Talk Evidence

Talk Evidence

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Talk Evidence episodes

  • Talk Evidence covid-19 update - lack of testing transparency, how to give good debate
    For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.
    We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
    This week:
    (1.10) Carl gives us an update on the UK's figures, and how deaths outside are now being counted.
    (2.10) When the pandemic slows down, and normal services resume - what should we start doing first? Helen picks up some evidence on what they might be.
    (6.05) There's a signal that covid-19 may be causing coagulopathies in some patients, and Helen picks up on a listeners request for more information.
    (11.22) John Deeks, professor of Biostatistics at the University of Birmingham, is leading a Cochrane initiative into examining the evidence around testing, and rivals Carl's rant when he explains how some research is being done behind a veil of confidentiality.

    (35.27) When there's a lot of uncertainty, and the stakes are very high, then tempers can flare. Vinay Prasad, hematologist-oncologist in the US, and host of Plenary Sessions podcast, joins us to talk about having a good, respectful, scientific debate.

    44 min
  • Talk Evidence covid-19 update - covid ethics, waste and a minimum RCT size
    For the next few months Talk Evidence is going to focus on the new corona virus pandemic.
    There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.
    We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
    This week:
    (1.00) Carl gives us an update on the UK’s covid-19 related mortality
    (7.40) When the evidence is uncertain, and the outcomes so massive, then the ethical dimensions of decisions become even more apparent. Helen talks ethics in guidelines with Julian Sheather, advisor on ethics and human rights to the BMA and MSF.
    (25.37) Update on covid-19 research, looking at viral particle shedding.

    (29.24) We’ve mentioned the potential wasted effort in covid-19 research, and Helen speaks to Paul Glaziou, director of the Institute for Evidence Based Research at Bond University, about the waste he’s already seen, and ways in which it could be avoided.

    48 min
  • Talk Evidence covid-19 update - Remdesivir, care homes, and death data
    For the next few months Talk Evidence is going to focus on the new corona virus pandemic.
    There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.
    We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
    This week:
    (3.14) Jeff Aronson from Oxford University explains why remdesivir is a potential therapeutic, but is pessimistic about the quality of the studies being done on it
    (13.22) Carl explains why smoking cessation is still a key public health priority under covid-19
    (16.30) Helen talks care homes, and interviews Mona Koshkouei, from Oxford University, about the research which shows staff are the main vector of infection.
    (27.20) David Spiegelhalter, professor of public understanding of risk, looks at the new data on excess deaths in the UK - and the difficulties with reporting that underlie it. Carl explains how deaths track infections, and why uncertainty there makes it hard to calcuate the case fatality rate (And why that is not a good measure to use in a pandemic)
    Reading list.
    Compassionate Use of Remdesivir for Patients with Severe Covid-19
    https://www.nejm.org/doi/full/10.1056/NEJMoa2007016
    How can pandemic spreads be contained in care homes?
    https://www.cebm.net/covid-19/how-can-pandemic-spreads-be-contained-in-care-homes/
    Covid-19: Death rate in England and Wales reaches record high because of covid-19

    https://www.bmj.com/node/1024784.full

    52 min
  • Talk Evidence covid-19 update - hydroxy/chloroquinine, prognostic models and facemaskss
    For the next few months Talk Evidence is going to focus on the new corona virus pandemic.
    There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.
    We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
    This week:
    (2.24) - Hydroxychloroquinine/chloroquinine - Robin Ferner, honorary professor of clinical pharmacology at the University of Birmingham explains why is it a potential therapeutic for covid-19, and why is it being hyped.
    (12.45) - We use prognostic models to make treatment decisions, but they have to be well conducted. Lots of them are being created for covid-19, but their quality isn’t great. Statisticians Laure Wynants Maastricht University and Maarten van Smeden from Utrecht University have done a systematic review of these models, and explain what’s needed for them to be useful.
    (26.30) PPE - specifically facemasks. What does the evidence say about their use by the public, and does the precautionary principle hold
    Reading list:
    COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community
    https://www.nice.org.uk/guidance/ng165/chapter/4-Managing-suspected-or-confirmed-pneumonia
    Chloroquine and hydroxychloroquine in covid-19
    https://www.bmj.com/content/369/bmj.m1432
    Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal
    https://www.bmj.com/content/369/bmj.m1328
    What is the efficacy of standard face masks compared to respirator masks in preventing COVID-type respiratory illnesses in primary care staff?

    https://www.cebm.net/covid-19/what-is-the-efficacy-of-standard-face-masks-compared-to-respirator-masks-in-preventing-covid-type-respiratory-illnesses-in-primary-care-staff/

    38 min
  • Talk Evidence covid-19 update - pneumonia, guidelines, preprints and testing
    For the next few months Talk Evidence is going to focus on the new corona virus pandemic.
    There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.
    We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
    This week
    5.00 - Carl gives us an update about pneumonia in primary care, should you give antibiotics when you're not sure if it's bacterial or viral
    10.00 - The importance and difficulty of making guidelines now
    15.00 - We hear from guideline maker Per Vandvik, about making guidance.
    21.40 - Preprint servers for medicine are showing their use in this fast changing situation. Joseph Ross from Yale School of Medicine, and one of The BMJ's research editors, talks to us about the kind of information we're seeing on medRxiv.
    31.10 - Testing. What are the tests, and when do we want specificity, and when do we want sensitivity. Nick Beeching from the Liverpool School of Tropical Medicine joins us to explain.
    Reading list:
    www.bmj.com/coronavirus
    Rapidly managing pneumonia in older people during a pandemic
    https://www.cebm.net/covid-19/rapidly-managing-pneumonia-in-older-people-during-a-pandemic/
    https://www.medrxiv.org/
    Covid-19: testing times

    https://www.bmj.com/content/369/bmj.m1403

    44 min
  • Talk Evidence covid-19 update - Confused symptoms, fatality rate uncertainty, Iceland’s testing
    For the next few months Talk Evidence is going to focus on the new corona virus pandemic.
    There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing.
    We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
    This week
    3.50 - There is a lot of confusion around symptoms, we hear what Carl's review of the case studies has found, and why he thinks fever and persistent dry cough may not be a sign of all cases.
    10.30 - where are we with research into antiviral treatment
    17.30 - John Ioannidis has expressed concerns about the quality data used in modelling and therefore our pandemic response. We hear what his concerns are, and what needs to be done to answer them.

    29.10 - Iceland is the only country attempting to do population level screening, we hear from Kári Stefánsson, CEO of deCODE genetics which is working with the Icelandic government to allow everyone to access testing for the virus.

    41 min
  • Talk Evidence - testing under the microscope and opioid prescription
    This edition of talk evidence was recorded before the big increase in covid-19 infections in the UK, and then delayed by some self isolation. We'll be back with more evidence on the pandemic very soon.
    As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence).
    in this episode
    (1.01) Helen talks about variation in prescription of opioids - do 1% of clinician really prescribe the vast majority of the drug?
    (8.45) Carl tells us that its time papers (in this case a lung screening one) really present absolute numbers.
    (17.30) Carl explains how a spoonfull (less) of salt helps the blood pressure go down
    (21.25) Helen puts test results under a microscope, and finds out that they may vary.
    (33.20) What do conflicts of interest in tanning papers mean for wider science?
    (48.05) Carl has a "super-rant" about smartphone apps for skin cancer - and a sensitivity of 0.
    Reading list:
    Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study
    https://www.bmj.com/content/368/bmj.l6968
    Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial
    https://www.nejm.org/doi/full/10.1056/NEJMoa1911793
    Effect of dose and duration of reduction in dietary sodium on blood pressure levels
    https://www.bmj.com/content/368/bmj.m315
    Your results may vary: the imprecision of medical measurements
    https://www.bmj.com/content/368/bmj.m149
    Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning: systematic review
    https://www.bmj.com/content/368/bmj.m7
    Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studies

    https://www.bmj.com/content/368/bmj.m127

    55 min
  • Talk Evidence - Building an evidence base for covid-19
    We're taking a break from the usual Talk Evidence to focus on the new corona virus that has emerged in China.
    With a brand new disease, we have to build our evidence base from scratch - basic virology, epidemiology, pathogenicity, transmissibility, and ultimately treatment are all unknowns.
    In this episode of Talk Evidence, we're trying to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues.
    (8.00) Peter Openshaw, professor of experimental medicine at Imperial College London, talks to us about the pathogenicity of covid-19
    (17.30) Wendy Barclay, head of the Department of Infectious Disease at Imperial College London, describes what can change the R0 of a viral disease.
    (20.50) Raina MacIntyre, professor of biosecurity at the Kirby Institute at the University of New South Wales, talks to us about how effective masks are at preventing spread of viruses.
    (30.00) We discuss treatment options in the face of massive uncertainty.

    To read more about covid-19 and to keep up to date with the disease visit https://www.bmj.com/coronavirus where all of the information on the disease if freely available.

    45 min
  • Talk Evidence - Sepsis, talc and blindsided by blinding
    Welcome to the festive talk evidence, giving you a little EBM to take you into the new year. As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence)*
    This month:
    (1.20) Carl tells us about new research on treating sepsis with steroids that might inform practice.
    (4.58)Proscribing of prophylactic PPIs or H2-blockers for intensive care patients.
    (11.00) Carl wonders if we can actually rule out an increased risk of ovarian cancer with the use of talc.
    (17.46) Helen drops and EBM bombshell - is all the work needed to blind participants in a double blind randomised control trial actually worth it?
    (33.00) Helen is annoyed about a press release from the department of health, and kicks of 2020 by stealing Carl's rant spot.
    Reading list:
    Corticosteroids for Treating Sepsis in Children and Adults
    https://pubmed.ncbi.nlm.nih.gov/31808551-corticosteroids-for-treating-sepsis-in-children-and-adults/?dopt=Abstract
    Gastrointestinal bleeding prophylaxis for critically ill patients: a clinical practice guideline
    https://www.bmj.com/content/368/bmj.l6722
    Association of Powder Use in the Genital Area With Risk of Ovarian Cancer.
    https://www.ncbi.nlm.nih.gov/pubmed/31910280
    Blinding
    Fool’s gold? Why blinded trials are not always best
    https://www.bmj.com/content/368/bmj.l6228
    Impact of blinding on estimated treatment effects in randomised clinical trials
    https://www.bmj.com/content/368/bmj.l6802

    *quick note to say sorry about the sound quality on Duncan's microphone - we had a technical glitch (he was left alone to record).

    42 min
  • Talk Xmas Evidence
    Welcome to the festive talk evidence, giving you a little EBM to take you into the new year. As always Duncan Jarvies is joined by Helen Macdonald (resting GP and editor at The BMJ) and Carl Heneghan (active GP, director of Oxford University’s CEBM and editor of BMJ Evidence)
    This month:
    (2.00) Helen look back at a Christmas article, which investigates a very common superstition in hospitals.
    (7.55) Carl has his pick of the top 100 altimetric most influential papers of the year.
    (12.40) We find out all about the preventing overdiagnosis conference which happened earlier in December.
    (34.15) Helen has her annual rant about misogeny in medicine.
    Reading list:
    Q fever—the superstition of avoiding the word “quiet” as a coping mechanism
    https://www.bmj.com/content/367/bmj.l6446
    Altimetric Top 100
    https://www.altmetric.com/top100/2019/
    Fiona Godlee’s keynote at Preventing Overdiagnosis
    https://www.preventingoverdiagnosis.net/
    Gender differences in how scientists present the importance of their research: observational study

    https://www.bmj.com/content/367/bmj.l6573

    44 min

About Talk Evidence

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The podcast for evidence based medicine - where research, guidance and practice are debated and demystified