Medicine and Science from The BMJ

Talk Evidence covid-19 update - pneumonia, guidelines, preprints and testing

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
5.00 - Carl gives us an update about pneumonia in primary care, should you give antibiotics when you're not sure if it's bacterial or viral
10.00 - The importance and difficulty of making guidelines now
15.00 - We hear from guideline maker Per Vandvik, about making guidance.
21.40 - Preprint servers for medicine are showing their use in this fast changing situation. Joseph Ross from Yale School of Medicine, and one of The BMJ's research editors, talks to us about the kind of information we're seeing on medRxiv.
31.10 - Testing. What are the tests, and when do we want specificity, and when do we want sensitivity. Nick Beeching from the Liverpool School of Tropical Medicine joins us to explain.
Reading list:
www.bmj.com/coronavirus
Rapidly managing pneumonia in older people during a pandemic
https://www.cebm.net/covid-19/rapidly-managing-pneumonia-in-older-people-during-a-pandemic/
https://www.medrxiv.org/
Covid-19: testing times
https://www.bmj.com/content/369/bmj.m1403

Wellbeing - Some advice on working in PPE

Wellbeing might not seem the obvious place to talk about PPE - but lack of appropriate PPE is causing healthcare staff a great deal of stress now.
Mary Brindle is a pediatric surgeon and the director of The EQuIS (Efficiency Quality Innovation and Safety) Research platform at Alberta Children’s hospital.
In this podcast she reflects on the use of PPE, talks a little about the culture of it - and how overuse by one person can amply the concerns of others, the effect on patients of seeing their carers in protective equipment (especially children), and the importance of communication when you can't see colleagues faces anymore.
www.bmj.com/wellbeing
www.bmj.com/coronavirus

Look after yourself during covid-19

Continuing our series on wellbeing during the pandemic, in this podcast we speak to Occupational Psychologist Roxane Gervais about how doctors can look after themselves during the covid-19 pandemic.
We discuss the importance of reaching out to friends and family during this difficult time, how to deal with the loss of control, as well how to tackle feelings of guilt when you are unable to work clinically.
For more wellbeing content
www.bmj.com/wellbeing
For more on covid-19
www.bmj.com/coronavirus

WHO’s response to covid-19

We knew a pandemic was coming at some point - it’s kind of why we have the WHO. We have had various smaller scale tests of the international response to an infectious disease outbreak - Ebola in west africa being the most recent.
After that, reports criticised the WHO's response - citing problems around the swiftness of their action, the lack of coordination between countries, and the platforms for knowledge sharing. Is the agency doing any better in Covid-19?
Suerie Moon is co-director of the Global Health Centre at the Graduate Institute of International and Development studies in Geneva, and author of one of those critical reports which was published in The BMJ. She joins us to assess how the WHO is responding.

Talk Evidence covid-19 update - Confused symptoms, fatality rate uncertainty, Iceland’s testing

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
3.50 - There is a lot of confusion around symptoms, we hear what Carl's review of the case studies has found, and why he thinks fever and persistent dry cough may not be a sign of all cases.
10.30 - where are we with research into antiviral treatment
17.30 - John Ioannidis has expressed concerns about the quality data used in modelling and therefore our pandemic response. We hear what his concerns are, and what needs to be done to answer them.
29.10 - Iceland is the only country attempting to do population level screening, we hear from Kári Stefánsson, CEO of deCODE genetics which is working with the Icelandic government to allow everyone to access testing for the virus.

Organisational kindness during covid-19

Reports from Italy, and more recently from the U.S. show the strain the healthcare system is under during this pandemic.
We know that staff will step up in an emergency, but this isn’t a fire or a bombing, this is going to last for months. So how can organisations be proactive in supporting staff, and how can leaders try to mitigate the inevitable burnout.
In this podcast, Michael West, professor of organisational psychology at Lancaster university, and author of the GMC report “Caring for doctors, caring for patients” joins us to talk about what compassionate leadership looks like in a time of covid-19.
Resources
www.bmj.com/coronavirus
www.bmj.com/wellbeing
www.bmj.com/podcasts
https://www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-patients_pdf-80706341.pdf

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