Medicine and Science from The BMJ

Each individual’s grief process is unique, when confronted with the death of a loved one, most people experience transient rather than persistent distress - however 10% of bereaved individuals, with an increased risk following the death of a partner or child and loss to unnatural or violent circumstances, experience prolonged grief disorder. In this podcast, Paul Boelen, a professor of psychiatry at Utrecht University, and Geert Smid, psychiatrist and senior researcher from the Dutch National Psychotrauma Centre, join us to discuss what constitutes complex grief, how to recognise it, and some strategies for helping patients cope. Read the full practice pointer: http://www.bmj.com/content/357/bmj.j2016

NHS hospitals must be willing to dispose of surplus land to help convince the Treasury to invest in new premises that are fit for purpose, the head of a major government review has urged. Robert Naylor, former chief executive of University College London Hospitals, who was asked by the health secretary, Jeremy Hunt, to produce a review of NHS property and estates - and in this interview we asked him how his plans would work, and what would be done with the land sold. Read Gareth Iacobucci's report: http://www.bmj.com/content/357/bmj.j2072

The BMJ publishes a lot of educational articles, and in an attempt to help you with your CPD, we have put together this round-up. Our authors and editors will reflect on the key learning points in the articles we discuss, and explain how they may change their practice in light of that new understanding. In this month's round up we're discussing: Addiction to exercise http://www.bmj.com/content/357/bmj.j1745 If your patient doesn’t speak the same language as you . . . http://www.bmj.com/content/357/bmj.j1511 Exploring thoughts of suicide http://www.bmj.com/content/356/bmj.j1128 The role of the microbiome in human health and disease http://www.bmj.com/content/356/bmj.j831

Adoption of shared decision making into routine practice has been remarkably slow, despite 40 years of research and considerable policy support. In 2010, the Health Foundation in the UK commissioned the MAGIC (Making Good Decisions in Collaboration) programme to design, test, and identify the best ways to embed shared decision making into routine primary and secondary care using quality improvement methods. In this podcast, Natalie Joseph-Williams from Cardiff University and Richard Thomson from Newcastle University, join us to discuss how the project went, and what key lessons they learned from the pilot. Read their full analysis: http://www.bmj.com/content/357/bmj.j1744

Pharma companies say that money spent on promotion is essential to educate doctors about the best drugs - but when a medical student asked Joseph Ross, associate professor of medicine and public health at Yale, if those companies are promoting the right drugs for that message to be true, the answer wasn't available. Ross and Tyler Greenaway, his medical student, then sat down and used the data from the US Physician Payments Sunshine Act to find out which drugs have the highest promotional budgets. They cross referenced that against prescription databases and measures of value to assess the effectiveness, usefulness, and affordability of the drugs that get the heaviest promotion. Read the full analysis: http://www.bmj.com/content/357/bmj.j1855

Biologics have revolutionised healthcare for some conditions - but have been expensive because of the multistep manufacturing processes required to create these complex molecules. Changes to the manufacturing of biological agents make them more affordable, but can lead to drugs with different components from the original medicine tested in clinical trials, challenging assumptions about safety. David Hunt, honorary consultant neurologist and Wellcome Trust intermediate clinical fellow, at the University of Edinburgh, joins us to describe how that happens and what the result can be. Read the full analysis: http://www.bmj.com/content/357/bmj.j1707

It’s been called “the universal panacea” - exercise has a positive effect on almost all health measures, and governments are actively campaigning for us to do more. But at the opposite end of the scale, the realisation that some people may be addicted to exercise is gaining traction. In this podcast we're joined by Heather Hausenblas - professor of kinesiology at Jacksonville University, James Smoliga - associate professor of physiology at highpoint University, and Katherine Schreiber - who’s experienced exercise addiction, and written about her experience. They describe the condition, and what drives people to become addicted to exercise. They also outline the key indicators of the addiction, and what options there are for treatment. Read their article: http://www.bmj.com/content/357/bmj.j1745

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 second discussion we went to Nottingham​ University, to find out what the people who create the bread and butter of EBM - randomised control trials - think about the issues with evidence synthesis, and how the information they create is being used in practice. http://evidencelive.org/manifesto/ - join the discussion, read, and comment on our manifesto.

Thankfully, electrical injuries are relatively uncommon - but that means that lack of evidence regarding the management of patients who have been electrocuted, which can cause concern for clinicians when these patients present. In this podcast, Cath Brizzel, clinical editor for The BMJ, is joined by one of the authors of a clinical update on the management of electrical injury - Kumar Narayanan, a Consultant Cardiologist and Electrophysiologist at MaxCure Hospitals in India. Read that full update, including the free infographic: http://www.bmj.com/content/357/bmj.j1418

Our latest debate asks whether there should be a Royal Commission (a high level enquiry, with statutory powers) into the future of the NHS. A high level inquiry could detoxify the radical changes needed and command wide support, say Maurice Saatchi, conservative peer, and Paul Buchanan, The BMJ's patient editor; but Nigel Crisp, independent peer, thinks that a less formal, more flexible and collaborative approach could be quicker. Read the debate: http://www.bmj.com/content/357/bmj.j1621