Medicine and Science from The BMJ

When a person’s heart or breathing stops and the cause is reversible, immediate cardiopulmonary resuscitation (CPR) offers a chance of life. However, when a person is dying—for example, from organ failure, frailty, or advanced cancer—and his or her heart stops as a final part of a dying process, CPR will not prevent death and may do harm. But conversations around that distinction are difficult. In a this podcast, we explore the ways in which these conversations go wrong, and give some practical advice on carrying them out better. Joining Helen Macdonald are Zoe Fritz, consultant acute physician, and Wellcome Fellow, David Pitcher, former president of the Resuscitation Council, and Kate Masters, whose mothers death led to a change in the law around DNACPR orders. Read the articles discussed in this podcast: Emergency care and resuscitation plans http://www.bmj.com/content/356/bmj.j876 Resuscitation policy should focus on the patient, not the decision http://www.bmj.com/content/356/bmj.j813 My mum’s care means that decisions not to resuscitate must now be discussed with patients http://www.bmj.com/content/356/bmj.j1084

The World Health Organization, the Roll Back Malaria Partnership, and the United Nations, all have a vision of a malaria-free world. The world has already committed to malaria eradication, albeit without a target date. Bruno Moonen, deputy director for malaria at the Bill and Melinda Gates Foundation, thinks that for malaria, eradication is the only equitable and sustainable solution. Where as Clive Shiff, associate professor at the Johns Hopkins Bloomberg School of Public Health, thinks this is a top-down strategy, dependent on massive concentrated funding until finished - funding which could be more effectively spent elsewhere. In this podcast they debate whether malaria should be eliminated, or eradicated, and how that might work. Read the full debate: http://www.bmj.com/content/356/bmj.j916

Scott Murray, professor of primary palliative care at the University of Edinburgh, has written, and talked in this podcast before, about the benefits of early palliative care - and today he’s back to explain how illness trajectory, and the pattern of decline at the end of life, affects 4 main areas of wellness - physical, social, psychological and spiritual or existential. Read his full analysis article: http://www.bmj.com/content/356/bmj.j878

In 2015, community acquired pneumonia (CAP) accounted for 15% of deaths in children under 5 years old globally and 922 000 deaths globally in children of all ages. In this podcast Iram Haq, a registrar and clinical research associate in paediatric respiratory medicine, joins us to discuss the definition of pneumonia, how to assess for the infection, and what treatments are effective. Read the full clinical update: http://www.bmj.com/content/356/bmj.j686

The UK government published its report Childhood Obesity: a Plan for Action, in August 2016. A new analysis article takes them to task for the inadequacy of that response to a growing problem. Neena Modi is a professor of neonatal medicine, at Imperial College London, and president of the Royal College of Paediatrics and Child Health, and joins us to discuss what that report should have contained. Read the full analysis: http://www.bmj.com/content/356/bmj.j762

A new rapid recommendation had concluded that LIPUS makes no different to patients experience of bone healing, and therefore shouldn't be used. In this podcast, we talk to three of those panel members - Rudolf Poolman, orthopaedic surgeon from The Netherlands, Stefan Schandelmaier, a methodologist from McMaster University, and Maureen Smith, a patient representative. Read the full recommendation: http://www.bmj.com/content/356/bmj.j576

All doctors, irrespective of their specialty or the setting in which they work, will care for patients who die. Around half of all deaths occur in hospitals. Evidence suggests that the quality of communication around this process is poorer in hospitals than in other settings, according to responses from relatives who have experienced bereavement. Over half of NHS complaints concern care of the dying. In this podcast, Katherine Sleeman, clinician scientist and honorary consultant in palliative medicine at King's College London, and Jane Harris, counselling and psychotherapy practitioner, and bereaved mother and daughter join us to discuss what support the carers and relatives of a dying patient need, and give practical advice on how to become better at having those difficult conversations. Read the full essentials article: http://www.bmj.com/content/356/bmj.j367

Persistent physical symptoms are common and include those symptoms that last at least three months and are insufficiently explained by a medical condition after adequate examination and investigation. Observational studies in primary care report that women, especially those aged 35-45 years, more commonly present with these symptoms. In this podcast, Madelon den Boeft, a GP and, Nikki Claassen-van Dessel, a GP trainee, both in The Netherlands, join us to explain why listening to a patient is important, and making sure that regular follow up is essential. Read the full uncertainties article: http://www.bmj.com/content/356/bmj.j268

Vivek Murthy, the US surgeon general, has highlighted prescription opioid misuse as a serious public health problem. In this podcast, Richard Hurley speaks to him about what he thinks needs to be done to tackle the issue. http://www.bmj.com/content/356/bmj.j715

Evidence shows using electronic health records can increase efficiency, and reduce preventable medical errors - but only if they are used properly. However, in the US, the president of the American Medical Association calls them almost unusable. In this debate, Richard Hurley is joined by George Gellert, Regional Medical Informatics Officer at CHRISTUS Santa Rosa Health System and Edward Melnick, Assistant Professor of Emergency Medicine at Yale, who debate whether US doctors should be using electronic medical records. Read the related article: http://www.bmj.com/content/356/bmj.j242.