bjsm

This week the panel are joined by Michael Brady, the national advisor for LGBT Health to discuss why your patient’s queerness might matter to you, and how to practice inclusively, as well as an interview with Lisa Power MBE,  a British sexual health and LGBT rights campaigner. Have a listen to hear Michael Brady answering your questions, agony aunt style!

Inclusive Practice

The mental health of athletes has been in the spotlight throughout this summer, as high-profile athletes such as Naomi Osaka and Simone Biles have spoken out about the importance of prioritizing their physical, and especially their mental, well-being.

In this episode, host Dr. Giselle Aerni, MD is joined by AMSSM Past Presidents Dr. Cindy Chang, MD and Dr. Margot Putukian, MD to discuss the AMSSM Position Statement on Mental Health Issues and Psychological Factors in Athletes, which Dr. Aerni also co-authored.

In this 33-minute conversation, they address the following topics:
The importance of a position statement on the mental health of athletes and the novel aspects addressed in the document
The team-based approach to mental health care and why it’s a crucial component for the well-being of athletes
How the acceptance of mental health issues has evolved in recent years and the impact social media has on those perceptions
The impact of the COVID-19 pandemic on athletes’ mental health and how it reinforces the need for conversations about this vital issue

Resources:
Mental health issues and psychological factors in athletes: detection, management, effect on performance and prevention: American Medical Society for Sports Medicine Position Statement (https://bjsm.bmj.com/content/54/4/216.full)
Madam Athlete Podcast (https://madamathlete.com/)

The Importance of Mental Health in Athletes with Two AMSSM Past Presidents EP #483

The BJSM community is well aware of the interest in the role of training load on injury. Dr Dr Tim Gabbett, Dr Alex Kountouris and Dr to be Michael Drew share insights into the principles that underpin successful player management. They give specific examples from football codes and cricket at the elite level. They also discuss what clinicians who do not have access to the full raft of data-gathering technology can do to advise players how to monitor load. 
We thank Sports Physiotherapist Paul Visentini (who invented the VISA score for tendinopathy) for producing the very successful event and for sharing two podcasts with us. (The second will be posted here within a month). (Twitter = @PaulVisentini and @PhysioSports429)
The guests: Dr Tim Gabbett, Applied Sports Scientist who consults to elite teams the world over. He is one of only 5 invited Keynote Speakers at the IOC World Congress in Monaco 2017 #IOCPrev2017 @TimGabbett
Dr Alex Kountouris, Sports Science and Sports Medicine Director Cricket Australia @Alex_Kountouris
Mr Michael Drew Senior Sports Physiotherapist at the Australian Institute of Sport. @_MickDrew
Links to related podcasts: 
Dr Tim Gabbett on how physiotherapists can work well alongside strength & conditioning coaches to prevent injuries and improve performance: http://ow.ly/10aOq2
Dr Alex Kountouris on how to prevent back pain in cricket: http://ow.ly/10aOHX
Link to papers on load monitoring: 
Training – injury prevention paradox. Should athletes be training smarter AND harder (Gabbett) http://bjsm.bmj.com/content/early/2016/01/12/bjsports-2015-095788
Cricket fast bowling workload patterns as risk factors for tendon, muscle, bone and joint injuries. John W Orchard, Peter Blanch2, …, , Alex Kountouris et al, http://bjsm.bmj.com/content/early/2015/03/09/bjsports-2014-093683
And the home page with lots of good background for the conference (March 2016): http://physiosports.com.au/mastering-load-symposium-2016/


Dream Team of training load management: How training influences injury and performance

Dr Kieran O’Sullivan, PT, PhD, was one of the first podcast guests to crack 9,000 listens! From the University of Limerick, Ireland, he has vast clinical experience and he completed a PhD on the role of sitting in back pain. In this 18-minute podcast he reviews his 2015 podcast in the first 3 minutes and then rattles off at least 7 practical tips. 

Kieran was a guest of PhysioFirst (UK) when BJSM interviewed him in April 2015. The 2017 PhysioFirst conference is on April 1-2 (2017!) in Nottingham (UK) and guest speakers include Professor Paul Hodges, Dr Tania Pizzari and Dr Igor Tak. 

Timeline: 
1.00 m Back pain is neither explained by what patients and clinicians see on scans nor just by load

2.00 m When treating, you need to assess the various factors that could be playing a role, such as load, posture, stress, and address the right one. 

4.00 m Should we try to prevent all back pain? Listen to Dr O’Sullivan challenge the belief that it’s important to never have back pain. He likens back pain to conditions like sadness, constipation – not great but not a major problem as long as it doesn’t persist. Athletes need to load their bodies and adapt rather than avoid load and become vulnerable (See Gabbett papers and podcast, below). Don’t pass on fear (of back pain coming on or persisting) to athletes. 

5.00 m Screen for red flags of course, if the clinical picture warrants it – but most long-term back pain is NOT due to something listed as a red flag. 

6.00 m Reassurance – being empathetic without inducing fear. 

7.00 m Think through. What precipitated the pain? Too much load, too much stress, bad posture, movement patterns? If unknown, have patient create a pain diary. Look for trends. Examine all the dimensions of the biopsychosocial model. 

9:00 m Don’t just make the diagnosis but be practical. Patient sad? Don’t just say ‘You are sad, your back pain will go away’. Provide specific treatment for the specific threat. 

10:00 m Empower the patient to choose the exercises he or she wants and what he or she will do! Exercise has benefits across systems. 

11:00 m Don’t give up. Here Kieran walks us through a challenging real life case. A simple tissue diagnosis would not have helped this person at the centre of the case 

12:00 m Explain! Explain the pain! (HT to Professor Lorimer Moseley and Dr David Butler).  

13:00 m The period at 4-6 weeks of pain can be difficult – patient has not adapted to the contemporary model and may still be on waiting list for imaging. 

14:00 m What is the evidence for this approach? How does the evidence compare, with, for example Hamstring injuries? 

Links to previous podcast: 
2015 – Dr O’Sullivan on “Effective treatments for back pain: Kieran O'Sullivan’s practical tips within a guiding framework” http://ow.ly/4nepGu

BJSM paper: 
O'Sullivan K, O'Sullivan P. The ineffectiveness of paracetamol for spinal pain provides opportunities to better manage low back pain. Br J Sports Med. 2016 Feb;50(4):197-8. http://ow.ly/4neqbS (Members Only/subscribers)

Manual Therapy paper: 
Hurley J, …., O'Sullivan K. Effect of education on non-specific neck and low back pain: A meta-analysis of randomized controlled trials. Man Ther. 2016 Mar 10. pii: S1356-689X(16)00017-5. doi: 10.1016/j.math.2016.02.009. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/27026111


Dr Kieran O’Sullivan on managing back pain: 7 habits of highly effective clinicians. Part 2, 2016

Whilst injuries will undoubtedly dominate the headlines at the Olympics, we shouldn't ignore the competitors' increased susceptibility to illnesses - which can cause just as much heartbreak. BJSM’s popular podcast host, Steffan Griffin (@lifestylemedic), speaks to Athletics New Zealand team sports and exercise medicine physician Dan Exeter. Dr Exeter will be in Rio in August for the 2016 Summer Games and he shares New Zealand’s secrets for prevention illness in individuals and across the New Zealand squad. Remember that the Australian College of Sports and Exercise Physicians (@ACSP_SportsDocs ) and Sports Physiotherapy New Zealand (@SportsPhysioNZ) are both BJSM member societies. If you belong to one of these (or BJSM’s other 21 member societies) you can access all BJSM content for free via your member organisation’s website. Not a member country yet? Email karim.khan@ubc.ca 

Links: 
Great podcast last week: How Rugby 7s are approaching their Olympic Games preparation and the demands of this new Olympic Sport. http://ow.ly/EfCY3017Z2B
Norway’s very experienced team physiotherapist, @BenClarsen (PT, PhD) on a systematic approach to monitoring elite athletes on a regular basis even when they are on the road for long periods of time. http://ow.ly/6GHV3017VMX
Professor Roald Bahr (@RoaldBahr) on the challenges of a team clinician making Return To Play decisions: http://ow.ly/TrSz3017Ycn
BJSM publishes 4 Injury Prevention and Health Protection (IPHP) issue annually. Check them all out here: http://bjsm.bmj.com/content/by/year
The paper (OPEN) on Illness and Injury at the London Olympic Games: http://ow.ly/gORM3017ZRT


Steffan Griffin Hard Talks sports physician Dan Exeter (Athletics NZ) on illness prevention for Rio

Often tendinopathy will be resistant to even the best traditional rehabilitation methods. Liam West chats to Dr Ebonie Rio, a PostDoctoral Fellow at La Trobe University’s Sports and Exercise Medicine Research Centre in Melbourne. Dr Rio’s research aims to explain the role of the primary motor cortex in tendinopathy. She discusses tendon neuroplastic training (TNT) and how it might help your tendinopathy patients regain pain free function in the clinic.

Timeline
0.40 – Why traditional rehabilitation for tendinopathy might be unsuccessful
1.40 - Changes in primary motor cortex and motor control in tendinopathy
2.35 – What is TNT & how to utilise it?
5.30 – How long does it take for TNT to help patients?
6.30 – Cross education for tendinopathy

Further Reading
Tendon neuroplastic training: changing the way we think about tendon rehabilitation – OPEN ACCESS - http://bit.ly/29ergE3 

Revisiting the continuum model of tendon pathology - http://bit.ly/29rSDPK 


Related Podcasts
Prof Jill Cook revisits Tendon Pathology - http://bit.ly/1UR3tvL 

Prof Michael Kjaer on the pathogenesis of tendinopathy and tendon healing - http://bit.ly/29pOZol 

Defining tissue capacity - http://bit.ly/29iVSKc 



Could TNT blast a hole in treatment barriers in tendinopathy? Ebonie Rio discusses

Die Evidenz basierte Medizin ist ein Grundpfeiler medizinischen Handelns  und ist im täglichen Leben des Arztes und Physiotherapeuten nicht mehr wegzudenken.

Dr Andreas Waltering (IQWIQ) gibt uns eine Einführung in die Evidenz basierte Medizin (EBM). Anfangen mit der Entstehungsgeschichte der EBM. Die EBM wurde im Gegensatz zu Deutschland von der Ärzteschafft selber gefordert. Im deutschsprachigen Raum wurde die EBM primär eingeführt um der Fehlversorgung entgegen zu wirken.  
Dr Markus Laupheimer (@swisssportscare) stellt die Fragen. 

Wieso ist EBM wichtig?

Sollen wir den Vorlieben der Chef oder Oberärzte folgen? Oder sollen wir Patientenbezogen die EBM einsetzten? 

EBZ ist für ein Gesundheitssystem wichtig um Therapien die nachweislich was Bewirken zu fördern und zu bezahlen. Im Gegensatz dazu  sollten Therapien die Nachweislich keinen Nutzen haben nicht von der Solidargemeinschaft bezahlt werden.

Systematische Übersichtsarbeiten helfen Verzerrungen von einzelnen Studien zu vermeiden um den größten Aussagewert zu erhalten. 
Hierarchie der Evidenz: http://canberra.libguides.com/c.php?g=599346&p=4149721

Praktisches Beispiel in der Sportmedizin gibt es viele, jedoch eines der meisten untersuchten  Therapien ist die Arthroskopie bei Gonarthrose, welche keinen Vorteil zu Placebo zeigt. 

#Bewegungsmedizin #Evidenzbasiert

Dabei sollten wir nicht vergessen “Bewegung bringt Heilung” (https://soundcloud.com/bmjpodcasts/einfuhrung-in-die-bewegungsmedizin-bewegung-bringt-heilung-mit-dr-boris-gojanovic?in=bmjpodcasts/sets/bjsm-1)


Weitere links zur Evidenzbasierten Medizin:

Deutsches Netzwerk Evidenzbasierten Medizin e.V.
http://www.ebm-netzwerk.de/

Center of evidence-based medicine University of Oxford

IQWIQ  : Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen
https://www.iqwig.de/

Euch einen aktiven und bewegungsreichen Tag!

Nun viel Spaß mit diesem Podcast des BJSM. Und vergesst nicht uns auf Twitter @BJSM_BMJ, Facebook oder google+ zu folgen. Da gibt es regelmäßig neue updates.
Für feedback oder Anregungen für neue Podcasts schreibt mir einfach eine mail markus@swisssportscare.com

Was ist evidenz basierte Medizin und warum ist es so wichtig für unser tägliches Handeln?

Professor Stanley Herring is a clinical professor at the University of Washington (UW) in the Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine, and Neurological Surgery. He is director of the UW Medicine Sports Health & Safety Institute, medical director of Sports, Spine and Orthopedic Health for UW Medicine, and co-medical director of the Sports Concussion Program, a partnership between UW Medicine and Seattle Children's.

Dr. Herring's clinical interests include non-operative musculoskeletal and sports medicine with a particular interest in disorders of the spine and sports concussion. He is a team physician for the Seattle Mariners and a consultant to the UW Sports Medicine Program. 

In this podcast he talks to BJSM’s Liam West about an important cause of low back pain in our adolescent sporting population – spondylolysis. They discuss common presentations, examination techniques, imaging protocols and clinical pearls for treatment.

References
Use of the one-legged hyperextension test and magnetic resonance imaging in the diagnosis of active spondylolysis - http://bjsm.bmj.com/content/40/11/940.info

Nonoperative treatment of active spondylolysis in elite athletes with normal X-ray findings: literature review and results of conservative treatment - https://www.ncbi.nlm.nih.gov/pubmed/11806390 

Union of defects in the pars interarticularis of the lumbar spine in children and adolescents - http://bjj.boneandjoint.org.uk/content/86-B/2/225 

Nonoperative treatment in lumbar spondylolysis and spondylolisthesis: a systematic review - https://www.ncbi.nlm.nih.gov/m/pubmed/24427393/

Low back pain in adolescents: Professor Stanley Herring talks spondylolysis

In this episode of the Heart podcast, Digital Media Editor Dr. James Rudd is joined by a vascular biology legend, Professor Peter Libby from Harvard University and Chief of Cardiovascular Medicine at Brigham and Women's Hospital in Boston. They discuss how the inflammation hypothesis of atherosclerosis has been proven by the CANTOS trial and what the future might hold. We trust you'll enjoy the police sirens in the middle of the interview and hope you enjoy the discussion.

Link for CANTOS study - http://www.nejm.org/doi/full/10.1056/NEJMoa1707914

Inflammation and heart disease - what's next?

In this episode of the Heart podcast, Digital Media Editor DrJames Rudd is joined by Dr Cara Hendry from Manchester and Dr Iain Simpson from Southampton. They are passionate about reducing barriers that exist in cardiology and other medical specialities. They discuss what the issues are and what is being done to help in the UK and beyond. If you enjoy the show, please leave us a podcast review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2

Women in cardiology - breaking down the barriers

In this episode of the Heart podcast, Digital Media Editor, Dr James Rudd, is joined by Professor Charalambos Antoniades from Oxford, UK. They discuss his novel method of measuring coronary plaque inflammation using CT imaging, and how this method might be important for predicting heart attacks.
If you enjoy the show, please leave us a podcast review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2
Link to published paper: https://heart.bmj.com/content/early/2018/07/24/heartjnl-2017-312324

Perivascular adipose tissue and coronary atherosclerosis

In this episode of the Heart podcast, Digital Media Editor, Dr James Rudd, is joined by Dr Charlotte Warren-Gash from the London School of Hygiene and Tropical Medicine. They discuss the links between respiratory infections and subsequent heart attacks and strokes.
If you enjoy the show, please subscribe to the podcast to get episodes automatically downloaded to your phone and computer. Also, please consider leaving us a review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2
Link to published paper: https://www.lshtm.ac.uk/newsevents/news/2018/respiratory-infections-could-increase-risk-heart-attack-and-stroke

Respiratory infections and subsequent heart attacks and strokes

In this episode of the Heart podcast, Digital Media Editor Dr James Rudd, is joined by Professor Bernard Prendergast from St Thomas' Hospital, London. They discuss his recent publication in Heart concerning the ability of the stethoscope to detect important valve disease in asymptomatic primary care patients. They also cover POCUS, the feasibility of screening elderly patients for valve disease and whether Bernard still uses a stethoscope in real life.

If you enjoy the show, please subscribe to the podcast to get episodes automatically downloaded to your phone and computer. Also, please consider leaving us a review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2

Link to published paper: 
Primary paper: https://heart.bmj.com/content/early/2018/07/24/heartjnl-2018-313082
Editorial: https://heart.bmj.com/content/early/2018/05/24/heartjnl-2018-313474
The Oxvalve study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5216199/

Do we still need stethoscopes?

In this episode of the Heart podcast, Digital Media Editor, Dr James Rudd, is joined by Dr Eric Topol, founder and director of the Scripps Research Translational Institute. They discuss the impact that AI will have in medicine and how this will affect us all.

Relevant links related to this podcast:
About Dr Topol - https://drerictopol.com/about/
Nature Medicine AI review - https://www.nature.com/articles/s41591-018-0300-7
Twitter - https://twitter.com/EricTopol?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor
Book - https://drerictopol.com/book/deep-medicine/
NHS Topol review - https://www.hee.nhs.uk/our-work/topol-review

Deep Medicine with Eric Topol, author of the Topol NHS review

In this episode of the Heart podcast, Digital Media Editor, Dr James Rudd, is joined by Dr Thomas Butler from the University of Chester. They discuss his Review paper in Heart entitled "Optimum nutritional strategies for cardiovascular disease prevention and rehabilitation (BACPR)".

If you enjoy the show, please subscribe to the podcast to get episodes automatically downloaded to your phone and computer. Also, please consider leaving us a review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2

Link to published paper: https://heart.bmj.com/content/106/10/724

Diet after a heart attack - what should we tell patients?

In this episode of the Heart podcast, Digital Media Editor, Dr James Rudd, is joined by lipid expert Dr Susan Connolly from Enniskillen, Northern Ireland. They discuss primary and secondary prevention, risk scores, imaging and two new drugs with the potential to improve lipid management significantly over the next 5 years.
If you enjoy the show, please subscribe to the podcast to get episodes automatically downloaded to your phone and computer. Also, please consider leaving us a review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2

Low back pain in adolescents: Professor Stanley Herring talks spondylolysis

BMJ talk medicine

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