BMJ talk medicine

The best of our October 2022 issue, covering a superb qualitative study exploring the experience of older adults in the Emergency Medicine Journal with a wonderful accompanying editorial; a look at variation in practice for treating pre-orbital and orbital cellulitis in children; the association between anticoagulation and mortality in major trauma; point of care testing for tetanus immunity and more.

Read the highlights: https://emj.bmj.com/content/39/10/723

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In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. David Viveros-Carreño and Rene Pareja to discuss Sedlis criteria. Dr. Viveros-Carreño is a Gynecologic Oncologist at Instituto Nacional de Cancerología, Clínica Universitaria Colombia and Clínica Los Nogales in Bogotá, Colombia. Dr. Pareja is a gynecologist oncologist at Astorga Oncology Clinic in Medellín and the National Cancer Institute in Bogotá, Colombia. Dr. Pareja is a reviewer for more than 20 specialty journals, an Associate Editor for IJGC, and a member of the board of directors of the International Gynecological Cancer Society (IGCS). He is the author of nine book chapters and more than 70 publications in peer-reviewed journals, and at IGCS 2021 he received an award for Community Advancement in Resource-Limited Settings.

Highlights:

-There is currently a debate regarding the role of adjuvant therapy for intermediate-risk cervical cancer.

-Adjuvant pelvic radiotherapy showed lower risk of recurrence for intermediate-risk cervical cancer in a randomized controlled trial more than 20 years ago.

-Preoperative imaging, surgery, pathology, and radiotherapy techniques have changed since the evidence for intermediate risk adjuvant treatments was described.

-The risk of recurrence for intermediate risk cervical cancer is probably lower now, and observation could be an option.

-New evidence from two randomized controlled trials (GOG 263 and CERVANTES trials) is expected to change definitions of intermediate risk and adjuvant algorithms.

On this episode of the AMSSM Sports Medcast (T: @TheAMSSM) host Dr. Jacob Wessels, MD is joined by Dr. Adam Tenforde, MD to discuss the topic of Exercise for Extracorporeal Shockwave Therapy (ESWT) in Musculoskeletal Medicine.

Dr. Tenforde recently published a research about best practices for ESWT, which is used in a variety of clinical applications including the management of musculoskeletal conditions. In this conversation, he addresses the following topics and questions about shockwave therapy:

· What is ESWT?

· The origins of shockwave therapy use and some of its additional applications

· Describing the process of shockwave therapy and its effects

· Some of the factors to consider when performing ESWT, especially to clinicians who have never used this treatment option before

· Understanding the different types of shockwave therapy and how they can be used to treat injuries

· What types of providers can administer ESWT, and what are the recommended treatment protocols for medical teams?

· What is the reimbursement status of shockwave therapy for providers?

· What are some of the medical conditions that are best treated by ESWT, in both the lower and upper extremities?

Additional Resources

Best practices for extracorporeal shockwave therapy in musculoskeletal medicine: Clinical application and training consideration. PM&R 2022 May;14(5):611-619. doi: 10.1002/pmrj.12790. https://doi.org/10.1002/pmrj.12790

Bone stress injuries. Nat Rev Dis Primers. 2022 Apr 28;8(1):26. doi: 10.1038/s41572-022-00352-y. PMID: 3548413

A Systematic Review of Systematic Reviews on the Epidemiology, Evaluation, and Treatment of Plantar Fasciitis. Life (Basel). 2021 Nov 24;11(12):1287. doi: 10.3390/life11121287.

Today we focus on presumptive and prophylactic management of bacterial STIs, talking with Dr Manoji Gunathilake, Head of sexual health services in Darwin, Australia, and Assistant Prof Will Nutland, the director of the NGO, the Love Tank, in London, UK.

Related links:

STI Guidelines Australia: https://sti.guidelines.org.au/

The Love Tank: http://thelovetank.info/

GRASP report: data to June 2021 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1033882/GRASP_2020_Report.pdf

Taking antibiotic after sex cuts STIs by two-thirds, ‘DoxyPEP’ study finds - www.aidsmap.com/news/jul-2022/tak…xypep-study-finds

Doxycycline PEP significantly reduces STIs in people at high risk of infections - i-base.info/htb/43528

Dr Philip Smith, Associate and Social Media Editor of FG and Consultant Gastroenterologist at the Royal Liverpool Hospital, Liverpool, UK, interviews Dr Jeremy Nightingale, Honorary Consultant Gastroenterologist and Intestinal Failure specialist from St Mark’s Hospital, London, UK, on the paper 'How to manage a high output stoma' published in Frontline Gastroenterology in 2021 and on the website: https://fg.bmj.com/content/13/2/140.

Listen to our regular podcasts and subscribe in Apple Podcasts, Google Podcasts, Stitcher and Spotify. If you enjoy our podcast, please rate us on your chosen platform, and leave us a review on the Frontline Gastroenterology Podcast page on iTunes: https://podcasts.apple.com/gb/podcast/fg-podcast/id942944229

In this podcast, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the October 2022 issue of DTB. They discuss whether the language used in announcements from organisations such as NHS England, NICE and the MHRA regarding new medicines is appropriate and highlight concerns that some press releases are at risk of promoting POMs to the public (https://dtb.bmj.com/content/60/10/146). They review a study that assessed the effect that regular doses of paracetamol had on blood pressure (https://dtb.bmj.com/content/60/10/147) and talk about an article that discusses the role played over the past 20 years by groups, organisations and individuals that have been critical of the pharmaceutical industry (https://dtb.bmj.com/content/60/10/151).

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 (https://podcasts.apple.com/gb/podcast/dtb-podcast/id307773309). Thank you for listening.

It's zoomers vs boomers on this week's Doctor Informed, as we assemble a multigenerational team to talk about the "good old days" and if the youth of today are really snowflakes.

Clara Munro is joined by Nikki Nabavi, a medical student at Manchester University and a regular on Sharp Scratch (The BMJ's student podcast); Ayisha Ashmoore, an trainee in obstetrics and gynaecology, in the East Midlands; and Alastair Munro, a retired professor of oncology (and Clara's dad).

Herpes zoster: an update on diagnosis and management

The annual incidence of herpes zoster in the UK is between 2 and 4 patients per thousand population. It can cause a range of complications including post-herpetic neuralgia, herpes zoster of the eye, and disseminated zoster. So it is important that we get the diagnosis and management of this condition right. In this BMJ Best Practice podcast on herpes zoster, Kieran Walsh talks to Professor Michael Rothberg, Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio. MR declares that he has no competing interests.-

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.

Practical Neurology Editors Phil Smith and Geraint Fuller talk you through the highlights of the October 2022 issue of the journal.

Read the highlights: https://pn.bmj.com/content/22/5/341.

Please subscribe to the Practical Neurology podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month.

If you enjoy our podcast, please consider leaving us a review or a comment on the Practical Neurology Podcast iTunes page (https://podcasts.apple.com/gb/podcast/pn-podcast/id942932053).

The PN podcast is produced by Letícia Amorim and edited by Brian O'Toole.

Thank you for listening.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Dmitriy Zamarin to discuss immune checkpoint inhibitors in ovarian cancer. Dr. Zamarin is a medical oncologist and a translational research director in gynecologic medical oncology at the Memorial Sloan Kettering Cancer Center. His research focuses on development of novel immune therapeutics in gynecologic malignancies and on the mechanisms of immune response to immunotherapy.

Highlights:

-Immune checkpoint blockade benefits a subset of patients with ovarian cancer, but predictors of such benefit remain unknown.

-Patients with ovarian clear cell carcinoma appear to be more likely to derive benefit from immunotherapy, particularly from combined immune checkpoint blockade; however, these patients still constitute only a minority of those with ovarian clear cell carcinoma.

-Larger prospective trials of immune checkpoint blockade, including combined immune checkpoint blockade in ovarian clear cell carcinoma, are needed to validate these early observations.

-Biomarkers of response to immunotherapy like PD-L1 expression and tumor mutation burden are of limited value in ovarian cancer, and other molecular and microenvironment biomarkers are needed.