Medicine and Science from The BMJ

Brexit. Who knows what’s going to happen in the next few weeks, months, years - the uncertainty is high. In the face of that, you’d hope that the government was doing all it could to plan for any eventuality - let alone for a massive, country altering one like suddenly crashing out without a deal - but Martin McKee, professor of public health at the London School of Hygiene and Tropical Medicine, and David Nicholl, Consultant Neurologist, don’t think that’s the case. In the debate about Brexit, increasingly we’re hearing about the impact on health in the UK - and in increasingly doomed ways. But what about across the rest of Europe? Natasha Azzopardi Muscat, president of the European Public Health Association, explains a little about what Brexit means for the whole of European public health. Assessing the health effects of a “no deal” Brexit: https://www.bmj.com/content/366/bmj.l5300

We heard a few podcasts ago about burnout - what it is, and why it should be thought of as a systems issue. Now a project in the Netherlands is trying to investigate who it is that is particularly at risk of burnout, and hopes to test whether individually tailored coaching and counselling can help those who are experiencing the symptoms change the way they’re working. Karel Scheepstra is a psychiatrist and researcher in the Amsterdam University Medical Centre, and joins us to discuss what we know about burnout in Dutch doctors, and what this new research hopes to uncover. For more from our wellbeing campaign; www.bmj.com/wellbeing

We know that exercise is good for you - the WHO recommends at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity aerobic physical activity each week. That recommendation is built on evidence that relied on self reporting that may underestimate the amount of lower intensity exercise those people were doing, and at the sometime overestimate the overall amount. That makes new research, published on bmj.com particularly interesting - it pulls together the published data on outcomes for measured activity, where study participants were given an accelerometer to wear. Ulf Ekelund, from the Department of Sports Medicine at the Norwegian School of Sport Sciences, joins us to discuss what they found, and what that means for those recommendations. Read the open access research: https://www.bmj.com/content/366/bmj.l4570

Welcome back to Talk Evidence - where Helen Macdonald and Carl Heneghan take you through what's happening in the world of Evidence. This month we'll be discussing tramadol being prescripted postoperatively, and a new EBM verdict says that should change(1.36). How much preventable harm does healthcare causes (11.20. A canadian project to help policy makers get the evidence they need (16.55) One of our listeners thinks "Simple" GPs are anything but (28.30) - and we'll be asking Alexa about our health queries. Reading list Treating postoperative pain? Avoid tramadol, long-acting opioid analgesics and long-term use https://ebm.bmj.com/content/early/2019/08/16/bmjebm-2019-111236 Prevalence, severity, and nature of preventable patient harm across medical care settings https://www.bmj.com/content/366/bmj.l4185 Helen Salisbury: “Alexa, can you do my job for me?” https://www.bmj.com/content/366/bmj.l4719

In 2001, Gottfried Hirnschall joined the WHO to work on the global response to HIV/AIDs, 18 years later he just retired as the director of WHO’s department for HIV and Hepatitis. The intervening period, almost half the time we’ve been aware of the disease the fight against the infection has been characterised by scientific breakthroughs, and disappointments - but the people mobilised against the virus have changed the way the world funds global health, the way patients are included in research agendas, and saved lives. Gottfried spoke to us during his post retirement holiday in France, and talked about his experiences, and what the legacy of HIV/AIDs will be.

Burnout is a problem in healthcare - it’s a problem for individuals, those who experience it and decide to leave a career they formerly loved, but it’s also a problem for our healthcare system. Burnout is associated with an increase in medical errors, and poor quality of care. Fundamentally it’s a patient safety issue. But, unlike other patient safety issues we tend to think about it, and try to prevent it, at an individual not systems level. However, Anthony Montgomery from the University of Macedonia, and Christina Maslach, from the University of California, Berkeley, urge us to start treating burnout as a systems issue. We hear about how we can spot burnout, and what can be done to try and mitigate it. Read their full analysis Burnout in healthcare: the case for organisational change https://www.bmj.com/content/366/bmj.l4774

The UK has just seen it’s hottest July on record, including the highest ever temperature recorded. With climate change in the forefront of our minds, it’s timely that we have two editorials on the sustainability and health. Michael Depledge, emeritus professor of environment and human health at University of Exeter Medical School, and author of the editorial Time and Tide, explains how closely the oceans and seas are linked to human health. Also Gillian Leng, deputy chief executive and director of health and social care at NICE has ideas about what the NHS can do to become more sustainable, and how we could evaluate the impact treatments have on the planet. Read the two editorials Time and tide - https://www.bmj.com/content/366/bmj.l4671 A more sustainable NHS - https://www.bmj.com/content/366/bmj.l4930

At EBM live recently, we ran a workshop with researchers, patients and clinicians to talk about patient rights in research - should patients be setting the full research agenda? Should they be full participants and authors? Helen Macdonald, BMJ’s UK research editor and co-host of our talk evidence podcast sat down to Paul Wicks, researcher and patient, and Emma Cartwright, The BMJ's What your patient is thinking editor, to reflect on what the workshop uncovered - and where we should be moving to next. Read more about the BMJ's patient and public partnership: https://www.bmj.com/campaign/patient-partnership Go to EBM live in Toronto in 2020 https://ebmlive.org/ebmlive-2020/

Cannabinoid hyperemesis syndrome is a relatively newly recognised condition - but, according to one study, can account for up to 6% of patients presenting to emergency departments. The causal mechanism is as yet unclear - but currently the only known way to prevent the syndrome is for the patient to stop their cannabis use. Yaniv Chocron, chief resident at Lausanne University Hospital, Lausanne, Switzerland talks us through spotting the condition, and what we think might be the mechanism of action. Read the full easily missed article: https://www.bmj.com/content/366/bmj.l4336

Cochrane Austria have been asking the public what they'd like to know about health. Not whether the latest drug is more efficacious, but whether glacier stone power cures hangovers. Gerald Gartlehner, director of the Cochrane Austria Centre joins us to explain what they do, and how their evidence has been received. Read more about the project (in German): https://www.medizin-transparent.at/