Talk Evidence

Anti-HIV injections vs. oral medication, and best uses for AI in healthcare

 

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:

 

1. HIV: Breakthrough study raises hopes of effective prevention if drug’s costs can be lowered. 
2. FUTURE-AI: International consensus guideline for trustworthy and deployable artificial intelligence in healthcare. 

UTI dipstick tests, and the effects of staff turnover on patients

In this first episode of 2025, hosts Helen MacDonald and Juan Franco focus on hospitals - asking how useful UTI dipstick tests really are for acutely ill patients, and what are the effects of staff turnover on patient care in NHS hospitals?

01:11 The use of dipsticks for acutely ill UTI patients

07:48 Interview with UTI paper author

17:26 Turnover of doctors and nurses and the effects on patient care

18:41 Interview with staff turnover paper author

29:34 Helen and Juan’s thoughts on the staff turnover paper

Reading list:

 - Diagnostic accuracy of dipsticks for urinary tract infections in acutely hospitalised patients: a prospective population-based observational cohort study.

 - Nurse and doctor turnover and patient outcomes in NHS acute trusts in England: retrospective longitudinal study.

Talking Christmas evidence 2024

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

 

Starting to measure sustainability, and changes in breast cancer screening

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

 

The evidence on deprescribing

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

Will semaglutide buck the trend of other weight loss drugs?

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

 

 

 

Insulin without refrigeration and the complexities of consent

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

 

 

Low carb and cancer screening

Each episode of Talk Evidence we take a dive into an issue or paper which is in the news, with a little help from some knowledgeable guests to help us to understand what it all means for clinical care, policy, or research. 

 

In this episode:

Helen Macdonald take a deep dive into cancer screening tests, prompted by a paper in JAMA which showed most have no effect on all cause mortality, and news that the NHS is evaluating a single test which screens for 50 common cancers - we ask Barry Kramer, former director of the Division of Cancer Prevention, at the U.S. National Cancer Institute to help explain how to hold those two pieces of knowledge.

Juan Franco has been looking into diet and obesity, prompted by new research in The BMJ and a new Cochrane review, looking at the role of low glycemic index foods in weightloss - we ask Khadidja Chekima, nutritional researcher at Taylor’s University in Malaysia, to define low GI foods, and why it’s so hard to research their role in diet and weightloss 

 

Reading list;

JAMA research - Estimated Lifetime Gained With Cancer Screening Tests; A Meta-Analysis of Randomized Clinical Trials

The BMJ news - Clinicians raise concerns over pilot of blood test for multiple cancers

The BMJ research - Association between changes in carbohydrate intake and long term weight changes: prospective cohort study

Cochrane review - Low glycaemic index or low glycaemic load diets for people with overweight or obesity