Identifying VTE in early pregnancy, gabapentinoids and COPD, managing ADHD

In this podcast accompanying the June issue of DTB, David Phizackerley (DTB Editor) is joined by Julian Treadwell (DTB Associate Editor) and Laurence Leaver (GP). David and Julian start by discussing the editorial - https://dtb.bmj.com/content/63/6/82 - which highlights some of the challenges in preventing VTE in early pregnancy. They also talk about a cohort study - https://dtb.bmj.com/content/63/6/84 - that assessed whether gabapentinoid use was associated with severe exacerbations among patients aged >55 years with chronic obstructive pulmonary disease (COPD). In the second half of the podcast, Julian talks to Laurence about two articles - https://dtb.bmj.com/content/63/5/74 and https://dtb.bmj.com/content/63/6/85 - he wrote on managing ADHD in adults.   Their discussion includes issues relating to diagnosis, effectiveness of medication, starting and titrating medication and some of the common adverse effects associated with medication. Both articles are currently free to access on the DTB website.   Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email [email protected]. Thank you for listening.

In this podcast accompanying the May issue (https://dtb.bmj.com/content/63/5) of DTB, David Phizackerley (DTB Editor) welcomes Syba Sunny (DTB Clinical Editor) to the podcast. Syba provides an overview of her role with DTB, discusses her previous work as a Consultant Microbiologist and talks about areas of interest for future DTB articles.  The editorial (https://dtb.bmj.com/content/63/5/66) discusses a paper in The BMJ which proposed offering a polypill containing rosuvastatin, hydrochlorothiazide, amlodipine and losartan to all people in the UK over the age of 50 years to reduce the risk of heart attacks and strokes. A DTB Select item (https://dtb.bmj.com/content/63/5/68) summarises the results of  a small study that assessed whether cytisinicline (cytisine) plus behavioural support was more effective than behavioural support alone for vaping cessation. The main article (https://dtb.bmj.com/content/63/5/74) is the first of two articles on the medical management of ADHD and there will be a longer discussion and an interview with the author in the June podcast.   Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email [email protected]. Thank you for listening.

In this podcast recorded in early March, David Phizackerley (DTB Editor-in-Chief) and James Cave (DTB Editor-in-Chief Emeritus) provide an overview of the April 2025 issue of DTB. The editorial discusses concerns over the use of feminist empowerment messages to sell tests and treatments - https://dtb.bmj.com/content/63/4/50. A DTB Select item summarises the results of an observational study that assessed the association between initiation of a triptan and the risk of myocardial infarction or stroke - https://dtb.bmj.com/content/63/4/51. The main article provides an overview of initiating angiotensin-converting enzyme inhibitors or angiotensin-II receptor antagonists in adults with CKD, highlighting current guideline recommendations and providing a practical approach to dealing with the challenges associated with their use - https://dtb.bmj.com/content/63/4/54.   Links Health Innovation Network: https://thehealthinnovationnetwork.co.uk/news/launch-of-new-game-changing-guide-to-tackle-overprescribing-and-support-governments-shifts-to-prevention-and-community/    Tackling overprescribing report: https://thehealthinnovationnetwork.co.uk//wp-content/uploads/2025/02/Health-Innovation-Network-Polypharmacy-Guide-Feb-2025.pdf    GP Evidence: (https://gpevidence.org/)   Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email [email protected]. Thank you for listening.

In this podcast recorded in early February, David Phizackerley and Julian Treadwell (DTB Associate Editor) provide an overview of the March 2025 issue of DTB. Julian talks about his work as an academic GP based at Bristol University. He explains why and how he developed the GP Evidence website (https://gpevidence.org/) as a resource for health professionals to use as part of a shared decision making process, and talks about the importance of providing patients with information on the absolute benefits and harms of different treatment options for long-term conditions.   The editorial discusses a paper published in The Lancet on the population-health impact of new drugs recommended by NICE and highlights the tension between NICE's role in ensuring that treatments are a cost-effective use of taxpayers’ money and its role in championing the for-profit life-sciences - https://dtb.bmj.com/content/63/3/34. A DTB Select item summarises safety alerts issued by the US Food and Drug Administration and the European Medicines Agency on liver problems associated with fezolinetant (▼Veoza), a drug licensed for the treatment of moderate-to-severe vasomotor symptoms associated with the menopause - https://dtb.bmj.com/content/63/3/36. The main article provides an overview of systemic anticancer treatments and conventional cytotoxic drugs - https://dtb.bmj.com/content/63/3/37.   Links GP Evidence (https://gpevidence.org/)   Naci H, Murphy P, Woods B, et al. Population-health impact of new drugs recommended by the National Institute for Health and Care Excellence in England during 2000–20: a retrospective analysis. The Lancet 2025;405:50–60. (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02352-3/fulltext)    Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email [email protected]. Thank you for listening.

In this podcast recorded in early January, David Phizackerley provides a brief overview of the February 2025 issue of DTB. The editorial discusses the importance of shared decision making and calls on guideline developers to produce patient decision aids to accompany their guidance - https://dtb.bmj.com/content/63/2/18. A DTB Select item summarises a study that evaluated implementation of NHS England’s type 2 diabetes path to remission programme -  https://dtb.bmj.com/content/63/2/19. The authors of a DTB Commentary article review a UK primary care study which reported that treatment with antihypertensive medicines in older people with complex health needs was associated with an increased risk of acute kidney injury (AKI) and a short-term increased risk of falls - https://dtb.bmj.com/content/63/2/20. The main article explores the evidence for gefapixant in the treatment of refractory or unexplained chronic cough in adults - https://dtb.bmj.com/content/63/2/22.   Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email [email protected]. Thank you for listening.

In this podcast recorded in early December, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the January 2025 issue of DTB. They provide an overview of the editorial that questions whether it is time for the medicine Patient Information Leaflet (PIL) to include information on the impact of a medicine on clinical outcomes - https://dtb.bmj.com/content/63/1/2. They talk about a recent announcement from the Irish College of GPs that it is phasing out sponsorship from pharmaceutical companies as evidence suggests that ‘engagement between pharmaceutical companies and prescribers is associated with inappropriately increased prescribing rates, lower prescribing quality and increased prescription costs’ - https://dtb.bmj.com/content/63/1/3. The main article provides an overview of Ryeqo (relugolix, estradiol and norethisterone acetate) for the treatment of moderate to severe symptoms of uterine fibroids - https://dtb.bmj.com/content/63/1/6. The podcast ends with a farewell to James, who is stepping down as Editor-in-Chief after more than 12 years. James reflects on his time as a doctor, GP and Editor of DTB.   Other links: Is ASCOT all it's cracked up to be? https://www.bmj.com/content/331/7523/1023.1 Don't lose your head over ASCOT https://www.bmj.com/content/331/7523/1022.1

In this podcast recorded in early November, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the December issue of DTB. They provide an overview of the editorial that discusses the need to record the sex and gender of all participants in clinical trials and the importance of recognising diversity and inclusivity in clinical research - https://dtb.bmj.com/content/62/12/178. They talk about a commentary article that addresses claims made in a systematic review that menopausal HT may support neurological function and reduce the risk of Alzeheimer's disease - https://dtb.bmj.com/content/62/12/179. The main article provides an overview of daridorexant for the management of chronic sleep - https://dtb.bmj.com/content/62/12/183. They begin by providing an update on the NICE guidance for tirzepatide and highlighting the publication of a toolkit for repeat prescribing in general practice.   Other related links NICE guidance on tirzepatide: https://www.nice.org.uk/guidance/gid-ta11156/documents/html-content-10 Repeat prescribing toolkit: https://www.rpharms.com/resources/repeat-prescribing-toolkit

In this podcast recorded in early October, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the November issue of DTB. They provide an overview of the editorial that discusses the need to support people taking drugs to help with weight loss: "Providing the drug is only one part of the process and if the other elements are not available to support people with obesity the full benefits of these expensive treatments will not be realised" - https://dtb.bmj.com/content/62/11/162. They talk about the results of an observational study that assessed the risk of major bleeds with concomitant use of selective serotonin reuptake inhibitors (SSRIs) and oral anticoagulants -  https://dtb.bmj.com/content/62/11/164. The main article discusses equity of care in the management of COPD and that those more at risk of COPD are also more likely to experience barriers to care - https://dtb.bmj.com/content/62/11/165. They begin by highlighting two articles* in the BMJ that consider the problem of conflicts of interest.   *Fabbri A, Grundy Q. Protecting early career physicians from commercial influence. BMJ. 2024 Sep 9;386:q1939. (https://www.bmj.com/content/386/bmj.q1939) McCartney M. Transparency as a means to conquer conflicts of interest is illusory. BMJ. 2024 Sep 24;386:q2092. (https://www.bmj.com/content/386/bmj.q2092)   Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email [email protected]. Thank you for listening.

In this podcast recorded in early September, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the October issue of DTB. They discuss the editorial that highlights the work of the Common Sense in Oncology movement and its aim "to counteract the trend towards irrational, industry-designed, profit-driven cancer drug development" - https://dtb.bmj.com/content/62/10/146. They talk about the results of a systematic review and meta-analysis of two randomised controlled trials that assessed the effect of treating people who have device-detected subclinical atrial fibrillation (AF) with a direct oral anticoagulant - https://dtb.bmj.com/content/62/10/147. The main article discusses the management of hypertension in older people - https://dtb.bmj.com/content/62/10/149. They begin by highlighting an article* that considers the challenges associated with the introduction of new drugs for the treatment of Alzheimer's disease. *Walsh S, Merrick R, Milne R, et al. Considering challenges for the new Alzheimer's drugs: clinical, population, and health system perspectives. Alzheimers Dement. 2024. doi: 10.1002/alz.14108. [Epub ahead of print 4 Aug 2024]. https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.14108 Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email [email protected]. Thank you for listening.

In this podcast recorded in early August, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the September issue of DTB. They discuss the editorial (https://dtb.bmj.com/content/62/9/130) that highlights some of the challenges associated with NHS England's national medicines optimisation measures for Integrated Care Boards. They talk about the MHRA's recent safety alert on the risk of an interaction between tramadol and warfarin (https://dtb.bmj.com/content/62/9/131), which was prompted by a coroner's prevention of future deaths report (summarised in a DTB article in March https://dtb.bmj.com/content/62/3/36). The main article reviews the evidence for icosapent ethyl for cardiovascular risk reduction (https://dtb.bmj.com/content/62/9/135).   Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email [email protected]. Thank you for listening.