Talk Evidence

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/

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

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.

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

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.

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).

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

Talk Evidence - aggravating acronyms, a time to prescribe, and screening (again)

Talk Evidence is back, with your monthly take on the world of EBM with Duncan Jarvies and GPs Carl Heneghan (also director for the Centre of Evidence Based Medicine at the University of Oxford) and Helen Macdonald (also The BMJ's UK research Editor). This month Helen talks about the messy business of colon cancer screening - which modality is best, and in what population is it actually effective (1.40) Carl talks about how the Netherlands did the right research at the right time to stop a new pregnancy scan before it became routine (10.35) The Rant: acronyms in research papers (17.45) Mini Rant: politicisation of the NHS, and Carl pitches for yet another job (25.15) Research in the news has talked about the importance of when drugs are taken, to maximise efficacy. Melvin Lobo, cardiologist specialising in hypertension joins us to explain that research and why we seem to have forgotten about that effect. Reading list: Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a clinical practice guideline https://www.bmj.com/content/367/bmj.l5515 Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study): nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial https://www.bmj.com/content/367/bmj.l5517 Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial

https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/5602478