Medicine and Science from The BMJ

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

Get political, for health’s sake

The influence of public health on politics, at least at the beginning of the pandemic, had never been stronger - but now it seems as hard to persuade politicians to pay attention as ever, yet political will is essential in making different sectors work together to create a healthier world.
In this podcast, The BMJ's editor in chief, Kamran Abbasi is joined by Shyama Kuruvilla, senior strategic adviser at World Health Organization, and Kent Buse, director of the global healthier societies program at The George Institute for Global Health.
They discuss examples of where multisectoral working has managed to bridge the gaps between sectors, and how healthcare needs to get political to make that success more widespread.
This is part of the collection "The world we want: Actions towards a sustainable, fairer and healthier society" - https://www.bmj.com/pmac-2022

Deep Breath In - what’s in store for general practice in the UK

This is a special episode of our podcast for GP's, Deep Breath In, where we tackle the everyday challenges of being a GP.
With the focus on covid, and the pressure on hospitals, it may be easy to overlook what’s happening in general practice in the UK - but changes are afoot. Our new health secretary Sajid Javid doesn’t seem to like our long standing GP practice arrangement, NHS England has imposed new weekend working arrangements on the already stretched service, and the workforce pressures continue.
In this episode of Deep Breath In, our GP panel of Tom Nolan, Navjoyt Ladher, and Jenny Rasanathan are joined by Gareth Iacobucci, The BMJ’s assistant news editor, to give them the lowdown on what’s happening around primary care, who some of the key players are, and what his predictions for 2022.
You can find Deep Breath In on all major podcast apps
https://www.bmj.com/podcasts/deepbreathin

Creativity and wellbeing

Paula Redmond, clinical psychologist who supports healthcare workers experiencing burnout and other difficulties related to their job. Before this, she worked for the NHS until she experienced bullying, and a lack of support from her organisation, which made her strike out on her own.
In this wellbeing podcast, she describes the way in which her experience of bullying affected her, and how she used the creative process to help her move on.
She and Cat Chatfield discuss what creativity actually is, and why small projects can be just as useful as big complex ones - depending upon what you need at the time.
Futher reading:
a Blog series on bullying in healthcare: https://drpaularedmond.com/category/bullying_in_healthcare/page/2/
a mindful embroidery craftivism project ("Do no harm but take no shit") https://drpaularedmond.com/donoharm/

Quality improvement and wellbeing are inextricably linked

Over the course of the last few years, the BMJ has published a series of articles in our Quality Improvement series - aiming to give those new to improvement science a good grasp of how to think about changing things in healthcare.
Then covid-19 came along, and it seemed like all of healthcare was now aimed at just surviving in the face of the pandemic, and all thoughts of quality improvement projects went out the window... But did they?
Cat Chatfield, is joined by Will Warburton, former director of quality improvement at the Health Foundation, and advisor on the series.
To read all of the open access articles mentioned in the discussion, visit https://www.bmj.com/quality-improvement

Doctor Informed - Medicine’s me too moments

In this episode we’re going to be talking about misogyny in surgery, recent revelations about sexual harassment in the theatre have emerged - but these behaviours have been endemic for a while, even as the profession seemed to ignore them.
Joining Clara Munro is Baroness Helena Kenned, the author of a recent report into diversity in medicine, who, as a barrister, has long worked on discrimination cases.
The reports mentioned in the episode are from the Royal College of Surgeons;
https://www.rcseng.ac.uk/about-the-rcs/about-our-mission/diversity-review-2021/