Podcasts  about  Medicine  &  Clinical  Practice

bmj talk

The podcast for evidence based medicine - where research, guidance and practice are debated and demystified

Talk Evidence

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

It's almost time for the Christmas edition of the BMJ to hit your doormats, and in this festive edition of Talk Evidence we're going to be talking Christmas research.

Joining Helen and Juan, we have Tim Feeney, BMJ research editor and researcher into Surgical outcomes at Boston University.

In this episode we'll be hearing about the health of footballers, and if a career in the sport predisposes Swedish players to substance use disorders. We'll hear about the performance of BMJ’s editors, when it comes to assessing the impact of a paper. We'll find out if AI algorithms can pass UK radiology exams, misinformation and a belief that everything causes cancer, and finally, some tips from BMJ’s statisticians to set the world right

Talking evidence at Christmas

In this week's episode, we're focusing on covid and the ongoing crisis in the NHS.

Helen Macdonald, Juan Franco and Joseph Ross cast their evidence seeking eyes over research into outcomes as well as the workload of doctors.

Firstly, Joe tells us about a new big data study into longer term outcomes after mild covid-19, how those ongoing symptoms relate to long covid, and how often they resolve themselves.

Juan looks back to his homeland to see what Argentina which was very early to offer children vaccinations against covid-19. He tells us how a new study design can help understand how effective different combinations of vaccines were.

Joe has a Danish registry paper, which links people's employment status after a MI, explains how that gives us an insight into morbidity following that event.

Helen looks at a new analysis which outlines the concept of "time needed to treat" - a measure of how much time it would take a clinician to actually carry out a guideline - and you'd be surprised how much GP time would be swallowed by a "brief" intervention to reduce inactivity in their patients.

Finally, the data on excess mortality in the UK has been up for debate recently - our health minister calling into question the Office of National Statistic's data. We hear from Nazrul Islam, Associate professor of medical statistics, advisor to the ONS and BMJ research editor, who has some bad news for him.

Reading list:
Long covid outcomes at one year after mild SARS-CoV-2 infection
https://www.bmj.com/content/380/bmj-2022-072529

Effectiveness of mRNA-1273, BNT162b2, and BBIBP-CorV vaccines against infection and mortality in children in Argentina, during predominance of delta and omicron covid-19 variants
https://www.bmj.com/content/379/bmj-2022-073070


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

Expanding the measurement of overdiagnosis in the context of disease precursors and risk factors
https://ebm.bmj.com/content/early/2023/01/10/bmjebm-2022-112117

Excess deaths associated with covid-19 pandemic in 2020
https://www.bmj.com/content/373/bmj.n1137.abstract

Talk Evidence - excess deaths, the ONS, and the healthcare crisis

In this episode of Talk Evidence, Helen Macdonald is joined by Juan Franco and Joe Ross, to bring you the newest evidence in The BMJ.

First, chronic pain. As prescribers move away from opioids, Juan finds an overview of systematic reviews asking whether anti-depressants might help. 

Joe finds new research on the link between six healthy lifestyle markers and cognitive decline. 

Helen looks at a trial to reduce prescribing among older people with suspected urinary tract infection or UTI.

Juan has a nuanced take on the updated evidence on masks to reduce the spread of respiratory viruses. 

Finally, an international group of researchers traced the health claims made about infant formula milk back to the evidence or lack of it 

Reading list:
Efficacy, safety, and tolerability of antidepressants for pain in adults
https://www.bmj.com/content/380/bmj-2022-072415

Association between healthy lifestyle and memory decline in older adults
https://www.bmj.com/content/380/bmj-2022-072691

Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults 
https://www.bmj.com/content/380/bmj-2022-072319

Physical interventions to interrupt or reduce the spread of respiratory viruses
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full

Health and nutrition claims for infant formula
https://www.bmj.com/content/380/bmj-2022-071075

Talk Evidence - masks, chronic pain, and baby milk formulae claims

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

In this episode of the Heart podcast, Digital Media Editor, Dr James Rudd, is joined by Dr Eric Topol, founder and director of the Scripps Research Translational Institute. They discuss the impact that AI will have in medicine and how this will affect us all.

Relevant links related to this podcast:
About Dr Topol - https://drerictopol.com/about/
Nature Medicine AI review - https://www.nature.com/articles/s41591-018-0300-7
Twitter - https://twitter.com/EricTopol?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor
Book - https://drerictopol.com/book/deep-medicine/
NHS Topol review - https://www.hee.nhs.uk/our-work/topol-review

Deep Medicine with Eric Topol, author of the Topol NHS review

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.

We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.

This week:

(1.20) Carl gives us an update on the England and Wales admission data.

(3.00) Helen talks about ways in which spread and severity of infection amongst household contacts.

(8.20) We talk natural history of covid-19, and Harlan Krumholz, cardiologist at Yale, tells us what we know, and why it's difficult to have a full picture at the moment.

(15.10) Helen picks up on a study from Tim Spectre and colleagues using an app to track cases.

(20.00) Henry Scowcroft, one of The BMJ's patient editor, who also works for Cancer Research UK, joins us to talk about patients who are taking part in clinical trials, and how this is affecting them. He also touches on the thin patient participation in the design of covid treatment guidelines.

(24.10) Carl talks rapidity of publishing, and where researchers should most target their evidence outreach.

Reading list:
Reducing risks from coronavirus transmission in the home
https://www.bmj.com/content/369/bmj.m1728

Rapid implementation of mobile technology for real-time
epidemiology of COVID-19
https://science.sciencemag.org/content/sci/early/2020/05/04/science.abc0473.full.pdf

The BMJ Public and Patient participation twitter chat
https://twitter.com/hashtag/BMJdebate

Talk evidence covid-19 update - natural history of covid, include patients in guidelines

Big data is being crunched to help us tackle some of the enormous amount of uncertainty about covid-19, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.

In these podcasts, we're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.

This week.

(3.10) Calum Semple, professor of outbreak medicine at the University of Liverpool talks about the ISARIC project - predesigned research brought off the shelf and deployed during a pandemic.

(14.20) Ben Goldacre, doctor, researcher and director of the EBM datalab at the University of Oxford, joins us to talk about how his team have managed to pull together records from 40% of NHS patients to look for patterns in covid-19 morbidity and mortality.

Reading list

OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients.
https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1

Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol
https://www.medrxiv.org/content/10.1101/2020.04.23.20076042v1

Talk evidence covid-19 update - answering questions with big data

Schizophrenia onset is usually in early adulthood and may be preceded by years of ill-differentiated symptoms, from behavioural changes and delusions to frank psychosis.

Initially, patients are usually referred by family members. As the illness progresses, patients tend to self-refer or are brought in by a case manager or law enforcement officer.

Antipsychotic therapy and psychosocial interventions are effective for most patients, but to varying degrees.

Adrian Preda, Professor of Clinical Psychiatry, Department of Psychiatry and Human Behavior, University of California, Irvine School of Medicine, tells us more about the condition.

For more on schizophrenia, visit BMJ Best Practice: bestpractice.bmj.com/topics/en-gb/406

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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

Schizophrenia

Kieran Walsh, clinical director at BMJ, asks editors from BMJ Learning and BMJ Best Practice to summarise the latest clinical guidance related to covid-19.

Abigail Davis discusses the latest guidance on ADHD and renal transplant patients care.

And Matt Castleden updates us on care for covid-19 patients post discharge.

For more, see:

BMJ Best Practice's topic on management of coexisting conditions in the context of COVID-19: bestpractice.bmj.com/topics/en-gb/3000190

BMJ Best Practice's topic on covid-19: bestpractice.bmj.com/topics/en-gb/3000168

BMJ Learning module on COVID-19 rapid guideline on critical care (NICE): https://learning.bmj.com/learning/module-intro/.html?moduleId=10065100

BMJ Learning covid-19 in primary care module: learning.bmj.com/learning/module-intro/.html?moduleId=10065230

NICE renal transplant guidelines: nice.org.uk/guidance/NG178

European ADHD guidelines group recommendations: thelancet.com/pdfs/journals/lanchi/PIIS2352-4642(20)30110-3.pdf

NHS England: After-care needs of inpatients recovering from COVID-19: england.nhs.uk/coronavirus/publication/after-care-needs-of-inpatients-recovering-from-covid-19/

Covid-19 update: ADHD, renal transplant patients, care for covid-19 patients post discharge

Dr. Dan Rhon (T: @danrhon) is an active researcher for the US Department of Defence, a consultant and assistant professor at both Duke (North Carolina) and Baylor (Texas) Universities. He attended a manual therapy clinical fellowship at Brooke Army Medical Center in Texas, is a fellow in the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT), and an orthopaedic clinical specialist (OCS). He completed a postdoc research fellowship through the University of Utah and has a strong research interest in the effectiveness of clinical care pathways for musculoskeletal disease, both at primary and specialty care levels, and the intersection of these two.
He was recently part of the investigating team who published a study on the effects of corticosteroid vs physiotherapy for managing knee osteoarthritis, published by the prestigious New England Journal of Medicine.
In this discussion with associate editor Paul Blazey (T: @blazey85), he focuses on the findings of the study and the implications for the effective management of one of the most prevalent conditions seen in MSK clinics across the world.


References
Deyle, GD., Allen, CS., Allison, SC., et al. Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee. N Engl J Med 2020; 382:1420-1429
DOI: 10.1056/NEJMoa1905877
https://www-nejm-org.ezproxy.library.ubc.ca/doi/10.1056/NEJMoa1905877

Exercise or corticosteroids or both for managing knee OA? Dr Dan Rhon sheds light. Episode #435

Dr. Andrea Mosler is a specialist sports physiotherapist and research fellow at La Trobe University, Melbourne. In this podcast, Liam West poses the questions that see Dr. Mosler explain how you should approach the prevention and management of hip and groin pain in athletes. She describes findings from her PhD and gives you the listener some clinical pearls to add to your “hip and groin” treatment toolbox!

What actually works? Hip and Groin masterclass with Dr. Andrea Mosler. Episode #437

Vaccines have been in the news this week - but when you dig into the stories, it turns out that the hype is about phase 1 trials. We're a long way from being sure any of the 150 possible vaccines being developed actually work. 

In this talk evidence we're talking to a researcher, a regulator, and a manufacturer about the way in covid-19 is upending normal vaccine development, which hurdles they'll have to reach to get onto the market, and how we'll know which one to choose when they are there.

This week

(1.10) We said that covid would have a knock-on effect on other treatments, and Helen looks at some research into acute coronary syndrome admissions in the UK.

(6.53) Peter Doshi, assistant professor of pharmaceutical health services research at the University of Maryland School of Pharmacy and an editor for The BMJ, tells us what to watch out for in the PICO for a vaccine study.

(15.20) Marco Cavaleri, head of Biological Health Threats and Vaccines Strategy at the European Medicines Agency, explains what regulators are looking for when thinking about licencing a vaccine - and how covid has made different agencies around the world align their requirements.

(22.22) Philip Cruz, UK head of vaccines at GSK, explains how a manufacturer tests their vaccines, and how they use adaptive study design to past regulatory hurdles and provide information for those choosing which vaccine to use.


Reading list

Lancet paper - COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31356-8/fulltext

ONS Data - Deaths registered weekly in England and Wales, provisional: week ending 3 July 2020
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/latest

The BMJ editorial - Vaccines, convalescent plasma, and monoclonal antibodies for covid-19
https://www.bmj.com/content/370/bmj.m2722

WHO report - Draft landscape of COVID-19 candidate vaccines
https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines

Research Methods & Reporting
The Adaptive designs CONSORT Extension (ACE) statement: a checklist with explanation and elaboration guideline for reporting randomised trials that use an adaptive design
https://www.bmj.com/content/369/bmj.m115

Talk Evidence covid-19 update - How will we know if a vaccine works?

Fresh outbreaks of covid in Europe and a wave of infections in the United States have been in the news this week, highlighting the renewed need for social distancing – but to what extent?

In this edition, we explore the real-world evidence for physical distancing measures as well as the research into whether or not facemasks make us behave more recklessly.

We also discuss the non-covid themes of research transparency and a BMJ investigation into the lucrative business of orphan drugs.

Talk Evidence covid-19 update - How well have physical distancing measures worked?

1.00) Carl has been looking at PCR testing, and explains why it picks up both viable SARS-cov-2, but also fragments of it’s RNA - leading to potential over diagnosis.


(8.50 ) What did the Living systematic review and accompanying guidelines say about treatment options for covid-19


(14.35) Helen talks to Reed Siemieniuk,  general internist from McMaster University, about creating a living network meta-analysis, to try and synthesis all the evidence on covid-19


(22.48) Helen also talks to Bram Rochwerg, associate professor  at McMaster University and 
consultant intensivist at Hamilton Health Sciences,  about turning the outcomes of a meta-analysis into guidelines, and why at the moment they’re still calling for more evidence on Remdesivir 



(30.08) Finally, there are worries about the uncertainty expressed in the living review - and in the way in which we communicate that. Helen goes back to Reed to find out how the review might evolve in the future.


(33.50)  Covid isn’t just an acute disease, there is emerging consensus that it’s systemic effects lead to long term problems for some patients - but there’s a lot of uncertainty there. 

(38.40) Carl talks about the IMMDS review and his involvement in it - and what recommendations we’ll be covering in future Talk Evidence programmes.


Reading list:
Drug treatments for covid-19: living systematic review and network meta-analysis -https://www.bmj.com/content/370/bmj.m2980

Remdesivir for severe covid-19: a clinical practice guideline - https://www.bmj.com/content/370/bmj.m2924

Management of post-acute covid-19 in primary care - https://www.bmj.com/content/370/bmj.m3026

Talk Evidence covid-19 update - How will we know if a vaccine works?

BMJ talk medicine