Medicine and Science from The BMJ

DNACPR

In this episode of the Dr. Informed podcast, the topic of discussion is death and dying, and how to involve patients in DNACPR decisions.
The panel discuss the importance of doctors having discussions with patients about end-of-life care as a way of creating the best possible death for patients. The conversation also touches on the challenges that doctors may face when having these difficult discussions and they give some advice on how they to overcome them.
Joining Clara are;
Mark Taubert, palliative care consultant, and national chair of future care planning for the Welsh Government
Kat Shelley, an anaesthetics trainee, who has stage four breast cancer, and is receiving palliative care
Lucy-Anne Frank, an elderly care consultant.
The article "Do not resuscitate me in Barbados" is published by BMJ Supportive and Palliative Care, and is free to access at;
https://spcare.bmj.com/content/11/3/310

Talk Evidence - endometriosis, falling, and better EBM

In this month's episode, Helen Juan and Joe delve into the clinical - with a new review of endometriosis, and why the difficulty in diagnosis has lead to a dearth of evidence and attention on the condition.
Joe tells us about a risk prediction tool that could be useful in helping to mitigate some of the problems of antihypertensive treatments.
We're also having a geek out about a group of papers we've published lately, on how well evidence is created, maintained, and diseminated.
Reading list;
Development and external validation of a risk prediction model for falls in patients with an indication for antihypertensive treatment: retrospective cohort study
https://www.bmj.com/content/379/bmj-2022-070918
Pathophysiology, diagnosis, and management of endometriosis
https://www.bmj.com/content/379/bmj-2022-070750
Effective knowledge mobilisation: creating environments for quick generation, dissemination, and use of evidence
https://www.bmj.com/content/379/bmj-2022-070195
Consistency of covid-19 trial preprints with published reports and impact for decision making: retrospective review
https://bmjmedicine.bmj.com/content/1/1/e000309
Changing patterns in reporting and sharing of review data in systematic reviews with meta-analysis of the effects of interventions: a meta-research study from the REPRISE project
https://www.medrxiv.org/content/10.1101/2022.04.11.22273688v2

#MedTwitter - a force for good or evil?

#MedTwitter consists of an online community of researchers, health practitioners and students who have created an open source decentralised forum for information sharing, medical education and professional networking. #MedTwitter also provides a space for publications to be shared and promoted. While many will credit Twitter with giving a voice to clinicians, it also comes with challenges, the potential for abuse, or the spread of misinformation.
Joining Clara to discuss are;
Jonathan Guckian, a dermatology registrar in Leeds, and director of social media and communications at the Association for the Study of Medical Education (ASMI).
Flo Wedmore, a medical registrar and NHS sustainability fellow
Declan Murphy, an academic medical fellow S2 in ophthalmology in Newcastle, and former Sharp Scratch panelist.

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