Medicine and Science from The BMJ

A lump in the throat with Nick Hamilton, Deonne Dersch-Mills and Bonnie Kaplan

A lump in the throat is a classic GP presentation, but one that often causes a lot of worry. Many people are struggling with high levels of anxiety anyway at the moment, and this may manifest physical symptoms, such as fatigue, insomnia and dysphagia.
In this week’s episode, we discuss how to differentiate between causes of a lump in the throat: is my patient experiencing laryngopharyngeal reflux, or could it be cancer? How do we reassure distressed patients when we need to refer them on for imaging, or a consultation with a specialist, before we can rule out a malignant cause?
We also talk about how to manage a patient who has difficulty swallowing pills, and the challenges of getting children, in particular, to take medication.
Our guests:
Nick Hamilton is a clinical lecturer in otorhinolaryngology at UCL, and also works as a specialist registrar in otorhinolaryngology head and neck surgery at North Thames Deanery, London.
Deonne Dersch-Mills is the clinical practice leader for pharmacy for paediatrics & neonatology with Alberta Health Services. She is based at Alberta Children’s Hospital, Calgary.
Bonnie J. Kaplan is a semi-retired research psychologist, and professor emerita from the Cumming School of Medicine, Calgary.

Coronavirus second wave - Making the lockdown work

As the second spike in covid-19 cases grows, we want to take stock of what's happening in the NHS. In these second wave updates, clinicians from primary care, secondary care, and public health, discuss what is happening in their field, and put questions to experts.
In this podcast, Fiona Godlee, editor in chief of The BMJ talks to Matt Morgan, consultant in intensive care medicine in Cardiff and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton.
They are joined by Andrew Hayward, professor of infectious disease epidemiology and inclusion health research, to talk about the lockdown in England, why the message should be clearer, what needs to be done to make the lockdown work, and how doctors are braced for the upcoming surge in cases.
https://www.bmj.com/coronavirus

Talk evidence covid-19 update - talking risk, remdesivir, and relevant research

In this talk evidence covid-19 update, we’re taking on risk - how do you figure out your individual risk of dying from the disease? Try QCovid, but remember that it’s figuring out your risk back in April.
When it comes to talking about risk, very few people actually engage with the number, so Alex Freeman from the Winton Centre for Risk and Evidence Communication at the University of Cambridge joins us to describe their research into more effective ways of presenting it.
Huseyin Naci, from the London School of Economics, returns to the podcast to talk to us about the problems of pulling all the trial data together, and where covid-19 has made people work together most effectively in tackling that issue.
Reading list;
Living risk prediction algorithm (QCOVID) for risk of hospital admission and mortality from coronavirus 19 in adults
https://www.bmj.com/content/371/bmj.m3731
Repurposed antiviral drugs for COVID-19 –interim WHO SOLIDARITY trial results
https://www.medrxiv.org/content/10.1101/2020.10.15.20209817v1
Producing and using timely comparative evidence on drugs: lessons from clinical trials for covid-19
https://www.bmj.com/content/371/bmj.m3869.full

Chris Whitty on the challenge of winter, lockdown, and following the science

Chris Whitty probably needs no introduction to our UK audience - he's the chief medical advisor to the UK government, has played a pivotal role in shaping the country's response to Covid-19.
He rarely does interviews - so in this conversation we wanted to ask him the questions that matter to clinicians, about how the pandemic will impact them over the winter.
This was recorded yesterday, just before the announcement of the strict lockdowns in France and Germany.
For more covid-19 coverage
www.bmj.com/coronavirus

Coronavirus second wave - what the modelling say about slowing transmission

As the world sees an upsurge in infections, this "second wave" feels different to the first - we have a much better understanding of the biology of the virus, in hospitals, guidelines for treatment have been rapidly developed... and the pipeline of research to improve that has been created. 
But a lot of questions remain - particularly about the dynamics of the spread of respiratory viruses.
Which brings us onto this episode - in these weekly discussions, clinicians from across the healthservice and I will be joined by experts, so we can find out more about the issues that really matter to frontline staff.
Joining us today are BMJ columnists, Matt Morgan, consultant in intensive care medicine in Cardiff and Helen Salisbury, GP in Oxfordshire. We also have The BMJ authors, Nisreen Alwan, consultant in public health, in Southampton and Karl Friston, neurologist and member of iSAGE
For more of The BMJ’s covid-19 coverage.
www.bmj.com/coronavirus

Deep Breath In - EUPD with Leisha Davies, Soumitra Burman-Roy and Marie Stella McClure

Personality disorder is often referred to as the “Cinderella” diagnosis of mental health. Around 1 in 20 people is estimated to have a personality disorder, and it is a neglected and under-resourced area of our healthcare system. In this week’s episode, we discuss the stigma surrounding personality disorder, which can often manifest itself in high levels of anxiety for both patients and GPs, when it comes to diagnosing and managing it, and how to help a patient come to terms with their diagnosis.
With suicidal ideation being experienced by many people with a personality disorder on a regular basis, we also talk about how we may best manage a situation of a patient in crisis presenting in primary care.
Our guests:
Leisha Davies is a clinical psychologist, originally from South Africa, who currently works in private practice.
Soumitra Burman-Roy is a consultant psychiatrist at the South London and Maudsley NHS Foundation Trust. He also works for Maudsley Learning, an organisation which provides mental health training for primary care.
Marie Stella McClure, who was diagnosed with borderline personality disorder at the age of 38, is the author of ‘Borderline: a Memoir’, a book about her life and experiences of BPD.

Second wave updates - How it’s affecting practice now

As the second spike in covid-19 cases grows, we want to take stock of what's happening in the NHS. In these second wave updates, clinicians from primary care, secondary care, and public health, discuss what is happening in their field, and put questions to experts.
In this podcast, Fiona Godlee, editor in chief of The BMJ talks to Matt Morgan, consultant in intensive care medicine in Cardiff and Helen Salisbury, GP in Oxfordshire - they discuss how full hospitals are getting, how many covid-19 cases are presenting in primary care, and how treating patients has fared as the pandemic hots up.
For more on covid-19 visit https://www.bmj.com/coronavirus

Wellbeing - Dreading the second wave

The "second wave" of covid is hitting the UK, and clinicians are anticipating a spike in demand in the NHS. The inevitability of that is weighing on NHS staff's minds.
In this podcast, Cormac Doyle, a retired senior army officer, who specialises in military mental health/ veterans and support other with psychological trauma, returns to the podcast to talk about his experience of deployment in the military, and how individuals and their employers can make the inevitability of a second wave less daunting.
For more wellbeing from The BMJ - https://www.bmj.com/wellbeing

Economics for Drs - what you need to know to understand UBI and a jobs guarantee

As the economic fall out of covid-19 starts to bite, attention is turning to how the state can support everyone - especially if the pandemic turns into a depression.
Universal basic income, and a jobs guarantee are two of the potential mechanisms a country could deploy, both with different effects on people's health and wellbeing.
In this podcast, Martin Hensher, associate professor of health system financing and organisation at Deakin university in Australia, and author of the new analysis "Covid-19, unemployment, and health: time for deeper solutions?" joins us to get you up to speed on the economic thought behind these two schemes.
Read the full analysis;
https://www.bmj.com/content/371/bmj.m3687

Coughing kids with Tim Spector and Edward Snelson

Persistent coughing in children is always a challenge, both for parents trying to describe and measure the cough, and for doctors making a diagnosis. In the current climate, this is all the more difficult, seeing as a continual cough is one of the major symptoms of COVID-19. UK Government guidance advises that anyone with a persistent cough should get a coronavirus test. But with the reopening of schools and the beginning of the cold & flu season both coinciding with a national shortage of tests available, should we all err on the side of caution and try to get a test at the first sign of a cough or sniffle, or can the data on cold virus symptoms help parents and GPs make an informed judgement on the likelihood that their child’s cough indicates COVID?
Our guests:
Tim Spector is a professor of Genetic Epidemiology, and director of the TwinsUK Registry, at King’s College London.
Edward Snelson is a paediatrician in the paediatric emergency department at Sheffield Children’s Hospital.