Medicine and Science from The BMJ

PreP And public health

The drug Truvada, licenced for HIV PrEP, costs £350 a month but is shown to be cost effective in preventing infection. However, in the English NHS, a row has broken out about which body should fund the treatment - NHS England claims local authorities have responsibility, local authorities believe NHS England does.
In this podcast Jim McManus, director of public health at Hertfordshire County Council, explains why he believes local authorities cannot afford the treatment, and describes the pressure that public health budgets are under.
Read the full editorial:
http://www.bmj.com/content/354/bmj.i3515

Can guidelines be reformulated to account for how doctors actually use information?

Guidelines usually assume a rational comprehensive decision model in which all values, means, and ends are known and considered. In clinical encounters, however, patients and doctors most often follow “the science of muddling through.
Given that clinical knowledge does not follow the narrow rationality of “if-then” algorithms contained in guidelines, alternatives are desperately needed.
Glyn Elwyn, professor at the Dartmouth Institute for Health Policy and Clinical Practice, joins us to discuss what we know about how doctors and patients use evidence, and what the alternative to guidelines could look like.
Read the full analysis:
http://www.bmj.com/content/353/bmj.i3200

Evidence live - Emily Sena on closing the gap between clinical and basic science

When we think about medical evidence, we think of RCTs, registries and meta-analysis. But these EBM tools have yet to filter into the basic science that underpins clinical science.
One person changing that is Emily Sena, research fellow in clinical brain sciences at the University of Edinburgh - and one of the few people who’s trying to meta-analyse animal studies.

Julia Beluz And Victor Montori - Journalists And doctors; separated by a common evidence

The same piece of evidence may reach you via a journalist, or via your doctor - but the way in which that evidence is communicated is changed by your relationship between that person.
Julia Beluz from Vox and Victor Montori from the Mayo Clinic join us to discuss if it's possible to reconcile those competing points of view.

Epilepsy in pregnancy

In every 1000 pregnancies, between two and five infants are born to women with epilepsy. For such women, pregnancy can be a time of anxiety over maternal and fetal wellbeing.
In 96% of pregnancies they will deliver a healthy child. However, some women will experience an increase in seizure frequency, which can be harmful for the mother or fetus, and evidence comes from observational study and registry data suggests some antiepileptic drugs are associated with an increased risk of congenital and neurodevelopmental abnormalities.
Michael Kinney, specialist registrar in neurology, and James Morrow, principal investigator of the UK and Ireland Epilepsy and Pregnancy Register, both based at the Royal Group of Hospitals in Belfast, join us to discuss how to manage epilepsy in pregnancy.
Read the review:
http://www.bmj.com/content/353/bmj.i2880
For information on joining the UK epilepsy and pregnancy register, call 0800 389 1248 or visit http://www.epilepsyandpregnancy.co.uk/

Caring for patients with delirium at the end of their life

Delirium is common in the last weeks or days of life. It can be distressing for patients and those around them. A clinical update explains why successful management involves excluding reversible causes of delirium and balancing drugs that may provoke or maintain delirium while appreciating that most patients want to retain clear cognition at the end of life.
Kate Adlington, clinical editor at The BMJ, is joined by the authors of the paper - Christian Hosker, consultant liaison psychiatrist at Leeds and York Partnership Foundation Trust, and Michael Bennett, professor of palliative medicine at the University of Leeds.
http://www.bmj.com/content/353/bmj.i3085

”What has convinced me is the evidence” - why mandatory treatment for drug use is a bad idea

Global evidence indicates that mandated treatment of drug dependence conflicts with drug users’ human rights and is not effective in treating addiction.
Karsten Lunze, associate professor at the Boston University School of Medicine, joins us to describe the evidence, and why he is convinced seemingly counter intuitive hard reduction works.
http://www.bmj.com/content/353/bmj.i2943

Tell me a story

How can asking patient to tell us their story improve healthcare? Helen Morant, content lead at BMJ, talks us through her project getting healthcare professionals to sit down with patients and record their conversations, and what on earth this has to do with quality improvement.
We also hear some of the recordings she has gathered through the project.
Here are links to the other podcasts and projects Helen mentions:
Story Corps - https://storycorps.org/
The Listening Project - http://goo.gl/3auSHX
Beautiful stories from anonymous people - http://goo.gl/78QSjU

Guidelines Not Tramlines

Julian Treadwell, Neal Maskrey and Richard Lehman join us in the studio to argue that new models of evidence synthesis and shared decision making are needed to accelerate a move from guideline driven care to individualised care.
Read the full analysis:
www.bmj.com/content/353/bmj.i2452

Uncovering the uncertainty on wound dressing

There is insufficient evidence to know whether dressings reduce the risk of surgical site infection in closed primary surgical wounds.
Jane Blazeby, professor of surgery at the University of Bristol, and Thomas Pinkney, consultant colorectal surgeon at the University of Birmingham, join us to discusses why there is a lack of evidence, and the implications for patient care.
read the full article:
http://www.bmj.com/content/353/bmj.i2270