Medicine and Science from The BMJ

Looking after a young child is hard enough, but when that child has learning difficulties and displays challenging behaviour - the burden on parents can be extreme. That behaviour may prompt a visit to the doctor, and in this podcast we’re talking about how parents can be supported in that - what services are available. We’ll also be discussing what is normal behaviour, and what might prompt a referral to a specialist team for further assessment. In this podcast we're joined by 2 of the authors of a recent practice pointer - Managing challenging behaviour in children with possible learning disability. Angela Hassiotis - professor of psychiatry of intellectual disability at University College London and Michael Absoud - consultant in paediatric neurodisability at the Evelina London Children’s Hospital. We also have Rebecca - mother of a child who displayed some of these behaviours, and is actually a parent/carer case worker supporting families of children with disabilities. Read the full practice article: https://www.bmj.com/content/365/bmj.l1663

In the UK we have a complex relationship with gambling, the government licences the national lottery, and uses profit from that to fund our art and museum sector - horse racing is a national TV event, and we've seen a proliferation of betting shops on our high streets. At the same time, there's increasing acceptance that gambling causes problems for some people - to the extent that it's been termed a "hidden epidemic" and a public health problem. And it's to that point that the authors of a new analysis have written in the BMJ - if we see gambling as a public health problem, why aren't we treating it as such. To talk about that, we're joined in the studio by Heather Wardle - Wellcome humanities and social science research fellow at the LSHTM. Read the full analysis: https://www.bmj.com/content/365/bmj.l1807

The National Surveys of Sexual Attitudes and Lifestyles is a deep look into the sex lives of us brits - and has been running now for 30 years, giving us some longitudinal data about the way in which those sex lives have changed. The latest paper to be published, based on that data, looks at the frequency of sex - how often different groups are having sex on a weekly basis, and has reported a drop in that frequency for some groups. Joining us to talk about the research, and why we're having less sex, is Kaye Wellings, Professor of Sexual and Reproductive Health at the London School of Hygiene and Tropical Medicine. Read the full open access research: https://www.bmj.com/content/365/bmj.l1525

Starting in the middle of April, the group “Extinction Rebellion” have organised a series of non-violent direct action protests. Most notably bringing central London to a standstill - but these events are now continuing around the country. Predictably, they have received a lot of criticism - they have also received a lot of support - amongst those arrested at the protests have been a few doctors, despite reservations that some may have for the impact on their careers. In this podcast, we'll hear from three people who have decided to support extinction rebellion, about why they do, and what the medical community's support might mean for climate change. We're joined by Rowan Williams, Master of Magdalene College, Cambridge and former Archbishop of Canterbury - the principle leader of the church of England. Robin Stott, retired physician and campaigner, and Alex Armitage, paediatric trainee. Schoolchildren’s activism is a lesson for health professionals https://www.bmj.com/content/365/bmj.l1938 Just 11 years to avert disaster https://www.bmj.com/content/365/bmj.l1801

Here's a taster for our new student podcast - Sharp Scratch. We're talking about the hidden curriculum, things you need to know to function as a doctor, but are rarely formally taught. This is a taster - if you enjoy, subscribe! https://podcasts.apple.com/gb/podcast/student-bmj-podcast/id331561304 Sharp Scratch episode 1: Surviving the night shift. Why nights shifts mess with your brain, how astronauts will cope with the time difference on Mars, and the power of frozen grapes when you need a boost. Join medical students Laura, Ryhan, Declan, and newly qualified doctor Chidera as we figure out how to survive the night shift. Featuring a guest interview with NASA researcher Erin, leader of the Fatigue Countermeasures Group. https://www.bmj.com/sharpscratch

In the UK, there's an ethnic group that is surprisingly large, but often overlooked by society, and formal healthcare services. The gypsy traveller community have poorer health outcomes because of systemic issues around access to health and education. In this podcast we're joined by Michelle Gavin and Samson Rattigan, who both work for Friend's Families and Travellers - and who have have been working hard in East Sussex to bridge the gap between the healthcare system and those who identify as gypsies or travellers, and explain some of the simple ways in which GPs and hospitals can support this neglected group. https://www.gypsy-traveller.org/

An “author pays” publishing model is the only fair way to make biomedical research findings accessible to all, say David Sanders, professor of gastroenterology at Sheffield University, but James Ashton and worries that it can lead to bias in the evidence base towards commercially driven results - as those are the researchers who can pay for open access fees. Dave deBronkart just wants patients to have access to key research. Read the full head to head: https://www.bmj.com/content/365/bmj.l1544

Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month. (1.20) Carl grinds his gears over general health checks, with an update in the Cochrane Library. (9.15) Helen is surprised by new research which looks at over prescription of antibiotics - but this time because the courses prescribed are far longer than guidelines suggest. (22.30) What is the true 99th centile of high sensitivity cardiac troponin in hospital patients? (29.02) Is it time to abandon statistical significance and be aware of the problem of the transposed conditional. Reading list: General health checks in adults for reducing morbidity and mortality from disease - https://www.ncbi.nlm.nih.gov/pubmed/30699470?dopt=Abstract Duration of antibiotic treatment for common infections in English primary care -https://www.bmj.com/content/364/bmj.l440 True 99th centile of high sensitivity cardiac troponin for hospital patients - https://www.bmj.com/content/364/bmj.l440 Significant debate - https://www.nature.com/magazine-assets/d41586-019-00874-8/d41586-019-00874-8.pdf The false positive risk: a proposal concerning what to do about p-values - https://www.youtube.com/watch?v=jZWgijUnIxI http://www.onemol.org.uk/?page_id=456

On the 7th of June, 1753, Dr Archibald Cameron was executed at Tyburn. "The body, after hanging twenty minutes, was cut down: it was not quartered; but the heart was taken out and burnt. " 250 years later, his sixth great grandson, Robert Syned found himself deeply involved in the process of execution, as an expert witness in a case about the use of a new drug for lethal injection in the USA. In this podcast, Robert joins us to talk about the dearth of evidence, and massive variation in the use of drugs used to execute someone, and reflects on how finding out about his ancestor meant to him in this process.

Jessica Perlo is the Director for Joy at Work at the Institute for Healthcare Improverment, and James Mountford is direct or of quality at the Royal Free London NHS Foundation Trust. Together they joined us at the International Forum on Quality and Safety in Healthcare to discuss joy at work - what that concept actually means, and practically, how hospitals can start implementing it. Watch Jessica’s session at the forum https://internationalforum.bmj.com/glasgow/2018/09/20/a1-leadership-models-for-co-producing-a-joyful-workforce/ BMJ's wellbeing campaign https://www.bmj.com/wellbeing https://www.facebook.com/groups/569230966796440/