Medicine and Science from The BMJ

Wellbeing – The joy of socks

In Australia, a staggering 25% of doctors have had thoughts of suicide in the past 12 months, a recent survey said. Mental health problems are higher in medicine than any other job – and yet healthcare professionals are still stigmatised for seeking help. Partly in response to his own struggles, Geoff Toogood, a cardiologist in Melbourne, started an ingenious campaign called CrazySocks4Docs to highlight the issue.
https://www.crazysocks4docs.com.au/

What Do We Know About Long Covid

Trisha Greenhalgh, professor of primary care health sciences at the University of Oxford has been a powerhouse of covid-19 evidence synthesis. She pulled together advice on doing remote consultations, on wearing masks to prevent spread, and a host of other information.
She’s now turning her attention to “long-covid” - as we learn more about the disease, it’s becoming apparent that it’s not just an acute infection, patients are reporting chronic long term consequences of having the virus.
In this podcast, she describes what we know about long-covid, where the uncertainty lies, and what clinicians should be doing to help patients who are experiencing the symptoms.
Management of post-acute covid-19 in primary care
https://www.bmj.com/content/370/bmj.m3026

Talk evidence covid-19 update - Living meta-analysis and covid uncertainty

1.00) Carl has been looking at PCR testing, and explains why it picks up both viable SARS-cov-2, but also fragments of it’s RNA - leading to potential over diagnosis.
(8.50 ) What did the Living systematic review and accompanying guidelines say about treatment options for covid-19
(14.35) Helen talks to Reed Siemieniuk,  general internist from McMaster University, about creating a living network meta-analysis, to try and synthesis all the evidence on covid-19
(22.48) Helen also talks to Bram Rochwerg, associate professor at McMaster University and
consultant intensivist at Hamilton Health Sciences, about turning the outcomes of a meta-analysis into guidelines, and why at the moment they’re still calling for more evidence on Remdesivir
(30.08) Finally, there are worries about the uncertainty expressed in the living review - and in the way in which we communicate that. Helen goes back to Reed to find out how the review might evolve in the future.
(33.50) Covid isn’t just an acute disease, there is emerging consensus that it’s systemic effects lead to long term problems for some patients - but there’s a lot of uncertainty there.
(38.40) Carl talks about the IMMDS review and his involvement in it - and what recommendations we’ll be covering in future Talk Evidence programmes.
Reading list:
Drug treatments for covid-19: living systematic review and network meta-analysis -https://www.bmj.com/content/370/bmj.m2980
Remdesivir for severe covid-19: a clinical practice guideline - https://www.bmj.com/content/370/bmj.m2924
Management of post-acute covid-19 in primary care - https://www.bmj.com/content/370/bmj.m3026

Thinking about vitamin D with Andrew Grey and Tom Chatfield

Interest in vitamin D, and it’s association with a range of health outcomes continues - at least if the regular flurry of papers on the subject that are submitted to The BMJ are anything to go by, and with Covid-19, interest has piqued again.
GPs are regularly asked to prescribe it, and to test for deficiencies. Low levels of vitamin D are associated with a large number of health outcomes, but, given the high costs and low accuracy of tests, would it be easier just to recommend taking supplements without testing vitamin levels first, taking a “won’t hurt but might help” approach? If so, should we all be taking them, and would doing so help to prevent against COVID-19?
Our guests:
Andrew Grey is an endocrinologist and an associate professor of Medicine at the University of Auckland.
Tom Chatfield is a philosopher, author and broadcaster, whose work looks at humans and technology, as well as cognitive biases.

Talk Evidence covid-19 update - How well have physical distancing measures worked?

Fresh outbreaks of covid in Europe and a wave of infections in the United States have been in the news this week, highlighting the renewed need for social distancing – but to what extent?
In this edition, we explore the real-world evidence for physical distancing measures as well as the research into whether or not facemasks make us behave more recklessly.
We also discuss the non-covid themes of research transparency and a BMJ investigation into the lucrative business of orphan drugs.

“Trust me, I’m a GP” with Karen Praeter and Rhea Boyd

In light of the publication of the Independent Medicines and Medical Devices Safety Review (the Cumberlege report) in early July, which assessed the use of vaginal mesh, sodium valproate and Primodos and their associated under-acknowledged complications, this week we discuss trust between patients and doctors, and how that relationship of trust can break down when patients feel that their concerns and their pain are not being recognised and supported. We talk about the influence of racial inequalities on trust and healthcare outcomes, GPs being an advocate for their patients, and we ask what structural changes to the healthcare system need to happen to allow us to spend more time with our patients and build up that trusting relationship with them?
Our guests:
Karen Praeter works on the admin team of Sling the Mesh, a campaign which raises awareness of the risks of having a vaginal mesh implant, having joined two years after her own mesh implant operation in 2015 which led to painful complications.
Rhea Boyd is a paediatrician at the Palo Alto Medical Foundation in California, and she is also a public health advocate and scholar.

Wellbeing – addiction during lockdown

Lockdown has been such a stressful period that many healthcare professionals developed abnormal behaviours to cope. Addiction is one such behaviour, be it to a substance – alcohol for example – or any other obsessive activity like exercise. Dr Caroline Walker, an NHS psychiatrist and therapist who has personal experience of addiction discusses the harmful behaviours to look out for and what to do about them.

Marian Knight - Improving obstetric outcomes with a single dose of antibiotics

This time of year we would usually be doing some podcasts from the BMJ awards - but the pandemic has delayed our plans.
We’re still working on acknowledging some of the best medicine from around the UK, but in the meantime we’ve decided to give out the awards for outstanding contribution to health, and research paper of the year.
In the following interview, Fiona Godlee - the BMJ’s editor in chief, talks to Marian Knight, lead author of the ANODE trial - The BMJ's research paper of the year.
For more about The BMJ Awards categories and previous winners; https://thebmjawards.bmj.com/

David Pencheon - measuring the climate impact of the NHS

This time of year we would usually be doing some podcasts from the BMJ awards - but the pandemic has delayed our plans.
We’re still working on acknowledging some of the best medicine from around the UK, but in the meantime we’ve decided to give out the awards for outstanding contribution to health, and research paper of the year.
In the following interview, Fiona Godlee - the BMJ’s editor in chief, talks to David Pencheon, director of the NHS sustainability unit about his work.
For more about The BMJ Awards categories and previous winners; https://thebmjawards.bmj.com/

Covid public health - Data is fundamental

As the pandemic play out, we’ve seen ways in which the collection of covid data - and it’s sharing, has been flawed, with reports in the UK that local authorities haven't got granular data, and in the US that the CDC is being circumvented for data reporting.
Kathleen Bachynski, assistant professor of public health at Muhlenburgh College, and Sridhar Venkatapuram, director of global health education & training at King's College London join us to discuss why data is fundamental to the social contract between the public and their government, and why undermining it is so dangerous.