Medicine and Science from The BMJ

As the pandemic plays out - the way in which doctors in the UK practice is changing, hospitals are reconfigured to increase critical care capacity, GPs are working from home and doing their day to day work remotely. Some of the changes have come at the detriment of staff and patient wellbeing but covid-19 has also helped cut through some of the inertia to get welcome changes done. In this podcast, Helen Salisbury, GP in Oxfordshire, and Clare Gerada, GP in south London, join us to talk about the way in which general practice has changed, and how they and their teams are experiencing that.

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: (1.00) Carl gives us an update on the UK’s covid-19 related mortality (7.40) When the evidence is uncertain, and the outcomes so massive, then the ethical dimensions of decisions become even more apparent. Helen talks ethics in guidelines with Julian Sheather, advisor on ethics and human rights to the BMA and MSF. (25.37) Update on covid-19 research, looking at viral particle shedding. (29.24) We’ve mentioned the potential wasted effort in covid-19 research, and Helen speaks to Paul Glaziou, director of the Institute for Evidence Based Research at Bond University, about the waste he’s already seen, and ways in which it could be avoided.

A new podcast from The BMJ, to help GP's feel more connected, heard, and supported. Subscribe on; Apple podcasts - https://bit.ly/applepodsDBI Spotify - https://bit.ly/spotifyDBI Google podcasts - https://bit.ly/googlepodsDBI In our first episode, we discuss the highs and lows of video consultations, and how coronavirus has altered the landscape of business as usual for GPs. How will this change affect our relationships with our patients? How do we cope with frustrating technical issues? Are we more likely to miss a crucial diagnosis if we can’t rely on physical examinations? And, finally, are teleconsultations the future of GP practice? Our guests: Trish Greenhalgh is a former GP of 30 years who is now Professor of Primary Care Health Sciences at the University of Oxford. Trish is a leading researcher on video consultations. Fiona Stevenson is a medical sociologist and researcher based at UCL. She is the co-director of their e-health unit. Deep Breath Out - the Rob Auton Daily Podcast https://play.acast.com/s/robautonpodcast https://www.bmj.com/podcasts/deepbreathin

A new podcast from The BMJ, to help GP's feel more connected, heard, and supported. Subscribe on; Apple podcasts - https://bit.ly/applepodsDBI Spotify - https://bit.ly/spotifyDBI Google podcasts - https://bit.ly/googlepodsDBI This week, our topic is fear: we try to get a better understanding of fear, how it affects all of us as clinicians for better or for worse, and the impact that fear has on the ways in which we approach our patients & practice. Does fear distort our judgement, and increase the likelihood of blundering, or does a healthy dose of fear help to keep us grounded? Our guests: Iona Heath is a former GP and president of the Royal College of GPs. Danielle Ofri is an internist at Bellevue Hospital in New York, and Clinical Professor of Medicine at NYU School of Medicine. She has written several books on topics such as medical error and how doctors’ emotions affect their practice. The Deep Breath Out - The bees of Brockwell Park Surgery https://www.bmj.com/podcasts/deepbreathin

There is no doubt that anxiety levels that clinicians are feeling during this pandemic are high. One military medic believes the current situation is comparable to his experience when posted during British campaigns in Afghanistan and Iraq. Cormac Doyle offers advice on how to deal with high-stress conditions, both in a work and at home, as well as how to negate the future effects of post-traumatic stress disorder. One strategy he supports is using Bilatural Stimulation using music, one example of which called “Strength Within” can be found here shorturl.at/fgrSW.

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: (3.14) Jeff Aronson from Oxford University explains why remdesivir is a potential therapeutic, but is pessimistic about the quality of the studies being done on it (13.22) Carl explains why smoking cessation is still a key public health priority under covid-19 (16.30) Helen talks care homes, and interviews Mona Koshkouei, from Oxford University, about the research which shows staff are the main vector of infection. (27.20) David Spiegelhalter, professor of public understanding of risk, looks at the new data on excess deaths in the UK - and the difficulties with reporting that underlie it. Carl explains how deaths track infections, and why uncertainty there makes it hard to calcuate the case fatality rate (And why that is not a good measure to use in a pandemic) Reading list. Compassionate Use of Remdesivir for Patients with Severe Covid-19 https://www.nejm.org/doi/full/10.1056/NEJMoa2007016 How can pandemic spreads be contained in care homes? https://www.cebm.net/covid-19/how-can-pandemic-spreads-be-contained-in-care-homes/ Covid-19: Death rate in England and Wales reaches record high because of covid-19 https://www.bmj.com/node/1024784.full

We’ve published info on Telehealth in primary care - and have been overwhelmed by the response from GPs who are finding it useful. But it’s not only primary care that is dramatically shifting to remote care - routine hospital care is moving online too, so we’ve asked Rowena McCash - GP and out of hours triage trainer joins us to give some tips on how to change your communication for the situation. She explains safety netting in telephone triage, note taking, and why there are some advantages to working that way. www.bmj.com/coronavirus www.bmj.com/wellbeing

As we cover the covid-19 outbreak, we want to hear some of the stories from the frontline - And who better to heart of what this pandemic is doing to the profession in the UK, than some of the people who write regularly for The BMJ? In this first one, we wanted to look specifically at acute care - those at the sharp end of the response, so we're joined by David Oliver, consultant in geriatrics and internal medicine, and Matt Morgan, consultant in intensive care medicine. Read the columns https://blogs.bmj.com/bmj/category/columnists/matt-morgan/ https://blogs.bmj.com/bmj/category/columnists/david-oliver/ For more free information on covid-19 www.bmj.com/coronavirus

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: (2.24) - Hydroxychloroquinine/chloroquinine - Robin Ferner, honorary professor of clinical pharmacology at the University of Birmingham explains why is it a potential therapeutic for covid-19, and why is it being hyped. (12.45) - We use prognostic models to make treatment decisions, but they have to be well conducted. Lots of them are being created for covid-19, but their quality isn’t great. Statisticians Laure Wynants Maastricht University and Maarten van Smeden from Utrecht University have done a systematic review of these models, and explain what’s needed for them to be useful. (26.30) PPE - specifically facemasks. What does the evidence say about their use by the public, and does the precautionary principle hold Reading list: COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community https://www.nice.org.uk/guidance/ng165/chapter/4-Managing-suspected-or-confirmed-pneumonia Chloroquine and hydroxychloroquine in covid-19 https://www.bmj.com/content/369/bmj.m1432 Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal https://www.bmj.com/content/369/bmj.m1328 What is the efficacy of standard face masks compared to respirator masks in preventing COVID-type respiratory illnesses in primary care staff? https://www.cebm.net/covid-19/what-is-the-efficacy-of-standard-face-masks-compared-to-respirator-masks-in-preventing-covid-type-respiratory-illnesses-in-primary-care-staff/

As part of our response to the covid-19 pandemic, we’re going to be running a series of discussions with experts about some of the big issues arising from the virus. In this one, we’re asking about the public health response to an outbreak - what’s necessary, and is it possible to go to far. Joining us are Martin Mckee - professor of european health at the London Schoole fo Hygiene and Tropical Medicine Kathleen Bachynski - assistant professor of public health at Muhlenberg College Sridhar Venkatapura - associate professor global health & philosophy at King's College London www.bmj.com/podcasts www.bmj.com/coronavirus