Medicine and Science from The BMJ

Two articles published on the bmj.com aim to help doctors treat patients who request support with their gender identity. Firstly a practice pointer on how to refer to gender clinic, and secondly a What Your Patient Is Thinking article about trans people's experiences in the healthcare system. In this podcast, two of the authors of that patient experience article, Emma-Ben and Reubs, join us to discuss identity, pronouns and what genderqueer means. I am your trans patient http://www.bmj.com/content/357/bmj.j2963 Gender dysphoria: assessment and management for non-specialists http://www.bmj.com/content/357/bmj.j2866

Findings from a range of prospective cohort studies based around the world indicate that higher intelligence in children is related to a lower risk of all cause mortality in adulthood - and now a new study, published on bmj.com, is trying to dig into that association further, with a whole population cohort and data on cause specific mortality. Ian J Deary, professor of differential psychology at the University of Edinburgh and one of the authors of that study, joins us to discuss what this tells us, and what might be causing that association. Read the full open access study: http://www.bmj.com/content/357/bmj.j2708

"Too many research studies are poorly designed or executed. Too much of the resulting research evidence is withheld or disseminated piecemeal. As the volume of clinical research activity has grown the quality of evidence has often worsened, which has compromised the ability of all health professionals to provide affordable, effective, high value care for patients.” Evidence is in crisis, and Carl Heneghan, director for the Centre for Evidence Based Medicine, and Fiona Godlee, editor in chief of The BMJ set out the 9 points of the Evidence manifesto, which tries to set a road map for strengthening the evidence base. 1) Expand the role of patients, health professionals and policy makers in research 2) Increase the systematic use of existing evidence 3) Make research evidence relevant, replicable and accessible to end users. 4) Reduce questionable research practices, bias, and conflicts of interests 5) Ensure drug and device regulation is robust, transparent and independent 6) Produce better usable clinical guidelines. 7) Support innovation, quality improvement, and safety through the better use of real world data. 8) Educate professionals, policy makers and the public in evidence-based healthcare to make informed choices. 9) Encourage the next generation of leaders in evidence-based medicine. http://www.bmj.com/content/357/bmj.j2973

Stress is one of the leading causes of work absence, recently overtaking back-pain, and an increasing part of a GPs workload. However good quality evidence about how to deal with stress is hard to come by. Alexis Descatha, an occupational/emergency practitioner, at the University hospital of Poincaré, gives some practical advice on what to do when you suspect stress is the underlying cause of a consultation, and what to do once you have confirmed that. Read the full practice article: http://www.bmj.com/content/357/bmj.j2489

Air pollution is a truly damaging environmental insult to the human body. The numbers of premature deaths, in the UK alone, that can be attributed to it are calculated to be 40,000 a year. Yet despite this, action to tackle the problem - as with the other huge environmental issue of our time, climate change - is distinctly lacking. Robin Russel-Jones dermatologist and chair of Help Rescue the Planet - joins us to discuss what should be done to tackle the problem. Read the full analysis: http://www.bmj.com/content/357/bmj.j2713

The 2014 west African Ebola epidemic shone a harsh light on the health systems of Guinea, Liberia, and Sierra Leone. While decades of domestic and international investment had contributed to substantial progress on the Millennium Development Goals, national health systems remained weak and were unable to cope with the epidemic. Margaret Kruk associate professor of global health at the Harvard TH Chan School of Public Health, joins us to discuss what makes a health system resilient, and how Liberia in particular has learned lessons from Ebola. Read the full analysis: http://www.bmj.com/content/357/bmj.j2323

A new study on BMJ.com, examines the effect of moderate drinking on brain structure. We know that heavy drinking has a deleterious effect on our brains, and is linked to dementias. However, for sometime it’s been thought that moderate drinking is actually protective. Anya Topiwala, clinical lecturer in old age psychiatry at the University of Oxford, joins us to discuss the association between alcohol consumption and those structural elements. Read the full research: http://www.bmj.com/content/357/bmj.j2353

The rapid changes in the global environment have led many scientists to conclude that we are living in a new geological epoch—the Anthropocene—in which human activities have become the dominant driving force transforming the Earth’s natural systems. A recent joint publication by the World Health Organization and Convention on Biological Diversity articulated the myriad connections between biodiversity and health and the threats to both posed by environmental change. Andy Haines, professor of public health and primary care, at the London School of Hygiene and Tropical Medicine joins us to talk about a new research platforms present an opportunity to advance understanding of how to safeguard health in the face of global environmental change. Read more: http://www.bmj.com/content/357/bmj.j2358

We're creating a manifesto for better evidence. The centre for Evidence Based Medicine at the University of Oxford, and the BMJ, are asking what are the problem with medical evidence, and how can we fix them? In this third discussion we went to Scotland, to find out what the people who create policy think about the issues with evidence synthesis, and how the information they create is being used in practice. evidencelive.org/manifesto/ - join the discussion, read, and comment on our manifesto.

Available data suggest about 50% of delirium is hypoactive; this and the mixed motor subtype account for 80% of all cases of delirium. It can be more difficult to recognise, and is associated with worse outcomes, than hyperactive delirium. In this podcast, Christian Hosker, consultant liaison psychiatrist at the Leeds Liaison Psychiatry Service outlines when to suspect hypoactive delirium, how to assess, and appropriately manage patients. Infographic explaining diagnosis: http://www.bmj.com/content/bmj/suppl/2017/05/25/bmj.j2047.DC1/hosc038261.wi.pdf Read the full article: http://www.bmj.com/content/357/bmj.j2047