Medicine and Science from The BMJ

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/

In this episode of Talk Evidence, Helen Macdonald, the BMJ’s research integrity editor is joined by Joe Ross, US research editor, and Juan Franco, editor in chief of BMJEBM, to talk about all things evidence. Joe gives us an update about covid, including new research on safety of the vaccine Association between covid-19 vaccination, SARS-CoV-2 infection, and risk of immune mediated neurological events https://www.bmj.com/content/376/bmj-2021-068373 Juan updates us on a potential new prophylactic for recurrent UTIs, Methenamine hippurate, which could be an alternative to antibiotics. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women https://www.bmj.com/content/376/bmj-2021-0068229 Helen tells us about some research which evaluates the way in which intersecting identities combine to make students experience of medical school more difficult. Marginalized identities, mistreatment, discrimination, and burnout among US medical students https://www.bmj.com/content/376/bmj-2021-065984

The issue of food on nightshifts is a perennial grumble in the NHS, and though it might seem trivial, what does it say of an organisation if they demand their staff work when they're hungry, and what is the onward implication for that on patient care? To discuss all of these issues, we're joined by Neely Mozawala, a community specialist diabetes podiatrist, and Sahlia Saliha Mahmood-Ahmed, a gastroenterologist who have started the #24hrhotfoodfortheNHS campaign.

Medicine is complex, and as a doctor you won't always do the right thing - but you can prepare yourself for when mistakes happen, both emotionally and logistically. In this episode of Doctor Informed, Clara Munro is joined by Susanna Stamford, a patient who was on the receiving end of a mistake, which catalysed her interest in patient safety. We're also joined by Anthea Martin, from Medical Protection, who dispels some myths about saying sorry. Ayisha Ashmore returns to the pod to digest the lessons from our experts. Futher reading: The video that Susanna mentioned is available to watch on youtube bitly.com/ManagingAdverseEvents

The covid-19 pandemic has stretched healthcare staff like never before. As part of the 2022 Nuffield Trust summit, The BMJ hosted a roundtable discussion looking at why workers leave the NHS and how staff wellbeing and retention can be improved. Joining us to discuss are: Kamran Abbasi, editor in chief, The BMJ Billy Palmer, senior fellow, Nuffield Trust Lucina Rolewicz, researcher, Nuffield Trust Mark Britnell, global healthcare expert and senior partner, KPMG International Neil Greenburg, consultant occupational and forensic psychiatrist, King's College London's centre for military health research Rose Penfold, National Institute for Clinical Research academic clinical fellow in geriatrics Rammya Mathew, GP and quality improvement lead for Islington GP Federation Partha Kar, diabetes consultant and NHS England's national advisor for diabetes Danny Mortimer, chief executive of NHS Employers The Nuffield Trust report, "The Long Goodbye" which was discussed in this roundtable is available here - https://www.nuffieldtrust.org.uk/resource/the-long-goodbye-exploring-rates-of-staff-leaving-the-nhs-and-social-care

In this episode of the podcast we’re going to be talking about rural healthcare - and specifically the difficulties that distance, demographics, and funding have introduced into the world’s covid-19 response. Rural regions made vulnerable by limited healthcare infrastructure, lower rates of vaccination, and opposition to government policies are the new frontlines in the pandemic, but support systems have not adjusted to the growing rural needs for health education, testing, vaccination, and treatment. Michael Forster Rothbart, Kata Karáth, and Lungelo Ndhlovu report from the US, Ecuador, and Zimbabwe

In previous episodes of Doctor Informed, we've talked about the importance of speaking out, but the culture in your organisation might not always make that easy, especially if you feel something has gone wrong and you might be blamed for it. Blame culture, no blame culture, just culture - there are many terms which are used to describe the environment in which individuals and teams work, the feel within a team and an organisation. In this episode we'll explore what they mean, why blame can be detrimental to patient safety, and give some tips on how to investigate problems without throwing blame around. Our guests in this episode; Joselle Wright - Deputy Director of Midwifery, Gynaecology and Sexual Health at Walsall Healthcare NHS Trust Susanna Stanford, who became involved in patient safety after experience of a spinal anaesthetic failing during a c-section in 2010. She is an ambassador for the Clinical Human Factors Group.

In previous episodes of Doctor Informed, we've talked about the importance of speaking out, and how to do that better, but as you progress through your medical career, you will become the person to whom those with problems will turn. In this episode we will explore listening. As a senior clinician, how can you make the space in your work to be a good listener, when what you hear might not be what you want to hear? Our guests; Megan Reitz is a professor of Leadership and Dialogue at Hult Business School. John Higgins is research director at The Right Conversation. Reading Speaking truth to power: why leaders cannot hear what they need to hear https://bmjleader.bmj.com/content/5/4/270

In the first Talk Evidence of 2022, we'll be asking about the evidence for isolation - now that isolation periods are being reduced, or even stopped in the event of a negative lateral flow test, we'll find out what data that's based on, and if it's appropriate. Vaccinations and treatments for covid-19 have been the one major success story of the pandemic, but that doesn't mean we should abandon the principles of openness and transparency when it comes to scrutinising the data - we'll hear what access to the data which underlies regulatory approval could do now. Finally, the impacts of climate change were set out in a WHO report in November last year - and recent weather seems to underline their conclusions. We'll discuss new evidence linking the environment and health, and ask what clinicians can do with that. Reading list: Mitigating isolation: The use of rapid antigen testing to reduce the impact of self-isolation periods https://www.medrxiv.org/content/10.1101/2021.12.23.21268326v1.full.pdf Covid-19 vaccines and treatments: we must have raw data, now https://www.bmj.com/content/376/bmj.o102 WHO report: Climate change and health https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health Ambient heat and risks of emergency department visits among adults in the United States: time stratified case crossover study https://www.bmj.com/content/375/bmj-2021-065653 Residential exposure to transportation noise in Denmark and incidence of dementia: national cohort study https://www.bmj.com/content/374/bmj.n1954 Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project: pooled analysis https://www.bmj.com/content/374/bmj.n1904

In the previous episodes of Doctor Informed, we've heard why it's so important to talk about patient safety concerns, and some of the mechanisms that allow hospital staff to raise them, but knowing why and how doesn't always make it easier to speak out. In this episode we're exploring the concept of a voiceable concern – identifying what counts as a concern, and what counts as an occasion for voice by an individual, is not a straightforward matter of applying objective criteria- for example how do you tell if you're witnessing poor practice, or just something that lies outside your area of understanding? Or how do you know if the common practice in this particular ward is actually an outlier when looking at other hospitals? Our guests this week; 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. Zoe Fritz is a consultant in acute medicine at Cambridge University Hospitals NHS Foundation Trust, she is also a Wellcome Fellow in society and ethics at THIS Institute, investigating how we communicate and record uncertainty around diagnosis. Reading: https://pubmed.ncbi.nlm.nih.gov/34978470/ www.bmj.com/podcasts/doctorinformed/ https://www.thisinstitute.cam.ac.uk/podcast/

Rachel Levine Trained as a paediatrician, before becoming firstly the state of Pennsylvania's Physician General, then its Health Secretary. During president Joe Biden's administration, she was nominated to become the U.S.'s assistant secretary of health. That lead to her becoming a four-star admiral in the U.S. Public Health Service Commissioned Corps, and thus the first openly transgender four-star officer in the US. In this podcast, we discussed the pandemic - but also wider problems affecting Americans' health, notably climate change, inequality and the opioid crisis. We also discuss the health and care of LGBT+ people, in the U.S, and around the world. This interview was recorded on the 16th of December 2021.

The BMJ has special criteria for considering Christmas research: first it should make you laugh, and then it should make you think. In this festive episode of the Talk Evidence podcast, our regular panel of Helen Macdonald and Joe Ross are again joined by Juan Franco, editor in chief of BMJ Evidence Based Medicine. They’ll give you a peek into what makes for good Christmas research, and why what may seem silly on the surface has a deeper meaning.

As clinicians, we're all taught that patient safety is everyone's responsibility - but on the ground it can be hard to know how to most effectively report concerns, especially if you're not sure how those concerns will be received. In this episode of Doctor Informed, Clara Munro is joined by Ayisha Ashmore, and they ask "who is actually responsible for patient safety?" To answer that we're joined by 2 guests Bill Kirkup, independent investigator who has worked on the reports into failings in Mid-Staffordshire, and Gosport. Henrietta Hughes - GP, and the NHS's first guardian, Henrietta championed the creation of freedom-to-speak-up guardians in the English NHS, to ensure that clinicians are able to freely speak out.

Fiona Godlee is stepping down as Editor-in-Chief of The BMJ after 16 years in the position. She was the first female editor of the journal, and over her tenure has seen a lot of changes - both to the publication she's run, and to the wider world of medicine. To mark her departure, Helen Macdonald sat down with Fiona to ask her a bit about those early days at the journal, on her view of women taking leadership roles in medicine, on her thoughts about some of the big issues facing science, and what is coming next. Note from the editor; apologies for the audio quality in the first half.

In this second podcast focussing on the covid response in South Asia, we’re focussing on the intersection of conflict and covid in the region. The pandemic has highlighted the underlying weaknesses in many health systems - but could it also be used as a catalyst for change, and be a step towards easing tensions? To discuss this, Kamran Abbasi, executive editor of The BMJ, is joined by Zulfiqar Bhutta, head of the Institute for Global Health and Development, Aga Khan University, and Arun Mitra senior vice president of Indian Doctors for Peace & Development. To read more; Conflict, extremism, resilience and peace in South Asia; can covid-19 provide a bridge for peace and rapprochement? https://www.bmj.com/content/375/BMJ-2021-067384

In this episode of Doctor Informed, Clara Munro is joined by Ayisha Ashmore - and they're getting to grips with being a compassionate colleague. While the topic might seem warm and fuzzy, there's some good hard science to suggest that compassionate leadership at every level of healthcare can make a huge difference to staff, and improve patient outcomes. Most people innately have the skills need to be compassionate colleagues - but often the pressures of the job can make it the lowest of priorities in our everyday interactions. Our two guests this week think that's wrong though - and say that compassionate leadership is one of the most important things to get right. Joining us are, Michael West, senior fellow at The King's Fund and professor of Work and Organisational Psychology at Lancaster, and Bob Klaber, consultant general paediatrician and director of strategy, research and innovation at Imperial College Healthcare NHS Trust Michael has written the book on compassionate leadership in health and social care - https://tinyurl.com/vh55mker. You can read more about Bob's work in his blog - https://www.imperial.nhs.uk/about-us/blog/how-acts-of-kindness-can-improve-care-and-strengthen-teams Ayisha has written about putting some of this all into practice in a maternity setting - https://bmjleader.bmj.com/content/early/2021/11/25/leader-2021-000449

In the wellbeing podcast, the dread topic of phone usage has come up again - how social media, and an "always on" culture can affect our wellbeing. But knowing that, and changing our behaviour are two different things - so to give some advice on reducing our reliance on phones, Abi and Cat are joined by Nidhi Gupta, assistant professor of pediatrics at Vanderbilt University Medical Center, who's been using techniques from behavioural addiction to help with device usage. For more from Nidhi, visit https://phreedom.net/ Some of the research that Nidhi mentions https://publications.aap.org/pediatrics/article/138/5/e20162591/60503/Media-and-Young-Minds A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children https://pubmed.ncbi.nlm.nih.gov/18316661/ Distraction: an assessment of smartphone usage in health care work settings https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437811/ Treatment Considerations in Internet and Video Game Addiction https://pubmed.ncbi.nlm.nih.gov/29502754/ The Smartphone Addiction Scale: Development and Validation of a Short Version for Adolescents https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0083558

When you hear the reports from a major patient safety issue, it will be shocking to hear how they have played out - but the patterns in behaviour, of people and institutions which have gone disastrously wrong, can be seen throughout healthcare. As this first series of Doctor Informed unfolds, we'll be exploring these patterns, and bring you evidence and expertise on tackling them - Doctor Informed is about going beyond medical knowledge to make you the best doctor you can be. In this first episode we're talking to experts who have seen these patterns firsthand, and whose work is all about tackling them; Bill Kirkup is a clinician turned investigator - he's 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 Mary Dixon-Woods is director of THIS Insitute, 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.

In this month’s Talk evidence, we’re going back to our roots and avoiding covid - so sit back and listen to Helen Macdonald and Joe Ross discuss a new nutrition study to prevent fractures in older adults by eating dairy, and a meta-analysis which helps you choose pain relief medications for management of osteoarthritis. We’ll hear from Steven Woloshin about the virtual Overdiagnosis conference, and why he’s so excited about a new category in the National Library of Medicine. Finally, we have a study on urinary retention and risk of cancer that has been over 25 years in the making. Reading list; Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care https://www.bmj.com/content/375/bmj.n2364 Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis https://www.bmj.com/content/375/bmj.n2321 To access the webinars Steven was talking about. https://www.preventingoverdiagnosis.net/ Acute urinary retention and risk of cancer https://www.bmj.com/content/375/bmj.n2305 Podcast listener survey. Please let us know how we could improve the podcasts for you, and your specialty - https://linktr.ee/BMJsurvey

Doctor Informed is a new podcast for hospital doctors, from The BMJ - created in collaboration with THIS Institute, and sponsored by Medical Protection. Medical expertise is fundamental to the practice of medicine. But other skills and knowledge are important too. Doctor Informed gives the inside story on the evidence about giving the best care and having positive relationships with patients and colleagues. In this trailer, meet two of the hosts of Doctor Informed - Clara Munro, a surgical trainee in the North East Deanery, and Jenni Burt, senior social scientist at THIS Institute. www.bmj.com/podcasts/doctorinformed

It's easy to decide to do something like exercise, or a hobby to improve your wellbeing, but actually following through and make that a regular part of your week can be much harder. In this podcast, Pedro Delgado, vice president of the Institute for Healthcare Improvement, joins Abi and Cat to explain how he turned some of the QI methodology he's been taught over the years on himself, and improved his wellbeing during the pandemic. www.bmj.com/wellbeing

In this podcast series, Kamran Abbasi, executive editor of The BMJ will convene experts from South Asia to discuss how the pandemic has affected the region, how measures like lock-down and vaccination have been handled, and the impact of the pandemic on the social determinants of health. In this first podcast, we're focussing on India and Nepal, and are joined by; Srinath Reddy, president of the Public Health Foundation of India. Biraj Swain, who works in global development in Asia and East Africa, is a senior media critic and Buddha Basnyat, director of the Oxford University Clinical Research Unit in Nepal. For more covid coverage www.bmj.com/coronavirus

This week our regular panelists, Helen Macdonald and Joe Ross, are joined by Juan Franco, editor in chief of BMJ Evidence Based Medicine - to take a primary care focussed look at what's been happening in the world of evidence. On this week’s episode. As kids go back to school, winter bugs surge and pressure mounts on health services we look at two trials which aimed to use reduce antibiotic prescribing for respiratory tract infections in nursing homes and primary care Juan brings us an update on prescribing medicinal cannabis for pain, based on a recent BMJ rapid recommendation article and linked systematic review and meta-analysis And finally, in covid news, how likely are you to be admitted or die from covid after one or two SARS-CoV 2 vaccinations? Reading list Effect of C reactive protein point-of-care testing on antibiotic prescribing for lower respiratory tract infections in nursing home residents - https://www.bmj.com/content/374/bmj.n2198 Procalcitonin and lung ultrasonography point-of-care testing to determine antibiotic prescription in patients with lower respiratory tract infection in primary care - https://www.bmj.com/content/374/bmj.n2132 Medical cannabis or cannabinoids for chronic pain - https://www.bmj.com/content/374/bmj.n2040 Risk prediction of covid-19 related death and hospital admission in adults after covid-19 vaccination - https://www.bmj.com/content/374/bmj.n2244

There has been a lot of work on the way in which surgeon's are affected by tiredness - and the whole medical workforce can probably relate to their experience. But there's a difference between tiredness and fatigue, and that difference might be important in understanding what's happening in your own life. Dale Whelehan is a physiotherapist, and PhD candidate at Trinity college Dublin, where he is investigating behavioural psychology and the effect of tiredness and fatigue on surgeons - in this podcast he describes how he thinks about those two things, what we know about the effect on wellbeing, and some strategies which might help manage them.

The infrastructure of Afghanistan healthcare is under threat, as international agencies who run clinics withdraw from the country. At the same time, some of the healthcare workforce are leaving the country, while those who remain face the prospect of their wages drying up as the economy of the country collapses. But there remain people dedicated to providing healthcare, and in this podcast we hear from, Wais Mohammad Qarani, president of the Afghanistan Midwifery and Nurses Council, about what changes might be seen under the new regime, and what needs to be done to support care in the country.

The final evacuation planes have left Kabul airport, and Afghanistan’s government have ceded power to the Taliban. Amongst the international community, worries about what that transition of power means for the people of Afghanistan have centred around the rights of women, access to education for the whole population, and the continuing prosperity of the country… However what this means for health is still uncertain. Nadia Akseer is an Afghan scientist and epidemiologist, now working at John's Hopkins Bloomberg School of Public Health and who has published extensively the health of her home country Reading list; Achieving maternal and child health gains in Afghanistan https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30002-X/fulltext Association of Exposure to Civil Conflict With Maternal Resilience and Maternal and Child Health and Health System Performance in Afghanistan https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2754253 Coverage and inequalities in maternal and child health interventions in Afghanistan https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3406-1 Geospatial inequalities and determinants of nutritional status among women and children in Afghanistan https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30025-1/fulltext

In this month's Talk Evidence, Helen Macdonald and Joe Ross are back with a wry look at the world of Evidence Based Medicine. They give us a round up of real world data emerging to address various uncertainties about vaccinations against covid Helen has an update on NHS Digital’s project to extract GP coding for planning of healthcare and research, and talks to Natalie Banner from Understanding Patient Data, to find out what the public really cares about. Finally, as routine care must go on a clinical review on cardiovascular disease in older adults introduces us to geroscience. Reading list Vaccines; Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study - https://doi.org/10.1136/bmj.n1943 Effectiveness of the CoronaVac vaccine in older adults during a gamma variant associated epidemic of covid-19 in Brazil: test negative case-control study - https://doi.org/10.1136/bmj.n2015 Associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission and death with covid-19 in nursing homes and healthcare workers in Catalonia: prospective cohort study https://doi.org/10.1136/bmj.n1868 Risk of thrombocytopenia and thromboembolism after covid-19 vaccination and SARS-CoV-2 positive testing: self-controlled case series study - https://doi.org/10.1136/bmj.n1931 CVD Cardiovascular care of older adults - https://doi.org/10.1136/bmj.n1593

The Midlands Charter, is a set of principles that hospitals in the midlands region of England have signed up to, to improve the health and wellbeing of trainees working in the area. It was created in a huge collaboration of trainees, NHS England, Health Education England and the GMC. Dan Smith is a junior doctor at Nottingham University Hospitals NHS Trust, and one of the authors of that charter. He joins us to explain how they're QI thinking to improve doctors wellbeing, and how other areas can follow their lead. Read the full charter: https://www.england.nhs.uk/midlands/information-for-professionals/nhs-midlands-charter/ To join the collaborative https://future.nhs.uk/MidlandsCharter/grouphome

Rota gaps are a big problem when it comes to loading stress on the medical workforce, and there is big pressure to spread the workforce as evenly as possible across wards and shifts. However the tyranny of the rota - especially when changing rotations or working across multiple sites, means that often doctors personal wishes, or big life events are not taken into account. The dehumanising status of becoming just a number in the system is not helping people have the kind of fulfilling careers that encourages people to stay within the workforce, and helps guard them from burnout. So how do we square that circle? Anas Nader, CEO of Patchwork Health, joins us to talk about why his own burnout lead him to try and fix the rota problem - and where he has got to now. Findout more at: https://www.patchwork.health/ Note - BMJ company has invested in patchwork health

It's been 25 years since the declaration on the rights of women, was signed in Beijing - and in that time the landscape of health car inequity has changed. To celebrate we created 3 podcasts, in collaboration with The WHO and UN University, as part of the collection on Women’s Health and Gender Inequalities www.bmj.com/gender In these podcasts we'll be hosting conversations between women early in, and some who are more advanced in, their careers - doctors, researchers, legislators and campaigners, all working towards building a future in which women can thrive. As well as these in depth discussions, you will hear some shorter interviews from experts who have written for the collection. These give you a flavour of the bigger discussions going on in global health when it comes to gender equity - so keep an ear out for those during the discussions. In this podcast, we're joined by lawyer and activist Hina Jilani, who has been campaigning for women's rights in her native Pakistan for her whole life. She and her sister set up the first female law firm in the country, she established a refuge for women who were fleeing violence and abuse, she was one of the founders of the Human Rights Commission of Pakistan, and is now an advocate on the country's Supreme Court. She is also one of The Elders. Hina talks about her career, how she has pulled the various levers of change - lobbying for legislation, legal challenge, and protest - to improve the lives of women in Pakistan. The additional interviews are from; Lia Quatrapella, Asha George, and Veloshnee Govender

In the wellbeing podcast, we have had a lot of personal experience of the pandemic, and schemes to support staff - but always we've wanted to know if there's research which can tell us how universal those experiences have been. In this podcast, Abi and Cat are joined by Danielle Lamb, senior research fellow at University College London, and Sam Gnanapragasam, clinical fellow in psychiatry at South London and the Maudsley NHS Trust. Danielle and Sam are both investigators on NHS Check - a representative survey of NHS staff about their mental wellbeing during covid-19. https://nhscheck.org/

The 19th of July in the UK saw the relaxation of covid rules that have been in place for 18 months - social distancing requirements in venues, mask wearing in public will no longer be legally mandated. There are a lot of questions about what this will mean for the pandemic, and in this episode of Talk Evidence Helen MacDonald, Joe Ross and Duncan Jarvies are joined by Iain Buchan, professor of public health in Liverpool, who has been involved in 2 key studies on covid transmission. Firstly, lateral flow tests - the big questions has been how well do they work in the wild - and how well do they have to work, to be useful in test trace and isolate? Iain tells us about new research into the innova test. Secondly, events - the football has shown that events can still be a big source of transmission, and the UK government put in place a number of trial events, all carefully monitored by public health researchers - Iain tells us about one nightclub test in Liverpool, and what we can glean from it. Reading list; Performance of the Innova SARS-CoV-2 antigen rapid lateral flow test in the Liverpool asymptomatic testing pilot: population based cohort study https://www.bmj.com/content/374/bmj.n1637 The UK government's events programme https://www.gov.uk/government/publications/events-research-programme-phase-i-findings/events-research-programme-phase-i-findings#findings https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/979461/S1195_Science_framework_for_opening_up_group_events.pdf Effect of the covid-19 pandemic in 2020 on life expectancy across populations in the USA and other high income countries: simulations of provisional mortality data https://www.bmj.com/content/373/bmj.n1343 Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM): cluster randomised controlled trial https://www.bmj.com/content/374/bmj.n1585 Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis https://www.bmj.com/content/374/bmj.n1446

It's been 25 years since the declaration on the rights of women, was signed in Beijing - and in that time the landscape of health car inequity has changed. To celebrate we created 3 podcasts, in collaboration with The WHO and UN University, as part of the collection on Women’s Health and Gender Inequalities www.bmj.com/gender In these podcasts we'll be hosting conversations between women early in, and some who are more advanced in, their careers - doctors, researchers, legislators and campaigners, all working towards building a future in which women can thrive. As well as these in depth discussions, you will hear some shorter interviews from experts who have written for the collection. These give you a flavour of the bigger discussions going on in global health when it comes to gender equity - so keep an ear out for those during the discussions. In this first podcast, Lulit Yonas Mengesha talks to Cara Tannenbaum Lulit Yonas Mengesha is right at the beginning of her medical career, she's a medical student in Ethiopia, but has already become passionate about woman's health Cara Tannenbaum is is Scientific Director of the Institute of Gender and Health at the Canadian Institutes of Health Research. Lulit and Cara discuss how women have been excluded from healthcare research - and how that affects practice today, how there are gaps in our understanding of basic biology, as well as how different life experiences affect outcomes. The additional interviews are from; Lavanya Vijayasingham, Claudia Lopes, and Claire Wenham

We know the pandemic has disproportionately affected the NHS workers who come from a ethnic minorities, we also know that doctors from an ethnic minority face additional barriers to accessing support - so how well have the various support schemes put in place during the pandemic helped those doctors from ethnic minorities? Dammie Olubawale, medical student and grants and partnerships manager at Melanin Medics, joins us to talk about a fund they've created specifically to help doctors of black African and Caribbean heritage, to access support tailored to them. Dammie explains some of the reasons which doctors, particularly from that heritage, may be more reluctant to access support - and how organisations large and small need to think about tailoring their wellbeing initiatives to include all staff. To access the melanin medics wellbeing fund visit https://www.melaninmedics.com/wellbeing-fund

It's been 25 years since the declaration on the rights of women, was signed in Beijing - and in that time the landscape of health car inequity has changed. To celebrate we created 3 podcasts, in collaboration with The WHO and UN University, as part of the collection on Women’s Health and Gender Inequalities https://www.bmj.com/gender In these podcasts we'll be hosting conversations between women early in, and some who are more advanced in, their careers - doctors, researchers, legislators and campaigners, all working towards building a future in which women can thrive. As well as these in depth discussions, you will hear some shorter interviews from experts who have written for the collection. These give you a flavour of the bigger discussions going on in global health when it comes to gender equity - so keep an ear out for those during the discussions. In this first podcast, Adrienne Germaine talks to Fila Magnus. Adrienne starter her career as an activist for women's health in the 1970s, and went on to become president of the International Women's Health Coalition Fila Magnus is Director of Communications at the International Youth Alliance for Family Planning, and was born in the same year as the Declaration was signed. Fila and Adrienne discuss campaigning, now and then, and how the work that led to the declaration can be built on, but is never over... The additional interviews are from; Emma Fulu, Sheena Hadi, Oswaldo Montoya, and Claudia Garcia-Moreno.

In this Talk Evidence, Helen Macdonald, Joe Ross and Duncan Jarvies discuss what's going on in the world of EBM. Firstly, a while ago on the podcast, we concluded that excess mortality would be the best way to measure the impact of the pandemic - and now a new paper looks at different country's excess mortalitites over the past year. We're joined by author Nazrul Islam Physician-Epidemiologist at the University of Oxford (and a research editor for The BMJ) to talk about why comparisons may still not be sensible. Read the full research here - https://www.bmj.com/content/373/bmj.n1137 The Delta variant is dominating headlines, and infections in the UK now - but until recently the Alpha one was ascendent, and new research has helped characterise how the mortality rate of that variant differed from previous viruses. We discuss how that research was done. Read the full research - https://www.bmj.com/content/372/bmj.n579 GP data in the UK - the planned cut-off for granting access to your GP data for researchers has been extended, but there are still a lot of questions remaining. Helen has tried to find out some basic answers, and is still confused. Finally, the FDA has approved a new drug for treatment of dementia - and researchers (and the FDA's own panel of experts) are up in arms. Joe Ross tells us why he thinks the decision was the wrong one, and why patients may be harmed because of it. https://edition.cnn.com/2021/06/17/opinions/biogen-alzheimers-drug-opinion-ramachandra-ross/index.html

We've been bringing you stories of doctors wellbeing for a while in the podcast, but we noticed a pattern. Woman would come on and talk about their own difficulties, men would talk about other peoples - so we wanted to dive into that a bit, and called out on twitter for men who would be willing to open up to our listeners about their own mental health. This interview is with Zeshan Quereshi - registrar in paediatrics, author and TedX talker. In this conversation we talk about why it is that men are particularly disinclined to open up about their difficulties at work, and what Zeshan has done to try and support his own. Zeshan's TedX talk https://www.youtube.com/watch?v=uctoTk64GVM

Finally it seems that life might return to normal in the UK, as the vaccination efforts continue apace, and despite concern about increasingly spreading variants, our hospitals are not being overwhelmed. Because of this, we are changing our approach to covering the pandemic - and taking this second wave podcast to pastures new, but before that, in this last episode we’re going to look backwards and forwards, at the UK’s response. On the panel today are Matt Morgan, consultant in critical care, Nisreen Alwan, associate professor in public health, Partha Kar, consultant in diabetes, and Helen Salisbury, GP. www.bmj.com/coronavirus

The pandemic has wrought a lot of change, not least to doctors relationship to their careers. While still loving the patient interaction, we're increasingly hearing that doctors are disillusioned with the other aspects of medicine. If you're feeling that way, there are ways to structure your thinking to help you make sense of your career. In this podcast Claire Kaye, former portfolio GP and now coach, explains how she went about deciding medicine wasn't for her, and how she helps doctors go through that process too. You can find Claire at https://www.drclairekaye.com/ https://www.instagram.com/drclairekaye_executivecoaching/

In this week's Talk Evidence, Joe Ross, BMJ editor and professor at Yale again joins Helen Macdonald to talk about emerging evidence on Covid-19. They also welcome to the podcast Juan Franco, family physician in Buenos Aires, and professor at the Instituto Universitario Hospital Italiano, and new editor-in-chief of BMJ Evidence Based Medicine. This week, the team bring you updates on; Post-covid syndrome in individuals admitted to hospital with covid-19 - how are people with long covid faring. Finally published research from Scandinavia on the risk of thrombotic events after administration of the Oxford-AstraZeneca vaccine - how big is the risk, and what does that mean for the overall benefit of that vaccine. How difficult the UK population found it to understand and stick to the rules with our test, trace and isolate system - and some of the questions that this raises for this public health approach. and finally, research that showed non-drug interventions are as good as pharmaceuticals at treating people with depression and dementia - and the holistic effect that alleviating depression can have. Full reading list Ayoubkhani, Daniel, Kamlesh Khunti, Vahé Nafilyan, Thomas Maddox, Ben Humberstone, Ian Diamond, and Amitava Banerjee. 2021. “Post-Covid Syndrome in Individuals Admitted to Hospital with Covid-19: Retrospective Cohort Study.” BMJ 372 (March): n693. https://www.bmj.com/content/372/bmj.n693 Pottegård, Anton, Lars Christian Lund, Øystein Karlstad, Jesper Dahl, Morten Andersen, Jesper Hallas, Øjvind Lidegaard, et al. 2021. “Arterial Events, Venous Thromboembolism, Thrombocytopenia, and Bleeding after Vaccination with Oxford-AstraZeneca ChAdOx1-S in Denmark and Norway: Population Based Cohort Study.” BMJ 373 (May): n1114. https://www.bmj.com/content/373/bmj.n1114 Smith, Louise E., Henry W. W. Potts, Richard Amlôt, Nicola T. Fear, Susan Michie, and G. James Rubin. 2021. “Adherence to the Test, Trace, and Isolate System in the UK: Results from 37 Nationally Representative Surveys.” BMJ 372 (March): n608. https://www.bmj.com/content/372/bmj.n608 Watt, Jennifer A., Zahra Goodarzi, Areti Angeliki Veroniki, Vera Nincic, Paul A. Khan, Marco Ghassemi, Yonda Lai, et al. 2021. “Comparative Efficacy of Interventions for Reducing Symptoms of Depression in People with Dementia: Systematic Review and Network Meta-Analysis.” BMJ 372 (March): n532. https://www.bmj.com/content/372/bmj.n532

This interview is part of our BMJ interview series, where we talk to the people who are changing medicine. The series thus far has been a bit male dominated - reflecting the leadership in medicine at the moment, if not the actual workforce. One woman who's planning to change that is Roopa Dhatt, executive director of Woman in Global Health - a new grassroots organistion which is making waves with its demand for equality of representation for woman in global health decision making. In this interview, we talk to Dr Dhatt about the genesis of Woman in Global Health, and how they've managed to cement real commitment from the WHO. We also discuss how her experience of being Indian and American has shaped her understanding of equality in medicine, and how the covid-19 pandemic has highlighted the way in which women are discounted.

In medicine, a lot of work has been done to encourage person centred care - but can that maxim be extended to the people working within the healthcare system? Subodh Dave has just been elected as dean of the Royal College of Psychiatrists, and joins us fresh from talking at the International conference on physician health to speak about his ambition to humanise medicine. In this podcast, Subodh, Abi and Cat discuss what lessons from the pandemic need to remain, why at this time it's really important to look out for your colleague with family overseas, and how ice cream trucks meant much more than a cold treat. www.bmj.com/wellbeing

On this wellbeing podcast, Abi and Cat are joined by Emma Lishman, a clinical psychologist and part of the North Bristol NHS Trust's staff wellbeing team.Emma helps doctors return to training after a break - be that for maternity leave, or covid-19. Emma describes some of the fears that doctors who have been shielding have expressed coming back onto the ward, the ways in which teams may inadvertently make those worse, and the problems with complying with risk assessments in the face of staffing pressures. Wellbeing podcasts have focused a lot on the importance of openness about mental health in the NHS, but in this podcast, you'll also hear how reluctant clinicians are to discuss physical health problems - and why the taboo around all aspects of illhealth needs to be tackled. For more wellbeing https://www.bmj.com/wellbeing

Recorded on Tuesday 13th of April, as the shops open in the UK, and England is heading to the beer gardens. The roll out of the vaccination programme has completed its first phase, and second doses have been given to the most vulnerable people - and now the under 50s are starting to get their first doses. In this podcast, Duncan Jarvies, multimedia editor for The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire. The genomicc trial Matt mentions is still recruiting - if you're interested more detail is available here https://genomicc.org/

The synergistic linking of increasing health and wealth is broadly accepted - it's an integral part of the thinking between the Sustainable Development Goals, and the World Bank's call for universal healthcare as a way of boosting a country's economy. But the quantification of that link - the extent to which a particular health intervention, has broader economic impacts, is actually pretty poorly understood. In this podcast, we hear from some economists, who have an idea about how we could - fairly easily - measure those impacts at the same time we measure clinical efficacy. Joining us are, Dean Jamison, professor emeritus of global health at the University of Washington Osondu Ogbuoji, assistant research professor at Duke Global Health Insitute. Till Bärnighausen, director of the Heidelberg Institute of Global Health Sebastian Vollmer, professor of development economics at the University of Göttingen The collection that prompted this discussion is "Health, Wealth and Profits" - https://www.bmj.com/health-wealth-profits

The evidence geekery continues, and this week Helen Macdonald and Duncan Jarvies are joined again by Joe Ross, The BMJ's US research editor, and professor of medicine and public health at Yale. This week we update you on treatment - the WHO's guidelines for covid and ivermectin, and why they're not ready to recommend it's use in treatment, and prophylactic anticoagulation treatment. We hear about two papers from the UK and Switzerland which look at children and covid, and we pick up on varients of concern and long covid. Reading list. Association between living with children and outcomes from covid-19: OpenSAFELY cohort study of 12 million adults in England https://www.bmj.com/content/372/bmj.n628 Clustering and longitudinal change in SARS-CoV-2 seroprevalence in school children in the canton of Zurich, Switzerland: prospective cohort study of 55 schools https://www.bmj.com/content/372/bmj.n616 Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: matched cohort study https://www.bmj.com/content/372/bmj.n579 Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study https://www.bmj.com/content/372/bmj.n311 Editorial - Prophylactic anticoagulation for patients in hospital with covid-19 https://www.bmj.com/content/372/bmj.n487 Living with Covid19 – Second review - Informative and accessible health and care research https://evidence.nihr.ac.uk/themedreview/living-with-covid19-second-review/

In the UK, phase 2 of our coronavirus vaccination strategy may be delayed by supply problems, at the same time many GPs, who carried out the majority of the first vaccination phases, are declining to take on the addition burden and are trying to return to normal clinical work. In this podcast, Duncan Jarvies, multimedia editor for The BMJ, talks to the full panel; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton.

In this Wellbeing podcast, sponsored by medical protection, Abi Rimmer and Cat Chatfield talk to Susanna Petche and Reina Popat, GPs and members of First You - an organisation of healthcare workers, promoting wellbeing in the NHS. They discuss why it is that clinicians learn to subjugate their own wellbeing to their patients', and the ways in which working in the healthcare system perpetuate that. They discuss how systemic change can come through individual action, and how peers can band together to support each other.

This round table, recorded at the nuffield summit 2021, asks what does following the science actually mean - do ministers understand the nuance of the science in the pandemic, and how does uncertainty get interpreted through the lens of ideology and the power of compelling stories. Taking part are: Kamran Abassi, executive editor of The BMJ Partha Kar, consultant in diabetes and endocrinology Deborah Cohen, health correspondent for BBC Newsnight Tom Sasse, associate director at the Institute for Government Christina Pagel, professor of Operational Research at University College London Matt Morgan, intensive care consultant Andy McKeon, chair of the Nuffield Trust Isobel Hardman, assistant editor of The Spectator Mary Dixon-Woods, director of This Institute Ben Page, chief executive of Ipsos MORI Alexandra Freeman, executive director of the Winton Centre for Risk & Evidence Communication Will Moy, chief executive of Full Fact Nigel Edwards, chief executive of the Nuffield Trust

In a slightly different talk evidence, Helen Macdonald and Duncan Jarvies are bringing you a couple, of in depth interviews, Firstly, Anthony Harnden, GP, academic and member of the UK's Joint Committee on Vaccination and Immunisation takes us inside their decision making, and explains what evidence they look at, how they assess it, and what the next year of vaccination may look like. Also in this episode, Gordon Guyatt, one of the founders of EBM, joins us to talk about Grade - the framework in which evidence for guidelines can be assessed - and explains why the most important thing is not the RCTs, but being very clear about what the guideline is supposed to achieve. https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation https://www.gradeworkinggroup.org/