Effective, efficient, patient-centred and safe healthcare is what we all want to see, and what the field of quality improvement is all about.

In these podcasts, Harriet Vickers talks to doctors and other healthcare professionals about how they’ve gone about improving care for their patients, and explores the ideas and techniques behind making change happen.

http://quality.bmj.com
 

Making the difference

The BMJ Best Practice podcast publishes interviews with clinical experts, aimed at healthcare professionals and students with an interest in keeping up to date with the latest scientific developments, evidence-based medicine and guidelines. 

BMJ Best Practice is ranked one of the best clinical decision support tools for health professionals worldwide.* Structured around the clinical workflow and updated daily, BMJ Best Practice uses the latest evidence-based research, guidelines and expert opinion to offer step-by-step guidance on diagnosis, prognosis, treatment and prevention.

bestpractice.bmj.com

*Kwag KH, González-Lorenzo M, Banzi R, Bonovas S, Moja L. Providing Doctors With High-Quality Information: An Updated Evaluation of Web-Based Point-of-Care Information Summaries

The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

BMJ Best Practice Podcast

From June 2023, all our podcasts will move to https://heartbmj.podbean.com.
You can continue with your subscription on your favourite podcast App.

Heart is an international, peer-reviewed journal that keeps cardiologists up to date with advances in the diagnosis and treatment of cardiovascular disease. Each issue contains original research, accompanying editorials and reviews.
* The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

Heart podcast

From June 2023, all our podcasts will move to https://dtbbmj.podbean.com.
You can continue with your subscription on your favourite podcast App.

For 50 years, Drug and Therapeutics Bulletin (DTB) has provided rigorous and independent evaluations of, and practical advice on, individual treatments and the overall management of disease for doctors, pharmacists and other healthcare professionals. DTB has always been wholly independent of the pharmaceutical industry, Government and regulatory authorities. DTB is also free of advertising and other forms of commercial sponsorship.
Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page - https://podcasts.apple.com/gb/podcast/dtb-podcast/id307773309.
* The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

DTB podcast

From June 2023, all our podcasts will move to https://fgbmj.podbean.com.
You can continue with your subscription on your favourite podcast App.

Frontline Gastroenterology publishes articles that accelerate adoption of innovative and best practice in the fields of gastroenterology and hepatology. Frontline Gastroenterology is especially interested in articles on multidisciplinary research and care, focusing on both retrospective assessments of novel models of care as well as putative future directions of best practice. Specifically Frontline Gastroenterology publishes articles in the domains of clinical quality, patient experience, service provision and medical education.
Listen to our regular podcasts and subscribe in Apple Podcasts, Google Podcasts, Stitcher and Spotify.
* The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

FG podcast

The mental health of athletes has been in the spotlight throughout this summer, as high-profile athletes such as Naomi Osaka and Simone Biles have spoken out about the importance of prioritizing their physical, and especially their mental, well-being.

In this episode, host Dr. Giselle Aerni, MD is joined by AMSSM Past Presidents Dr. Cindy Chang, MD and Dr. Margot Putukian, MD to discuss the AMSSM Position Statement on Mental Health Issues and Psychological Factors in Athletes, which Dr. Aerni also co-authored.

In this 33-minute conversation, they address the following topics:
The importance of a position statement on the mental health of athletes and the novel aspects addressed in the document
The team-based approach to mental health care and why it’s a crucial component for the well-being of athletes
How the acceptance of mental health issues has evolved in recent years and the impact social media has on those perceptions
The impact of the COVID-19 pandemic on athletes’ mental health and how it reinforces the need for conversations about this vital issue

Resources:
Mental health issues and psychological factors in athletes: detection, management, effect on performance and prevention: American Medical Society for Sports Medicine Position Statement (https://bjsm.bmj.com/content/54/4/216.full)
Madam Athlete Podcast (https://madamathlete.com/)

The Importance of Mental Health in Athletes with Two AMSSM Past Presidents EP #483

Karim Khan calls mechanotherapy “the most important fundamental concept that underpins rehabilitation exercises”. 

Listen to Karim explain that all exercise-based rehabilitation relies on the cells of the injured tissue sensing the exercise stimulus, converting that signal to protein synthesis, and repairing tissue. He explains why ‘rest doesn’t work’ and argues that mechanotherapy has substantial evidence in its favour. The process applies to all body tissues – to injuries / pathology in bone, muscle, tendon and cartilage. 

Read the review article, which has had over 32,000 full-page views since 2009:

Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair -  http://bjsm.bmj.com/content/43/4/247.full


“Mechanotherapy” and why it’s important for clinicians with Karim Khan

In this podcast, Dr. Truchetet discusses her work on the role of innate lymphoid cells in the fibrotic processes in systemic sclerosis (SSc) patients. The group of Dr. Truchetet found that ILC2 are crucial mediators of skin fibrosis in SSc and that combined treatment of patients with TGFb inhibitors and IL-10 might be an attractive new therapeutic approach in SSc. 
Read the full paper on the ARD website: https://ard.bmj.com/content/80/12/1594
Please subscribe to the ARD podcast on all podcast platforms, including Apple Podcast, Google Podcasts, Stitcher and Spotify. If you enjoy the show, feel free to leave us a comment or a review on the podcast iTunes page (https://podcasts.apple.com/gb/podcast/ard-podcast/id1171058059).

Innate Lymphoid Cells link TGFb and fibrotic pathways in systemic sclerosis skin

Transient ischemic attacks are common - in the UK, the US and around the world. And they are important – mainly because of the high risk of stroke following a TIA. The risk of stroke is high in the first 7 days. So it is important to get on with diagnosis, investigations, and management as soon as possible.  In this BMJ Best Practice podcast, Kieran Walsh talks to Dr Jennifer Simpson, Vascular Neurologist and Associate Professor in the Department of Neurology at the University of Colorado.

-

The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

TIA - an update on diagnosis and management

Herpes zoster: an update on diagnosis and management
The annual incidence of herpes zoster in the UK is between 2 and 4 patients per thousand population. It can cause a range of complications including post-herpetic neuralgia, herpes zoster of the eye, and disseminated zoster. So it is important that we get the diagnosis and management of this condition right.  In this BMJ Best Practice podcast on herpes zoster, Kieran Walsh talks to Professor  Michael Rothberg, Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio.  MR declares that he has no competing interests.-

The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

Herpes zoster infection

Data and big data in healthcare are both important and topical. Big data has the potential to transform how we provide healthcare but can also be problematic. There can be problems with how data is captured, cleaned, and corrected or with how we update data. BMJ is playing an increasing role in this field. We have our own BMJ Data Set which provides AI healthcare technologies with current, credible, and AI-ready content. In this BMJ Best Practice podcast on healthcare and data, Kieran Walsh talks to Professor Dipak Kalra, President of The European Institute for Innovation through Health Data.

Data and healthcare

We release episodes fortnightly. Parkinson's disease is a common and serious condition. It is the second most common neurodegenerative disorder in the world - only Alzheimer's disease is more common. And Parkinson's disease can cause a range of complications - from dyskinesias to depression to dementia. So it is important that we get the diagnosis and management of this condition right. In this BMJ Best Practice podcast, Kieran Walsh talks to Delaram Safarpour, Assistant Professor of Neurology at Oregon Health & Science University.

Competing interests: DS has received honoraria for participation in advisory boards for Boston Scientific (the manufacturer of Deep Brain Stimulation devices) and Abbvie (the manufacturer of Duopa). She has received consultation fees from Abbott (the manufacturer of Deep Brain Stimulation devices). DS has received an institutional grant and has received an honorarium for lectures from the Parkinson’s Study Group.

Parkinson's disease

We release episodes fortnightly. Bell's palsy is the most common unilateral facial palsy in adults. It is most prevalent in people between 15 and 45 years of age. And it can cause a range of complications - including ongoing facial weakness, keratoconjunctivitis sicca, exposure keratopathy, and ectropion. So it is important that we get the diagnosis and management of this condition right. In this BMJ Best Practice podcast, Kieran Walsh talks with Professor Matthew Miller about Bell's palsy. Matt is Assistant Professor Otolaryngology and Head and Neck Surgery, University of North Carolina Chapel Hill. 

Competing interests: none declared

Bell's palsy: an update on diagnosis and management

We release episodes fortnightly. Stroke is the fourth and fifth leading cause of death in the UK and US, respectively. There are more than 100,000 strokes in the UK every year. And approximately 10% to 15% of all ischaemic strokes are associated with carotid artery stenosis. So it is important that we get the diagnosis and management of this condition right. In this BMJ Best Practice podcast on carotid artery stenosis, Kieran Walsh talks to Brajesh Lal, Professor of Vascular Surgery, University of Maryland School of Medicine and Professor of Neurology, Mayo Clinic. 

Competing interests: None

Carotid artery stenosis: an update on diagnosis and management

In this episode of the Heart podcast, Digital Media Editor, Dr James Rudd, is joined by Professor Carolyn Lam, a world expert in heart failure from the University of Singapore and the National Heart Centre, also in Singapore. They discuss updates in the diagnosis and management of heart failure, including wearables, biomarkers, the 4 pillars of therapy, and how and why there has historically been an under-representation of women in heart failure trials. 

This episode is sponsored by an educational grant from the Boehringer Ingelheim-Lilly Alliance. The sponsor has no influence over podcast content, the selection of speakers or any associated educational material. 

If you enjoy the show, please leave us a podcast review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2

Circulation on the Run podcast - https://www.ahajournals.org/circ/podcasts

What's new in heart failure? An update from Professor Carolyn Lam

A selection of the best papers from our December 2022, picked apart and distilled for you by Rick Body and Sarah Edwards. In this festive issue we cover anaesthesia for paediatric forearm fractures, ultrasound diagnosis of acute appendicitis, a deep dive into the predictive value of vital signs, clinical judgement versus early warning scores, pulmonary embolism and... Do you know what calibration drift is? If not, listen and you'll find out!
Read the highlights: https://emj.bmj.com/content/39/12/881.
You can subscribe to the EMJ podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month.
If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244). 
Thank you for listening!

Primary Survey - the highlights of December 2022

In this month's episode, Helen Juan and Joe delve into the clinical - with a new review of endometriosis, and why the difficulty in diagnosis has lead to a dearth of evidence and attention on the condition.

Joe tells us about a risk prediction tool that could be useful in helping to mitigate some of the problems of antihypertensive treatments.

We're also having a geek out about a group of papers we've published lately, on how well evidence is created, maintained, and diseminated.

Reading list;


Development and external validation of a risk prediction model for falls in patients with an indication for antihypertensive treatment: retrospective cohort study
https://www.bmj.com/content/379/bmj-2022-070918

Pathophysiology, diagnosis, and management of endometriosis
https://www.bmj.com/content/379/bmj-2022-070750


Effective knowledge mobilisation: creating environments for quick generation, dissemination, and use of evidence
https://www.bmj.com/content/379/bmj-2022-070195

Consistency of covid-19 trial preprints with published reports and impact for decision making: retrospective review 
https://bmjmedicine.bmj.com/content/1/1/e000309

Changing patterns in reporting and sharing of review data in systematic reviews with meta-analysis of the effects of interventions: a meta-research study from the REPRISE project
https://www.medrxiv.org/content/10.1101/2022.04.11.22273688v2

Talk Evidence - endometriosis, falling, and better EBM

In this episode of the Dr. Informed podcast, the topic of discussion is death and dying, and how to involve patients in DNACPR decisions.

The panel discuss the importance of doctors having discussions with patients about end-of-life care as a way of creating the best possible death for patients. The conversation also touches on the challenges that doctors may face when having these difficult discussions and they give some advice on how they to overcome them.

Joining Clara are;
Mark Taubert, palliative care consultant, and national chair of future care planning for the Welsh Government
Kat Shelley, an anaesthetics trainee, who has stage four breast cancer, and is receiving palliative care
Lucy-Anne Frank, an elderly care consultant.

The article "Do not resuscitate me in Barbados" is published by BMJ Supportive and Palliative Care, and is free to access at;
https://spcare.bmj.com/content/11/3/310

DNACPR

Dr Philip Smith(1) interviews Dr James Ashton(2) on the papers, "The importance of high quality ‘big data’ in the application of artificial intelligence in inflammatory bowel disease" and "Artificial intelligence and inflammatory bowel disease: practicalities and future prospects" published online in Frontline Gastroenterology in 2022. Read the articles in Frontline Gastroenterology here: 
https://fg.bmj.com/content/early/2022/11/17/flgastro-2022-102342
https://fg.bmj.com/content/13/4/325

(1) Social Media and Associate Editor of FG and Honorary Consultant Gastroenterologist at the Royal Liverpool Hospital, Liverpool, UK.
(2) Paediatric Gastroenterology trainee at the Southampton Children’s Hospital, Southampton, UK, and Clinical Lecturer in Human Genetics and Genomic Medicine at the University of Southampton

Listen to our regular podcasts and subscribe in Apple Podcasts, Google Podcasts, Stitcher and Spotify. If you enjoy our podcast, please rate us on your chosen platform, and leave us a review on the Frontline Gastroenterology Podcast page on iTunes: https://podcasts.apple.com/gb/podcast/fg-podcast/id942944229

Artificial intelligence in inflammatory bowel disease

We release episodes fortnightly. Osteoarthritis is the most common form of arthritis. It is more common in women than in men, with incidence increasing sharply around the age of 50. And it can cause complications - including the inability to perform activities of daily living and spinal stenosis in cervical and lumbar osteoarthritis. So it is vital that we get the diagnosis and management of this condition right. In this BMJ Best Practice podcast on osteoarthritis, Kieran Walsh talks to Fadi Badlissi, Assistant Professor at Harvard Medical School and Director of the Musculoskeletal Medicine Unit at Beth Israel Deaconess Medical Center in Boston. Competing interests: None

Osteoarthritis

Halitosis is common and can affect people of all ages. Severe halitosis is less common but it can affect confidence and quality of life. It can even result in social isolation. So it is important that we get the diagnosis and management of this condition right.

In this BMJ Best Practice podcast on halitosis, Kieran Walsh talks with Professor Stephen Porter, Director of the UCL Eastman Dental Institute in London.

Competing interests: none declared

Halitosis: an update on diagnosis and management

The highlights of this edition brought to you by the Editor-in-Chief of Frontline Gastroenterology Mark Beattie.
Read the UpFront of the January 2023 issue of Frontline Gastroenterology:
https://fg.bmj.com/content/14/1/1
The full issue is now online: https://fg.bmj.com/content/14/1
Listen to our regular podcasts and subscribe in Apple Podcasts, Google Podcasts, Stitcher and Spotify.

Mark Beattie's UpFront January 2023

In this podcast, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the March 2023 issue of DTB. They discuss incorrect penicillin allergy labels and ways that these can be corrected (https://dtb.bmj.com/content/61/3/34). They review clinical trial results for lecanameb in early Alzheimer's disease (https://dtb.bmj.com/content/61/3/37) and also talk about a new combined oral contraceptive that contains estetrol and drospirenone (https://dtb.bmj.com/content/61/3/39). They begin by discussing a proposal from the National Institute for Health and Care Excellence to lower the threshold for offering statins for primary prevention.

The contact address for the DTB team is dtb@bmj.com.
Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page (https://podcasts.apple.com/gb/podcast/dtb-podcast/id307773309). Thank you for listening.

Penicillin allergy, lecanemab and Alzeimer's disease, a new oral contraceptive and statins for all

Spinal cord compression is an extremely serious disorder that can have devastating consequences. These include weakness of the legs, bladder and bowel dysfunction, and loss of sensation.

Rapid diagnosis and treatment can make a big difference to the outcome - so it is vital that we get the diagnosis and management of this condition right. 

In this BMJ Best Practice podcast on spinal cord compression, Kieran Walsh talks with Professor Kenneth Casey, Clinical Associate Professor in Neurosurgery at Michigan State University and Clinical Associate Professor in Physical Medicine and Rehabilitation at Wayne State University School of Medicine.

Competing interests: none declared

We release episodes fortnightly.

Spinal cord compression: an update on diagnosis and management

Dr Philip Smith, Deputy Editor and Associate Editor of FG and Honorary Consultant Gastroenterologist at the Royal Liverpool Hospital, Liverpool, UK interviews Dr Keith Siau, Consultant Gastroenterologist at the Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, UK and Dr Aravinth Murugananthan, Consultant Gastroenterologist at The Royal Wolverhampton NHS Trust, Wolverhampton, UK and Director of the Midlands Endoscopy Training Academy on the paper 'JAG consensus statements for training and certification in colonoscopy’ published online in Frontline Gastroenterology in January 2023 and available online: https://fg.bmj.com/content/early/2023/01/26/flgastro-2022-102260

Listen to our regular podcasts and subscribe in Apple Podcasts, Google Podcasts, Stitcher and Spotify. If you enjoy our podcast, please rate us on your chosen platform, and leave us a review on the Frontline Gastroenterology Podcast page on iTunes: https://podcasts.apple.com/gb/podcast/fg-podcast/id942944229

JAG consensus statements for training and certification in colonoscopy

In a series of podcasts to mark the 60th anniversary of DTB, we talk to some of DTB's Editorial Board members and other colleagues about their work and their involvement with DTB. In this podcast, recorded May 2022, David Phizackerley (DTB's deputy editor) talks to Joanna Girling who is a consultant in obstetric medicine in north London and has been involved with DTB since 2006. Joanna talks about her clinical work, her role with establishing the local maternity network and her involvement in research. She also talks about supporting women who have pre-existing medical conditions and who are pregnant or who are planning pregnancy and the importance of checking that they are on the most appropriate medicines.

The contact address for the DTB team is dtb@bmj.com.
Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page (https://podcasts.apple.com/gb/podcast/dtb-podcast/id307773309). Thank you for listenin

DTB 60th anniversary podcast interview - Joanna Girling

The prevalence of cluster headache is about one in 500. In people coming to a headache clinic, the prevalence is about 10%.

Cluster headaches are excruciating and incapacitating, and affect quality of life. Prompt diagnosis and treatment can make a big difference to the outcome - so it is vital that we get the diagnosis and management of this condition right.

In this BMJ Best Practice podcast on cluster headache, Kieran Walsh talks with Professor Amaal Starling, Associate Professor of Neurology at the Department of Neurology in the Mayo Clinic.

Further resources: clusterbusters.org/.

Competing interests: AS has received consulting fees from AbbVie, Allergan, Amgen, Axsome Therapeutics, Everyday Health, Lundbeck, Med-IQ, Medscape, Neurolief, Satsuma, and WebMD.

We release episodes fortnightly.

Cluster headache: an update on diagnosis and management

In this podcast, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the April 2023 issue of DTB. They discuss evidence around morning and evening doses of antihypertensive medication (https://dtb.bmj.com/content/61/4/50). They review a study that analysed health technology assessment decisions made in Australia, Canada and England (https://dtb.bmj.com/content/61/4/51) and also talk about managing skin conditions in women who are planning pregnancy or who are pregnant (https://dtb.bmj.com/content/61/4/55). They begin by responding to a listener's letter about last month's podcast.

The Prescribing for pregnancy series of articles can be found here: https://dtb.bmj.com/pages/prescribing-for-pregnancy-series/

When should you take antihypertensive medication. Prescribing for skin conditions in pregnancy

Dr Philip Smith, Deputy Editor of FG and Social Media Associate Editor and Honorary Consultant Gastroenterologist at the Royal Liverpool Hospital, Liverpool, UK interviews Dr Simon Everett, Consultant Gastroenterologist at Leeds Teaching Hospitals NHS Trust, Leeds, UK and BSG ERCP and EUS Quality improvement Lead, on the paper 'Individualised consent for endoscopy: update on the 2016 BSG guidelines’ published online in Frontline Gastroenterology in February 2023: https://fg.bmj.com/content/early/2023/02/07/flgastro-2022-102353

Listen to our regular podcasts and subscribe in Apple Podcasts, Google Podcasts, Stitcher and Spotify. If you enjoy our podcast, please rate us on your chosen platform, and leave us a review on the Frontline Gastroenterology Podcast page on iTunes: https://podcasts.apple.com/gb/podcast/fg-podcast/id942944229

Individualised consent for endoscopy: update on the 2016 BSG guidelines

In this episode of the Heart podcast, Andrew Perry visits Dr. Bairey Merz to discuss the diagnosis and management of INOCA and MINOCA. Dr. Bairey Merz spoke on this topic at the American College of Cardiology Scientific Sessions in March 2023. If you enjoy the show, please leave us a podcast review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2

Link to published paper: https://heart.bmj.com/content/104/4/284

INOCA and MINOCA with Dr. C Noel Bairey Merz

Age-related macular degeneration is the third most common cause of visual impairment worldwide. The main risk is advanced disease and resultant visual loss.

Prompt diagnosis and treatment can make a big difference to the outcome - so it is vital that we get the diagnosis and management of this condition right.

In this BMJ Best Practice podcast on macular degeneration, Kieran Walsh talks with Dr. Sajjad Mahmood, Consultant Ophthalmic Surgeon, Medical Retina Specialist, and Honorary Clinical Lecturer at the University of Manchester.

For more on age-related macular degeneration, visit BMJ Best Practice: bestpractice.bmj.com/topics/en-gb/554

Competing interests: SM has done consultancy work and received honoraria for lecturing and travel from Bayer Pharmaceuticals and Novartis. He has also been a principal investigator for clinical trials on behalf of Bayer, Novartis, and Roche.

Age-related macular degeneration: an update on diagnosis and management

Snoring is common. In the 30- to 35-year-old age group, 20% of men and 5% of women snore. By 60, 60% of men and 40% of women will snore habitually.

And snoring can affect the quality of life - of both the patient and their partner.

In this BMJ Best Practice podcast on snoring, Kieran Walsh talks with Dr Showkat Mirza, Consultant in Otorhinolaryngology and Head & Neck Surgery, Sheffield Teaching Hospitals NHS Trust.

For more on snoring, visit BMJ Best Practice: bestpractice.bmj.com/topics/en-gb/1035

Competing interests: SM has no competing interests

Snoring

In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by Dr Rachel M J van der Velden from Maastricht in The Netherlands. They discuss the use of mobile devices for detecting recurrences of AF in high-risk subjects and how acceptable this is to patients. If you enjoy the show, please leave us a podcast review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2

Link to published paper:

https://heart.bmj.com/content/109/1/26

Remote detection of AF - what's acceptable to patients?

Gastro-oesophageal reflux disease (GORD) is a common condition that affects between 10% and 30% of people in developed countries.

There can be a range of complications from haemorrhage to stricture to Barrett's oesophagus. So it is important that we get the diagnosis and management of this condition right.

In this BMJ Best Practice podcast on GORD, Kieran Walsh talks with Dr Andres Carrion, Associate Professor of Clinical Medicine at The Division of Digestive Health and Liver Diseases in University of Miami Miller School of Medicine.

For more on GORD, visit BMJ Best Practice: bestpractice.bmj.com/topics/en-gb/82

Competing interests: None

Gastro-oesophageal reflux disease (GORD)

In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by Dr Helen Routledge from Worcester Royal Hospital, UK. They discuss all aspects of intervention for ischaemic stroke, including the workforce challenges in delivering this lifesaving therapy. If you enjoy the show, please leave us a podcast review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2

Link to published paper:
https://heart.bmj.com/content/109/10/794

Percutaneous management of acute ischaemic stroke

In this podcast, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the May 2023 issue of DTB. They celebrate 60 years since DTB became independent from The Medical Letter and discuss what DTB stands for (https://dtb.bmj.com/content/61/5/66). They review a retrospective cohort study involving people taking oral anticoagulants that compared the risk of bleeding and embolic events in new users of NSAIDs with those not prescribed NSAIDs (https://dtb.bmj.com/content/61/5/67). They also talk about the main review article that explores the therapeutics of siRNA medicines (https://dtb.bmj.com/content/61/5/72). They begin by discussing the UK Government’s recent Budget statement that the MHRA will introduce a new approval process for medicines that have been licensed elsewhere.

May 2023 - another DTB celebration (or two), OACs and NSAIDs, and siRNA-based therapeutics

Adhesive capsulitis affects 2% to 5% of the population. It is slightly more common in women than in men, and is most common in people between the ages of 40 and 70.

And it can cause a range of problems - including pain, stiffness, and loss of function. So it is important that we get the diagnosis and management of this condition right.

To give us more details about this problem and what we can do about it, Kieran Walsh, Clinical Director at BMJ, speaks with Professor Lance LeClerc, Associate Professor of Orthopedic Surgery at Vanderbilt University Medical Centre in Nashville.  

For more on adhesive capsulitis, visit BMJ Best Practice: bestpractice.bmj.com/topics/en-gb/1043

Competing interests: None

Adhesive capsulitis

In this co-interview, both Dr Philip Smith, Deputy Editor of FG and Social Media Associate Editor and Honorary Consultant Gastroenterologist at the Royal Liverpool Hospital, and Dr Vivek Goodoory, Frontline Gastroenterology trainee editor, Clinical Research Fellow and Registrar in Gastroenterology at Leeds Teaching Hospitals NHS Trust, interview Dr Nasar Aslam, Endoscopy Research fellow at University College London Hospitals NHS Foundation Trust, on the paper 'Minimally invasive endoscopic therapies for gastro-oesophageal reflux disease’, published in Frontline Gastroenterology: https://fg.bmj.com/content/14/3/249.

Listen to our regular podcasts and subscribe in Apple Podcasts, Google Podcasts, Stitcher and Spotify. If you enjoy our podcast, please rate us on your chosen platform, and leave us a review on the Frontline Gastroenterology Podcast page on iTunes: https://podcasts.apple.com/gb/podcast/fg-podcast/id942944229

Minimally invasive endoscopic therapies for GORD

In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by Professor Sarah Zaman from the University of Sydney, Australia. They discuss her systematic review and meta-analysis of the effect of this diet specifically in women, something not previously studied. If you enjoy the show, please leave us a podcast review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2

Link to published paper: https://heart.bmj.com/content/early/2023/02/14/heartjnl-2022-321930

Primary Prevention of Cardiovascular Disease in Women with a Mediterranean Diet

Helen Macdonald, Juan Franco, and Joe Ross are back with our monthly update on the world of evidence based medicine.

This episode delves into new methodologies which can use observational data to emulate trial data.  We discuss a new systematic review and meta-analysis of RCTs for surgical treatment of sciatica.  There is elaboration and explanation of the CONSORT Harms 2022 statement - and we'll be asking if it goes far enough. Finally, the old chestnut of surrogate endpoints in cancer treatment trials - are benefits communicated to patients accurately?

Reading list;
Nirmatrelvir and risk of hospital admission or death in adults with covid-19: emulation of a randomized target trial using electronic health records - https://www.bmj.com/content/381/bmj-2022-073312

Surgical versus non-surgical treatment for sciatica
https://www.bmj.com/content/381/bmj-2022-070730


CONSORT Harms 2022 statement, explanation, and elaboration
https://www.bmj.com/content/381/bmj-2022-073725

Funders crack down on unpublished clinical trials—but is it enough?
https://www.bmj.com/content/381/bmj.p840

Communication of anticancer drug benefits and related uncertainties to patients and clinicians
https://www.bmj.com/content/380/bmj-2022-073711

Talk Evidence - cloning, reporting, and disseminating

In this episode of the podcast, Andrew Perry discusses with Dr. Albert the barriers to implementing guideline-directed medical therapy in heart failure with reduced ejection fraction and how to improve matters.

If you enjoy the show, please leave us a podcast review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2

Improving GDMT Implementation in HFrEF with Dr. Nancy Albert of the Cleveland Clinic

There are concerns that junior healthcare professionals do not use decision support as they don’t see senior staff using it. There are concerns that seniors don't use clinical decision support as they worry about looking things up people in front of people. So a complex issue to discuss. 

To find out more about this, listen to this interview with  Dr Tom Foley, Consultant Child and Adolescent Psychiatrist with expertise in digital health.

How to model safe clinical practice

In this podcast, JNIS Editor-in-Chief, Dr. Felipe C. Albuquerque, speaks with Dr. Marco Colasurdo (1) and Prof. Dheeraj Gandhi (2), authors of the original research article, "Predictors for large vessel recanalization before stroke thrombectomy: the HALT score" - https://jnis.bmj.com/content/early/2023/04/25/jnis-2023-020220

This paper is free-to-access for a month following the publication of this podcast. 

Please subscribe to the JNIS Podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest episodes. Also, please consider leaving us a review or a comment on the JNIS Podcast iTunes page: https://podcasts.apple.com/gb/podcast/jnis-podcast/id942473767 

Thank you for listening! This episode was edited by Brian O'Toole. 

(1) Interventional Neuroradiology, Dept. of Diagnostic Radiology, Uni. of Maryland Medical Center, Baltimore, Maryland, USA 
(2) Dept. of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA

Predictors for large vessel recanalization before stroke thrombectomy: the HALT score

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Ramez N. Eskander to discuss NRG-018 pembrolizumab and chemotherapy in uterine cancer. Dr. Eskander is a gynecologic oncologist who specializes in the comprehensive management of female reproductive system cancers, including ovarian, uterine, cervical, vulvar and vaginal cancer. His expertise includes diagnostic and therapeutic procedures, including minimally invasive (robotic) surgery, chemotherapy and novel drugs.

Highlights:

• NRG-GY018 showed that the addition of pembrolizumab to chemotherapy, followed by maintenance pembrolizumab, resulted in a 70% lower risk of disease progression or death in patients in the dMMR cohort and a 46% lower risk in the pMMR cohort than in the placebo group.

• These data suggest that the incorporation of immunotherapy into the first-line treatment of advanced or recurrent endometrial cancer improves oncologic outcomes, regardless of MMR status or histologic findings.

• Previous monotherapy drugs against PD-1 and PD-L1 in recurrent or metastatic pMMR endometrial cancer resulted in only modest improvement.

NRG-018 Pembrolizumab and Chemotherapy in Uterine Cancer with Ramez Eskander

Dr Kerry Costello and Dr Deepak Kumar discuss a BSJM paper that investigated gait and physical activity predictors of cartilage worsening in people with knee osteoarthritis from the MOST study, using a machine learning model. Kerry and Deepak do a brilliant job of explaining the biomechanical variables, and the advantages of machine learning, and what these findings might mean for clinicians treating people with knee osteoarthritis. 

Link to paper: https://bjsm.bmj.com/content/early/2023/03/02/bjsports-2022-106142
Connect with Kerry: https://mae.ufl.edu/people/faculty/primary/profiles/kerry-costello/

Quantity AND Quality Is Key For People With Knee OA – Dr Kerry Costello And Dr Deepak Kumar. EP#531

Editor-in-Chief of the Archives of Disease in Childhood, Dr. Nick Brown, and Senior Editor of ADC, Dr. Rachel Agbeko, bring you the monthly Atoms - the highlights of the June 2023 issue.
Read it on the Archives of Disease in Childhood website: https://adc.bmj.com/content/108/6/i
Please listen to our regular podcasts and subscribe in Apple Podcasts, Google Podcasts, Stitcher and Spotify to get episodes automatically downloaded to your phone and computer. And if you enjoy the podcast, please leave us a review at https://podcasts.apple.com/gb/podcast/adc-podcast/id333278832

Atoms: the highlights from the ADC June 2023

In this podcast, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the June 2023 issue of DTB. They discuss new guidelines on post-exposure prophylaxis
for varicella or shingles during pregnancy (https://dtb.bmj.com/content/61/6/82). They review the effect of low-dose aspirin on fractures and falls (https://dtb.bmj.com/content/61/6/85), and talk about a study that does not provide meaningful cardiovascular outcome data for inclisiran (https://dtb.bmj.com/content/61/6/86). The main review article explores hospitalisation as a consequence of medication-related harm and the need to reduce the burden of harm caused by medication (https://dtb.bmj.com/content/61/6/87). They begin by discussing an announcement from NHS England that antibiotics will be provided without the need for a prescription from community pharmacies to free up GP time.

The contact address for the DTB team is dtb@bmj.com.
Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page (https://podcasts.apple.com/gb/podcast/dtb-podcast/id307773309). Thank you for listening.

Aciclovir PEP after VZ exposure in pregnancy, falls and fractures with aspirin, an inclisiran rant

Dr Philip Smith, Digital and Education Editor of Gut and Honorary Consultant Gastroenterologist at the Royal Liverpool Hospital, Liverpool, UK interviews Professor Kathy DelGiorno, from the Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee, USA, on the paper 'It is better to light a candle than to curse the darkness: single-cell transcriptomics sheds new light on pancreas biology and disease' published in paper copy in Gut in June 2023 and available online: https://gut.bmj.com/content/72/6/1211

Please subscribe to the Gut Podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the Gut Podcast iTunes page (https://podcasts.apple.com/gb/podcast/gut-podcast/id330976727).

Single-cell transcriptomics sheds new light on pancreas biology and disease

A summary of some of the best paper we published in the June 2023 issue of the Emergency Medicine Journal. Rick and Sarah talk through topics including home pulse oximetry, out of hospital cardiac arrest, the perils of correctly calculating respiratory rate in the ED and even cross-cultural adaptation of patient communication material.

Read the highlights: https://emj.bmj.com/content/40/6/393

You can subscribe to the EMJ podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month.
If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244). 
Thank you for listening!

Primary Survey - the highlights of June 2023

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Diego Raimondo and Giulia Rovero. 

Dr. Raimondo works as medical director and assistant researcher at the Division of Gynecology and Pathophysiology of Human Reproduction, Bologna, Italy, directed by Prof. Renato Seracchioli. He received his PhD on new technologies for endometriosis surgical removal from the University of Bologna in 2021. He is an Advisory Board Member of the ESGE (European Society for Gynaecological Endoscopy) and member of the Special Interest Group in Robotics. His research interests are focused on minimally invasive surgery (laparoscopic, robotic and hysteroscopic) for endometriosis and endometrial cancer. 

Dr. Giulia Rovero graduated in Medicine in 2017 at the University of Florence. She is currently a fifth-year resident at the Division of Gynecology and Pathophysiology of Human Reproduction, Bologna, Italy, directed by Prof. Renato Seracchioli. In 2022/23 she spent twelve months at the Lariboisiere Hospital in Paris focusing on gynecologic oncology. She is developing her research activity in collaboration with Dr. Raimondo in the field of minimally invasive surgery for endometrial cancer. 

Highlights:

* In endometrial carcinoma (EC) patients, the rate of sentinel lymph node (SLN) mapping failure ranges from 20% to 25%.
* Pooled data assessing predictive factors of SLN mapping failure in EC patients undergoing SLN biopsy through the cervical injection of indocyanine green (ICG) are lacking.
* ICG dose <3mL, advanced FIGO stage, lymph node involvement and bulky lymph node are predictive factors of SLN mapping failure in EC patients.
* Neither clinical features (i.e., BMI >30 kg/m2, menopausal status, adenomyosis) nor surgical history is significantly associated with SLN mapping failure in EC patients.
* Deep myometrial invasion, FIGO grade 3, non-endometrioid histotype, and lymphovascular space invasion are not significantly associated with SLN mapping failure in EC patients.

Predictors of SLN Mapping Failure with Diego Raimondo and Giulia Rovero

Dr Kieran O’Sullivan, PT, PhD, was one of the first podcast guests to crack 9,000 listens! From the University of Limerick, Ireland, he has vast clinical experience and he completed a PhD on the role of sitting in back pain. In this 18-minute podcast he reviews his 2015 podcast in the first 3 minutes and then rattles off at least 7 practical tips. 

Kieran was a guest of PhysioFirst (UK) when BJSM interviewed him in April 2015. The 2017 PhysioFirst conference is on April 1-2 (2017!) in Nottingham (UK) and guest speakers include Professor Paul Hodges, Dr Tania Pizzari and Dr Igor Tak. 

Timeline: 
1.00 m Back pain is neither explained by what patients and clinicians see on scans nor just by load

2.00 m When treating, you need to assess the various factors that could be playing a role, such as load, posture, stress, and address the right one. 

4.00 m Should we try to prevent all back pain? Listen to Dr O’Sullivan challenge the belief that it’s important to never have back pain. He likens back pain to conditions like sadness, constipation – not great but not a major problem as long as it doesn’t persist. Athletes need to load their bodies and adapt rather than avoid load and become vulnerable (See Gabbett papers and podcast, below). Don’t pass on fear (of back pain coming on or persisting) to athletes. 

5.00 m Screen for red flags of course, if the clinical picture warrants it – but most long-term back pain is NOT due to something listed as a red flag. 

6.00 m Reassurance – being empathetic without inducing fear. 

7.00 m Think through. What precipitated the pain? Too much load, too much stress, bad posture, movement patterns? If unknown, have patient create a pain diary. Look for trends. Examine all the dimensions of the biopsychosocial model. 

9:00 m Don’t just make the diagnosis but be practical. Patient sad? Don’t just say ‘You are sad, your back pain will go away’. Provide specific treatment for the specific threat. 

10:00 m Empower the patient to choose the exercises he or she wants and what he or she will do! Exercise has benefits across systems. 

11:00 m Don’t give up. Here Kieran walks us through a challenging real life case. A simple tissue diagnosis would not have helped this person at the centre of the case 

12:00 m Explain! Explain the pain! (HT to Professor Lorimer Moseley and Dr David Butler).  

13:00 m The period at 4-6 weeks of pain can be difficult – patient has not adapted to the contemporary model and may still be on waiting list for imaging. 

14:00 m What is the evidence for this approach? How does the evidence compare, with, for example Hamstring injuries? 

Links to previous podcast: 
2015 – Dr O’Sullivan on “Effective treatments for back pain: Kieran O'Sullivan’s practical tips within a guiding framework” http://ow.ly/4nepGu

BJSM paper: 
O'Sullivan K, O'Sullivan P. The ineffectiveness of paracetamol for spinal pain provides opportunities to better manage low back pain. Br J Sports Med. 2016 Feb;50(4):197-8. http://ow.ly/4neqbS (Members Only/subscribers)

Manual Therapy paper: 
Hurley J, …., O'Sullivan K. Effect of education on non-specific neck and low back pain: A meta-analysis of randomized controlled trials. Man Ther. 2016 Mar 10. pii: S1356-689X(16)00017-5. doi: 10.1016/j.math.2016.02.009. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/27026111


Dr Kieran O’Sullivan on managing back pain: 7 habits of highly effective clinicians. Part 2, 2016

Medical error is not included on death certificates or in rankings of cause of death. Martin Makary, professor of surgery at Johns Hopkins University School of Medicine, joins us to explain why we don't measure medical error, and why it is so important that we start.

Read the full analysis:
http://www.bmj.com/content/353/bmj.i2139

Medical error—the third leading cause of death in the US

"Those who do not study the past are doomed to repeat it." 

At the International Forum on Quality and Safety in Healthcare, in Gothenburg in April, Don Berwick spoke on the scientific foundations of improvement. This is the full audio of his talk.

Don Berwick is president emeritus and senior fellow, Institute for Healthcare Improvement. On twitter, he's @donberwick.

Extra: Don Berwick on the science of improvement

Fiona Moss, dean at the Royal Society of Medicine, gives us an overview of quality improvement, and it's underpinnings.

This interview was recorded at the International Forum on Quality and Safety in Healthcare, Gothenburg, April 2016.

Find Fiona Moss on twitter, @FiMoss.

Extra: Fiona Moss on the science of improvement

This week, we look at medication reconciliation.

Joshua Pevnick, health services researcher and hospital physician at Cedars-Sinai Hospital, LA, US, talks us through what it is and why it can be so hard to get right. 

And Emma Iddles, a junior doctor in general surgery at Hairmyres Hospital, Lanarkshire, UK, explains how her project improved medicines reconciliation in the surgical admissions unit of the hospital.

For more, read Joshua's full paper, http://goo.gl/O59BWo, and Emma's project write up http://goo.gl/znrNGQ.

What are they on?

How can asking patient to tell us their story improve healthcare? Helen Morant, content lead at BMJ, talks us through her project getting healthcare professionals to sit down with patients and record their conversations, and what on earth this has to do with quality improvement.

We also hear some of the recordings she has gathered through the project.

Here are links to the other podcasts and projects Helen mentions:

Story Corps - https://storycorps.org/

The Listening Project - http://goo.gl/3auSHX

Beautiful stories from anonymous people - http://goo.gl/78QSjU

Tell me a story

Is efficiency the enemy of innovation and improvement? Are efficiency programmes oppressive, leaving healthcare staff no time to be creative and piling on burdensome bureaucracy, or are efficiency, innovation and improvement positively correlated?

These questions were debated at the International Forum on Quality and Safety in Healthcare, in Gothenburg in April, and here we dip into that debate and pick out the key arguments.

Featuring contributions from: 

Jason Leitch, national clinical director, Healthcare Quality and Strategy, Scottish Government.

Frank Federico, executive director, Institute of Healthcare Improvement.

Mohsin Choudry, national medical director's clinical fellow, Royal College of Physicians.

Robbert Huijsman, professor of management and organisation of elderly care, Erasmus University, Rotterdam.

For more on the Forum, see http://internationalforum.bmj.com/.

This episode is the last in the first series of the Making the difference podcast. We'll be back in a month with series two.




 


Efficiency vs innovation and improvement

Available data suggest about 50% of delirium is hypoactive; this and the mixed motor subtype account for 80% of all cases of delirium. 
It can be more difficult to recognise, and is associated with worse outcomes, than hyperactive delirium. 

In this podcast, Christian Hosker, consultant liaison psychiatrist at the Leeds Liaison Psychiatry Service outlines when to suspect hypoactive delirium, how to assess, and appropriately manage patients.

Infographic explaining diagnosis:
http://www.bmj.com/content/bmj/suppl/2017/05/25/bmj.j2047.DC1/hosc038261.wi.pdf

Read the full article:
http://www.bmj.com/content/357/bmj.j2047

50% of delirium is hypoactive - how to spot it

Complexity science offers ways to change our collective mindset about healthcare systems, enabling us to improve performance that is otherwise stagnant, argues Jeffrey Braithwaite, professor of health systems research and president elect of the International Society for Quality in Health Care.

Read the full analysis:
https://www.bmj.com/content/361/bmj.k2014

Quality improvement series:
https://www.bmj.com/quality-improvement


The BMJ in partnership with and funded by The Health Foundation are launching a joint series of papers exploring how to improve the quality of healthcare delivery. The series aims to discuss the evidence for systematic quality improvement, provide knowledge and support to clinicians and ultimately to help improve care for patients.

BMJ talk medicine

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