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

In this month's Talk Evidence, Helen Macdonald and Joe Ross are back with a wry look at the world of Evidence Based Medicine.

They give us a round up of real world data emerging to address various uncertainties about vaccinations against covid

Helen has an update on NHS Digital’s project to extract GP coding for planning of healthcare and research, and talks to Natalie Banner from Understanding Patient Data, to find out what the public really cares about.

Finally, as routine care must go on a clinical review on cardiovascular disease in older adults introduces us to geroscience.


Reading list

Vaccines;
Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study - https://doi.org/10.1136/bmj.n1943 

Effectiveness of the CoronaVac vaccine in older adults during a gamma variant associated epidemic of covid-19 in Brazil: test negative case-control study -  https://doi.org/10.1136/bmj.n2015

Associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission and death with covid-19 in nursing homes and healthcare workers in Catalonia: prospective cohort study
https://doi.org/10.1136/bmj.n1868

Risk of thrombocytopenia and thromboembolism after covid-19 vaccination and SARS-CoV-2 positive testing: self-controlled case series study - https://doi.org/10.1136/bmj.n1931 

CVD
Cardiovascular care of older adults - https://doi.org/10.1136/bmj.n1593

Talk Evidence - real world vaccine data, GP records and CVD

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 - real world vaccine data, GP records and CVD

BMJ talk medicine