Medicine and Science from The BMJ

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

Women and the Zika Virus

Interviews from the Women deliver conference in Copenhagen.
Donna McCarraher, director of reproductive, maternal, newborn and child health at FHI 360, explains why women should be at the centre of efforts to mitigate the effect of Zika Virus in Brazil.

Abortion as a development issue

Interviews from the Women deliver conference in Copenhagen.
Catrin Schulte-Hillen, co-ordinator of reproductive health and sexual violence care at Medecins Sans Frontieres, explains why the development community shouldn't conflate sexual violence and access to abortion.

What are they on?

This week, we look at medication reconciliation.
Joshua Pevnick, health services researcher and hospital physician at Cedars-Sinai Hospital, LA, US, talks us through what it is and why it can be so hard to get right.
And Emma Iddles, a junior doctor in general surgery at Hairmyres Hospital, Lanarkshire, UK, explains how her project improved medicines reconciliation in the surgical admissions unit of the hospital.
For more, read Joshua's full paper, http://goo.gl/O59BWo, and Emma's project write up http://goo.gl/znrNGQ.

The Weekend Effect - what’s (un)knowable, and what next?

We do we know about the weekend effect? As Martin McKee puts it in an editorial on thebmj.com, "almost nothing is clear in this tangled tale"
In this roundtable, Navjoyt Ladher, Analysis editor for The BMJ is joined by some of the key academics who have published research and commented on the weekend effect to make sense of what we know and don’t know about weekend care in hospitals.
http://www.bmj.com/weekend
Taking part in the discussion are:
Cassie Aldridge, HiSLAC study project manager at the University of Birmingham
Rachel Meacock, research fellow in health economics at Manchester University
Nick Black, professor of health services research at the London School of Hygiene and Tropical Medicine
Paul Aylin, professor of epidemiology and public health at Imperial College London
Nick Freemantle, professor of clinical epidemiology and biostatistics at University College London
Peter Rothwell, professor of neurology at the University of Oxford

”Women deliver, and not only babies”

Katja Iversen, CEO of Women Deliver, joins Rebecca Coombes to explain why the UN sustainable development goals are unachievable if we don't empower women and girls to take control of their health, wellbeing, and reproductive rights.
http://womendeliver.org/