Medicine and Science from The BMJ

Public health - time for pragmatism or knowledge production?

We have evidence on which to act, and inaction costs lives, argues Simon Capewell, Professor of Public Health and Policy, at the University of Liverpool. But Aileen Clarke, professor of public health and health services research at Warwick Medical School, says our understanding of the human behaviour that leads to unhealthy choices is still lacking
Read the head to head
http://www.bmj.com/content/360/bmj.k292

Smoking one a day can’t hurt, can it?

We know that smoking 20 cigarettes a day increases your risk of CHD and stroke - but what happens if you cut down to 1, do you have 1/20th of that risk?
Allan Hackshaw, professor of epidemiology at UCL joins us to discuss a new systematic review and meta analysis published on bmj.com, examining the risk of smoking just one or two cigarettes a day.
Read the full review:
http://www.bmj.com/content/360/bmj.j5855

Virginia Murray - the science of disaster risk reduction

Virginia Murray, public health consultant in global disaster risk reduction at Public Health England, was instrumental in putting together the Sendai Framework for Disaster Risk Reduction - an international agreement which aims to move the world from reacting to disasters, to proactively preventing them.
In this podcast, she explains what they learned in the process, and why science had to become storytelling, in order to make politicians pay attention.
Read the editorial on creating a set of indicators for disaster preparedness.
http://www.bmj.com/content/359/bmj.j5279

Education round-up - January 2018

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 audio round-up The BMJ’s clinical editors discuss what they have learned, and how they may alter their practice. Kate Addlington, associate editor and trainee psychiatrist is joined by Cat Chatfield, quality editor and GP.
They discuss acute respiratory distress syndrome:
http://www.bmj.com/content/359/bmj.j5055
Why it’s important to have early diagnosis of psychotic symptoms, and the evidence for improved outcomes:
http://www.bmj.com/content/357/bmj.j4578
And finally, why it’s important to consider hearing-loss on the ward:
http://www.bmj.com/content/360/bmj.k21

They can’t hear you - how hearing loss can affect care.

Many older adults have difficulty understanding speech in acute healthcare settings owing to hearing loss, but the effect on patient care is often overlooked.
Jan Blustein professor of health policy and medicine at New York University, and who has also experienced the affects of hearing loss, joins us to explain what that's like, and gives some tips on making it easier to communicate.
Read the full analysis:
http://www.bmj.com/content/360/bmj.k21
Full transcript of the interview:
https://docs.google.com/document/d/1Rp7zvRlnTG5KRVLgmR-PFt-0fVRLBqINU5EmOrT5RDU/edit?usp=sharing

MVA85A trial investigation - press conference.

Trial MVA85A - monkey trials for a booster vaccine for BCG, developed by researchers at Oxford University, is the subject of an investigation published on bmj.com.
Experts warn that today’s investigation is just one example of “a systematic failure” afflicting preclinical research and call for urgent action “to make animal research more fit for purpose as a valuable and reliable forerunner to clinical research in humans.”
The press conference is led by Dr Fiona Godlee, the editor-in-chief of the BMJ, who provides a background to the investigation. The panel members are:
Dr Deborah Cohen, author of the investigation and associate editor at the BMJ, talking about carrying out the investigation and the difficulty to obtain basic information
Professor Paul Garner from the Liverpool School of Tropical Medicine, addressing the ineffectiveness of the current TB vaccine and also talking about the backlash he experienced after publishing a systematic review concluding that the animal studies results had been overstated
Malcolm Macleod, from the University of Edinburgh, talking about the broader public health aspect
Merel Ritskes-Hoitinga from the Department for Health Evidence in The Netherlands, addressing the quality of animal studies and the need for systematic reviews
and Jonathan Kimmelman, from McGill University in Canada analysing the story from the perspective of biomedical ethics.

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