Medicine and Science from The BMJ

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

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