Medicine and Science from The BMJ

Talk Evidence - real world vaccine data, GP records and CVD

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

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

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

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

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

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

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

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

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

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