Medicine and Science from The BMJ

Could open access have unintended consequences?

An “author pays” publishing model is the only fair way to make biomedical research findings accessible to all, say David Sanders, professor of gastroenterology at Sheffield University, but James Ashton and worries that it can lead to bias in the evidence base towards commercially driven results - as those are the researchers who can pay for open access fees. Dave deBronkart just wants patients to have access to key research.
Read the full head to head:
https://www.bmj.com/content/365/bmj.l1544

Talk Evidence - health checks, abx courses and p-values

Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month.
(1.20) Carl grinds his gears over general health checks, with an update in the Cochrane Library.
(9.15) Helen is surprised by new research which looks at over prescription of antibiotics - but this time because the courses prescribed are far longer than guidelines suggest.
(22.30) What is the true 99th centile of high sensitivity cardiac troponin in hospital patients?
(29.02) Is it time to abandon statistical significance and be aware of the problem of the transposed conditional.
Reading list:
General health checks in adults for reducing morbidity and mortality from disease - https://www.ncbi.nlm.nih.gov/pubmed/30699470?dopt=Abstract
Duration of antibiotic treatment for common infections in English primary care -https://www.bmj.com/content/364/bmj.l440
True 99th centile of high sensitivity cardiac troponin for hospital patients - https://www.bmj.com/content/364/bmj.l440
Significant debate - https://www.nature.com/magazine-assets/d41586-019-00874-8/d41586-019-00874-8.pdf
The false positive risk: a proposal concerning what to do about p-values - https://www.youtube.com/watch?v=jZWgijUnIxI
http://www.onemol.org.uk/?page_id=456

Capital punishment, my sixth great grandfather, and me

On the 7th of June, 1753, Dr Archibald Cameron was executed at Tyburn. "The body, after hanging twenty minutes, was cut down: it was not quartered; but the heart was taken out and burnt. "
250 years later, his sixth great grandson, Robert Syned found himself deeply involved in the process of execution, as an expert witness in a case about the use of a new drug for lethal injection in the USA.
In this podcast, Robert joins us to talk about the dearth of evidence, and massive variation in the use of drugs used to execute someone, and reflects on how finding out about his ancestor meant to him in this process.

How to have joy at work

Jessica Perlo is the Director for Joy at Work at the Institute for Healthcare Improverment, and James Mountford is direct or of quality at the Royal Free London NHS Foundation Trust.
Together they joined us at the International Forum on Quality and Safety in Healthcare to discuss joy at work - what that concept actually means, and practically, how hospitals can start implementing it.
Watch Jessica’s session at the forum
https://internationalforum.bmj.com/glasgow/2018/09/20/a1-leadership-models-for-co-producing-a-joyful-workforce/
BMJ's wellbeing campaign
https://www.bmj.com/wellbeing
https://www.facebook.com/groups/569230966796440/

Social prescribing

Non-medical interventions are increasingly being proposed to address wider determinants of health and to help patients improve health behaviours and better manage their conditions - this is known as social prescribing. In England, the NHS Long Term Plan states that nearly one million people will qualify for referral to social prescribing schemes by 2024.
In this podcast, Chris Drinkwater, emeritus professor of primary care and Louise Cook, a link worker, both at Newcastle University's Ways to Wellness - who provide social prescribing support.
They describe the evidence base for the service, how they work with patients to coordinate their non-medical interventions, and how they measure success.
Read the full clinical update:
https://www.bmj.com/content/364/bmj.l1285

Applying new power in medicine

Change requires the application of power - the way in which individuals can accrue power has shifted in our digitally connected world. Traditional ways of influencing change in healthcare (getting the chief executive on side, having a quiet chat with the medical director) are not the only way to build a momentum.
Henry Timms - author of “New Power” the internationally best selling book joins us to talk about about how much of his thinking on these power structures has come from healthcare.
https://thisisnewpower.com/
https://twitter.com/hashtag/newpower
Henry Timms onstage at the International Forum on Quality and Safety in Healthcare
https://livestream.com/IFQSH/Glasgow2019/videos/189271449

Talk Evidence - Shoulders, statins and doctors messes

Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month.
They start by talking about shoulders - what does the evidence say about treating subacromial pain, and why the potential for a subgroup effect shouldn't change our views about stop surgery (for now, more research needed).
(16.00) Statins - more uncertainty about statins, this is now looking at older people. Age is a big risk factor for cardiovascular disease - at what point does that risk overwhelm any potential benefit from taking statins?
(20.30)Carl explains his rule-of-thumb for turning relative risks into absolute risks, in a way can help doctors talk to patients about new evidence.
(25.46)What's the evidence for doctors messes? Carl's rant of the week focuses on the calls (including the BMJ's campaign) to have spaces for doctors to relax in hospitals. He asks, is that better than putting in a gym? What's the evidence for that.
Reading list:
Subacromial decompression surgery for adults with shoulder pain
https://www.bmj.com/content/364/bmj.l294
Efficacy and safety of statin therapy in older people
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31942-1/fulltext
The future of doctor's messes
https://www.bmj.com/content/364/bmj.k5367.abstract

Is opt-out the best way to increase organ donation?

As England’s presumed consent law for 2020 clears parliament, Veronica English, head of medical ethics and human rights at the BMA, say that evidence from Wales and other countries shows that it could increase transplantation rates. But Blair L Sadler, physician and senior adviser to California State University, consider such legal changes a distraction lacking strong evidence: they say that public education and trained staff would have a proven impact.
We also hear from Erin Walker, the recipient of 2 liver transplants, about her concerns on families over-ruling donor's wishes.
Read the full debate, and Erin's commentary:
https://www.bmj.com/content/364/bmj.l967

An acutely disturbed person in the community

It can be difficult to know what to do when a person in severe psychological distress presents to a general practice or community clinic, particularly if they are behaving aggressively, or if they are refusing help.
Most patients who are acutely disturbed present no danger to others, however situations can evolve rapidly. Frontline staff need to know how to call for help, how to assess and manage physical risk, and how to de-escalate such situations.
In this podcast Aileen O’Brien, reader in psychiatry and education at St George’s University of London joins us to give some advice on what to do in that situation - why deescalation is useful, and who else to involve.
We also hear from someone who lives with bipolar disorder, and has had experiences of being acutely unwell in a public places, which have lead to police and psychiatric intervention.
Read the full practice article:
https://www.bmj.com/content/364/bmj.l578

Passing on the secret knowledge of loop diuretics

In every generation there are a few that know the secret; the counterintuitive effects of loop diuretics.
In this podcast Steven Anisman, cardiologist at the Dartmouth Hitchcock Department of Cardiovascular Medicine, joins us to explain about the threshold effects of these drugs, and why that might change the way in which you think about prescribing them.
Read the full article on treatment of oedema with loop diuretics, and contribute to the discussion: https://www.bmj.com/content/364/bmj.l359