Medicine and Science from The BMJ

Covid vaccine safety, Methenamine hippurate, and intersectionality

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

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

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

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

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

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

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

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?

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

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.