JournalSpotting

Are you trying to keep up with the latest medical literature but your journals keep getting blown away by the industrial fan you’ve bought to try and survive this sweaty heat wave? Your ears are in the right place! In this months episode:

...Tranexamic acid in UGI bleeding: more harm than good?...(04:35)
HALT-IT Trial Collaborators. “Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial.” Lancet (London, England) vol. 395,10241 (2020): 1927-1936. doi:10.1016/S0140-6736(20)30848-5

...Cocoa beans in acute ischaemic stroke?...(08:15)
Modrau, Boris et al. “Theophylline as an Add-On to Thrombolytic Therapy in Acute Ischemic Stroke: A Randomized Placebo-Controlled Trial.” Stroke vol. 51,7 (2020): 1983-1990.

...Ticagrelor for stroke prevention?...(12:40)
Johnston, S Claiborne et al. “Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA.” The New England journal of medicine vol. 383,3 (2020): 207-217.

...Probiotics for your mood?... (16:28)
Noonan S, Zaveri M, Macaninch E, et al Food & mood: a review of supplementary prebiotic and probiotic interventions in the treatment of anxiety and depression in adults BMJ Nutrition, Prevention & Health 2020

...Probiotics in care homes... (22:15)
Butler, Christopher C et al. “Effect of Probiotic Use on Antibiotic Administration Among Care Home Residents: A Randomized Clinical Trial.” JAMA vol. 324,1 (2020): 47-56.

...Tofu to reduce mortality?... (25:11)
Cai, Xiaoyan et al. “Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis.” BMJ (Clinical research ed.) vol. 370 m2297. 15 Jul. 2020,

...Coffee time: the facts and myths... (29:16)
van Dam, Rob M et al. “Coffee, Caffeine, and Health.” The New England journal of medicine vol. 383,4 (2020): 369-378.

...Does MTX actually cause ILD?...(33:15)
Juge, Pierre-Antoine et al. “Methotrexate and rheumatoid arthritis associated interstitial lung disease.” The European respiratory journal, 2000337. 9 Jul. 2020,

JOURNALBITES (38:13)
Vitamin D & diabetes prevention
An app for cardiac arrest
Noradrenaline dysregulates the immune response
AI & Skin disease

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Do you keep hearing numerous statistics about the mortality risk in COVID but want to know what the most robust data shows? How much of it is media hype? Can we really put 
it down to racism?..

And what should we be doing about it??

Your ears are in the right place.

We interview the inspiring Professor Ewen Harrison; HPB surgeon, Lead for the Centre for Medical Infomatics at Edinburgh University, and Lead author of the impressive and essential study:
“Ethnicity and outcomes from COVID-19: the ISARIC (International Severe Acute Respiratory and Emerging Infection Consortium)  CCP-UK (Clinical characterisation Protocol)  prospective observational cohort study of hospitalised patients”

Introduction to the JournalSpotters (01:00)
Introduction to Professor Ewen Harrison (06:00)
Why this study was needed (09:45)
Ewen's role in the study (13:45)
Success in enrolling (16:55)
Extra information collected and studies awaited (18:30)
What the study found (20:25)
Role of Obesity (23:00)
Difficulty of data interpretation (24:48)
ICNARC report comparison with study and difference in outcomes for sex (27:00)
What are the other key factors in South Asians apart from diabetes? (32:45)
Role of deprivation / socioeconomic status (35:15)
Limitations of study (37:30)

What this means for policy makers (39:00)
How this should impact healthcare professionals (40:40)
Risk assessment tools (44:20)
Data sharing / linkage (46:38)
The role of racism in the findings (48:00)
Ewen's top take home points (50:30)

Don't forget to check out Kosta's awesome Podpoint graphics on www.JournalSpotting.com, Twitter @ JournalSpotting, Instagram or Facebook.

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Are you trying to keep up with the latest medical literature but now you can go out for dinner, go to pubs, and send your kids to school...oh wait no...they're still stuck at home...nevermind...your ears are still in the right place!

In this months episode:

...Lung ultrasound scans for heart failure follow up... (06:30)
D. Araiza-Garaygordobil, R. Gopar-Nieto, P. Martinez- Amezcua, et al., A randomized controlled trial of lung ultrasound guided therapy in heart failure (CLUSTER-HF study), American Heart Journal (2020), https://doi.org/10.1016/ j.ahj.2020.06.003 

...Depression and the risk of cardiovascular disease... (09:40)
Rajan, Selina et al. “Association of Symptoms of Depression With Cardiovascular Disease and Mortality in Low-, Middle-, and High-Income Countries.” JAMA psychiatry, e201351. 10 Jun. 2020, doi:10.1001/jamapsychiatry.2020.1351

...The link between mental health and the immune system... (14:45)
Shields, Grant S et al. “Psychosocial Interventions and Immune System Function: A Systematic Review and Meta-analysis of Randomized Clinical Trials.” JAMA psychiatry, e200431. 3 Jun. 2020, doi:10.1001/jamapsychiatry.2020.0431

...When to look for primary hyperaldosteronism?... (18:00)
Brown, Jenifer M et al. “The Unrecognized Prevalence of Primary Aldosteronism: A Cross-sectional Study.” Annals of internal medicine vol. 173,1 (2020): 10-20. doi:10.7326/M20-0065

...Migraines are not as benign as we might think... (22:56)
Kurth, Tobias et al. “Association of Migraine With Aura and Other Risk Factors With Incident Cardiovascular Disease in Women.” JAMA vol. 323,22 (2020): 2281-2289. doi:10.1001/jama.2020.7172

...Technology takeover of T1 Diabetes care... (31:22)
Agarwal, Shivani, and Anne R Cappola. “Continuous Glucose Monitoring in Adolescent, Young Adult, and Older Patients With Type 1 Diabetes.” JAMA vol. 323,23 (2020): 2384-2385. doi:10.1001/jama.2020.7058

...ICU outcomes in the elderly, not all bad news... (36:30)
Haas, Lenneke E M et al. “Outcomes of Intensive Care Patients Older Than 90 Years: An 11-Year National Observational Study.” Journal of the American Geriatrics Society, 10.1111/jgs.16624. 27 Jun. 2020, doi:10.1111/jgs.16624

JOURNALBITES (42:00)
Ketamine for rapid tranquillisation
Discrimination and hypertension
DOACs in end-stage renal failure
Clarithromycin + DOACs= bleeding
Haloperidol for headaches
Putting Type 2 diabetes into remission: DIRECT style.

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Are you trying to keep up with the COVID literature but by the time you’ve read one article you realise it was from one month ago and therefore is currently irrelevant?

Here we have the Brilliant Professor Beverley Hunt to help us wade through the literature, learn from her experience and figure out how we should be treating our COVID-19 patients relating to their bloody sticky blood.

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01:00 Introduction to hosts / what we are talking about
03:30 Professor Beverley explains her role in COVID crisis
05:00 Why the blood is so sticky
06:40 How we have come to understand this
08:50 Rates & Cause of thrombosis - immunothrombosis
11:10 Why Dexamethasone helps
12:50 What thromboses do we see in patients?
15:10 Which patients are most at risk
16:35 And in pregnancy?
18:45 Which blood tests are useful? And the D-Dimer?
24:25 Which dose of LMWH? Call for trials
27:50 Rates of bleeding with LMWH
29:45 Are the thrombosis rates higher than other conditions?
30:45 OP / discharge Tx
33:20 Key Take Home Points for Bloody COVID
- Thromboprophylaxis on D1 admission!
- Enter your patients into trials
- Don't over treat with LMWH
- Sometimes the best is what existed before and had good evidence
35:00 An OBE for COVID?
35:15 Thank yous and sign offs

Want more info on Professor Hunt? Just google her name or find her on Twitter @bhwords.

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We welcome  Mr. Mahmood Bhutta an ENT surgeon who is an experienced campaigner in the fight for the ethical procurement of medical supplies.

We discuss how many of our medical supplies including PPE are produced in conditions that amount to modern slavery and how COVID-19 has affected this situation.

Important sources for the show:

• BMA fair medical trade 
• Time for a global response to labour rights violations in the manufacture of health-care goods, WHO bulletin by Mr. Mahmood Bhutta
• Clean Gloves, Dirty Practices: Debt Bondage in Malaysia's Rubber Glove Industry- The Diplomat article
• Guardian article on slave-like conditions of glove industry

Show Notes

• Background to the link between PPE & modern slavery (1:50)
• The secret to Mood's fascinating and diverse career (04:08)
• What is meant by modern slavery (08:04)
• Mood's personal story on how he became interested in ethical procurement (09:05)
• How involved is the NHS & the complexity of supply chains (10:50)
• Working conditions in which medical supplies are made (14:24)
• The glove industry (17:00)
• How do we get reliable data? (20:08)
• The effect of COVID-19 (22:35)
• How is the NHS responding (26:15)
• What can clinicians do? (28:05)
• Plugs (36:20)
• Take-home points (37:27)

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Here at Journalspotting headquarters we sacrificed our vitamin d levels and frisbee skills during the sunny month of May, and have compiled an episode that will get you up to scratch with what you missed while you were out sunbathing. In this months episode:

...Does a lower BP lower the risk of dementia?...(04:38)
Hughes, Diarmaid et al. “Association of Blood Pressure Lowering With Incident Dementia or Cognitive Impairment: A Systematic Review and Meta-analysis.” JAMA. doi:10.1001/jama.2020.4249

...When’s the right time to start dialysis in severe AKI?...(08:51)
Gaudry, Stéphane et al. “Delayed versus early initiation of renal replacement therapy for severe acute kidney injury: a systematic review and individual patient data meta-analysis of randomised clinical trials.” Lancet, doi:10.1016/S0140-

...Do I really need to find ice for an ammonia level?...(13:10)
Haj, Mona, and Don C Rockey. “Ammonia Levels Do Not Guide Clinical Management of Patients With Hepatic Encephalopathy Caused by Cirrhosis.” The American journal of gastroenterology. doi:10.14309/ajg.0000000000000343

...Is there a safer antiplatelet for the elderly?...(19:18)
Gimbel, Marieke et al. “Clopidogrel versus ticagrelor or prasugrel in patients aged 70 years or older with non-ST-elevation acute coronary syndrome.” Lancet. doi:10.1016/S0140-6736(20)30325-1

...How can we better serve our patients in care homes?...(23:21)
Alcorn, Gemma et al. “Care home residents who die in hospital: exploring factors, processes and experiences.” Age and ageing, doi:10.1093/ageing/afz174

...Are fancy lipid-lowering drugs all their cracked up to be?...(29:24)
Gencer, Baris et al. “Efficacy of Evolocumab on Cardiovascular Outcomes in Patients With Recent Myocardial Infarction: A Prespecified Secondary Analysis From the FOURIER Trial.” JAMA cardiology, doi:10.1001/jamacardio.2020.0882

...How significant is the wrong diagnosis?...
Newman-Toker, David E et al. “Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the "Big Three".” Diagnosis (Berlin, Germany), doi:10.1515/dx-2019-0104

...Can you trust the EWS score?...
Gerry, Stephen et al. “Early warning scores for detecting deterioration in adult hospital patients: systematic review and critical appraisal of methodology.” BMJ. doi:10.1136/bmj.m1501

JOURNALBITES
Canadian Syncope Score
Opioids in dialysis patient
VTE guideline update

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Introduction chat with Barney and Annalan:

• Meet the hosts
• Get you up to speed with what differential attainment (DA) is.
• The stats behind DA and racial inequality in the UK.
• Who is Sir Sam Everington anyway?

 Interview with Sir Everington: (15:25)

• Getting to know Sir Sam
• What is racism?
• Selection process for students and doctors 
• Mentoring
• Views on ‘colourblind’
• Celebrating diversity
• Challenging behaviours
• Microaggressions at work
• Leadership / teamwork
• Appointments commission 
• WRES / Observatory
• Changing how we manage our workload

Post-interview chat with Annalan: (63:10)

• Take home points and final words

Links as promised:

Websites / articles

• BMJ on Racism
• BMJ on DA
• GMC on DA
• Equality and Human rights website
• Gov.uk Stats
  
  
• Bromley by Bow

Books

• Why I know longer talk to white people about race
• Natives

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We welcome the inspirational Dr. Joel Meyer, an adult intensivist and co-founder of LifeLines. Joel joins us to cover:

• Communication in the ICU & virtual visiting during COVID-19
• LifeLines: the inspiration and development for a novel virtual visiting platorm
• The Post ICU syndrome and recovery

Introduction
- Joel tells us a bit about himself and his experience of COVID-19 (04:07)
- Something positive to come out of the pandemic (06:10)

Virtual Visiting & Lifelines
- "The whole structure of visiting has been turned on its head" (08:35)
- How lifelines was developed (12:00)
- Applications of Lifelines beyond the ICU (18:10)

Post ICU syndrome
- An overview of the syndrome (23:40)
- Physical manifestations (26:30)
- Post ICU syndrome and COVID-19 (28:30)
- Complications to look out for when patients are stepped down from the ICU (31:30)
- Psychological effects of a prolonged COVID ICU admission (37:15)
- Optimisation of the post ICU care (40:30)

Important Links

• Critical care recovery: managing and supporting ICU recovery
• ICM guidance on recovery from COVID-19
• LifeLines
• BTS guidance on follow up

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Welcome back to the COVID-ZONE for another round-up of the latest COVID-19 literature.
---------------------------
In today's episode:

# S(o)wab's the big deal? The trouble with false-negative swabs (05:29)

#Proning in the A&E department: flipping around what we do in COVID respiratory failure (09:52)

#Treatment Update
- The Remdesevir saga continues: the Lancet trial, the NIH trial, and the controversy over ending it early. (13:39)
- Hydroxychloroquine not living up to the hype: JAMA & NEJM papers (20:35)
- Anakinra is promising in severe COVID-19 (24:17)

#Cardiac arrest & COVID-19 (26:55)

#Neurological manifestations of COVID-19 (34:03)
- An overview of presentations
- A case series of GBS
- Summary of all the published literature

#Man's best friend is called up to help fight the pandemic (38:38)

#Covert COVID distractions:
- The fantastic healthcare practitioners from 3 GP practices in the Brownlow Health Central, Liverpool with an amazing health promotion message!

----------------------------
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Get in touch: [email protected]
Twitter @JournalSpotting
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Are you trying to keep up with the general medicine literature but after completing Love is Blind and Tiger King, you’ve spent your evenings cringing through episodes of Normal People with your family?
--------------------------------
Check out the awesome infographics on Twitter @JournalSpotting or our website
In this month's episode...
(05:11)...Sepsis bundles, not greater than the sum of their parts?...
Baghdadi, Jonathan D et al. “Association of a Care Bundle for Early Sepsis Management With Mortality Among Patients With Hospital-Onset or Community-Onset Sepsis.” JAMA

(10:39)...Aspirin might prevent HCC (and preserve flowers?)
Simon, Tracey G et al. “Association of Aspirin with Hepatocellular Carcinoma and Liver-Related Mortality.” NEJM

(17:30)...CPAPathon: ACS/OSA/CO (there's a good anagram in there somewhere)...
Sánchez-de-la-Torre, Manuel et al. “Effect of OSA and its treatment with continuous positive airway pressure on the prevalence of cardiovascular events in patients with acute coronary syndrome (ISAACC study): a randomised controlled trial.” Lancet
Wimms, Kelly et al. "CPAP versus standard care for the treatment of people with mild obstructive sleep apnoea (MERGE): a multicentre, randomised controlled trial" Lancet
Turgut & Yavuz. "Comparison of non-invasive CPAP with mask use in carbon monoxide poisoning" AJEM

(27:52)...Diets and cardiovascular disease...
Ge, Long et al. “Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials.” BMJ 

(37:17)...Does MRSA bacteremia need anything more than vancomycin ...
Tong, Steven Y C et al. “Effect of Vancomycin or Daptomycin With vs Without an Antistaphylococcal β-Lactam on Mortality, Bacteremia, Relapse, or Treatment Failure in Patients With MRSA Bacteremia: A Randomized Clinical Trial.” JAMA

(40:43)...is your stethoscope spreading the next pandemic?...
Sukaina Ali Alali et. al "Community Hospital Stethoscope Cleaning Practices and Contamination Rates" AJIC

(44:24)...JOURNALBITES...
Benzo-resistant status epilepticus
Penicillin allergy decision rule
New anaphylaxis guidelines
SGLT2 inhibitors and heart failure

(50:07)...Medieval strains of m. leprae in the red squirrel...

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