Medicine and Science from The BMJ

Attention deficit hyperactivity disorder, or ADHD, presents with persistent symptoms of inattention, hyperactivity, and impulsivity causing impairment in multiple settings. It is a disorder that attracts considerable debate and controversy. The this part of this podcast, focused on the treatment of ADHD, two of the authors of the review, Mina Fazel, consultant psychiatrist at Oxford University Hospitals NHS Trust, and Nienke Verkuijl, specialty trainee at the University of Oxford and Rachel, a parent of a child who has a diagnosis of ADHD. Read the full review: http://www.bmj.com/content/350/bmj.h2168 Listen to the second part of the podcast: https://soundcloud.com/bmjpodcasts/adhd-in-childhood-diagnosis

Speech and language therapists Cristina McKean and Angela Morgan join us to discuss their clinical review "Identifying and managing common childhood language and speech impairments", published on thebmj.com. They talk about the prevalence, the steps to take if parents believes their child has a speech problem, and the importance of knowing which resources are locally available to support children. Read the full review: http://www.bmj.com/content/350/bmj.h2318

Paul Lennon, a specialist registrar at University Hospital Limerick, and Michael Crotty, general practitioner from the Synergy Medical Clinic in Canada, join Emma Parish to answer some frequently asked questions about infectious mononucleosis. Read their full clinical review: http://www.bmj.com/content/350/bmj.h1825

The future of health and social care looks certain to be a defining issue in the forthcoming UK general election. Social care has been subject to deep public spending cuts, raising concerns about the sustainability of services in the future. Whoever wins the next election will need to grapple with providing joined up health and social care services in an era of continued austerity. A recent debate (heathdebate.net) with key spokespeople from across the political spectrum took place this week, and we assembled a panel of experts to discuss how they think the debate went, and the key promises and gaps in the parties plans for the NHS. Taking part were: Fiona Godlee, editor in chief of The BMJ Jeremy Taylor - chief executive of National Voices Johnny Marshall - director of policy at the NHS Confederation Jane Dacre - president of the Royal College of Physicians Anita Charlesworth - chief economist at the Health Foundation Mark Porter - chair of council at the BMA Nigel Edwards - chief executive of the Nuffield Trust Chris Ham - chief executive of The King's Fund For more analysis of the election's health promises, read Gareth Iacobucci's Election Watch column: http://www.bmj.com/content/350/bmj.h2165

Nicki Ward-Abel, a lecturer practitioner in MS at Birmingham City University, joins us to explain how to treat patients who are experiencing a relapse of their MS symptoms. She discusses what constitutes a relapse, which treatments are available, and what effect a relapse can have on a patient. Read more at: http://www.bmj.com/content/350/bmj.h1765

Some apps have the potential to encourage healthier habits and are accessible to most people, argues Iltifat Husain, but Des Spence notes the lack of any evidence of effectiveness and the potential for encouraging unnecessary anxiety. Read more about in our head to head "Can healthy people benefit from health apps?" - http://www.bmj.com/content/350/bmj.h1887

Doctors are witnessing increasing numbers of patients seeking referrals to food banks in the United Kingdom. Rachel Loopstra, a post-doctoral researcher at the University of Oxford and colleagues have been asking if that rise is due to supply or demand? Read their full analysis: http://www.bmj.com/content/350/bmj.h1775

Peter Lepping, consultant psychiatrist and honorary professor at Betsi Cadwaladr University Health Board in North Wales, joins us to discuss his experience dealing with patients who have delusional infestations. He talks about how to broach the diagnosis, and gives practical tips on how to investigate this difficult condition. Read his practice pointer: http://www.bmj.com/content/350/bmj.h1328

Flaws in the Department of Health’s interim evaluation of an alcohol industry pledge to remove one billion alcohol units from the market raise questions about the claimed success argue John Holmes, Colin Angus and Petra Meier from the Sheffield Alcohol Research Group at the University of Sheffileld. They say that the report should be withdrawn and revised targets set Read the full analysis: http://www.bmj.com/content/350/bmj.h1301

Sudden cardiac death in athletes aged less than 35 years is the leading cause of medical death in this subgroup, with an estimated incidence of 1 in 50 000 to 1 in 80 000 athletes per year. it is most commonly caused by an underlying genetic heart disorder, such as hypertrophic cardiomyopathy. In this podcast Christopher Semsarian, professor of medicine at the University of Sydney, joins us to discuss the diagnosis of cardiac changes and prevention of death in this population. Read the full clinical review: http://www.bmj.com/content/350/bmj.h1218

A BMJ Clinical Evidence systematic overview looks at the evidence for medical and surgical treatments of trigeminal neuralgia, and the uncertainties that exist due to gaps in the evidence. This has been summarised in The BMJ. The authors of the overview and bmj.comsummary, Prof. Joanna Zakrzewska from the Facial Pain Unit at the Eastman Dental Hospital, London, and Mark Linskey, Professor of Neurological Surgery at the University of California Irvine, discuss the evidence, the issues around it, and put this all into a clinical context. Read the full systematic overview: http://clinicalevidence.bmj.com/x/systematic-review/1207/overview.html Disclaimer: The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. BMJ does not warrant the accuracy of the information contained in the podcast and to the fullest extent permitted by law, BMJ Publishing Group Limited is not responsible for any loss whatsoever resulting from the application of, or reliance upon, the information contained in this podcast.

In the US the licence, or marketing authorisation, for alteplase is limited to 0-3 hours after onset of stroke, but some other countries - including the UK and Australia - have extended the licence to 4.5 hours. In an analysis article on thebmj.com Brian Alper, vice president of evidence based medicine research and development at Dynamed, and colleagues, interpret the evidence to suggest increased mortality with uncertain benefit for its use beyond three hours. Read their full analysis: http://www.bmj.com/content/350/bmj.h1075

Chris Moulton is VP of the Royal College of Emergency Medicine and an A&E consultant in the Royal Bolton Hospital. He believes that the majority of patients who attend A&E cannot be adequately treated elsewhere, and that measures to try and reduce emergency presentations may be counterproductive. If you would like to contribute to this collection, please email a brief audio recording to [email protected] or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

BMJ Voices is a collection of readers’ experiences of working in the NHS. For this, The BMJ is seeking short audio submissions from UK listeners. These submissions will be published on thebmj.com. Patrick Keating, a GP from Enfield, is concerned that small practices are under pressure to increase list size, but aren't able to muster resources to meet this increased demand. If you would like to contribute to this collection, please email a brief audio recording to [email protected] or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

Obioma Ezekobe is a GP in an urgent care centre in Central Middlesex Hospital. She believes that the public need to be educated about the use of NHS resources, and be taught when it is appropriate to seek care. If you would like to contribute to this collection, please email a brief audio recording to [email protected] or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

Katherine Henderson is the clinical lead of the emergency department at St Thomas's hospital in London. She worries that lack of ward space is having a domino effect throughout A and E and is the cause of increased waiting time for both patients and ambulances. If you would like to contribute to this collection, please email a brief audio recording to [email protected] or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

Abdominal aortic aneurysms (AAA) are usually asymptomatic until they rupture, which is fatal in more than 80% of cases. Screening aims to detect the aneurysm before it ruptures, enabling preventive surgery and hence reducing morbidity and mortality. However, preventive surgery has a mortality of 3.9-4.5%. As the prevalence of risk factors, ie smoking, decreases and the definition of the condition is expanded, Minna Johansson from the University of Gothenburg and colleagues wonder if the balance of benefit and harm may have tipped. Read the full analysis: http://www.bmj.com/content/350/bmj.h825

Ashish Jha, professor of health policy and management at Harvard School of Public Health, talking about how the Affordable Care Act has fostered new models of integrated service delivery in the United States Read more from the summit: http://www.bmj.com/content/350/bmj.h1172

Bastiaan Bloem, consultant neurologist at Radboud University Nijmegen Medical Centre, Netherlands, discussing his revolutionary approach to patient centred care. Read more from the summit: http://www.bmj.com/content/350/bmj.h1172

Overdiagnosis means different things to different people. Stacy Carter, associate professor at the Centre for Values, Ethics and the Law in Medicine at the University of Sydney argues that we should use a broad term such as too much medicine for advocacy and develop precise, case by case definitions of overdiagnosis for research and clinical purposes. Read the full analysis article: http://www.bmj.com/content/350/bmj.h869 For the full overdiagnosis digital edition: http://www.bmj.com/specialties/digital-theme-issue-overdiagnosis

In this podcast Alexandra Barratt, professor of public health at the University of Sydney, discusses how questions about overdiagnosis in breast cancer screening programmes were first raised 45 years ago, and why it has taken so long for the concept to become mainstream. Read her full analysis: http://www.bmj.com/content/350/bmj.h867

The BMJ held a breakfast roundtable at the annual health policy summit held by the Nuffield Trust think tank to explore some of the key policy discussions that took place during the ​proceeding day. These included NHS England chief executive Simon Stevens' five year plan, whether politics can be removed from the NHS, and what the creation of a central unit to coordinate care for Manchester means for the rest of the ​NHS in England. Chaired by Fiona Godlee, editor in chief of The BMJ, the particpants were: Richard Jones - Clinical director of the Wessex Cardiovascular Strategic Clinical Network Suzie Bailey - Development director at health service regulator Monitor Jonathan Michael​ - ​chief executive of Oxford University Hospital NHS Trust Steve Field - Chief inspector of general practice for the Care Quality Commission Nigel Edwards - Chief executive of The Nuffield Trust Jeremy Taylor - Chief executive of health and care charity National Voices Massoud Fouladi - Chief medical officer of Circle Partnership Rebecca Rosen - GP and clinical commissioner of Greenwich Clinical Commissioning Group, London Jennifer Dixon - Chief executive of the Health Foundation

As the level of alcohol consumption goes up, so the risk of physical, psychological, and social problems increases. In this podcast we’re joined by Ed Day, consultant addiction psychiatrist at Kings College London, Alex Copello, professor of addiction research at the University of Birmingham, and Martyn Hull, GP with a special interest in substance misuse at the Ridgacre Medical Centres in Birmingham. They discuss practical aspects of the assessment and treatment of alcohol use disorders from the perspective of the non-specialist hospital doctor or general practitioner. Read the full clinical review: http://www.bmj.com/content/350/bmj.h715

Jackie Applebee is a GP in Tower Hamlets in London, and is concerned that the way the GP funding formula is working doesn't take account of the earlier health needs of people in deprived areas. For more about the Tower Hamlets Save Our Surgery campaign, visit their facebook page https://www.facebook.com/SaveOurGPsurgeries BMJ Voices is a collection of readers’ experiences of working in the NHS. For this, The BMJ is seeking short audio submissions from UK listeners. These submissions will be published on thebmj.com. If you would like to contribute to this collection, please email a brief audio recording to [email protected] or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

Michelle Sinclar, a GP in Hampshire who is concerned that GP premises aren't fit for purpose and limit her ability to provide fully rounded patient care. BMJ Voices is a collection of readers’ experiences of working in the NHS. For this, The BMJ is seeking short audio submissions from UK listeners. These submissions will be published on thebmj.com. If you would like to contribute to this collection, please email a brief audio recording to [email protected] or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

Mark Folman, a GP in Nottinghamshire, is concerned that more and more work, with more and more patients, means less time with those who really need him. BMJ Voices is a collection of readers’ experiences of working in the NHS. For this, The BMJ is seeking short audio submissions from UK listeners. These submissions will be published on thebmj.com. If you would like to contribute to this collection, please email a brief audio recording to [email protected] or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

Participants in our discussion on person centred care in January agreed that a change in culture and better use of technology could benefit both patients and doctors. At the roundtable: Fiona Godlee (chair), editor in chief, The BMJ Tessa Richards, senior editor, patient partnership, The BMJ Rosamund Snow, patient editor, The BMJ Navjoyt Ladher, clinical editor, The BMJ Angela Coulter, director of global initiatives, Informed Medical Decisions Foundation (www.informedmedicaldecisions.org) Paul Wicks, vice president of innovation, PatientsLikeMe (www.patientslikeme.com) Michael Seres, founder, 11 Health (www.11health.com) Alf Collins, clinical associate in person centred care, Health Foundation (www.health.org.uk) Jeremy Taylor, chief executive, National Voices (www.nationalvoices.org.uk) Dave deBronkart, cochair, Society for Participatory Medicine (www.participatorymedicine.org) Amir Hannan, general practitioner and member of clinical commissioning group board Alexander Silverstein, past president, International Diabetes Federation’s young leaders in diabetes project Paul Hodgkin, founder, Patient Opinion (www.patientopinion.org.uk) Ben Mearns, consultant in acute care and elderly medicine, Surrey and Sussex Healthcare NHS Trust Sara Riggare, PhD student in health informatics, Karolinska Institute Rupert Whitaker, founder, Tuke Institute (www.tukeinstitute.org) Stephen Leyshon (observer), DNV Healthcare

In our accompanying roundtable discussion,we hear views from a group of patients and clinicians based largely in the UK on the actions required to advance progress towards providing patient centred care. To extend the conversation we talked to members of the BMJ's international patient advisory panel and other patient advocates - and what follows are short clips of hour long conversations with people in the US, Europe, India, Equador and Uganda. While the quality of the recordings vary there is no mistaking the passion of these advocates to improve care for fellow patients and the barriers which need to be overcome to make it happen. Taking part in this discussion in order are: Dominck Frosch,associate professor, University of California Maggie Breslin US designer, researcher and writer Matthew Maleska, designer, Patient Revolution Project Cristin Lind, patient advocate, Rare Diseases Sweden Corine Jansen, cheif listening officer, JoConnect Jonas Gonseth, chief executive, Gaerente en Hospital de Especialidades Guayaquil, Equador Rakhal Gaitonde chair, community advisory board of the National Institute for Research on Tuberculosis Robinah Alambuya, president of the Pan African Network of People with Psychosocial Disabilities, Uganda Daniel Iga Mwesigwa, executive medical director, Mwesigwa Medical Centre, Uganda

Karen Grépin, assistant professor of global health policy at New York University, has been examining the pledges made by the international community to help fight the ebola virus outbreak - was it really too little, too late? Read her full analysis: http://www.bmj.com/content/350/bmj.h376

Katie Sidle is a consultant neurologist at the National Hospital for Neurology and Neurosurgery, in London. She helped actor Eddie Redmayne in his portrayal of theoretical physicist and cosmologist Stephen Hawking in the film The Theory of Everything. She joins us to describe how that process worked, and what Motor Neurone Disease patients thought about how their condition was depicted. Read the feature: http://www.bmj.com/content/350/bmj.h483

Bone pain is the most common type of pain from cancer and is present in around one third of patients with bone metastases, currently, improvements in cancer treatments mean that many patients are living with metastatic cancer for several years. Christopher Kane, NIHR academic clinical fellow in palliative medicine at Leeds University School of Medicine, and Michael Bennett, St Gemma’s professor of palliative medicine at University College London join us to discuss the management of cancer induced bone pain. Read the full clinical review: http://www.bmj.com/content/350/bmj.h315

Private hospital chains have been “buying” referrals by offering clinicians lucrative packages, including free facilities in sought after locations. And the doctors’ regulator is turning a blind eye to those who are tempted, Reporter Jonathan Gornall joins us to discuss the investigation. Read the full report: http://www.bmj.com/content/350/bmj.h396

Multimorbidity presents a number of different challenges, for the patients living with the conditions, but also for the health professionals caring for them in systems that often are not designed with these more complex needs in mind. Emma Wallace, general practice lecturer, and Susan Smith, a professor of general practice at the Royal College of Surgeons in Ireland Medical School join us to discuss how to work within the system, and what their dream scenario for care would be. Read the full clinical review: http://www.bmj.com/content/350/bmj.h176

Philipe de Souto Barreto argues that, to reduce premature mortality, policies should focus on getting fully inactive people to do a little physical activity rather than strive for the entire population to meet current physical activity recommendations. Read the full analysis paper: http://www.bmj.com/content/350/bmj.h23

Dominique Thompson, GP and director of the Students’ Health Service at the University of Bristol, is concerned that young people's health is being neglected. BMJ Voices is a collection of readers’ experiences of working in the NHS. For this, The BMJ is seeking short audio submissions from UK listeners. These submissions will be published on thebmj.com. If you would like to contribute to this collection, please email a brief audio recording to [email protected] or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

Rabies is the archytypical zoonotic disease, and only by vaccination in animals will we prevent infections in people. In two podcasts linked to our latest clinical review "The prevention and management of rabies"​ we'll be discussing how we can get there. In this podcast Sarah Cleaveland, professor of comparative epidemiology at the University of Glasgow discusses control​ling the disease in animals​.​ To find out about the clincial presentation listen to the accompanying podcast with ​Natasha Crowcroft, chief of infectious disease at Public Health Ontario Listen to the accompanying podcast: https://soundcloud.com/bmjpodcasts/rabies-in-humans Read the full clinical review: http://www.bmj.com/content/350/bmj.g7827

Rabies is the archytypical zoonotic disease, and only by vaccination in animals will we prevent infections in people. In two podcasts linked to our latest clinical review "The prevention and management of rabies"​ we'll be discussing how we can get there. In this podcast Natasha Crowcroft, chief of infectious disease at Public Health Ontario to discuss the human aspect of the disease, and in the second Sarah Cleaveland, professor of comparative epidemiology at the University of Glasgow explains animal control. Listen to the accompanying podcast: https://soundcloud.com/bmjpodcasts/rabies-in-animals Read the full clinical review: http://www.bmj.com/content/350/bmj.g7827

Until recently, hepatitis C screening was offered to people at increased risk of infection - such as intravenous drug users - but now, the US Centers for Disease Control and Prevention has recommended screening all people born between 1945 and 1965. Kenny Lin, associate professor of family medicine at Georgetown University in Washington, DC, and Jeanne Lenzer, an investigative health journalist from New York, explain why they worry that the evidence doesn't support this expansion. ead their analysis article: http://www.bmj.com/content/350/bmj.g7809

Drug development happens in stages – pre-clinical, phase I, II, III, and so on. But how much do trial participants know about what has happened before their enrolment to test for safety, and how much should they be told? Holger Pedersen from Denmark was one trial participant who tried to find information about the drug he was on, and was surprised at how little data had actually been collected, let alone shared – which has been detailed in an analysis article on thebmj.com He talks to Helen Macdonald, analysis editor for the BMJ about his experience. Read the analysis article: http://www.bmj.com/content/349/bmj.g6714

Waiting times in theatre can be a source of friction – but is the delay due to mandatory anaesthetic faff around time (MAFAT), or AWOL surgeons? Elizabeth Travis, and orthopaedic house officer in New Zealand and colleagues, have been trying to create and evidence base to argue the toss, and she joins me now to discuss her study, Operating theatre time, where does it all go? Read the full research: http://www.bmj.com/content/349/bmj.g7182

Those who rise to the top in medicine see themselves as hardworking extroverts with a caring nature, suggests an unscientific analysis of the answers given by contributors to BMJ Confidential. But ask about their pet hates and another, less nurturing, side emerges. We gathered 6 former confidentialists in The BMJ studio to moan over mince pies. Read Doctors: caring extroverts or self deluded chocoholics?: http://www.bmj.com/content/349/bmj.g7623

How much can you trust the advice given by TV doctors? A new research paper on thebmj.com has analysed over 40 episodes of popular American TV shows, to see if health claims are evidence based. This podcast is a bit different, as the authors host their own show - The BS Medicine Podcast, which tops the charts around the world - and they've given us permission to repost on The BMJ. Read the​​ full research: http://www.bmj.com/content/349/bmj.g7346

In AD 1028 King Canute tried to command the tide to turn back. History records that the king of all lands surrounding the North Sea got very cross, wet, and made a hasty retreat. Every day, in general practices across the country, dedicated practice teams get very cross when they are yet again unsuccessful at meeting the daily demand for appointments and the incoming tide of patient demand and expectation. Ron Neville, a partner in the Westgate Health Centre in Dundee joins us to discuss what his new appointment system learned from the soggy monarch. http://www.bmj.com/content/349/bmj.g7228

Winners of the Darwin Award must eliminate themselves from the gene pool in such an idiotic manner that their action ensures one less idiot will survive. Ben and Dennis Lendrem, and colleagues, have reviewed the data on winners of the Darwin Award over a 20 year period and they join us to discuss why men are idiots, and why their team is not the only ones to have noticed. www.bmj.com/content/349/bmj.g7094

One hundred years ago, Pennsylvanian surgeon Evan Kane penned a brief letter to JAMA in which he declared himself a rigorous proponent of the “benefic [sic] effects of the phonograph within the operating room.” Now David Bosenquet, a surgeon from University Hospital of Wales in Cardiff has written a Christmas editorial about the evidence for the benefit of music to patients. Read his editorial here: http://www.bmj.com/content/349/bmj.g7436 And share your perfect playlist with us at bmj.com/playlists

The UK’s austerity programme has disproportionately affected children and people with disabilities, says David Taylor-Robinson, a senior clinical lecturer in public health at the University of Liverpool. He joins us to discuss why the evidence shows the vulnerable are hit hardest by the cuts to public services, despite the UN conventions on human rights giving children and people with disabilities special protection. Read his full editorial: http://www.bmj.com/content/349/bmj.g7350

Blood transfusions have been identified as one of the most overused therapies both in the United States and the UK. In this podcast Lawrence Tim Goodnough, from Stanford University Medical Center's Transfusion Service, and Michael Murphy, from NHS Blood and Transplant, explain the physiological reasons why liberal blood transfusion will not benefit patients, and can potentially harm them. Read their full analysis: http://www.bmj.com/content/349/bmj.g6897

The BMJ has a new policy on competing interestings - from 2015 we will have zero tolerance for them in authors who write education articles or editorials. Cath Brizzell and Mabel Chew explain what that policy is about, and why we think it's important.

Eight months into the NHS’s top job, Simon Stevens’s intelligent refusal to enforce a “one size fits all” solution on the service’s ills is, so far, winning him the backing of staff. He talks to Gareth Iacobucci

Guidelines encourage the use of self monitoring of blood pressure in pregnancy, and research suggests that women prefer it. But Richard McManus, GP and professor of primary care at the University of Oxford explains that our enthusiasm may run ahead of the evidence and call for more research before it is routinely adopted. Read the full analysis: http://www.bmj.com/content/349/bmj.g6616