Talk Evidence
Talk Evidence - aggravating acronyms, a time to prescribe, and screening (again)
11 Nov 2019
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
Chapter 1: What is the main topic discussed in this episode?
Welcome back to Talk Evidence, your monthly roundup of everything in the world of EBM. Well, maybe not everything, at least a decent chunk of it. I'm Duncan Jarvis, multimedia editor for the BMJ. And as always, I'm joined by our two favourite EBM nerds, Helen and Carl.
Hi, my name's Carl Hennigan. I am editor-in-chief of BMJ Evidence-Based Medicine, a GP and also an academic.
You're getting more important every time you come on this show.
Well, I'm sort of slightly distracted because I was thinking of the idea that we were just abreast of all the evidence in the world and we were on top of everything, which is complete nonsense.
I mean, you're a professor of EBM. Surely that is your one job.
How can anybody keep up to date? It is incredibly difficult, and if not getting harder in the world, with the amount of information that's published. Added to that is a bit of fake news. Added to that is an overwhelming number of journals that are increasing. So it's a real difficult problem.
That's why you should listen to this podcast, because we distill it for you to some of the important stuff.
Or at least talk about the general big themes anyway. So, Helen, could you introduce yourself as well?
I'm Hannah MacDonald, UK Research Editor at the BMJ, and I also trained as a GP.
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Chapter 2: What are the pros and cons of colorectal cancer screening?
I could see you putting it on your wall as a nice little piece. But actually, it took quite a bit of time for me to get my head around it. And when it did, actually, it was quite useful. But I think there's a need to produce a very simple summary on one page. that says, here's what's going to happen, and also that might print out.
Now, I think this is a really important area to develop and for people to start working on to really improve the quality of this information. I think this is a great start, and I suspect it needs loads of people to think about it, try different aspects of it. And this is at the forefront of shared decision-making, informing the public. There's very little research goes into this type of work,
and there's actually very little testing goes on in terms of how do people use this information. So I think it's great, and it should be invested in, and there should be much more of it.
Well, that paper is called Colorectal Cancer Screening with Fecal Immunochemical Testing, Sigmoidoscopy or Colonoscopy, a Clinical Practice Guideline. And I'll put the links in the book.
That was a bit of a mouthful, wasn't it?
It is. I've got good at doing these now. It used to take me like 20 goes to be able to say the name of the paper. The next one we're going to talk about is even longer. brace yourselves, effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low-risk pregnancy, the IRIS study, nationwide pragmatic multicenter stepped wedge cluster randomized trial.
Basically, should you scan very pregnant ladies? That would have been so much easier.
Carl?
The Irish study. The Irish study. Now, look, I really do like this paper, and there's lots of really interesting evidence-based components to this. The first to say is this is, as you said, routine ultrasound in third trimester patients, in largely well ladies who are pregnant. 13,046 women, greater than 16 years of age, and they did this stepped, wedged, randomised control design.
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Chapter 3: How did the Netherlands prevent unnecessary pregnancy scans?
I think that, yeah, my brain can retain about three acronyms per paper.
So I wonder if there's a... I mean, I really like the economist style guide. If you're a writer out there, you have to go to areas where you go, look, it helps you focus your writing down. And the newspapers rip out acronyms if you go in the main media because they just don't like them.
I wonder if we need a style guide for acceptable acronyms versus ones where we go, OK, if you're going to use this, you only have a maximum of three unknowns.
And acronyms have an overwhelming number of meanings, like E.D., Well, I was going to say, I found this. Emergency department, eating disorder, erectile dysfunction. I'm sure there's more. Every day. Every day.
But there's something in here about, just on that point, it kind of abstracts what you're talking about and allows a lot of...
i don't know fuzziness to come into people's thinking about what these things are sometimes it's really easy to say copd but actually you know it makes it maybe that's a bad example but it it takes it away from what the patients actually experience you see i think the assumption is that people read papers from beginning to end
Yeah, when we talk about critical appraisal or trying to read a paper, you just don't have time to go and say, I'm going to read everything. So if you come in at the middle and go, right, I want to go right to the results section and understand what's going on. If you come right in at the acronyms, you're lost. And so you can end up spending quite a few minutes going around the paper.
Now, in most books or reports, they would actually say, here's a sort of bibliography of the acronyms that we're about to use. So there may be something that says, here's the nine we're going to use in this paper. It might make life easier if you can up front say, here's the list of them. So I think there's some thinking needs to go into this.
And I think there's some style guide of, here's the accepted ones that are okay. And I like your free or max is the position because then it would sort of limit people to think we're going to use ones and we're not going to use them in a way that confuses everybody.
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