Medicine and Science from The BMJ

Doctor Informed - what to expect from an inquest

In our new season of Doctor Important, we'll be discussing topics that are not always talked about, and today, by popular request of our listners, we're talking about Coroner's Court and inquests - two things that strike terror into doctors, but are often not as bad as you may fear.
Our panel;
Clara Munro is a surgical trainee in the North East Deanery.
She's joined by her colleage Katie Strong, another surgical trainee. We also have returning to Doctor Informed Ayisha Ashmore, an Obs and Gynae registrar in the East Midlands.
Our Expert guest this week is Beth Walker, a former palliative care registrar who now works as an advisor for Medical Protection.

Series 1 wrap up

This is our last episode of series 1 of Doctor Informed, and with it we're coming full circle. Clara will be talking to our first two guests, Mary Dixon-Woods and Bill Kirkup, having now heard from all of our other experts over this series.
In this first series, we've learned about speaking out, team work, compassionate leadership - all the things that are needed to help clinicians challenge the status quo, So in this episode, we'll be asking Mary how much she thinks things have changed, and Bill how he manages a career challenging the healthcare system.
Our guests
Mary Dixon-Woods is director of THIS Institute, and a Health Foundation Professor of Healthcare Improvement Studies in the Department of Public Health and Primary Care at the University of Cambridge. Her work is concerned with generating a high quality evidence-base to support the organisation, quality and safety of care delivered to patients.
For links to the work that Mary talked about visit https://www.thisinstitute.cam.ac.uk/
Bill Kirkup is a clinician turned investigator - he led investigations into failings at a maternity and neonatal unit in Morcambe Bay, into the Oxford paediatric cardiac surgery unit and into Jimmy Savile’s involvement with Broadmoor Hospital. He was also a member of the Hillsborough Independent Panel

Talk Evidence - a new way of understanding antidepressant effectiveness

In this week's episode, Joe Ross, professor of medicine at Yale, and The BMJ's US research editor, and Juan Franco, researcher at Heinrich-Heine-Universität and editor in chief of BMJ EBM are in the hot-seat.
They will discuss new research on the effectiveness of antidepressants - based on all the individual patient data submitted to the FDA between 1979 and now.
We'll take a look at a study of industry sponsorship of cost effectiveness analysis, and seeing similar patters of publication bias to RCTs.
And finally we'll be talking about new research on the ongoing, and emergent pandemics - covid and monkeypox.
Reading listResponse to acute monotherapy for major depressive disorder in randomized, placebo controlled trials submitted to the US Food and Drug Administration: individual participant data analysis
https://www.bmj.com/content/378/bmj-2021-067606)
Using individual participant data to improve network meta-analysis projects
https://ebm.bmj.com/content/early/2022/08/10/bmjebm-2022-111931
Industry sponsorship bias in cost effectiveness analysis: registry based analysis
https://www.bmj.com/content/377/bmj-2021-069573
Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak https://www.bmj.com/content/378/bmj-2022-072410
Effectiveness of a fourth dose of covid-19 mRNA vaccine against the omicron variant among long term care residents in Ontario, Canada:
https://www.bmj.com/content/378/bmj-2022-071502

Reflecting on a crisis

Previous Doctor Informed episodes have discussed how to prevent patient safety issues from occurring, but sometimes situations are beyond anyone's control - like COVID.
It can be hard to look back, especially if difficult decisions and compromises were made, including ones we did not completely agree with, or if there could be criticism of the way we responded. We ask how individual doctors, teams, and organisations could respond to and recover from major problems?
In this episode, we're joined by Annelieke Driessen, a THIS Institute fellow and medical anthropologist. She is a research fellow at the University of Oxford and honorary assistant professor in medical anthropology at the London School of Hygiene and Tropical Medicine, who has spent hours listening to and understanding patient experiences of ICU during the pandemic. We'll also hear from Dominque Allwood, Chief Medical Officer at UCL Partners, and Director of Population Health at Imperial College Healthcare NHS Trust, who focuses on creating positive change in healthcare.
The research Annelieke Driessen discussed, and the full versions of the patient interviews that are included in the podcast are available at https://healthtalk.org/Experiences-of-Covid-19-and-Intensive-Care/overview

Talk Evidence - shoulders, knees, and woes

In this episode, Juan Franco, editor in chief of BMJ EBM, and Helen Macdonald, The BMJ's research integrity editor, sit down to discuss what's new in the world of evidence.
Firstly, last week they went to the first EBM Live conference for two years - and report back on what happened when the evidence community got back together.
We have two research papers looking at knees and shoulders, and finding out about the balance of risks and benefits.
In covid news, we're still finding new symptoms associated with infection, 2.5 years after the pandemic started. We'll also hear how complex it is to research vaccine efficacy now.
Reading list:
Smell and taste dysfunction after covid-19 https://www.bmj.com/content/378/bmj.o1653
Serious adverse event rates and reoperation after arthroscopic shoulder surgery
https://www.bmj.com/content/378/bmj-2021-069901
Viscosupplementation for knee osteoarthritis
https://www.bmj.com/content/378/bmj-2022-069722
Waning effectiveness of BNT162b2 and ChAdOx1 covid-19 vaccines over six months since second dose
https://www.bmj.com/content/378/bmj-2022-071249

Diabetes in Ukraine - supporting NCDs in a conflict zone

As the Russian invasion of Ukraine continues, living under the uncertainty has become the new normal for thousands of patients with diabetes who are dependant on insulin.
Supporting patients with non-communicable disease is the reality of all disaster situations now, and that added layer of complexity makes coordinating responses even harder.
In this podcast, we'll hear how people with diabetes are being supported in Ukraine, and what is being done to improve things, despite the continued fighting.
Our guests;
Iryna Vlasenko, Vice President of the International Diabetes Federation
Slim Slama, unit head for NCD management at the WHO
Yaroslav Diakunchak, family physician in Brovary, Kyiv.

Talk Evidence - political persuasion and mortality, too much medicine

In this week's episode, Helen Macdonald is joined by Joseph Ross, US research editor for The BMJ, and Juan Franco, editor of BMJ EBM.
They begin by discussing a review of obesity interventions in primary care, and Joe wonders if GPs are really the best people to tackle the issue.
https://www.bmj.com/content/377/bmj-2021-069719
Cervical screening in the UK now includes HPV testing, and they look at research which examines whether this could mean longer periods between screening tests.
https://www.bmj.com/content/377/bmj-2021-068776
They all enjoy a new State of the Art Review into Revascularization in stable coronary artery disease.
https://www.bmj.com/content/377/bmj-2021-067085
Juan and Joe look at a review into combinations of covid-19 vaccinations - and wonder whether we'll ever see more trials to fit into this meta-analysis.
https://www.bmj.com/content/377/bmj-2022-069989
Finally, they find out how your political persuasion has affected mortality in the US, with new research that links Republican and Democrat voters with differential changes in mortality.
https://www.bmj.com/content/377/bmj-2021-069308

Violence against GPs with Adam Janjua, Marcela Schilderman, and Anita Bignell

A recent investigation, by The BMJ, showed a worrying increase in incidence of violence, directed to wards GPs, and reported to the police. In this episode of Deep Breath in, Tom and Jenny are joined by Gareth Iacobucci, assistant news editor for The BMJ who broke the story.
They'll hear from a GP affected, and get some advice on preventing violence, and deescalation, from two mental health experts, who deal with the most agitated patients.
Our guests:
Adam Janjua, a GP in Fleetwood, Lancashire.
Marcela Schilderman, a consultant psychiatrist at South London and the Maudsley NHS Foundation Trust
and Anita Bignell, a mental health nurse, at South London and the Maudsley NHS Foundation Trust
Reading list
Violent incidents at GP surgeries double in five years, BMJ investigation finds
https://www.bmj.com/content/377/bmj.o1333

”But it’s always been done that way”

In Doctor Informed, we've been hearing a lot about the problems of healthcare, but we also want to talk about solutions. Whatever we're going to do to fix healthcare, whether that's bullying, or burnout, or patient safety - it's going to require change. And change is hard.
In this episode Clara Munro is joined by Graham Martin, director of research at THIS Institute. They discuss the dreaded phrase "But it's always been done this way", and why failing is the path to success, and the true importance of listening.
Our guests;
Penny Pereira, Q managing director at the Health Foundation. Q helps promote improvement within the health and care system, encouraging and supporting a wide range of people to effectively lead improvement. https://www.health.org.uk/about-the-health-foundation/our-people/q-and-q-labs-team
Moira Durbridge, director of safety and risk at University Hospitals of Leicester NHS Trust. Moira trained as a nurse, and continues to work clinically, as well as her role in leading her Trust's change.

Talk Evidence - evidence in Roe vs Wade, MI treatment variation, and tribal methodologies

Helen Macdonald, The BMJ's research integrity editor is back with another episode, and this week is joined by Joe Ross, professor of medicine and public health at Yale, and US research editor for The BMJ, and Juan Franco, editor in chief of BMJ EBM, and Professor at the Instituto Universitario Hospital Italiano de Buenos Aires
In this episode they discuss;
The US supreme court looks set to overturn Roe v Wade, creating a patchwork of abortion provision across the U.S. We consider the role which evidence might play in documenting how health is affected by that decision, and whether medical evidence is being used at all in the debate.
We'll give you a quick update on treatment for Covid-19
We know that trials are needed for new treatments, but in the face of an exponentially growing amount of observational data, is it time for a shift in that certainty? Joe tells us about his research into whether trials and observational studies of three drugs in covid produce the same answer?
And finally, treatment variation - it's one of the things that helped kick-start the EBM revolution, but there's still much to learn. Juan describes some new research which examines how countries stack up when you compare their handling of and outcomes of a common condition such as a myocardial infarction.
Reading list;
Navigating Loss of Abortion Services — A Large Academic Medical Center Prepares for the Overturn of Roe v. Wade
https://www.nejm.org/doi/full/10.1056/NEJMp2206246.
A living WHO guideline on drugs for covid-19
https://www.bmj.com/content/370/bmj.m3379
Agreement of treatment effects from observational studies and randomized controlled trials evaluating hydroxychloroquine, lopinavir-ritonavir, or dexamethasone for covid-19
https://www.bmj.com/content/377/bmj-2021-069400
Variation in revascularisation use and outcomes of patients in hospital with acute myocardial infarction across six high income countries
https://www.bmj.com/content/377/bmj-2021-069164