Medicine and Science from The BMJ

neoadjuvant treatment for breast cancer - not living up to the promise

Neoadjuvant chemotherapy for breast cancer is a new strategy that was introduced towards the end of the 20th century with the aim of reducing tumour size - rendering an otherwise inoperable tumour operable, allowing more conservative surgery, and hopefully improving overall survival.
Although data indicate that the first rationale remains valid, the others have not led to the desired outcomes. More conservative surgery after neoadjuvant chemotherapy can result in a higher rate of local recurrence, and, despite the earlier initiation of systemic treatment, no improvement in survival has been seen.
Jayant Vaidya, professor of surgery and oncology and consultant breast cancer surgeon at University College London, joins us to explain why he is rethinking the use of neoadjuvant chemotherapy for breast cancer.
Read the full analysis:
http://www.bmj.com/content/360/bmj.j5913

Winter pressures - ”You run the risk of dropping the ball”

Winter pressures on NHS services have kicked in a little bit earlier than usual. So here to discuss that, and also the issue of how local NHS leaders can support staff in times of extreme pressure.
Discussing that with Rebecca Coombes, The BMJ’s head of news and views, are Matthew Inada-Kim, a consultant in acute and general medicine at Hampshire Hospitals NHS Foundation Trust, and Joe Harrison, CEO of Milton Keynes Hospital NHS Foundation Trust.

Suspect, investigate, and diagnose acute respiratory distress syndrome

Acute respiratory distress syndrome was first described in 1967 and has become a defining condition in critical care. Around 40% of patients with ARDS will die, and survivors experience long term sequelae. No drug treatments exist for ARDS, however good supportive management reduces harm and improves outcome.
In this podcast, John Laffey, professor of anaesthesiology at St Michael’s Hospital, Toronto and Brian Kavanagh, clinician-scientist, intensive care medicine at the University of Toronto take us through the background to diagnosis and treatment of ARDS.
Cheryl Misak, professor of philosophy at the University of Toronto, and survivor of ARDS, also joins us to explain how she has faired in recovery.
Read the full easily missed article:
http://www.bmj.com/content/359/bmj.j5055

Hope is important - early psychosis for the non-specialist doctor

Psychosis often emerges for the first time in adolescence and young adulthood. In around four out of five patients symptoms remit, but most experience relapses and further difficulties.
Psychosis can be a frightening and bewildering experience for both patients and families. Early proactive support and intervention improves clinical outcomes, avoids costly and traumatic hospital admissions, and is preferred by patients and their families
In this podcast,Sagnik Bhattacharyya, consultant psychiatrist at the Lambeth Hospital South London and Maudsley NHS Foundation Trust, and David Shiers, former GP, honorary reader in early psychosis at at Manchester University, join us to discuss early treatment - and why hope is important for both GPs and patients.
Read the full practice article:
http://www.bmj.com/content/357/bmj.j4578
And see the infographic on identification and management of psychotic disorders.
http://www.bmj.com/content/bmj/suppl/2017/11/08/bmj.j4578.DC1/psychosis_v28.pdf

Cats, dogs, and biomarkers of ageing.

The notion that animal companionship might be linked to human health can be traced to ancient writings and, with the first population based study conducted at least four decades ago.
Although some empirical evidence links animal companionship with apparent protection against a series of important health outcomes in middle aged populations, including premature mortality, obesity, hypertension, and hyperlipidaemia, systematic reviews and position statements suggest that these associations are not universal.
To investigate this further, the authors of this observational study, looked at the prospective link between pet ownership and a selected range of objective biomarkers of ageing proposed for use in large scale population based studies of older people.
Richard Watt, professor of dental public health at University College London joins us to discuss their results.
http://www.bmj.com/content/359/bmj.j5558

Small, medium, or a pint of wine?

Wine glasses come in a range of sizes, but the average wine glass in the UK today can hold almost ½ a litre.
That wasn’t always the case - and a new analysis, on bmj.com takes a look at the changing size of wineglasses from 1700 until now.
To discuss how the size of glass affects consumption we're joined by Theresa Marteau, director of the Behaviour and Health Research Unit at the University of Cambridge and Zorana Zupan, a research associate in the Unit.
We're also joined by Matthew Winterbottom, curator of decorative arts at the Ashmolean Museum in Oxford, to tell us about the history of wine drinking in the UK.
Read the full analysis:
http://www.bmj.com/content/359/bmj.j5623

Taking the temperature of 37°C

Average body temperature is 37°C, right?
That was the conclusion of Carl Wunderlich in his magnum opus, The Course of Temperature in Diseases - Wunderlich published that in 1868, following his extensive collection of body temperature readings - and 37°C stuck. But, it’s not as simple as that
Philip Mackowiak, emeritus professor of medicine, and now history of medicine scholar in residence, at the University of Maryland School of Medicine, has been interested in temperature for a long time. He joins us to explain how Wunderlich measured temperature, and what he actually found.
Read his editorial:
http://www.bmj.com/content/359/bmj.j5697

Manflu - are men immunologically inferior?

Manflu, the phenomenon that men experience the symptoms of viral illness more than woman, is usually used with derision - but a new review, published in the Christmas edition, is asking - is there a plausible biological basis for this sex difference?
Kyle Sue is a clinical assistant professor in family medicine at Memorial University of Newfoundland, and a GP in northern Canada - and has been looking at the research on sex difference in immune response.
Read the full article:
http://www.bmj.com/content/359/bmj.j5560

I thought I wasn’t thin enough to be anorexic

Assessing young people with possible eating disorders can be complex for a variety of reasons. Building a therapeutic relationship with a young person with a possible eating disorder and their family is key to enabling a thorough assessment and ongoing management, but it introduces difficult issues regarding confidentiality and risk.
In this podcast we speak to the mother and daughter authors of a What you patient is thinking article, who describe what it's like for a family to experience a child with an eating disorder.
In a linked podcast, we talk with the authors of two practice articles, which give advice on spotting and treating eating disorders in young people.
Read the articles:
http://www.bmj.com/content/359/bmj.j5328
http://www.bmj.com/content/359/bmj.j5378
http://www.bmj.com/content/359/bmj.j5245

Early detection of eating disorders

Assessing young people with possible eating disorders can be complex for a variety of reasons. Building a therapeutic relationship with a young person with a possible eating disorder and their family is key to enabling a thorough assessment and ongoing management, but it introduces difficult issues regarding confidentiality and risk.
In this podcast we talk with the authors of two practice articles, which give advice on spotting and treating eating disorders in young people.
In a linked podcast, we speak to the mother and daughter authors of a What you patient is thinking article, who describe what it's like for a family to experience a child with an eating disorder.
Read the articles:
http://www.bmj.com/content/359/bmj.j5328
http://www.bmj.com/content/359/bmj.j5378
http://www.bmj.com/content/359/bmj.j5245