Medicine and Science from The BMJ

Should all fetuses be monitored electronically during birth?

Our latest H2H debate asks: Is continuous electronic fetal monitoring useful for all women in labour?
Peter Brocklehurst is professor of women’s health at the University of Birmingham. He argues that continuous electronic fetal monitoring during labour can lead to harm and increase the risk of caesarean section.
Christoph Lees is reader in obstetrics and fetal medicine at Imperial College London. He argues that continuous electronic fetal monitoring is useful for all women in labour as it helps avoid fetal and neonatal morbidity

”Obesity is the last thing it’s OK to discriminate on the basis of”

We have a problem in obesity research — clinical trials continue to prioritise weight loss as a primary outcome and rarely consider patients’ experience, quality of life, or adverse events - and now a new analysis article, "Challenging assumptions in obesity research" questions that focus on weight.
Navjoyt Ladher discusses this thorny topic with Liz Sturgiss, GP, obesity researcher at Australian National University Medical School, and one of the authors of that paper.
Read the full analysis:
http://www.bmj.com/content/359/bmj.j5303

Dieting, cardiovascular disease, cancer, and mortality

We know that adults with obesity have an increased risk of premature mortality, cardiovascular disease, some cancers, type 2 diabetes, and many other diseases.
However, the effect of dieting on 3 of those outcomes (cancer, cvd, and mortality) is surprisingly little studied.
However a new systematic review and meta-analysis does bring together what we know of that effect, and to explain the evidence we're joined by Alison Avenell, professor in the Health Services Research Unit, University of Aberdeen.
Read the full systematic review and meta-analysis: http://www.bmj.com/content/359/bmj.j4849

Antibiotic prescription course - an update

In July, The BMJ published an analysis article called “The Antibiotic Course has had it’s day” - a provocative title that turned out the garner a lot of debate on our site. The article said that the convention for the length of a course of antibiotics was set by Flemming, in his Nobel Prize acceptance speech - “If you use penicillin, use enough!” - and that the evidence base hasn’t moved on since then.
The article has had over 40 substantive responses, both agreeing and vehemently not - and so we thought it worth revisiting that argument, now the dust has settled.
Discussing that are Martin Llewellyn, professor of infectious disease at Brighton and Sussex Medical School, and Paul Little, professor of primary care at the University of Southampton.
Read the original analysis:
http://www.bmj.com/content/358/bmj.j3418

Is it time to scrap the UK’s mental health act?

Unjust discrimination against people with mental ill health should be replaced with universal rules based on decision making ability, argues George Szmukler, emeritus professor of psychiatry and society at King’s College, London.
However Scott Weich, professor of mental health at the University of Sheffield, worries about legal distractions that won’t improve outcomes while services are so thinly stretched.
Read the full debate:
http://www.bmj.com/content/359/bmj.j5248

Three talks to good decision making

The Three Talk Model of shared decision is a framework to help clinicians to think about how to structure their consultation to ensure that shared decision making can most usefully take place.
The model is based around 3 concepts - option talk, decision talk, and team talk - with active listening at the centre.
Three Talk was first proposed in 2012, now new research published on bmj.com updates that model. Professor Glynn Elwyn, from The Dartmouth Institute for Health Policy and Clinical Practice, joins us to explain how that was done, and what it's creators learned from the process.
Read the full research:
http://www.bmj.com/content/359/bmj.j4891

Education round up October 2017

The BMJ publishes a variety of education articles, to help doctors improve their practice. Often authors join us in our podcast to give tips on putting their recommendations into practice.
In this new monthly audio round-up The BMJ’s clinical editors discuss what they have learned, and how they may alter their practice.
In this edition, GP Cat Chatfield, psychiatric trainee Kate Addlington and Gastrology trainee Robin Baddeley discuss the articles;
Diagnosis and management of postpartum haemorrhage
http://www.bmj.com/content/358/bmj.j3875
Indications for anticoagulant and antiplatelet combined therapy
http://www.bmj.com/content/356/bmj.j1128
Safe Handover
http://www.bmj.com/content/359/bmj.j4328
and why fixing the broken medical ward round is in everyone’s interests
http://blogs.bmj.com/bmj/2017/10/13/robin-baddeley-fixing-the-broken-medical-ward-round-is-in-everyones-interests/

Money for editors

As journal editors, we’re aware of the fact that we have a role to play in scientific discourse - that’s why The BMJ has been so keen to talk about the way in which scientific knowledge is constructed, through our Evidence Manifesto.
We also know that money has influence in the scientific literature - which is why we have a zero tolerance policy for financial conflicts of interest in our educational content.
Where do journal editors fit into this?
The first step into investigating that is to find out if journal editors receive payments from pharma and device companies - and new research, published on bmj.com does that.
Jessica Liu - internist and assistant professor at the university of Toronto, and one of the authors of that study joins us to discuss.
Read the full research:
http://www.bmj.com/content/359/bmj.j4619

The death of QOF?

The Quality and Outcomes Framework (QOF) is one of the most ambitious pay-for-performance schemes introduced into any health system. It's now being scrapped by bits of the NHS, and is under reform elsewhere.
Martin Marshall, GP and professor of Health Improvement at University College London, thinks it's time to rethink the experiment. He joins us to discuss how we got here, what we've learned, and what will replace QOF.
Read the editorial:
http://www.bmj.com/content/359/bmj.j4681

70% rise in incidence of self harm in teenagers

Half of adolescents who die by suicide have a history of self harm. And in the UK, the rates of adolescents who commit suicide jumped from 3.2, to 5.4 per 100 000 between 2010 and 2015. The national suicide prevention strategy recently expanded its scope by aiming to reduce self harm rates as a common precursor to suicide.
Therefore it's important that we have an accurate measure of rates of self harm in the population, and new research published on bmj.com aims to do that.
To discuss we're joined by one of the authors of that paper - Navneet Kapur, professor of psychiatry and population health at the University of Manchester.
Read the full research:
http://www.bmj.com/content/359/bmj.j4351