Medicine and Science from The BMJ

Low intensity pulsed ultrasound - no difference for bone healing

A new rapid recommendation had concluded that LIPUS makes no different to patients experience of bone healing, and therefore shouldn't be used.
In this podcast, we talk to three of those panel members - Rudolf Poolman, orthopaedic surgeon from The Netherlands, Stefan Schandelmaier, a methodologist from McMaster University, and Maureen Smith, a patient representative.
Read the full recommendation:
http://www.bmj.com/content/356/bmj.j576

How people die remains in the memory of those who live on - supporting the relatives of the dying

All doctors, irrespective of their specialty or the setting in which they work, will care for patients who die. Around half of all deaths occur in hospitals.
Evidence suggests that the quality of communication around this process is poorer in hospitals than in other settings, according to responses from relatives who have experienced bereavement. Over half of NHS complaints concern care of the dying.
In this podcast, Katherine Sleeman, clinician scientist and honorary consultant in palliative medicine at King's College London, and Jane Harris, counselling and psychotherapy practitioner, and bereaved mother and daughter join us to discuss what support the carers and relatives of a dying patient need, and give practical advice on how to become better at having those difficult conversations.
Read the full essentials article:
http://www.bmj.com/content/356/bmj.j367

Helping patients with medically unexplained symptoms

Persistent physical symptoms are common and include those symptoms that last at least three months and are insufficiently explained by a medical condition after adequate examination and investigation.
Observational studies in primary care report that women, especially those aged 35-45 years, more commonly present with these symptoms.
In this podcast, Madelon den Boeft, a GP and, Nikki Claassen-van Dessel, a GP trainee, both in The Netherlands, join us to explain why listening to a patient is important, and making sure that regular follow up is essential.
Read the full uncertainties article:
http://www.bmj.com/content/356/bmj.j268

US Surgeon General - “For far too long addiction has been looked at as a moral failing”

Vivek Murthy, the US surgeon general, has highlighted prescription opioid misuse as a serious public health problem.
In this podcast, Richard Hurley speaks to him about what he thinks needs to be done to tackle the issue.
http://www.bmj.com/content/356/bmj.j715

Should all American doctors be using electronic medical records?

Evidence shows using electronic health records can increase efficiency, and reduce preventable medical errors - but only if they are used properly. However, in the US, the president of the American Medical Association calls them almost unusable.
In this debate, Richard Hurley is joined by George Gellert, Regional Medical Informatics Officer at CHRISTUS Santa Rosa Health System and Edward Melnick, Assistant Professor of Emergency Medicine at Yale, who debate whether US doctors should be using electronic medical records.
Read the related article:
http://www.bmj.com/content/356/bmj.j242.

Expanding your mind about novel psychoactives

The use of novel psychoactive substances is increasing, however there is little information about what these are, and how they work.
Dr Derek Tracy, consultant psychiatrist at Oxleas NHS Foundation Trust, and David Wood, consultant physician and toxicologist at Guy's and St Thomas' NHS Foundation Trust join us to explain that doctors already know how to deal with these, if they think about them in terms of traditional drug use.
Read the two related articles:
http://www.bmj.com/content/356/bmj.i6814
http://www.bmj.com/content/356/bmj.i6848

Big Data - what effect is it going to have on EBM

http://evidencelive.org/manifesto/
The BMJ, and the Centre for Evidence Based Medicine in Oxford have long collaborated to document the problems with the creation and use of Evidence based medicine - and together we host evidence gatherers, synthesisers and users in the conference Evidence Live.
We know what the problems are - but what would positive change, when it comes to the creation and use of medical evidence look like? To find out we’re doing a series of discussions at various places around the world - where we’re talking to people who have a particular insight into one area of the evidence ecosystem. Ultimately we’re collating this into what we’re calling the evidence manifesto.
In this discussion we went to the The Farr Institute which is a of 21 academic institutions and health partners in the UK - whose mission is to deliver high-quality, cutting-edge research using ‘big data”.

Gluten free on the NHS

Should gluten-free foods be available on prescription?
A gluten free diet is the main treatment for celiac disease, and gluten-free food has been available on prescription from the NHS. However, as finances become tighter, in some areas patients no longer have that option.
Prescriptions of gluten free food is the same as a prescription for a drug, argues David Sanders, professor of gastroenterology from Royal Hallamshire Hospital, but James Cave lambasts a costly system that frustrates patients and doctors alike. Gemma Gleed is the mother of a child with coeliac disease, who has had her prescriptions cancelled.
Read the debate:
http://www.bmj.com/content/356/bmj.i6810

Surrogate outcomes distorting medicine

Surrogate endpoints are commonly used in clinical trials to get quicker results, however Michael Baum, emeritus professor at University College London, worries that by not focusing on real outcomes - length of life, and quality of life - that these are being used to justify expensive treatments which may not benefit patients.
Read the full analysis:
http://www.bmj.com/content/355/bmj.i6286

Nanny state knows best

State regulation is necessary for safety, says Simon Capewell, professor of public health and policy at the University of Liverpool. Richard Lilford, professor of public health at the University of Warwick, argues that restricting adults’ choice can undermine such aims.
Read the debate:
http://www.bmj.com/content/355/bmj.i6341