new premises that are fit for purpose, the head of a major government review has urged.
Robert Naylor, former chief executive of University College London Hospitals, who was asked by the health secretary, Jeremy Hunt, to produce a review of NHS property and estates - and in this interview we asked him how his plans would work, and what would be done with the land sold.
Read Gareth Iacobucci's report:
http://www.bmj.com/content/357/bmj.j2072
Education Round - Exercising too much, microbiome, suicide and translation
15 maj 2017 |
31 min
The BMJ publishes a lot of educational articles, and in an attempt to help you with your CPD, we have put together this round-up. Our authors and editors will reflect on the key learning points in the articles we discuss, and explain how they may change their practice in light of that new understanding.
In this month's round up we're discussing:
Addiction to exercise
http://www.bmj.com/content/357/bmj.j1745
If your patient doesn’t speak the same language as you . . .
http://www.bmj.com/content/357/bmj.j1511
Exploring thoughts of suicide
http://www.bmj.com/content/356/bmj.j1128
The role of the microbiome in human health and disease
http://www.bmj.com/content/356/bmj.j831
The magic of shared decision making
9 maj 2017 |
21 min
Adoption of shared decision making into routine practice has been remarkably slow, despite 40 years of research and considerable policy support.
In 2010, the Health Foundation in the UK commissioned the MAGIC (Making Good Decisions in Collaboration) programme to design, test, and identify the best ways to embed shared decision making into routine primary and secondary care using quality improvement methods.
In this podcast, Natalie Joseph-Williams from Cardiff University and Richard Thomson from Newcastle University, join us to discuss how the project went, and what key lessons they learned from the pilot.
Read their full analysis:
http://www.bmj.com/content/357/bmj.j1744
Drug promotion, prescription, and value
4 maj 2017 |
12 min
Pharma companies say that money spent on promotion is essential to educate doctors about the best drugs - but when a medical student asked Joseph Ross, associate professor of medicine and public health at Yale, if those companies are promoting the right drugs for that message to be true, the answer wasn't available.
Ross and Tyler Greenaway, his medical student, then sat down and used the data from the US Physician Payments Sunshine Act to find out which drugs have the highest promotional budgets.
They cross referenced that against prescription databases and measures of value to assess the effectiveness, usefulness, and affordability of the drugs that get the heaviest promotion.
Read the full analysis:
http://www.bmj.com/content/357/bmj.j1855
How established biologics become less safe
28 april 2017 |
17 min
Biologics have revolutionised healthcare for some conditions - but have been expensive because of the multistep manufacturing processes required to create these complex molecules.
Changes to the manufacturing of biological agents make them more affordable, but can lead to drugs with different components from the original medicine tested in clinical trials, challenging assumptions about safety.
David Hunt, honorary consultant neurologist and Wellcome Trust intermediate clinical fellow, at the University of Edinburgh, joins us to describe how that happens and what the result can be.
Read the full analysis:
http://www.bmj.com/content/357/bmj.j1707
“I had two herniated discs in my back, and I was still running” - addicted to exercise
27 april 2017 |
20 min
It’s been called “the universal panacea” - exercise has a positive effect on almost all health measures, and governments are actively campaigning for us to do more. But at the opposite end of the scale, the realisation that some people may be addicted to exercise is gaining traction.
In this podcast we're joined by Heather Hausenblas - professor of kinesiology at Jacksonville University, James Smoliga - associate professor of physiology at highpoint University, and Katherine Schreiber - who’s experienced exercise addiction, and written about her experience.
They describe the condition, and what drives people to become addicted to exercise. They also outline the key indicators of the addiction, and what options there are for treatment.
Read their article:
http://www.bmj.com/content/357/bmj.j1745
The evidence manifesto - better trials, better use of trial data
21 april 2017 |
28 min
We're creating a manifesto for better evidence. The centre for Evidence Based Medicine at the University of Oxford, and the BMJ, are asking what are the problem with medical evidence, and how can we fix them?
In this second discussion we went to Nottingham University, to find out what the people who create the bread and butter of EBM - randomised control trials - think about the issues with evidence synthesis, and how the information they create is being used in practice.
http://evidencelive.org/manifesto/ - join the discussion, read, and comment on our manifesto.
Assessing and treating an electrical injury
13 april 2017 |
10 min
Thankfully, electrical injuries are relatively uncommon - but that means that lack of evidence regarding the management of patients who have been electrocuted, which can cause concern for clinicians when these patients present.
In this podcast, Cath Brizzel, clinical editor for The BMJ, is joined by one of the authors of a clinical update on the management of electrical injury - Kumar Narayanan, a Consultant Cardiologist and Electrophysiologist at MaxCure Hospitals in India.
Read that full update, including the free infographic:
http://www.bmj.com/content/357/bmj.j1418
”We’re kicking the can down the road” - how to get agreement on the future of the NHS
12 april 2017 |
18 min
Our latest debate asks whether there should be a Royal Commission (a high level enquiry, with statutory powers) into the future of the NHS.
A high level inquiry could detoxify the radical changes needed and command wide support, say Maurice Saatchi, conservative peer, and Paul Buchanan, The BMJ's patient editor; but Nigel Crisp, independent peer, thinks that a less formal, more flexible and collaborative approach could be quicker.
Read the debate:
http://www.bmj.com/content/357/bmj.j1621
Fighting inequality, corruption, and conflict - how to improve South Asia’s health
11 april 2017 |
12 min
The BMJ has published a series of articles, taking an in-depth look at health in South Asia. In this collection, authors from India, Pakistan, Nepal, Bangladesh, Sri Lanka, and Afghanistan collaborate to identify evidence-based solutions to shape health policy and interventions, and drive innovations and research in the region.
In this podcast, two of the driving forces behind the series - Dr Zulfiqar Bhutta, from Aga Khan University, and Dr Samiran Nundy from the Ganga Ram Postgraduate institute for Medical Education and research - join Anita Jain to discuss the key issues affecting the region now.
Read all of the open access articles:
http://www.bmj.com/health-in-south-asia
STPs - who, what, why, when, where.
7 april 2017 |
18 min
The NHS Delivery Plan - setting out what’s in store of the English NHS in the coming years, has been delivered by Simon Stevens the chief executive. Key to those are the sustainability and transformation plans (STPs) which have been made in 44 areas, and yet again reorganise care - crucially, this time, with social care included in the mix.
In this podcast Hugh Alderwick, senior policy advisor at the King’s Fund explains what STPs are, and what they're planning, and crucially, the cash involved.
Read the full analysis:
http://www.bmj.com/content/356/bmj.j1541
High integrity child mental healthcare
6 april 2017 |
17 min
Around 1 in 10 children and young people worldwide have mental health difficulties that substantially affect their lives.
Child mental health services often concentrate on risk reduction, at the expense of the wider aspects of a child's wellbeing.
As part of the high integrity healthcare series, this podcast focuses on novel ways of providing support to children and adolescents, and particularly Pause - a city centre drop in centre in Birmingham, England.
Read the full analysis:
http://www.bmj.com/content/357/bmj.j1500
What is high integrity healthcare?
31 mars 2017 |
18 min
This week, a new series starts in The BMJ - the aim is to rethink how hospitals, clinics, community services and public health work - with the aim of stopping the perverse blocks and incentives that prevent doctors, and other healthcare professionals, from providing the care that patients want and need.
Talking to Navjoyt Ladher, are Albert Mulley - professor of medicine at the Dartmouth Institute, and Jane Druce, an evaluations manger, and Donal Collins, a GP - both of whom work in an NHS Vanguard area, where new ways of delivering care are being tested.
Read the full analysis:
http://www.bmj.com/content/356/bmj.j1401
”Watching the world through a clear fog” - recognising depersonalisation and derealisation
31 mars 2017 |
32 min
Transient symptoms of depersonalisation and derealisation - feeling detached from the world, and feeling as if you are watching events at a remove - are common. However for some, persistent symptoms can make the disorder extremely distressing.
In this podcast, Kate Adlington is joined by Elaine Hunter, consultant clinical psychologist, Anthony David, professor of cognitive neuropsychiatry, and by Jane Charlton and Fiona Godlee - who have both experienced depersonalisation/derealisation over a number of years.
Read the full education article:
http://www.bmj.com/content/356/bmj.j745
American healthcare - what next?
29 mars 2017 |
20 min
For seven years, Republicans have vowed to repeal the Affordable Healthcare Act (Obamacare), and that promise took a central place in President Trump's campaign. The first major vote to replace it was due to happen last week, but was cancelled at the 11th hour.
In advance of the potential vote, The BMJ published a debate asking "Should US doctors mourn for Obamacare?". Now we're asking the authors of that debate, what next?
Joining Peter Doshi are Adam Gaffney, from Harvard Medical School and Saurabh Jha from the Hospital of the University of Pennsylvania.
Read their original debate:
http://www.bmj.com/content/356/bmj.j1441
Dying on the canal
24 mars 2017 |
10 min
Lady-Jacqueline Aster lives on a 72 foot canal boat. She's been diagnosed with adrenocortical cancer, and is receiving palliative care and is planning to die in the home she loves.
In this interview The BMJ's patient editor, Rosamund Snow, talks to Lady-Jacqueline about her cancer, her care and her funeral plans - and why planning one's own death can be fun.
Read more about healthcare on the water
http://www.bmj.com/content/356/bmj.j245
Since this recording, Rosamund died by suicide, making these discussions about planning for death more poignant. You can read more about Rosamund's life and work in her obituary.
http://www.bmj.com/content/346/bmj.j850
Education round up - HIV testing, legal highs and care for relatives of the dying
17 mars 2017 |
35 min
The BMJ publishes a lot of educational articles, and in an attempt to help you with your CPD, we have put together this round-up. Our authors and editors will reflect on the key learning points in the articles we discuss, and explain how they may change their practice in light of that new understanding.
In this week's round up we're discussing:
The offer of an HIV screen for an asymptomatic adult
http://www.bmj.com/content/356/bmj.i6656
Two articles on legal highs
Novel psychoactive substances: types, mechanisms of action, and effects
http://www.bmj.com/content/356/bmj.i6848
Novel psychoactive substances: identifying and managing acute and chronic harmful use
http://www.bmj.com/content/356/bmj.i6814
and how to become better at supporting relatives and carers at the end of a patient’s life
http://www.bmj.com/content/356/bmj.j367
Identifying a viral rash in pregnancy
17 mars 2017 |
12 min
Viral exanthema can cause rash in a pregnant woman and should be considered even in countries that have comprehensive vaccination programmes. Measles and rubella can cause intrauterine death. Intrauterine infection with rubella can lead to congenital rubella syndrome in the liveborn baby.
In this podcast, Jack Carruthers, honorary clinical research fellow at Imperial College London joins us to discuss spotting a viral rash, what steps to take to assess cause, and what advice to give a worried parent.
Read the full clinical review:
http://www.bmj.com/content/356/bmj.j512
Nuffield Summit 2017 - Reducing Demand
16 mars 2017 |
53 min
As the NHS strains under pressure from rising patient activity, an ageing population, and financial constraints, The BMJ hosted a discussion on how clinicians should be helping to manage demand at last week’s Nuffield Trust health policy summit.
Taking part are:
- Eileen Burns, president of the British Geriatrics Society
- Andrew Fernando, GP and medical director of North Hampshire Urgent Care
- Candace Imison, director of policy at the Nuffield Trust
- Martin Marshall, vice chair of the Royal College of General Practitioners
- Amanda Philpott, chief officer of two clinical commissioning groups
- Maxine Power, director of innovation and improvement science at Salford Royal NHS Foundation Trust
- Jeremy Taylor, chief executive of the charities’ coalition National Voices
- Judith Smith, director of the Health Services Management Centre
- Ashok Soni, chair of NHS England’s local professional network for pharmacy in London
Listen to all of our other Nuffield Summit Roundtables:
http://www.bmj.com/nuffieldsummit
Emergency care plans at the end of life
8 mars 2017 |
34 min
When a person’s heart or breathing stops and the cause is reversible, immediate cardiopulmonary resuscitation (CPR) offers a chance of life. However, when a person is dying—for example, from organ failure, frailty, or advanced cancer—and his or her heart stops as a final part of a dying process, CPR will not prevent death and may do harm. But conversations around that distinction are difficult.
In a this podcast, we explore the ways in which these conversations go wrong, and give some practical advice on carrying them out better. Joining Helen Macdonald are Zoe Fritz, consultant acute physician, and Wellcome Fellow, David Pitcher, former president of the Resuscitation Council, and Kate Masters, whose mothers death led to a change in the law around DNACPR orders.
Read the articles discussed in this podcast:
Emergency care and resuscitation plans http://www.bmj.com/content/356/bmj.j876
Resuscitation policy should focus on the patient, not the decision
http://www.bmj.com/content/356/bmj.j813
My mum’s care means that decisions not to resuscitate must now be discussed with patients
http://www.bmj.com/content/356/bmj.j1084
Should malaria be eradicated?
7 mars 2017 |
15 min
The World Health Organization, the Roll Back Malaria Partnership, and the United Nations, all have a vision of a malaria-free world. The world has already committed to malaria eradication, albeit without a target date.
Bruno Moonen, deputy director for malaria at the Bill and Melinda Gates Foundation, thinks that for malaria, eradication is the only equitable and sustainable solution.
Where as Clive Shiff, associate professor at the Johns Hopkins Bloomberg School of Public Health, thinks this is a top-down strategy, dependent on massive concentrated funding until finished - funding which could be more effectively spent elsewhere.
In this podcast they debate whether malaria should be eliminated, or eradicated, and how that might work.
Read the full debate:
http://www.bmj.com/content/356/bmj.j916
Palliative care is about life, not death
3 mars 2017 |
15 min
Scott Murray, professor of primary palliative care at the University of Edinburgh, has written, and talked in this podcast before, about the benefits of early palliative care - and today he’s back to explain how illness trajectory, and the pattern of decline at the end of life, affects 4 main areas of wellness - physical, social, psychological and spiritual or existential.
Read his full analysis article:
http://www.bmj.com/content/356/bmj.j878
Community acquired pneumonia in children
2 mars 2017 |
11 min
In 2015, community acquired pneumonia (CAP) accounted for 15% of deaths in children under 5 years old globally and 922 000 deaths globally in children of all ages.
In this podcast Iram Haq, a registrar and clinical research associate in paediatric respiratory medicine, joins us to discuss the definition of pneumonia, how to assess for the infection, and what treatments are effective.
Read the full clinical update:
http://www.bmj.com/content/356/bmj.j686
The inadequacy of the UK’s childhood obesity strategy
2 mars 2017 |
14 min
The UK government published its report Childhood Obesity: a Plan for Action, in August 2016. A new analysis article takes them to task for the inadequacy of that response to a growing problem.
Neena Modi is a professor of neonatal medicine, at Imperial College London, and president of the Royal College of Paediatrics and Child Health, and joins us to discuss what that report should have contained.
Read the full analysis:
http://www.bmj.com/content/356/bmj.j762
Low intensity pulsed ultrasound - no difference for bone healing
24 februari 2017 |
18 min
A new rapid recommendation had concluded that LIPUS makes no different to patients experience of bone healing, and therefore shouldn't be used.
In this podcast, we talk to three of those panel members - Rudolf Poolman, orthopaedic surgeon from The Netherlands, Stefan Schandelmaier, a methodologist from McMaster University, and Maureen Smith, a patient representative.
Read the full recommendation:
http://www.bmj.com/content/356/bmj.j576
How people die remains in the memory of those who live on - supporting the relatives of the dying
21 februari 2017 |
23 min
All doctors, irrespective of their specialty or the setting in which they work, will care for patients who die. Around half of all deaths occur in hospitals.
Evidence suggests that the quality of communication around this process is poorer in hospitals than in other settings, according to responses from relatives who have experienced bereavement. Over half of NHS complaints concern care of the dying.
In this podcast, Katherine Sleeman, clinician scientist and honorary consultant in palliative medicine at King's College London, and Jane Harris, counselling and psychotherapy practitioner, and bereaved mother and daughter join us to discuss what support the carers and relatives of a dying patient need, and give practical advice on how to become better at having those difficult conversations.
Read the full essentials article:
http://www.bmj.com/content/356/bmj.j367
Helping patients with medically unexplained symptoms
17 februari 2017 |
14 min
Persistent physical symptoms are common and include those symptoms that last at least three months and are insufficiently explained by a medical condition after adequate examination and investigation.
Observational studies in primary care report that women, especially those aged 35-45 years, more commonly present with these symptoms.
In this podcast, Madelon den Boeft, a GP and, Nikki Claassen-van Dessel, a GP trainee, both in The Netherlands, join us to explain why listening to a patient is important, and making sure that regular follow up is essential.
Read the full uncertainties article:
http://www.bmj.com/content/356/bmj.j268
US Surgeon General - “For far too long addiction has been looked at as a moral failing”
15 februari 2017 |
32 min
Vivek Murthy, the US surgeon general, has highlighted prescription opioid misuse as a serious public health problem.
In this podcast, Richard Hurley speaks to him about what he thinks needs to be done to tackle the issue.
http://www.bmj.com/content/356/bmj.j715
Should all American doctors be using electronic medical records?
19 januari 2017 |
13 min
Evidence shows using electronic health records can increase efficiency, and reduce preventable medical errors - but only if they are used properly. However, in the US, the president of the American Medical Association calls them almost unusable.
In this debate, Richard Hurley is joined by George Gellert, Regional Medical Informatics Officer at CHRISTUS Santa Rosa Health System and Edward Melnick, Assistant Professor of Emergency Medicine at Yale, who debate whether US doctors should be using electronic medical records.
Read the related article:
http://www.bmj.com/content/356/bmj.j242.
Expanding your mind about novel psychoactives
19 januari 2017 |
25 min
The use of novel psychoactive substances is increasing, however there is little information about what these are, and how they work.
Dr Derek Tracy, consultant psychiatrist at Oxleas NHS Foundation Trust, and David Wood, consultant physician and toxicologist at Guy's and St Thomas' NHS Foundation Trust join us to explain that doctors already know how to deal with these, if they think about them in terms of traditional drug use.
Read the two related articles:
http://www.bmj.com/content/356/bmj.i6814
http://www.bmj.com/content/356/bmj.i6848
Big Data - what effect is it going to have on EBM
19 januari 2017 |
18 min
http://evidencelive.org/manifesto/
The BMJ, and the Centre for Evidence Based Medicine in Oxford have long collaborated to document the problems with the creation and use of Evidence based medicine - and together we host evidence gatherers, synthesisers and users in the conference Evidence Live.
We know what the problems are - but what would positive change, when it comes to the creation and use of medical evidence look like? To find out we’re doing a series of discussions at various places around the world - where we’re talking to people who have a particular insight into one area of the evidence ecosystem. Ultimately we’re collating this into what we’re calling the evidence manifesto.
In this discussion we went to the The Farr Institute which is a of 21 academic institutions and health partners in the UK - whose mission is to deliver high-quality, cutting-edge research using ‘big data”.
Gluten free on the NHS
13 januari 2017 |
19 min
Should gluten-free foods be available on prescription?
A gluten free diet is the main treatment for celiac disease, and gluten-free food has been available on prescription from the NHS. However, as finances become tighter, in some areas patients no longer have that option.
Prescriptions of gluten free food is the same as a prescription for a drug, argues David Sanders, professor of gastroenterology from Royal Hallamshire Hospital, but James Cave lambasts a costly system that frustrates patients and doctors alike. Gemma Gleed is the mother of a child with coeliac disease, who has had her prescriptions cancelled.
Read the debate:
http://www.bmj.com/content/356/bmj.i6810
Surrogate outcomes distorting medicine
6 januari 2017 |
14 min
Surrogate endpoints are commonly used in clinical trials to get quicker results, however Michael Baum, emeritus professor at University College London, worries that by not focusing on real outcomes - length of life, and quality of life - that these are being used to justify expensive treatments which may not benefit patients.
Read the full analysis:
http://www.bmj.com/content/355/bmj.i6286
Nanny state knows best
3 januari 2017 |
15 min
State regulation is necessary for safety, says Simon Capewell, professor of public health and policy at the University of Liverpool. Richard Lilford, professor of public health at the University of Warwick, argues that restricting adults’ choice can undermine such aims.
Read the debate:
http://www.bmj.com/content/355/bmj.i6341
Christmas 2016 - War
23 december 2016 |
27 min
In this year's Christmas BMJ 2016 podcasts, we’ve been discussing morality, compassion, truth. In this final one, it's time for war.
After the second world war, there was an attempt to bring a moral sense to conflict - and Julian Sheather, specialist adviser on ethics and human rights to the BMA, and author of the christmas editorial “medicine under fire” is worried about the retrenchment of those ideals.
http://www.bmj.com/content/355/bmj.i6464
Peter Wever is a doctor in The Netherlands, and has been uncovering the story of the number 10 stationary hospital, in st-omer in northern france - a British army hospital that was targeted and destroyed during the first world war.
http://www.bmj.com/content/355/bmj.i6509
Christmas 2016 - truth, post truth, nothing like the truth
22 december 2016 |
27 min
In response to the turmoil of 2016, with political campaigns being run on, and won on, misinformation - many commentators are disparing that we’ve become a post-truth society. And what is truth anyway?
Tracy Brown, director of Sense about Science, the charity set up to champion evidence in everyday life, is less pessimistic about the public's appetite for evidence.
http://www.bmj.com/content/355/bmj.i6467
Anders Huitfeldt, a postdoctoral scholar at Stanford University School of Medicine, and has been trying to puzzle out “Is caviar a risk factor for being a millionaire?”
http://www.bmj.com/content/355/bmj.i6536
Christmas 2016 - Health and happiness
21 december 2016 |
24 min
Underneath all of our civilisation and science, we’re still primates - and the connection between patient and doctor can be reinforced by simply taking a hand.
Robin Youngson, cofounder of hearts in healthcare, and Mitzi Blennerhassett, who has written extensively on patient engagement, have co-authored an editorial calling for the humanisation of medicine, and we talk to them about the power of touch.
Read the editorial:
www.bmj.com/content/355/bmj.i6262
Andrew Steptoe is the British Heart Foundation professor of psychology, at University College London. He and colleagues have been using a large cohort study to measure the link between overall happiness and health.
Read the full research:
www.bmj.com/content/355/bmj.i6267
Christmas 2016 - ideologies and moralities
16 december 2016 |
33 min
In an ideal world, policies would be evidence based - but governments are made of humans, who have positions and ideologies and moral bases.
In this podcast Anthony Painter, from the RSA will be talking about why universal basic income may work, but who’s proponents cross ideological barriers, and writer and philosopher AC Grayling explains how economic arguments become moral crusades.
A universal basic income: the answer to poverty, insecurity, and health inequality?
http://www.bmj.com/content/355/bmj.i6473
Morality and non-medical drug use
http://www.bmj.com/content/355/bmj.i5850
Education round up - November
7 december 2016 |
36 min
The BMJ publishes a variety of education articles, to help doctors improve their practice. Often authors join us in our podcast to give tips on putting their recommendations into practice.
In this new monthly audio round-up The BMJ’s clinical editors discuss what they have learned, and how they may alter their practice.
In our second audio edition, GPs Sophie Cook and Helen Macdonald, surgical trainee Jessamy Baganel, and internalist and methodologist Reed Siemieniuk, talk about the evidence for vitamin D supplements.
http://www.bmj.com/content/355/bmj.i6201
The new Rapid Recommendation series in the BMJ
http://www.bmj.com/content/354/bmj.i5085
Communication with patients who have learning difficulties, or others who have experienced torture.
http://www.bmj.com/content/355/bmj.i5296
http://www.bmj.com/content/355/bmj.i5019
And safety netting of people with low, but not no, risk of cancer.
Can safety-netting improve cancer detection in patients with vague symptoms?
Caring for renal transplant patients
2 december 2016 |
31 min
Renal transplantation improves quantity and quality of life compared with chronic dialysis. A UK general practice with 8000 patients will have around four patients with a functioning renal transplant, one patient on the transplant waiting list, and several under consideration for transplantation.
Many medical problems in renal transplant recipients will be managed by non-specialist clinicians, and this article provides advice for the non-specialist on managing renal transplant patients.
In this podcast, Tom Nieto, and Paul Cockwell from the Renal Services unit in the, College of Medical and Dental Sciences at the University of Birmingham, join us to discuss how non-specialists can spot problems early, and when it’s appropriate to talk about the potential for transplantation.
Read their full clinical update:
http://www.bmj.com/content/355/bmj.i6158
Margaret McCartney wants to fix the NHS
28 november 2016 |
22 min
Glasgow GP, writer, broadcaster, and The BMJ's weekly columnist Margaret McCartney joins us to talk about her new book "The State of Medicine: Keeping the Promise of the NHS".
Read all of Margaret's columns:
goo.gl/iKmmie
Evidence for vitamin D supplimentation
25 november 2016 |
13 min
Despite high quality systematic reviews reporting ineffectiveness, many guideline groups continue to recommend vitamin D supplementation (with or without calcium) for fall or fracture prevention. Recently Public Health England recommended that everyone needs vitamin D equivalent to an average daily intake of 10 μg (400 IU) to protect bone and muscle health,
In this podcast, Andrew Grey, associate professor of medicine at the University of Aukland joins us to discuss what the evidence says for who should, and who shouldn't take vitamin D supplimentation.
Read the full uncertainties article:
http://www.bmj.com/content/355/bmj.i6201
Blinding the randomisation
18 november 2016 |
12 min
Allocation concealment - blinding which arm of a trial a patient is randomised to - is being questioned in an analysis published on thebmj.com.
David Torgerson, director of the York Trials Unit at the university of York and colleagues have been looking at the way in which trials do this randomisation, and how they subsequently report it - and have found both lacking.
Read the full analysis:
http://www.bmj.com/content/355/bmj.i5663
What to do after a concussion
18 november 2016 |
18 min
Concussion is a clinical diagnosis made after a head injury with consequent associated signs, symptoms, and neurological or cognitive impairment (infographic - http://bmj.co/conrecG). In the absence of strong evidence, most recommendations on the management and recovery from concussion are based on international expert consensus.
In this podcast John Brooks, academic clinical fellow in general practice, and Simon Kemp, chief medical officer for the Rugby Football Union take us through the process of guiding a patient through recovery and back into everyday life, including sport.
Read the full 10 minute consultation:
http://www.bmj.com/content/355/bmj.i5629
Non-drug treatments for chronic insomnia
17 november 2016 |
21 min
Between 13 & 33% of the adult population have regular difficulty in getting to sleep, or staying asleep. It's important to recognise the difference between acute and chronic insomnia, as treatment strategies differ.
David Cunnington, director of the Melbourne Sleep Disorders Centre, joins us to explain what non-drug interventions are available to help those with chronic insomnia.
Read the full clinical review:
http://www.bmj.com/content/355/bmj.i5819
Cancer drugs, survival, and ethics
11 november 2016 |
17 min
Despite considerable investment and innovation, chemotherapy drugs have had little effect on survival in adults with metastatic cancer.
In this podcast, Navjoyt Ladher, clinical editor for The BMJ, talks to Peter Wise, former consultant physician and senior lecturer Imperial College School of Medicine, and author of a recent analysis on TheBMJ.com
Read the full analysis:
http://www.bmj.com/content/355/bmj.i5792
Advertising junk food to children
4 november 2016 |
19 min
In the UK, junk food advertising is banned on children’s TV - but manufactures are still able to target children in other ways. A recent report from the WHO "Tackling food marketing to children in a digital world", takes a look at the issue.
In this podcast we're joined by João Breda, programme manager for nutrition physical activity and obesity at the regional office for Europe of the World Health Organisation, and Mimi Tatlow-Golden, lecturer in childhood studies and developmental psychology at the open university, and the lead author on the report.
Read the full report:
http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/publications/2016/tackling-food-marketing-to-children-in-a-digital-world-trans-disciplinary-perspectives-2016
Research before researching
4 november 2016 |
12 min
To avoid waste of research, no new studies should be done without a systematic review of existing evidence. That argument has been made for 20 years, yet the lack of reference to a systematic review before designing new studies is still a problem.
Hand Lund, professor at the University of Southern Denmark joins us to explain why research before researching is still an issue.
Read the full analysis:
http://www.bmj.com/content/355/bmj.i5440
Rapid Recs - patient preference in heart valve replacement
1 november 2016 |
14 min
In patients with symptomatic severe aortic stenosis but at lower risk of perioperative death, how do minimally invasive techniques compare with open surgery? Prompted by a recent trial, an expert panel produced these recommendations based on three linked rapid systematic reviews.
In this podcast we talk to Michael Shapiro who was a patient representative on that panel about what matters to patients, and how he found taking part in creating the recommendation.
Read the recommendation in full:
http://www.bmj.com/content/354/bmj.i5085
Catherine Calderwood’s realistic medicine
28 oktober 2016 |
20 min
Catherine Calderwood has been chief medical officer for Scotland since March 2015 - her first CMO report, which she titled “Realistic Medicine” has created a stir beyond the borders of Scotland. The BMJ, sat down with Catherine at a the Preventing Overdiagnosis conference to find out what she intended with that report.
Read more:
http://www.bmj.com/content/355/bmj.i5455
Middle East respiratory syndrome
21 oktober 2016 |
20 min
Middle East respiratory syndrome (MERS) is an acute viral respiratory tract infection caused by the novel betacoronavirus.
Cases have been limited to the Arabian Peninsula and its surrounding countries, and to travellers from the Middle East or their contacts.
The clinical spectrum of infection varies from no symptoms or mild respiratory symptoms to severe, rapidly progressive pneumonia, acute respiratory distress syndrome, septic shock, or multiorgan failure resulting in death.
In this podcast Sarah Shalhoub, infectious diseases consultant at King Fahad Armed Forces Hospital, in Saudi Arabia joins us to discuss the history of the disease, clinical presentation, and what can be done to support those infected.
Read the full clinical update:
http://www.bmj.com/content/355/bmj.i5281
Beyond data sharing - ”It was me who got my research team out of jail... that’s my data”
11 oktober 2016 |
22 min
Elizabeth Pisani, visiting senior research fellow at King's College London, collects data on sex workers and injecting drug users in low and middle income countries.
For years she has been sharing her data, and joins us to explain why she went from being protective of her research to to making it freely available - and talk about some of the practicalities of keeping participants anonymous.
Read the full analysis:
http://www.bmj.com/content/355/bmj.i5295
Head to head - Should all GPs be NHS employees?
7 oktober 2016 |
17 min
Independent contractor status creates unnecessary stress, argues Azeem Majeed, GP partner and professor of primary care at Imperial College London.
Laurence Buckman, GP partner and former head of the BMA GP committee, values his autonomy and distance from a non-benign employer.
Read the full head to head:
http://www.bmj.com/content/355/bmj.i5064
We also hear from former columnist and current partner in a federated practice, Des Spence, who thinks that the days of small GP surgeries are numbered.
Independent or employed? There is a third way. . .
http://www.bmj.com/content/355/bmj.i5329
Preventing Overdiagnosis In Barcelona
6 oktober 2016 |
50 min
The Preventing Overdiagnosis conference is part of The BMJ's campaign against Too Much Medicine.
Helen Macdonald clinical editor for The BMJ was at the conference, and talked to some of the key speakers there about what they believe the key issues are, and what's being done to roll back the harms of too much medicine.
http://www.bmj.com/too-much-medicine
http://www.preventingoverdiagnosis.net/
Living kidney donation
23 september 2016 |
19 min
Globally each year more than 30 000 people become living kidney donors. Living kidney donation is constantly evolving, with new ways of pooling donors and recipients to maximise opportunity. With increased numbers, there is increasing information regarding the long term outcomes associated with donation.
Pippa Bailey, clinical lecturer in renal medicine at the University of Bristol, and Aisling Courtney, consultant nephrologist at Belfast City Hospital join us to explain who can donate, to whom, and the possible impact of donation on the donor’s health.
Read the full update:
http://www.bmj.com/content/354/bmj.i4746
The ethics of placebo
16 september 2016 |
19 min
In a clinical trial, we usually think of risk in terms of the new active compound - will it have unwanted effects. However, two analyses in The BMJ are concerned about the risk associated with the control arm.
Robin Emsley is a professor of psychiatry at Stellenbosch University in South Africa, he and colleagues have written about the risk associated with forgoing treatment in patients with schizophrenia.
Read the full analysis: http://www.bmj.com/content/354/bmj.i4728
Jonathan Mendel, lecturer in human geography at the University of Dundee, and Ben Goldacre, senior clinical research fellow at the University of Oxford, have examined the ethical approval given to trials, and are concerned that identified risks are not adequately communicated to patients.
Read the full analysis: http://www.bmj.com/content/354/bmj.i4626
Ghostwriting redefined
9 september 2016 |
12 min
Alastair Matheson, independant consultant and former ghostwriter, describes how the pharmaceutical publications industry seeks to legitimise ghostwriting by changing its definition while deflecting attention from wider marketing practices in academic publishing.
Read his full analysis:
http://www.bmj.com/content/354/bmj.i4578
Reprehensible, but the people carrying out atrocities have very low rates of mental disorders
8 september 2016 |
11 min
Oversimplification and lack of evidence stigmatise people with mental illness and impede prevention efforts, says Simon Wessley, professor of psychiatry at King's College London, in an editorial published on thebmj.com.
Read the full editorial:
http://www.bmj.com/content/354/bmj.i4869
Late effects of anticancer chemotherapy: It’s hard to trust your body, after it’s betrayed you
8 september 2016 |
24 min
Lily was diagnosed at 14 years old with stage four Hodgkin's lymphoma and received six rounds of chemotherapy and two weeks of radiotherapy. She survived but now lives with the long term effects of that therapy - and joins us to discuss how it has impacted her quality of life.
We're also joined by Saif Ahmad and Thankamma Ajithkumar, oncologists from Cambridge University Hospitals NHS Foundation Trust, who give advice for generalists on late effects of anticancer chemotherapy that may affect quality of life.
Read the full clinical review:
http://www.bmj.com/content/354/bmj.i4567
”It suggests that older people have a lower value in society” - Ageism in global development
2 september 2016 |
12 min
The United Nation's Millennium Development Goals, and the subsequent Sustainable Development Goals, define premature mortality as being a death under the age of 70.
As demographic change means more people are living longer than this, Peter Lloyd-Sherlock, professor of social policy and international development at the University of East Anglia, argues that this will lead to discrimination against older people.
Read the full analysis:
http://www.bmj.com/content/354/bmj.i4514
Not just our ethical credibility as a profession, but our shared humanity
30 augusti 2016 |
13 min
"I say to all Australian doctors - young, old, the political and the apolitical - that on this depends not just our ethical credibility as a profession, but our shared humanity. "
Following the leaked emails published in The Guardian newspaper, alleging abuse of asylum seekers detained by the Australian government on the Pacific island of Nauru, David Berger joins us again to say it is time that doctors take a stand and march to protest against this treatment.
Read his full editorial:
http://www.bmj.com/content/354/bmj.i4606
Listen to the head to head debating if doctors should boycott working at the detention centres:
https://soundcloud.com/bmjpodcasts/should-doctors-boycott-working-in-australias-immigration-detention-centres
Education round up - ICE, examinations, and adherence
25 augusti 2016 |
21 min
The BMJ publishes a variety of education articles, to help doctors improve their practice. Often authors join us in our podcast to give tips on putting their recommendations into practice.
In this new monthly audio round-up The BMJ’s clinical editors discuss what they have learned, and how they may alter their practice.
In our first audio edition, GPs Sophie Cook and Helen Macdonald, psychiatry trainee Kate Adlington, and HIV and sexual health trainee Deborah Kirkham talk about communication skills – ICE - obtaining a patient’s ideas, concerns and expectations about their health.
http://www.bmj.com/content/354/bmj.i3729
They also examine the lack of evidence for cardiovascular examination.
http://www.bmj.com/content/354/bmj.i3309
And finally, they talk about how 50% of patients with treatment resistant hypertension may actually be treatment non-adherent, and what that could mean for other conditions.
http://www.bmj.com/content/354/bmj.i3268
A maladaptive pathway to drug approval
19 augusti 2016 |
17 min
The European Medicines Agency (EMA) has embraced a new model of drug testing and marketing called “adaptive pathways”, allowing new drugs for “unmet medical needs” to be launched on the market faster, on the basis of fewer data.
While industry claims this is necessary, an analysis on thebmj.com looks at the assumptions underlying the new pathway, and raises concerns about the negative impact on patient safety and the cost of healthcare.
To discuss, we're joined by Courtney Davis, senior lecturer at King’s College London, Peter Gøtzsche, director of the Nordic Cochrane Centre and Joel Lexchin, a professor at York University in Toronto.
Read the full analysis:
http://www.bmj.com/content/354/bmj.i4437
Evidence for examination
16 augusti 2016 |
16 min
You may have spent hours practicing for your examination exams, but how evidence based are the techniques taught?
Andrew Elder, a professor at the University of Edinburgh, and author of the clinical review “How valuable is physical examination of the cardiovascular system?” joins us to discuss.
Read the full review:
http://www.bmj.com/content/354/bmj.i3309
Andrew also discussed likelihood ratios; which are useful in understanding the relative use of tests in different clinical scenarios: https://soundcloud.com/bmjpodcasts/likelyhood-ratios-in-diagnostic-tests
Likelihood ratios in diagnostic tests
16 augusti 2016 |
8 min
Andrew Elder, a professor at the University of Edinburgh talks about likelihood ratios in diagnostic testing, and how they’re helpful in thinking about how context changes the predictive value of a test.
This is part of a wider discussion on the evidence behind clinical examination of the cardiovascular system https://soundcloud.com/bmjpodcasts/evidence-for-examination
Read the full clinical review:
http://www.bmj.com/content/354/bmj.i3309
Poor adherence to antihypertensives
16 augusti 2016 |
17 min
It is estimated that 50% of patients who have what appears to be treatment resistant hypertension are actually not taking their drugs as prescribed.
Indranil Dasgupta, a consultant nephrologist at the Heart of England NHS Foundation Trust joins us to discuss what factors may influence non-adherence, and how to encourage patients to divulge that information.
Read the full article:
http://www.bmj.com/content/354/bmj.i3268
Anticipatory care
5 augusti 2016 |
17 min
“How long have I got, doc” is a TV medical drama cliche - but like all cliches has it’s feet in real life - and it’s medicine’s attempt to answer these questions that the authors of an analysis article on TheBMJ.com are questioning.
Kirsty Boyd is a consultant in palliative care in NHS lothian, a trainer and a researcher with the University of Edinburgh. Scott Murray is a GP, and St Columba's Hospice Chair of Primary Palliative Care, also at the University of edinburgh. They argue that it’s time to rethink how we talk about prognosis, and what conversations to have as patients become more unwell.
Read the full analysis:
http://www.bmj.com/content/354/bmj.i3802
Ivan Oransky watching retractions
29 juli 2016 |
33 min
Ivan Oransky, co-founder of Retraction Watch and global editorial director at MedPage Today, discusses which areas of science are most affected by research fraud, and what motivates individuals to risk their careers by fabricating data.
How does maximizing shareholder value distort drug development?
28 juli 2016 |
18 min
With the emergence of sofobuvir, a new direct acting antiviral, treatment for Hepatitis C infection is currently undergoing it's greatest change since the discovery of the virus 25 years ago.
However Gilead, who manufacture the treatment, are under fire for the cost of the druge - around $90 000 for a course of treatment.
Victor Roy, doctoral researcher at the University of Cambridge, discusses how the new drug was discovered and came to market, and what happened to the profits from sale.
Read the full analysis:
http://www.bmj.com/content/354/bmj.i3718
What went wrong with care.data?
22 juli 2016 |
13 min
Failures in implementation of data sharing projects have eroded public trust.
In the wake of NHS England’s decision to close down its care.data programme, Tjeerd-Pieter van Staa professor of health e-research at the University of Manchester, examines what lessons must be learnt, and what we can do better next time.
Read the full analysis:
http://www.bmj.com/content/354/bmj.i3636
You’ve been ICE’d
22 juli 2016 |
22 min
We’re taught that patients' ideas, concerns, and expectations are central to a successful consultation, but has ICEing gone too far?
A “What your patient is thinking” article published this week talks about the pressure that asking questions in the wrong way can put on a patient.
Sophie Cook, education editor for The BMJ, is joined by the author of that article - The BMJ’s patient editor, Rosamund Snow, and by Roger Neighbour, former president of the royal college of general practice, and author of "The Inner Consultation".
http://www.bmj.com/content/354/bmj.i3729
Should we scrap the internal market in England’s NHS
15 juli 2016 |
19 min
The "internal market" was created after the 1987 UK general election focused attention on inadequate funding in the NHS, long waiting lists for elective surgery, and large unwarranted variations in clinical care.
Economists attributed these problems to a lack of incentives for efficiency, and the remedies offered included increasing competition in the NHS.
Twenty nine years later, this interesting experiment is not likely to have been worth it, says Alan Maynard, professor emeritus of health economics at the University of York. But Michael Dixon, a GP and commissioner in Devon, says that if properly funded and liberated from some of the administrative burdens of "red tape," the internal market could increase accountability.
Read their full debate:
http://www.bmj.com/content/354/bmj.i3825
Treating hip osteoarthritis
8 juli 2016 |
24 min
2.46 million people in England have osteoarthritis of the hip, and many of those go on to eventually have a hip replacement - which is now widely considered one of the most commonly performed and successful operations in the world.
Jessamy Bagenal, clinical fellow with The BMJ, talks to Nick Aresti, a specialist registrar in trauma and orthopaedic surgery and one of the authors of a clinical update on hip osteoarthritis, recently published on thebmj.com
In a linked podcast, Nick Nicholas, a patient who has hip OA gives us his perspective.
Read the full article:
http://www.bmj.com/content/354/bmj.i3405
Listen to the linked podcast:
https://soundcloud.com/bmjpodcasts/having-hip-osteoarthritis
Having hip osteoarthritis
8 juli 2016 |
13 min
2.46 million people in England have osteoarthritis of the hip, and many of those go on to eventually have a hip replacement - which is now widely considered one of the most commonly performed and successful operations in the world.
Jessamy Bagenal, clinical fellow with The BMJ, talks to Nick Nicholas, an obstetrician who has had OA and one of the authors of a clinical update on hip osteoarthritis, recently published on thebmj.com
In a linked podcast, Nick Aresti, a specialist registrar in trauma and orthopaedic surgery to talks about management of the condition.
Read the full article:
http://www.bmj.com/content/354/bmj.i3405
Listen to the linked podcast:
https://soundcloud.com/bmjpodcasts/treating-hip-osteoarthritis
PreP And public health
8 juli 2016 |
17 min
The drug Truvada, licenced for HIV PrEP, costs £350 a month but is shown to be cost effective in preventing infection. However, in the English NHS, a row has broken out about which body should fund the treatment - NHS England claims local authorities have responsibility, local authorities believe NHS England does.
In this podcast Jim McManus, director of public health at Hertfordshire County Council, explains why he believes local authorities cannot afford the treatment, and describes the pressure that public health budgets are under.
Read the full editorial:
http://www.bmj.com/content/354/bmj.i3515
Can guidelines be reformulated to account for how doctors actually use information?
1 juli 2016 |
20 min
Guidelines usually assume a rational comprehensive decision model in which all values, means, and ends are known and considered. In clinical encounters, however, patients and doctors most often follow “the science of muddling through.
Given that clinical knowledge does not follow the narrow rationality of “if-then” algorithms contained in guidelines, alternatives are desperately needed.
Glyn Elwyn, professor at the Dartmouth Institute for Health Policy and Clinical Practice, joins us to discuss what we know about how doctors and patients use evidence, and what the alternative to guidelines could look like.
Read the full analysis:
http://www.bmj.com/content/353/bmj.i3200
Evidence live - Emily Sena on closing the gap between clinical and basic science
24 juni 2016 |
17 min
When we think about medical evidence, we think of RCTs, registries and meta-analysis. But these EBM tools have yet to filter into the basic science that underpins clinical science.
One person changing that is Emily Sena, research fellow in clinical brain sciences at the University of Edinburgh - and one of the few people who’s trying to meta-analyse animal studies.
Julia Beluz And Victor Montori - Journalists And doctors; separated by a common evidence
23 juni 2016 |
17 min
The same piece of evidence may reach you via a journalist, or via your doctor - but the way in which that evidence is communicated is changed by your relationship between that person.
Julia Beluz from Vox and Victor Montori from the Mayo Clinic join us to discuss if it's possible to reconcile those competing points of view.
Epilepsy in pregnancy
21 juni 2016 |
18 min
In every 1000 pregnancies, between two and five infants are born to women with epilepsy. For such women, pregnancy can be a time of anxiety over maternal and fetal wellbeing.
In 96% of pregnancies they will deliver a healthy child. However, some women will experience an increase in seizure frequency, which can be harmful for the mother or fetus, and evidence comes from observational study and registry data suggests some antiepileptic drugs are associated with an increased risk of congenital and neurodevelopmental abnormalities.
Michael Kinney, specialist registrar in neurology, and James Morrow, principal investigator of the UK and Ireland Epilepsy and Pregnancy Register, both based at the Royal Group of Hospitals in Belfast, join us to discuss how to manage epilepsy in pregnancy.
Read the review:
http://www.bmj.com/content/353/bmj.i2880
For information on joining the UK epilepsy and pregnancy register, call 0800 389 1248 or visit http://www.epilepsyandpregnancy.co.uk/
Caring for patients with delirium at the end of their life
14 juni 2016 |
18 min
Delirium is common in the last weeks or days of life. It can be distressing for patients and those around them. A clinical update explains why successful management involves excluding reversible causes of delirium and balancing drugs that may provoke or maintain delirium while appreciating that most patients want to retain clear cognition at the end of life.
Kate Adlington, clinical editor at The BMJ, is joined by the authors of the paper - Christian Hosker, consultant liaison psychiatrist at Leeds and York Partnership Foundation Trust, and Michael Bennett, professor of palliative medicine at the University of Leeds.
http://www.bmj.com/content/353/bmj.i3085
”What has convinced me is the evidence” - why mandatory treatment for drug use is a bad idea
10 juni 2016 |
12 min
Global evidence indicates that mandated treatment of drug dependence conflicts with drug users’ human rights and is not effective in treating addiction.
Karsten Lunze, associate professor at the Boston University School of Medicine, joins us to describe the evidence, and why he is convinced seemingly counter intuitive hard reduction works.
http://www.bmj.com/content/353/bmj.i2943
Tell me a story
3 juni 2016 |
26 min
How can asking patient to tell us their story improve healthcare? Helen Morant, content lead at BMJ, talks us through her project getting healthcare professionals to sit down with patients and record their conversations, and what on earth this has to do with quality improvement.
We also hear some of the recordings she has gathered through the project.
Here are links to the other podcasts and projects Helen mentions:
Story Corps - https://storycorps.org/
The Listening Project - http://goo.gl/3auSHX
Beautiful stories from anonymous people - http://goo.gl/78QSjU
Guidelines Not Tramlines
27 maj 2016 |
22 min
Julian Treadwell, Neal Maskrey and Richard Lehman join us in the studio to argue that new models of evidence synthesis and shared decision making are needed to accelerate a move from guideline driven care to individualised care.
Read the full analysis:
www.bmj.com/content/353/bmj.i2452
Uncovering the uncertainty on wound dressing
26 maj 2016 |
12 min
There is insufficient evidence to know whether dressings reduce the risk of surgical site infection in closed primary surgical wounds.
Jane Blazeby, professor of surgery at the University of Bristol, and Thomas Pinkney, consultant colorectal surgeon at the University of Birmingham, join us to discusses why there is a lack of evidence, and the implications for patient care.
read the full article:
http://www.bmj.com/content/353/bmj.i2270
Abortion as a development issue
25 maj 2016 |
11 min
Interviews from the Women deliver conference in Copenhagen.
Catrin Schulte-Hillen, co-ordinator of reproductive health and sexual violence care at Medecins Sans Frontieres, explains why the development community shouldn't conflate sexual violence and access to abortion.
Women and the Zika Virus
25 maj 2016 |
8 min
Interviews from the Women deliver conference in Copenhagen.
Donna McCarraher, director of reproductive, maternal, newborn and child health at FHI 360, explains why women should be at the centre of efforts to mitigate the effect of Zika Virus in Brazil.
What are they on?
20 maj 2016 |
14 min
This week, we look at medication reconciliation.
Joshua Pevnick, health services researcher and hospital physician at Cedars-Sinai Hospital, LA, US, talks us through what it is and why it can be so hard to get right.
And Emma Iddles, a junior doctor in general surgery at Hairmyres Hospital, Lanarkshire, UK, explains how her project improved medicines reconciliation in the surgical admissions unit of the hospital.
For more, read Joshua's full paper, http://goo.gl/O59BWo, and Emma's project write up http://goo.gl/znrNGQ.
The Weekend Effect - what’s (un)knowable, and what next?
20 maj 2016 |
54 min
We do we know about the weekend effect? As Martin McKee puts it in an editorial on thebmj.com, "almost nothing is clear in this tangled tale"
In this roundtable, Navjoyt Ladher, Analysis editor for The BMJ is joined by some of the key academics who have published research and commented on the weekend effect to make sense of what we know and don’t know about weekend care in hospitals.
http://www.bmj.com/weekend
Taking part in the discussion are:
Cassie Aldridge, HiSLAC study project manager at the University of Birmingham
Rachel Meacock, research fellow in health economics at Manchester University
Nick Black, professor of health services research at the London School of Hygiene and Tropical Medicine
Paul Aylin, professor of epidemiology and public health at Imperial College London
Nick Freemantle, professor of clinical epidemiology and biostatistics at University College London
Peter Rothwell, professor of neurology at the University of Oxford
”Women deliver, and not only babies”
16 maj 2016 |
24 min
Katja Iversen, CEO of Women Deliver, joins Rebecca Coombes to explain why the UN sustainable development goals are unachievable if we don't empower women and girls to take control of their health, wellbeing, and reproductive rights.
http://womendeliver.org/
Travellers’ diarrhoea
13 maj 2016 |
18 min
Travellers’ diarrhoea is one of the most common illnesses in people who travel internationally, and depending on destination affects 20-60% of the more than 800 million travellers each year. In most cases the diarrhoea occurs in people who travel to areas with poor food and water hygiene.
Mike Brown, consultant in infectious diseases and tropical medicine at the London School of Hygiene and Tropical Medicine, explains the approach to the prevention and treatment of diarrhoea in travellers.
Read the full review:
http://www.bmj.com/content/353/bmj.i1937
”The information we get can be harmfull”; Informed consent is not a panacea
9 maj 2016 |
9 min
Providing information to enable informed choices about healthcare sounds immediately appealing to most of us.
But Minna Johansson, GP trainee and PhD student at the University of Gothenburg, argues that preventive medicine and expanding disease definitions have changed the ethical premises of informed choice and our good intentions may inadvertently advance overmedicalisation.
Read the full analysis:
http://www.bmj.com/content/353/bmj.i2230
The science of improvement
6 maj 2016 |
14 min
Or, the one where Fiona Moss and Don Berwick tells us what they think quality improvement is.
Fiona Moss is dean, Royal Society of Medicine, and Don Berwick is president emeritus and senior fellow, Institute for Healthcare Improvement.
Don's talk and the interview with Fiona were both recorded at the International Forum on Quality and Safety in Healthcare, Gothenburg, April 2016. Watch out for the extended versions of these recordings, up next Friday.
Medical error—the third leading cause of death in the US
4 maj 2016 |
12 min
Medical error is not included on death certificates or in rankings of cause of death. Martin Makary, professor of surgery at Johns Hopkins University School of Medicine, joins us to explain why we don't measure medical error, and why it is so important that we start.
Read the full analysis:
http://www.bmj.com/content/353/bmj.i2139
Ecigarettes; ”...the risk is 5% of that caused by smoking”
29 april 2016 |
15 min
Nicholas Hopkinson, reader in respiratory medicine at Imperial College London, joins us to explain why a new report from the Royal College of Physicians supports the role of electronic cigarettes as part of a comprehensive tobacco control strategy.
Read the full analysis:
http://www.bmj.com/content/353/bmj.i1745
BMJ roundtable: How to fix out of hours care
27 april 2016 |
23 min
The BMJ recently held a discussion between experts in the fields of general practice, emergency medicine, and paediatrics about the state of out of hours care in the UK, and crucially offered their vision for a better service.
Are children a special case, can urgent care ‘hubs’ be a silver bullet, is NHS 111 up to the job of triaging patients, do there enough clinicians involved in out of hours care, and are other countries doing a better job?
The state of out of hours care can best be described as ‘patchy,’ with some, even most, people receiving good and timely care although from a confusing plethora of different bodies - walk-in centres, urgent care centres, out of hours centres, telephone consultation and - that most recognisable of all NHS brands - Accident and Emergency. But there are also very serious deficiencies attributed to core problems identified by our experts below.
Around the table were: Clifford Mann, president of The Royal College of Emergency Medicine and an emergency medicine consultant in Taunton in Somerset; Neena Modi, professor of Neonatal Medicine in the Imperial College, London and president of Royal College of Paediatrics and Child Health; and Professor Martin Roland, professor of Health Service Research at the University of Cambridge and who has 35 years experience as a GP.
Read the write up:
Bad with names
22 april 2016 |
11 min
It's bad practice to prescribe a brand name drug when a cheaper, viable and approved generic is available. But, particularly in the US, this happens too much, at major cost to the health system.
The team behind Michigan State University's paediatric clinics set out to increase their prescribing of generics, and found that much of the problem was that whilst brand names lodged in staff and patient's minds, generic names were easily forgotten.
Sath Sudhanthar, paediatrician and assistant professor in paediatrics, and Kari Chandler, nurse manager, tell Harriet Vickers how they overcame this and tripled the team's generic medication prescription rate.
Read their full report: http://qir.bmj.com/content/4/1/u209517.w3931.full
”The harm and the benefit of treatment is about the same” - cardiac screening for athletes
22 april 2016 |
17 min
Sudden cardiac death of young athletes needs to be avoided but does screening really help? Hans Van Braband, researcher at the Belgian Health Care Knowledge Centre, joins us to explain that the evidence for screening doesn't show benefit, and may lead to harm.
Read the full analysis:
http://www.bmj.com/content/353/bmj.i1156
Doctors in spaaaaaace
15 april 2016 |
30 min
Sheyna Gifford has an unusual claim to fame—she is the first doctor ever to work on Mars. Not the planet Mars, of course, but Mauna Loa, a volcano in Hawaii, whose dusty, rust coloured landscape is probably the closest on earth to the red planet. She is serving on the Hi-Seas programme, a mission run the University of Hawaii and funded by NASA, whose purpose is to simulate a three year voyage to Mars and back.
Since last August Gifford and six other scientists have been living in a 1000 square foot solar powered dome, which they rarely leave. The project is treated as a real mission to Mars so the crew have all the supplies for their year long stay and, because of the time delay between Mars and Earth, they cannot speak to the outside world. They can, however, communicate by email, so Sheyna sent The BMJ this voice file to answer 15 of our questions.
Questions: Anne Gulland
Copyright: Sheyna Gifford, MD, 2016.
The pattern of damage caused by Zika virus in the brains of 23 foetuses
14 april 2016 |
19 min
In February World Health Organization (WHO) declared the microcephaly epidemic in South America an international public health emergency. Today, the US Centers for Disease Control and Prevention, the CDC, has confirmed that it’s is Zika virus which is causing that microcephaly.
The outbreak was originally spotted in Recife, in Brazil, and it’s from there that the authors of this research paper have been carrying out imaging of the skulls of babies born with microcephaly and probable Zika virus infection - to establish patterns of damage in the brain.
We're joined by Maria de Fatima Vasco Aragao, professor of radiology and scientific director of Multimagem Radiology Clinic, Recife. Also, Vanessa Van Der Linden, paediatric neurologist and clinic director of Association for Assistance of Disabled Children Recife.
Read the full research:
http://www.bmj.com/content/353/bmj.i1901
”What’s the point in living, in a body I don’t want” - how the NHS treats trans people
11 april 2016 |
17 min
James Barrett, president of the British Association of Gender Identity Specialists, and Nina, a trans woman, join us to discuss how difficult it can be for trans people to access gender clinics, and what barriers are faced by the community after their transition has been completed.
Read James Barrett's personal view:
http://www.bmj.com/content/352/bmj.i1694
Budget decisions can decrease alcohol deaths in less than 18 months
8 april 2016 |
23 min
Alcohol consumption has been a perennial problem, but recently The economic downturn and rises in alcohol taxation seem to have stemmed the persistent rise in associated mortality.
Nick Sheron, head of clinical herpetology at Southampton university, and one of the authors of an analysis article, explains how government fiscal policy has the ability to immediately reduce alcohol related deaths.
Greenwing cast explain why they’re with the junior doctors
8 april 2016 |
8 min
Abi Rimmer, BMJ careers reporter, talks to the cast of hospital comedy Greenwing, who explain why they're supporting junior doctors on the picket line.
Read her report:
http://bmj.co/1oJ2W41
Why the junior doctors are striking again
8 april 2016 |
6 min
Abi Rimmer, BMJ Careers reporter, talks to junior doctors on the picket line at Northwick Park Hospital.
Read her report:
http://bmj.co/1qydmFq
Mistakes were made
8 april 2016 |
16 min
The Francis report, the Berwick report, the Keogh review - all of these have highlighted how important learning from mistakes is in healthcare.
Reporting incidents is key to this, and in this podcast Jen Perry, from BMJ Quality, tells Harriet Vickers the whats, hows and whys of incident reporting.
And Emily Hotton, previously a foundation doctor at Royal United Hospital Bath, UK, talks about how her project helped junior doctors at the hospital become more confident at incident reporting, and bumped up the number of incidents they logged.
Read Emily's full report: http://qir.bmj.com/content/3/1/u202381.w2481.full
Check out BMJ Quality: http://quality.bmj.com
Plan, do, study, act
8 april 2016 |
14 min
Plan, do, study, act cycles, or PDSA cycles, are the basis of many quality improvement projects, they're a model to trial changes and feed the lessons from each test into the next.
Why are they a popular method, and how do you get the best out of them? And what on earth happens when they explode?
Harriet Vickers asks Julie Reed, National Institute for Healthcare Research CLAHRC (Collaboration for Leadership in Applied Health Research and Care) for north west London.
Read all of Julie's paper (for free): http://qualitysafety.bmj.com/content/25/3/147
Check out BMJ Quality: http://quality.bmj.com
Médecins Sans Frontières’s Dunkirk spirit
31 mars 2016 |
3 min
As France has moved in recent weeks to clear camps where migrants stay while trying to cross illegally into Britain, Médecins Sans Frontières has just opened a new one.
Sophie Arie talks to Caroline Gollé, medical coordinator at the Médecins Sans Frontières La Linière camp.
Read more about the camp:
http://www.bmj.com/content/352/bmj.i1696
How and when to treat depression in pregnancy
24 mars 2016 |
17 min
Depression in pregnancy affects up to 10% of women, a rate only slightly lower than in the postpartum period. Yet, as few as 20% of pregnant women with depression receive adequate treatment.
Louise Howard, professor in women’s mental health at King's College London, joins us to discuss the clinical review on depression in pregnancy.
Read the full article:
http://www.bmj.com/content/352/bmj.i1547
Should doctors boycott working in Australia’s immigration detention centres?
24 mars 2016 |
16 min
However well intentioned, working in detention centres amounts to complicity in torture, says David Berger, a district medical officer in emergency medicine at Broome Hospital in Australia.
However, Steven Miles, chair in bioethics at the University of Minnesota thinks that they play an important role in telling the world about conditions in these camps.
Read the full debate:
http://www.bmj.com/content/352/bmj.i1600
Jeremy Hunt Interview
23 mars 2016 |
20 min
Jeremy Hunt is a health secretary under pressure. In this exclusive interview with The BMJ’s editor in chief Fiona Godlee, the man who could soon become England's longest serving health secretary insists he has more to give.
The steady hand brought in to steer the NHS away from the front pages has been shaking in recent months, but the grip seems to be intact. As he greets The BMJ in his Whitehall office, Jeremy Hunt does not betray the signs of a man buckling under the pressure despite a tumultuous few months that have left many NHS staff feeling downtrodden, battered, and
bruised—and that have brought calls for his resignation after he was rebuked for misrepresenting data published in The BMJ to support the case for seven day working in the NHS.
Read Gareth Iacobucci's report of the interview:
http://www.bmj.com/content/352/bmj.i1632
”I thought I was the worst person with type I...” - Self management of diabetes
14 mars 2016 |
28 min
Nick Oliver, consultant diabetologist at Imperial Healthcare NHS Trust and Philippa Cooper, who has type I diabetes, join us to explain how structured education works for patients, and give tips on self management.
Read the full review:
http://www.bmj.com/content/352/bmj.i998
”We’re pulling the rug out from under the feet of [GPs]”
14 mars 2016 |
11 min
Gareth Iacobucci talks to Candace Imison, director of policy at The Nuffield Trust, about the problems facing GPs, and how primary care could be changed.
"5 minutes with... Candace Imison": http://www.bmj.com/content/352/bmj.i1378
”It’s the workforce, stupid” - is the NHS workforce in crisis?
9 mars 2016 |
37 min
As the junior doctors in England strike, concerns for the workforce are foremost in the minds of those running the NHS.
A summary is available here: http://www.bmj.com/content/352/bmj.i1510
In The BMJ roundtable, recorded at the Nuffield Trust Health Policy Summit on Friday 4 March 2016, we asked our participants if they think the NHS is in crisis, and what they think can be done to help those working across the system.
The participants were Clifford Mann, president of the Royal College of Emergency Medicine, Samantha Barrell, chief executive at Taunton and Somerset NHS Foundation Trust, Candace Imison, director of policy at the Nuffield Trust, Richard Jones, consultant cardiologist, Saira Ghafur, specialist registrar, Neena Modi, president of the Royal College of Paediatrics and Child Health, Claire Lemer, consultant in general paediatrics, Ben Mearns , chief of medicine at Surrey & Sussex Healthcare NHS Trust, Sarah Pickup, deputy chief executive at the Local Government Association, and Jeremy Taylor, chief executive of National Voices.
Zika virus - ”it really felt like having bad sunburn, all over your body”
26 februari 2016 |
28 min
“Juliet”, a woman living in London, was diagnosed with a mysterious illness in November 2015, Ian Cropley, a consultant in infectious disease from The Royal Free London NHS Foundation Trust, was there to investigate.
In this podcast, we find out how Zika, once a little known virus causing a rash and fever, has subsequently become a global health emergency. We also discuss how the infection is linked to microcephaly, and what we still need to understand to control the disease.
All Zika virus resources from BMJ are now freely available on www.bmj.com/freezikaresources.
What is vaginal seeding - and is it safe?
23 februari 2016 |
10 min
How should health professionals engage with this increasingly popular but unproved practice?
Aubrey Cunnington, a consultant paediatrician from Imperial College London joins us to discuss.
Read the full editorial:
http://www.bmj.com/content/352/bmj.i227
Frontline NHS charges for migrants will harm the most vulnerable
19 februari 2016 |
15 min
The Department of Health is proposing to extend charging for migrants into some NHS primary care services and emergency departments.
Although the government asserts that the NHS is “overly generous to those who have only a temporary relationship with the UK,” Lucy Jones, UK lead for Doctors of the World says these proposals will disproportionately harm vulnerable undocumented migrants.
Read the full editorial:
http://www.bmj.com/content/352/bmj.i685
Time to end the federal ban on gun violence research funding
11 februari 2016 |
13 min
In recent weeks, the firearms controversy has again lit up the media in the United States, with clarification that anyone engaged in the business of selling firearms must get a license and conduct background checks.
But, argues Fred Rivara from the Seattle Children’s Research Institute and Harborview Injury Prevention and Research Center, we may never know its effects because of the continuing ban on federal funding of research into gun violence.
http://www.bmj.com/content/352/bmj.i578
Junior doctors second strike - from the picket line
10 februari 2016 |
14 min
This week, junior doctors in England have taken industrial action for the second time in as many months after failing to reach agreement with the government over their proposed new contract.
Tom Moberley and Abi Rimmer, from BMJ Careers, went to the picket lines at Northwick Park Hospital, and University Hospital Lewisham to talk to the doctors, and their supporters.
Keep up to date with the junior doctor's continuing industrial action with our live blog:
http://blogs.bmj.com/bmj/2016/02/08/junior-doctors-strike-february-2016-live-blog/
Stopping the overtreatment of malaria
5 februari 2016 |
18 min
The Rapid diagnostic tests have the potential to reduce the overtreatment of malaria by 95%, but time and extensive logistical, behavioural, and technical interventions may be required to achieve this.
Eleanor Ochodo from the Centre for Evidence-Based Health Care, at Stellenbosch University, joins us to discuss.
Read the full article:
http://www.bmj.com/content/352/bmj.i107
The role of stenting in stable angina
5 februari 2016 |
12 min
Iqbal Malik, consultant cardiologist at Imperial College Healthcare NHS Trust in London, joins Mabel Chew to discuss the role of angioplasty and stenting in patients with stable angina.
Read the full article online:
http://www.bmj.com/content/352/bmj.i205
Exercise induced bronchoconstriction
9 januari 2016 |
23 min
James Smoliga, from High Point University, North Carolina, and Ken Rundell, from The Commonwealth Medical College, Pennsylvania, join us to discuss how to test for, and manage, exercise induced bronchoconstriction, and particularly how to distinguish it from other respiratory conditions.
Read the full review at http://www.bmj.com/content/352/bmj.h6951
Could campaigns like Dry January do more harm than good?
9 januari 2016 |
21 min
Are you having a dry January?
In this podcast Ian Gilmore, honorary professor at Liverpool University, and Ian Hamilton, a lecturer in the Department of Health Sciences at York University, debate whether campaigns such as this have any public health benefit.
Read the full head to head article: http://www.bmj.com/content/352/bmj.i143
CKD In the elderly - disease, or disease label
9 januari 2016 |
15 min
Around half of people aged over 75 meet the diagnostic criteria for chronic kidney disease (CKD), but there is debate about what this means for patients as only a proportion of elderly people with CKD will have clinically important outcomes as a result.
In this podcast, Dr Arif Khwaja argues that for CKD in the elderly, we should focus on patient centered outcomes rather than applying population risks.
Read the full Analysis article: http://www.bmj.com/content/352/bmj.h6559
Cancer screening - does it save lives?
8 januari 2016 |
14 min
The claim that cancer screening saves lives is based on fewer deaths due to the target cancer. Vinay Prasad, assistant professor at Oregon Health and Science University, joins us to argue that reductions in overall mortality should be the benchmark and call for higher standards of evidence for cancer screening.
Read the full analysis:
http://www.bmj.com/content/352/bmj.h6080
Why are Dutch GPs happier than British ones?
8 januari 2016 |
31 min
General practice is similar in the Netherlands and the UK yet it appeals far more to young Dutch doctors than to their British counterparts. In collaboration with the Dutch medical journal Nederlands Tijdschrift voor Geneeskunde, Roger Damoiseaux, professor of general practice, and Margaret McCartney, Glasgow GP and The BMJ columnist, met to try to work out why. Sophie Arie reports
Read the feature:
http://www.bmj.com/content/351/bmj.h6870
In search of the Christmas spirit
15 december 2015 |
15 min
Is the Christmas sprit divinely inspired, or does it reside within the body? Researchers from Denmark have tried to answer that age-old philosophical question with fMRI. Bryan Haddock, medical physicist at Rigshospitalet in Copenhagen joins us to explain what they found.
Read the full research:
http://www.bmj.com/cgi/doi/10.1136/bmj.h6266
The big (research) book of British teeth
15 december 2015 |
8 min
Despite what hollywood says, science has proven that British teeth are actually better than American. Richard Watt, head of the Research Department of Epidemiology and Public Health at UCL explains how they came to that conclusion.
Read the full research:
http://www.bmj.com/cgi/doi/10.1136/bmj.h6543
Gunslingers gait
15 december 2015 |
11 min
A lot of attention has been paid to Russian president Vladimir Putin recently, but a group of researchers from The Netherlands are more interested in his walk than his intervention in Syria. Bastiaan Bloem, medical director of the Parkinson's Centre in Nijmegen, joins us to explain more.
http://www.bmj.com/content/351/bmj.h6141
Diagnosing COPD in primary care
4 december 2015 |
16 min
Francesca Conway, from the Department of Primary Care and Public Health at Imperial College London is co-author of an article on diagnosis of COPD. She joins us to discuss the major guideline recommendations, and highlights where they concur and where they differ.
Read the full article:
http://www.bmj.com/content/351/bmj.h6171
The more you see, the more you eat
3 december 2015 |
14 min
Larger portions of food increase consumption. Theresa Marteau, director of the Behaviour and Health Research Unit at the University of Cambridge, joins us to discuss how government action to tackle portion size and packaging could help reset our appetites and make us thinner.
Read the full analysis:
http://www.bmj.com/content/351/bmj.h5863
Sarah Wollaston - obesity, not a sugary drinks tax, is regressive
2 december 2015 |
16 min
The UK Parliament's Health Select Committee's recent report on childhood obesity says 1 in 5 children are obese by the time they leave school. The committee calls for legislation to turn the tide by taxing sugary drinks, a pre-watershed ban on junk food advertising, and investment in public health.
We joined Sarah Wollaston, conservative MP for Totnes, and chair of the committee for lunch (thai chicken soup) to discuss their recommendations.
The diagnosis and treatment of post-traumatic stress disorder
27 november 2015 |
25 min
PTSD may develop after exposure to exceptionally threatening or horrifying events. About 3% of the adult population has PTSD at any one time, and more than 50% in survivors of rape.
In this podcast Jonathan Bisson, professor of psychiatry at the School of Medicine in Cardiff joins us to talk about the evidence for diagnosis and treatment, and Sarah Cosgrove, the patient author of the paper, discusses her experience of treatment.
Read the full clinical review:
http://www.bmj.com/content/351/bmj.h6161
The evidence on doctors strikes and patient harm
27 november 2015 |
10 min
Doctors considering strike action may worry about the effect on patients. David Metcalfe and colleagues examine the evidence and find that “patients do not come to serious harm during industrial action provided that provisions are made for emergency care.”
Read the full analysis:
http://www.bmj.com/content/351/bmj.h6231
Revisiting the bridge
13 november 2015 |
12 min
In the podcast, we’ll hear from Kevin Hines the survivor of such an attempt, and Alys Cole-King, a psychiatrist who wants to break down the stigma of suicide.
Originally broadcast in 2010
For more on suicide risk assessment and prevention, read our latest clinical review:
http://www.bmj.com/content/351/bmj.h4978
Unexpected findings, with uncertain implications, in research imaging
13 november 2015 |
13 min
When healthy volunteers are scanned as part of a research project, unexpected findings, with uncertain implications, can be thrown up.
Joanna Wardlaw, professor of applied neuroimaging and honorary consultant neuroradiologist at the University of Edinburgh, joins us to discuss how her group deals with these incidental findings, and what volunteers and patients want to happen when they are found.
Read the full analysis:
http://www.bmj.com/content/351/bmj.h5190
This house believes that medicine is the best career in the world.
2 november 2015 |
45 min
Medicine has long been a rewarding career, but doctors say the profession needs to overcome the frustrations of working in the NHS to ensure it remains so.
During the Big Debate at BMJ Live in London last week six speakers argued for and against the motion, “This house believes that medicine is the best career in the world.” After presentations from the six speakers and questions from the floor, the audience voted in favour of the motion.
Arguing the motions are:
Jennie Watson, medical student, Imperial College (for)
Janis Burns, junior clinical fellow, Royal Brompton and Harefield NHS Foundation Trust (against)
Helgi Johannsson, anaesthetic consultant, Imperial College Healthcare NHS Trust(for)
Pete Deveson, GP, Epsom, Surrey(against)
Clare Gerada, medical director, Practitioner Health Programme(for)
Partha Kar, diabetes and endocrinology consultant, Portsmouth Hospitals NHS Trust(against)
edit: To see Pete Devesons slides - check out https://www.youtube.com/watch?v=cfRezS1dZJY
Diagnosis and treatment of diabetic ketoacidosis in adults
30 oktober 2015 |
18 min
Shivani Misra, clinical research fellow and specialist trainee in metabolic medicine from Imperial College London, joins us to discuss diagnosis and management of diabetic ketoacidosis in adults. She talks us through UK and US guidelines, and explains what the latest evidence tells us about prescribing fluid and insulin.
Read the full clinical review:
http://www.bmj.com/content/351/bmj.h5660
Europe’s impending syrup tsunami
29 oktober 2015 |
19 min
Europe's common agricultural policy (CAP) on sugar is due to change, and Emilie Aguirre, from the UKCRC Centre for Diet and Activity Research at the University of Cambridge, argues that an influx of cheap high fructose corn syrup (HFCS, isoglucose) into the European market will have a negative effect on on the health of the continent.
Read the full analysis here:
http://www.bmj.com/content/351/bmj.h5085
Mark Britnell - You have to value your workforce
22 oktober 2015 |
26 min
“The people of the UK are right to treasure their NHS,” writes Mark Britnell in his new book In Search of the Perfect Health System (Palgrave Macmillan). Currently chairman of KPMG Global Health, Britnell has worked in healthcare systems in over 60 countries. For his book he analysed 25 healthcare systems in search of what was working and what wasn’t in times of challenging demographic and economic change. He doesn’t find perfection, but against the others the NHS measures up pretty well.
Buy the book:
http://www.amazon.co.uk/In-Search-Perfect-Health-System/dp/1137496614
The junior doctor protest
21 oktober 2015 |
8 min
Thousands of NHS staff have demonstrated against the government’s threatened “imposition” of an “unsafe and unfair” contract for junior doctors.
At a London rally on Saturday 17 October junior doctors and supporters noisily defended their trade union, as speakers accused England’s health secretary, Jeremy Hunt, of misleading the public about research evidence on weekend mortality rates in hospitals and the nature of contract negotiations.
Matt Limb was there for the BMJ, finding out why junior doctors are so angry.
Read more:
http://www.bmj.com/content/351/bmj.h5572
Are new diabetes drugs approved too easily?
19 oktober 2015 |
25 min
Given the number of effective treatments for type II diabetes, which have good evidence about safety and efficacy, should any new drugs for the condition be subject to a higher regulatory bar?
In this podcast, Huseyin Naci from the London School of Economics, John Yudkin from Univerity College London, and Ben Goldacre from the University of Oxford, explain why they believe the current process is inadequate, and suggest some ways in which it could be improved.
Read the full analysis article:
http://www.bmj.com/content/351/bmj.h5260
Is place of death important to patients?
12 oktober 2015 |
19 min
The current orthodoxy is that home is the best and preferred place of death for most people, but in this podcast, Kristian Pollock a sociologist from Nottingham University questions these assumptions and calls for greater attention to improving the experience of dying in hospital and elsewhere.
Read the full analysis:
http://www.bmj.com/content/351/bmj.h4855
Why do the Scottish do fewer knee arthroscopies?
26 september 2015 |
18 min
The “correct” rates of discretional interventions are difficult to define. However, David Hamilton and Colin Howie point out that discrepancies in usage of knee arthroscopy within the UK suggest the organisation of the care pathway may be an important determinant
Read their full analysis:
http://www.bmj.com/content/351/bmj.h4720
Cardiac rehab
26 september 2015 |
25 min
With improved survival and and ageing population, the number of people living with coronary heart disease in the UK has increased to an estimated 2.3 million. There is increasing evidence that cardiac rehabilitation benefits these patients, and as such it has been included in international clinical guidelines.
To discuss cardiac rehabilitation in this podcast, we're joined by Hasnain Dalal, a GP and honorary clinical associate professor at the University of Exeter Medical School, Rod Taylor, academic lead for Exeter Clinical Trials Support Network and NIHR senior investigator, and Jenny Wingham, a senior clinical researcher in cardiac rehabilitation.
Read the full clinical review online:
http://www.bmj.com/content/351/bmj.h5000
Listen to our podcast with a patient who's been through cardiac rehabilitation: https://soundcloud.com/bmjpodcasts/cardiac-rehab-patient
What it’s like to receive cardiac rehabilitation
26 september 2015 |
13 min
With improved survival and and ageing population, the number of people living with coronary heart disease in the UK has increased to an estimated 2.3 million. There is increasing evidence that cardiac rehabilitation benefits these patients, and as such it has been included in international clinical guidelines.
In this podcast, we're joined by Kevin Paul, who explains what it's like to receive cardiac rehabilitation, and what doctors should be aware of when they recommend it to patients.
Read the full clinical review online: http://www.bmj.com/content/351/bmj.h5000
How scientific are US dietary guidelines?
25 september 2015 |
15 min
They have a big impact on the diet of American citizens, and those of most Western nations, so why does the expert advice underpinning US government dietary guidelines not take account of all the relevant scientific evidence asks Nina Teicholz.
Read the full investigation:
http://www.bmj.com/content/351/bmj.h4962
Dengue fever
24 september 2015 |
8 min
Around two fifths of the world’s population (those in tropical and subtropical countries), or up to 2.5 billion people, are at risk of dengue infection.
An estimated 50 million infections occur annually worldwide, with 0.5 million of these cases being admitted to hospital for dengue haemorrhagic fever. Approximately 90% of these cases are in children aged less than 5 years. The epidemiology is, however, changing both regionally and globally.
In this podcast, Senanayake A M Kularatne, senior professor of medicine at the University of Peradeniya in Sri Lanka, joins us to discuss which symptoms should make doctors consider a diagnosis of Dengue fever.
Read the full clinical review:
http://www.bmj.com/content/351/bmj.h4661
Read the best practice monograph:
http://bestpractice.bmj.com/best-practice/monograph/1197.html
They drained 92L from me - diagnosis and management of pleural effusion
10 september 2015 |
23 min
Pleural effusions are common, with an estimated 1-1.5 million new cases in the United States and 200 000-250 000 in the United Kingdom each year.
Rahul Bhatnagar, academic clinical lecturer at the University of Bristol, describes how pleural effusions may be investigated and treated in the community and secondary care, with a particular focus on the emerging phenomenon of ambulatory management.
We're also joined by Ron who boasts that he could have filled his car twice over, with the fluid drained over the two years he had a catheter in situ.
Read the full clinical review:
http://www.bmj.com/content/351/bmj.h4520
Being diagnosed with ovarian cancer
9 september 2015 |
26 min
Ovarian cancer is the 7th most common cancer in women world wide, and 5 year survival continues to remain low - in the UK this has been attributed to delayed diagnosis.
In this podcast Sophie Cook is joined today by two women who have had, and been treated for, ovarian cancer. Adele and Rosemary describe their experience, and what they think doctors should know about what patients are feeling.
Read the full clinical review:
www.bmj.com/content/351/bmj.h4443
Listen to the podcast on diagnosing ovarian cancer:
https://soundcloud.com/bmjpodcasts/diagnosing-ovarian-cancer
Diagnosing ovarian cancer
8 september 2015 |
16 min
Ovarian cancer is the 7th most common cancer in women world wide, and 5 year survival continues to remain low - in the UK this has been attributed to delayed diagnosis.
In this podcast Sudha Sundar, senior lecturer in gynaecological oncology at the University of Birmingham, discusses how doctors can identify women at risk, and who to refer for specialist evaluation.
Read the full clinical review:
http://www.bmj.com/content/351/bmj.h4443
Find out what patients are experiencing:
https://soundcloud.com/bmjpodcasts/being-diagnosed-with-ovarian-cancer
A research agenda for medical overuse
2 september 2015 |
10 min
Although overuse in medicine is gaining increased attention, many questions remain unanswered.
At the Preventing Overdiagnosis conference in Washington, Dan Morgan, associate professor at the University of Maryland School of Medicine, and Sanket Dhruva, research fellow at Yale University, propose an agenda for coordinated research to improve our understanding of the problem.
Read the full agenda at:
http://www.bmj.com/content/351/bmj.h4534
Diagnosis and treatment of hepatic encephalopathy
14 augusti 2015 |
24 min
Hepatic encephalopathy constitutes a spectrum of neuropsychiatric abnormalities, beginning with subtle psychomotor changes and progressing to confusion with asterixis, somnolence, and then coma, arising in patients with impaired liver function.
In this podcast, Tim Cross, a consultant hepatologist from the Royal Liverpool University Hospital, describes how to diagnose and manage the condition.
We're also joined by Ralph Crawford, who suffers from hepatic encephalopathy, to talk about the burden of the disease and the treatment from a patient's perspective.
Read the full review:
http://www.bmj.com/content/351/bmj.h4187
Open Doors For Sex Workers
14 augusti 2015 |
17 min
Following on from the clinical review "Caring for sex workers", we spoke to the team at Open Doors, a sex worker outreach clinic in east London, run from the Homerton University Hospital NHS Foundation Trust.
Kim Leveret and Anca Doczi join us to give practical advice on reaching out to sex workers, what barriers exist to them accessing care, and how to take a sex worker sexual history.
Listen to the author of the clinical review, Michael Rekart, talk about the infectious disease side of sex worker health in our accompanying podcast:
https://soundcloud.com/bmjpodcasts/sex-worker-health
Read the full review:
http://www.bmj.com/content/351/bmj.h4011
Practical advice for sex workers and health professionals, including links to Ugly Mugs:
http://www.opendoors.nhs.uk/
The historic reasons for high abortion rates in Romania, from the journal of family planning and reproductive healthcare:
https://soundcloud.com/bmjpodcasts/romanian-womens-fertility
Sex worker health
10 augusti 2015 |
15 min
Sex workers are unique population with specific health needs, caring for them can present non-specialists with a challenge, and there are important health promotion opportunities which should no be missed.
Michael Rekart, clinical professor of infectious disease at the University of British Columbia, joins us to discuss his clinical review on caring for sex workers.
Read the full article:
http://www.bmj.com/content/351/bmj.h4011
Listen to outreach workers from Open Doors, a sex worker healthcare initiative in east London, give practical tips on caring for sex workers:
https://soundcloud.com/bmjpodcasts/open-doors-for-sex-workers
The system can abuse older people too
24 juli 2015 |
17 min
Elder abuse is often the result of the organisation of health systems rather than the fault of individuals, argue Jolanda Lindenberg and Rudi Westendorp, two authors of a recent analysis paper.
They call for system abuse to be acknowledged and addressed by incorporating older people’s views when designing health services.
Read the full analysis:
http://www.bmj.com/content/350/bmj.h2697
Tackling racism in the NHS
23 juli 2015 |
22 min
For decades research has shown that discrimination, harassment, and exclusion are pervasive experiences for staff from black and minority ethnic (BME) backgrounds in the National Health Service.
In this podcast, the authors of a recent analysis article in The BMJ talk about the evidence for discrimination, what the NHS has done and is doing, and what has worked to promote equality in the wider world.
Read their full analysis at:
http://www.bmj.com/content/351/bmj.h3297
Should doctors recommend homeopathy?
14 juli 2015 |
17 min
A recent review by the Australian National Health and Medical Research Council concluded that “there are no health conditions for which there is reliable evidence that homeopathy is effective”, but Europe currently spends €1bn annually on such remedies - often at the recommendation of doctors.
So a recent head to head debate in The BMJ asks, should doctors recommend homeopathy? Peter Fisher, director of research, Royal London Hospital for Integrated Medicine argues yes, and Edzard Ernst, emeritus professor of complementary medicine at the University of Exeter argues no.
Read their full arguments:
http://www.bmj.com/content/351/bmj.h3735
Rheumatic fever - diagnosis and treatment
14 juli 2015 |
13 min
Many doctors may believe that acute rheumatic fever is a disease of the past, but it's estimated that, worldwide, there are 500,000 new annual cases, and that 15 million have chronic rheumatic heart disease.
Rachel Helena Webb, paediatric infectious diseases specialist at the Starship Children’s Hospital in Auckland, joins us to discuss diagnosis and management of this condition.
Read the full clinical review:
http://www.bmj.com/content/351/bmj.h3443
Tarnished GOLD - diagnosing COPD
13 juli 2015 |
19 min
Read the full analysis:
http://www.bmj.com/content/351/bmj.h3021
The prevalence and mortality of chronic obstructive pulmonary disease (COPD) is increasing globally.
However, Martin Miller, honorary professor of medicine at the University of Birmingham, and Mark Levy, GP with a special interest in respiratory medicine, argue that the GOLD (Global Initiative for Obstructive Lung Disease) criteria used for diagnosis may be leading to misdiagnosis.
GI bleeding, slow to diagnose, slow to treat
3 juli 2015 |
9 min
The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has been examining the treatment of acute GI bleeds in England's NHS.
Two of the authors, Martin Sinclair, consultant surgeon, and Simon McPherson, consultant vascular radiologist, join us to talk about their findings.
Read the full report:
http://www.ncepod.org.uk/gih.htm
Read The BMJ news story:
http://www.bmj.com/content/351/bmj.h3488
The trials and tribulations of peer review
30 juni 2015 |
31 min
Bias and peer review are of universal importance to all those that produce scholarly work. Fiona Godlee and Rob Tarr, editors in chief of The BMJ and JNIS respectively, share their insights and experience on these highly topical issues with Joshua Hirsch.
Read the related paper: http://jnis.bmj.com/content/early/2015/04/17/neurintsurg-2015-011781.full
How GPs can help carers looking after patients with
23 juni 2015 |
10 min
By 2050 an estimated 135 million people worldwide will have dementia. Of all chronic diseases, dementia is one of the most important contributors to dependence and disability.
In this part of a 2-part podcast, Sue, who cared for her mother who had dementia, and Louise Robinson, GP and professor of primary care at Newcastle University, join us to discuss what GPs can do to support carers.
Listen to part 1 of the podcast:
https://soundcloud.com/bmjpodcasts/diagnosis-and-management-of-dementia
Read the full clinical review:
http://www.bmj.com/content/350/bmj.h3029
Time to target older women for cervical cancer screening?
23 juni 2015 |
15 min
Cervical screening programmes in many countries stop at around the age of 65 and much of the focus is often on younger women. However, comparatively little attention has been given to older women despite the fact that they account for about a fifth of cases each year and half of deaths.
In this podcast Susan Sherman, a senior lecturer in psychology at Keele University, and Esther Moss, consultant gynaecological oncologist at University Hospitals of Leicester NHS Trust, argue that the upper age limit for cervical screening needs revisiting and call for awareness campaigns to target older as well as younger women.
Read the full analysis:
http://www.bmj.com/content/350/bmj.h2729
Diagnosis and management of dementia
23 juni 2015 |
16 min
By 2050 an estimated 135 million people worldwide will have dementia. However, increasing evidence showing that dementia may be preventable.
In this part of a 2-part podcast, Sue, who cared for her mother who had dementia, and Louise Robinson, GP and professor of primary care at Newcastle University, join us to discuss how to diagnose and manage the condition.
Listen to part 2 of the podcast:
https://soundcloud.com/bmjpodcasts/how-gps-can-help-dementia-carers
Read the full clinical review:
http://www.bmj.com/content/350/bmj.h3029
QOF, what is it good for?
15 juni 2015 |
13 min
Martin McShane, medical director of long term conditions at NHS England, questions the validity of the Quality and Outcomes Framework and suggests how it should change in the future.
Read the related article:
http://www.bmj.com/content/350/bmj.h2540
Rethinking caesarean delivery
12 juni 2015 |
17 min
Caesarean delivery can improve maternal and child health, and even save lives. But recent research points to latent risks for chronic disease: children delivered by caesarean have a higher incidence of type diabetes, obesity, and asthma.
Jan Blustein, from New York University, joins us to discuss why she and colleage Jainmeng Liu believe this evidence should be examined and taken into account when considering elective caesarean.
Read their full analysis:
http://www.bmj.com/content/350/bmj.h2410
Methodological gloss won’t fix a rubbish evidence base
11 juni 2015 |
12 min
Information on the effectiveness and safety of healthcare should be valid, precise, up to date, clear, and freely available. Currently none of these criteria are fully satisfied, and Cochrane systematic reviews are not the solution.
Ian Roberts, co-director of the clinical trials unit at the London School of Hygiene and Tropical Medicine, joins us to describe what the Cochrane Injuries Group is doing to address some of these problems.
Read the full analysis article:
http://www.bmj.com/content/350/bmj.h2463
They want to say something on health . . . so what can you fish up?
3 juni 2015 |
16 min
In Glaziers and Window Breakers: the Role of the Secretary of State for Health in Their Own Words, published by the Health Foundation, Nicholas Timmins and Edward Davies find out what 10 of our recent health secretaries think the job is about.
Read the feature on The BMJ
http://www.bmj.com/content/350/bmj.h2954
bmj.com at 20
22 maj 2015 |
20 min
The BMJ website is 20 years old this week - the first general medical journal online. Launch editor Tony Delamothe discusses with fellow digital pioneers Richard Smith and John Sack how the internet transformed doctors’ reading habits and the journal’s international reach. David Payne reports
www.bmj.com/twenty
The BMJ requires data sharing on request for all trials
22 maj 2015 |
12 min
The movement to make data from clinical trials widely accessible has achieved enormous success, and it is now time for medical journals to play their part. From 1 July The BMJ will extend its requirements for data sharing to apply to all submitted clinical trials, not just those that test drugs or devices.
The BMJ's Elizabeth Loder explains what this means for authors, and how we expect researchers to make their data available.
Read the full editorial:
http://www.bmj.com/content/350/bmj.h2373
ADHD in childhood - diagnosis
21 maj 2015 |
12 min
Attention deficit hyperactivity disorder, or ADHD, presents with persistent symptoms of inattention, hyperactivity, and impulsivity causing impairment in multiple settings. It is a disorder that attracts considerable debate and controversy.
The this part of this podcast, focused on the diagnosis of ADHD, two of the authors of the review, Mina Fazel, consultant psychiatrist at Oxford University Hospitals NHS Trust, and Nienke Verkuijl, specialty trainee at the University of Oxford and Rachel, a parent of a child who has a diagnosis of ADHD.
Read the full review:
http://www.bmj.com/content/350/bmj.h2168
Listen to the second part of the podcast:
https://soundcloud.com/bmjpodcasts/adhd-in-childhood-treatment
ADHD in childhood - treatment
21 maj 2015 |
24 min
Attention deficit hyperactivity disorder, or ADHD, presents with persistent symptoms of inattention, hyperactivity, and impulsivity causing impairment in multiple settings. It is a disorder that attracts considerable debate and controversy.
The this part of this podcast, focused on the treatment of ADHD, two of the authors of the review, Mina Fazel, consultant psychiatrist at Oxford University Hospitals NHS Trust, and Nienke Verkuijl, specialty trainee at the University of Oxford and Rachel, a parent of a child who has a diagnosis of ADHD.
Read the full review:
http://www.bmj.com/content/350/bmj.h2168
Listen to the second part of the podcast:
https://soundcloud.com/bmjpodcasts/adhd-in-childhood-diagnosis
Speech difficulties in preschool children
15 maj 2015 |
17 min
Speech and language therapists Cristina McKean and Angela Morgan join us to discuss their clinical review "Identifying and managing common childhood language and speech impairments", published on thebmj.com.
They talk about the prevalence, the steps to take if parents believes their child has a speech problem, and the importance of knowing which resources are locally available to support children.
Read the full review:
http://www.bmj.com/content/350/bmj.h2318
Infectious mononucleosis FAQs
29 april 2015 |
21 min
Paul Lennon, a specialist registrar at University Hospital Limerick, and Michael Crotty, general practitioner from the Synergy Medical Clinic in Canada, join Emma Parish to answer some frequently asked questions about infectious mononucleosis.
Read their full clinical review:
http://www.bmj.com/content/350/bmj.h1825
The health debate - the analysis
23 april 2015 |
45 min
The future of health and social care looks certain to be a defining issue in the forthcoming UK general election. Social care has been subject to deep public spending cuts, raising concerns about the sustainability of services in the future. Whoever wins the next election will need to grapple with providing joined up health and social care services in an era of continued austerity.
A recent debate (heathdebate.net) with key spokespeople from across the political spectrum took place this week, and we assembled a panel of experts to discuss how they think the debate went, and the key promises and gaps in the parties plans for the NHS.
Taking part were:
Fiona Godlee, editor in chief of The BMJ
Jeremy Taylor - chief executive of National Voices
Johnny Marshall - director of policy at the NHS Confederation
Jane Dacre - president of the Royal College of Physicians
Anita Charlesworth - chief economist at the Health Foundation
Mark Porter - chair of council at the BMA
Nigel Edwards - chief executive of the Nuffield Trust
Chris Ham - chief executive of The King's Fund
For more analysis of the election's health promises, read Gareth Iacobucci's Election Watch column: http://www.bmj.com/content/350/bmj.h2165
Management of a multiple sclerosis relapse
16 april 2015 |
20 min
Nicki Ward-Abel, a lecturer practitioner in MS at Birmingham City University, joins us to explain how to treat patients who are experiencing a relapse of their MS symptoms. She discusses what constitutes a relapse, which treatments are available, and what effect a relapse can have on a patient.
Read more at:
http://www.bmj.com/content/350/bmj.h1765
Health apps for well people - problematic or panacea?
15 april 2015 |
18 min
Some apps have the potential to encourage healthier habits and are accessible to most people, argues Iltifat Husain, but Des Spence notes the lack of any evidence of effectiveness and the potential for encouraging unnecessary anxiety.
Read more about in our head to head "Can healthy people benefit from health apps?" - http://www.bmj.com/content/350/bmj.h1887
Foodbanks - is supply or demand increasing their usage
9 april 2015 |
14 min
Doctors are witnessing increasing numbers of patients seeking referrals to food banks in the United Kingdom. Rachel Loopstra, a post-doctoral researcher at the University of Oxford and colleagues have been asking if that rise is due to supply or demand?
Read their full analysis:
http://www.bmj.com/content/350/bmj.h1775
How to talk to a patient about delusional infestation
2 april 2015 |
25 min
Peter Lepping, consultant psychiatrist and honorary professor at Betsi Cadwaladr University Health Board in North Wales, joins us to discuss his experience dealing with patients who have delusional infestations. He talks about how to broach the diagnosis, and gives practical tips on how to investigate this difficult condition.
Read his practice pointer:
http://www.bmj.com/content/350/bmj.h1328
Withdraw the interim report on the UK’s billion unit pledge
26 mars 2015 |
21 min
Flaws in the Department of Health’s interim evaluation of an alcohol industry pledge to remove one billion alcohol units from the market raise questions about the claimed success argue John Holmes, Colin Angus and Petra Meier from the Sheffield Alcohol Research Group at the University of Sheffileld. They say that the report should be withdrawn and revised targets set
Read the full analysis:
http://www.bmj.com/content/350/bmj.h1301
Preventing sudden cardiac death in athletes
20 mars 2015 |
17 min
Sudden cardiac death in athletes aged less than 35 years is the leading cause of medical death in this subgroup, with an estimated incidence of 1 in 50 000 to 1 in 80 000 athletes per year. it is most commonly caused by an underlying genetic heart disorder, such as hypertrophic cardiomyopathy.
In this podcast Christopher Semsarian, professor of medicine at the University of Sydney, joins us to discuss the diagnosis of cardiac changes and prevention of death in this population.
Read the full clinical review:
http://www.bmj.com/content/350/bmj.h1218
Trigeminal neuralgia - the evidence base for medical and surgical treatments
18 mars 2015 |
27 min
A BMJ Clinical Evidence systematic overview looks at the evidence for medical and surgical treatments of trigeminal neuralgia, and the uncertainties that exist due to gaps in the evidence. This has been summarised in The BMJ.
The authors of the overview and bmj.comsummary, Prof. Joanna Zakrzewska from the Facial Pain Unit at the Eastman Dental Hospital, London, and Mark Linskey, Professor of Neurological Surgery at the University of California Irvine, discuss the evidence, the issues around it, and put this all into a clinical context.
Read the full systematic overview:
http://clinicalevidence.bmj.com/x/systematic-review/1207/overview.html
Disclaimer:
The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions.
By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.
BMJ does not warrant the accuracy of the information contained in the podcast and to the fullest extent permitted by law, BMJ Publishing Group Limited is not responsible for any loss whatsoever resulting from the application of, or reliance upon, the information contained in this podcast.
Thrombolysis in acute ischaemic stroke - time for a rethink?
18 mars 2015 |
16 min
In the US the licence, or marketing authorisation, for alteplase is limited to 0-3 hours after onset of stroke, but some other countries - including the UK and Australia - have extended the licence to 4.5 hours.
In an analysis article on thebmj.com Brian Alper, vice president of evidence based medicine research and development at Dynamed, and colleagues, interpret the evidence to suggest increased mortality with uncertain benefit for its use beyond three hours.
Read their full analysis:
http://www.bmj.com/content/350/bmj.h1075
Chris Moulton A and E - patients are usually justified in presenting as an emergency
11 mars 2015 |
2 min
Chris Moulton is VP of the Royal College of Emergency Medicine and an A&E consultant in the Royal Bolton Hospital.
He believes that the majority of patients who attend A&E cannot be adequately treated elsewhere, and that measures to try and reduce emergency presentations may be counterproductive.
If you would like to contribute to this collection, please email a brief audio recording to [email protected] or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.
Katherine Henderson A and E consultant - lack of ward beds is hitting A and E the hardest
11 mars 2015 |
3 min
Katherine Henderson is the clinical lead of the emergency department at St Thomas's hospital in London.
She worries that lack of ward space is having a domino effect throughout A and E and is the cause of increased waiting time for both patients and ambulances.
If you would like to contribute to this collection, please email a brief audio recording to [email protected] or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.
Obioma Ezekobe GP - patients need to be educated about resources
11 mars 2015 |
2 min
Obioma Ezekobe is a GP in an urgent care centre in Central Middlesex Hospital.
She believes that the public need to be educated about the use of NHS resources, and be taught when it is appropriate to seek care.
If you would like to contribute to this collection, please email a brief audio recording to [email protected] or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.
Patrick Keating GP - under pressure to increase list size
11 mars 2015 |
1 min
BMJ Voices is a collection of readers’ experiences of working in the NHS. For this, The BMJ is seeking short audio submissions from UK listeners. These submissions will be published on thebmj.com.
Patrick Keating, a GP from Enfield, is concerned that small practices are under pressure to increase list size, but aren't able to muster resources to meet this increased demand.
If you would like to contribute to this collection, please email a brief audio recording to [email protected] or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.
Has the balance of screening for AAA tipped towards harm?
6 mars 2015 |
8 min
Abdominal aortic aneurysms (AAA) are usually asymptomatic until they rupture, which is fatal in more than 80% of cases.
Screening aims to detect the aneurysm before it ruptures, enabling preventive surgery and hence reducing morbidity and mortality. However, preventive surgery has a mortality of 3.9-4.5%.
As the prevalence of risk factors, ie smoking, decreases and the definition of the condition is expanded, Minna Johansson from the University of Gothenburg and colleagues wonder if the balance of benefit and harm may have tipped.
Read the full analysis:
http://www.bmj.com/content/350/bmj.h825
Nuffield summit - Ashish Jha explains Acountable Care Organisations
5 mars 2015 |
7 min
Ashish Jha, professor of health policy and management at Harvard School of Public Health, talking about how the Affordable Care Act has fostered new models of integrated service delivery in the United States
Read more from the summit:
http://www.bmj.com/content/350/bmj.h1172
Nuffield summit - Bastiaan Bloem on parkinsons.net
5 mars 2015 |
14 min
Bastiaan Bloem, consultant neurologist at Radboud University Nijmegen Medical Centre, Netherlands, discussing his revolutionary approach to patient centred care.
Read more from the summit:
http://www.bmj.com/content/350/bmj.h1172
How to diagnose overdiagnosis
5 mars 2015 |
17 min
Overdiagnosis means different things to different people. Stacy Carter, associate professor at the Centre for Values, Ethics and the Law in Medicine at the University of Sydney argues that we should use a broad term such as too much medicine for advocacy and develop precise, case by case definitions of overdiagnosis for research and clinical purposes.
Read the full analysis article:
http://www.bmj.com/content/350/bmj.h869
For the full overdiagnosis digital edition:
http://www.bmj.com/specialties/digital-theme-issue-overdiagnosis
Overdiagnosis in breast cancer - 45 years to become a mainstream idea
4 mars 2015 |
21 min
In this podcast Alexandra Barratt, professor of public health at the University of Sydney, discusses how questions about overdiagnosis in breast cancer screening programmes were first raised 45 years ago, and why it has taken so long for the concept to become mainstream.
Read her full analysis:
http://www.bmj.com/content/350/bmj.h867
Roundtable: Hopes for the NHS, the election and beyond
27 februari 2015 |
45 min
The BMJ held a breakfast roundtable at the annual health policy summit held by the Nuffield Trust think tank to explore some of the key policy discussions that took place during the proceeding day. These included NHS England chief executive Simon Stevens' five year plan, whether politics can be removed from the NHS, and what the creation of a central unit to coordinate care for Manchester means for the rest of the NHS in England.
Chaired by Fiona Godlee, editor in chief of The BMJ, the particpants were:
Richard Jones - Clinical director of the Wessex Cardiovascular Strategic Clinical Network
Suzie Bailey - Development director at health service regulator Monitor
Jonathan Michael - chief executive of Oxford University Hospital NHS Trust
Steve Field - Chief inspector of general practice for the Care Quality Commission
Nigel Edwards - Chief executive of The Nuffield Trust
Jeremy Taylor - Chief executive of health and care charity National Voices
Massoud Fouladi - Chief medical officer of Circle Partnership
Rebecca Rosen - GP and clinical commissioner of Greenwich Clinical Commissioning Group, London
Jennifer Dixon - Chief executive of the Health Foundation
Assessment and management of alcohol use disorders
19 februari 2015 |
34 min
As the level of alcohol consumption goes up, so the risk of physical, psychological, and social problems increases.
In this podcast we’re joined by Ed Day, consultant addiction psychiatrist at Kings College London, Alex Copello, professor of addiction research at the University of Birmingham, and Martyn Hull, GP with a special interest in substance misuse at the Ridgacre Medical Centres in Birmingham.
They discuss practical aspects of the assessment and treatment of alcohol use disorders from the perspective of the non-specialist hospital doctor or general practitioner.
Read the full clinical review:
http://www.bmj.com/content/350/bmj.h715
Jackie Applebee GP - the funding formula is hurting deprived practices
13 februari 2015 |
5 min
Jackie Applebee is a GP in Tower Hamlets in London, and is concerned that the way the GP funding formula is working doesn't take account of the earlier health needs of people in deprived areas.
For more about the Tower Hamlets Save Our Surgery campaign, visit their facebook page https://www.facebook.com/SaveOurGPsurgeries
BMJ Voices is a collection of readers’ experiences of working in the NHS. For this, The BMJ is seeking short audio submissions from UK listeners. These submissions will be published on thebmj.com.
If you would like to contribute to this collection, please email a brief audio recording to [email protected] or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.
Michelle Sinclair GP - surgery buildings are not up to scratch
13 februari 2015 |
3 min
Michelle Sinclar, a GP in Hampshire who is concerned that GP premises aren't fit for purpose and limit her ability to provide fully rounded patient care.
BMJ Voices is a collection of readers’ experiences of working in the NHS. For this, The BMJ is seeking short audio submissions from UK listeners. These submissions will be published on thebmj.com.
If you would like to contribute to this collection, please email a brief audio recording to [email protected] or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.
Mark Folman GP - time pressure and patient care
13 februari 2015 |
3 min
Mark Folman, a GP in Nottinghamshire, is concerned that more and more work, with more and more patients, means less time with those who really need him.
BMJ Voices is a collection of readers’ experiences of working in the NHS. For this, The BMJ is seeking short audio submissions from UK listeners. These submissions will be published on thebmj.com.
If you would like to contribute to this collection, please email a brief audio recording to [email protected] or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.
Patient spotlight - How can we get better at providing patient centred care?
10 februari 2015 |
78 min
Participants in our discussion on person centred care in January
agreed that a change in culture and better use of technology
could benefit both patients and doctors.
At the roundtable:
Fiona Godlee (chair), editor in chief, The BMJ
Tessa Richards, senior editor, patient partnership, The BMJ
Rosamund Snow, patient editor, The BMJ
Navjoyt Ladher, clinical editor, The BMJ
Angela Coulter, director of global initiatives, Informed Medical Decisions Foundation (www.informedmedicaldecisions.org)
Paul Wicks, vice president of innovation, PatientsLikeMe (www.patientslikeme.com)
Michael Seres, founder, 11 Health (www.11health.com)
Alf Collins, clinical associate in person centred care, Health Foundation (www.health.org.uk)
Jeremy Taylor, chief executive, National Voices (www.nationalvoices.org.uk)
Dave deBronkart, cochair, Society for Participatory Medicine (www.participatorymedicine.org)
Amir Hannan, general practitioner and member of clinical commissioning group board
Alexander Silverstein, past president, International Diabetes Federation’s young leaders in diabetes project
Paul Hodgkin, founder, Patient Opinion (www.patientopinion.org.uk)
Ben Mearns, consultant in acute care and elderly medicine, Surrey and Sussex Healthcare NHS Trust
Sara Riggare, PhD student in health informatics, Karolinska Institute
Rupert Whitaker, founder, Tuke Institute (www.tukeinstitute.org)
Stephen Leyshon (observer), DNV Healthcare
Patient spotlight - Doing it for themselves
10 februari 2015 |
52 min
In our accompanying roundtable discussion,we hear views from a group of patients and clinicians based largely in the UK on the actions required to advance progress towards providing patient centred care.
To extend the conversation we talked to members of the BMJ's international patient advisory panel and other patient advocates - and what follows are short clips of hour long conversations with people in the US, Europe, India, Equador and Uganda.
While the quality of the recordings vary there is no mistaking
the passion of these advocates to improve care for fellow patients and the barriers which need to be overcome to make it happen.
Taking part in this discussion in order are:
Dominck Frosch,associate professor, University of California
Maggie Breslin US designer, researcher and writer
Matthew Maleska, designer, Patient Revolution Project
Cristin Lind, patient advocate, Rare Diseases Sweden
Corine Jansen, cheif listening officer, JoConnect
Jonas Gonseth, chief executive, Gaerente en Hospital de Especialidades Guayaquil, Equador
Rakhal Gaitonde chair, community advisory board of the National
Institute for Research on Tuberculosis
Robinah Alambuya, president of the Pan African Network of People with Psychosocial Disabilities, Uganda
Daniel Iga Mwesigwa, executive medical director, Mwesigwa Medical Centre, Uganda
International donations to the Ebola virus outbreak: too little, too late?
4 februari 2015 |
15 min
Karen Grépin, assistant professor of global health policy at New York University, has been examining the pledges made by the international community to help fight the ebola virus outbreak - was it really too little, too late?
Read her full analysis:
http://www.bmj.com/content/350/bmj.h376
Helping Eddie Redmayne play Stephen Hawking
3 februari 2015 |
7 min
Katie Sidle is a consultant neurologist at the National Hospital for Neurology and Neurosurgery, in London. She helped actor Eddie Redmayne in his portrayal of theoretical physicist and cosmologist Stephen Hawking in the film The Theory of Everything.
She joins us to describe how that process worked, and what Motor Neurone Disease patients thought about how their condition was depicted.
Read the feature:
http://www.bmj.com/content/350/bmj.h483
Management of cancer induced bone pain
30 januari 2015 |
19 min
Bone pain is the most common type of pain from cancer and is present in around one third of patients with bone metastases, currently, improvements in cancer treatments mean that many patients are living with metastatic cancer for several years.
Christopher Kane, NIHR academic clinical fellow in palliative medicine at Leeds University School of Medicine, and Michael Bennett, St Gemma’s professor of palliative medicine at University College London join us to discuss the management of cancer induced bone pain.
Read the full clinical review:
http://www.bmj.com/content/350/bmj.h315
Cash for referrals
29 januari 2015 |
14 min
Private hospital chains have been “buying” referrals by offering clinicians lucrative packages, including free facilities in sought after locations. And the doctors’ regulator is turning a blind eye to those who are tempted, Reporter Jonathan Gornall joins us to discuss the investigation.
Read the full report:
http://www.bmj.com/content/350/bmj.h396
Managing multimorbidity in primary care
23 januari 2015 |
18 min
Multimorbidity presents a number of different challenges, for the patients living with the conditions, but also for the health professionals caring for them in systems that often are not designed with these more complex needs in mind.
Emma Wallace, general practice lecturer, and Susan Smith, a professor of general practice at the Royal College of Surgeons in Ireland Medical School join us to discuss how to work within the system, and what their dream scenario for care would be.
Read the full clinical review:
http://www.bmj.com/content/350/bmj.h176
WHO needs exercise?
22 januari 2015 |
10 min
Philipe de Souto Barreto argues that, to reduce premature mortality, policies should focus on getting fully inactive people to do a little physical activity rather than strive for the entire population to meet current physical activity recommendations.
Read the full analysis paper:
http://www.bmj.com/content/350/bmj.h23
Dominique Thompson GP - Young people’s health is overlooked
19 januari 2015 |
3 min
Dominique Thompson, GP and director of the Students’ Health Service at the University of Bristol, is concerned that young people's health is being neglected.
BMJ Voices is a collection of readers’ experiences of working in the NHS. For this, The BMJ is seeking short audio submissions from UK listeners. These submissions will be published on thebmj.com.
If you would like to contribute to this collection, please email a brief audio recording to [email protected] or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.
Rabies in animals
16 januari 2015 |
15 min
Rabies is the archytypical zoonotic disease, and only by vaccination in animals will we prevent infections in people. In two podcasts linked to our latest clinical review "The prevention and management of rabies" we'll be discussing how we can get there.
In this podcast Sarah Cleaveland, professor of comparative epidemiology at the University of Glasgow discusses controlling the disease in animals. To find out about the clincial presentation listen to the accompanying podcast with Natasha Crowcroft, chief of infectious disease at Public Health Ontario
Listen to the accompanying podcast:
https://soundcloud.com/bmjpodcasts/rabies-in-humans
Read the full clinical review:
http://www.bmj.com/content/350/bmj.g7827
Rabies in humans
16 januari 2015 |
20 min
Rabies is the archytypical zoonotic disease, and only by vaccination in animals will we prevent infections in people. In two podcasts linked to our latest clinical review "The prevention and management of rabies" we'll be discussing how we can get there.
In this podcast Natasha Crowcroft, chief of infectious disease at Public Health Ontario to discuss the human aspect of the disease, and in the second Sarah Cleaveland, professor of comparative epidemiology at the University of Glasgow explains animal control.
Listen to the accompanying podcast:
https://soundcloud.com/bmjpodcasts/rabies-in-animals
Read the full clinical review:
http://www.bmj.com/content/350/bmj.g7827
Is the Hep C screening expansion justified?
14 januari 2015 |
16 min
Until recently, hepatitis C screening was offered to people at increased risk of infection - such as intravenous drug users - but now, the US Centers for Disease Control and Prevention has recommended screening all people born between 1945 and 1965.
Kenny Lin, associate professor of family medicine at Georgetown University in Washington, DC, and Jeanne Lenzer, an investigative health journalist from New York, explain why they worry that the evidence doesn't support this expansion.
ead their analysis article:
http://www.bmj.com/content/350/bmj.g7809
Being a human guinea pig
8 januari 2015 |
9 min
Drug development happens in stages – pre-clinical, phase I, II,
III, and so on. But how much do trial participants know about what has happened before their enrolment to test for safety, and how much should they be told?
Holger Pedersen from Denmark was one trial participant who tried to find information about the drug he was on, and was surprised at how little data had actually been collected, let alone shared – which has been detailed in an analysis article on thebmj.com
He talks to Helen Macdonald, analysis editor for the BMJ about his experience.
Read the analysis article:
http://www.bmj.com/content/349/bmj.g6714
Operating theatre time, where does it all go?
19 december 2014 |
6 min
Waiting times in theatre can be a source of friction – but is the delay due to mandatory anaesthetic faff around time (MAFAT), or AWOL surgeons?
Elizabeth Travis, and orthopaedic house officer in New Zealand and colleagues, have been trying to create and evidence base to argue the toss, and she joins me now to discuss her study, Operating theatre time, where does it all go?
Read the full research:
http://www.bmj.com/content/349/bmj.g7182
Grumpy old doctors
18 december 2014 |
21 min
Those who rise to the top in medicine see themselves as hardworking extroverts with a caring nature, suggests an unscientific analysis of the answers given by contributors to BMJ Confidential.
But ask about their pet hates and another, less nurturing, side emerges. We gathered 6 former confidentialists in The BMJ studio to moan over mince pies.
Read Doctors: caring extroverts or self deluded chocoholics?: http://www.bmj.com/content/349/bmj.g7623
Can you trust the advice of TV doctors?
17 december 2014 |
46 min
How much can you trust the advice given by TV doctors? A new research paper on thebmj.com has analysed over 40 episodes of popular American TV shows, to see if health claims are evidence based.
This podcast is a bit different, as the authors host their own show - The BS Medicine Podcast, which tops the charts around the world - and they've given us permission to repost on The BMJ.
Read the full research:
http://www.bmj.com/content/349/bmj.g7346
Turning back the tide of appointments
16 december 2014 |
13 min
In AD 1028 King Canute tried to command the tide to turn back. History records that the king of all lands surrounding the North Sea got very cross, wet, and made a hasty retreat. Every day, in general practices across the country, dedicated practice teams get very cross when they are yet again unsuccessful at meeting the daily demand for appointments and the incoming tide of patient demand and expectation.
Ron Neville, a partner in the Westgate Health Centre in Dundee joins us to discuss what his new appointment system learned from the soggy monarch.
http://www.bmj.com/content/349/bmj.g7228
Men are idiots
15 december 2014 |
7 min
Winners of the Darwin Award must eliminate themselves from the gene pool in such an idiotic manner that their action ensures one less idiot will survive.
Ben and Dennis Lendrem, and colleagues, have reviewed the data on winners of the Darwin Award over a 20 year period and they join us to discuss why men are idiots, and why their team is not the only ones to have noticed.
www.bmj.com/content/349/bmj.g7094
Musical (operating) theatre
12 december 2014 |
6 min
One hundred years ago, Pennsylvanian surgeon Evan Kane penned a brief letter to JAMA in which he declared himself a rigorous proponent of the “benefic [sic] effects of the phonograph within the operating room.”
Now David Bosenquet, a surgeon from University Hospital of Wales in Cardiff has written a Christmas editorial about the evidence for the benefit of music to patients.
Read his editorial here:
http://www.bmj.com/content/349/bmj.g7436
And share your perfect playlist with us at bmj.com/playlists
Great leap backwards - austerity measures are hitting the vulnerable hardest
10 december 2014 |
15 min
The UK’s austerity programme has disproportionately affected children and people with disabilities, says David Taylor-Robinson, a senior clinical lecturer in public health at the University of Liverpool.
He joins us to discuss why the evidence shows the vulnerable are hit hardest by the cuts to public services, despite the UN conventions on human rights giving children and people with disabilities special protection.
Read his full editorial: http://www.bmj.com/content/349/bmj.g7350
Too much blood: when transfusions do more harm than good
5 december 2014 |
18 min
Blood transfusions have been identified as one of the most overused therapies both in the United States and the UK.
In this podcast Lawrence Tim Goodnough, from Stanford University Medical Center's Transfusion Service, and Michael Murphy, from NHS Blood and Transplant, explain the physiological reasons why
liberal blood transfusion will not benefit patients, and can potentially harm them.
Read their full analysis:
http://www.bmj.com/content/349/bmj.g6897
Zero tolerance for competing interests
4 december 2014 |
10 min
The BMJ has a new policy on competing interestings - from 2015 we will have zero tolerance for them in authors who write education articles or editorials.
Cath Brizzell and Mabel Chew explain what that policy is about, and why we think it's important.
Simon Stevens - saving the NHS?
2 december 2014 |
3 min
Eight months into the NHS’s top job, Simon Stevens’s intelligent refusal to enforce a “one size fits all” solution on the service’s ills is, so far, winning him the backing of staff. He talks to Gareth Iacobucci
Self monitoring of hypertension in pregnancy
20 november 2014 |
17 min
Guidelines encourage the use of self monitoring of blood pressure in pregnancy, and research suggests that women prefer it. But Richard McManus, GP and professor of primary care at the University of Oxford explains that our enthusiasm may run ahead of the evidence and call for more research before it is routinely adopted.
Read the full analysis:
http://www.bmj.com/content/349/bmj.g6616
Crohn’s disease - a patient’s perspective
20 november 2014 |
21 min
The incidence and prevalence of Crohn’s disease is increasing worldwide, and a clinical review on thebmj.com provides a practical approach to the diagnosis, management, and long term care of patients with Crohn’s disease.
To help us understand what it’s like to have this condition, we're joined by Sarah, who was diagnosed with Crohn’s 13 years ago when she was 18.
Read the full clinical review:
http://www.bmj.com/content/349/bmj.g6670
The diagnosis and management of Menieres disease
13 november 2014 |
16 min
A clinical review on thebmj.com looks at Meniere’s disease. One of the review's authors, Jonny Harcourt, a consultant otologist at Charing Cross Hospital in London, takes us through the pathogenic process and clinical presentation of the disease, its clinical course and prognosis, and what clinical features help to discriminate the condition from other diagnoses. He also discusses the evidence for treatment.
In a second interview Corine from The Netherlands discusses her experience of having the disease, and offers her tips to others with the condition.
https://soundcloud.com/bmjpodcasts/menieres-disease-patient
Read the full review:
http://www.bmj.com/content/349/bmj.g6544
Menieres disease - a patient perspective
13 november 2014 |
17 min
A clinical review on thebmj.com looks at Meniere's disease. Corine from The Netherlands discusses her experience of having the disease and explains how the symptoms of vertigo and tinnitus have affected her everyday life. She also offers her top tips on coping with the disease to others with the condition.
In a second podcast, Jonny Harcourt, a consultant otologist at Charing Cross Hospital in London and one of the authors of the review, takes us through the clinical course and prognosis of the disease.
https://soundcloud.com/bmjpodcasts/menieres-disease
Read the full review:
http://www.bmj.com/content/349/bmj.g6544
Should we still be using hydroxyethyl starch?
11 november 2014 |
16 min
Large trials show that hydroxyethyl starch increases the risk of death, kidney injury, and bleeding. So why does the European Medicines Agency still allow its use?
Helen Macdonald, analysis editor for The BMJ, discusses the issue with Christiane Hartog, a lecturer in intensive care medicine at Jena University Hospital in Germany, and one of the authors of an analysis paper on thebmj.com
Read the full analysis paper:
www.bmj.com/content/349/bmj.g5981
Atul Gawande - It’s about having a good life not a good death
7 november 2014 |
24 min
Surgeon, writer, and researcher, Atul Gawande is best known for the development of surgical checklists, but the death of his father has inspired him to write his latest book exploring medical and societal attitudes to death.
We joined him for breakfast during his whistle stop tour of the UK recording this year's BBC Reith Lectures, to discuss Being Mortal.
It’s time to change surgical training in the UK
31 oktober 2014 |
12 min
In a GMC survey last year, the UK’s surgical trainees came bottom of the list when it came to satisfaction about their training.
Today, Craig McIlhenny, Director of the faculty of surgical training at the Royal college of surgeons of Edinburgh has released a report with a series of recommendations to improve standards of training, and he hopes, help it come inline with the European Working Time Directive
Read his full report
http://goo.gl/kH55lW
Fighting on many fronts - how tackling ebola is effecting other diseases
24 oktober 2014 |
11 min
Fatoumata Nafo-Traoré is the executive director of the Roll Back Malaria Partnership, and has just returned from Sierra Leone and Guinea. In this podcast, she describes the effect of the west African ebola outbreak on the prevention and treatment of malaria, and other diseases, in affected regions. In an earlier podcast, Dr Nafo examined recent successes in the global effort to control malaria.
Update on malaria - new technologies helping to tackle the disease
24 oktober 2014 |
13 min
Fatoumata Nafo-Traoré is the executive director of the Roll Back Malaria Partnership. In this podcast, she updates us on recent successes in the global effort to control the disease. A second podcast examines the effect of the current ebola outbreak on the prevention and treatment of malaria, and other diseases, in affected regions.
The blockbuster sex drug for women; creating a feminist issue
16 oktober 2014 |
21 min
A thrice failed antidepressant is at the centre of a new marketing campaign to win approval for what could become the world’s first blockbuster sex pill for women. Frustrated by the drug’s repeated rejection, proponents have orchestrated a fierce attack, accusing the regulator of unfairness, and enlisting support from several well connected women’s organisations in the US.
Critics counter that the campaign is exceedingly misleading, that it targets a desire disorder that does not exist, and that approval could see widespread overprescribing of a drug with marginal benefits and real safety concerns.
Ray Moynihan has investigated for The BMJ, and talks to Rebecca Coombes about the way this publicity campaign has been orchestrated.
Read the full feature:
http://www.bmj.com/content/349/bmj.g6246
”Death is not inevitable”; why society’s beliefs fuel overtreatment
15 oktober 2014 |
19 min
Our whole society views risk in medicine wrongly, argue Jerome Hoffman and Hemal Kanzaria from the University of California Los Angeles. In this podcast they slay some strongly held myths about medicine's ability to heal, and say that one of our big beliefs, that death is not inevitable, is leading to overtreatment.
Read their full analysis of the situation:
http://www.bmj.com/content/349/bmj.g5702
For more information about overdiagnosis and overtreatment, visit www.bmj.com/too-much-medicine
Is NHS England being whittled down to a core service?
9 oktober 2014 |
19 min
Allyson Pollock, professor of global health, and Peter Roderick, a barrister and senior research fellow, both at Queen Mary University of London, argue that, through various mechanisms in the 2012 Health and Social Care Act, the NHS in England could be turned into a small core service. For full healthcare coverage, will we have to turn to commercial medicine?
Read their analysis article:
http://www.bmj.com/content/349/bmj.g5603
The NHS Reinstatement Bill Campaign:
http://www.nhsbill2015.org/
How to manage cerebral palsy in children
29 september 2014 |
21 min
Cerebral palsy is a clinical diagnosis, which describes a wide spectrum of neurological disability – all as a result of some sort of trauma to the developing brain, either pre or post natally.
Neil Wimalasundera, a consultant in paediatric neurodisability at Great Ormond Street Hospital, and one of the authors of The BMJ clinical review discusses how to diagnose and manage cerebral palsy in children.
Read the full clinical review:
http://www.bmj.com/content/349/bmj.g5474
Are we overmedicalising global health?
26 september 2014 |
13 min
Jocalyn Clarke, executive editor at icdd,b, argues the solutions proposed to improve global health are too focused on the medical, and fail to tackle the underlying socioeconomic factors which will undermine those efforts.
Read her full analysis of the situation:
http://www.bmj.com/content/349/bmj.g5457
Listen to patients, how Radboud UMC changed quality and care
25 september 2014 |
17 min
In April 2006 one of the largest hospitals in the Netherlands hit the national headlines with the exposure of “scandalously” poor results for cardiac surgery.
Melvin Samsom, CEO of the hospital, explains how the high death rates galvanised quality improvement and innovative change, transforming it into a model for patient participation.
Read more about the transformation at:
http://www.bmj.com/content/349/bmj.g5765
How not to miss kawasaki disease
19 september 2014 |
12 min
Kawasaki Disease presents as fever and rash, which makes diagnosis difficult.
In this podcast, Anthony Harnden, professor of primary care at the University of Oxford, describes what to watch out for to ensure you don’t miss the diagnosis.
Read the full article:
http://www.bmj.com/content/349/bmj.g5336
Risky Business - Kevin Fong - learning too much from aviation?
18 september 2014 |
6 min
Is medicine trying to learn too much from aviation?
Kevin Fong, consultant anaesthetist at UCLH is currently working with Kent, Surrey and Sussex air ambulance. At Risky Business he talked to The BMJ about why he thinks medicine is trying to learn too much from aviation.
Preventing overdiagnosis - the problems with screening
17 september 2014 |
15 min
Screening tests were central to many of the discussions taking place at the Preventing Overdiagnosis conference (preventingoverdiagnosis.net)
To sum up some of the problems with screening we’re joined by Carl Heneghan, director of the Centre for Evidence Based Medicine at the University of Oxford, and John Broderson, associate professor in the Research Unit and Section of General Practice at the University of Copenhagen.
For more on over diagnosis, visit
www.bmj.com/too-much-medicine
Trans-sphenoidal surgery, a patient’s experience
12 september 2014 |
6 min
A recent clinical review in The BMJ discusses diagnosis and management of prolactinomas and non-functioning pituitary adenomas.
One management option is surgery to remove the tumour, often this can done trans-sphenoidally. Though major complications of this type of surgery are low (~1%), there are still effects that can be distressing to patients, and should be discussed.
In this interview the patient wished to remain anonymous, so we have re-recorded her words. She describes the way in which attempts to reassure her about the surgery made he under-estimate the risks involved.
Read the full review:
http://www.bmj.com/content/349/bmj.g5390
Overtreating mild hypertension, are we doing more harm than good?
12 september 2014 |
21 min
Stephen Martin, an associate professor at the University of Massachusetts Medical School, thinks we're overtreating otherwise healthy patients who have mild hypertension.
In this podcast he sets out his argument, and explains why prescribing drugs to these people may actually be doing more harm than good.
Read the full analysis article:
http://www.bmj.com/cgi/doi/10.1136/bmj.g5432
Should patients be able to email their doctor?
4 september 2014 |
17 min
Demand for better access to primary care is ever rising, but is email the answer? In this podcast, Elinor Gunning, a clinical teaching fellow in London says that patients want it and that careful planning can mitigate worries about safety and security. Emma Richards, trainee academic GP, is not so sure and thinks clearer guidance and resourcing are needed first.
Read the head to head online:
http://www.bmj.com/content/349/bmj.g5338
Ebola virus disease, a long terms perspective
20 augusti 2014 |
18 min
David Heymann, professor of infectious disease epidemiology, and head and senior fellow, at the Chatham House Centre on Global Health Security was sent to investigate the first outbreaks of Ebola in 1976. In this podcast he gives a longer term perspective on the disease, and talks about the importance and challenges of introducing novel treatments.
For more information on ebola virus disease, including working in a front line clinic, visit bmj.com/ebola
David Heymann's analysis article, Prevention is better than cure for emerging infectious diseases: http://www.bmj.com/content/348/bmj.g1499
How to test for an immediate food allergy
8 augusti 2014 |
17 min
A new rational testing article, published on thebmj.com, looks at how to diagnose an immediate food allergy. Mabel Chew, The BMJ's practice editor, is joined by Cathal Steele from the Belfast Trust Regional Immunology Service - they discuss which tests are appropriate, and the common pitfalls in diagnosis.
Read the full article:
http://www.bmj.com/content/349/bmj.g3695
Diagnosing and managing spasticity in adults
5 augusti 2014 |
26 min
Management of spasticity requires a balanced approach, weighing the benefits of treatment against the usefulness of the spasticity. Current interventions to treat spasticity lack a robust evidence base, and guidelines often depend on expert recommendations. A new clinical review published on thebmj.com discusses the assessment and treatment of spasticity in adults.
In this podcast we're joined by one of the authors of that review, Siva Nair, from the Department of Neurology at The Royal Hallamshire Hospital, and by a patient with spasticity, Ian, who is chairman of the Hereditary Spastic Paraplegia (HSP) Support Group.
Read the clinical review: http://www.bmj.com/content/349/bmj.g4737
For more information on HSP visit http://hspgroup.org/
Are essential medicines essential?
1 augusti 2014 |
11 min
Global endorsement as a WHO essential medicine is big step. But Corrado Barbui, from the Department of Public Health and Community Medicine at the University of Verona, has found that the quality of applications for antidepressants and antipsychotics is poor and calls on applicants and WHO to raise standards.
Read the analysis article:
http://www.bmj.com/content/349/bmj.g4798
Pre-diabetes - epidemic or emperor’s new clothes?
17 juli 2014 |
15 min
Pre-diabetes is an umbrella term and the most widely used phrase to describe a blood concentration of glucose or glycated haemoglobin (HbA1c) that lies above normal but below that defined for diabetes.
John S Yudkin, emeritus professor of diabetes at University College London, thinks this is over-medicalisation and will only increase the burden on individuals and the health system.
Read the full analysis article:
http://www.bmj.com/content/349/bmj.g4485
Should research fraud be a criminal offence?
15 juli 2014 |
14 min
Research fraud, the deliberate falsification of research data, undermines science and can lead to horrible outcomes, as exemplified by Andrew Wakefield and the MMR/Autism scandal.
A new Head to Head in The BMJ sets out the case for and against making research fraud a crime.
Arguing yes is Prof. Zulfiqar Bhutta, from the Hospital for Sick Children in Toronto, who says that criminal sanctions are necessary to deter growing deliberate research misconduct, which can ultimately harm patients.
Prof. Julian Crane, from the University of Otago Wellington, disagrees: he doubts that sanctions will have any deterrent effect and worries that criminalisation would undermine trust.
Read the full debate:
http://www.bmj.com/content/349/bmj.g4532
Newly diagnosed HIV
11 juli 2014 |
30 min
HIV testing is now being routinely offered in increasingly diverse health settings, including primary care. In this podcast we talk to HIV consultant Mike Rayment, from Chelsea and Westminster NHS Foundation Trust, and Paul, a patient diagnosed with HIV infection 4 years ago.
They discuss how to go about offering testing, and what matters to patients when they receive the diagnosis.
Read the clinical review discussed:
http://www.bmj.com/content/349/bmj.g4275
Why we need an independent WHO
20 juni 2014 |
15 min
Devi Sridhar, population health researcher and lecturer, joins us to discuss why an independent organisation to co-ordinate international health concerns is absolutely necessary.
Read more in her analysis article,
Global rules for global health: Why we need an independent, impartial WHO
FiFA, the World Cup, and the disappearing alcohol ban
13 juni 2014 |
7 min
Whichever country hoists aloft the World Cup trophy on 13 July, the real winner will be the alcohol industry.
In this podcast Jonathan Gornall explains why FIFA promotes the interests of the alcohol industry, and the extraordinary demands countries comply with in order to host the World Cup.
World Cup 2014: festival of football or alcohol?
http://www.bmj.com/content/348/bmj.g3772
Drugs for weight loss
6 juni 2014 |
23 min
Drugs to encourage weight loss have a chequered past, with many of them having been withdrawn from the market due to increased morbidity and mortality.
In this podcast Raj Padwal, associate professor of medicine at the University of Alberta, takes us through the remaining therapy Orlistat, and discusses the potential for two new therapies, Phentermine-ER topiramate, and Lorcaserin, which are being licensed in some countries
Read the full article: http://www.bmj.com/content/348/bmj.g3526
Helicobacter pylori - new evidence, and when to test and treat
27 maj 2014 |
22 min
Two articles on bmj.com look at helicobacter pylori; a systematic review and meta-analysis examines if eradication treatment reduces rates of gastric cancer, and an uncertainties article asks who we should be testing and treating for the infection.
Two of the authors of those articles, Alex Ford from the Leeds Gastroenterology Institute, and Paul Moayyedi from the Gastroenterology Division of McMaster University, join us to discuss the bacterium.
Read the full articles
www.bmj.com/content/348/bmj.g3174
www.bmj.com/content/348/bmj.g3320
Is advice to cut down smoking wrong?
23 maj 2014 |
17 min
New NICE guidance says that smokers should be encouraged to cut down on the number of cigarettes they smoke, as well as trying to quit.
In a head to head, published on bmj.com, Paul Aveyard, professor of behavioural medicine at the University of Oxford, says that reducing smoking is a worthwhile step towards cessation, but Gerard Hastings, professor of social marketing at Stirling and Open Universities, argues that the lifelong nicotine replacement therapy being recommended in support may benefit industry more than public health.
Read the full head to head:
http://www.bmj.com/content/348/bmj.g2787
Investigating UTIs in older adults
22 maj 2014 |
11 min
UTIs are often diagnosed in secondary care, but often that diagnosis isn't accurate. In this podcast Gavin Barlow from the Department of infection and tropical medicine at Hull & East Yorkshire Hospitals NHS Trust joins us to discuss when and how to test for the infection.
Read the full clinical review
Investigation of suspected urinary tract infection in older people http://www.bmj.com/content/348/bmj.g3861
Alcohol - The UK’s billion unit pledge is worthless
21 maj 2014 |
20 min
The BMJ has been investigating the “cosy relationship” between the alcohol industry and the British government.
In a series of articles Under the influence, journalist Jonathan Gornall has been looking into UK government’s consultation into introducing a minimum unit price for alcohol in England and Wales, and also at the wider responsibility deal between government and industry which is meant to champion public health.
In his latest article, he looks at the billion unit pledge, and how it's actually being used as a marketing tool to attract new drinkers.
Read all of the articles discussed on www.bmj.com/alcohol
Operating to remove recurrent colorectal cancer: have we got it right?
15 maj 2014 |
19 min
A new analysis article on bmj.com discusses the story of a surgical colon cancer trial, that was started 30 years ago and then abandoned, and the data lost.
In this podcast Helen Macdonald talks to Tom Treasure from Imperial College London, who has unearthed the data and now published the research. Also joining the discussion is Peter Doshi, one of the instigators of the RIAT initiative set up to encourage this kind of work to correct the scientific record.
Read the full article: http://www.bmj.com/content/348/bmj.g2085
Patient confidentiality in the digital age
9 maj 2014 |
18 min
Digital technology introduces new concerns for confidentiality and information security. In this podcast Bradley Crotty and Arash Mostaghimi, both from Harvard Medical School, outline the regulations governing confidentiality and medical privacy and provide practical advice on how to safeguard patient information
Read their article for more details:
http://www.bmj.com/content/348/bmj.g2943
The problems with testosterone testing in female athletes
30 april 2014 |
18 min
The International Olympic Committee (IOC) and other international sports federations have recently introduced policies which require a medical investigation of women athletes known or suspected to have hyperandrogenism.
Women who are found to have naturally high testosterone levels and tissue sensitivity are banned from competition unless they have surgical or pharmaceutical interventions to lower their testosterone levels.
But a recent analysis published on bmj.com says that these tests and procedures are at best not medically necessary, and at worst totally unethical.
In this podcast we're joined by two of the authors, Rebecca Jordan-Young, professor women’s gender and sexuality studies at Barnard College, and Katrina Karkazis, bioethicist at Stanford centre for biomedical ethics.
Read the full analysis article online:
http://www.bmj.com/content/348/bmj.g2926
Should doctors be prescribing cannabinoids?
25 april 2014 |
19 min
Michael Farrell, professor and director of the National Drug and Alcohol Research Centre at the University of New South Wales in Sydney, talks to Mabel Chew, The BMJ's practice editor, about prescription of cannabinoids.
They discuss the latest evidence on nausea and appetite, when cannabinoids may be effective for chronic pain, and which common problems to watch out for.
Read the full article:
http://www.bmj.com/content/348/bmj.g2737
Using HbA1c to diagnose type 2 diabetes
24 april 2014 |
15 min
Glycated Haemoglobin (HbA1c) is used to measure glucose control in patients with diabetes, but can now be used as an alternative test to glucose concentration for diagnosing type 2 diabetes or identifying people at high risk of developing the disease.
in this podcast Eric Kilpatrick, from the Department of Clinical Biochemistry at Hull York Medical School, and Stephen Atkin, from Weill Cornell Medical College Qatar, describe when testing HbA1c may be appropriate for diagnosis, and what comorbidities would rule it out.
Read the full rational testing article: http://www.bmj.com/content/348/bmj.g2867
How to manage the first seizure in an adult
14 april 2014 |
30 min
First seizure covers a wide range of manifestations, but picking up the minor events can prevent a patient from experiencing a major event, so early diagnosis is key.
Heather Angus-Leppan, consultant neurologist and epilepsy lead at the Royal Free Hospital in London, talks to Navjoyt Ladher about how to manage the first seizure in an adult.
Read the full clinical review at:
http://www.bmj.com/content/348/bmj.g2470
Tamiflu US Press Conference
9 april 2014 |
33 min
Tamiflu (oseltamivir) is a neuraminidase inhibitor, developed by Roche, for the treatment of seasonal and pandemic influenza. Yet for the first time a comprehensive review of the data, by independent researchers, has shown that the claims for Tamiflu’s effectiveness have been overestimated, and that harms have been underreported.
Here is the audio of a recent press conference where researchers and the BMJ's editors describe the findings of that research, and the systematic regulatory failures those findings expose.
Taking part were:
Fiona Godlee - BMJ editor in chief
Carl Heneghan - Director of Oxford University's Centre for Evidence Based Medicine
Peter Doshi - Assistant Professor of Pharmaceutical Health Services Research
Elizabeth Loder - The BMJ clinical epidemiology editor
David Tovey - Editor in chief, Cochrane Library
Ben Goldacre - Founder of the AllTrials campaign
Triptans for the acute treatment of migraine
7 april 2014 |
18 min
Mabel Chew talks to Tamara Pringsheim, from the University of Calgary, about the use of triptans for acute treatment of migraine. When, how, and what contraindications a physician should be aware of.
Read the full article:
http://www.bmj.com/content/348/bmj.g2285
Friends and family test: Don’t just collect data, use it
27 mars 2014 |
14 min
The NHS has been collecting data on patients’ experience of care for over 10 years but few providers are systematically using the information to improve services.
Angela Coulter joins us to discuss the new Friends and Family test, and why it will fail to change services until it asks the right questions.
read the full paper:
http://www.bmj.com/content/348/bmj.g2225
Who, when and how: Screening for MRSA
21 mars 2014 |
13 min
Meticillin resistant Staphylococcus aureus (MRSA) remains one of the foremost hospital acquired pathogens.
Patients colonised or infected with MRSA provide a reservoir within hospitals, although infection prevention and control measures minimise the risk of transmission.
Although there is broad agreement on the control measures required for patients colonised or infected with MRSA, there is considerable controversy over who, when and how to screen for the bacteria.
John Coia, a consultant microbiologist at Glasgow Royal Infirmary, discusses when screening may be appropriate, how it should be carried out, and the best strategy for decolonisation.
Read the full article: http://www.bmj.com/content/348/bmj.g1697
ParkinsonNet: a new approach to management of chronic disease
20 mars 2014 |
15 min
Read the full analysis of ParkinsonNet: http://www.bmj.com/content/348/bmj.g1838
Patients with Parkinson’s disease need long term support to manage their condition. In this podcast Bastiaan Bloem, medical director at the Parkinsons Institute in Nijmegen, and Marko van der Vegt, a Parkinsons patient, describe the benefits of ParkinsonNet; a model of integrated care provided by a network of specialists and suggest it has promise for other long term conditions
Recognising a subdural haematoma in the elderly
11 mars 2014 |
19 min
Subdural haematoma is more common in elderly patients, yet the condition is easy to miss in this group.
John Young, a consultant geriatrician at Bradford Teaching Hospitals NHS Foundation Trust, describes what clinical signs to look out for, and what tests can confirm a diagnosis of subdural haematoma.
The Health and Social Care bill: An end of year report
7 mars 2014 |
45 min
Each year at the Nuffield Trust Health Policy Summit, The BMJ hosts a breakfast roundtable. It has been one year since the Health and Social Care Bill for England was enacted, and the reconfiguration of the NHS continues, so this year we asked our panel to give the bill an end of year report.
Taking part were:
John Richards – Southampton Clinical Commissioning Group
Nigel Edwards - CEO Nuffield Trust
Jennifer Dixon - CEO Health Foundation
Terence Stephenson - president Academy of Medical Royal Colleges
Maureen Baker - Chair RCGP
Hugh Taylor - Chairman Guys and St Thomas' Foundation Trust
Nick Hicks - CEO COBIC Ltd
Jeremy Taylor - National Voices
Tim Ferris - VP for population health management, Partners Healthcare, MA
Nick Timmins - Senior Associate Nuffield Trust
HPV vaccination and cervical cancer screening in Australia
6 mars 2014 |
22 min
Read the open access research: http://www.bmj.com/cgi/doi/10.1136/bmj.g1458
Australia was one of the first countries to introduce HPV vaccination, and due to it's cervical cancer screening programme, is one of the first to be able to measure the effectiveness of the vaccine.
In this podcast, 3 of the authors of a new paper on bmj.com discuss their findings and talk about implications for cervical cancer screening in Australia.
Recognising and treating fibromyalgia
24 februari 2014 |
19 min
Most doctors are familiar with patients who describe chronic pain all over the body, which is associated with a range of other symptoms including poor sleep, fatigue, and depression. This complex of symptoms is sometimes referred to as fibromyalgia.
Management of patients with this condition is often complex and challenging. The diagnosis of fibromyalgia has long been controversial, with some experts questioning whether it exists as a separate entity
In this podcast Anisur Rahman, professor of rheumatology at University College London, joins us to discuss diagnosis and management of the condition.
Read the full clinical review article:
http://goo.gl/MYryTJ
Steps to limit smoking in China could save 13,000,000 lives in 35 years
17 februari 2014 |
20 min
Complete implementation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) recommends policies in China that would prevent almost 13m smoking related deaths by 2050, suggests a paper published on bmj.com.
China is home to about one third of the world’s smokers and reducing smoking in China could have an enormous public health impact, even on a global scale.
To discuss their research, we are joined by three of the paper's authors, David Levy from Georgetown University, Teh-Wei Hu from University of California at Berkeley, and Andrew Moran from Columbia University Medical Center.
Read the full open access research: http://www.bmj.com/cgi/doi/10.1136/bmj.g1134
Twenty-five Year Follow-up of the Canadian National Breast Screening Study
7 februari 2014 |
17 min
Controversy rages over the relative benefits or harms of screening for breast cancer, with evidence suggesting that in younger women at least it does more harm than good.
Now a new paper on bmj.com reports the results of 25 years of follow up of women who have taken part in a breast cancer screening trial in Canada, and suggests that annual screening does not cut breast cancer deaths.
Anthony Miller, Professor Emeritus at the Dalla Lana School of Public Health, University of Toronto, lead author on the paper, and director of the trial, joins us to discuss the results.
Veggie drugs
5 februari 2014 |
12 min
Read the full article online: http://www.bmj.com/content/348/bmj.g401
When you prescribe a drug, do you ever stop to wonder if it's suitable for vegetarians? Kinesh Patel and Kate Tatham from Imperial College London have found that 74 of the 100 drugs most commonly prescribed by GPs in the UK contain ingredients which may have been derived from animals.
BMJ podcast: Treating erectile dysfunction
27 januari 2014 |
17 min
Read the full article: http://www.bmj.com/content/348/bmj.g129
Erectile dysfunction is a common problem, and novel treatments mean that patient’s options have widened. In this podcast Asif Muneer, consultant urological surgeon and andrologist at University College Hospital in London, explains the aetiology, treatment, and prognosis for the condition.
BMJ podcast - high risk devices for rare conditions
24 januari 2014 |
14 min
Two articles on bmj.com look at high risk devices for rare conditions, and how the US Food and Drug Administration regulates them.
Joining us to discuss the problems are Rita Redberg, professor of medicine at the University of California San Francisco, and Aaron Kesselheim, assistant professor of medicine at the Harvard School of Public health.
Read the articles
Presumed safe no more: lessons from the Wingspan saga on regulation of devices
http://www.bmj.com/content/348/bmj.g93
Assessment of US pathway for approving medical devices for rare conditions http://www.bmj.com/content/348/bmj.g217
Why don’t WHO guidelines on fluid resuscitation in children include the FEAST trial results?
17 januari 2014 |
15 min
Read the article: http://www.bmj.com/content/348/bmj.f7003
The 2013 World Health Organization guidelines continue to recommend rapid fluid resuscitation for children with shock, despite evidence from the FEAST trial that this can increase mortality.
Katheryn Maitland, professor of tropical paediatric infectious disease at Imperial College London, who led the FEAST trial, joins us to discuss it.
Should journals stop publishing research funded by the drug industry?
15 januari 2014 |
16 min
Read the head to head:
http://www.bmj.com/content/348/bmj.g171
The BMJ no longer publishes research funded by tobacco companies. Richard Smith says that research funded by drug companies is also flawed and published to encourage sales, but Trish Groves says that the industries are fundamentally different and that moves are afoot to increase integrity
Join the authors live on Twitter to debate the issue on 21 January, 1200-1230 GMT at #pharmaban.
Solving the case, making the diagnosis: Neurology and detective writing
3 januari 2014 |
20 min
When searching for clues to reach a diagnosis, neurologists often empathise with the detective who is trying to solve a case, write Peter Kempster and Andrew Lees in BMJ sister journal Practical Neurology bit.ly/1dqReQq.
In this podcast, journal editor Phil Smith and Andrew Lees, director of the Queen Square Brain Bank in London, discuss how neurologists draw upon detective skills. They also talk about neurologists who have turned these skills to crime fiction writing, and the use of narrative in clinical case histories.
The expert witnesses called upon are:
- Oliver Sacks, best selling author and professor of neurology at NYU School of Medicine
- Peter Gautier Smith, now retired from consulting at Queen Square and author of 31 detective novels
- Chris Goetz, who worked at Rush University Medical Centre with Harold Klawans, crime fiction writer and authority on Parkinson’s disease
Listen to the full interviews here:
Andrew Lees bit.ly/1cPaoxM
Peter Gautier-Smith bit.ly/1d5HhKj
Harold Klawans bit.ly/19cXR
Oliver Sacks bit.ly/1hBsbgz
Virgin births, poor house hospital and right or happy
20 december 2013 |
29 min
It is generally agreed that sex is useful when getting pregnant, but is it necessary? Professors Amy Herring, and Carolyn Halpern from the University of North Carolina explain how they found virgin births in the US for their Christmas BMJ paper.
Also Gareth Jones, emeritus professor of anaesthesia at Cambridge University, recalls his early life in the City Lodge Hospital – formerly Cardiff Union Workhouse
Finally, does being right always make you happy? Bruce Aroll, professor of primary care at the University of Auckland wanted to know, and so designed a pilot study.
See also:
Like a virgin (mother): analysis of data from a longitudinal, US population representative sample survey (http://www.bmj.com/content/347/bmj.f7102)
Being right or being happy: pilot study (http://www.bmj.com/content/347/bmj.f7398)
Growing up over the shop (http://www.bmj.com/content/347/bmj.f6922)
James Bond’s drinking and caring for undocumented migrants
13 december 2013 |
20 min
James Bond, legendary secret agent, marksman, womaniser, smoker, but perhaps most famously, drinker. Neil Guha and Patrick Davies from Nottingham University Hospitals NHS Trust, and Graham Johnson from the Royal Derby Hospital, have documented Commander Bond's drinking in a Christmas BMJ paper, and join us to discuss its findings.
Also this week, Doctors of the World, The BMJ's Christmas charity, has a role beyond emergency response to humanitarian crises, helping undocumented migrants in the UK access healthcare. Richard Hurley visits its clinic in the east end of London to find out out more.
See also
Were James Bond’s drinks shaken because of alcohol induced tremor?
http://www.bmj.com/content/347/bmj.f7255
Christmas charity appeal and treating polymyalgia rheumatica
6 december 2013 |
23 min
This year The BMJ has chosen Doctors of the World as it's Christmas appeal. This week we hear about the charity's international work. Deputy magazine editor Richard Hurley talks to some of the doctors who are working in Syria and the camps surrounding the stricken country.
Also this week, a clinical review on BMJ.com looks at polymyalgia rheumatica. Clinical reviews editor Sophie Cook asks Sarah Mackie, from the Leeds Institute of Rheumatic and Musculoskeletal Medicine, how she explains this difficult condition to patients.
After the typhoon: how volunteer doctors are bringing medical care to those most in need
http://www.bmj.com/content/347/bmj.f7193
Polymyalgia rheumatica
http://www.bmj.com/content/347/bmj.f6937
Patient centred research and doctors burnout
29 november 2013 |
28 min
Professor Sir John Oldham, from the Institute of Global Health Innovation at Imperial College London, talks about reforming reform, and why he worries that research agendas are more influenced by career aspirations than patient care.
Tom Kenny, director of external relations at the Evaluation, Trials, and Studies Coordinating Centre at the National Institute for Health Research, explains how the NIHR is trying to put patients at the centre of the research it funds.
Finally doctors' health - Michael Peters from the BMA's Doctors for Doctors Unit, explains why life's everyday struggles are hard for doctors to cope with.
See also:
Reform reform: an essay by John Oldham
http://www.bmj.com/content/347/bmj.f6716
Doctors’ health: taking the lifecycle approach
http://www.bmj.com/content/347/bmj.f7086
Aneurysmal subarachnoid haermorrhage
22 november 2013 |
19 min
The latest NCEPOD (National Confidential Enquiry into Patient Outcome and Death) report examines the management of aneurysmal subarachnoid haemorrhage, in England's National Health Service.
Two of the report's clinical co-ordinators, Mike Gough, a vascular surgeon at Leeds General Hospital, and Alex Goodwin, anaesthetist at the Royal United Hospital in Bath, join us to discuss the reports findings and recommendations.
Read the full report: http://www.ncepod.org.uk/sah.htm
Population ageing, the timebomb that isn’t
15 november 2013 |
21 min
The population timebomb: The idea that an ageing population is making it harder and harder to fund pensions, social care, and healthcare, as the number of older people grows in proportion to the working population. Jeroen Spijker, senior research fellow at the School of Social and Political Science in the University of Edinburgh, explains why he thinks the risk has been overblown.
Also, Michael Kidd, current president of WONCA – the world organisation of family doctors - talks about the pressures on primary care, and how he would like to attract the best medical talent to the specialty.
http://www.bmj.com/content/347/bmj.f6598
A sugary drinks tax, liver tests in pregnancy
8 november 2013 |
28 min
A modelling study on bmj.com suggests that a 20% tax on sugar sweetened drinks would reduce the number of obese adults in the UK by 1.3%, and by 0.9 for those who are overweight. The health gains are fairly similar across all income groups. Oliver Mytton, one of the study's authors, describes why a 20% figure was chosen and how the modelling was done.
Also, liver function tests follow a different normal range during pregnancy. Catherine Williamson, professor of women’s health at King's College London, explains why.
Read the articles:
Overall and income specific effect on prevalence of overweight and obesity of 20% sugar sweetened drink tax in UK - http://www.bmj.com/content/347/bmj.f6189
Abnormal liver function tests in pregnancy - http://www.bmj.com/content/347/bmj.f6055
Heath in Europe, When to order ANA tests
1 november 2013 |
28 min
Professor Michael Marmot has spearheaded WHO Europe’s Health 2020 report, which looks at the disparity in the social determinants of health across the region. He joins us to explain why he’s hopeful for change.
Also, Spencer Ellis, consultant rheumatologist at Lister Hospital in Stevenage, explains when and why to order antinuclear antibody (ANA) tests.
Statins: benefits and harms for low risk patients
25 oktober 2013 |
19 min
NB: In our interview about statins, Abramson quotes the figure of an 18% relative increase in risk of adverse effects of statins. This figure should be couched in uncertainty, and a correction has been posted on bmj.com to reflect that - http://www.bmj.com/content/348/bmj.g3329
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It may soon be recommended that statins are prescribed to patients with a low risk of cardiovascular disease. John Abramson from the Department of Health Care Policy at Harvard Medical School explains why the risks associated with taking the drug may have been underplayed.
Also this week, interviews with Steve Field, the new chief inspector of hospitals, and Richard Vautry, deputy chairman of the BMA's GP committee, recorded at the National Association of Primary Care's annual Best Practice conference.
See also:
Should people at low risk of cardiovascular disease take a statin?
http://www.bmj.com/content/347/bmj.f6123
Tobacco industry vs science, vCJD in the UK
18 oktober 2013 |
33 min
The BMJ, BMJ Open, Heart, Thorax, and Tobacco control – all journals in BMJ’s stable, have announced they will no longer carry research funded in part, or in whole, by the tobacco industry. Fiona Godlee, BMJ Editor in chief, explains what that means, and Allen Brandt, professor of the history of science at Harvard University, gives us a potted history of the way in which the tobacco industry has manipulated science.
Also this week, Sebastian Brandner, professor of neuropathology at UCL, explains his research into the population prevalence of the prion which causes vCJD.
See also
Prevalent abnormal prion protein in human appendixes after bovine spongiform encephalopathy epizootic
http://www.bmj.com/content/347/bmj.f5675
Journal policy on research funded by the tobacco industry
http://www.bmj.com/content/347/bmj.f5193
Brain tumours in children, and why all polyps are not equal
15 oktober 2013 |
30 min
There are many overlapping classifications for bowel polyps. Geir Hoff, professor of gastroenterology at the University of Oslo, explains why he fears screening for one type has lead to overtreatment of another.
Also, Sophie Wilne, consultant paediatric oncologist at Nottingham University Hospitals NHS Trust, discusses the clinical signs of brain tumours in children and young adults, and what treatment should follow.
See also:
Identifying brain tumours in children and young adults
www.bmj.com/content/347/bmj.f5844
New polyps, old tricks: controversy about removing benign bowel lesions
www.bmj.com/content/347/bmj.f5843
Leaving the RCGP
4 oktober 2013 |
25 min
As Clare Gerada's stint as RCGP chair comes to a close, she gives BMJ news reporter Gareth Iacobucci a typically honest exit interview.
And David Loxterkamp, a primary care physician in Belfast, Maine, tells us why he thinks metrics are obscuring humanism in medical care.
See also:
Clare Gerada: “It’s like the wild west in healthcare” http://goo.gl/SiWZ5y
Humanism in the time of metrics—an essay by David Loxterkamp http://goo.gl/FRD0xC
Possible racial bias in the RCGP exam
30 september 2013 |
30 min
A study on bmj.com raises raises concerns over possible “subjective bias owing to racial discrimination” in the MRCGP - the Royal College of General Practitioner''s postgraduate exams required to become a registered GP in the UK. Aneez Esmail, professor of primary care at the University of Manchester and the paper's lead author, explains the background to the study and its findings. Read the accompanying editorial and news story, which includes a response from RCGP chairwoman Claire Gerada.
See also:
Academic performance of ethnic minority candidates and discrimination in the MRCGP examinations between 2010 and 2012: analysis of data
http://www.bmj.com/content/347/bmj.f5662
BMJ author hits out at attempts to dismiss findings of possible racial bias in RCGP exam
http://www.bmj.com/content/347/bmj.f5871
A new chief inspector of hospitals
30 september 2013 |
13 min
Professor Sir Mike Richards, previously National Cancer Director at the Department of Health, and former head of the Academic Division of Oncology at King's College London, is the new chief inspector of hospitals in England.
In his new role he will have the power to enter hospitals, both in planned and unplanned inspections, to highlight problems before they develop into another scandal of the kind that happened in Mid-Staffordshire. He talks about his new role to Nigel Hawkes.
See also:
“We know where to probe,” says Mike Richards, the new chief inspector of hospitals http://www.bmj.com/content/347/bmj.f5557
Safety from Syria
30 september 2013 |
1 min
UN Refugee Agency High Commissioner António Guterres described the Syrian crisis this week as the great tragedy of the century, a "disgraceful humanitarian calamity with suffering and displacement unparalleled in recent history." Every 15 seconds a Syrian seeks refuge in neighbouring countries. UNHCR spokesperson Andrej Mahecic describes a typical refugee's journey from the stricken country and how their health needs are addressed when they reach refugee camps and host communities in Jordan, Lebanon, and Turkey.
See also:
http://www.bmj.com/content/347/bmj.f5413
Treating childhood autism, and cardiac imaging for stable chest pain
30 september 2013 |
30 min
NICE has published now guidelines on the treatment of children with autism. Mabel Chew BMJ practice editor talks to Tim Kendall, director of the National Collaborating Centre for Mental Health at the Royal College of Psychiatrists, who helped draw up the guidelines.
Mabel also talks to Declan P O’Regan, consultant radiologist at the MRC Clinical Sciences Centre in London, and an author of our rational imaging article on investigating stable chest pain
See also:
http://www.bmj.com/content/347/bmj.f3940
http://www.bmj.com/content/347/bmj.f4865
HPV testing in preventing cervical cancer
30 september 2013 |
16 min
What do clinicians need to know about the developing role of HPV in cervical cancer prevention? BMJ clinical reviews editor Sophie Cook speaks to Henry Kitchener, professor of gynaecological oncology, and Emma Crosbie, senior lecturer and honorary consultant in gynaecological oncology, both at the University of Manchester.
Read the full clinical review:
http://www.bmj.com/content/347/bmj.f4781
Diagnosing dementia, treating personality disorder
16 september 2013 |
25 min
inda Gask, professor of primary care psychiatry at the University of Manchester, explains why a personality disorder diagnosis is not as hopeless as many patients and doctors fear.
Also Carol Brayne, professor of public health at the University of Cambridge, discusses how to make the most of the UK government’s push to diagnose dementia, even though the evidence is limited.
See also:
http://www.bmj.com/content/347/bmj.f5276
http://www.bmj.com/content/347/bmj.f5125
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61570-6/fulltext
Looking forward
29 augusti 2013 |
18 min
For our first podcast of 2010, we’ll be asking various medical professionals what they’d like to see happen to healthcare in the next decade.
Also, Chris Grundy tells us how effective 20 mph zones really are at preventing accidents.
Retrained to eat
29 augusti 2013 |
22 min
This week, research published on bmj.com shows that overweight and obese teenagers can be taught to eat more sensibly by using a device called a mandometer. Professor Julian Shield, who led the study, talks about the results.
Also this week, the response to one of the articles in the latest Christmas BMJ was enormous. Duncan Jarvies talks to Nathan Grills, the author of the article, about the storm in a sleigh.
Disaster and dementia
29 augusti 2013 |
23 min
Haiti this week suffered its worst earthquake in 200 years. Marc Dubois, general director of aid charity MSF UK, talks about how his organisation is responding to the disaster and how doctors can help.
Also, BMJ clinical editor Elizabeth Loder interviews Benjamin Wolozin about the link between cardiovascular disease and dementia.
Krishna Moorthy talks to Helen Morant about what medicine can learn from aviation.
12 steps to public health
29 augusti 2013 |
21 min
This week the Faculty of Public Health has released its manifesto tor a healthier Britain. Duncan Jarvies speaks to the faculty’s president, Professor Alan Maryon-Davis, about the manifesto’s recommendations.
Also new online this week, we have a clinical review on depression in adolescents. We talk to one of the authors, Professor Anita Thapar, about one aspect of it - prevention - and the promising research that is under way.
Clubfoot
29 augusti 2013 |
18 min
Several articles on bmj.com deal with clubfoot disorder. Kirsten Patrick gives us a quick history of the condition, and talks to Andrew Hogg - a GP trainee - about a film he made in South Africa to help Zulu parents understand it. Also this week, Trish Groves tells Duncan Jarvies about the importance of sharing data - and the possible problems that may arise. Deborah Cohen takes us through the news.
Urinary tract infections
29 augusti 2013 |
12 min
Urinary tract infections are commonly seen in primary care, particularly in women, yet there are gaps in the evidence about their treatment. Trish Groves talks to Paul Little about a group of papers that compare management approaches for the condition, look at their cost effectiveness, and analyse patients’ reactions to them.
Duncan Jarvies takes us through the news.
Transmuting tamoxifen
29 augusti 2013 |
22 min
This week new research was published on the use of the SSRI (selective serotonin re-uptake inhibitor) antidepressants, in combination with the drug tamoxifen. For some time there have been concerns about prescribing them together, and a new study finally quantifies that, David Juurlink explains how.
Also this week, a child’s early years will affect the rest of their life, in terms of medical as well as social and educational outcomes. Clyde Hertzman talks about what governments are, and should be, doing to help build a solid foundation.
Juliet Walker and Birte Twisselmann takes us through the week’s news.
Personal care
29 augusti 2013 |
23 min
In this week’s podcast Sam Lister, health editor of the Times, explains the political fight that’s emerging around provision of free home health care for elderly people.
Duncan Jarvies talks to Iain Chalmers, from the the James Lind Initiative, about the importance of making information about clinical trials available to the public.
Sabreena Malik takes us through this week’s news.
Disinvestment
29 augusti 2013 |
21 min
Estimates of HIV are just that, estimates – but in order to research the progression of the virus, and the effectiveness of intervention strategies, those estimates have to be as accurate as possible. Professor Prabhat Jha joins us to explain the novel way in which he and his team have collected data in India to provide a more accurate picture about the spread of the virus.
Also this week, as spending cuts are planned across public services, the financial strain on the UK health service is increasing. One way in which some money can be saved is through disinvestment; ceasing treatments which have been superseded, or shown ineffective. Peter Littlejohns, the clinical and public health director of the National Institute for Health and Clinical Excellence (NICE), joins us to explain what NICE is doing in that arena.
Annabel Ferriman takes us through the news.
Chronic fatigue syndrome
29 augusti 2013 |
25 min
This week’s hot topic is chronic fatigue syndrome. The journal Science published a paper in October 2009, which suggested a possible link between a new virus (xenotrophic murine leukaemia virus-like virus) and the syndrome. Duncan Jarvies is looking at the evidence behind this link, and finding out more about the history and treatment of the condition. Richard Hurley takes us through what caught his eye on bmj.com week.
Sex life - from soup to nuts
29 augusti 2013 |
20 min
This week, Duncan Jarvies talks to Stacy Lindau and Natalia Garilova about their new sex life expectancy measure, and what it could mean for patients and public health.
Zosia Kmietowicz talks to Douglas Gwatidzo and Rutendo Bonde about the health care system in Zimbabwe, and how the situation there has changed since its nadir in 2008.
David Payne takes us through this week’s news.
Variolae Vaccina
29 augusti 2013 |
25 min
If you visited Trafalgar Square in central London today you’d see Admiral Nelson gazing down from his column. What you won’t see is a statue to celebrate the work of Edward Jenner – although once there was one.
Gareth Williams, a professor of medicine at the University of Bristol, is backing a campaign to have Jenner’s statue reinstated. Mabel Chew talks to him about the life and times of the father of vaccination.
Sunbeds and spotlights
29 augusti 2013 |
20 min
This week the BMJ published research into the use of sunbeds. Cancer Research UK surveyed teenagers across the country to find out how often they top up their tan. Duncan Jarvies talks to Catherine Thomson, from Cancer Research UK, and Madeleine Brindley, a journalist who’s often campaigned on the dangers of solariums, about the results.
Also this week, recent revelations from a group of stem cell scientists shone a light on some of the problems with peer review. Modern science often holds it sacrosanct, but in a feature in this week’s BMJ, Mark Henderson - science editor of the Times newspaper - highlights various ways in which it might not work. Trish Groves, the BMJ’s research editor, talks to Liz Wager, an independent researcher into peer review, about the process and the ways in which it might be improved.
Cannabis conversations
29 augusti 2013 |
21 min
This week Duncan Jarvies discusses with London GP Chris Ford how to talk to patients about their cannabis use.
Rebecca Coombes talks to Jim Swire, a retired GP whose daughter Flora died in the Lockerbie bombing. Dr Swire has written an article for the BMJ about the role of Abdelbaset Al-Megrahi’s doctors in his early release.
Regulating herbal medicines
29 augusti 2013 |
17 min
This week Ike Iheanacho investigates the role of herbal remedies in modern medicine. He speaks to Dr Linda Anderson, Principal Pharmaceutical Assessor at the Medicines and Healthcare products Regulatory Agency (MHRA), and Michael Mcintyre, chair of the European Herbal Practitioners Association.
Sabreena Malik and David Payne take us through the week’s news.
Sudden death
29 augusti 2013 |
22 min
This week’s podcast is based on the BMJ series Competent Novice.Junior doctors play an important part in verifying sudden deaths in hospital and communicating with the family of the deceased. Unexpected, and often premature, deaths can be challenging to manage.
In this podcast Mabel Chew talks to Paul Frost, a consultant in intensive care medicine at the University of Wales. Paul gives practical step by step advice on dealing with sudden death, illustraded by a case study of a 19 year old stab victim who has died in the accident and emergency department.
Also this week, Annabel Ferriman takes us through the news.
Seeing the body
29 augusti 2013 |
23 min
A traumatic death can be very difficult for friends and family to deal with. A clinician’s instinct may be to protect them from seeing the extent of the damage to the body. However this may not be best in the long run. Duncan Jarvies talks to Alison Chapple about her research into people’s experiences of viewing a body after a traumatic death.
Also this week, the National Patient Safety Agency regularly issue alerts about clinical problems that can be averted. Mabel Chew talks to the NPSA about its latest alert featuring digital tourniquets.
Birte Twisselmann takes us through the news.
Cambodia
29 augusti 2013 |
18 min
This week David Payne talks to Emily Friedman, a health policy and ethics analyst, about Cambodia – a country with a difficult past that is now rebuilding its healthcare system to try to meet some of the particular needs of its population.
Screening and serodiscordance
29 augusti 2013 |
23 min
In this week’s podcast Duncan Jarvies talks to Theresa Marteau about screening for diabetes; can patients be given too much information? Also Anne Buvé discusses the likelihood of HIV transmission in serodiscordant couples when the infected partner is receiving antiretroviral treatment.
Annabel Ferriman takes us through the news.
Legacy of the games
29 augusti 2013 |
23 min
This week we’ re looking at the legacy of large sports events - with the 2012 Olympic games costing £9bn, and that cost being justified by saying how great an impact the games will have on the health of the nation. We talk to Gerry McCartney about his systematic review of the evidence for those claims.
Antibiotic resistance is a major problem, and we increasingly have to turn to second line drugs as bacteria become immune. We have just published a systematic review on bmj.com that looks at the link between prescribed antibiotics in primary care and antimicrobial resistance. Coauthor Alastair Hay tells us about his findings.
Annabel Ferriman, takes us through the news.
Healthy heart, happy smile
29 augusti 2013 |
24 min
In this week’s podcast we examine the link between toothbrushing and cardiovascular disease – Richard Watts talks about his research in Scotland.
Also this week the Department of Health issued a statement that has made some people wonder about the future of NICE. Fiona Godlee discusses the statement with health economist James Raftery.
Finally this week, Evan Harris may have recently lost his seat in parliament, but one thing that’ll keep him busy is his new job as a columnist for the BMJ. Trevor Jackson talks to him about his first column on Wakefield and MMR.
Suicide, sport, and CME
29 augusti 2013 |
25 min
What is the association between IQ and attempted suicide? David Batty talks to us about his research in Sweden.
Also this week, Steven Kawczak, associate director of the Cleveland Clinic’s Center for Continuing Education, outlines the clinic’s new CME partnership with the BMJ and BMJ Learning.
And finally, Richard Budgett, chief medical officer of the London 2012 Olympics, speaks about how scientists are hoping to beat the cheats. He also discusses a recent BMJ research paper about the limited health and economic benefits that big sporting events have on their host nations. The recent Legacy of the games podcast includes an interview with the lead author of that paper.
I ♥ the smoking ban
29 augusti 2013 |
13 min
This week research published on bmj.com looks at the association between the smoking ban and a drop in acute myocardial infarctions. Anna Gilmore, director of the Tobacco Control Centre at the University of Bath, talks to us about her findings. We also hear from the London Health Observatory about how much money the drop has saved the NHS.
Radios and retinas
29 augusti 2013 |
25 min
Since mobile phones have been around there has been public concern about their safety - fears over radiation exposure causing cancer have been particularly trenchant. This week Paul Elliott and his colleagues published research looking for an increase in the incidence of childhood cancers around mobile phone base stations. Paul joins us in the studio.
NCEPOD (the National Confidential Enquiry into Patient Outcome and Death) have published a report on parenteral nutrition. Kayte McCann talks to gastroenterologist Jim Stewart about the findings.
Finally, bevacizumab (traded as Avastin) has been used for off-label treatment of age related macular degeneration for some time. The BMJ published research looking at the effectiveness of this monoclonal antibody compared with what was formerly the standard NHS treatment. Adnan Tufail, one of the study’s authors, joins us in the studio.
BMA-on-Sea
29 augusti 2013 |
17 min
This week saw the British Medial Association’s Annual Representatives Meeting. Deborah Cohen and Helen Morant tell us what was going on in Brighton. Also this week we have the second part of Sophie Arie’s special report on Haiti.
Methado, methadon’t, methadone
29 augusti 2013 |
21 min
Later this month sees the 17th International AIDS Conference in Vienna. One of the topics that will be discussed there is harm reduction, and the political will to embrace it.In this podcast, we look at the effects of long term opiate substitution programmes in Muirhouse, Edinburgh. Local GP Roy Robertson discusses the research he conducted there. We also travel to Kiev in Ukraine, where Richard Hurley talks to NGOs and injecting drug users about local harm reduction programmes.
The white paper
29 augusti 2013 |
24 min
The new coalition government’s white paper on health – encompassing the future of the NHS - was published this week. Chris Ham, chief executive of the health policy think-tank the King’s Fund and professor of health policy and management at the University of Birmingham, and Edward Davies, editor of BMJ Careers, discuss their immediate impressions with Ashley McKimm.
Also this week a paper on www.bmj.com looks at suicide, and how the method of an attempted suicide relates to a later successful attempt. Professor Bo Runeson from the Karolinska Institutet in Sweden joins us on the phone to discuss his research.
The bridge
29 augusti 2013 |
25 min
This week the print BMJ has a cluster of articles on suicide – one of which talks about the efficacy of physical barriers to prevent suicide from bridges. In the podcast, we’ll hear from Kevin Hines the survivor of such an attempt, and Alys Cole-King, a psychiatrist who wants to break down the stigma of suicide.
We’ll also hear from Gordon Smith, one of the authors of a study looking at a link between the time when a mother gives birth – whether it’s in the normal working week, or out of hours - and the risk of neonatal death.
Finally Richard Hurley tells us about AIDS 2010, the 25 000 delegate conference in Vienna.
The NHS market place
29 augusti 2013 |
21 min
The new coalition government’s plans for the NHS in England put GPs firmly in the driving seat - how do their secondary care colleagues feel about that?
Jacky Davis, co-chair of the NHS Consultants’ Association and a founder member of the “Keep our NHS Public” campaign, shares her views with Duncan Jarvies. Duncan also talks to Professor Julian Le Grand from the London School of Economics about how market pressures can help make health care more efficient and what GP fundholding taught us.
To see all BMJ Group’s articles about the NHS white paper for England, including discussion threads, podcasts, blogs, and learning modules, visit doc2doc.bmj.com/whitepaper
Musical lithotomy
29 augusti 2013 |
25 min
In June 2010 the drug company Novo Nordisk announced that its only conventional human biphasic insulin, human Mixtard 30, would no longer be available in the UK from January 2011, a decision that affects an estimated 90,000 patients Drug and Theraputics Bulletin (DTB), one of the BMJ’s sister journals, is campaigning against that decision. DTB editor Ike Ihenacho talks about the campaign.
Mabel Chew talks to the authors of a rational testing article on what to do about mildly abnormal serum amine transferase levels, what to suspect, and how to diagnose.
Finally, we have a musical interlude.
Heavy weather
29 augusti 2013 |
21 min
In this week’s podcast we discover the link between the weather and the risk of heart attacks - Krishnan Bhaskaran tells us about his research.
Also, criticism and response are crucial parts of the scientific process, but how well do authors of research papers respond to critics of their work? Peter Gøtzsche and Tony Delamothe discuss their work looking at that in the BMJ.
The hidden eunuch
29 augusti 2013 |
22 min
Jill Morrison talks about how people on long term incapacity benefit because of mental health problems could be identified by their GPs three years before they stop working.
BMJ Deputy editor Trish Groves explains more about the journal’s new policy of asking authors of eligible research articles to pay a publication fee.
And, finally, why does the modern eunuch remain invisible?
Shit happens
28 augusti 2013 |
17 min
This week, to steal a line from the latest BMJ editor’s choice, we’ll be talking shit. The millennium development goal on sanitation is way off track; Lyla Mehta, a sociologist from the Institute of Development Studies, tells us why, and Kamal Kar, a development consultant from India, explains how his grass roots initiative changes the way people view sanitation.
Also, National confidential enquiry into patient outcome and death reported on cosmetic surgery this week. Dr Alex Goodwin, anaesthetist and clinical coordinator of the report, tells us about the problems they had collecting data, and some of the implications of their findings.
NICE in America
28 augusti 2013 |
17 min
In this week’s podcast we find out from Sean Tunis about the future of comparative effectiveness research in the USA, and how the new institute created to champion it will differ from the UK’s National Institute of Clinical Excellence.
Also, Claudia Cooper talks about her research that could support carers in the decisions they have to make for dementia sufferers.
Rational suicide
28 augusti 2013 |
21 min
A person’s right to refuse treatment is based on their capacity to make a rational decision – but what is the situation when someone is admitted after a suicide attempt? Can you be simultaneously rational and suicidal? Anthony David from the Institute of Psychiatry gives us his views.
A second interview deals with Barrett’s oesophagus, which is on the increase. The same is true for adenocarcinoma of the oesophagus, which can arise from the condition. We talked to Rebecca Fitzgerald from the Hutchison/MRC Research Centre how developments in treatment, and a new method of sampling, could make a national screening test a possibility.
Spotlight on palliative care beyond cancer
28 augusti 2013 |
16 min
In a series of articles, this spotlight focuses on recognising and managing the end of life, having the difficult conversations with patients about their death, and the importance of taking into account the spiritual aspects of death. In this podcast Duncan Jarvies talks to the authors of 2 of those articles.
Professor Jane Maher, oncologist and CMO of Macmillan Cancer Support, talks about the importance of end of life care. Dr Mike Knapton, GP and CMO of the British Heart Foundation, talks about their move into palliation.
Radical reforms
28 augusti 2013 |
18 min
This week we’re joined by Martin McKee, professor of European public health at the Loncon School of Hygiene and Tropical Medicine. He’s also research director of the European observatory on health systems and policies, a group that promotes evidence based healthcare policies in Europe.
We’ll be discussing the effect the squeeze in funding is having on health care in Europe, and the various strategies different countries are using to save money.
Safety comes second
28 augusti 2013 |
17 min
Last week saw Safety 2010, the international conference on preventable accidents. We hear from some of the speakers there why safety comes second when it comes to global health.
Also this week, female sexual dysfunction - fact or fiction. In advance of a BMJ debate on the topic, we get to the heart of the issue.
The new lost tribe
28 augusti 2013 |
13 min
Last week BMJ Careers published “The new lost tribe,” describing the cohort of surgical trainees moving from ST2 to ST3. In this podcast Edward Davies, BMJ Careers editor, and Tom Dolphin, a member of the BMA junior doctors’ committee, describe how competition for training places is affecting career progression.
Reboxetine and the missing data
28 augusti 2013 |
25 min
This week Beate Wieseler from IQWiG (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) tells us how they uncovered data on the antidepressant reboxetine.
Also Angela Thomas and Julia Anderson, haematologists from the Comprehensive Care Haemophilia and Thrombosis Centre, Royal Infirmary of Edinburgh, explain how to investigate a child who bruises easily.
Hyper hypo
28 augusti 2013 |
19 min
In this week’s podcast Jayati Das-Munshi, from the Institute of Psychiatry, London, talks about her study into the mental health effects of ethnic density.
Also, hyper/hypo - antonyms that can sound almost identical. Adam Frankel and Phillip Vecchio from the Princess Alexandra Hospital in Woolloongabba, Australia, explain their their plan to do away with these troublesome prefixes.
China
28 augusti 2013 |
17 min
China’s New Rural Cooperative Medical Scheme, aims to provide health insurance to 800 million rural citizens. We’ll be finding out from Scott Rozelle, from Stanford University and Qingye Meng from Peking University, the background to the formation of the scheme, and its place in the wider Chinese medical system.
Regulation, regulation, regulation
28 augusti 2013 |
16 min
A BMJ investigation this week raises concerns about the ability of the US Food and Drug Administration to monitor the safety of medical devices through post-approval surveillance. We ask: is the FDA giving device manufacturers an easy regulatory ride?
Also, the National Institute for Health and Clinical Excellence (NICE) is set to lose the power to restrict the use of any drug that exceeds its £30k cost per quality adjusted life year ceiling. Alan Maynard, professor of health economics at the University of York, discusses what this will mean.
Risky business 2010
28 augusti 2013 |
22 min
This week the podcast’s all about risk, as we bring you two reports from Risky Business, the conference where speakers from a wide range of hazardous industries came together to share ideas.
Pat Crosskerry tells Rebecca Coombes how his work shows thinking more analytically, and less intuitively, could help doctors make better diagnostic decisions, and save lives.
We also look at the contentious subject of medical litigation, and ask if it improves patient safety.
Refer, or not to refer...
28 augusti 2013 |
21 min
This week Dulcie McBride, a consultant in public health at University College London, joins us to talk about the UK’s practice variation in referring to secondary care.
Also Simon Wright, head of health at Save the Children, the BMJ’s Christmas charity, talks to Rebecca Coombes about how the money you donate helps health care in some of the world’s poorest countries.
A tale of two cycles
28 augusti 2013 |
23 min
This week we’re joined by Jack Wennberg, author of the Dartmoth Atlas of Healthcare. He and Fiona Godlee discuss his work, and what the UK can learn from the US.
Also this week what do you buy a MAMIL (Middle Aged Man in Lycra) for Christmas?
Christmas 2010
28 augusti 2013 |
26 min
In this week’s cracker of a show…
Firstly, could how you park your car indicate your choice of specialty?
Secondly, how a team of scientists managed to solve the mystery of the missing French monarch.
And are doctors in ITU more likely to be oliguric, and at greater risk of acute kidney injury than their patients?
We read a modern fable, which has an important message for the management of complex clinical collaborations.
And finally, how much beauty is there in beauty sleep?
And that was 2010
28 augusti 2013 |
20 min
In the final BMJ podcast of 2010, David Payne asks the Independent’s Jeremy Laurance about the year past, and BMJ authors how they feel going into the one ahead.
Also, Adama Traore tells us about the work Save the Children are doing in Sierra Leone. The charity has been instrumental in implementing free healthcare for women and children there, and we hear about their success.
Sting in the tale
28 augusti 2013 |
19 min
This week we find out the best way to treat a Mesobuthus tamulus (indian red scorpion) sting. We also discuss the current state of healthcare in Iraq; and how Andrew Wakefield’s article linking the MMR vaccine and autism was not bad science, but deliberate fraud.
Dowsing for data
28 augusti 2013 |
20 min
In this week’s podcast we hear from Tom Jefferson of the Cochrane Collaboration about the problem of publication bias – and a tool that could help researchers dowse for hidden data.
Also, Brian Deer discusses his features and explains why it’s been so long from the original publication of Wakefield’s work in the Lancet to the revelations just published in the BMJ.
And David Payne talks to us about the new BMJ iPad app.
Andrew Lansley’s apples and oranges
28 augusti 2013 |
17 min
Andrew Lansley said this week his NHS reforms are needed because the UK’s health outcomes are amongst the poorest in Europe. However John Appleby, chief economist at the King’s Fund, tells us why the comparisons are flawed.
We also hear from Turkey’s minister of health, Recep Akdağ, on the strides his country has made in providing healthcare.
Judging the nudging
28 augusti 2013 |
17 min
In this week’s podcast Theresa Marteau, director of the Behaviour and Health Research Unit at the University of Cambridge, wonders if a nudge is enough to change our health behaviours.
Also this week, Aziz Sheikh, from the E-medicine Group at The University of Edinburgh, explains how telemedicine is going to be an integral part of future healthcare.
Overusing oxygen
28 augusti 2013 |
22 min
In this week’s podcast Andrew Farmer from the National Institute of Health Research, Health Technology Assessment programme (NIHR HTA), tackles uncertainty.
Also, Andrew Clark from the University of Hull tells us that the case for administering oxygen isn’t air tight.
Diabetes
28 augusti 2013 |
18 min
This week we find out about diabetes. Mabel Chew, our Sydney based associate editor, discovers why it’s important not to miss the diagnosis of type I diabetes in children. And we learn about a new therapeutic agent for type II diabetes: glucagon-like peptide-1 analogues.
A hearty drink
28 augusti 2013 |
25 min
In this week’s podcast we find out from Susan Brien and Paul Ronksley about the cardioprotective effects of alcohol.
Also, Annabel Ferriman tells us about the nominees for the BMJ Group lifetime achievement award.
Food for thought
28 augusti 2013 |
23 min
Between March 2010 and March 2011 the cost of maize and wheat doubled. This is just the latest in a series of price hikes in food staples. In an editorial this week, Joachim Von Braun sets out some of the problems that this price rise is going to cause. David Nabarro, UN special representative of the secretary-general on food security and nutrition, describes why and how we should control the price rise.
Watching waiting times
28 augusti 2013 |
16 min
In this week’s podcast, Johan Sundstrom explains how blood pressure in adolescents effects mortality in adults. And John Appleby, chief economist of the King’s Fund, talks waiting times.
30 years of AIDS
28 augusti 2013 |
24 min
This month marks the 30th anniversary of the first diagnosed case of AIDS. Bertrand Audoin, from the International AIDS Society, brings us up to date with the latest developments in the fight against the disease.
Also this week, Francesco Capuccio from Warwick University explains the importance of sleep as a “health commodity” and the problems with its sacrifice, in our increasingly busy lives.
NHS reforms round table
28 augusti 2013 |
19 min
This week the British government has tabled an amendment to remove maximum pricing from the Health and Social Care Bill. We convened a round table discussion to find out what other elements of the bill need re-examining.
Joining us in the studio at BMA house were:
John Black - president of the Royal College of Surgeons.
Clare Gerada - chair of the Royal College of General Practitioners
Michelle Drage - chief executive of the London Wide LMCs
Nigel Edwards – acting chief executive of the NHS Confederation
Anna Dixon - director of policy at the King’s Fund
From Fukushima
28 augusti 2013 |
21 min
As the world’s attention turns to Fukushima, we hear from Ryuki Kassai, Director of Community and Family Medicine at Fukushima Medical University, about the situation on the ground there. He tells us about the difficulties they currently face, and the uncertainty of the next few days and weeks.
Also this week, Paul Mackin of Newcastle University discusses the use and efficacy of atypical antipsychotic
Trade in generics
28 augusti 2013 |
12 min
Jamie Love, Knowledge Ecology International, and Hans Hogerzeil, director of essential medicines and pharmaceutical policies at the World Health Organization (WHO), discuss the ongoing EU trade negotiations with India. They set out their concerns that it may lead to an interruption in the supply of new generic drugs to the developing world.
BMJ Round Table Shared Decision - Making Patients
28 augusti 2013 |
36 min
At BMA house, we convened a group of world experts in shared decision making. Inspired by the Salzburg Global Summit meeting we discussed the background, practical challenges, and how to engage patients with their health
The participants were:
Fiona Godlee , editor in chief, BMJ
Angela Coulter , director of global initiatives, Foundation for Informed Medical Decision Making
Albert Mulley , co-founder, Foundation for Informed Medical Decision Making, and director, Dartmouth Center for Health Care Delivery Science
Glyn Elwyn, research professor with an interest in shared decision making, Cardiff University
Muir Gray , chair of the Information Standard, Department of Health, and co-editor (with Gerd Gigerenzer of the new book Better Doctors, Better Patients, Better Decisions: Envisioning Health Care 2020
Marion Collict, national programme manager, shared decision making, NHS (UK’s National Health System)
Alf Collins , consultant in pain medicine, Taunton and Somerset NHS Foundation Trust, and national clinical lead for Co-Creating Health
Margaret McCartney , writer and GP
Anu Dhir , junior surgical trainee and co-signatory of the Salzburg Statement
Gerd Gigerenzer , director, Center for Adaptive Behaviour and Cognition, Max Planck Institute for Human Behaviour
Lisa Schwartz , professor of medicine, Dartmouth Medical School, author (with Steve Woloshin (see below)) of Know Your Chances available free online.
Steve Woloshin , professor of medicine, Dartmouth Medical School
“e-Patient Dave” deBronkart , co-chair, Society for Participatory Medicine
Tessa Richards , analysis editor, BMJ
Sue Ziebland , research director of the Health Experiences Research Group and a reader in qualitative health research, Department of Primary Health Care, University of Oxford
BMJ Round Table Shared Decision - Making Practicalities
28 augusti 2013 |
24 min
At BMA house, we convened a group of world experts in shared decision making. Inspired by the Salzburg Global Summit meeting we discussed the background, practical challenges, and how to engage patients with their health
The participants were:
Fiona Godlee , editor in chief, BMJ
Angela Coulter , director of global initiatives, Foundation for Informed Medical Decision Making
Albert Mulley , co-founder, Foundation for Informed Medical Decision Making, and director, Dartmouth Center for Health Care Delivery Science
Glyn Elwyn, research professor with an interest in shared decision making, Cardiff University
Muir Gray , chair of the Information Standard, Department of Health, and co-editor (with Gerd Gigerenzer of the new book Better Doctors, Better Patients, Better Decisions: Envisioning Health Care 2020
Marion Collict, national programme manager, shared decision making, NHS (UK’s National Health System)
Alf Collins , consultant in pain medicine, Taunton and Somerset NHS Foundation Trust, and national clinical lead for Co-Creating Health
Margaret McCartney , writer and GP
Anu Dhir , junior surgical trainee and co-signatory of the Salzburg Statement
Gerd Gigerenzer , director, Center for Adaptive Behaviour and Cognition, Max Planck Institute for Human Behaviour
Lisa Schwartz , professor of medicine, Dartmouth Medical School, author (with Steve Woloshin (see below)) of Know Your Chances available free online.
Steve Woloshin , professor of medicine, Dartmouth Medical School
“e-Patient Dave” deBronkart , co-chair, Society for Participatory Medicine
Tessa Richards , analysis editor, BMJ
Sue Ziebland , research director of the Health Experiences Research Group and a reader in qualitative health research, Department of Primary Health Care, University of Oxford
BMJ Round Table Shared Decision - Making Background
28 augusti 2013 |
26 min
At BMA house, we convened a group of world experts in shared decision making. Inspired by the Salzburg Global Summit meeting we discussed the background, practical challenges, and how to engage patients with their health
The participants were:
Fiona Godlee , editor in chief, BMJ
Angela Coulter , director of global initiatives, Foundation for Informed Medical Decision Making
Albert Mulley , co-founder, Foundation for Informed Medical Decision Making, and director, Dartmouth Center for Health Care Delivery Science
Glyn Elwyn, research professor with an interest in shared decision making, Cardiff University
Muir Gray , chair of the Information Standard, Department of Health, and co-editor (with Gerd Gigerenzer of the new book Better Doctors, Better Patients, Better Decisions: Envisioning Health Care 2020
Marion Collict, national programme manager, shared decision making, NHS (UK’s National Health System)
Alf Collins , consultant in pain medicine, Taunton and Somerset NHS Foundation Trust, and national clinical lead for Co-Creating Health
Margaret McCartney , writer and GP
Anu Dhir , junior surgical trainee and co-signatory of the Salzburg Statement
Gerd Gigerenzer , director, Center for Adaptive Behaviour and Cognition, Max Planck Institute for Human Behaviour
Lisa Schwartz , professor of medicine, Dartmouth Medical School, author (with Steve Woloshin (see below)) of Know Your Chances available free online.
Steve Woloshin , professor of medicine, Dartmouth Medical School
“e-Patient Dave” deBronkart , co-chair, Society for Participatory Medicine
Tessa Richards , analysis editor, BMJ
Sue Ziebland , research director of the Health Experiences Research Group and a reader in qualitative health research, Department of Primary Health Care, University of Oxford
Shared decision making
28 augusti 2013 |
20 min
This week’s podcast is a summary of the shared decision making round table - looking at it’s history, practicalities of implementation and how to get patients involved.
The full round table can be found on bmj.com/podcasts.
ACE to ARB
28 augusti 2013 |
22 min
Should we screen for prostate cancer? A study published on bmj.com suggests that it doesn’t improve survival rates, and could lead to over treatment. Gabriel Sandblom, of the Karolinska Institute, tells us about his research.
Also, James Ritter, emeritus professor of pharmacology at King’s College London, explains the As in the ABCD of hypertension treatment.
Understanding information
28 augusti 2013 |
15 min
Information abounds in our burgeoning knowledge economy, but how much is useful - let alone essential? Martin Dawes from the University of British Colombia tells us about the hierachy of evidence.
Also this week, data journalist and author of Information is Beautiful, David McCandless, talks to us about the power and the pitfalls of graphically representing data.
Artificial pancreas and a genetic ISO
28 augusti 2013 |
13 min
Regulation of genetic testing kits is difficult, so how do we start to control this growing market? Christine Hauskeller, from the ESRC Centre for Genomics in Society at the University of Exeter, discusses her idea for an international standard which will help consumers make the right choices. Also this week, management of type 2 diabetes could be improved using an “artificial pancreas”. Roman Hovorka, principal research associate at the Institute of Metabolic Science, University of Cambridge, describes his new intelligent system for insulin delivery.
Travelling when pregnant
28 augusti 2013 |
16 min
The problems associated with arsenic in drinking water have been known for some time, but new research published in the BMJ helps quantify that risk with respect to cardiovascular disease. Yu Chen, New York University School of Medicine, joins us to discuss her research.
Also this week, requests for travel information for pregnant women are on the increase, but the available information is patchy. Lucy Chappell, a lecturer at Kings College London School of Medicine and one of the authors of a new clinical review on the subject, joins us in the studio to talk about the evidence and how to assess risk.
Cold homes cost lives
28 augusti 2013 |
18 min
What are the health impacts of cold homes and fuel poverty? Michael Marmot, professor of epidemiology and public health at University College London, talks about findings of the report he co- authored for environmental charity Friends of the Earth.
BMJ editor in chief Fiona Godlee and deputy editor Trish Groves talk about the BMJ Group’s evidence to the UK parliamentary science and technology select committee inquiry into peer review.
Prophylaxis for endocarditis
28 augusti 2013 |
14 min
Richard Peto, renowned epidemiologist at Oxford University, won the BMJ Group lifetime achievement award this week. We hear from him about his work, and some of impact it has had.
Also this week, Martin Thornhill, from the University of Sheffield, talks about his research, which shows the effect of a change to NICE guidance on antibiotic prophylaxis for endocarditis.
Climate change and population, sleep and obesity
28 augusti 2013 |
17 min
In this week’s podcast Babatunde Osotimehin, executive director of the UN population fund, joins us in the studio to talk about climate change and reproductive rights.
Also, Barry Taylor from the University of Otago in New Zealand, describes his research into the link between sleep, BMI, and body fat in children.
Immunisation and ectopic pregnancy
28 augusti 2013 |
22 min
In this week’s podcast Trish Groves talks to Marzio Babille, UNICEF representative in Chad, about the country with the lowest immunisation rates in the world.
Sophie Cook finds out from Davor Jurkovic, from University College Hospital London, about clinical signs of ectopic pregnancy that may be easy to miss.
Sharing the pain
28 augusti 2013 |
25 min
How can doctors and police sharing information help stop violent crime? Jonathan Shepherd, from Cardiff University, explains the Cardiff Violence Prevention Programme - and his research into its effectiveness.
Also this week, as a new antiplatelet agent is being considered by the National Institute for Health and Clinical Excellence (NICE), Albert Ferro, from King’s College London, takes us through this class of drugs, their effectiveness, and their indications.
Beansprouts and blood pressure
28 augusti 2013 |
20 min
In this week’s podcast, we look at the ups and downs of postural hypotension.
Also, beansprouts have been fingered as the cause of the recent E coli outbreak in Germany, David Payne investigates this microbiological detective story.
A world without smoking
28 augusti 2013 |
18 min
If everyone were to stop smoking, what would be the major public health hazards, and what would happen to health inequalities? Laurence Gruer, director of public health science at NHS Health Scotland, tells podcast producer Duncan Jarvies what his cohort study, examining Scottish women who have never smoked, reveals.
And BMJ web editor David Payne talks to editor-in-chief Fiona Godlee about what came to pass at the BMA Annual Representatives Meeting this week.
Bed blues
28 augusti 2013 |
20 min
In this week’s podcast, Margaret McCartney examines Hydration for Health, Quentin Anstee explains how big a problem non-alcoholic fatty liver disease is, and Patrick Keown explains the association between provision of mental health beds and the involuntary admission of mental health patients.
Artificial organs and surgical research
28 augusti 2013 |
13 min
In this week’s podcast, Duncan Jarvies speaks to Alexander Seifalian, professor of nanotechnology and regenerative medicine, about a groundbreaking procedure that enabled a multinational surgical team to implant an entirely synthetic organ—a trachea—into a patient. And Norman Williams, president of the Royal College of Surgeons, talks about the college’s plans for improving the quality of surgical research.
Designed for health
28 augusti 2013 |
20 min
In this week’s podcast Jeremy Myerson, from the Royal College of Art, tells us how good design techniques can make cities more friendly places to grow old gracefully. Clive Ballard, from Kings College London, explains how important pain relief is for dementia patients. Elizabeth Draper, from the University of Leicester, talks us through her investigation into how socioeconomic class affects how women deal with severe congenital abnormalities during pregnancy.
Sharing decisions and data
28 augusti 2013 |
27 min
In this week’s podcast we discuss publishing medical details with former health editor of The Sun, Jacqui Thornton. Rogaia Abuelgasim Abdelrahim, the UN Population Fund’s deputy representative in Somalia, explains how the drought and subsequent crop failure there has been exacerbated by existing political problems and led to widespread famine. And Natalie Grazin, Assistant Director of the Health Foundation, talks about making shared decision making a reality.
Tracking down TB
28 augusti 2013 |
17 min
In this week’s podcast, Sue Rabbit Roff describes how she thinks a system of paid for kidney donations could work in practice. Al Story, clinical lead of the Find and Treat programme – a travelling team who scour the streets of London for tuberculosis – explains the programme’s mission.
Doctors in the danger zone
28 augusti 2013 |
16 min
A recent study compared cost efficiency of different healthcare systems around the world. We hear from Colin Pritchard, from Bournemouth University, about how the NHS came out near the top. Also this week, the International Committee of the Red Cross has a mandate under the Geneva convention to protect the victims of both international and internal armed conflict. Head of mission Geoff Loane explains why they’re finding that increasingly difficult to do.
Global Health and TB
28 augusti 2013 |
25 min
Last week BMJ Group held an inaugural global health conference http://globalhealth.bmj.com/ in London, looking at policies for sustainable and effective healthcare. David Heymann, chair of the UK Health Protection Agency, and Martha Gyansa-Lutterodt, Director of Pharmaceuticals at the Ministry of Health, Ghana, discuss how vertical aid programmes can lead to systemic improvements in lower income countries. And, Kalipso Chalkidou, Director of NICE International, explains a bit more about its work.
Also, smoking is known to increase TB mortality. A modelling study this week suggests that the number of excess deaths from TB, caused by tobacco consumption, could be as high as 40 million over the next 40 years. Stanton Glantz, Director of the Centre for Tobacco Control Research and Education at the University of California, San Francisco, joins us to set out the numbers.
Drink, drugs, and comic book villains
28 augusti 2013 |
21 min
In this week’s podcast, Shaun Walker reports on alcohol consumption in Russia. Ewan Hoyle explains why he wants the Lib Dems to discuss drug policy. And we found out how realistic comic book villains’ mental health problems are.
Facing the dragon
28 augusti 2013 |
20 min
This week, chocolate is good for your emotional heart, but what about your physical one? Oscar Franco, clinical lecturer in public health at the University of Cambridge, tells us about the results of his recent meta-analysis.
Also, Irfan Dhalla , an internist and lecturer at the University of Toronto, highlights the problem of opioid related death in the USA, and how he thinks we can avoid a crisis.
Unprecedented access
28 augusti 2013 |
21 min
John Young, professor of elderly care medicine at Leeds University, gives Mabel Chew tips on carrying out a cognitive assessment of an older person. Also this week, Harlan Krumholz explains to Deborah Cohen how he got Medtronic to agree to independent scrutiny of their data that is “unprecedented in the medical industry”.
Mental health and mortality
28 augusti 2013 |
18 min
Research has found that the gap in all-cause mortality between psychiatric patients after discharge, and the general population, is growing. Uy Hoang (Oxford University) tells us what his paper reveals about the trend, and we discuss possible ways to tackle the disparity with Fiona Gaughran and Shubulade Smith (Institute of Psychiatry, South London and Maudsley NHS Foundation Trust).
Also, a UN conference this week aims to tackle non-communicable disease. Rebecca Coombes, BMJ features editor, explains how they’re doing that, and some of the problems with the negotiations.
Caring for the carers
28 augusti 2013 |
17 min
This week, the UK’s General Medical Council is reviewing its standards of good medical practice. Helen Jaques quizzes Niall Dickson, the council’s chief executive, about the possible changes.
Also this week, Ian Cameron, head of the rehabilitation studies unit at the University of Sydney, explains how doctors should care for the carers of older patients.
10 Lords revolting
27 augusti 2013 |
17 min
Seth Berkley, CEO of GAVI (formerly the “Global Alliance for Vaccines and Immunisation”), talks to Rebecca Coombes about the future of vaccination funding. Also this week, the Health and Social Care bill, set to change the English NHS, is about to enter the House of Lords before becoming law. We find out which areas will receive most scrutiny from members of the Upper House from liberal democrat peer Baroness Shirley Williams of Crosby, a leading critic of the changes.
Regulating education, and respiratory infections
27 augusti 2013 |
19 min
The Health and Social Care Bill for England has now reached the House of Lords. With the proposed demise of deaneries, questions still remain about how medical training will be carried out in the future. Niall Dickson, chief executive of the General Medical Council, explains how the council hopes to maintain professional standards whatever the outcome, and what changes to postgraduate education are on the horizon. Also this week, James Chalmers takes us through the steps in treating a non-responding presumed lower respiratory tract infection.
Climate, health, and security
27 augusti 2013 |
14 min
Hugh Montgomery, director of the University College London Institute for Human Health & Performance, talks about the space where climate, health, and international security meet. Christabel Owens, head of mental health research at the Devon Partnership NHS Trust, explains why warning signs for suicidal thoughts may not be visible to those best placed to spot them.
Decriminalisation of drugs in Portugal
27 augusti 2013 |
18 min
In 2001 Portugal abolished all criminal penalties for personal possession of drugs – effectively decriminalising their use. Health journalist Nigel Hawkes talks to João Goulão, Portugal’s drug tsar, to find out how effective this policy change has been.
Also, the General Medical Council is introducing revalidation for doctors. Part of that revalidation will require input from a doctor’s colleagues and patients. We hear from John Campbell, Peninsula College of Medicine and Dentistry, about possible independent factors that could affect the scores.
Watching receptionists, watching weight
27 augusti 2013 |
18 min
One way of tackling obesity is by attending a weight loss club, such as WeightWatchers . There are many such schemes available on the NHS, but which one is the most effective? We find out the results of an RCT that aims to find out. Also this week, ethnographic studies aren’t just limited to lost tribes. We find out what observation of receptionists in general practice surgeries uncovered.
Undernutrition in India
27 augusti 2013 |
19 min
Tessa Richards (BMJ’s analysis editor) and Duncan Jarvies (BMJ’s multimedia producer) talk to Veena Rao (adviser at Karnataka Nutrition Mission, India) about the issue of undernutrion in the country.
And David Payne (BMJ’s web editor) gives us a run-down of the new bmj.com.
Sudden death in epilepsy; NAFLD mortality
27 augusti 2013 |
15 min
Mariana Lazo, from Johns Hopkins Bloomberg School of Public Health, tells us how non-alcoholic fatty liver disease has affected all cause mortality in the US. Also, Ley Sander, from University College London, discusses the problem of sudden death in epilepsy.
Evolved to run
27 augusti 2013 |
16 min
This week’s podcast is from UKSEM, the big sports and exercise medicine conference in London. Daniel Lieberman, an evolutionary biologist from Harvard, explains how we have evolved to run. Steven Blair, University of South Carolina, explains how physical inactivity is having serious effects on our health. Finally Karim Khan, BJSM’s editor, tells us how much exercise gives you the most bang for your buck.
If you’re interested in sports medicine, then have a listen to the BJSM podcast, where your can find more interviews with world leaders in sports medicine - http://podcasts.bmj.com/bjsm
AIDS at 30
27 augusti 2013 |
26 min
To mark World AIDS Day, the WHO has issued a report outlining policy successes and failures in the diagnosis and treatment of HIV/AIDS. Yves Souteyrand, the co-ordinator of the report, joins us to discuss its findings and how to combat the disease in the future.
Alan White, professor of men's health at Leeds Metropolitan University and the author of a new European report into men's health, explains why we need to look at men differently.
Finally, renowned surgeon Atul Gawande launches the BMJ's 2011 Christmas appeal, in aid of charity Lifebox, by describing how a cheap reliable pulse oximeter costing £160 should be available in all operating theatres. You can donate at www.lifebox.org/donations
Brain drain
27 augusti 2013 |
21 min
How much does it cost sub-Saharan countries to train all the doctors who end up working in the UK, US, Canada, and Australia? Edward Mills from the University of Ottawa explains his economic analysis of healthcare migration. Also Hungarian health minister Miklós Szócska talks about his country's challenges and plans when it comes to improving health outcomes, currently among the worst in Europe.
Death in Borsetshire
27 augusti 2013 |
20 min
Vanessa Whitburn, editor of BBC Radio 4’s The Archers, talks morbidity and mortality in Ambridge. James Raftery, University of Southampton, updates the Forrest Report – whose evidence prompted the breast cancer screening programme in the UK.
2011
27 augusti 2013 |
25 min
Somehow we've come to the end of another year. The Independent's health editor Jeremy Laurance talks us through the big health stories from 2011.
And Greg Scott discusses his Christmas paper on the phrase "obs stable", and what it's revealed these two words have actually come to mean to hospital doctors.
Missing data
27 augusti 2013 |
23 min
The problem of missing data is well known, especially in cases where drug companies conceal evidence. However pharmaceutical industry misconduct is not the only cause, and a cluster of papers in this week's BMJ show how aspects of the culture of medical science contribute to the problem.
Elizabeth Loder, BMJ's clinical editor, talks to Harlan Krumholz (Harold H Hines Jr professor of medicine at Yale University) and Joseph Ross (assistant professor of medicine, also at Yale) about missing data from US publicly funded trials. Lisa Bero (professor at the Department of Clinical Pharmacy, University of California) describes how adding missing data to meta-analyses of drug trials can change the results, and Richard Riley (senior lecturer in medical statistics at Birmingham University) explains why individual participant meta-analyses aren't as balanced as we may think.
Surgical performance
27 augusti 2013 |
14 min
Antoine Declos, Université de Lyon, explains the performance curve of surgeons as they become more experienced. Peter Wilmshurst, Royal Shrewsbury Hospital, and veteran whistleblower explains why it may be harder to expose the truth in a lab, than on the ward.
Antidepressants and tamiflu
27 augusti 2013 |
20 min
Simon Hatcher, associate professor of psychiatry at the University of Aukland, sets out the use of newer antidepressants for the treatment of depression in adults. Deborah Cohen, BMJ's investigations editor, updates us on the Tamiflu saga, and how Roche is still holding onto its full patient data.
New antiepileptics and the drop in MI deaths
27 augusti 2013 |
24 min
Mabel Chew talks to epileptologists Martin Brodie from the Western Infirmary Glasgow and Patrick Kwan from the University of Melbourne, about the newer drug treatments for the condition. Also, Kate Smolina from Oxford University's Department of Public Health explains what constitutes the drop in deaths from acute myocardial infarction.
Healthcare and corruption in Uttar Pradesh
27 augusti 2013 |
18 min
The Indian government has invested £1.2bn to kick start rural healthcare in its most populous northern state, Uttar Pradesh. Much of that money has now disappeared, and the programme is blighted by corruption and murder. Harriet Vickers hears the details. Also this week, the UK's Department for International Development has to make decisions on sometimes scant evidence. We find out how DFID is trying to improve research into aid programmes.
Cannabis in cars
27 augusti 2013 |
16 min
Journalist Karen McColl interviews Wendell Potter, US health industry lobbying guru turned critic. Mark Ashbridge, an associate professor at Dalhousie University, explains how cannabis intoxication is an increasingly important factor in motor vehicle collisions.
Menopause, HRT, and cancer
27 augusti 2013 |
27 min
This week we look at older women's health, Gita Mishra from the School of Population Health, University of Queensland, explains the trajectories of perimenopausal symptoms. Martha Hickey, professor of obstetrics and gynaecology at the University of Melbourne, and Jane Elliott a senior lecturer at the University of Adelaide, give Mabel Chew practical tips on prescribing HRT. Finally Steinar Tretli, research director of the Cancer Registry of Norway, explains the results of their research into how HRT and mammography combine to increase apparent rates of breast cancer.
After the health bill - what next?
27 augusti 2013 |
42 min
With the future of the Health and Social Care bill more certain, how will the health service react to the legislative changes? At this year's Nuffield Trust Health Policy Summit, the BMJ's editor Fiona Godlee hosted a round table to discuss this question.
Taking part were:
David Bennett, Chairman and CEO, Monitor
Paul Corrigan, Management consultant, Southside
Penny Dash, McKinseys
Nigel Edwards, Kings Fund
Clare Gerada, RCGP
Gareth Goodier, CEO, Cambridge University Hospitals NHS Foundation Trust, Cambridge
Alastair McLellan, Editor, Health Services Journal
James Morrow, GP, Sawston, Cambridge
Judith Smith, Nuffield Trust
Simon Stevens, CEO, Global Health, United Health Group, USA
Helen Thomas, Medical Director, Sentinel Commissioning, Plymouth
For more from the summit, and to watch some of the keynote speeches, go to the Nuffield Trust site.
Tackling NCDs in developing countries
27 augusti 2013 |
9 min
Dan Chisholm, a health economist with the World Health Organisation talks to Harriet Vickers about a cluster of articles which examines the more cost effective way to tackle non-communicable diseases in sub-Saharan Africa and South East Asia.
Elective ventilation and the future of medical professionalism
27 augusti 2013 |
17 min
Is elective ventilation an acceptable way to increase organs available for transplant? Duncan Jarvies discusses the ethics with Dominic Wilkinson (associate professor of neonatal medicine and bioethics, and consultant neonatologist, at the University of Adelaide).
And Harriet Vickers talks to Iona Heath (president of the Royal College of General Practitioners) and David Haslam (president of the British Medical Association) about how the NHS reforms fundamentally threaten medical professionalism.
Neurodegenerative disease and cancer, and peer led parenting
27 augusti 2013 |
19 min
A new peer led parenting group is having success in South London, we visit a session to find out why. Also Jane Driver, an associate professor at Brigham and Women’s Hospital in Boston, explains how Alzheimer's disease and cancer maybe opposite sides of the same coin.
Emergency contraception, and stopping smoking
27 augusti 2013 |
24 min
Indhu Prabakar, a subspecialty registrar in sexual and reproductive health at Abacus Services for Sexual and Reproductive Healthcare in Liverpool, goes through the options for emergency contraception. Tim Coleman, a professor of primary care at the UK Centre for Tobacco Control Studies, University of Nottingham, explains his research on methods to help smokers quit.
SSRIs in dementia, and exposure to a rash in pregnancy
27 augusti 2013 |
20 min
Eithne MacMahon, consultant and honorary senior lecturer at the Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, explains how to test and treat a pregnant woman exposed to a child with a rash. Sverre Bergh, a researcher at the Centre for Old Age Psychiatric Research, Sanderud Hospital in Norway, discusses the results of his research into stopping SSRIs in dementia patients in Norway.
Stopping the spread of disease at the Olympics and Hajj
27 augusti 2013 |
12 min
Hopes are high that the 2012 Olympics and Paralympics will have a lasting sports and exercise legacy, but the work done to ensure the health of the millions of attendees could also have an important impact.
Harriet Vickers talks to Brian McCloskey, the Health Protection Agency’s national Olympics and Paralympics lead, about how infectious diseases will be monitored and controlled during the games, and ensuring the knowledge and structures developed are captured. And Ziad Memish, deputy public health minister for Saudi Arabia’s Department of Health, discusses the innovations and interventions his country has pioneered for public health at the Hajj, paving the way for other mass gatherings.
Overactive bladder syndrome
27 augusti 2013 |
21 min
This week we’re concentrating on the problem of an overactive bladder, the subject of a cluster of articles in this week’s BMJ. Practice editor Mabel Chew is joined by Linda Cardozo, professor of urogynaecology, and Dudley Robinson, consultant urogynaecologist, both from King’s College Hospital, London.
23.5 hours to change behaviour
27 augusti 2013 |
31 min
The focus of this week’s programme is health promotion and behaviour change.
Joining Karim Khan, BJSM editor, and Domhnall McAuley, BMJ primary care editor, is Mike Evans, associate professor of family medicine at the University of Toronto and founder of the Health Design Lab. Dan Heath, senior fellow at Duke University’s Center for the Advancement of Social Entrepreneurship, and co-author of a book “Switch – how to change things when change is hard” also joins the panel.
The Health Design Lab’s viral video 23 and 1/2 hours: What is the single best thing we can do for our health? has been watched over 2.5m times, and is freely available on youtube
SPARX and spirometry
27 augusti 2013 |
28 min
SPARX is a new cognitive behavioural therapy based computer game for young people with depression. Sally Merry, an associate professor of child and adolescent psychiatry at the University of Auckland, joins us to explain how it was created. Also this week Christine Jenkins, thoracic physician at Concord Hospital in Sydney, gives Mabel Chew a masterclass in spirometry.
Type 1 or type 2 diabetes?
27 augusti 2013 |
22 min
BMJ deputy editor Trish Groves talks to Bianca Hemmingsen, a PhD student at Copenhagen University Hospital, about research comparing metformin and insulin with insulin alone, for the treatment of type 2 diabetes. Also, Dan Lasserson, a senior clinical researcher at the University of Oxford, tells BMJ practice editor Mabel Chew how late onset type 1 diabetes can be easily missed.
GAVI in Ghana
27 augusti 2013 |
20 min
BMJ features editor Rebecca Coombes finds out more about a new pneumococcal vaccine being rolled out in Ghana. And David Payne meets Kenneth Kizer, the US doctor who transformed the failing Veteran’s Health Administration and took on the tobacco industry in California.
Anti vaccination movements
27 augusti 2013 |
18 min
Paul Offit, the author of the yes side of our head to head article "Should childhood vaccination be mandatory", joins us to discuss his book Deadly Choices: How the anti-vaccine movement threatens us all, and explains why he thinks it is wrong to refuse to accept patients who haven't been vaccinated.
Also, in the month when UK prime minister David Cameron said dementia care is a “national crisis” and that he is making it one of his personal priorities, Marcel Olde Rikkert, professor in geriatrics at Radboud University Nijmegen Medical Centre in the Netherlands, discusses his research which looks at the relative effectiveness of dementia follow up care by either dedicated memory clinics or general practitioners.
Doctors on strike
27 augusti 2013 |
19 min
It's the first time doctors have been polled for strike action since 1975, and we've heard a lot about the moral arguments of doing so, but what about the practicalities? Edward Davies, BMJ Careers editor, talked to Mark Porter, chair of the BMA's consultant committee, about how he thinks doctors can balance industrial action and patient safety.
Also this week, Richard Hurley finds out why Sam Shuster, emeritus professor of dermatology at the University of Newcastle, thinks drug testing for athletes is illogical and immoral.
It’s time to say sorry
27 augusti 2013 |
21 min
In this weeks podcast BMJ features editor Rebecca Coombes reports from Risky Business, the patient safety conference held in London last week. She talks to Loretta Evans, a mother who lost her son because of medical negligence, and about her fight to receive an apology from the hospital. Dr Liliane Field, medicolegal adviser at the Medical Protection Society, talks about the importance of a genuine apology, and what doctors should do if they feel prevented from doing so.
Are statins still safe?
27 augusti 2013 |
15 min
Keith Fox, president of the British Cardiovascular Society, and Rory Collins, co-director of the University of Oxford's Clinical Trial Service Unit and Epidemiological Studies Unit, discuss the safety of statins, and how clever prescribing can overcome worries about myopathy. Also this week, Tony Delamothe, BMJ deputy editor, explains why the sudden interest in atrial fibrillation is making him queasy.
Herpes simplex encephalitis
27 augusti 2013 |
18 min
This week we look at herpes simplex encephalitis, an easily missed central nervous system infection which can have serious consequences.
Our practice editor Mabel Chew discusses the features of the illness with Tom Solomon, professor of neurological science at Walton Centre NHS Foundation Trust, Liverpool. And podcast producer Duncan Jarvies gets advice on diagnosis from Adam Zeman, professor of cognitive and behavioural neurology at Peninsular Medical School.
Research free for all?
27 augusti 2013 |
22 min
For the last year a group commissioned by the UK government has been looking at whether making all published research freely available is attainable or not. BMJ editor Fiona Godlee speaks to Dame Janet Finch, the group's chair, about its conclusions.
We also bring you highlights from a BMJ hosted round table on what the landscape of research publishing could, and should, look like in the future.
The future of secondary care - full roundtable
27 augusti 2013 |
81 min
With changes to the NHS such as cuts, competition and tendering, secondary care will need to adapt. Joining BMJ features editor Rebecca Coombes to discuss how, are:
Yi Mien Koh, chief executive of Whittington Health, London
Jan Filochowski, chief executive of West Hertfordshire Hospitals NHS Trust
Fergus Gleeson, divisional director of Critical Care, Theatres, Diagnostics and Pharmacy at Oxford University Hospitals
Nigel Edwards, senior fellow at the King’s Fund
Derek Greatorex, chair of the South Devon and Torbay Clinical Commissioning Group
Kate Hall, policy advisor, Monitor, London
This is the full version of the roundtable. See the podcast above for highlights.
The future of secondary care
27 augusti 2013 |
22 min
The healthcare landscape in the England is shifting, with cuts, competition and tendering some of the major changes. Secondary care must adapt to these, but how? Joining BMJ features editor Rebecca Coombes to discuss the issues are:
Yi Mien Koh, chief executive of Whittington Health, London
Jan Filochowski, chief executive of West Hertfordshire Hospitals NHS Trust
Fergus Gleeson, divisional director of Critical Care, Theatres, Diagnostics and Pharmacy at Oxford University Hospitals
Nigel Edwards, senior fellow at the King’s Fund
Derek Greatorex, chair of the South Devon and Torbay Clinical Commissioning Group
And BMJ practice editor Mabel Chew talks to Ruth Reed (specialty registrar in child and adolescent psychiatry, Warneford Hospital, Oxford) and Mina Fazel (postdoctoral research fellow, Warneford Hospital Oxford) about why post-traumatic stress disorder is easily missed, and what clinicians should look out for.
Obama’s healthcare reforms on trial
27 augusti 2013 |
17 min
Barack Obama saw his Affordable Care Act remain law last week, as the US Supreme Court ruled it is constitutional. Ed Davies (BMJ US news and features editor) talks to Janice Hopkins Tanne (freelance journalist based in New York) about the ruling’s implications.
And what are the options for tackling childhood obesity? Li Ming Wen (research and evaluation manager at Sydney University) believes intervention needs to be early, and has demonstrated that giving new mothers simple nutrition messages reduces their child’s BMI at age two. BMJ assistant editor Helen MacDonald speaks to him.
Telehealth: Running before walking?
27 augusti 2013 |
22 min
It seems the race to implement telehealth is on – the UK government’s response to its Whole System Demonstrator pilot has been very positive. But has it been over-hyped? We find out from Jennifer Dixon, Director of the Nuffield Trust, which has evaluated the pilot.
Also, alcohol: beneficial or detrimental? Evidence shows it depends on what aspects of health you look at. Research published on bmj.com this week adds to the picture by looking at the association between alcohol consumption and the risk of developing arthritis. Alicja Wolk, professor of nutritional epidemiology at the Karolinska Institutet, explains her study.
Insanity in the dock
27 augusti 2013 |
15 min
It has been almost exactly a year since Anders Breivik bombed government buildings in Oslo, and then carried out a mass shooting on the island of Utøya, where he killed 69 people, mostly teenagers. In that time there has been much discussion about his mental state. Vivienne Nathanson and Julian Sheather from the BMA join us to discuss the moral and ethical problems that a diagnosis of insanity bring to the case.
Also this week, seven articles on bmj.com look at the science behind sports product adverts. We hear from Matthew Thompson, from the Centre for Evidence Based Medicine in Oxford, who criticises the quality of the evidence submitted to the European Food Safety Authority to back these claims
Shift workers’ health and assessing risk of violence
27 augusti 2013 |
18 min
Daniel Hackam, associate professor at Western University in Canada, explains how shift patterns can have a detrimental effect on the vascular health of workers.
Also this week Seena Fazel, Wellcome Trust senior research fellow in clinical science at the University of Oxford, queries the predictive value of the risk assessment tools routinely used to predict violent behaviour
Renal patient records
27 augusti 2013 |
22 min
A feature this week asks "Should patients be able to control their own records?". The website renalpatientview.org allows patients to do exactly that. Neil Turner, a professor of nephrology at Edinburgh Royal Infirmary, explains how he and colleagues developed the resource.
Also Steven Woloshin and Lisa Schwartz, authors of the "Not So Stories" column have turned their statistical scrutiny onto a recent advert by Susan G. Komen for the Cure®, the breast cancer charity. They explain how the case for mammography has been massively oversold.
Is the drug pipeline really drying up?
27 augusti 2013 |
22 min
This week we’ll hear why Donald Light, professor of comparative health systems research at the University of Medicine and Dentistry of New Jersey, thinks the innovation crisis in the development of drugs is more marketing rhetoric than reality.
Also this week, a research paper on bmj.com looks at how subclinical psychological distress affects mortality. Tom Russ, Alzheimer Scotland clinical research fellow at the University of Edinburgh and one of the paper's authors, explains what they found.
Fighting the food giants
27 augusti 2013 |
15 min
Marion Nestle is the Paulette Goddard Professor of Nutrition, Food Studies, and Public Health at New York University. She has written widely about food and nutrition, and is an iconoclast in the world of food politics. In this podcast she explains how economic forces have changed the food industry, and how that change is fuelling the obesity epidemic.
Ecological public health
27 augusti 2013 |
19 min
Over the decades public health has had many incarnations. Geof Rayner and Tim Lang (Center for Food Policy) argue that public health today needs an overhaul, and to focus on our co-existence with nature and relationships with each other. They explain why, and how.
Many of the issues Dr Rayner and Professor Lang are concerned about are being taken up by the People's Health Movement. Member Jonny Currie explains what he wants the movement to achieve, and others involved talk about actions they are taking.
Bad for wealth, bad for health?
27 augusti 2013 |
14 min
In 2008 the rates of suicide in the UK began to increase. Is it a coincidence that this was also when the financial crisis hit? Ben Barr, research fellow in the department of Public Health and Policy at the University of Liverpool, explains what his study found.
Those who've attempted to kill themselves once are at high risk of doing so again, but interventions to prevent this have been hard to find. Merete Nordentoft, professor at the Mental Health Centre Copenhagen, University of Copenhagen, talks us through the results of her study examining a promising candidate.
Acutely ill patients
27 augusti 2013 |
25 min
It's increasingly obvious that acutely ill patients have received less than gold standard care. Deficiencies in training are often blamed. Paul Frost, consultant in intensive care medicine at the University Hospital of Wales, takes us through the admission of an acutely ill patient.
Also this week, BRCA mutations and ionising radiation both increase the risk of developing cancer, but how do these risk factors combine? Anouk Pijpe, an epidemiologist at the Netherlands Cancer Institute, explains the results of her retrospective cohort study.
Spotting pre-eclampsia, and debating obesity
27 augusti 2013 |
29 min
A BMJ head to head article this week asks: "Are the causes of obesity primarily environmental?" John Wilding, Head of the Department of Obesity and Endocrinology at the University of Liverpool, and Tim Frayling, professor of human genetics at the University of Exeter, argue their cases.
Also this week, David Williams, a consultant obstetric physician at University College Hospital London, explains why pre-eclampsia is easily missed.
Newer insulins and stents in diabetic patients
27 augusti 2013 |
22 min
This week we concentrate on diabetes
"The difference between insulin management in type 1 and type 2 diabetes is rather like the difference between driving a sports car and driving a lorry," says Edwin Gale, emeritus professor of diabetes at the University of Bristol. He tells us why this means the newer insulins that have benefits in the treatment of type 1 diabetes may not be as good for type 2.
Sripal Bangalore, director of research at the New York University School of Medicine, discusses his research into the relative effectiveness of different types of stents in diabetes patients
Reducing emergency admissions: are we on the right track?
27 augusti 2013 |
22 min
Schemes which reduce emergency admissions sound like a good thing, but Martin Rowland, professor of health services research, Cambridge Centre for Health Services Research, University of Cambridge, explains how they can go off track.
And Mabel Chew gets some advice on the prognosis of children with acute coughs from Matthew Thompson, a senior clinical scientist in the Department of Primary Care Health Sciences, Oxford University.
Stayin’ Alive, in the cardboard city
27 augusti 2013 |
19 min
A head to head article this week asks: "Does celebrity involvement in public health campaigns deliver long term benefit?”. The British Heart Foundation’s Hands Only CPR campaign, featuring Hollywood actor Vinnie Jones, seems to be having positive effects. Maura Gillespie, head of policy and advocacy at the BHF, explains why.
Also this week, care for the homeless is often fragmented and transient. A team at University College Hospital in London is trying to unite the disparate agencies involved to ensure long term medical and social care for these vulnerable people. They tell us how their pilot service has improved outcomes and reduced costs.
Treating the masses, overtreating the few
27 augusti 2013 |
15 min
In the US, overly aggressive treatment is estimated to cause 30 000 deaths among Medicare recipients alone each year. Reporter Jeanne Lenzer has investigated the problem for the BMJ, and explains why she thinks profit driven healthcare is to blame.
And, experience of treating rare conditions can take time to build. Rej Bhumbra, a surgical trainee in orthopaedic oncology, explains how his time in India fast tracked his learning.
Bariatric surgery, neuromuscular blocking agents, and calcium in primary parahyperthyroidism
27 augusti 2013 |
25 min
Bariatric surgery is under scrutiny from NCEPOD, the National Confidential Enquiry into Patient Outcome and Death, Ian Martin, NCEPOD's clinical co-ordinator for surgery, takes us through the highlights of its latest report. Also this week, Julie Paik, instructor and physician at Harvard Medical School, tells us about a new risk factor for primary hyperparathyroidism. And finally, some neuromuscular agents may lead to respiratory complications after surgery. Matthias Eikermann, director of research in the surgical intensive care unit at Massachusetts General Hospital, explains how they investigated this vexed problem.
Smoking in Japan
27 augusti 2013 |
18 min
Deborah Cohen explains how a joint BMJ and Daily Telegraph investigation helped uncover problems with device regulation in Europe. Previous research has shown smoking reduces life expectancy by about a decade, but only by four years if you are Japanese. Sarah Darby, from the University of Oxford, explains why her new research shows they are actually just as unhealthy as their British counterparts.
Fishy data
27 augusti 2013 |
20 min
Rajiv Chowdury, a research associate from the Department of Public Health and Primary Care at the University of Cambridge, explains why eating whole fish is better than fish oil - at least when it comes to cerebrovascular disease. Also this week Peter Doshi and Tom Jefferson from the Cochrane Collaboration talk about the BMJ's open data campaign, and how publishing correspondence with Roche, the WHO and Centers for Disease Control and Prevention might reveal the missing data on Tamiflu.
The silent misdiagnosis
27 augusti 2013 |
19 min
This week, Al Mulley, Dartmouth Center for Health Care Delivery Science, and Tessa Richards, BMJ associate editor, discuss the silent misdiagnosis: that of patient preferences.
Removing pre-cancerous cells spotted through screening is the foremost defence against cervical cancer. However, a recent BMJ paper has shown that women who go through this have a fourfold risk of going on to develop cancer compared to women who’ve only ever had normal smears, even if they complete follow up and are given the all clear. Matejka Rebolj, postdoctoral researcher, Department of Public Health, University of Copenhagen, and Chris Meijer and Maaike Bleeker, pathologists in the Department of Pathology, VU Medical Centre, Amsterdam, discuss what could be done to mitigate the risk.
Countering counterfeits
27 augusti 2013 |
18 min
Last year 125 people died in Pakistan after taking contaminated cardiac medication. The disaster is one example of the dangers of counterfeit and substandard medicines, an issue the WHO is struggling to control.
In this podcast we hear from Amir Attaran, Canada research chair in law, population health, and global development policy at the University of Ottawa, on the international wrangling he sees at the political level. And Sania Nishtar, president of Heartfile, an independent think tank based in India, discusses what went wrong in Pakistan, and how to prevent it happening again.
Checking out the check-ups
27 augusti 2013 |
16 min
Lasse Krogsbøll, from the Nordic Cochrane Centre, explains research into whether general health checks improve mortality and morbidity in the population. Also, the European Medicines Agency (EMA) this week announced plans to make trial data used as the basis for its decisions publicly available. BMJ Deputy editor Trish Groves finds out more from some of the key players in the campaign for open data.
Neonatal survival and Lifebox
27 augusti 2013 |
30 min
Helen Macdonald, assistant editor at the BMJ, talks to Neil Marlow, professor of neonatal medicine at University College London, about his update to the EPICure study looking at outcomes for extremely premature babies.
Jane Feinmann talks to writer and surgeon Atul Gawande, about Lifebox – which has been chosen again as the BMJ’s Christmas appeal for 2012.
Emergency oxygen use
27 augusti 2013 |
20 min
Is too much oxygen a good thing? Christine Roffe, consultant physician, Stoke Stroke Research Group, North Staffordshire Combined Healthcare NHS Trust, talks Mabel Chew, BMJ associate editor, through the evidence for routinely treating stroke patients with oxygen.
And Russell Gruen, professor of surgery and public health, Alfred and Monash University, Melbourne, explains how and when tranexamic acid should be used after trauma.
Non-coeliac but gluten sensitive?
27 augusti 2013 |
16 min
Many patients are following a wheat free diet, which they believe helps with their gastrointestinal symptoms, yet they don't exhibit markers of coeliac disease. Mabel Chew finds out from David Sanders, a professor of gastroenterology at the Royal Hallamshire Hospital, about non-coeliac gluten sensitivity.
Also, Fiona Godlee gives us an update on the open data campaign.
Christmas 2012: The speed bump test
27 augusti 2013 |
20 min
We know that speed bumps have an important public health role, but a Christmas BMJ paper shows they're also clinically useful, and can help diagnose appendicitis. Helen Ashdown, academic clinical fellow in general practice, University of Oxford, and Mike Puttick, consultant surgeon, Stoke Mandeville Hospital, explain.
And want to know how many carrots you need to eat to balance out that festive champagne? David Spiegelhalter, Winton professor for the public understanding of risk, University of Cambridge, tells us how to work it out.
Prison health
27 augusti 2013 |
23 min
The final article in the analysis series examining prison health in England and Wales is published this week. To sum up, Francis Crook, Director of the Howard League for Penal Reform - the UK's oldest charity examining prison conditions - joins us to discuss prison reform.
Also this week, Myasthenia gravis; Jennifer Spillane, clinical research associate at the Institute of Neurology in London, explains why it's easily missed.
Deworming debunked
27 augusti 2013 |
19 min
You may well assume that a programme supported by organisations such as the World Bank and the World Health Organization does what it says on the tin. However, it turns out this is not the case with deworming initiatives in countries such as Africa and India. Paul Garner, co-author of the Cochrane review on the topic, explains what's going on.
And Michael Wilson, instructor of medicine at the Mayo Clinic, gives us some advice on diagnosing Klinefelter's syndrome.
The science of sugar
27 augusti 2013 |
18 min
The authors of the recent meta-analysis on dietary sugar and body weight, Lisa Te Morenga, and Jim Mann, from the Departments of Human Nutrition and Medicine at the University of Otago, join us to discuss their findings.
Also this week, the BMA wants doctors to be more involved in influencing policy on recreational drugs. Vivienne Nathanson, its director of professional activities, explains its new report, and how individual testimony can combine to convince governments to change policy.
H7N9, and NHS standardised mortality rates
12 augusti 2013 |
18 min
An epidemiological investigation on bmj.com discusses the first probable case of human to human transmission of novel avian influenza A (H7N9). The author of the accompanying editorial, James Rudge, from the London School of Hygiene and Tropical Medicine, explains what this means for public health.
Also this week, we know that standardised mortality rates are tricky and have to be interpreted carefully. David Spiegelhater, Winton Professor for the Public Understanding of Risk at the university of Cambridge, explains why a figure of 13 000 excess deaths in NHS hospitals is “number abuse”.
Read the articles:
http://www.bmj.com/content/347/bmj.f4730
http://www.bmj.com/content/347/bmj.f4893
American life
7 augusti 2013 |
26 min
US Health in International Perspective: Shorter Lives, Poorer Health produced by the National Research Council and Institute of Medicine of the National Academies, has found that on almost every comparative measure, Americans fare worse than their counterparts from other developed countries. Steve Woolf, from the Department of Family Medicine at Virginia Commonwealth University, who chaired the report, joins us to discuss its findings, and the implications.
Treating early psychosis
7 augusti 2013 |
14 min
How can you treat a young person who is exhibiting the first signs of psychosis? Mabel Chew talks to Professor Tim Kendall a consultant psychiatrist and director of the National Collaborating Centre for Mental Health at the Royal College of Psychiatrists. Professor Kendall is co-author of both a systematic review and meta-analysis into early treatments to prevent psychosis, and co-author of a new set of NICE guidelines into management of the condition.
Screening and treating clinically localised prostate cancer
7 augusti 2013 |
21 min
In this practice special podcast, Timothy Wilt, professor of medicine at Minneapolis VA Center for Chronic Disease Outcomes Research, explains how to talk to patients about prostate cancer screening. Benjamin C Thomas, senior clinical fellow at Addenbrooks Hospital in Cambridge then talks us through androgen deprivation therapy.
Mid Staffs inquiry, and digging for data
7 augusti 2013 |
31 min
The Francis report into care standards at Mid Staffordshire NHS Foundation Trust was published this week. Triggered by deaths at a hospital in England, Robert Francis QC was appointed by the government to look into why the quality of care in some wards was so low, and what can be done to make sure that this doesn’t happen in other hospitals.
Also this week, research has unearthed data hidden for 40 years on magnetic tapes. It casts new light on the link between consumption of unsaturated fatty acids and secondary prevention of cardiovascular events. We hear from Christopher Ramsden, a clinical investigator at the US National Institutes of Health, who dug up the data.
The future of primary care
7 augusti 2013 |
79 min
The BMJ held a round table in January 2013 to discuss the future of primary care in England and Wales. The wide ranging topics included out of hours care, commissioning, education, time management, and integration. This is the full version, lasting one hour and 20 minutes. Edited highlights are available in this week's podcast.
Chair:
Domhnall MacAuley, primary care editor, BMJ.
Participants:
Helen Thomas, former GP partner, and current GP Strategic Health Authority lead for the south west of England
Clare Gerada, chair of the Royal College of General Practitioners.
Nav Chana, postgraduate dean of GP and community based education at the London Deanery.
Judith Smith, director of policy at the policy think tank, the Nuffield Trust.
Start with the basics, food and fluid
7 augusti 2013 |
22 min
How involved are doctors in the non medical aspects of patient care? An analysis on bmj.com this week examines the problem of nutrition and fluid balance in hospitalised patients. Helen Macdonald, a junior doctor and editor at the BMJ, asks Richard Leach, clinical director of Guy's and St Thomas' NHS Foundation Trust, about how it should best be handled.
Also this week, a summary of the BMJ round table on the future of primary care, which is available in full on the podcast page.
Health in all policies
7 augusti 2013 |
18 min
Of the myriad of clinical decision support tools, what features actually improve patient outcomes? Pavel Romanov, medical student at Western University in Canada, discusses his research.
Also this week: Is it feasible to get governments to consider the public health impact of every policy decision they make? Politicians in Wales have drafted legislation to make the devolved nation the first in the world to implement this WHO recommendation. Adam Fletcher, senior lecturer in social science and health at Cardiff University, has written an editorial about the plan, and joins us to discuss the practicalities of enshrining public health in law.
How do we put the compassion back into healthcare?: Full roundtable discussion
7 augusti 2013 |
39 min
In the wake of the Francis report, the BMJ gathered experts to discuss compassion in the health service. This is the discussion in full.
Taking part are:
Domhnall MacAuley, BMJ primary care editor
Anthony Silverstone, consultant at UCH
Peter Carter, chief executive for the Royal College of Nursing
Jocelyn Cornwall, director, The Point of Care programme, The King's Fund
Joanne Watson, consultant at Musgrove Park Hospital
Sean O'Brien, head of the patient experience group at Musgrove Park Hospital
Compassion and variation
7 augusti 2013 |
17 min
If patients living in one area have more diagnoses than those living in another, use more care, but have similar mortality rates, you would think they were simply sicker, but that the extra care they were receiving must be good and making them better. Not so, says new research published on bmj.com. John Wennberg, emeritus professor of community and family medicine at the Dartmouth Institute in the US, joins us to explains how this flawed logic is harmfully perpetuating overdiagnosis and variation in care.
Also, post Mid Staffs, how do we put compassion back at the heart of care? A BMJ round table discusses this, and we have edited highlights. The full round table is also available on the podcast page.
Witty words on data
7 augusti 2013 |
19 min
Andrew Witty is the CEO of GlaxoSmithKline. He’s been credited with taking on a pharma company with a history of behaving badly in the past – as shown by a record $3bn fine levied by the US government last year. How much is he able or willing to change the culture of an industry, which is under pressure to alter its practices? Rebecca Coombes finds out.
Also this week, Michael Dowling, president and CEO of the North Shore-LIJ Health System in New York, has built his organisation up from two hospitals undergoing a difficult merger into a giant integrated system. He explains his no-nonsense approach to making change work.
After Francis, what next?
6 augusti 2013 |
49 min
Recorded at the recent Nuffield health policy summit, this round table asks how to impliment the Francis reports recommendations.
Taking part were:
Robert Francis, chair of The Mid Staffordshire NHS Foundation Trust Public Enquiry
Simon Stevens, president of global health at the UnitedHealth Group
Sam Barrell, chief clinical officer of South Devon and Torbay CCG
Niall Dickson, CEO of the General Medical Council
Stephen Dorrell MP, chair of the HOC Health Select Committee
Nigel Edwards, director of the Global Healthcare Group, KPMG
Jan Filochowski, chief executive, Great Ormond Street Hospital for Children NHS Foundation Trust
Julie Moore, chief executive of University Hospitals Birmingham
Bruce Keogh, medical director of the NHS
Alastair McLellan, Editor of Health Services Journal
Jeremy Taylor, chief executive, National Voices
Ruth Thorlby, senior fellow at the Nuffield Trust.
Are all calories equal?
6 augusti 2013 |
23 min
Are all calories equal? Thermodynamics would say that energy is energy, be it derived from carbohydrate, fat, or protein. But things get more complicated when appetite is taken into consideration , says Robert Lustig, professor of pediatric endocrinology at the University of California, San Francisco.
Also this week, life expectancy in Europe is increasing, but at the same time health inequalities are widening. Claudia Stein, director of the Division of Information, Evidence, Research, and Innovation at the World Health Organization's regional office for Europe, talks about a new report that highlights both the good and the bad of Europe's health.
Carotid atherosclerosis and patient participation
6 augusti 2013 |
20 min
A clinical review this week looks at the diagnosis and treatment of carotid atherosclerosis, including when to screen and the threshold for intervention. Alun Davies, professor of vascular surgery at Imperial College London, also answers how useful or harmful screening offered commercially is.
Also this week, the BMJ’s editorial board met to discuss how patient participation should be represented and encouraged by the journal. We captured some of their views.
All trials registered | All results reported
6 augusti 2013 |
15 min
The issues of hidden data are well known, and the BMJ’s open data campaign page documents some of the problems which have arisen as a result of clinical trial data remaining undisclosed.
At Evidence Live 2013 in Oxford this week, Fiona Godlee, BMJ editor in chief, convened a group of those closely involved with the AllTrials campaign, to discuss where we are now and what still needs to be done
Tackling hypertension in India
6 augusti 2013 |
13 min
The World Health Organization has chosen hypertension as the public health threat it will focus on for the next year. The problem is particularly pressing in India, and Anita Jain, the BMJ's India editor, spoke to François Decaillet, Coordinator for Health Programs, WHO India, about what needs to be done to tackle hypertension in the country's population.
Dealing with delirium
6 augusti 2013 |
21 min
Delirium is often missed in primary and secondary care. Edison Vidal, assistant professor in internal medicine at the Universidade Estadual Paulista, Brazil, advises on diagnosing and managing the condition.
Rheumatoid arthritis, non-biological drug treatments, or both, might suppress tumour surveillance and in theory increase the risk of melanoma. Pauline Raaschou, consultant in clinical pharmacology at the Karolinska Institutet, Sweden, explains what she found while investigating the association.
Warts and all
6 augusti 2013 |
28 min
This week, we discuss how Australia’s national human papillomavirus (HPV) vaccination programme has caused a dramatic drop in genital warts. Does this foretell elimination of all disease caused by HPV in the country?
And some advice on how to diagnose and manage pulmonary hypertension.
Dying patients in hospital, e-patients online
6 augusti 2013 |
27 min
Patients are increasingly going online to find and discuss information about their condition. What are they getting on the web that they’re not getting from clinicians, and how is this changing healthcare?
Also, how to care for a dying patient in hospital.
Suspected heart failure
6 augusti 2013 |
14 min
Mabel Chew, practice editor at the BMJ, talks to Tushar Kotecha, a cardiology specialist registrar at Charing Cross Hospital in London, about when to suspect heart failure, and how to diagnose the condition.
The BMJ Awards: Medical Team of the Year
6 augusti 2013 |
10 min
The BMJ Awards were held last Thursday. Fiona Godlee, the BMJ's editor in chief, announced that the Britain Nepal Otology Service (BRINOS) was named Medical Team of the Year.
BRINOS (brinos.org.uk) started out in 1988 by setting up joint British and Nepalese surgical camps to treat ear disease among patients living outside the reach of hospitals in the capital of Kathmandu. A national survey in 1991 found that among the 19m people in Nepal, 2.7m were deaf and 1.5m had abnormal ear drums indicative of ear disease. BRINOS has performed more than 4000 major ear operations at 49 surgical day camps since its first expedition in 1989. Furthermore, there have been many anecdotal stories of improved education and employment opportunities in social isolation after surgery. The organisation expanded in 2000 to introduce community ear assistants, who are specially trained in the diagnosis and treatment of ear disease and dispense hearing aids passed on from the NHS.
Vulnerable adults, and the road to cycle safety
6 augusti 2013 |
20 min
In a drive to improve safety, many cyclists now wear helmets. But how useful is legislation that mandates their use when compared with all the other safety initiatives available? Jessica Dennis, a PhD candidate from the Dalla Lana School of Public Health at the University of Toronto, tells us about her research into accident trends.
Also this week, doctors play a key role in spotting when a vulnerable person is experiencing abuse, but it can be difficult to know how to tackle the issue. A clinical review sets out some advice. We're joined by the authors, Billy Boland, consultant psychiatrist and lead doctor for safeguarding adults, and Jemima Burnage, head of social work and safeguarding, at Hertfordshire Partnership NHS Foundation Trust in the UK.
Think then scan, don’t scan then think
5 augusti 2013 |
19 min
Until now, the increased risk of cancer from CT scans has been modelled from the data gathered from survivors of the Hiroshima and Nagasaki bombings. However, new BMJ research, based on a large Australian cohort, offers new evidence to support the modelling. John Matthews, from the university of Melbourne, joins us to explain what they found.
Also this week, social media is relatively new – but did you realise that doctors had been using social networks to improve health for centuries? Enrico Coiera, director of the Centre for Health Informatics at the University of New South Wales, explains more, and how in the digital age we might try and use virtual networks to do the same job on a larger scale.
Corporations as vectors of disease
5 augusti 2013 |
14 min
This month the UK parliament has been looking at the big accountancy firms' involvement in drafting tax laws. Conversely, the Department of Health has hidden the involvement of tobacco lobbyists in proposed plain packaging legislation.
Jeff Collin, professor of global health policy at the University of Edinburgh, argues that this culture of industry participation is worrying, but the lack of transparency by government is even worse.
Also this week, what day of the week is safest for surgery? Paul Aylin, a clinical reader in epidemiology and public health at Imperial College London, explains his research.
Bias in clinical guidelines, and giving birth at home
5 augusti 2013 |
19 min
Despite repeated calls to prohibit or limit conflicts of interests among authors and sponsors of clinical guidelines, the problem persists. Jeanne Lenzer explains what's going wrong.
And is giving birth at home as safe for the mother as giving birth in hospital? New research from the Netherlands suggests that it is, and that risk assessment is key.
Tackling violence against women
5 augusti 2013 |
26 min
This week, the World Health Organisation called for healthcare providers to be more aware of intimate partner and sexual violence against women, calling it a "global health problem of epidemic proportions." We look into what doctors need to know.
And we discuss advice on diagnosing and treating first trimester miscarriage.
NSAIDs update
5 augusti 2013 |
18 min
Recent research shows that some non-steroidal anti-inflammatory drugs increase cardiovascular risk in some patients. Given their widespread use, and breadth of indications for prescription, should clinicians be more circumspect about their practice?
In this podcast, Mabel Chew BMJ's practice editor, talks to Richard O'Day, professor of clinical pharmacology at the University of New South Wales and author of a recent therapeutics article, about the latest research on NSAIDs
Surgical outcome data
5 augusti 2013 |
33 min
Last week saw the start of a campaign to publish patient death rates for individual surgeons. Bruce Keogh, medical director of the NHS in England, talks to BMJ editor in chief Fiona Godlee about the initiative and the background to it.
Also, the WHO has launched its Guidelines and Global Progress in HIV/AIDs report. Anne Gulland interviews Gottfried Hirnschall, a Director of the WHO’s HIV/AIDS Department, and his his scientist colleague, Philippa Easterbrook.
Antibiotics in agriculture
5 augusti 2013 |
29 min
This week a head to head article asks: "Does adding routine antibiotics to animal feed pose a serious risk to human health? The authors David Wallinga, a physician member of the steering committee of Keep Antibiotics Working: the Campaign to End Antibiotic Overuse in Animal Agriculture, and David Burch, a veterinarian and consultant on antibiotic use in agriculture from Octagon Services, argue their sides.
Also this week, a BMJ investigation looks at changes in rationing patterns in the new NHS in England. News editor Annabel Ferriman talks Gareth Iacobucci, who carried out the investigation, about the squeeze on access to hospital care.
Dying at home
5 augusti 2013 |
21 min
This week, we look at how to help patients have better deaths at home.
BMJ assistant editor Sophie Cook talks to Emily Collis, a consultant in palliative medicine and the author of a recent clinical review about caring for dying patients in the community.
BMJ columnist Des Spence, a GP in Glasgow, explains why the dying deserve better from GPs.
Lost in transfusion?
5 augusti 2013 |
14 min
Blood transfusion is an essential part of modern healthcare and can be lifesaving when used appropriately. In this podcast, Sophie Cook, The BMJ's clinical reviews editor, talks to Michael Murphy, consultant haematologist and professor of blood transfusion medicine at NHS Blood and Transplant at the John Radcliffe Hospital, Oxford, about best practice for the safety of patients receiving blood; including ways to reduce unnecessary transfusion, and the warning signs of an adverse reaction.
Plain Packaging
5 augusti 2013 |
27 min
Plain packaging on tobacco products is the latest strategy aimed at reducing smoking. Campaigners had hoped the UK would follow Australia’s example. But they have been disappointed as the UK government postpones the plans until “more evidence” is available.
We hear from Linda Bauld, professor of public policy at the University of Stirling, about why she thinks the current evidence is convincing enough.
Also this week, one of the most difficult consultations a doctor can have doesn’t involve a complex diagnosis, but rather a statement of intent: suicide. Richard Morriss, professor of psychiatry and community mental health at the University of Nottingham, explains how to have that conversation.
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En liten tjänst av I'm With Friends. Finns även på engelska.