Medicine and Science from The BMJ

In July, The BMJ published an analysis article called “The Antibiotic Course has had it’s day” - a provocative title that turned out the garner a lot of debate on our site. The article said that the convention for the length of a course of antibiotics was set by Flemming, in his Nobel Prize acceptance speech - “If you use penicillin, use enough!” - and that the evidence base hasn’t moved on since then. The article has had over 40 substantive responses, both agreeing and vehemently not - and so we thought it worth revisiting that argument, now the dust has settled. Discussing that are Martin Llewellyn, professor of infectious disease at Brighton and Sussex Medical School, and Paul Little, professor of primary care at the University of Southampton. Read the original analysis: http://www.bmj.com/content/358/bmj.j3418

Unjust discrimination against people with mental ill health should be replaced with universal rules based on decision making ability, argues George Szmukler, emeritus professor of psychiatry and society at King’s College, London. However Scott Weich, professor of mental health at the University of Sheffield, worries about legal distractions that won’t improve outcomes while services are so thinly stretched. Read the full debate: http://www.bmj.com/content/359/bmj.j5248

The Three Talk Model of shared decision is a framework to help clinicians to think about how to structure their consultation to ensure that shared decision making can most usefully take place. The model is based around 3 concepts - option talk, decision talk, and team talk - with active listening at the centre. Three Talk was first proposed in 2012, now new research published on bmj.com updates that model. Professor Glynn Elwyn, from The Dartmouth Institute for Health Policy and Clinical Practice, joins us to explain how that was done, and what it's creators learned from the process. Read the full research: http://www.bmj.com/content/359/bmj.j4891

The BMJ publishes a variety of education articles, to help doctors improve their practice. Often authors join us in our podcast to give tips on putting their recommendations into practice. In this new monthly audio round-up The BMJ’s clinical editors discuss what they have learned, and how they may alter their practice. In this edition, GP Cat Chatfield, psychiatric trainee Kate Addlington and Gastrology trainee Robin Baddeley discuss the articles; Diagnosis and management of postpartum haemorrhage http://www.bmj.com/content/358/bmj.j3875 Indications for anticoagulant and antiplatelet combined therapy http://www.bmj.com/content/356/bmj.j1128 Safe Handover http://www.bmj.com/content/359/bmj.j4328 and why fixing the broken medical ward round is in everyone’s interests http://blogs.bmj.com/bmj/2017/10/13/robin-baddeley-fixing-the-broken-medical-ward-round-is-in-everyones-interests/

As journal editors, we’re aware of the fact that we have a role to play in scientific discourse - that’s why The BMJ has been so keen to talk about the way in which scientific knowledge is constructed, through our Evidence Manifesto. We also know that money has influence in the scientific literature - which is why we have a zero tolerance policy for financial conflicts of interest in our educational content. Where do journal editors fit into this? The first step into investigating that is to find out if journal editors receive payments from pharma and device companies - and new research, published on bmj.com does that. Jessica Liu - internist and assistant professor at the university of Toronto, and one of the authors of that study joins us to discuss. Read the full research: http://www.bmj.com/content/359/bmj.j4619

The Quality and Outcomes Framework (QOF) is one of the most ambitious pay-for-performance schemes introduced into any health system. It's now being scrapped by bits of the NHS, and is under reform elsewhere. Martin Marshall, GP and professor of Health Improvement at University College London, thinks it's time to rethink the experiment. He joins us to discuss how we got here, what we've learned, and what will replace QOF. Read the editorial: http://www.bmj.com/content/359/bmj.j4681

Half of adolescents who die by suicide have a history of self harm. And in the UK, the rates of adolescents who commit suicide jumped from 3.2, to 5.4 per 100 000 between 2010 and 2015. The national suicide prevention strategy recently expanded its scope by aiming to reduce self harm rates as a common precursor to suicide. Therefore it's important that we have an accurate measure of rates of self harm in the population, and new research published on bmj.com aims to do that. To discuss we're joined by one of the authors of that paper - Navneet Kapur, professor of psychiatry and population health at the University of Manchester. Read the full research: http://www.bmj.com/content/359/bmj.j4351

There's a crisis in old age care - not just in the UK, around the world, as population demographics shift, and the proportion of older people increase - there's a worry about who's going to look after them, and how much is it going to cost? However, a new analysis on bmj.com says this picture need not be so gloomy - they say that encouraging exercise in older people could save billions - by keeping frailty at bay and increasing healthy life expectancy. We're joined by two of the authors of that analysis - Scarlett McNally, consultant orthopedic surgeon at Eastbourne District General Hospital, and Muir Gray, public health doctor. Read the full analysis: http://www.bmj.com/content/359/bmj.j4609

New research published on bmj.com has evaluated how well women surgeons operate, when compared to their male colleagues - and shows that there is a marginal improvement in patient outcomes. To discuss how that was studied, and what the findings mean, we're joined by Chris Wallis, a resident at the University of Toronto, and Raj Satkunasivam, a urologic-surgeon and assistant professor at the Houston methodist hospital in Texas. Also joining us, to contextualise that research, is Clare Marx - associate medical director of Ipswich Hospital NHS Ttrust, and former president of the Royal College of Surgeons. Read the open access research: http://www.bmj.com/content/359/bmj.j4366 and editorial: http://www.bmj.com/content/359/bmj.j4580

Last week we published some new research which showed that 2/3 of new cancer drugs approved by the European Medicines Agency - the drug regulator for Europe - didn’t have any evidence of improved life expectancy or quality of life. In this interview, Vinau Prasad, ematologist-oncologist and Assistant Professor of Medicine at the Oregon Health and Sciences University, explains how we came to accept surrogate measures in oncology trials, and how he tries to navigate the evidence for his patients. Read his editorial: http://www.bmj.com/content/359/bmj.j4528