Medicine and Science from The BMJ

How scientific are US dietary guidelines?

They have a big impact on the diet of American citizens, and those of most Western nations, so why does the expert advice underpinning US government dietary guidelines not take account of all the relevant scientific evidence asks Nina Teicholz.
Read the full investigation:
http://www.bmj.com/content/351/bmj.h4962

Dengue fever

Around two fifths of the world’s population (those in tropical and subtropical countries), or up to 2.5 billion people, are at risk of dengue infection.
An estimated 50 million infections occur annually worldwide, with 0.5 million of these cases being admitted to hospital for dengue haemorrhagic fever. Approximately 90% of these cases are in children aged less than 5 years. The epidemiology is, however, changing both regionally and globally.
In this podcast, Senanayake A M Kularatne, senior professor of medicine at the University of Peradeniya in Sri Lanka, joins us to discuss which symptoms should make doctors consider a diagnosis of Dengue fever.
Read the full clinical review:
http://www.bmj.com/content/351/bmj.h4661
Read the best practice monograph:
http://bestpractice.bmj.com/best-practice/monograph/1197.html

They drained 92L from me - diagnosis and management of pleural effusion

Pleural effusions are common, with an estimated 1-1.5 million new cases in the United States and 200 000-250 000 in the United Kingdom each year.
Rahul Bhatnagar, academic clinical lecturer at the University of Bristol, describes how pleural effusions may be investigated and treated in the community and secondary care, with a particular focus on the emerging phenomenon of ambulatory management.
We're also joined by Ron who boasts that he could have filled his car twice over, with the fluid drained over the two years he had a catheter in situ.
Read the full clinical review:
http://www.bmj.com/content/351/bmj.h4520

Being diagnosed with ovarian cancer

Ovarian cancer is the 7th most common cancer in women world wide, and 5 year survival continues to remain low - in the UK this has been attributed to delayed diagnosis.
In this podcast Sophie Cook is joined today by two women who have had, and been treated for, ovarian cancer. Adele and Rosemary describe their experience, and what they think doctors should know about what patients are feeling.
Read the full clinical review:
www.bmj.com/content/351/bmj.h4443
Listen to the podcast on diagnosing ovarian cancer:
https://soundcloud.com/bmjpodcasts/diagnosing-ovarian-cancer

Diagnosing ovarian cancer

Ovarian cancer is the 7th most common cancer in women world wide, and 5 year survival continues to remain low - in the UK this has been attributed to delayed diagnosis.
In this podcast Sudha Sundar, senior lecturer in gynaecological oncology at the University of Birmingham, discusses how doctors can identify women at risk, and who to refer for specialist evaluation.
Read the full clinical review:
http://www.bmj.com/content/351/bmj.h4443
Find out what patients are experiencing:
https://soundcloud.com/bmjpodcasts/being-diagnosed-with-ovarian-cancer

A research agenda for medical overuse

Although overuse in medicine is gaining increased attention, many questions remain unanswered.
At the Preventing Overdiagnosis conference in Washington, Dan Morgan, associate professor at the University of Maryland School of Medicine, and Sanket Dhruva, research fellow at Yale University, propose an agenda for coordinated research to improve our understanding of the problem.
Read the full agenda at:
http://www.bmj.com/content/351/bmj.h4534

Diagnosis and treatment of hepatic encephalopathy

Hepatic encephalopathy constitutes a spectrum of neuropsychiatric abnormalities, beginning with subtle psychomotor changes and progressing to confusion with asterixis, somnolence, and then coma, arising in patients with impaired liver function.
In this podcast, Tim Cross, a consultant hepatologist from the Royal Liverpool University Hospital, describes how to diagnose and manage the condition.
We're also joined by Ralph Crawford, who suffers from hepatic encephalopathy, to talk about the burden of the disease and the treatment from a patient's perspective.
Read the full review:
http://www.bmj.com/content/351/bmj.h4187

Open Doors For Sex Workers

Following on from the clinical review "Caring for sex workers", we spoke to the team at Open Doors, a sex worker outreach clinic in east London, run from the Homerton University Hospital NHS Foundation Trust.
Kim Leveret and Anca Doczi join us to give practical advice on reaching out to sex workers, what barriers exist to them accessing care, and how to take a sex worker sexual history.
Listen to the author of the clinical review, Michael Rekart, talk about the infectious disease side of sex worker health in our accompanying podcast:
https://soundcloud.com/bmjpodcasts/sex-worker-health
Read the full review:
http://www.bmj.com/content/351/bmj.h4011
Practical advice for sex workers and health professionals, including links to Ugly Mugs:
http://www.opendoors.nhs.uk/
The historic reasons for high abortion rates in Romania, from the journal of family planning and reproductive healthcare:
https://soundcloud.com/bmjpodcasts/romanian-womens-fertility

Sex worker health

Sex workers are unique population with specific health needs, caring for them can present non-specialists with a challenge, and there are important health promotion opportunities which should no be missed.
Michael Rekart, clinical professor of infectious disease at the University of British Columbia, joins us to discuss his clinical review on caring for sex workers.
Read the full article:
http://www.bmj.com/content/351/bmj.h4011
Listen to outreach workers from Open Doors, a sex worker healthcare initiative in east London, give practical tips on caring for sex workers:
https://soundcloud.com/bmjpodcasts/open-doors-for-sex-workers

The system can abuse older people too

Elder abuse is often the result of the organisation of health systems rather than the fault of individuals, argue Jolanda Lindenberg and Rudi Westendorp, two authors of a recent analysis paper.
They call for system abuse to be acknowledged and addressed by incorporating older people’s views when designing health services.
Read the full analysis:
http://www.bmj.com/content/350/bmj.h2697