Talk Evidence

There is a growing market of new diagnostic tests being targeted directly to consumers, often before high-quality evidence about their effectiveness is available. This is causing issues in clinical practice as patients arrive at the NHS’s front door with results that have alarmed them.   The accuracy of these tests is unknown, developed in idealised populations then released to the general public, the positive predictive value of these tests plummet in the real world - but false positives require extensive further testing to rule out problems.   But advances in technology, with real potential, and commercial and societal incentives have aligned - these tests aren’t going to go away. So how do we start grappling with the power and pitfalls of early diagnosis - define exactly how we should be evaluating and regulating this growing industry, and what changes will we need to put in place in our healthcare systems to make sure an early diagnosis is good diagnosis?   In this podcast;   Peter Donnelly, professor of public health medicine at the University of St Andrews Bethany Jenkins, professor of health economics at the University of Leeds Stuart Hogarth, researcher at the University of Cambridge Andreas Halner, co-founder of Oxford Cancer Analytics Alex Richter, director of clinical immunology services at the University of Birmingham Carl Heneghan, director of the Centre for Evidence-Based Medicine at the University of Oxford. This podcast was recorded at the Evidence Based Early Diagnosis Conference

Helen MacDonald and Juan Franco are back to examine the newest in evidence based medicine.   In this episode: gabapentinoids are medications routinely prescribed for treating epilepsy and nerve pain. But, they come with side effects; among them - dizziness, cognitive impairment, and a dent to motor coordination - as well as an increase in suicidal ideation for the patient. Seena Fazel is professor of forensic psychiatry at University of Oxford and joins Juan to discuss a new paper tracking the association of self-harm and gabapentinoids use in Sweden.   Meanwhile, GRADE is a fundamental tool for clinicians to assess the quality of evidence for medical interventions. But, the sheer number of recommendations in the GRADE series can be overwhelming. Gordon Guyatt is a distinguished professor of medicine at McMaster University in Canada, and an early figure in the rise of evidence based medicine. He joins Helen to reflect on the future of EBM, and how the new Core GRADE system can cut through the noise.   Reading list:   1. Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and violent crime: population based cohort study in Sweden 2. Why Core GRADE is needed: introduction to a new series in The BMJ  

Helen MacDonald and Juan Franco are back, magnifying glasses in hand, to take a closer look at what’s happening in evidence based medicine.   In this episode: the NHS increasingly relies on physician associates to plug some of its leaks. But, what do academic studies show about the effectiveness of these newest healthcare team members? Trish Greenhalgh is professor of primary healthcare at the University of Oxford, and she tells us about her meta-study reviewing the evidence.   Meanwhile, chronic back pain can be debilitating. When it’s at its worst, patients are eager for treatments. But, what is the true effectiveness of spinal injections to alleviate pain? Jane Ballantyne is a retired professor of pain medicine. She discusses where interventions go wrong, and how new recommendations for pain management reflect the best evidence.   Finally, Helen and Juan face uncertainty. A new research methods and reporting paper published in the BMJ takes a critical look at clinical prediction models. What does the evidence tell clinicians about how to behave when outcomes can’t be exact?   Reading list: Physician associates and anaesthetic associates in UK: rapid systematic review of recent UK based research. Spinal interventions for chronic back pain Uncertainty of risk estimates from clinical prediction models: rationale, challenges, and approaches

  Helen Macdonald and Juan Franco are back, delving into some new evidence.   Studies showing that bi-annual injection that could prevent HIV transmission sound incredible, but will the implementation research find that the tried and tested pill regime is better? Jen Manne-Goehler, Assistant Professor of Medicine at Brigham and Women's Hospital, explains all about Lenicaprovir .   And while silicon valley tells us the future is AI, how can we trust the tools they produce? FUTURE-AI is an acronym and a potential answer, Karim Lekadir, director of the University of Barcelona’s Artificial intelligence in medicine lab, join us to explain what FUTURE-AI means, and why its principles are important in both the design and evaluation of machine learning.   Reading list:   HIV: Breakthrough study raises hopes of effective prevention if drug’s costs can be lowered.  FUTURE-AI: International consensus guideline for trustworthy and deployable artificial intelligence in healthcare. 

Giuseppe Moscelli, an author focused on healthcare research, joins to unpack pivotal insights on staff turnover in NHS hospitals. He reveals the alarming correlation between high turnover rates among nurses and increased patient mortality. The discussion also dives into the utility of UTI dipstick tests for acutely ill patients, questioning their accuracy and potential for overdiagnosis. Giuseppe emphasizes the necessity of better retention strategies to improve patient care and outcomes in healthcare systems.

In this special festive episode, Helen MacDonald, Juan Franco, and guest Tim Feeney discuss three intriguing themes from BMJ's 2024 Christmas edition: cognitive dysfunction in careers that require spatial cognition, and in large language models; the effectiveness of heated mittens on osteoarthritis hand symptoms; and a trial exploring just-in-time training for doctors.      00:40 Cognitive dysfunction and hippocampus stimulating jobs 07:00 Cognitive testing of large language models 10:30 Warming mittens for osteoarthritis 17:11 Coaching clinicians for high-stakes procedures Reading list Alzheimer’s disease mortality among taxi and ambulance drivers Age against the machine—susceptibility of large language models to cognitive impairment Effect of heated mittens on physical hand function in people with hand osteoarthritis Coaching inexperienced clinicians before a high stakes medical procedure

Measuring the carbon impact of healthcare interventions is essential if we're going to make the sector sustainable, however tracing all of the emmission from even a simple treatment can be tricky. Romi Haas, a research fellow at Monash Department of Clinical Epidemiology joins us to explain how it works, and how research could be more efficient. New U.S. guideline on breast cancer screening  have been extended to women in their 40s -  Katy Bell, from the University of Sydney, and Stacy Carter, from the University of Wollongong explain why the good intention of that change wont be mirrored in outcomes - and may even induce harm.   Reading list: Clinician and health service interventions to reduce the greenhouse gas emissions generated by healthcare: a systematic review  Breast cancer screening from age 40 in the US  

It's a therapeutics evidence feast this month. We start with deprescribing in older adults - Anna Hung, assistant professor at the Duke University School of Medicine has written a summary of the evidence, and we discuss why there are so few trials on an important topic. Metformin is typically first line for type II diabetes, but what should be next? A new cohort study emulating a comparative effectiveness trial has been published, and the team discuss using observational data for this very common problem. Finally, a new trial on nirmaltrevir for covid 19 in those at higher risk of severe disease or those who are unvaccinated.   Links BMJ - Deprescribing in older adults with polypharmacy BMJ - Comparative effectiveness of second line oral antidiabetic treatments among people with type 2 diabetes mellitus: emulation of a target trial using routinely collected health data NEJM - Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with Covid-19

Helen Macdonald, BMJ's publication ethics and content integrity editor, and Juan Franco, editor of BMJ EBM are back with another episode of Talk Evidence. This month, we'll be focussing on semaglutide, for managing obesity. Interviews with James Cave, editor-in-chief of Drug and Therapeutic Bulletin, and Lene Bull Christiansen, who has personal and professional experience with obesity, are featured. They discuss the history of drug therapies for obesity, and wonder if the wonderdrug semaglutide will turn out to be as disappointing. They discuss the evidence base for use of semaglutide, its effectiveness in weight management, and the broader societal issues surrounding obesity treatment. Next, the hosts delve into undisclosed financial conflicts of interest in the DSM-5, focusing on a study led by Lisa Cosgrove and colleagues. The study reveals significant ties between DSM-5 authors and pharmaceutical companies, raising concerns about industry influence on psychiatric diagnosis and treatment recommendations. The episode concludes with a discussion on survival rates after in-hospital cardiac arrest, based on a study using data from the Get With The Guidelines Resuscitation database. The hosts analyze the implications of the study findings for clinical practice and advanced care planning.   Interview with James Cave: 00:03:15 Interview with Lene Bull Christiansen: 00:11:07 Interview with Lisa Cosgrove: 00:25:07 Survival after in-hospital cardiac arrest: 00:31:25 Reading list NEJM - Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes DTB - Semaglutide: a new drug for the treatment of obesity BMJ - Undisclosed financial conflicts of interest in DSM-5-TR: cross sectional analysis BMJ - Duration of cardiopulmonary resuscitation and outcomes for adults with in-hospital cardiac arrest: retrospective cohort study      

The December edition of the Talk Evidence podcast discusses the complexities of seeking consent from patients who are part of large data sets, and some new research to help patients living with diabetes in places without certain power supplies. First patient consent and data - in the UK,  two stories that have made the public worry about the use of their health data. Firstly the news that UK biobank, who hold a lot of genomic and health data, allowed research by an insurance company, and second that the NHS has entered a contract with Palentir to do analysis on NHS data. Natalie Banner, director of ethics at Genomics England has been thinking hard about putting patients at the centre of decision making about their data, and explains why she thinks a sole reliance on a consent model falls short. Next, uncertain power supplies, such as in conflict or disaster zones, means uncertain refrigeration. Hard enough for most people to survive, but if you need to keep your insulin cold, it can be lifethreatening. However a new cochrane review has found good news about the thermostability of insulin at room temperature. We ask Phillipa Boulle, MSF Intersectional NCD Working Group Leader and Cyrine Farhat,is  a global diabetes advocate based in Lebanon, how this will affect care for patients around the world.   Reading list Thermal stability and storage of human insulin   Outline   00:06 introduction and overview 00:24 the challenge of seeking consent in big data sets 01:34 understanding consent issues in large datasets 01:52 the role of participant panels in data accountability 02:44 the complexity of public attitudes towards data use 04:54 the importance of transparency and engagement in data use 05:48 the impact of external factors on public trust in data use 07:49 the ethical challenges of using health data 09:17 the limitations of consent in ethical discussions 09:23 the need for more conversation about group benefits, risks, and harms 10:41 the role of governance in ethical decision making 12:05 discussion on the interview with natalie banner 14:59 the challenge of managing chronic conditions in disaster zones 15:15 the impact of temperature and storage conditions on insulin 17:32 interview with Philippa Boulle from medecins sans frontieres 29:10 interview with Cyrine Farhat, a person living with diabetes in lebanon 36:18 discussion on the interviews and the challenges of diabetes management