BMJ talk medicine

In surgical care worldwide, there has been a growing trend towards enhanced recovery with the emphasis on early mobility, avoidance of unnecessary procedures and drug-induced side effects, and

faster return of normal gastrointestinal function, with the end result of shorter hospital stay. It’s natural to assume that regional anesthesiology and acute pain medicine would play a central role in enhanced recovery protocols for all of the well-described benefits. However, the base evidence is continually evolving as both anesthetic and surgical practices change.

In this month’s RAPM Focus, Associate Editor Edward Mariano, MD, joins Kariem El-Boghdadly, MBBS, BSc, FRCA, EDRA, lead author of an international collaboration in the regional anesthesiology and

enhanced recovery world, “Role of regional anesthesia and analgesia in enhanced recovery after colorectal surgery: a systematic review of randomized controlled trials,” first published in March 2022

(https://rapm.bmj.com/content/47/5/282). Investigators carefully evaluated thirteen published randomized controlled trial studies involving 1,170 participants and concluded that regional analgesia

may only have modest evidence to support its inclusion in enhanced recovery protocols involving colorectal surgery patients.

Dr. Kariem El-Boghdadly is a consultant anesthetist at Guy’s and St. Thomas’ NHS Trust in London, and an editor of the journal Anesthesia. Dr. El-Boghdadly completed his undergraduate training at University College of London in 2007 and proceeded to undertake his anesthetic training in Southeast School of Anesthesia. He was awarded the Nuffield Prize for the fellowship of the Royal College of Anaesthetists and completed fellowships in prehospital medicine in Australia, followed by regional anesthesia in Toronto, Canada. Dr. El-Boghdadly is an honorary senior lecturer at King’s College London, and his research interests include regional anesthesia, airway management, and research delivery. He is a brilliant researcher and writer and is well-known for his work in the COVIDSurg Collaborative during the ongoing pandemic, and the ASRA-ESRA regional anesthesia nomenclature project.

*The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical

treatment or for the medical treatment of others.

Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez, is joined by Dr. Félix Boria to discuss the validation of ESGO quality indicators for cervical cancer. Mr. Boria is an attending physician of the gynecologic oncology division at the University of Navarra (Madrid, Spain) under the mentorship of Dr. Luis Chiva. He is currently finishing his PhD at Universidad Autonoma de Madrid about PET/CT and advanced ovarian cancer.

Highlights:

- Women who were operated on centers with high compliance of quality indicators had significant lower risk of relapse (HR, 0.39; 95% CI, 0.25 to 0.61; p<0.001). The association remained significant after further adjustment for conization, surgical approach and use of manipulator and for adjuvant therapy.

- High compliance centers performed more open surgeries (58.4% vs 36.7%, p<0.01), more cone biopsies (45.4% vs 30.0%, p<0.01), lower use of a uterine manipulator (15.5% vs 31.7%, p<0.01), lower use of adjuvant treatment (40.2% vs 48.4%, p=0.01).

- The rate of adjuvant treatment in Europe is surprisingly high, especially in low compliance centers (48%). Future investigations should try to address if we are overtreating patients with cervical cancer.

Medicine is occasionally like the reality TV show I’m a Celebrity… Get Me Out of Here! in that some of the things we have to do are just unpleasant, whereas other parts may be phobia-inducing. But how might having a phobia as a medical student affect the ways you are able to work on placement?

In today’s episode, we’re going to be talking all about phobias. We’ll discuss what happens when you have a phobic response to something, the ways that this can impact you whilst studying medicine, and how to tell whether something is just dislike or an actual phobia.

Expert guests:

Dr Digby Quested is a general adult psychiatrist working in Oxford. He works in the community, and has covered many of the GP practices which serve the student population. He self managed blood phobia whilst at medical school

Check us out on social media:

Twitter: https://twitter.com/BMJStudent

Instagram: https://www.instagram.com/bmj_student/

Facebook: https://www.facebook.com/BMJStudent/

This podcast is produced and edited by Dom Byrne and Duncan Jarvies.

#MedTwitter consists of an online community of researchers, health practitioners and students who have created an open source decentralised forum for information sharing, medical education and professional networking. #MedTwitter also provides a space for publications to be shared and promoted. While many will credit Twitter with giving a voice to clinicians, it also comes with challenges, the potential for abuse, or the spread of misinformation.

Joining Clara to discuss are;

Jonathan Guckian, a dermatology registrar in Leeds, and director of social media and communications at the Association for the Study of Medical Education (ASMI).

Flo Wedmore, a medical registrar and NHS sustainability fellow

Declan Murphy, an academic medical fellow S2 in ophthalmology in Newcastle, and former Sharp Scratch panelist.

In this month’s podcast, Journal of Investigative Medicine Social Media Editor John Dickinson, MD, PhD, University of Nebraska Medical Center, welcomes guest Nick Bell for a discussion of cystic fibrosis from the patient perspective. Nick has lived his entire life under the shadow of CF. However, thanks to new advances in CF treatment based on our understanding of the fundamental biology of the CF protein, Nick has been able to emerge from the shadow of CF. He is a successful business owner and community philanthropist who has used his talent with poetry and creative writing to enrich the lives of the less fortunate in the community. In this episode, we explore how science and medical research make lasting impacts on people’s lives.

We release episodes fortnightly. Hypothermia is a serious condition - it can cause rhabdomyolysis, electrolyte disturbances, and cardiac arrhythmias. It can also kill. In the UK, the annual number of hypothermia-related deaths is about 300. And in countries with colder climates, the numbers are far higher.

So it is important that we get the diagnosis and management of this condition right. In this BMJ Best Practice podcast, Kieran Walsh talks to Dr Alexander Alexiou, Emergency Medicine Consultant, Barts Health NHS Trust about hypothermia.

Competing interests: none declared

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Ilaria Betella and Francesco Multinu. Dr. Betella is an attending in the Department of Gynecologic Surgery at the European Institute of Oncology (IEO) in Milan. Her research focuses on molecular classification of endometrial cancer and on hereditary gynecologic cancer syndromes. Dr. Multinu is a gynecologic oncologist at the European Institute of Oncology (IEO) in Milan as well as a research collaborator in the Department of Obstetrics and Gynecology, Division of Gynecologic Surgery at the Mayo Clinic in Rochester, Minnesota. His special research interests include surgical and postoperative treatment of endometrial cancer.

Highlights:

- There is evidence that the new molecular classification will be the future in the management of endometrial cancer.

- The implementation of molecular analysis allows oncologists to reallocate to a different risk class 6.8% of endometrial cancers that otherwise would have been misclassified and consequently undertreated or overtreated.

- The interpretation of molecular classification requires a validated hierarchical algorithm, for which POLE analysis is essential: Even though POLE testing has not been implemented in many institutions, there is no way to use part of the molecular analysis and completely escape POLE analysis.

- According to the new algorithm proposed by Dr. Betella et al., POLE analysis could be spared in 67% of patients and reserved only for those in whom the incorporation of the molecular classification could change the risk class attribution and post-operative management.

One way that start-ups can help accelerate their growth is by entering (and winning!) competitions – like the WISH 2022 Innovation Award. BMJ Innovations was in Doha and spoke to the organisers and some of the winners of this year’s award to get their insight on what makes for a successful entry. Joining us are –

Mahmoud El Achi, Head of Innovation at the World Innovation Summit for Health (WISH)

Nicolas Vachicouras, CEO & Co-founder at Neurosoft Bioelectronics

Yashar Faranjani, CEO & Co-founder at Smiletronix

Editor-in-Chief of ADC Nick Brown brings you the monthly Atoms - the highlights of the December 2022 issue.

Read it on the Archives of Disease in Childhood website: https://adc.bmj.com/content/107/12/i

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In this episode of the Heart podcast, Digital Media Editor, Dr James Rudd, is joined by Dr Maoyi Tian, from Harbin Medical University in China. They discuss his paper entitled "Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis".

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/2022/07/21/heartjnl-2022-321332