Medicine and Science from The BMJ

Treating early psychosis

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.

Mid Staffs inquiry, and digging for data

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

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

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

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

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 editorAnthony 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

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

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?

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 EnquirySimon Stevens, president of global health at the UnitedHealth GroupSam 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 BirminghamBruce Keogh, medical director of the NHSAlastair McLellan, Editor of Health Services JournalJeremy Taylor, chief executive, National Voices Ruth Thorlby, senior fellow at the Nuffield Trust.

Are all calories equal?

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.