Medicine and Science from The BMJ

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.
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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

Wellbeing - some advice for telehealth in secondary care

We’ve published info on Telehealth in primary care - and have been overwhelmed by the response from GPs who are finding it useful.
But it’s not only primary care that is dramatically shifting to remote care - routine hospital care is moving online too, so we’ve asked Rowena McCash - GP and out of hours triage trainer joins us to give some tips on how to change your communication for the situation.
She explains safety netting in telephone triage, note taking, and why there are some advantages to working that way.
www.bmj.com/coronavirus
www.bmj.com/wellbeing

Front line stories - How corona is changing acute care

As we cover the covid-19 outbreak, we want to hear some of the stories from the frontline - And who better to heart of what this pandemic is doing to the profession in the UK, than some of the people who write regularly for The BMJ?
In this first one, we wanted to look specifically at acute care - those at the sharp end of the response, so we're joined by David Oliver, consultant in geriatrics and internal medicine, and Matt Morgan, consultant in intensive care medicine.
Read the columns
https://blogs.bmj.com/bmj/category/columnists/matt-morgan/
https://blogs.bmj.com/bmj/category/columnists/david-oliver/
For more free information on covid-19
www.bmj.com/coronavirus

Talk Evidence covid-19 update - hydroxy/chloroquinine, prognostic models and facemaskss

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:
(2.24) - Hydroxychloroquinine/chloroquinine - Robin Ferner, honorary professor of clinical pharmacology at the University of Birmingham explains why is it a potential therapeutic for covid-19, and why is it being hyped.
(12.45) - We use prognostic models to make treatment decisions, but they have to be well conducted. Lots of them are being created for covid-19, but their quality isn’t great. Statisticians Laure Wynants Maastricht University and Maarten van Smeden from Utrecht University have done a systematic review of these models, and explain what’s needed for them to be useful.
(26.30) PPE - specifically facemasks. What does the evidence say about their use by the public, and does the precautionary principle hold
Reading list:
COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community
https://www.nice.org.uk/guidance/ng165/chapter/4-Managing-suspected-or-confirmed-pneumonia
Chloroquine and hydroxychloroquine in covid-19
https://www.bmj.com/content/369/bmj.m1432
Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal
https://www.bmj.com/content/369/bmj.m1328
What is the efficacy of standard face masks compared to respirator masks in preventing COVID-type respiratory illnesses in primary care staff?
https://www.cebm.net/covid-19/what-is-the-efficacy-of-standard-face-masks-compared-to-respirator-masks-in-preventing-covid-type-respiratory-illnesses-in-primary-care-staff/

The public health response to covid - 19

As part of our response to the covid-19 pandemic, we’re going to be running a series of discussions with experts about some of the big issues arising from the virus.
In this one, we’re asking about the public health response to an outbreak - what’s necessary, and is it possible to go to far.
Joining us are
Martin Mckee - professor of european health at the London Schoole fo Hygiene and Tropical Medicine
Kathleen Bachynski - assistant professor of public health at Muhlenberg College
Sridhar Venkatapura - associate professor global health & philosophy at
King's College London
www.bmj.com/podcasts
www.bmj.com/coronavirus

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