Medicine and Science from The BMJ

Your brain on booze

A new study on BMJ.com, examines the effect of moderate drinking on brain structure. We know that heavy drinking has a deleterious effect on our brains, and is linked to dementias. However, for sometime it’s been thought that moderate drinking is actually protective.
Anya Topiwala, clinical lecturer in old age psychiatry at the University of Oxford, joins us to discuss the association between alcohol consumption and those structural elements.
Read the full research:
http://www.bmj.com/content/357/bmj.j2353

Future Earth - linking health and environmental research

The rapid changes in the global environment have led many scientists to conclude that we are living in a new geological epoch—the Anthropocene—in which human activities have become the dominant driving force transforming the Earth’s natural systems.
A recent joint publication by the World Health Organization and Convention on Biological Diversity articulated the myriad connections between biodiversity and health and the threats to both posed by environmental change.
Andy Haines, professor of public health and primary care, at the London School of Hygiene and Tropical Medicine joins us to talk about a new research platforms present an opportunity to advance understanding of how to safeguard health in the face of global environmental change.
Read more:
http://www.bmj.com/content/357/bmj.j2358

Government and evidence

We're creating a manifesto for better evidence. The centre for Evidence Based Medicine at the University of Oxford, and the BMJ, are asking what are the problem with medical evidence, and how can we fix them?
In this third discussion we went to Scotland, to find out what the people who create policy think about the issues with evidence synthesis, and how the information they create is being used in practice.
evidencelive.org/manifesto/ - join the discussion, read, and comment on our manifesto.

50% of delirium is hypoactive - how to spot it

Available data suggest about 50% of delirium is hypoactive; this and the mixed motor subtype account for 80% of all cases of delirium.
It can be more difficult to recognise, and is associated with worse outcomes, than hyperactive delirium.
In this podcast, Christian Hosker, consultant liaison psychiatrist at the Leeds Liaison Psychiatry Service outlines when to suspect hypoactive delirium, how to assess, and appropriately manage patients.
Infographic explaining diagnosis:
http://www.bmj.com/content/bmj/suppl/2017/05/25/bmj.j2047.DC1/hosc038261.wi.pdf
Read the full article:
http://www.bmj.com/content/357/bmj.j2047

Helping patients with complex grief

Each individual’s grief process is unique, when confronted with the death of a loved one, most people experience transient rather than persistent distress - however 10% of bereaved individuals, with an increased risk following the death of a partner or child and loss to unnatural or violent circumstances, experience prolonged grief disorder.
In this podcast, Paul Boelen, a professor of psychiatry at Utrecht University, and Geert Smid, psychiatrist and senior researcher from the Dutch National Psychotrauma Centre, join us to discuss what constitutes complex grief, how to recognise it, and some strategies for helping patients cope.
Read the full practice pointer:
http://www.bmj.com/content/357/bmj.j2016

NHS must “get its act together” to secure cash for new buildings

NHS hospitals must be willing to dispose of surplus land to help convince the Treasury to invest in new premises that are fit for purpose, the head of a major government review has urged.
Robert Naylor, former chief executive of University College London Hospitals, who was asked by the health secretary, Jeremy Hunt, to produce a review of NHS property and estates - and in this interview we asked him how his plans would work, and what would be done with the land sold.
Read Gareth Iacobucci's report:
http://www.bmj.com/content/357/bmj.j2072

Education Round - Exercising too much, microbiome, suicide and translation

The BMJ publishes a lot of educational articles, and in an attempt to help you with your CPD, we have put together this round-up. Our authors and editors will reflect on the key learning points in the articles we discuss, and explain how they may change their practice in light of that new understanding.
In this month's round up we're discussing:
Addiction to exercise
http://www.bmj.com/content/357/bmj.j1745
If your patient doesn’t speak the same language as you . . .
http://www.bmj.com/content/357/bmj.j1511
Exploring thoughts of suicide
http://www.bmj.com/content/356/bmj.j1128
The role of the microbiome in human health and disease
http://www.bmj.com/content/356/bmj.j831

The magic of shared decision making

Adoption of shared decision making into routine practice has been remarkably slow, despite 40 years of research and considerable policy support.
In 2010, the Health Foundation in the UK commissioned the MAGIC (Making Good Decisions in Collaboration) programme to design, test, and identify the best ways to embed shared decision making into routine primary and secondary care using quality improvement methods.
In this podcast, Natalie Joseph-Williams from Cardiff University and Richard Thomson from Newcastle University, join us to discuss how the project went, and what key lessons they learned from the pilot.
Read their full analysis:
http://www.bmj.com/content/357/bmj.j1744

Drug promotion, prescription, and value

Pharma companies say that money spent on promotion is essential to educate doctors about the best drugs - but when a medical student asked Joseph Ross, associate professor of medicine and public health at Yale, if those companies are promoting the right drugs for that message to be true, the answer wasn't available.
Ross and Tyler Greenaway, his medical student, then sat down and used the data from the US Physician Payments Sunshine Act to find out which drugs have the highest promotional budgets.
They cross referenced that against prescription databases and measures of value to assess the effectiveness, usefulness, and affordability of the drugs that get the heaviest promotion.
Read the full analysis:
http://www.bmj.com/content/357/bmj.j1855

How established biologics become less safe

Biologics have revolutionised healthcare for some conditions - but have been expensive because of the multistep manufacturing processes required to create these complex molecules.
Changes to the manufacturing of biological agents make them more affordable, but can lead to drugs with different components from the original medicine tested in clinical trials, challenging assumptions about safety.
David Hunt, honorary consultant neurologist and Wellcome Trust intermediate clinical fellow, at the University of Edinburgh, joins us to describe how that happens and what the result can be.
Read the full analysis:
http://www.bmj.com/content/357/bmj.j1707