Medicine and Science from The BMJ

QI and improvement are not synonyms

In October 2019, Mary Dixon-Woods, director of the THIS Institute, dedicated to healthcare improvement. In that she explained how she believed healthcare improvement could be improved.
The essay took the position that "Quality Improvement" isn't necessarily the best way to improve healthcare, and that more rigour needs to be brought to the field.
That paper has created a great deal of discussion, so in this podcast we wanted to go back to Mary and ask her what she thinks about improvement, and how we can practically put into place some of the things she calls for.
Read the full essay:
https://www.bmj.com/content/367/bmj.l5514
And the rest of our healthcare improvement series:
https://www.bmj.com/quality-improvement

Prevalence and treatment of precocious puberty

Precocious puberty, that is puberty that starts before age 8 in girls and 9 in boys seems to be on the rise, but whether that’s because of an increase in incidence, or greater attention is unknown - what we do know that precocious puberty in girls is commonly idiopathic, while in boys is a red flag for pathology. But either way ther first point of call is the GP.
In this podcast, Steven Bradley GP, and Neil Lawrence, paediatric trainee join us to discuss how common precocious puberty is, how GPs should respond to a family presenting with it, and if intimate examination is actually warranted in primary care.
Read the full practice pointer:
https://www.bmj.com/content/368/bmj.l6597

Talk Evidence - Sepsis, talc and blindsided by blinding

Welcome to the festive talk evidence, giving you a little EBM to take you into the new year. 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)*
This month:
(1.20) Carl tells us about new research on treating sepsis with steroids that might inform practice.
(4.58)Proscribing of prophylactic PPIs or H2-blockers for intensive care patients.
(11.00) Carl wonders if we can actually rule out an increased risk of ovarian cancer with the use of talc.
(17.46) Helen drops and EBM bombshell - is all the work needed to blind participants in a double blind randomised control trial actually worth it?
(33.00) Helen is annoyed about a press release from the department of health, and kicks of 2020 by stealing Carl's rant spot.
Reading list:
Corticosteroids for Treating Sepsis in Children and Adults
https://pubmed.ncbi.nlm.nih.gov/31808551-corticosteroids-for-treating-sepsis-in-children-and-adults/?dopt=Abstract
Gastrointestinal bleeding prophylaxis for critically ill patients: a clinical practice guideline
https://www.bmj.com/content/368/bmj.l6722
Association of Powder Use in the Genital Area With Risk of Ovarian Cancer.
https://www.ncbi.nlm.nih.gov/pubmed/31910280
Blinding
Fool’s gold? Why blinded trials are not always best
https://www.bmj.com/content/368/bmj.l6228
Impact of blinding on estimated treatment effects in randomised clinical trials
https://www.bmj.com/content/368/bmj.l6802
*quick note to say sorry about the sound quality on Duncan's microphone - we had a technical glitch (he was left alone to record).

Surviving childhood cancer treatment

In a British cohort, 30% of patients who had survived childhood cancer had died within 45 years of diagnosis; only 6% were expected to have died.
51% had developed a new primary cancer, but a 26% died of cardiovascular disease - thought to be caused by their treatment. Consequently, efforts to reduce long term mortality have focused on reducing exposure to the most toxic aspects of anticancer treatment, including radiotherapy.
In this podcast we’re joined by Daniel Mulrooney, associate professor in the Division of Cancer Survivorship, at St Jude Children’s Research Hospital and one of the authors of the paper Major cardiac events for adult survivors of childhood cancer diagnosed between 1970 and 1999: report from the Childhood Cancer Survivor Study cohort
Read the full research:
https://www.bmj.com/content/368/bmj.l6794

Is it possible to have fair pricing for medicines

Is it possible to have a fair price for medicines? Yes, according to a new collection just published on bmj.com.
The authors set out to evaluate how we could improve the functioning of the market for medicines, to honestly compensate industry for innovation, whilst allowing the poorest to afford them.
Suerie Moon, co-director of global health at the Graduate Institute of Geneva joins us to explain what's wrong with how we decided what to pay for medicine's now, and how we could change that.
Read the full collection:
https://www.bmj.com/fair-pricing

Michael West - GMC Report On Wellbeing

Michael West is professor of organisational psychology, at Lancaster University, and co-author of a new GMC report into the wellbeing of NHS staff.
The review he led together with the clinical psychiatrist Denise Coia, focused on primary interventions related to workplace factors and the systems that doctors work in, rather than secondary interventions such as resilience training.
In this podcast interview, he describes what he found - and talks about how low wellbeing is amongst doctors, why the command and control nature of some management teams has increased the problem, and why he has hope because of some of the good practice he sees in NHS organisations.
Read the full report:
https://www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-patients_pdf-80706341.pdf

From dance class to social prescription - starting and evaluating an idea

If you read the Christmas BMJ in the last few weeks, you might have noticed a lot around art and health - the way in which engagement in arts can help in prevention and treatment, but can also affect those more nebulous things which really matter to patients - loneliness, self expression, being connected to the wider community.
That obviously links to social prescribing, which looks like it’s going to be one of the big changes to medicine which will happen in near future.
In this podcast we hear from Simon Opher, a GP in gloucestershire who has had artists and poets in residence in his surgery, and has experience of setting up services which link art and health - and we discuss how to do that practically. SImon makes it sound easy, but also has a few tips for GPs out there who have an idea about a non-medical service that could help their patients, but doesn’t yet exist.
We’ll also be talking to Helen Stokes Lampard, former chair of the Royal College of Surgeons and head of the new National Academy for Social Prescribing - as services bloom, how do we know what actually works?
Helen is sceptical that our current ways of evaluating an intervention are going to be inadequate to look at the much more messy world of social prescribing, with it’s localisation, multitude of influences, and difficult to measure outcomes.
Reading list:
Previous BMJ podcast on social prescribing
https://podcasts.apple.com/no/podcast/social-prescribing/id283916558?i=1000446265663
Clinical update on social prescribing
https://www.bmj.com/content/364/bmj.l1285

Editors pick of education in 2019

If you’re lucky enough to not be back at work, you might be feeling like you need to quickly refresh your medical knowledge - and this podcast the BMJ’s education editors take you on a whistlestop tour through the BMJ’s education articles of 2019.
Tom Nolan (GP in London) is joined by Navjoyt Ladher (GP in London), Anita Jain (GP in India) and Jenny Rasanathan (GP in Phnom Penh).
Our reading list:
Please don’t call me mum
https://www.bmj.com/content/367/bmj.l5373
Which emollients are effective and acceptable for eczema in children?
https://www.bmj.com/content/367/bmj.l5882
Pre-eclampsia: pathophysiology and clinical implications
https://www.bmj.com/content/366/bmj.l2381
A borderline HbA1c result
https://www.bmj.com/content/365/bmj.l1361

Talk Xmas Evidence

Welcome to the festive talk evidence, giving you a little EBM to take you into the new year. 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)
This month:
(2.00) Helen look back at a Christmas article, which investigates a very common superstition in hospitals.
(7.55) Carl has his pick of the top 100 altimetric most influential papers of the year.
(12.40) We find out all about the preventing overdiagnosis conference which happened earlier in December.
(34.15) Helen has her annual rant about misogeny in medicine.
Reading list:
Q fever—the superstition of avoiding the word “quiet” as a coping mechanism
https://www.bmj.com/content/367/bmj.l6446
Altimetric Top 100
https://www.altmetric.com/top100/2019/
Fiona Godlee’s keynote at Preventing Overdiagnosis
https://www.preventingoverdiagnosis.net/
Gender differences in how scientists present the importance of their research: observational study
https://www.bmj.com/content/367/bmj.l6573

The need for (psychiatrists’) speed

The internecine takes on medical specialty are a common thread in the Christmas BMJ, and this year we're doing it through the lens of driving. Which speciality speeds the most, who has the nicest cars?
André Zimerman, soon to be cardiologist, and researcher lets us know - and also why you can't rely on being a doctor to get off a speeding ticket. At least in Florida.
Read the full article:
https://www.bmj.com/content/367/bmj.l6354