Medicine and Science from The BMJ

WISH 2022 - Antimicrobial resistance, and workforce wellbeing

Last month, saw the WISH 2022 - the World Innovation Summit for Health, where experts from around the world came and presented their ideas.
In this podcast we'll hear from Dame Sally Davies, the UK’s Special Envoy on Antimicrobial Resistance - she explains how covid, and treatment uncertainty, put paid to conservative prescribing; and what innovations in microbial treatment are on the horizon.
Following that, James Campbell, director of the health workforce department at the WHO, who joins us to talk about new data they have on the wellbeing, and why the international market for healthcare staff is no longer the simple solution for vacancies.
The BMJ's collections we mentioned are on empowering and engaging patients (https://www.bmj.com/empowering-and-engaging-patients) and food security and health in a changing environment (https://www.bmj.com/food-security-and-health-in-a-changing-environment)

Talk Evidence - Diabetes data, colonoscopies, and researchers behaving badly

In this month's Talk Evidence, Helen Macdonald, The BMJ's research integrity editor, is joined again by Juan Franco, editor in chief of BMJ EBM, and Joe Ross, US research editor.
They're straying beyond the pages of The BMJ, and discussing an NEJM paper about colonoscopy for colorectal cancer screening.
We have a listener request, asking about evidence for England's " NHS Diabetes Prevention Programme" - what do we know about how lifestyle interventions work at a population level? Juan puts on his Cochrane hat to answer the query.
We stay with diabetes, and Joe tells us about his research trying to see if routinely collected observational data could be used to match the outcomes of an RCT into drug treatments.
Finally, Helen updates us about what she's been doing about a case of plagiarism in one of BMJ's journals - and what that means for researchers who are writing in multiple journals about their work.
Reading list
Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
https://www.nejm.org/doi/full/10.1056/NEJMoa2208375
Emulating the GRADE trial using real world data: retrospective comparative effectiveness study
https://www.bmj.com/content/379/bmj-2022-070717
Expression of concern about content of which Dr Paul McCrory is a single author
https://bjsm.bmj.com/content/early/2022/10/11/bjsports-2022-106408eoc

Doctor informed - sustainability isn’t just waste management

In this episode of Doctor Informed, we're talking sustainability. The BMJ has a special edition on the climate crisis, and finding hope amid dispair - and we want to help our listeners with some of that. Clara is joined by three of the NHS's sustainability fellows, Florence, Who is a medical registrar, Emily a paedatrics trainee, and Li, an anaesthetics trainee
For more on the climate crisis, read The BMJ's special edition
https://www.bmj.com/content/379/8356

Talk Evidence - Inquiring about covid, burnout, and marginal data

It's October's Talk Evidence, and that means the autumn is upon us including those autumnal viruses. Here in the UK covid is on the rise, and Joe Ross is looking at some research on how good those elusive lateral flows are at detecting infection among people with symptoms of covid.
Juan will give us an update on the covid inquiry, the collection of analysis articles The BMJ is publishing looking at the interface of evidence and policy in our decisions about how to handle the pandemic.
Since the pandemic moral among clinicians in many health systems has fallen even further, workloads have spiralled. Coupled with other problems with workforce planning and investment in health and healthcare, this is increasing burnout - with a consequential impact on patient care. Helen will tell us about new research which is trying to put some numbers to how much clinican burnout effects patient outcomes
Finally, we're turning to a very clinical topic that we don't often cover in Talk Evidence - oncology, and some interesting insights into clearance margins in cancer surgery.
Reading list
Diagnostic accuracy of covid-19 rapid antigen tests with unsupervised self-sampling in people with symptoms in the omicron period
https://www.bmj.com/content/378/bmj-2022-071215
Guided by the science? Questions for the UK’s covid-19 public inquiry
https://www.bmj.com/content/378/bmj.o2066
Associations of physician burnout with career engagement and quality of patient care
https://www.bmj.com/content/378/bmj-2022-070442
Margin status and survival outcomes after breast cancer conservation surgery
https://www.bmj.com/content/378/bmj-2022-070346

Doctor Informed - the generational divide

It's zoomers vs boomers on this week's Doctor Informed, as we assemble a multigenerational team to talk about the "good old days" and if the youth of today are really snowflakes.
Clara Munro is joined by Nikki Nabavi, a medical student at Manchester University and a regular on Sharp Scratch (The BMJ's student podcast); Ayisha Ashmoore, an trainee in obstetrics and gynaecology, in the East Midlands; and Alastair Munro, a retired professor of oncology (and Clara's dad).

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