Medicine and Science from The BMJ

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

#talkaboutcomplications

Renza Scibilia and Chris Aldred have diabetes, and their introduction to the idea of complications arising from the condition were terrifying.
Because of this early experience, and Chris's later development of complications, they have campaigned to make doctors really think about the way in which they talk about complications with patients. Challenging the use of "non-compliant" and other stigmatising language.
Chris has also documented his experience of developing an ulcer, and having it successfully treated, on social media, to open up the conversation and make us all #talkaboutcomplications.
Chris Aldred is @grumpy_pumper on twitter, and blogs at http://www.the-grumpy-pumper.com. Renza Scibilia is @RenzaS on twitter and blogs at https://diabetogenic.wordpress.com/

Ebola - Stepping up in Sierre Leone

In 2014, Oliver Johnson was a 28 year old British doctor, working on health policy in Sierre Leone after finishing medical school. Also working in Freetown was Sinead Walsh, then the Irish Ambassador to the country.
Then the biggest outbreak of Ebola on record happened in West Africa, starting in Guinea and quickly spreading to Liberia, Sierre Leone and Nigeria.
Oliver and Sinead have co-authored a book about the change that wrought on their lives, how they stepped into roles coordinating the international response to the disease and running a treatment centre. They join us today to talk about their experiences there.
For more information about Ebola, including the current outbreak in the Democratic Republic of Congo visit https://www.bmj.com/ebola.
For Sinead and Oliver's book - Getting to Zero: A Doctor and a Diplomat on the Ebola Frontline is available now.
https://www.amazon.co.uk/dp/B07DFLFF9P/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1

Signals from the NIHR

If you've been keeping up to day with The BMJ - online on in print, you might have noticed that we've got a new type of article - NIHR Signals - and they are here to give busy clinicians a quick overview of practice changing research that has come out of the UK's National Institute for Health Research.
Tara Lamont, director of the NIHR dissemination centre, joins us to talk a bit more about the research underpinning these articles.
You can find the full list of articles:
https://www.bmj.com/NIHR-signals

Nuffield 2019 - How can the NHS provide a fulfilling lifelong career

More doctors are choosing to retire early, doctors who take career breaks find it hard to return to practice, and doctors at all stages of their careers are frustrated by the lack of support given to training and development in today’s NHS.
Each year the BMJ holds a roundtable discussion at the Nuffield Summit - where health leaders come together to talk about the NHS. We wanted to know what more the NHS can do to provide fulfilling careers for staff and to improve support for doctors who want to keep working and those seeking to return to practice.
Taking part in the discussion were:
Tom Moberly - UK editor for The BMJ
Rahkee Shah - paediatric registrar
Ronny Cheung - consultant general paedatrician
Claire Lemer - consultant paediatrician
Candace Imison - Director of Workforce Strategy at the Nuffield Trust
James Morrow - GP partner

Diabetes Insipidus - the danger of misunderstanding diabetes

Diabetes is synonymous with sugar, but diabetes insipidus, "water diabetes", can't be forgotten. Between 2009 and 2016, 4 people died in hospital in England, when lifesaving treatment for the condition was not given.
In this podcast, we hear some practical tips for non-specialists to aid diagnosis, and how patients should be managed during hospital admission.
On the podcast are
Miles Levy, consultant endocrinologist from Leicester Royal Infirmary
Pat McBride, head of family services at the Pituitary Foundation
John Wass, professor of endocrinology at Oxford University
Malcolm Prentice, consultant endocrinologist at Croydon University Hospital.
Read the full practice article:
https://www.bmj.com/content/364/bmj.l321