Medicine and Science from The BMJ

Frontline stories - caring for non-covid patients

As the pandemic plays out - hospitals are reconfigured to increase critical care capacity, outpatient clinics become virtual, and elective procedures delayed.
How are these affecting care for those who are in hospital but don't have covid-19?
In this podcast, Matt Morgan,honorary senior research fellow at Cardiff University, consultant in intensive care medicine and Partha Kar, consultant in diabetes and endocrinology in Portsmouth, join us to discuss how their working week is changing.
Read the BMJ's columns
https://www.bmj.com/uk/news/views%20%26amp%3B%20reviews

Talk Evidence covid-19 update - lack of testing transparency, how to give good debate

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.
We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
This week:
(1.10) Carl gives us an update on the UK's figures, and how deaths outside are now being counted.
(2.10) When the pandemic slows down, and normal services resume - what should we start doing first? Helen picks up some evidence on what they might be.
(6.05) There's a signal that covid-19 may be causing coagulopathies in some patients, and Helen picks up on a listeners request for more information.
(11.22) John Deeks, professor of Biostatistics at the University of Birmingham, is leading a Cochrane initiative into examining the evidence around testing, and rivals Carl's rant when he explains how some research is being done behind a veil of confidentiality.
(35.27) When there's a lot of uncertainty, and the stakes are very high, then tempers can flare. Vinay Prasad, hematologist-oncologist in the US, and host of Plenary Sessions podcast, joins us to talk about having a good, respectful, scientific debate.

Wellbeing – how one junior doctor found a way to support frontline staff

How can we help frontline clinicians? Sometimes medics may feel uneasy or even guilty and that they could be doing more. That was what a junior doctor in Abergavenny in Wales felt and she did something about it.
In this podcast, we speak to Josie Cheetham about how she started her initiative to provide support boxes in hospitals for her colleagues working at the frontline, and how that initiative inspired others and mushroomed across the UK.

Public Health Vs The Economy

Around the world, as the covid pandemic plays out, and some countries are starting to ease their restrictions, this narrative of the economy and public health being opposing weights on a set of scales keeps returning - they need to be balanced.
But before this, a healthy population is very much seen as being supportive of the economy. So is a pandemic different, or is that dichotomy false.
Joining us to discuss are;
Martin Mckee, professor of european health at LSHTM
Kathleen Bachynski, assistant professor of public health at Muhlenberg College
Sridhar Venkatapuram, associate professor global Health & philosophy at King's College London

Frontline stories - working as a GP during covid

As the pandemic plays out - the way in which doctors in the UK practice is changing, hospitals are reconfigured to increase critical care capacity, GPs are working from home and doing their day to day work remotely.
Some of the changes have come at the detriment of staff and patient wellbeing but covid-19 has also helped cut through some of the inertia to get welcome changes done.
In this podcast, Helen Salisbury, GP in Oxfordshire, and Clare Gerada, GP in south London, join us to talk about the way in which general practice has changed, and how they and their teams are experiencing that.

Talk Evidence covid-19 update - covid ethics, waste and a minimum RCT size

For the next few months Talk Evidence is going to focus on the new corona virus pandemic.
There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.
We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
This week:
(1.00) Carl gives us an update on the UK’s covid-19 related mortality
(7.40) When the evidence is uncertain, and the outcomes so massive, then the ethical dimensions of decisions become even more apparent. Helen talks ethics in guidelines with Julian Sheather, advisor on ethics and human rights to the BMA and MSF.
(25.37) Update on covid-19 research, looking at viral particle shedding.
(29.24) We’ve mentioned the potential wasted effort in covid-19 research, and Helen speaks to Paul Glaziou, director of the Institute for Evidence Based Research at Bond University, about the waste he’s already seen, and ways in which it could be avoided.

Teleconsulting with Trish Greenhalgh and Fiona Stevenson

A new podcast from The BMJ, to help GP's feel more connected, heard, and supported.
Subscribe on;
Apple podcasts - https://bit.ly/applepodsDBI
Spotify - https://bit.ly/spotifyDBI
Google podcasts - https://bit.ly/googlepodsDBI
In our first episode, we discuss the highs and lows of video consultations, and how coronavirus has altered the landscape of business as usual for GPs. How will this change affect our relationships with our patients? How do we cope with frustrating technical issues? Are we more likely to miss a crucial diagnosis if we can’t rely on physical examinations? And, finally, are teleconsultations the future of GP practice?
Our guests:
Trish Greenhalgh is a former GP of 30 years who is now Professor of Primary Care Health Sciences at the University of Oxford. Trish is a leading researcher on video consultations.
Fiona Stevenson is a medical sociologist and researcher based at UCL. She is the co-director of their e-health unit.
Deep Breath Out - the Rob Auton Daily Podcast https://play.acast.com/s/robautonpodcast
https://www.bmj.com/podcasts/deepbreathin

Feeling the fear with Iona Heath and Danielle Ofri

A new podcast from The BMJ, to help GP's feel more connected, heard, and supported.
Subscribe on;
Apple podcasts - https://bit.ly/applepodsDBI
Spotify - https://bit.ly/spotifyDBI
Google podcasts - https://bit.ly/googlepodsDBI
This week, our topic is fear: we try to get a better understanding of fear, how it affects all of us as clinicians for better or for worse, and the impact that fear has on the ways in which we approach our patients & practice. Does fear distort our judgement, and increase the likelihood of blundering, or does a healthy dose of fear help to keep us grounded?
Our guests:
Iona Heath is a former GP and president of the Royal College of GPs.
Danielle Ofri is an internist at Bellevue Hospital in New York, and Clinical Professor of Medicine at NYU School of Medicine. She has written several books on topics such as medical error and how doctors’ emotions affect their practice.
The Deep Breath Out - The bees of Brockwell Park Surgery
https://www.bmj.com/podcasts/deepbreathin

Wellbeing – advice from a military medic to frontline clinicians

There is no doubt that anxiety levels that clinicians are feeling during this pandemic are high.
One military medic believes the current situation is comparable to his experience when posted during British campaigns in Afghanistan and Iraq. Cormac Doyle offers advice on how to deal with high-stress conditions, both in a work and at home, as well as how to negate the future effects of post-traumatic stress disorder.
One strategy he supports is using Bilatural Stimulation using music, one example of which called “Strength Within” can be found here shorturl.at/fgrSW.

Talk Evidence covid-19 update - Remdesivir, care homes, and death data

For the next few months Talk Evidence is going to focus on the new corona virus pandemic.
There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.
We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
This week:
(3.14) Jeff Aronson from Oxford University explains why remdesivir is a potential therapeutic, but is pessimistic about the quality of the studies being done on it
(13.22) Carl explains why smoking cessation is still a key public health priority under covid-19
(16.30) Helen talks care homes, and interviews Mona Koshkouei, from Oxford University, about the research which shows staff are the main vector of infection.
(27.20) David Spiegelhalter, professor of public understanding of risk, looks at the new data on excess deaths in the UK - and the difficulties with reporting that underlie it. Carl explains how deaths track infections, and why uncertainty there makes it hard to calcuate the case fatality rate (And why that is not a good measure to use in a pandemic)
Reading list.
Compassionate Use of Remdesivir for Patients with Severe Covid-19
https://www.nejm.org/doi/full/10.1056/NEJMoa2007016
How can pandemic spreads be contained in care homes?
https://www.cebm.net/covid-19/how-can-pandemic-spreads-be-contained-in-care-homes/
Covid-19: Death rate in England and Wales reaches record high because of covid-19
https://www.bmj.com/node/1024784.full