Medicine and Science from The BMJ

Sudden cardiac death in athletes aged less than 35 years is the leading cause of medical death in this subgroup, with an estimated incidence of 1 in 50 000 to 1 in 80 000 athletes per year. it is most commonly caused by an underlying genetic heart disorder, such as hypertrophic cardiomyopathy. In this podcast Christopher Semsarian, professor of medicine at the University of Sydney, joins us to discuss the diagnosis of cardiac changes and prevention of death in this population. Read the full clinical review: http://www.bmj.com/content/350/bmj.h1218

A BMJ Clinical Evidence systematic overview looks at the evidence for medical and surgical treatments of trigeminal neuralgia, and the uncertainties that exist due to gaps in the evidence. This has been summarised in The BMJ. The authors of the overview and bmj.comsummary, Prof. Joanna Zakrzewska from the Facial Pain Unit at the Eastman Dental Hospital, London, and Mark Linskey, Professor of Neurological Surgery at the University of California Irvine, discuss the evidence, the issues around it, and put this all into a clinical context. Read the full systematic overview: http://clinicalevidence.bmj.com/x/systematic-review/1207/overview.html Disclaimer: The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. BMJ does not warrant the accuracy of the information contained in the podcast and to the fullest extent permitted by law, BMJ Publishing Group Limited is not responsible for any loss whatsoever resulting from the application of, or reliance upon, the information contained in this podcast.

In the US the licence, or marketing authorisation, for alteplase is limited to 0-3 hours after onset of stroke, but some other countries - including the UK and Australia - have extended the licence to 4.5 hours. In an analysis article on thebmj.com Brian Alper, vice president of evidence based medicine research and development at Dynamed, and colleagues, interpret the evidence to suggest increased mortality with uncertain benefit for its use beyond three hours. Read their full analysis: http://www.bmj.com/content/350/bmj.h1075

Chris Moulton is VP of the Royal College of Emergency Medicine and an A&E consultant in the Royal Bolton Hospital. He believes that the majority of patients who attend A&E cannot be adequately treated elsewhere, and that measures to try and reduce emergency presentations may be counterproductive. If you would like to contribute to this collection, please email a brief audio recording to voices@bmj.com or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

Obioma Ezekobe is a GP in an urgent care centre in Central Middlesex Hospital. She believes that the public need to be educated about the use of NHS resources, and be taught when it is appropriate to seek care. If you would like to contribute to this collection, please email a brief audio recording to voices@bmj.com or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

BMJ Voices is a collection of readers’ experiences of working in the NHS. For this, The BMJ is seeking short audio submissions from UK listeners. These submissions will be published on thebmj.com. Patrick Keating, a GP from Enfield, is concerned that small practices are under pressure to increase list size, but aren't able to muster resources to meet this increased demand. If you would like to contribute to this collection, please email a brief audio recording to voices@bmj.com or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

Katherine Henderson is the clinical lead of the emergency department at St Thomas's hospital in London. She worries that lack of ward space is having a domino effect throughout A and E and is the cause of increased waiting time for both patients and ambulances. If you would like to contribute to this collection, please email a brief audio recording to voices@bmj.com or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

Abdominal aortic aneurysms (AAA) are usually asymptomatic until they rupture, which is fatal in more than 80% of cases. Screening aims to detect the aneurysm before it ruptures, enabling preventive surgery and hence reducing morbidity and mortality. However, preventive surgery has a mortality of 3.9-4.5%. As the prevalence of risk factors, ie smoking, decreases and the definition of the condition is expanded, Minna Johansson from the University of Gothenburg and colleagues wonder if the balance of benefit and harm may have tipped. Read the full analysis: http://www.bmj.com/content/350/bmj.h825

Ashish Jha, professor of health policy and management at Harvard School of Public Health, talking about how the Affordable Care Act has fostered new models of integrated service delivery in the United States Read more from the summit: http://www.bmj.com/content/350/bmj.h1172

Bastiaan Bloem, consultant neurologist at Radboud University Nijmegen Medical Centre, Netherlands, discussing his revolutionary approach to patient centred care. Read more from the summit: http://www.bmj.com/content/350/bmj.h1172