BMJ Podcast fourteen: Recent Episodes
BMJ Group
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
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
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
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
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
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
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, 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
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 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
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.
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/
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.
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
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
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
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
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
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.
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 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:
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
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
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
“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.
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
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
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
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
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
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
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
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
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
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.
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
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
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
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
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
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
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.
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
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.
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.
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
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
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/
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
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
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
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
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.
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
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
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
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
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
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
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/
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 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
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
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
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
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 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
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
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
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
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
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
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 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
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
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
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 (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
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
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
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
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
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.
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
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.
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
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
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.
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.
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.
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
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.
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.
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:
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Oliver Sacks, best selling author and professor of neurology at NYU School of Medicine
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Peter Gautier Smith, now retired from consulting at Queen Square and author of 31 detective novels
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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
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
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
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
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
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 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
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.