Medicine and Science from The BMJ

Talk Evidence - testing under the microscope and opioid prescription

This edition of talk evidence was recorded before the big increase in covid-19 infections in the UK, and then delayed by some self isolation. We'll be back with more evidence on the pandemic very soon.
As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence).
in this episode
(1.01) Helen talks about variation in prescription of opioids - do 1% of clinician really prescribe the vast majority of the drug?
(8.45) Carl tells us that its time papers (in this case a lung screening one) really present absolute numbers.
(17.30) Carl explains how a spoonfull (less) of salt helps the blood pressure go down
(21.25) Helen puts test results under a microscope, and finds out that they may vary.
(33.20) What do conflicts of interest in tanning papers mean for wider science?
(48.05) Carl has a "super-rant" about smartphone apps for skin cancer - and a sensitivity of 0.
Reading list:
Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study
https://www.bmj.com/content/368/bmj.l6968
Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial
https://www.nejm.org/doi/full/10.1056/NEJMoa1911793
Effect of dose and duration of reduction in dietary sodium on blood pressure levels
https://www.bmj.com/content/368/bmj.m315
Your results may vary: the imprecision of medical measurements
https://www.bmj.com/content/368/bmj.m149
Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning: systematic review
https://www.bmj.com/content/368/bmj.m7
Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studies
https://www.bmj.com/content/368/bmj.m127

For a greener NHS - a call for evidence

The NHS is a world leader in sustainable healthcare - and it's the staff who have have been leading the charge.
The For A Greener NHS campaign is asking everyone who has made a change to the way they work, to submit evidence and help shape the whole organisation's response to the climate emergency.
In this podcast, Isobel Braithwaite, public health registrar & academic clinical fellow at UCL, and Sandy Robertson, LTFT Emergency Medicine Trainee and Chair of RCEM environmental specialist interest group, join us to explain what they're doing, and what kind of evidence is needed.
For more on the For A Greener NHS campaign
https://www.england.nhs.uk/greenernhs/
To submit evidence
https://www.engage.england.nhs.uk/survey/nhs-net-zero/

Cycling - Does the health benefit outweigh the accident risk (in the UK)

We all know we should be doing more exercise, and one way to do that is by active commuting - journeying to work on foot or by bike.
One thing preventing people from taking up cycling is the fear of being involved in road traffic accidents, and that the risk isn't worth the benefit of the extra exercise. It’s even more confusing when air pollution has to be taken into account.
Joining us to discuss new research into that risk/benefit calculation are
Paul Welsh, a Senior Lecturer, and Carlos Celis, a research fellow, both Institute of Cardiovascular & Medical Sciences at the University of Glasgow.
Read their open access research - Association of injury related hospital admissions with commuting by bicycle in the UK: prospective population based study
https://www.bmj.com/content/368/bmj.m336

Why we are failing patients with multimorbidity

We know that the number of people living with multiple health conditions is rising year on year, and yet training, guidelines, organisations and physical spaces in healthcare still largely focus on single diseases or organ systems.
The means that patients in the NHS are often treated as if their conditions exist in isolation, and that their care lacks coordination, and isn't as good as it should be.
To look at why patients with multiple conditions pose a challenge to the NHS, and what we can do to improve the care they receive, we’re joined by
Louella Vaughan, acute physician and senior clinical fellow at the Nuffield Trust
Jihad Malasi, GP and clinical chair of Thanet CCG
Rammya Mathew, GP and a quality improvement lead and columnist for The BMJ
and David Oliver, consultant in geriatrics, clinical vice president of the RCP and columnist for The BMJ

Yvonne Coghill is trying to fix racism in the NHS

In this week's special episode of Sharp Scratch, we've got something a little different for you! Last week the panel talked microaggressions, so this week we're hearing from an expert guest who is leading the work the NHS is doing to combat inequality in healthcare.
If you like this special edition, let us know on Facebook, Instagram or Twitter using #SharpScratch
This week's special guest:
Yvonne Coghill, CBE is the director of Workforce Race Equality Standard (WRES) at NHS England and NHS Improvement. Yvonne has over 20 years’ experience in nursing, before taking up operational and strategic leadership posts.
During her 40 plus years career, she has held a wide variety of clinical and managerial roles at the Department for Health and NHS Leadership Academy. In 2013 she was voted by colleagues in the NHS as one of the top 50 most inspirational women, one of the top 50 most inspirational nurse leaders and one of the top 50 black and minority ethnic (BME) pioneers, two years in a row.
In July 2015 Yvonne joined NHS England as director for WRES Implementation. She was awarded an Order of the British Empire for services to healthcare in 2010 and Commander of the British Empire in 2018. Yvonne was elected deputy president of the Royal College of Nursing (RCN) in November 2018.
Some of the resources Yvonne mentions during the interview:
https://www.england.nhs.uk/2020/02/nhs-publishes-new-workforce-race-equality-data-ahead-of-nhs-and-race-summit/
https://www.england.nhs.uk/about/equality/equality-hub/equality-standard/resources/
https://www.england.nhs.uk/2019/01/race-equality/

Born equal - the launch of The BMJ special issue on race in medicine

Last week the BMJ published it’s first special edition into Racism in Medicine. The issues tacked ranged from differential attainment in medical school, to the physiological effects that experiencing everyday discrimination has.
The issue was guest edited by Victor Adebowale, the Chief Executive of the social care enterprise Turning Point, and Mala Rao, Professor of Public Health, at Imperial College London - and they, along with Simon Stevens, chief executive of the NHS, Chand Nagpul Chair of council of the BMA, and the Olalade Obedare, medical student from Nottingham University Medical School, talked at the event.
www.bmj.com/racism-in-health.

Talk Evidence - Building an evidence base for covid-19

We're taking a break from the usual Talk Evidence to focus on the new corona virus that has emerged in China.
With a brand new disease, we have to build our evidence base from scratch - basic virology, epidemiology, pathogenicity, transmissibility, and ultimately treatment are all unknowns.
In this episode of Talk Evidence, we're trying to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
(8.00) Peter Openshaw, professor of experimental medicine at Imperial College London, talks to us about the pathogenicity of covid-19
(17.30) Wendy Barclay, head of the Department of Infectious Disease at Imperial College London, describes what can change the R0 of a viral disease.
(20.50) Raina MacIntyre, professor of biosecurity at the Kirby Institute at the University of New South Wales, talks to us about how effective masks are at preventing spread of viruses.
(30.00) We discuss treatment options in the face of massive uncertainty.
To read more about covid-19 and to keep up to date with the disease visit https://www.bmj.com/coronavirus where all of the information on the disease if freely available.

David Williams - everyday discrimination is an independent predictor of mortality

There comes a tipping point in all campaigns when the evidence is overwhelming and the only way to proceed is with action. According to David Williams, it’s time to tackle the disproportionate effects of race on patients in the UK.
David Williams, from Harvard University, developed the Everyday Discrimination Scale that, in 1997, launched a new scientific approach to assessing social influences, such as racism, on health.
He’s shown that people who experience every day acts of discrimination— like getting poorer service in a bank or a restaurant, or being treated with less courtesy—will over time have worse health outcomes, including higher rates of heart disease, lower life expectancy, and greater infant mortality.
In this podcast he is interviewed by Lilian Anekwe, assistant news editor
for New Scientist.
Read Lilian's article on tackling racism in the NHS
https://www.bmj.com/content/368/bmj.m341
And all of the special issue on racism in medicine
https://www.bmj.com/racism-in-medicine

Big Tan - Is the sunbed industry targeting research?

In 2012, Eleni Linos, professor of dermatology at Stanford university, published a systematic review and meta-analysis of the link between non-melanoma cancer and sun-beds.
That bit of pretty standard research, and a particular rapid response to it, has kicked of years of work - and in this podcast I talk to Eleni and her colleagues Stanton Glantz, and Yogi Hendlin about what they’ve uncovered.
Reading list:
Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning
https://www.bmj.com/content/368/bmj.m7
Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis
https://www.bmj.com/content/345/bmj.e5909

Writing a good outpatient letter means addressing it to the patient

In many countries (including the UK and Australia) it is still common practice for hospital doctors to write letters to patients’ general practitioners (GPs) following outpatient consultations, and for patients to receive copies of these letters.
However, Hugh Rayner, consultant nephrologist, and Peter Rees, former Chair of the Academy of Medical Royal Colleges' lay patient committee, suggest that hospital doctors who have changed their practice to include writing letters directly to patients have more patient centred consultations and experience smoother handovers with other members of their multidisciplinary teams.
Read their article explaining what makes for a good outpatient letter; https://www.bmj.com/content/368/bmj.m24