Talk Evidence

Talk Evidence - Inquiring about covid, burnout, and marginal data

It's October's Talk Evidence, and that means the autumn is upon us including those autumnal viruses. Here in the UK covid is on the rise, and Joe Ross is looking at some research on how good those elusive lateral flows are at detecting infection among people with symptoms of covid. Juan will give us an update on the covid inquiry, the collection of analysis articles The BMJ is publishing looking at the interface of evidence and policy in our decisions about how to handle the pandemic. Since the pandemic moral among clinicians in many health systems has fallen even further, workloads have spiralled. Coupled with other problems with workforce planning and investment in health and healthcare, this is increasing burnout - with a consequential impact on patient care. Helen will tell us about new research which is trying to put some numbers to how much clinican burnout effects patient outcomes Finally, we're turning to a very clinical topic that we don't often cover in Talk Evidence - oncology, and some interesting insights into clearance margins in cancer surgery. Reading list Diagnostic accuracy of covid-19 rapid antigen tests with unsupervised self-sampling in people with symptoms in the omicron period https://www.bmj.com/content/378/bmj-2022-071215 Guided by the science? Questions for the UK’s covid-19 public inquiry https://www.bmj.com/content/378/bmj.o2066 Associations of physician burnout with career engagement and quality of patient care https://www.bmj.com/content/378/bmj-2022-070442 Margin status and survival outcomes after breast cancer conservation surgery

https://www.bmj.com/content/378/bmj-2022-070346

Talk Evidence - a new way of understanding antidepressant effectiveness

In this week's episode, Joe Ross, professor of medicine at Yale, and The BMJ's US research editor, and Juan Franco, researcher at Heinrich-Heine-Universität and editor in chief of BMJ EBM are in the hot-seat. They will discuss new research on the effectiveness of antidepressants - based on all the individual patient data submitted to the FDA between 1979 and now. We'll take a look at a study of industry sponsorship of cost effectiveness analysis, and seeing similar patters of publication bias to RCTs. And finally we'll be talking about new research on the ongoing, and emergent pandemics - covid and monkeypox. Reading listResponse to acute monotherapy for major depressive disorder in randomized, placebo controlled trials submitted to the US Food and Drug Administration: individual participant data analysis https://www.bmj.com/content/378/bmj-2021-067606) Using individual participant data to improve network meta-analysis projects https://ebm.bmj.com/content/early/2022/08/10/bmjebm-2022-111931 Industry sponsorship bias in cost effectiveness analysis: registry based analysis https://www.bmj.com/content/377/bmj-2021-069573 Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak https://www.bmj.com/content/378/bmj-2022-072410 Effectiveness of a fourth dose of covid-19 mRNA vaccine against the omicron variant among long term care residents in Ontario, Canada:

https://www.bmj.com/content/378/bmj-2022-071502

Talk Evidence - shoulders, knees, and woes

In this episode, Juan Franco, editor in chief of BMJ EBM, and Helen Macdonald, The BMJ's research integrity editor, sit down to discuss what's new in the world of evidence. Firstly, last week they went to the first EBM Live conference for two years - and report back on what happened when the evidence community got back together. We have two research papers looking at knees and shoulders, and finding out about the balance of risks and benefits. In covid news, we're still finding new symptoms associated with infection, 2.5 years after the pandemic started. We'll also hear how complex it is to research vaccine efficacy now. Reading list: Smell and taste dysfunction after covid-19 https://www.bmj.com/content/378/bmj.o1653 Serious adverse event rates and reoperation after arthroscopic shoulder surgery https://www.bmj.com/content/378/bmj-2021-069901 Viscosupplementation for knee osteoarthritis https://www.bmj.com/content/378/bmj-2022-069722 Waning effectiveness of BNT162b2 and ChAdOx1 covid-19 vaccines over six months since second dose

https://www.bmj.com/content/378/bmj-2022-071249

Talk Evidence - political persuasion and mortality, too much medicine

In this week's episode, Helen Macdonald is joined by Joseph Ross, US research editor for The BMJ, and Juan Franco, editor of BMJ EBM. They begin by discussing a review of obesity interventions in primary care, and Joe wonders if GPs are really the best people to tackle the issue. https://www.bmj.com/content/377/bmj-2021-069719 Cervical screening in the UK now includes HPV testing, and they look at research which examines whether this could mean longer periods between screening tests. https://www.bmj.com/content/377/bmj-2021-068776 They all enjoy a new State of the Art Review into Revascularization in stable coronary artery disease. https://www.bmj.com/content/377/bmj-2021-067085 Juan and Joe look at a review into combinations of covid-19 vaccinations - and wonder whether we'll ever see more trials to fit into this meta-analysis. https://www.bmj.com/content/377/bmj-2022-069989 Finally, they find out how your political persuasion has affected mortality in the US, with new research that links Republican and Democrat voters with differential changes in mortality.

https://www.bmj.com/content/377/bmj-2021-069308

Talk Evidence - evidence in Roe vs Wade, MI treatment variation, and tribal methodologies

Helen Macdonald, The BMJ's research integrity editor is back with another episode, and this week is joined by Joe Ross, professor of medicine and public health at Yale, and US research editor for The BMJ, and Juan Franco, editor in chief of BMJ EBM, and Professor at the Instituto Universitario Hospital Italiano de Buenos Aires In this episode they discuss; The US supreme court looks set to overturn Roe v Wade, creating a patchwork of abortion provision across the U.S. We consider the role which evidence might play in documenting how health is affected by that decision, and whether medical evidence is being used at all in the debate. We'll give you a quick update on treatment for Covid-19 We know that trials are needed for new treatments, but in the face of an exponentially growing amount of observational data, is it time for a shift in that certainty? Joe tells us about his research into whether trials and observational studies of three drugs in covid produce the same answer? And finally, treatment variation - it's one of the things that helped kick-start the EBM revolution, but there's still much to learn. Juan describes some new research which examines how countries stack up when you compare their handling of and outcomes of a common condition such as a myocardial infarction. Reading list; Navigating Loss of Abortion Services — A Large Academic Medical Center Prepares for the Overturn of Roe v. Wade https://www.nejm.org/doi/full/10.1056/NEJMp2206246. A living WHO guideline on drugs for covid-19 https://www.bmj.com/content/370/bmj.m3379 Agreement of treatment effects from observational studies and randomized controlled trials evaluating hydroxychloroquine, lopinavir-ritonavir, or dexamethasone for covid-19 https://www.bmj.com/content/377/bmj-2021-069400 Variation in revascularisation use and outcomes of patients in hospital with acute myocardial infarction across six high income countries

https://www.bmj.com/content/377/bmj-2021-069164

Covid vaccine safety, Methenamine hippurate, and intersectionality

In this episode of Talk Evidence, Helen Macdonald, the BMJ’s research integrity editor is joined by Joe Ross, US research editor, and Juan Franco, editor in chief of BMJEBM, to talk about all things evidence. Joe gives us an update about covid, including new research on safety of the vaccine Association between covid-19 vaccination, SARS-CoV-2 infection, and risk of immune mediated neurological events https://www.bmj.com/content/376/bmj-2021-068373 Juan updates us on a potential new prophylactic for recurrent UTIs, Methenamine hippurate, which could be an alternative to antibiotics. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women https://www.bmj.com/content/376/bmj-2021-0068229 Helen tells us about some research which evaluates the way in which intersecting identities combine to make students experience of medical school more difficult. Marginalized identities, mistreatment, discrimination, and burnout among US medical students

https://www.bmj.com/content/376/bmj-2021-065984

Talk Evidence - isolation periods, openness, and environmental impacts

In the first Talk Evidence of 2022, we'll be asking about the evidence for isolation - now that isolation periods are being reduced, or even stopped in the event of a negative lateral flow test, we'll find out what data that's based on, and if it's appropriate. Vaccinations and treatments for covid-19 have been the one major success story of the pandemic, but that doesn't mean we should abandon the principles of openness and transparency when it comes to scrutinising the data - we'll hear what access to the data which underlies regulatory approval could do now. Finally, the impacts of climate change were set out in a WHO report in November last year - and recent weather seems to underline their conclusions. We'll discuss new evidence linking the environment and health, and ask what clinicians can do with that. Reading list: Mitigating isolation: The use of rapid antigen testing to reduce the impact of self-isolation periods https://www.medrxiv.org/content/10.1101/2021.12.23.21268326v1.full.pdf Covid-19 vaccines and treatments: we must have raw data, now https://www.bmj.com/content/376/bmj.o102 WHO report: Climate change and health https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health Ambient heat and risks of emergency department visits among adults in the United States: time stratified case crossover study https://www.bmj.com/content/375/bmj-2021-065653 Residential exposure to transportation noise in Denmark and incidence of dementia: national cohort study https://www.bmj.com/content/374/bmj.n1954 Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project: pooled analysis

https://www.bmj.com/content/374/bmj.n1904

Talking Christmas Evidence 2021

The BMJ has special criteria for considering Christmas research: first it should make you laugh, and then it should make you think. In this festive episode of the Talk Evidence podcast, our regular panel of Helen Macdonald and Joe Ross are again joined by Juan Franco, editor in chief of BMJ Evidence Based Medicine.

They’ll give you a peek into what makes for good Christmas research, and why what may seem silly on the surface has a deeper meaning.