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

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

BMJ Best Practice Podcast

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

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

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

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

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

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)

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 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

With improved survival and and ageing population, the number of people living with coronary heart disease in the UK has increased to an estimated 2.3 million. There is increasing evidence that cardiac rehabilitation benefits these patients, and as such it has been included in international clinical guidelines.

To discuss cardiac rehabilitation in this podcast, we're joined by Hasnain Dalal, a GP and honorary clinical associate professor at the University of Exeter Medical School, Rod Taylor, academic lead for Exeter Clinical Trials Support Network and NIHR senior investigator, and Jenny Wingham, a senior clinical researcher in cardiac rehabilitation.

Read the full clinical review online:
http://www.bmj.com/content/351/bmj.h5000

Listen to our podcast with a patient who's been through cardiac rehabilitation: https://soundcloud.com/bmjpodcasts/cardiac-rehab-patient

Cardiac rehab

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

Transient symptoms of depersonalisation and derealisation - feeling detached from the world, and feeling as if you are watching events at a remove - are common. However for some, persistent symptoms can make the disorder extremely distressing.

In this podcast, Kate Adlington is joined by Elaine Hunter, consultant clinical psychologist, Anthony David, professor of cognitive neuropsychiatry, and by Jane Charlton and Fiona Godlee - who have both experienced depersonalisation/derealisation over a number of years.

Read the full education article:
http://www.bmj.com/content/356/bmj.j745

"Watching the world through a clear fog" - recognising depersonalisation and derealisation

Adoption of shared decision making into routine practice has been remarkably slow, despite 40 years of research and considerable policy support.

 In 2010, the Health Foundation in the UK commissioned the MAGIC (Making Good Decisions in Collaboration) programme to design, test, and identify the best ways to embed shared decision making into routine primary and secondary care using quality improvement methods.

In this podcast, Natalie Joseph-Williams from Cardiff University and Richard Thomson from Newcastle University, join us to discuss how the project went, and what key lessons they learned from the pilot.

Read their full analysis:
http://www.bmj.com/content/357/bmj.j1744

The magic of shared decision making

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

A study published by The BMJ today reports a possible association between intake of highly processed (“ultra-processed”) food in the diet and cancer. 

Ultra-processed foods include packaged baked goods and snacks, fizzy drinks, sugary cereals, ready meals and reconstituted meat products - often containing high levels of sugar, fat, and salt, but lacking in vitamins and fibre. They are thought to account for up to 50% of total daily energy intake in several developed countries.

Mathilde Touvier, senior researcher in nutritional epidemiology and Bernard Srour, pharmacist and PhD Candidate, both at INSERM, join us to discuss what ultra processed foods actually are, why it is they could be leading to cancer, and what their cohort study tells us about that potential risk.

Read the full open access research:
http://www.bmj.com/content/360/bmj.k322

"We don't really know the impact of these products on our health": Ultraprocessed food & cancer risk

International travel is increasingly common. Between 10% and 42% of travellers to any destination, and 15%-70% of travellers to tropical settings experience ill health, either while abroad or on returning home,

Malaria is the commonest specific diagnosis, accounting for 5%-29% of all individuals presenting to specialist clinic, followed by dengue, enteric fever, and rickettsial infections .

In this podcast Doug Fink specialist registrar, and Victoria Johnston consultant,  in infectious diseases at The Hospital for Tropical Diseases join us to discuss diagnosis, and treatment - and why the clinically most interesting diagnosis is rarely the right one.

Read the full practice article:
http://www.bmj.com/content/360/bmj.j5773

Fever in the returning traveller

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.

Think of healthcare is an ecosystem, not a machine

Mendelian randomisation - it’s a technique that uses the chance distribution of genes in a population, combined with big data sets, to investigate causative relationships.

But there are a lot of questions we have in The BMJ about how the technique works - the association between genes and apparently non-biologically mediated behaviours, how much the strict rule of not claiming causation based on observational data has actually been overturned, and general confusion about how the non-methodologists amongst us can read these studies.

Neil Davies and George Davey Smith from University of Bristol, and Michael Holmes from the University of Oxford, join us to explain how the technique works, where it can be applied, and what readers should look out for when they're trying to assess the quality of a mendelian randomisation study.

Read their full research methods and reporting paper:
https://www.bmj.com/content/362/bmj.k601

Popular tracks by BMJ talk medicine