Medicine and Science from The BMJ

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/

Never has the spotlight been as strong on a clinical trial as that on the Pfizer BioNTech vaccine, the first approved for covid-19. In this interview, Joanne Silberner spoke to its lead principal investigator, Stephen Thomas chief of infectious diseases at SUNY Upstate Medical University, New York, became the lead principal investigator for one of the most closely watched clinical trials in history. They discuss the moment the positive results came through, what will happen to the people who are still enrolled in the trial, but got a placebo dose, and why the trial was designed in the way it was. www.bmj.com/coronavirus

Many surgeries have been cancelled during the pandemic, with good reason, as early data showed the increase in mortality associated with a coronavirus infection, but now waiting lists grow, and there are questions about how the NHS will pick up the slack. In this podcast, Fiona Godlee, editor in chief of 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. They are joined by Mary Venn, research fellow, and honorary surgical registrar in London, who's been looking into the pandemic's effect on surgery. For more on that research: http://nihrglobalsurgery.org/surgeryduringcovid To register for our covid known unknowns webinar - https://www.bmj.com/covid-19-webinars

Ashling Lillis is a now consultant in acute medicine at Whittington Health NHS Trust, but she was almost a consultant in intensive care medicine - but a mental health crisis just 6 months before she qualified made her reassess her career, and choose a different path. In this podcast, Ash talks to Abi and Cat about the difficulty many doctors have when discussing their mental health - and how speaking out about her own experiences, has encouraged others to talk to her privately - and opened her eyes to the extent of the problem in the NHS. www.bmj.com/wellbeing

Jeremy Farrar, is director of the Wellcome Trust, as well as advisor to the government on SAGE. Trained as a medic and with a PhD in neuro-immunology, he was a professor of Tropical Medicine and Global health at the University of Oxford. In this podcast, he tells us why he thinks that vaccine nationalism is a very short-termist response the pandemic, and why he's bullish about new variants of the SARS-CoV-2 virus. www.bmj.com/coronavirus

In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton. This week our special guest is Rachel Clarke, author and palliative care specialist. The panel discuss how end of life care has changed in the pandemic, and how clinicians have become targets of abuse on social media, for speaking out about things like masks and hospital capacity.

The observation period, after receiving a covid-19 vaccination may be the only 15 minutes someone in the NHS might get all day. In this podcast, we're joined again by Chris Bu, psychiatry trainee who has previously spoken to us about how Burmese Buddhism helped him in his training. He takes us through a guided mindfullness meditation, tailored to that post-vaccination period, to help you make the most of your observation time. www.bmj.com/wellbeing

The evidence geekery continues, and this week Helen Macdonald and Duncan Jarvies are joined by Joe Ross, The BMJ's US research editor, and professor of medicine and public health at Yale. This week we pick up on a preprint in medRxiv, which has been attracting attention on social media - it tries to look at the longer term effects of covid hospitalisation. Joe explains why he thinks propensity matching can be summarised as "doing your best". Finally, as more and more care moves remotely, we discuss a trial on a digital intervention to help manage poorly controlled hypertension remotely. Reading list: Epidemiology of post-COVID syndrome following hospitalisation with coronavirus: a retrospective cohort study https://www.medrxiv.org/content/10.1101/2021.01.15.21249885v1.full.pdf Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial https://www.bmj.com/content/372/bmj.m4858

Neil Greenberg is a psychiatrist, and professor of Defence Mental Health at King's College London. He spent 23 in the military, and now continues to work with them on things like peer led traumatic stress support packages. A recent survey of NHS staff showed disturbing signs that covid-19 has caused a widespread trauma in staff, so in this podcast we talked to Neil about trauma and moral injury, what some of the warning signs are, and what individuals and organisations can do to help their colleagues. www.bmj.com/wellbeing

Jeremy Hunt probably needs no introduction to our audience - the UK's longest serving health minister, he now chairs Westminster's Health and Social Care Committee - the powerful committee that holds the government to account for its policy choices. In this interview Gareth Iacobucci asks Hunt if he regrets his decision to impose the contract on junior doctors which lead to their industrial action, how workforce issues have left the NHS in a poor state to deal with a health emergency. They also talk about the potential for a public enquiry into the government's handling of the pandemic, and what an upcoming committee report into the same issue might find.

The "public health emergency of international concern" was issued by the WHO a year and a lifetime ago. As the UK ramps up testing for the South African virus variant, and is full steam ahead on vaccination, we look back at what we've learned in that time. In this podcast, Fiona Godlee, editor in chief of 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. They talk about working in the NHS at the moment, the utility of international comparisons, and their remaining questions about vaccination regimes. www.bmj.com/coronavirus

It’s been just over a year since the WHO declared the pandemic a “Public Health Emergency of International Concern” - if you cast your mind back to then, the news was full of reassurances about how prepared the UK and the USA were for a pandemic. Now a year later, with the benefit of hindsight, that confidence was wildly overstated - but why was that, what is the gap between that theoretical readiness, and reality. In this podcast we're joined by talking to Tom Frieden - former director of the Centres for Disease Control and Prevention, under President Obama, and who has a long history of public health leadership. He talks about the gap between the apparatus to do something, the the political will to do that. Why data have been lacking, and the interaction between a infectious and non-infectious diseases. www.bmj.com/coronavirus

Recorded on the 26th January 2021 The UK has become, officially, the worst performing country in terms of Covid-19 deaths, per head of population - and the number of people in hospital is still higher than at any point in the pandemic. In this podcast, Fiona Godlee, editor in chief of 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. They talk about working in the NHS at the moment, and the challenges in things like oxygen and vaccine supplies. How the pandemic has exposed a gap in general medicine, and the importance of challenging poor responses at all levels.

In the UK, over 37,000 people are in hospital with covid-19, and the NHS comes closer than ever to being overwhelmed - though 4 million people have received their first dose of the vaccine, we are warned that things will get worse before they get better. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to; 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, about the pressure on hospitals, why GPs are questioning the need for max vaccination centres, and why the public health approach can't be just lockdown and vaccinations. www.bmj.com/coronavirus

US president elect Joe Biden wasted no time in appointing a special advisory board of experts to guide America out of its coronavirus crisis. One of those experts is Celine Gounder, an infectious diseases epidemiologist who has worked on Ebola, tuberculosis, and HIV in Africa and South America. She’s a clinical assistant professor of medicine and infectious diseases at New York University’s School of Medicine, as well as an active writer and podcast host, including of Epidemic In this podcast she talks to Joanne Silberner about the ways in which the taskforce is helping prepare for action immediately after the inauguration, what the big challenges they need to tackle are, and how they plan to rebuild trust in the U.S. covid response. https://www.bmj.com/content/372/bmj.n33

In this episode of Talk Evidence, Jon Deeks, professor of biostatistics at the University of Birmingham, returns to the pod with an update on lateral flow tests - and why the government plan for using them in asymptomatic screening for covid-19 doesn't follow the science. We're also joined by Allyson Pollock, clinical professor of public health at Newcastle University, and author of a recent editorial in The BMJ about asymptomatic transmission of SARS-CoV-2. She explains why she thinks supporting social isolation is the missing piece of our approach to tackling the pandemic. Covid-19 INNOVA testing in schools: don’t just test, evaluate https://blogs.bmj.com/bmj/2021/01/12/covid-19-innova-testing-in-schools-dont-just-test-evaluate/ Asymptomatic transmission of covid-19 https://www.bmj.com/content/371/bmj.m4851

Andrew Pollard is Director of the Oxford Vaccines Group - who, along with Astra Zeneca, have developed an modified adenovirus vaccine for SARS-CoV-2. In this interview we talk to him about the development of that vaccine - what he thinks about the UK government's plan to increase the interval between doses; if he worries about a mutating virus and vaccine escape; and how the university came to make a deal with a commercial company to provide cost-price vaccinations for the world. www.bmj.com/coronavirus

The Samaritans have traditionally been there for people in a crisis, those who are on the verge of ending their life by suicide - but during this pandemic, with the personal toll of caring for covid-19 patients, they are also here to provide emotional support for NHS staff however they are feeling. In this podcast, Ben Phillips, head of service programmes for Samaritans joins us to explain how being listened to can help - and how to tactfully point your colleagues towards that emotional help if you feel they need it. If you need support at this time you can call 0800 069 6222 or visit https://www.samaritans.org/how-we-can-help/health-and-care/

The growth in the need for food aid, in the UK, has been staggering. That's why The BMJ has chosen the Independent Food Aid Network (IFAN) as its annual charity appeal. Nutritional guidelines which work for everyone is difficult, even harder for food aid providers who have to factor in things like long term storage, reduced access to fresh produce and in some cases the inability to afford the electricity to cook with. In this podcast, Sabine Goodwin, IFAN's coordinator is joined by Isabel Rice, dietician at the charity Centrepoint, and Dee Woods, co-chair of IFAN and who co-runs Granville Community Kitchen, a food aid provider in London. Please time the time to donate at; https://www.foodaidnetwork.org.uk/bmj

Recorded Tuesday 5th Jan 2021 As the UK enters lockdown, again, schools are closed, the NHS struggles under the surge of cases, new variants of SARS-COV-2 virus stalk the world, and vaccination programmes make a faltering start. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton, about the pressure on critical care, England's vaccination roll out, the closure of schools and why communication is undermining trust in the vaccines. All the BMJ's corona virus coverage is currently free to access www.bmj.com/coronavirus

The BMJ has long campaigned for better patient and public participation in research, making the case that it leads to better outcomes for patients and for society - but an article published in the Christmas edition of The BMJ goes further than that - and talks about the insights that participants in research provide- insights that the academic team would never be able to have themselves. In this podcast, Seb Crutch a professor of neuropsychology, and Martin Rossor, national director for dementia research - who have been involved in neurological research as academics, and also by Valerie Mansfield, who’s a member of a patient support group, discuss how the scientific establishment can recognise those invaluable insights. Read the full article: https://www.bmj.com/content/371/bmj.m4478

As 2021 hoves into view, we look back at a year of extraordinary evidence. Helen Macdonald is joined by Joe Ross, one of The BMJ's research editors, as well as a researcher at Yale. They discuss the way in which clinical pre-prints have become an important part of the research ecosystem, especially during the pandemic, and pick up on some of the non-coronavirus things you might have missed in the deluge of data.

In this end-of-year podcast from Deep Breath In, we're bringing you a light hearted look back at 2020, and trying to remember some of the non-covid-19 medicine that has crossed our desks. This festive quiz features the deep breath in gang, as well as Cat Chatfield from the Wellbeing podcast, and Helen Macdonald from our Talk Evidence podcasts. Reading list; Thyroid disease assessment and management: summary of NICE guidance https://www.bmj.com/content/368/bmj.m41 Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline https://www.bmj.com/content/365/bmj.l2006 Judd Brewer's advice for coping with burnout https://drjud.com/

If you've had time to digest this year's Christmas edition of The BMJ, you might have wondered how those papers get into The BMJ. Well in this Talk Evidence podcast, Helen Macdonald, UK research editor at The BMJ talks to two of her research team colleagues, John Fletcher and Tim Feeney, as they talk through why they chose their favourite papers. Toxicological analysis of George’s marvellous medicine https://www.bmj.com/content/371/bmj.m4467 Does medicine run in the family—evidence from three generations of physicians in Sweden https://www.bmj.com/content/371/bmj.m4453 The time to act is now https://www.bmj.com/content/371/bmj.m4143

How do human behaviours affect patient outcomes? And what has that got to do with Christmas? Graham Shaw, director of Critical Factors, and Peter Brennan, a maxillofacial surgeon in Portsmouth, join us to explain what human factors are, why they’re not a bigger part of medical training, and talk about their importance as the NHS comes under greater and greater pressure because of the surge in covid-19 cases. They also offer a word of advice to Santa, about making sure a festive never-event never happens. www.bmj.com/wellbeing

Every year, the BMJ has a charity appeal - we’ve regularly focused on organisations like MSF, or Lifebox - providing support to areas of the world which don’t have good healthcare provision… This year though, covid-19 has changed everything - and we’re focussed inwards, on the UK. With growing unemployment, sections of the population being laid off, and with the well documented delays in receiving universal credit - food insecurity has become a major issue in the sixth largest economy in the world. In this podcast Martin Caraher, emeritus professor of food and health policy at City University of London, explains how this crisis is a long time coming, and the result of the inattention of successive governments to the issue of hunger. We also hear from Sabine Goodwin, coordinator of the Independent Food Aid Network, the recipients of this years award funds, about how the their network is being affected by the covid-19 pandemic, and how your money will be used to supports food banks, and advocate for their obsolescence Donate the the Independent Food Aid Network here: https://www.foodaidnetwork.org.uk/bmj

Until hear death in 2019, Annabel and her husband James Weaver, spent a lot of time together in hospitals - in patient and outpatient wards, waiting in makeshift waiting rooms in corridors and atriums. And while you or I might notice things about the way in which the hospital looks - James and Annabel noticed the way in which is sounded. James is perusing a PhD at Queen Mary University of London into acoustics and the intelligibility of sound - and in this podcast we delve into the sound of a hospital, and why it can make communication between staff and patients so hard. Read James's Christmas article, The sound of medicine https://www.bmj.com/content/371/bmj.m4682

Robert Poynton is an associate fellow of the Saïd Business School at the University of Oxford, and author of books designed to help people work in ways which help both their career and wellbeing. In this wellbeing podcast, we focus on "Do Pause; you are not a to do list" - a book that Cat has had on her to do list for months. Rob explain to us what the concept of "pausing" is, and why he thinks a small gesture can have a significant effect on our ability to deal with the stresses of day to day work life. Rob's books are available on Bookshop Do Pause https://uk.bookshop.org/a/98/9781907974632 Do Improvise https://uk.bookshop.org/a/98/9781907974014

As London and some neighbouring counties move up to tier 3, and Germany, Italy and The Netherlands impose tighter restrictions over over the coming days of Christmas, in this podcast we ask - should Christmas gatherings be cancelled? In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire. They're joined by Mike Tildesley, reader in mathematics at Warwick School of Life Sciences, who models infectious disease spread. They discuss why the key to controlling is pruning network connections - but why that concept hasn't been well explained to the public, what's happening in Cardiff, where ICU is running at 120% capacity, and how the vaccine roll out is being coordinated in primary care. For more on the pandemic www.bmj.com/coronavirus

The last few weeks we’ve been feverish in our coverage of vaccines - the evidence base for them is, how they’ve been evaluated and licensed, and who’s going to get them first. But what we’ve not covered much is what it’s like to do, and take part in, a vaccine trial. In this special podcast, we’re going to hear from John Wright, director of the Bradford Institute of Health Research. He’s been keeping a “doctors diary” for BBC radio, and in this podcast we’re doing a deeper dive into that - and finding out about the people working on, and volunteering to test, a corona virus vaccine.

The vaccines are being rolled out - but approval is still on an emergency basis, and the evidence underpinning those decisions is only just becoming available for scrutiny. In this podcast we talk to Baruch Fischhoff, professor at Carnegie Mellon University and expert on public health communication about how that messaging should be done. Peter Doshi, associate editor at The BMJ, and vaccine regulation researcher also joins us to talk about the data now released on the vaccine trials - what questions does it raise, and what are the next steps for researching safety. For more on The BMJ's covid-19 coverage www.bmj.com/coronavirus

As the first people outside of a trial have started receiving Pfizer's sars-cov-2 vaccine, including Matt, but that's not the end of the story for the pandemic, there are still logistics of rollout, plus treating those who have already contracted the disease. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire. They discuss why it's impossible to get the vaccine into care homes, because of the need for very low temperature storage, why the survival rate in ICU has gone down, and how messaging on the non-vaccine ways of preventing spread need to be tightened up, especially now. For more of The BMJ’s covid-19 coverage. www.bmj.com/coronavirus

Anne Hicks, is an emergency medicine consultant in Plymouth, and for 16 years was the medical director for the British Antarctic Survey (she stepped down last year). The British Antarctic Survey operates all through the antarctic winter - where for 90 days, the sun sets and plunges their base into cold and darkness. So who better to give us some advice on coping with the strict covid-19 rules during our winter period. Anne talks to Cat Chatfield about the ways in which structure, even the seemingly small and arbitrary, can help, how to spot signs of someone struggling, and how the lack of daylight affects teams working at the bottom of the world. https://www.bmj.com/wellbeing

As the first vaccine for corona virus is approved, and England joins the other nations of the UK outside of full lockdown, we are all entering tiers of restrictions - variable across the country, which will continue until that vaccine coverage is enough to slow transmission in the community. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire, and are re-joined by Karl Friston, neurologist and member of iSAGE. They discuss what we know about the efficacy of these tiers, and how they interact with things like track and trace, and the mass testing taking place in Liverpool. For more of The BMJ’s covid-19 coverage. www.bmj.com/coronavirus

The government has decided to pursue a strategy of mass-testing in Liverpool, in a pilot to see what effect that has on containment of corona virus. A lot of criticism has been levelled at the scheme, from the sensitivity of the lateral flow test used, to whether this is screening and should be referred to the national screening committee to be evaluated. Calum Semple, professor of child health and outbreak medicine at the University of Liverpool is evaluating the project, and joins us to explain what we can understand from this - how initial data shows the new testing regime is reaching more of the population, and why he thinks this is a public health intervention, not a personal screening test. www.bmj.com/coronavirus

The BMJ is a champion of openness and transparency in research, in clinical practice and in health policy. However, if you’ve kept and eye on the journals recently, you’ll have seen that governments have been less diligent about keeping an eye on competing interests than they should be. In this podcast we’re joined by Jolyon Maugham QC - one of the founding members of the Good Law Project, who have successfully litigated against the government on Brexit, and are now turning their eyes to procurement during the pandemic. Jo talks to Kamran Abbasi about how big the contracts have been, how the UK’s system lacks the checks and balances to prevent a government from forging ahead, and if cronyism and corruption have damaged the pandemic response www.bmj.com/coronavirus

As further promising news emerges of vaccine effectiveness, although still with no data published, and as plans emerge for the return home of university students and limited festive winter celebrations. But as we talked about in the last podcast, there needs to be a concerted effort to re-centre patients and the public within the decisions made about how the NHS will treat covid patients and those with continuing healthcare conditions impacted by the pandemic. National Voices, a coalition of charities that stands for patient centred care, have been talking to patients about what matters to people during COVID-19 and beyond, and have written a report with some clear recommendations to health and care leaders and professionals. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton. They are joined by Charlotte Augst, Chief Executive of national voices to talk about that report; why some patients have felt abandoned; how covid has accelerated the conversation about rationing; and why now is the time to rebuild services around patient needs. www.bmj.com/coronavirus

Uncertainty abounds - even as we get better data on treatments, with the big RCTs beginning to report, and new trials on masks, the evidence remains uncertain, in both the statistical realm (confidence intervals crossing 0) and in what to do in the face of that continuing lack of clear effect. As always Helen Macdonald and Duncan Jarvies are looking at the evidence, and this week are joined by John Brodersen, professor of general practice at the University of Copenhagen. Helen talks to Bram Rochwerg, methodology lead on the WHO treatment guidelines for covid, about why their latest review has stopped recommending remdesivir for covid-19 treatment. John tells us about the Danmask study - what question it was actually trying to answer. We also discuss the ways in which there is a tendency to express certainty where there is none, and why distrusting simple solutions to complex problems is a good rule of thumb. Reading list: A living WHO guideline on drugs for covid-19 https://www.bmj.com/content/370/bmj.m3379 Covid-19’s known unknowns https://www.bmj.com/content/371/bmj.m3979 Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers https://www.acpjournals.org/doi/10.7326/M20-6817

Clare Gerada and Zaid Al-Najjar have been treating doctors for a while now, through the NHS Practitioner Programme. In that time they have noticed some themes in the issues that bring doctors to them, from isolation to stress. In this podcast they reflect on what they've learned about the problems that affect doctors, and how covid-19 has exacerbated some, and surprisingly reduced others. Their book Beneath the White Coat: Doctors, Their Minds and Mental Health is out now https://www.routledge.com/Beneath-the-White-Coat-Doctors-Their-Minds-and-Mental-Health/Gerada/p/book/9781138499737

Covid-19 continues its grip on the Northern Hemisphere alongside news of a vaccine trial showing real success at first glance. In this second wave update, we explore the latest issues with healthcare professionals from primary care, secondary care, and public health, and discuss what is happening in their field, and put their questions to experts. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton. They are joined by Katrina Pollock, senior clinical research fellow in vaccinology at Imperial College London, to talk about: the three vaccines in the news; why different groups may require different vaccines; and how to choose who to get the vaccination first. www.bmj.com/coronavirus

In the first wave of covid-19, hospitals started to reconfigure space and services, to provide rest areas and food for staff, to help them cope with the surge in patients. Michael West, professor professor of work and organisational psychology at Lancaster University Management School, returns to the podcast to talk about how well those changes helped staff - and what needs to be done, now that a second wave is hitting, to make sure those essential services don't disappear. www.bmj.com/wellbeing

Covid-19 continues its grip on the Northern Hemisphere alongside news of a vaccine trial showing real success at first glance. In this second wave update, we explore the latest issues with healthcare professionals from primary care, secondary care, and public health, and discuss what is happening in their field, and put their questions to experts. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Alison Pittard, a consultant in anaesthesia and intensive care medicine in Leeds, and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton. They are joined by Müge Çevik, an infectious diseases researcher at the University of St Andrews, to talk about: what’s happening with track and trace and how to make it work better; transmission and asymptomatic spread, in particular hospital-acquired infections; views on the news of Pfizer’s vaccine; and reaction to US presidential election. www.bmj.com/coronavirus

A lump in the throat is a classic GP presentation, but one that often causes a lot of worry. Many people are struggling with high levels of anxiety anyway at the moment, and this may manifest physical symptoms, such as fatigue, insomnia and dysphagia. In this week’s episode, we discuss how to differentiate between causes of a lump in the throat: is my patient experiencing laryngopharyngeal reflux, or could it be cancer? How do we reassure distressed patients when we need to refer them on for imaging, or a consultation with a specialist, before we can rule out a malignant cause? We also talk about how to manage a patient who has difficulty swallowing pills, and the challenges of getting children, in particular, to take medication. Our guests: Nick Hamilton is a clinical lecturer in otorhinolaryngology at UCL, and also works as a specialist registrar in otorhinolaryngology head and neck surgery at North Thames Deanery, London. Deonne Dersch-Mills is the clinical practice leader for pharmacy for paediatrics & neonatology with Alberta Health Services. She is based at Alberta Children’s Hospital, Calgary. Bonnie J. Kaplan is a semi-retired research psychologist, and professor emerita from the Cumming School of Medicine, Calgary.

As the second spike in covid-19 cases grows, we want to take stock of what's happening in the NHS. In these second wave updates, clinicians from primary care, secondary care, and public health, discuss what is happening in their field, and put questions to experts. In this podcast, Fiona Godlee, editor in chief of The BMJ talks to Matt Morgan, consultant in intensive care medicine in Cardiff and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton. They are joined by Andrew Hayward, professor of infectious disease epidemiology and inclusion health research, to talk about the lockdown in England, why the message should be clearer, what needs to be done to make the lockdown work, and how doctors are braced for the upcoming surge in cases. https://www.bmj.com/coronavirus

In this talk evidence covid-19 update, we’re taking on risk - how do you figure out your individual risk of dying from the disease? Try QCovid, but remember that it’s figuring out your risk back in April. When it comes to talking about risk, very few people actually engage with the number, so Alex Freeman from the Winton Centre for Risk and Evidence Communication at the University of Cambridge joins us to describe their research into more effective ways of presenting it. Huseyin Naci, from the London School of Economics, returns to the podcast to talk to us about the problems of pulling all the trial data together, and where covid-19 has made people work together most effectively in tackling that issue. Reading list; Living risk prediction algorithm (QCOVID) for risk of hospital admission and mortality from coronavirus 19 in adults https://www.bmj.com/content/371/bmj.m3731 Repurposed antiviral drugs for COVID-19 –interim WHO SOLIDARITY trial results https://www.medrxiv.org/content/10.1101/2020.10.15.20209817v1 Producing and using timely comparative evidence on drugs: lessons from clinical trials for covid-19 https://www.bmj.com/content/371/bmj.m3869.full

Chris Whitty probably needs no introduction to our UK audience - he's the chief medical advisor to the UK government, has played a pivotal role in shaping the country's response to Covid-19. He rarely does interviews - so in this conversation we wanted to ask him the questions that matter to clinicians, about how the pandemic will impact them over the winter. This was recorded yesterday, just before the announcement of the strict lockdowns in France and Germany. For more covid-19 coverage www.bmj.com/coronavirus

As the world sees an upsurge in infections, this "second wave" feels different to the first - we have a much better understanding of the biology of the virus, in hospitals, guidelines for treatment have been rapidly developed... and the pipeline of research to improve that has been created. But a lot of questions remain - particularly about the dynamics of the spread of respiratory viruses. Which brings us onto this episode - in these weekly discussions, clinicians from across the healthservice and I will be joined by experts, so we can find out more about the issues that really matter to frontline staff. Joining us today are BMJ columnists, Matt Morgan, consultant in intensive care medicine in Cardiff and Helen Salisbury, GP in Oxfordshire. We also have The BMJ authors, Nisreen Alwan, consultant in public health, in Southampton and Karl Friston, neurologist and member of iSAGE For more of The BMJ’s covid-19 coverage. www.bmj.com/coronavirus

Personality disorder is often referred to as the “Cinderella” diagnosis of mental health. Around 1 in 20 people is estimated to have a personality disorder, and it is a neglected and under-resourced area of our healthcare system. In this week’s episode, we discuss the stigma surrounding personality disorder, which can often manifest itself in high levels of anxiety for both patients and GPs, when it comes to diagnosing and managing it, and how to help a patient come to terms with their diagnosis. With suicidal ideation being experienced by many people with a personality disorder on a regular basis, we also talk about how we may best manage a situation of a patient in crisis presenting in primary care. Our guests: Leisha Davies is a clinical psychologist, originally from South Africa, who currently works in private practice. Soumitra Burman-Roy is a consultant psychiatrist at the South London and Maudsley NHS Foundation Trust. He also works for Maudsley Learning, an organisation which provides mental health training for primary care. Marie Stella McClure, who was diagnosed with borderline personality disorder at the age of 38, is the author of ‘Borderline: a Memoir’, a book about her life and experiences of BPD.

As the second spike in covid-19 cases grows, we want to take stock of what's happening in the NHS. In these second wave updates, clinicians from primary care, secondary care, and public health, discuss what is happening in their field, and put questions to experts. In this podcast, Fiona Godlee, editor in chief of The BMJ talks to Matt Morgan, consultant in intensive care medicine in Cardiff and Helen Salisbury, GP in Oxfordshire - they discuss how full hospitals are getting, how many covid-19 cases are presenting in primary care, and how treating patients has fared as the pandemic hots up. For more on covid-19 visit https://www.bmj.com/coronavirus

The "second wave" of covid is hitting the UK, and clinicians are anticipating a spike in demand in the NHS. The inevitability of that is weighing on NHS staff's minds. In this podcast, Cormac Doyle, a retired senior army officer, who specialises in military mental health/ veterans and support other with psychological trauma, returns to the podcast to talk about his experience of deployment in the military, and how individuals and their employers can make the inevitability of a second wave less daunting. For more wellbeing from The BMJ - https://www.bmj.com/wellbeing