Helen Macdonald, Juan Franco, and Joe Ross are back with our monthly update on the world of evidence based medicine.

This episode delves into new methodologies which can use observational data to emulate trial data. We discuss a new systematic review and meta-analysis of RCTs for surgical treatment of sciatica. There is elaboration and explanation of the CONSORT Harms 2022 statement - and we'll be asking if it goes far enough. Finally, the old chestnut of surrogate endpoints in cancer treatment trials - are benefits communicated to patients accurately?

Reading list;

Nirmatrelvir and risk of hospital admission or death in adults with covid-19: emulation of a randomized target trial using electronic health records - https://www.bmj.com/content/381/bmj-2022-073312

Surgical versus non-surgical treatment for sciatica

https://www.bmj.com/content/381/bmj-2022-070730

CONSORT Harms 2022 statement, explanation, and elaboration

https://www.bmj.com/content/381/bmj-2022-073725

Funders crack down on unpublished clinical trials—but is it enough?

https://www.bmj.com/content/381/bmj.p840

Communication of anticancer drug benefits and related uncertainties to patients and clinicians

https://www.bmj.com/content/380/bmj-2022-073711

Everyone has coping mechanisms, but sometimes those ways of coping become problem behaviours - addictions.

In this episode of Doctor Informed, we're focussing on how to spot the signs that you may be sliding into addiction, how to have conversations with friends and colleagues if you worry about their behaviour, and how seeking treatment is the best way to avoid GMC scrutiny.

Joining Clara Munro are Liz Croton and Zaid Al-Najjar, GPs who work for NHS Practitioner health - a mental health and addiction service specifically for health professionals. They are also joined by Ruth Mayall, a retired consultant anaesthetist who has experienced addiction herself, and has contributed to the Association of Anaesthetists guidance on drug and alcohol abuse.

Some resources mentioned in the podcast;

NHS Practitioner Health

https://www.practitionerhealth.nhs.uk/

The Sick Doctor's Trust

http://sick-doctors-trust.co.uk/

British Doctors & Dentists Group

https://www.bddg.org/

Substance use disorder in the anaesthetist

https://anaesthetists.org/Home/Resources-publications/Guidelines/Substance-use-disorder-in-the-anaesthetist

Substance abuse in anaesthetists

https://academic.oup.com/bjaed/article/16/7/236/2196385?login=false

In this month’s Talk Evidence, Helen Macdonald, Juan Franco and Joseph Ross are back to talk us through some of the latest research,

They’ll talk about pay-for-perfomance schemes, and whether the data they routinely collect is measuring outcomes or tickboxes. They’ll also talk about a new analysis published on bmj.com which suggests ways in which that data could be better.

We’re also by Huseyin Naci, associate professor of health policy at the London School of Economics and Political Science, who will tell us about proposed changes to drug regulation in the UK - and we discuss research which has linked speedier regulatory approval to more adverse advents in post marketing studies.

Finally, we talk about point of care apps. The availability of medical information in the clinic has changed practice, but how good is that information? We hear about research which has evaluated those point of care apps (including BMJ’s Best Practice app) and rates them against different criteria.

Reading list

Estimated impact from the withdrawal of primary care financial incentives on selected indicators of quality of care in Scotland

https://www.bmj.com/content/380/bmj-2022-072098

How can we improve the quality of data collected in general practice?

https://www.bmj.com/content/380/bmj-2022-071950#

UK to give “near automatic sign off” for treatments approved by “trusted” regulators

https://www.bmj.com/content/380/bmj.p633

Smartphone apps for point-of-care information summaries

https://ebm.bmj.com/content/early/2023/03/14/bmjebm-2022-112146

Fatigue can have as much of an affect in your ability to function as alcohol, and yet while you would be chastised for drinking before appearing on the ward, hospitals have systematically removed the spaces where tired clinicians can rest and recover.

The Royal College of Anaesthetists have been campaigning to raise awareness of the dangers of fatigue, and it seems that anaesthetic trainees have benefitted from that, with sleep pods and flexible schedules - but other specialties are lagging behind.

In this podcast, Roo McCrossan, a consultant anaesthetist joins our host Clara Munro, a surgical trainee, and Ayesha Ashmore, obstetric trainee, to talk about how to fight fatigue. They discuss circadian rhythms, what to eat, nappuccinos, and why trusts should make more sleeping spaces.

For more information about fighting fatigue;

https://anaesthetists.org/Home/Wellbeing-support/Fatigue/-Fight-Fatigue-download-our-information-packs

We're bringing you an episode of the BMJ's podcast for primary care, Deep Breath In, which we think you'll enjoy.

How long would it take GPs to enact all of the guideline recommendations that they might be expected too? Far more GP hours than exist in any healthcare system; but as medicine has turned its attention to primary prevention, and expanded the populations whose health we seek to improve, those guidelines are taking up more and more time.

A recent analysis in The BMJ has proposed the concept of “Time Needed to Treat” - and implores guideline makers to take account consultation time as a precious, finite, resource when thinking about their recommendations.

In this episode of Deep Breath In, we’re joined by Minna Johansson, family doctor and director Global Center for Sustainable Healthcare, who co-authored that analysis to talk about how the concept has gone down, and what it might mean for rethinking what primary care is supposed to do.

Reading list:

Guidelines should consider clinicians’ time needed to treat

https://www.bmj.com/content/380/bmj-2022-072953

As workforce gaps in the NHS, and other healthcare systems around the world widen, the need to improve staff retention has become an ever more pressing concern. Yet work-life balance issues continue to drive staff away from the service.

What is the imperative to get flexible working right, and what can be done to remove the barriers facing healthcare workers seeking to change the way they work?

Joining us in the discussion are;

Kamran Abbasi, editor in chief of The BMJ

Rachel Hutchings, fellow at the Nuffield Trust

Sarah Sweeney, interim chief executive, National Voices

Farzana Hussain, a GP in Newham, London

Thea Stein, chief executive of Leeds Community Healthcare NHS Trust

The report that Rachel Hutchings has authors is summaried in a BMJ feature - Challenges of combining a career in surgery with parenting https://www.bmj.com/content/380/bmj.p449

In this episode of Talk Evidence, Helen Macdonald is joined by Juan Franco and Joe Ross, to bring you the newest evidence in The BMJ.

First, chronic pain. As prescribers move away from opioids, Juan finds an overview of systematic reviews asking whether anti-depressants might help.

Joe finds new research on the link between six healthy lifestyle markers and cognitive decline.

Helen looks at a trial to reduce prescribing among older people with suspected urinary tract infection or UTI.

Juan has a nuanced take on the updated evidence on masks to reduce the spread of respiratory viruses.

Finally, an international group of researchers traced the health claims made about infant formula milk back to the evidence or lack of it

Reading list:

Efficacy, safety, and tolerability of antidepressants for pain in adults

https://www.bmj.com/content/380/bmj-2022-072415

Association between healthy lifestyle and memory decline in older adults

https://www.bmj.com/content/380/bmj-2022-072691

Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults

https://www.bmj.com/content/380/bmj-2022-072319

Physical interventions to interrupt or reduce the spread of respiratory viruses

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full

Health and nutrition claims for infant formula

https://www.bmj.com/content/380/bmj-2022-071075

Grit is one of those concepts (like the dreaded resilience) that has a specific meaning, but has become a buzzword in healthcare.

It’s the ability to persevere in the pursuit of a goal, in the face of obstacles - and it’s something all doctors have.

However that trait has benefits and drawbacks. It’s not necessarily fixed, but will depend on context, and it is measurable but not a very helpful measure in isolation.

In this episode, Clara Munro is joined by Declan Murphy and Ayisha Ashmore - and they sit down with neurourgeon and researcher Simone Betchen, who has measured grit in women surgeons, and helps them understand their grit scores.

Reading list

Grit in surgeons

https://pubmed.ncbi.nlm.nih.gov/34218313/

Claire Mulrenan, specialist registrar in public health, and Mark Petticrew, professor of public health evaluation, both working at the London School of Hygiene and Tropical medicine were surprised to see high-fat, high-salt fast food brands being featured heavily on the website of one of the UK's most beloved children's comics.

In this podcast, they describe why they think that is harmful, and why the Beano should think again about its editorial policies, to protect children's health.

To read the full investigation:
www.bmj.com/content/380/bmj.p197

In this week's episode, we're focusing on covid and the ongoing crisis in the NHS.

Helen Macdonald, Juan Franco and Joseph Ross cast their evidence seeking eyes over research into outcomes as well as the workload of doctors.

Firstly, Joe tells us about a new big data study into longer term outcomes after mild covid-19, how those ongoing symptoms relate to long covid, and how often they resolve themselves.

Juan looks back to his homeland to see what Argentina which was very early to offer children vaccinations against covid-19. He tells us how a new study design can help understand how effective different combinations of vaccines were.

Joe has a Danish registry paper, which links people's employment status after a MI, explains how that gives us an insight into morbidity following that event.

Helen looks at a new analysis which outlines the concept of "time needed to treat" - a measure of how much time it would take a clinician to actually carry out a guideline - and you'd be surprised how much GP time would be swallowed by a "brief" intervention to reduce inactivity in their patients.

Finally, the data on excess mortality in the UK has been up for debate recently - our health minister calling into question the Office of National Statistic's data. We hear from Nazrul Islam, Associate professor of medical statistics, advisor to the ONS and BMJ research editor, who has some bad news for him.

Reading list:

Long covid outcomes at one year after mild SARS-CoV-2 infection

https://www.bmj.com/content/380/bmj-2022-072529

Effectiveness of mRNA-1273, BNT162b2, and BBIBP-CorV vaccines against infection and mortality in children in Argentina, during predominance of delta and omicron covid-19 variants

https://www.bmj.com/content/379/bmj-2022-073070

Guidelines should consider clinicians’ time needed to treat

https://www.bmj.com/content/380/bmj-2022-072953

Expanding the measurement of overdiagnosis in the context of disease precursors and risk factors

https://ebm.bmj.com/content/early/2023/01/10/bmjebm-2022-112117

Excess deaths associated with covid-19 pandemic in 2020

https://www.bmj.com/content/373/bmj.n1137.abstract