The BMJ Podcast

Subdural haematoma is more common in elderly patients, yet the condition is easy to miss in this group.John Young, a consultant geriatrician at Bradford Teaching Hospitals NHS Foundation Trust, describes what clinical signs to look out for, and what tests can confirm a diagnosis of subdural haematoma.

Each year at the Nuffield Trust Health Policy Summit, The BMJ hosts a breakfast roundtable. It has been one year since the Health and Social Care Bill for England was enacted, and the reconfiguration of the NHS continues, so this year we asked our panel to give the bill an end of year report.Taking part were:John Richards – Southampton Clinical Commissioning GroupNigel Edwards - CEO Nuffield TrustJennifer Dixon - CEO Health FoundationTerence Stephenson - president Academy of Medical Royal CollegesMaureen Baker - Chair RCGPHugh Taylor - Chairman Guys and St Thomas' Foundation TrustNick Hicks - CEO COBIC LtdJeremy Taylor - National VoicesTim Ferris - VP for population health management, Partners Healthcare, MANick Timmins - Senior Associate Nuffield Trust

Read the open access research: http://www.bmj.com/cgi/doi/10.1136/bmj.g1458 Australia was one of the first countries to introduce HPV vaccination, and due to it's cervical cancer screening programme, is one of the first to be able to measure the effectiveness of the vaccine. In this podcast, 3 of the authors of a new paper on bmj.com discuss their findings and talk about implications for cervical cancer screening in Australia.

Most doctors are familiar with patients who describe chronic pain all over the body, which is associated with a range of other symptoms including poor sleep, fatigue, and depression. This complex of symptoms is sometimes referred to as fibromyalgia. Management of patients with this condition is often complex and challenging. The diagnosis of fibromyalgia has long been controversial, with some experts questioning whether it exists as a separate entityIn this podcast Anisur Rahman, professor of rheumatology at University College London, joins us to discuss diagnosis and management of the condition.Read the full clinical review article:http://goo.gl/MYryTJ

Complete implementation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) recommends policies in China that would prevent almost 13m smoking related deaths by 2050, suggests a paper published on bmj.com.China is home to about one third of the world’s smokers and reducing smoking in China could have an enormous public health impact, even on a global scale.To discuss their research, we are joined by three of the paper's authors, David Levy from Georgetown University, Teh-Wei Hu from University of California at Berkeley, and Andrew Moran from Columbia University Medical Center.Read the full open access research: http://www.bmj.com/cgi/doi/10.1136/bmj.g1134

Controversy rages over the relative benefits or harms of screening for breast cancer, with evidence suggesting that in younger women at least it does more harm than good.Now a new paper on bmj.com reports the results of 25 years of follow up of women who have taken part in a breast cancer screening trial in Canada, and suggests that annual screening does not cut breast cancer deaths.Anthony Miller, Professor Emeritus at the Dalla Lana School of Public Health, University of Toronto, lead author on the paper, and director of the trial, joins us to discuss the results.

Read the full article online: http://www.bmj.com/content/348/bmj.g401 When you prescribe a drug, do you ever stop to wonder if it's suitable for vegetarians? Kinesh Patel and Kate Tatham from Imperial College London have found that 74 of the 100 drugs most commonly prescribed by GPs in the UK contain ingredients which may have been derived from animals.

Read the full article: http://www.bmj.com/content/348/bmj.g129Erectile dysfunction is a common problem, and novel treatments mean that patient’s options have widened. In this podcast Asif Muneer, consultant urological surgeon and andrologist at University College Hospital in London, explains the aetiology, treatment, and prognosis for the condition.

Two articles on bmj.com look at high risk devices for rare conditions, and how the US Food and Drug Administration regulates them. Joining us to discuss the problems are Rita Redberg, professor of medicine at the University of California San Francisco, and Aaron Kesselheim, assistant professor of medicine at the Harvard School of Public health. Read the articles Presumed safe no more: lessons from the Wingspan saga on regulation of devices http://www.bmj.com/content/348/bmj.g93 Assessment of US pathway for approving medical devices for rare conditions http://www.bmj.com/content/348/bmj.g217

Read the article: http://www.bmj.com/content/348/bmj.f7003The 2013 World Health Organization guidelines continue to recommend rapid fluid resuscitation for children with shock, despite evidence from the FEAST trial that this can increase mortality.Katheryn Maitland, professor of tropical paediatric infectious disease at Imperial College London, who led the FEAST trial, joins us to discuss it.

Read the head to head:http://www.bmj.com/content/348/bmj.g171The BMJ no longer publishes research funded by tobacco companies. Richard Smith says that research funded by drug companies is also flawed and published to encourage sales, but Trish Groves says that the industries are fundamentally different and that moves are afoot to increase integrityJoin the authors live on Twitter to debate the issue on 21 January, 1200-1230 GMT at #pharmaban.

When searching for clues to reach a diagnosis, neurologists often empathise with the detective who is trying to solve a case, write Peter Kempster and Andrew Lees in BMJ sister journal Practical Neurology bit.ly/1dqReQq.In this podcast, journal editor Phil Smith and Andrew Lees, director of the Queen Square Brain Bank in London, discuss how neurologists draw upon detective skills. They also talk about neurologists who have turned these skills to crime fiction writing, and the use of narrative in clinical case histories.The expert witnesses called upon are:- Oliver Sacks, best selling author and professor of neurology at NYU School of Medicine- Peter Gautier Smith, now retired from consulting at Queen Square and author of 31 detective novels- Chris Goetz, who worked at Rush University Medical Centre with Harold Klawans, crime fiction writer and authority on Parkinson’s diseaseListen to the full interviews here:Andrew Lees bit.ly/1cPaoxMPeter Gautier-Smith bit.ly/1d5HhKjHarold Klawans bit.ly/19cXROliver Sacks bit.ly/1hBsbgz

It is generally agreed that sex is useful when getting pregnant, but is it necessary? Professors Amy Herring, and Carolyn Halpern from the University of North Carolina explain how they found virgin births in the US for their Christmas BMJ paper.Also Gareth Jones, emeritus professor of anaesthesia at Cambridge University, recalls his early life in the City Lodge Hospital – formerly Cardiff Union WorkhouseFinally, does being right always make you happy? Bruce Aroll, professor of primary care at the University of Auckland wanted to know, and so designed a pilot study.See also:Like a virgin (mother): analysis of data from a longitudinal, US population representative sample survey (http://www.bmj.com/content/347/bmj.f7102)Being right or being happy: pilot study (http://www.bmj.com/content/347/bmj.f7398)Growing up over the shop (http://www.bmj.com/content/347/bmj.f6922)

James Bond, legendary secret agent, marksman, womaniser, smoker, but perhaps most famously, drinker. Neil Guha and Patrick Davies from Nottingham University Hospitals NHS Trust, and Graham Johnson from the Royal Derby Hospital, have documented Commander Bond's drinking in a Christmas BMJ paper, and join us to discuss its findings.Also this week, Doctors of the World, The BMJ's Christmas charity, has a role beyond emergency response to humanitarian crises, helping undocumented migrants in the UK access healthcare. Richard Hurley visits its clinic in the east end of London to find out out more. See alsoWere James Bond’s drinks shaken because of alcohol induced tremor?http://www.bmj.com/content/347/bmj.f7255

This year The BMJ has chosen Doctors of the World as it's Christmas appeal. This week we hear about the charity's international work. Deputy magazine editor Richard Hurley talks to some of the doctors who are working in Syria and the camps surrounding the stricken country. Also this week, a clinical review on BMJ.com looks at polymyalgia rheumatica. Clinical reviews editor Sophie Cook asks Sarah Mackie, from the Leeds Institute of Rheumatic and Musculoskeletal Medicine, how she explains this difficult condition to patients.After the typhoon: how volunteer doctors are bringing medical care to those most in needhttp://www.bmj.com/content/347/bmj.f7193Polymyalgia rheumaticahttp://www.bmj.com/content/347/bmj.f6937