science

The BMJ is an international peer reviewed medical journal and a fully “online first” publication. The BMJ’s vision is to be the world’s most influential and widely read medical journal. Our mission is to lead the debate on health and to engage, inform, and stimulate doctors, researchers, and other health professionals in ways that will improve outcomes for patients. We aim to help doctors to make better decisions. 

The BMJ Podcast

We're bringing you an episode of the BMJ's podcast for primary care, Deep Breath In, which we think you'll enjoy.

How long would it take GPs to enact all of the guideline recommendations that they might be expected too? Far more GP hours than exist in any healthcare system; but as medicine has turned its attention to primary prevention, and expanded the populations whose health we seek to improve, those guidelines are taking up more and more time.

A recent analysis in The BMJ has proposed the concept of “Time Needed to Treat” - and implores guideline makers to take account consultation time as a precious, finite, resource when thinking about their recommendations.

In this episode of Deep Breath In, we’re joined by Minna Johansson, family doctor and director Global Center for Sustainable Healthcare, who co-authored that analysis to talk about how the concept has gone down, and what it might mean for rethinking what primary care is supposed to do.

Reading list:
Guidelines should consider clinicians’ time needed to treat
https://www.bmj.com/content/380/bmj-2022-072953

Why guideline authors need to pay attention to doctor's time

Fatigue can have as much of an affect in your ability to function as alcohol, and yet while you would be chastised for drinking before appearing on the ward, hospitals have systematically removed the spaces where tired clinicians can rest and recover.

The Royal College of Anaesthetists have been campaigning to raise awareness of the dangers of fatigue, and it seems that anaesthetic trainees have benefitted from that, with sleep pods and flexible schedules - but other specialties are lagging behind.

In this podcast, Roo McCrossan, a consultant anaesthetist joins our host Clara Munro, a surgical trainee, and Ayesha Ashmore, obstetric trainee, to talk about how to fight fatigue. They discuss circadian rhythms, what to eat, nappuccinos, and why trusts should make more sleeping spaces.

For more information about fighting fatigue;
https://anaesthetists.org/Home/Wellbeing-support/Fatigue/-Fight-Fatigue-download-our-information-packs

Nappuccinos and circadian rhythms

In this month’s Talk Evidence, Helen Macdonald, Juan Franco and Joseph Ross are back to talk us through some of the latest research, 

They’ll talk about pay-for-perfomance schemes, and whether the data they routinely collect is measuring outcomes or  tickboxes. They’ll also talk about a new analysis published on bmj.com which suggests ways in which that data could be better.


We’re also by Huseyin Naci, associate professor of health policy at the London School of Economics and Political Science, who will tell us about proposed changes to drug regulation in the UK - and we discuss research which has linked speedier regulatory approval to more adverse advents in post marketing studies.

Finally, we talk about point of care apps. The availability of medical information in the clinic has changed practice, but how good is that information? We hear about research which has evaluated those point of care apps (including BMJ’s Best Practice app) and rates them against different criteria.


Reading list

Estimated impact from the withdrawal of primary care financial incentives on selected indicators of quality of care in Scotland 
https://www.bmj.com/content/380/bmj-2022-072098
How can we improve the quality of data collected in general practice?
https://www.bmj.com/content/380/bmj-2022-071950#


UK to give “near automatic sign off” for treatments approved by “trusted” regulators
https://www.bmj.com/content/380/bmj.p633


Smartphone apps for point-of-care information summaries
https://ebm.bmj.com/content/early/2023/03/14/bmjebm-2022-112146

Talk Evidence - automatic approval, evidence apps, and pay for performance data

Everyone has coping mechanisms, but sometimes those ways of coping become problem behaviours - addictions.

In this episode of Doctor Informed, we're focussing on how to spot the signs that you may be sliding into addiction, how to have conversations with friends and colleagues if you worry about their behaviour, and how seeking treatment is the best way to avoid GMC scrutiny.

Joining Clara Munro are Liz Croton and Zaid Al-Najjar, GPs who work for NHS Practitioner health - a mental health and addiction service specifically for health professionals. They are also joined by Ruth Mayall, a retired consultant anaesthetist who has experienced addiction herself, and has contributed to the Association of Anaesthetists guidance on drug and alcohol abuse.

Some resources mentioned in the podcast;

NHS Practitioner Health
https://www.practitionerhealth.nhs.uk/

The Sick Doctor's Trust
http://sick-doctors-trust.co.uk/

British Doctors & Dentists Group
https://www.bddg.org/

Substance use disorder in the anaesthetist
https://anaesthetists.org/Home/Resources-publications/Guidelines/Substance-use-disorder-in-the-anaesthetist

Substance abuse in anaesthetists
https://academic.oup.com/bjaed/article/16/7/236/2196385?login=false

Addiction in doctors

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

Professor Lorimer Moseley holds the Inaugural Chair in Physiotherapy at the University of South Australia as well as being a Professor of Neurosciences. He completed his PhD in 2002 and has both learned and shared wisdom at the Universities of Queensland, Sydney and Oxford before settling in Adelaide. He leads the Body in Mind Research Group and coauthored the best-selling ‘Explain Pain’.

In this podcast he answers questions from Ebonie Rio, Department of Physiotherapy, Monash University, covering the important difference between pain and nociception, and sharing thoughts on how pain science can help clinicians working in sports medicine. 

You’ll hear him share the best, and worst, ways to explain pain to patients. He predicts how low back pain management will look in 100 years’ time. As always with Lorimer Moseley. expect thoughtful reflections shared with big dob of humour and humility. 

See also:

TEDx talk ‘Why things hurt’: http://www.youtube.com/watch?v=gwd-wLdIHjs

Acupuncture applied as a sensory discrimination training tool decreases movement-related pain in patients with chronic low back pain more than acupuncture alone: a randomised cross-over experiment http://goo.gl/zaNX8s

Are children who play a sport or a musical instrument better at motor imagery than children who do not? http://goo.gl/Xv9Qum

Exercise is medicine, for the body and the brain: http://bjsm.bmj.com/content/48/12/943.full

Chronic traumatic encephalopathy in sport: a systematic review: http://bjsm.bmj.com/content/48/2/84.full

Professor Lorimer Moseley on the brain and mind in chronic pain

In this episode John gets a chance to chat with International best seller David Epstein about his book the Sports Gene. David is a relentless researcher who is more concerned with doing things the way research says instead of how we've always been doing it. To that end, he sets himself apart from others by seeking what science says about extraordinary athletic performance and pushing for it to be tailored to the individual. David Epstein writes about sports science and medicine, Olympic sports, and is an investigative reporter. The Sports Gene is his first book. It was a top 10&nbsp;New York Times&nbsp;best seller, and was chosen as a best non-fiction book of 2013 by The Washington Post and Publisher’s Weekly. Runner’s World chose&nbsp;The Sports Gene&nbsp;as its book of the year, and the book was a finalist for the William Hill Sports Book of the Year Award, the PEN/ESPN Literary Sports Writing Award, and the National Academy of Sciences Communication Award. It has been translated into sixteen languages. You can buy the Sports Gene here: The Sports Gene on Amazon You can find David on Twitter and his website: The Sports Gene Website @DavidEpstein &nbsp; Time is running out:&nbsp;Join us for the Way of Champions Coaching Conference June 2-4 2017 Way of Champions Conference - Sign up before May 1st

#4 David Epstein: The Sports Gene and the Science of Extraordinary Athletic Performance

Chris Whitty probably needs no introduction to our UK audience - he's the chief medical advisor to the UK government, has played a pivotal role in shaping the country's response to Covid-19.

He rarely does interviews - so in this conversation we wanted to ask him the questions that matter to clinicians, about how the pandemic will impact them over the winter. 

This was recorded yesterday, just before the announcement of the strict lockdowns in France and Germany.

For more covid-19 coverage
www.bmj.com/coronavirus

Chris Whitty on the challenge of winter, lockdown, and following the science

BMJ talk medicine