Medicine and Science from The BMJ

Covid in south Asia - India and Nepal

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

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

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

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

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

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/