Medicine and Science from The BMJ

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

Talk Evidence - Radiation, fertility, and pneumonia

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 how difficult a task it is to find evidence that's definitely practice changing, what GPs can learn from Malawian children with nonsevere fast-breathing pneumonia, how radiation dosage varies substantially - and consultant radiologist Amy Davies what that means for patients.
They also rail against add-on tests for fertility, and the lack of evidence underpinning their use - will the traffic light system suggested help patients make treatment choices.
Carl's rant this week is based on a new study by Steve Woloshin and Lisa Schwartz which documented 20 years of medical marketing in the USA.
Reading list:
Pneumonia in Malawi - https://www.ncbi.nlm.nih.gov/pubmed/30419120
Variation in radiation dose - https://www.bmj.com/content/364/bmj.k4931
Traffic light fertility tests - https://www.bmj.com/content/364/bmj.l226
Medical marketing - https://jamanetwork.com/journals/jama/fullarticle/2720029

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Safeguarding LGBT+ young people

Recent years have seen political and social progress for people who identify as LGBT+ (lesbian, gay, bisexual, and transgender; the “+” indicating inclusion of other minority sexual and gender identities).
Yet international evidence shows ongoing health and social inequalities in this group, many of which emerge during adolescence and represent unique safeguarding risks.
In this podcast, Kate Addlington, psychiatry trainee and associate editor at The BMJ is joined by Ginger Drage, expert patient educator at University College London, Jessica Salkind, academic clinical fellow in paediatrics & teaching lead for LGBT+, at Imperial College London and Rosanna Bevan, psychiatry trainee from East London Foundation Trust
They discuss the the risks faced by LGBT+ young people, which include increased rates of self harm, suicide, and family rejection or abuse, and what steps clinicians can take to support and intervene if necessary.
Read the full practice article:
https://www.bmj.com/content/364/bmj.l245

Should we be screening for AF?

Current evidence is sufficient to justify a national screening programme, argues Mark Lown clinical lecturer at the University of Southampton, but Patrick Moran, senior research fellow in health economics at Trinity College Dublin, thinks there are too many unanswered questions and evidence from randomised trials is needed to avoid overdiagnosis
Read the full debate:
https://www.bmj.com/content/364/bmj.l43

Chronic Rhinosinusitis

Patients who experience chronic rhinosinusitis may way for a considerable period of time before presenting, because they believe the condition to be trivial.
In this podcast, Alam Hannan, ENT Consultant at the Royal Throat Nose and Ear Hospital in London, explains why that belief is not founded, and describes which treatments can be effective at providing relief.

Assisted dying: should doctors help patients to die?

The Royal College of Physicians will survey all its members in February on this most controversial question. It says that it will move from opposition to neutrality on assisted dying unless 60% vote otherwise.
The BMJ explores several conflicting views. From Canada, palliative care doctor Sandy Buchman explains why he sees medical aid in dying as a compassionate treatment that fully respects patient autonomy. The Canadian Medical Association is neutral on the issue, and Jeff Blackmer, its vice president for international health, shares how that stance enabled it to represent all its members, including doctors with conscientious objections.
But many are unconvinced to say the least. Rob George, a UK palliative care doctor and professor at King's College London, says assisted suicide has no place in medicine. Tony Baldwinson, from the UK campaign group Not Dead Yet, worries for disabled people were society to endorse doctors actively ending lives. And Zoe Fritz, a consultant physician in acute medicine at Addenbrooke’s Hospital, Cambridge, has a proposal that she says would protect the doctor-patient relationship.
Read all our content at https://www.bmj.com/assisted-dying
"Why I decided to provide assisted dying: it is truly patient centred care" by Sandy Buchman https://www.bmj.com/content/364/bmj.l412
"How the Canadian Medical Association found a third way to support all its members on assisted dying" by Jeff Blackmer https://www.bmj.com/content/364/bmj.l415
"Religious and non-religious people share objections to assisted suicide" by Mark Pickering https://blogs.bmj.com/bmj/2019/01/30/religious-and-non-religious-people-share-objections-to-assisted-suicide/
"The courts should judge applications for assisted suicide, sparing the doctor-patient relationship" by Zoe Fritz https://blogs.bmj.com/bmj/2019/01/30/the-courts-should-judge-applications-for-assisted-suicide-sparing-the-doctor-patient-relationship/