Medicine and Science from The BMJ

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week: (3.14) Jeff Aronson from Oxford University explains why remdesivir is a potential therapeutic, but is pessimistic about the quality of the studies being done on it (13.22) Carl explains why smoking cessation is still a key public health priority under covid-19 (16.30) Helen talks care homes, and interviews Mona Koshkouei, from Oxford University, about the research which shows staff are the main vector of infection. (27.20) David Spiegelhalter, professor of public understanding of risk, looks at the new data on excess deaths in the UK - and the difficulties with reporting that underlie it. Carl explains how deaths track infections, and why uncertainty there makes it hard to calcuate the case fatality rate (And why that is not a good measure to use in a pandemic) Reading list. Compassionate Use of Remdesivir for Patients with Severe Covid-19 https://www.nejm.org/doi/full/10.1056/NEJMoa2007016 How can pandemic spreads be contained in care homes? https://www.cebm.net/covid-19/how-can-pandemic-spreads-be-contained-in-care-homes/ Covid-19: Death rate in England and Wales reaches record high because of covid-19 https://www.bmj.com/node/1024784.full

We’ve published info on Telehealth in primary care - and have been overwhelmed by the response from GPs who are finding it useful. But it’s not only primary care that is dramatically shifting to remote care - routine hospital care is moving online too, so we’ve asked Rowena McCash - GP and out of hours triage trainer joins us to give some tips on how to change your communication for the situation. She explains safety netting in telephone triage, note taking, and why there are some advantages to working that way. www.bmj.com/coronavirus www.bmj.com/wellbeing

As we cover the covid-19 outbreak, we want to hear some of the stories from the frontline - And who better to heart of what this pandemic is doing to the profession in the UK, than some of the people who write regularly for The BMJ? In this first one, we wanted to look specifically at acute care - those at the sharp end of the response, so we're joined by David Oliver, consultant in geriatrics and internal medicine, and Matt Morgan, consultant in intensive care medicine. Read the columns https://blogs.bmj.com/bmj/category/columnists/matt-morgan/ https://blogs.bmj.com/bmj/category/columnists/david-oliver/ For more free information on covid-19 www.bmj.com/coronavirus

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week: (2.24) - Hydroxychloroquinine/chloroquinine - Robin Ferner, honorary professor of clinical pharmacology at the University of Birmingham explains why is it a potential therapeutic for covid-19, and why is it being hyped. (12.45) - We use prognostic models to make treatment decisions, but they have to be well conducted. Lots of them are being created for covid-19, but their quality isn’t great. Statisticians Laure Wynants Maastricht University and Maarten van Smeden from Utrecht University have done a systematic review of these models, and explain what’s needed for them to be useful. (26.30) PPE - specifically facemasks. What does the evidence say about their use by the public, and does the precautionary principle hold Reading list: COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community https://www.nice.org.uk/guidance/ng165/chapter/4-Managing-suspected-or-confirmed-pneumonia Chloroquine and hydroxychloroquine in covid-19 https://www.bmj.com/content/369/bmj.m1432 Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal https://www.bmj.com/content/369/bmj.m1328 What is the efficacy of standard face masks compared to respirator masks in preventing COVID-type respiratory illnesses in primary care staff? https://www.cebm.net/covid-19/what-is-the-efficacy-of-standard-face-masks-compared-to-respirator-masks-in-preventing-covid-type-respiratory-illnesses-in-primary-care-staff/

As part of our response to the covid-19 pandemic, we’re going to be running a series of discussions with experts about some of the big issues arising from the virus. In this one, we’re asking about the public health response to an outbreak - what’s necessary, and is it possible to go to far. Joining us are Martin Mckee - professor of european health at the London Schoole fo Hygiene and Tropical Medicine Kathleen Bachynski - assistant professor of public health at Muhlenberg College Sridhar Venkatapura - associate professor global health & philosophy at King's College London www.bmj.com/podcasts www.bmj.com/coronavirus

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week 5.00 - Carl gives us an update about pneumonia in primary care, should you give antibiotics when you're not sure if it's bacterial or viral 10.00 - The importance and difficulty of making guidelines now 15.00 - We hear from guideline maker Per Vandvik, about making guidance. 21.40 - Preprint servers for medicine are showing their use in this fast changing situation. Joseph Ross from Yale School of Medicine, and one of The BMJ's research editors, talks to us about the kind of information we're seeing on medRxiv. 31.10 - Testing. What are the tests, and when do we want specificity, and when do we want sensitivity. Nick Beeching from the Liverpool School of Tropical Medicine joins us to explain. Reading list: www.bmj.com/coronavirus Rapidly managing pneumonia in older people during a pandemic https://www.cebm.net/covid-19/rapidly-managing-pneumonia-in-older-people-during-a-pandemic/ https://www.medrxiv.org/ Covid-19: testing times https://www.bmj.com/content/369/bmj.m1403

Wellbeing might not seem the obvious place to talk about PPE - but lack of appropriate PPE is causing healthcare staff a great deal of stress now. Mary Brindle is a pediatric surgeon and the director of The EQuIS (Efficiency Quality Innovation and Safety) Research platform at Alberta Children’s hospital. In this podcast she reflects on the use of PPE, talks a little about the culture of it - and how overuse by one person can amply the concerns of others, the effect on patients of seeing their carers in protective equipment (especially children), and the importance of communication when you can't see colleagues faces anymore. www.bmj.com/wellbeing www.bmj.com/coronavirus

Continuing our series on wellbeing during the pandemic, in this podcast we speak to Occupational Psychologist Roxane Gervais about how doctors can look after themselves during the covid-19 pandemic. We discuss the importance of reaching out to friends and family during this difficult time, how to deal with the loss of control, as well how to tackle feelings of guilt when you are unable to work clinically. For more wellbeing content www.bmj.com/wellbeing For more on covid-19 www.bmj.com/coronavirus

We knew a pandemic was coming at some point - it’s kind of why we have the WHO. We have had various smaller scale tests of the international response to an infectious disease outbreak - Ebola in west africa being the most recent. After that, reports criticised the WHO's response - citing problems around the swiftness of their action, the lack of coordination between countries, and the platforms for knowledge sharing. Is the agency doing any better in Covid-19? Suerie Moon is co-director of the Global Health Centre at the Graduate Institute of International and Development studies in Geneva, and author of one of those critical reports which was published in The BMJ. She joins us to assess how the WHO is responding.

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week 3.50 - There is a lot of confusion around symptoms, we hear what Carl's review of the case studies has found, and why he thinks fever and persistent dry cough may not be a sign of all cases. 10.30 - where are we with research into antiviral treatment 17.30 - John Ioannidis has expressed concerns about the quality data used in modelling and therefore our pandemic response. We hear what his concerns are, and what needs to be done to answer them. 29.10 - Iceland is the only country attempting to do population level screening, we hear from Kári Stefánsson, CEO of deCODE genetics which is working with the Icelandic government to allow everyone to access testing for the virus.

Reports from Italy, and more recently from the U.S. show the strain the healthcare system is under during this pandemic. We know that staff will step up in an emergency, but this isn’t a fire or a bombing, this is going to last for months. So how can organisations be proactive in supporting staff, and how can leaders try to mitigate the inevitable burnout. In this podcast, Michael West, professor of organisational psychology at Lancaster university, and author of the GMC report “Caring for doctors, caring for patients” joins us to talk about what compassionate leadership looks like in a time of covid-19. Resources www.bmj.com/coronavirus www.bmj.com/wellbeing www.bmj.com/podcasts https://www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-patients_pdf-80706341.pdf

This edition of talk evidence was recorded before the big increase in covid-19 infections in the UK, and then delayed by some self isolation. We'll be back with more evidence on the pandemic very soon. As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence). in this episode (1.01) Helen talks about variation in prescription of opioids - do 1% of clinician really prescribe the vast majority of the drug? (8.45) Carl tells us that its time papers (in this case a lung screening one) really present absolute numbers. (17.30) Carl explains how a spoonfull (less) of salt helps the blood pressure go down (21.25) Helen puts test results under a microscope, and finds out that they may vary. (33.20) What do conflicts of interest in tanning papers mean for wider science? (48.05) Carl has a "super-rant" about smartphone apps for skin cancer - and a sensitivity of 0. Reading list: Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study https://www.bmj.com/content/368/bmj.l6968 Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1911793 Effect of dose and duration of reduction in dietary sodium on blood pressure levels https://www.bmj.com/content/368/bmj.m315 Your results may vary: the imprecision of medical measurements https://www.bmj.com/content/368/bmj.m149 Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning: systematic review https://www.bmj.com/content/368/bmj.m7 Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studies https://www.bmj.com/content/368/bmj.m127

The NHS is a world leader in sustainable healthcare - and it's the staff who have have been leading the charge. The For A Greener NHS campaign is asking everyone who has made a change to the way they work, to submit evidence and help shape the whole organisation's response to the climate emergency. In this podcast, Isobel Braithwaite, public health registrar & academic clinical fellow at UCL, and Sandy Robertson, LTFT Emergency Medicine Trainee and Chair of RCEM environmental specialist interest group, join us to explain what they're doing, and what kind of evidence is needed. For more on the For A Greener NHS campaign https://www.england.nhs.uk/greenernhs/ To submit evidence https://www.engage.england.nhs.uk/survey/nhs-net-zero/

We all know we should be doing more exercise, and one way to do that is by active commuting - journeying to work on foot or by bike. One thing preventing people from taking up cycling is the fear of being involved in road traffic accidents, and that the risk isn't worth the benefit of the extra exercise. It’s even more confusing when air pollution has to be taken into account. Joining us to discuss new research into that risk/benefit calculation are Paul Welsh, a Senior Lecturer, and Carlos Celis, a research fellow, both Institute of Cardiovascular & Medical Sciences at the University of Glasgow. Read their open access research - Association of injury related hospital admissions with commuting by bicycle in the UK: prospective population based study https://www.bmj.com/content/368/bmj.m336

We know that the number of people living with multiple health conditions is rising year on year, and yet training, guidelines, organisations and physical spaces in healthcare still largely focus on single diseases or organ systems. The means that patients in the NHS are often treated as if their conditions exist in isolation, and that their care lacks coordination, and isn't as good as it should be. To look at why patients with multiple conditions pose a challenge to the NHS, and what we can do to improve the care they receive, we’re joined by Louella Vaughan, acute physician and senior clinical fellow at the Nuffield Trust Jihad Malasi, GP and clinical chair of Thanet CCG Rammya Mathew, GP and a quality improvement lead and columnist for The BMJ and David Oliver, consultant in geriatrics, clinical vice president of the RCP and columnist for The BMJ

In this week's special episode of Sharp Scratch, we've got something a little different for you! Last week the panel talked microaggressions, so this week we're hearing from an expert guest who is leading the work the NHS is doing to combat inequality in healthcare. If you like this special edition, let us know on Facebook, Instagram or Twitter using #SharpScratch This week's special guest: Yvonne Coghill, CBE is the director of Workforce Race Equality Standard (WRES) at NHS England and NHS Improvement. Yvonne has over 20 years’ experience in nursing, before taking up operational and strategic leadership posts. During her 40 plus years career, she has held a wide variety of clinical and managerial roles at the Department for Health and NHS Leadership Academy. In 2013 she was voted by colleagues in the NHS as one of the top 50 most inspirational women, one of the top 50 most inspirational nurse leaders and one of the top 50 black and minority ethnic (BME) pioneers, two years in a row. In July 2015 Yvonne joined NHS England as director for WRES Implementation. She was awarded an Order of the British Empire for services to healthcare in 2010 and Commander of the British Empire in 2018. Yvonne was elected deputy president of the Royal College of Nursing (RCN) in November 2018. Some of the resources Yvonne mentions during the interview: https://www.england.nhs.uk/2020/02/nhs-publishes-new-workforce-race-equality-data-ahead-of-nhs-and-race-summit/ https://www.england.nhs.uk/about/equality/equality-hub/equality-standard/resources/ https://www.england.nhs.uk/2019/01/race-equality/

Last week the BMJ published it’s first special edition into Racism in Medicine. The issues tacked ranged from differential attainment in medical school, to the physiological effects that experiencing everyday discrimination has. The issue was guest edited by Victor Adebowale, the Chief Executive of the social care enterprise Turning Point, and Mala Rao, Professor of Public Health, at Imperial College London - and they, along with Simon Stevens, chief executive of the NHS, Chand Nagpul Chair of council of the BMA, and the Olalade Obedare, medical student from Nottingham University Medical School, talked at the event. www.bmj.com/racism-in-health.

We're taking a break from the usual Talk Evidence to focus on the new corona virus that has emerged in China. With a brand new disease, we have to build our evidence base from scratch - basic virology, epidemiology, pathogenicity, transmissibility, and ultimately treatment are all unknowns. In this episode of Talk Evidence, we're trying to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. (8.00) Peter Openshaw, professor of experimental medicine at Imperial College London, talks to us about the pathogenicity of covid-19 (17.30) Wendy Barclay, head of the Department of Infectious Disease at Imperial College London, describes what can change the R0 of a viral disease. (20.50) Raina MacIntyre, professor of biosecurity at the Kirby Institute at the University of New South Wales, talks to us about how effective masks are at preventing spread of viruses. (30.00) We discuss treatment options in the face of massive uncertainty. To read more about covid-19 and to keep up to date with the disease visit https://www.bmj.com/coronavirus where all of the information on the disease if freely available.

There comes a tipping point in all campaigns when the evidence is overwhelming and the only way to proceed is with action. According to David Williams, it’s time to tackle the disproportionate effects of race on patients in the UK. David Williams, from Harvard University, developed the Everyday Discrimination Scale that, in 1997, launched a new scientific approach to assessing social influences, such as racism, on health. He’s shown that people who experience every day acts of discrimination— like getting poorer service in a bank or a restaurant, or being treated with less courtesy—will over time have worse health outcomes, including higher rates of heart disease, lower life expectancy, and greater infant mortality. In this podcast he is interviewed by Lilian Anekwe, assistant news editor for New Scientist. Read Lilian's article on tackling racism in the NHS https://www.bmj.com/content/368/bmj.m341 And all of the special issue on racism in medicine https://www.bmj.com/racism-in-medicine

In 2012, Eleni Linos, professor of dermatology at Stanford university, published a systematic review and meta-analysis of the link between non-melanoma cancer and sun-beds. That bit of pretty standard research, and a particular rapid response to it, has kicked of years of work - and in this podcast I talk to Eleni and her colleagues Stanton Glantz, and Yogi Hendlin about what they’ve uncovered. Reading list: Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning https://www.bmj.com/content/368/bmj.m7 Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis https://www.bmj.com/content/345/bmj.e5909

In many countries (including the UK and Australia) it is still common practice for hospital doctors to write letters to patients’ general practitioners (GPs) following outpatient consultations, and for patients to receive copies of these letters. However, Hugh Rayner, consultant nephrologist, and Peter Rees, former Chair of the Academy of Medical Royal Colleges' lay patient committee, suggest that hospital doctors who have changed their practice to include writing letters directly to patients have more patient centred consultations and experience smoother handovers with other members of their multidisciplinary teams. Read their article explaining what makes for a good outpatient letter; https://www.bmj.com/content/368/bmj.m24

In October 2019, Mary Dixon-Woods, director of the THIS Institute, dedicated to healthcare improvement. In that she explained how she believed healthcare improvement could be improved. The essay took the position that "Quality Improvement" isn't necessarily the best way to improve healthcare, and that more rigour needs to be brought to the field. That paper has created a great deal of discussion, so in this podcast we wanted to go back to Mary and ask her what she thinks about improvement, and how we can practically put into place some of the things she calls for. Read the full essay: https://www.bmj.com/content/367/bmj.l5514 And the rest of our healthcare improvement series: https://www.bmj.com/quality-improvement

Precocious puberty, that is puberty that starts before age 8 in girls and 9 in boys seems to be on the rise, but whether that’s because of an increase in incidence, or greater attention is unknown - what we do know that precocious puberty in girls is commonly idiopathic, while in boys is a red flag for pathology. But either way ther first point of call is the GP. In this podcast, Steven Bradley GP, and Neil Lawrence, paediatric trainee join us to discuss how common precocious puberty is, how GPs should respond to a family presenting with it, and if intimate examination is actually warranted in primary care. Read the full practice pointer: https://www.bmj.com/content/368/bmj.l6597

Welcome to the festive talk evidence, giving you a little EBM to take you into the new year. As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence)* This month: (1.20) Carl tells us about new research on treating sepsis with steroids that might inform practice. (4.58)Proscribing of prophylactic PPIs or H2-blockers for intensive care patients. (11.00) Carl wonders if we can actually rule out an increased risk of ovarian cancer with the use of talc. (17.46) Helen drops and EBM bombshell - is all the work needed to blind participants in a double blind randomised control trial actually worth it? (33.00) Helen is annoyed about a press release from the department of health, and kicks of 2020 by stealing Carl's rant spot. Reading list: Corticosteroids for Treating Sepsis in Children and Adults https://pubmed.ncbi.nlm.nih.gov/31808551-corticosteroids-for-treating-sepsis-in-children-and-adults/?dopt=Abstract Gastrointestinal bleeding prophylaxis for critically ill patients: a clinical practice guideline https://www.bmj.com/content/368/bmj.l6722 Association of Powder Use in the Genital Area With Risk of Ovarian Cancer. https://www.ncbi.nlm.nih.gov/pubmed/31910280 Blinding Fool’s gold? Why blinded trials are not always best https://www.bmj.com/content/368/bmj.l6228 Impact of blinding on estimated treatment effects in randomised clinical trials https://www.bmj.com/content/368/bmj.l6802 *quick note to say sorry about the sound quality on Duncan's microphone - we had a technical glitch (he was left alone to record).

In a British cohort, 30% of patients who had survived childhood cancer had died within 45 years of diagnosis; only 6% were expected to have died. 51% had developed a new primary cancer, but a 26% died of cardiovascular disease - thought to be caused by their treatment. Consequently, efforts to reduce long term mortality have focused on reducing exposure to the most toxic aspects of anticancer treatment, including radiotherapy. In this podcast we’re joined by Daniel Mulrooney, associate professor in the Division of Cancer Survivorship, at St Jude Children’s Research Hospital and one of the authors of the paper Major cardiac events for adult survivors of childhood cancer diagnosed between 1970 and 1999: report from the Childhood Cancer Survivor Study cohort Read the full research: https://www.bmj.com/content/368/bmj.l6794

Is it possible to have a fair price for medicines? Yes, according to a new collection just published on bmj.com. The authors set out to evaluate how we could improve the functioning of the market for medicines, to honestly compensate industry for innovation, whilst allowing the poorest to afford them. Suerie Moon, co-director of global health at the Graduate Institute of Geneva joins us to explain what's wrong with how we decided what to pay for medicine's now, and how we could change that. Read the full collection: https://www.bmj.com/fair-pricing

Michael West is professor of organisational psychology, at Lancaster University, and co-author of a new GMC report into the wellbeing of NHS staff. The review he led together with the clinical psychiatrist Denise Coia, focused on primary interventions related to workplace factors and the systems that doctors work in, rather than secondary interventions such as resilience training. In this podcast interview, he describes what he found - and talks about how low wellbeing is amongst doctors, why the command and control nature of some management teams has increased the problem, and why he has hope because of some of the good practice he sees in NHS organisations. Read the full report: https://www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-patients_pdf-80706341.pdf

If you read the Christmas BMJ in the last few weeks, you might have noticed a lot around art and health - the way in which engagement in arts can help in prevention and treatment, but can also affect those more nebulous things which really matter to patients - loneliness, self expression, being connected to the wider community. That obviously links to social prescribing, which looks like it’s going to be one of the big changes to medicine which will happen in near future. In this podcast we hear from Simon Opher, a GP in gloucestershire who has had artists and poets in residence in his surgery, and has experience of setting up services which link art and health - and we discuss how to do that practically. SImon makes it sound easy, but also has a few tips for GPs out there who have an idea about a non-medical service that could help their patients, but doesn’t yet exist. We’ll also be talking to Helen Stokes Lampard, former chair of the Royal College of Surgeons and head of the new National Academy for Social Prescribing - as services bloom, how do we know what actually works? Helen is sceptical that our current ways of evaluating an intervention are going to be inadequate to look at the much more messy world of social prescribing, with it’s localisation, multitude of influences, and difficult to measure outcomes. Reading list: Previous BMJ podcast on social prescribing https://podcasts.apple.com/no/podcast/social-prescribing/id283916558?i=1000446265663 Clinical update on social prescribing https://www.bmj.com/content/364/bmj.l1285

If you’re lucky enough to not be back at work, you might be feeling like you need to quickly refresh your medical knowledge - and this podcast the BMJ’s education editors take you on a whistlestop tour through the BMJ’s education articles of 2019. Tom Nolan (GP in London) is joined by Navjoyt Ladher (GP in London), Anita Jain (GP in India) and Jenny Rasanathan (GP in Phnom Penh). Our reading list: Please don’t call me mum https://www.bmj.com/content/367/bmj.l5373 Which emollients are effective and acceptable for eczema in children? https://www.bmj.com/content/367/bmj.l5882 Pre-eclampsia: pathophysiology and clinical implications https://www.bmj.com/content/366/bmj.l2381 A borderline HbA1c result https://www.bmj.com/content/365/bmj.l1361

Welcome to the festive talk evidence, giving you a little EBM to take you into the new year. As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence) This month: (2.00) Helen look back at a Christmas article, which investigates a very common superstition in hospitals. (7.55) Carl has his pick of the top 100 altimetric most influential papers of the year. (12.40) We find out all about the preventing overdiagnosis conference which happened earlier in December. (34.15) Helen has her annual rant about misogeny in medicine. Reading list: Q fever—the superstition of avoiding the word “quiet” as a coping mechanism https://www.bmj.com/content/367/bmj.l6446 Altimetric Top 100 https://www.altmetric.com/top100/2019/ Fiona Godlee’s keynote at Preventing Overdiagnosis https://www.preventingoverdiagnosis.net/ Gender differences in how scientists present the importance of their research: observational study https://www.bmj.com/content/367/bmj.l6573

The internecine takes on medical specialty are a common thread in the Christmas BMJ, and this year we're doing it through the lens of driving. Which speciality speeds the most, who has the nicest cars? André Zimerman, soon to be cardiologist, and researcher lets us know - and also why you can't rely on being a doctor to get off a speeding ticket. At least in Florida. Read the full article: https://www.bmj.com/content/367/bmj.l6354

As editors, we feel like we’re spending a lot of time taking the superlatives out from articles - amazing, novel, important… But new research on BMJ.com suggests that we might not be doing that great a job, and that for some reason, papers authored by men tend to have more of them - because men put more in, or maybe a bias against woman writing in that way. Marc Lerchenmueller, assistant professor at the University of Mannheim joins us to talk about how they did the research, and what it means for women's careers. Read the full article https://www.bmj.com/content/367/bmj.l6573

We’re back for the December Talk Evidence, and this month we’re being very digital Firstly,(1.20) Helen tells us about arthritic fingers - should we be using prednisolone for treatment when people have painful osteoarthritis of the hand Then (13.30) Carl gets us all to check our fingers for clubbing, and we find out how useful it is as a test for lung cancer (23.10) Minna Johansson GP and Cochrane Sweden researcher explains why EBM needs to take into account sustainability, and why that isn’t just carbon footprint. (33.50) We talk AF and the Apple Watch - and why drop out is going to be a massive problem for the kind of big studies that they’re attempting to do with new consumer smart devices. This month's reading: Results of a 6-week treatment with 10 mg prednisolone in patients with hand osteoarthritis (HOPE) https://www.sciencedirect.com/science/article/pii/S0140673619324894?via%3Dihub Cancer research UK - finger clubbing and mesothelioma https://www.cancerresearchuk.org/about-cancer/mesothelioma/symptoms/finger-clubbing Cochrane launches new Sustainable Healthcare Field, in Lund https://sweden.cochrane.org/news/cochrane-launches-new-sustainable-healthcare-field-lund Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/NEJMoa1901183

In this special edition of talk evidence, Helen Macdonald and Carl Henneghan talk about creating an evidence base from harms. We hear from a member of the pubic who experienced harm from a drug, and now advises the FDA. A former regulator who explains why reporting harms is so important. And finally, an investigative journalist who explains what "ghost management" is.

The UK general election is happening this week, and you’ve probably made your mind up which MP you’re voting for already - and maybe the NHS has influenced that decision. This year has seen an increase in the number of doctors running for parliament, and in this podcast we find out what motivates doctors to step away from clinical practice, and why their voice on national issues is important to guide the health of their patients. We’re joined by Louise Irving, gp and former parliamentary candidate for the NHS action party, and Andy Cowper, editor of Health Policy Insight

UK general election has been called - polling day is on the 12th of December, and from now until then we’re going to be bringing you a weekly election-themed podcast. We want to help you make sense of the promises and pledges, claims and counter-claims, that are being made around healthcare and the NHS out on the campaign trail. This week we're focussing on what the NHS means to the election, from people who have been inside the political process and know about how campaign promises are made. We talk about retail pledges, and why spending claims which don't cause real change might come back to bite politicians. Joining us are Sally Warren, director of policy at The King's Fund, Siva Anandaciva, chief analyst at The King's Fund and Bill Morgan, former policy advisor and founding partner of Incisive Health www.kingsfund.org.uk/Podcast‎ https://www.kingsfund.org.uk/topics/general-election-2019

A UK general election has been called - polling day is on the 12th of December, and from now until then we’re going to be bringing you a weekly election-themed podcast. We want to help you make sense of the promises and pledges, claims and counter-claims, that are being made around healthcare and the NHS out on the campaign trail. This week we're focussing on health beyond the NHS - public health spending, and pledges to tackle air pollution and climate change. To discuss we're joined by Jennifer Dixon, chief executive of the Health Foundation, and Nicky Philpott, director of the UK Health Alliance on Climate Change. Reading list The BMJ's 2019 election coverage https://www.bmj.com/content/general-election-2019 Health Foundation report: Mortality and life expectancy trends in the UK https://www.health.org.uk/publications/reports/mortality-and-life-expectancy-trends-in-the-uk UK Health Alliance on Climate Change general election briefing http://www.ukhealthalliance.org/general-election-briefing/

A UK general election has been called - polling day is on the 12th of December, and from now until then we’re going to be bringing you a weekly election-themed podcast. We want to help you make sense of the promises and pledges, claims and counter-claims, that are being made around healthcare and the NHS out on the campaign trail. This week we're focussing on spending pledges. NHS budgets have not been keeping up with healthcare demand, and social care is in dire financial straits. David Oliver, consultant physician in Berkshire and author of the weekly BMJ “Acute perspective” column, and Hugh Alderwick, assistant director of policy at the Health Foundation. Reading list Acute perspective column https://blogs.bmj.com/bmj/category/columnists/david-oliver/ Health Foundations analysis of spending https://www.health.org.uk/news-and-comment/blogsf talk through what the parties are promising

A UK general election has been called - polling day is on the 12th of December, and from now until then we’re going to be bringing you a weekly election-themed podcast. We want to help you make sense of the promises and pledges, claims and counter-claims, that are being made around healthcare and the NHS out on the campaign trail. This week has seen pledges about GP numbers, so we're focussing on primary care - and are joined by two GPs, Clare Gerada, co chair of the NHS Assembly, and former chair of the Royal College of GPs, and Rebecca Rosen, who is also a senior fellow at the Nuffield Trust. Reading list: Health, wellbeing, and care should be top of everyone’s political agenda https://www.bmj.com/content/367/bmj.l6503 Labour pledges to outspend Conservatives on health with £26bn NHS “rescue plan” https://www.bmj.com/content/367/bmj.l6537 Tories promise 6000 extra GPs by 2024 https://www.bmj.com/content/367/bmj.l6463 Is the number of GPs falling across the UK? https://www.nuffieldtrust.org.uk/news-item/is-the-number-of-gps-falling-across-the-uk

Reverse innovation may sound like some attempt to return to the dark ages - but it has a specific meaning, especially when it comes to med-tech. It’s about where we look for innovation - and overturning our preconceived ideas of where new ideas come from. Mark Skopec, and Matthew Harris - both from Imperial College London are two of the authors of a new analysis, setting out to highlight those preconceptions, and creating new routes to bring innovation into the NHS. Read the analysis: https://www.bmj.com/content/367/bmj.l6205

Talk Evidence is back, with your monthly take on the world of EBM with Duncan Jarvies and GPs Carl Heneghan (also director for the Centre of Evidence Based Medicine at the University of Oxford) and Helen Macdonald (also The BMJ's UK research Editor). This month Helen talks about the messy business of colon cancer screening - which modality is best, and in what population is it actually effective (1.40) Carl talks about how the Netherlands did the right research at the right time to stop a new pregnancy scan before it became routine (10.35) The Rant: acronyms in research papers (17.45) Mini Rant: politicisation of the NHS, and Carl pitches for yet another job (25.15) Research in the news has talked about the importance of when drugs are taken, to maximise efficacy. Melvin Lobo, cardiologist specialising in hypertension joins us to explain that research and why we seem to have forgotten about that effect. Reading list: Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a clinical practice guideline https://www.bmj.com/content/367/bmj.l5515 Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study): nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial https://www.bmj.com/content/367/bmj.l5517 Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/5602478

Giving staff the confidence to speak out is important in healthcare - It's a key aspect of the WHO patient safety checklist, decreasing incidence of medical error, but it's also important to stop incidents of harassment and abuse which undermine staff and increase burnout. Creating that culture is a difficult task, but two hospitals in the southern hemisphere have been trying to do do that by putting in place ways which support staff in making complaints when they wouldn't normally feel confident to do so. In this podcast we hear from Alex Sia, CEO of KK hospital Singapore, Jeanette Conley, medical executive at Adventist Healthcare in Sydney and Mark O”Brien, medical director of the Cognitive Institute, who talk about their challenges and successes in changing the way they work. For more on burnout; https://podcasts.apple.com/co/podcast/burnout-dont-try-to-make-canary-in-coal-mine-more-resilient/id283916558?i=1000446459269 http://www.bmj.com/wellbeing

The NHS Practitioner Health Programme - once only for doctors in London, now it’s being rolled out across the NHS to provide the largest, publicly funded, comprehensive physician health service, in the world. However, while helping the individual is essential, systemic change needs to be made to support doctors in our healthcare system. Clare Gerada, GP and medical director of NHS PHP joins us to talk about how the expanded service will work, and what role regulation and inspections should play in wellbeing. For more on the NHS PHP https://blogs.bmj.com/bmj/2019/10/31/clare-gerada-protecting-practitioners-health/ 020 3049 4505 https://php.nhs.uk/

There has been a lot of noise made about calorie counts on labels - the idea being it’s one of those things that might nudge people to make healthier choices. So much so that in 2018, in the USA, it became mandatory for food chains with more than 20 outlets to label the calories in their food. But the effectiveness of that is hard to gauge - it’s relied on reporting from customers, which leads to an incomplete picture. The really killer data would be from the chains themselves, but they’re reluctant to share that widely. That's where new research comes in - and we're joined in the podcast by Joshua Petimar, postdoctoral researcher at the Harvard T.H. Chan School of Public Health, and Jason Block, associate professor at Harvard Pilgrim Healthcare Institute & Harvard Medical School, to discuss what they've done. Read the full research: https://www.bmj.com/content/367/bmj.l5837

A TB infection can take two forms, active and latent. Active disease is transmissible, and causes the damage to the lungs which makes TB one of the biggest killers in the world. In the latent form, the bacteria Mycobacterium tuberculosis is quiescent and can stay that way for years until it becomes active and causes those clinical signs. Testing for the active version of the disease is done directly, but when it comes to latency, we use the tuberculin skin test to see if someone has an immunological response - and when that happens we consider them to have latent disease. However, in this podcast Lalita Ramakrishnan, professor of immunology and infectious diseases at the University of Cambridge; Paul Edelstein, professor of pathology and laboratory medicine at the University of Pennsylvania; and Marcel Behr, professor of medicine at McGill University question that conclusion. Read their full analysis: https://www.bmj.com/content/367/bmj.l5770/ Their previous analysis: https://www.bmj.com/content/362/bmj.k2738.abstract And search for their previous podcast - "Have we misunderstood TB's timeline?"

This week, Dr Arnav Agarwal joins Ray to share the perspective and experiences of a young, recently graduated doctor working in a busy, metropolitan hospital. Despite the long shifts and demanding environment, Arnav makes time and space to reflect on work, life and mortality through his thought-provoking poetry and volunteer work.

This week, Ray ventures into the notoriously complex field of nutrition with special guest, Professor Marion Nestle. Named by Forbes as one of the world's most powerful foodies, Marion’s stellar career spans five decades of research, teaching, advocacy work and the publication of countless prize-winning books.

Statins are now the most commonly used drug in the UK and one of the most commonly used medicines in the world, but debate remains about their use for primary prevention for people without cardiovascular disease. Paula Byrne from the National University of Ireland Galway, joins us to talk about the evidence of benefit for low risk individuals, and what needs to be done to finally answer the questions about efficacy and harms. Read the full analysis: https://www.bmj.com/content/367/bmj.l5674

Direct-to-consumer genetic tests are sold online and in shops as a way to “find out what your DNA says". They insights into ancestry or disease risks; others claim to provide information on personality, athletic ability, and child talent. However, interpretation of genetic data is complex and context dependent, and DTC genetic tests may produce false positive and false negative results. Rachel Horton, clinical training fellow, Anneke Lucassen, chair of British Society of Genetic Medicine, and Jude Hayward the RCGP clinical champion for genomics join us to discuss how this deluge of genetic data is affecting patients, GPs and clinical geneticists in the NHS. Read the full article: https://www.bmj.com/content/367/bmj.l5688

Blockchain is the digital technology that underpins cryptocurrencies such as bitcoin, and has been proposed as the digital panacea of our times. But Leeza Osipenko, from the London School of Economics, has thought about how it could actually be used in clinical trials, and what else would need to change in our regulatory environment to make that work. Read her full essay: https://www.bmj.com/content/367/bmj.l5561