BJSM Podcast

AMSSM Sports Medcast - FAI and hip dysplasia: two ends of an overlapping spectrum. Episode #355

Is this a dysplasia problem? Or is this an impingement problem? Did you know that a young adult with a non-arthritic hip problem sees an average of 4.2 health care providers before a diagnosis of
impingement is made?!
On this week’s podcast, Dr J.W. Thomas Byrd MD (T:@nashvillehipmds) joins AMSSM’s Sports Medcast (T: @TheAMSSM) to discuss femoroacetabular impingement and hip dysplasia.
Dr. Byrd founded the Nashville Hip Institute to help treat patients with complex hip disorders using advanced surgical techniques. A recent Past President of both the International Society for Hip
Arthroscopy (ISHA) and the Arthroscopy Association of North America (AANA), Dr Byrd has pioneered many of the surgical techniques for hip arthroscopy commonly employed throughout the
orthopaedic world and invented numerous instruments that have revolutionised aspects of orthopaedic surgery. He has been one of the leaders for defining and developing the role of less invasive arthroscopic techniques in and around the hip. Dr. Byrd is currently the team physician for the Tennessee Titans and consults for many professional sports teams. https://nashvillehip.org/jw-
thomas-byrd-md-orthopedic-hip-specialist-nashville-tn/ 
In this 20 minute conversation, Dr. Byrd addresses the following topics:
       What is FAI?
       The work-up of FAI – examination and imaging
       Management of FAI - when to intervene
       Hip dysplasia in athletes
       Common errors in managing hip pathology

Knowledge translation with Dr Sandro Demaio. Episode #354

Knowledge translation with Dr Sandro Demaio. Episode #354
There are over 1.5 million papers published each year…but as many as 50% of them are never read by anyone other than their authors, referees and journal editors. How can we move research from
the laboratory, the academic journal, and the medical conference into the hands of people and organisations who can put it to practical use?
On this week’s podcast, Dr Sandro Demaio (@SandroDemaio) joins BJSM’s Daniel Friedman (@ddfriedman) to discuss how we can bridge the gap between evidence and practice in the real
world.
After leaving his role as the WHO’s medical officer for NCDs and Nutrition, Sandro was appointed the CEO of EAT (https://eatforum.org/contributor/dr-alessandro-demaio), a non-profit startup focused on food and sustainability. Formerly an Assistant Professor and Course Director at the University of
Copenhagen’s School of Global Health, and a postdoctoral fellow at Harvard, Sandro regularly shares his knowledge and ideas at international conferences, universities and public events. He founded the PLOS Global Health Blog, NCDFREE (https://ncdfree.org)  and festival21 (https://www.festival21.com.au), and is currently a bestselling author and TV host. http://sandrodemaio.com/about
 
In this 20 minute conversation, Sandro addresses the following topics:
       The importance of knowledge translation
       Ways in which knowledge translation can be achieved
       Overcoming the “leaky research pipeline”
       Social media tips for clinicians

Sham surgery for shoulder impingement

Management of shoulder pain has been estimated to account for 4.5 million visits to the doctor and $3bn (£2.3bn; €2.6bn) each year in the US alone. 44-70% of patients with shoulder pain are diagnosed with shoulder impingement syndrome. Although various non-operative treatment modalities are recommended as initial treatment for patients with shoulder impingement, subacromial decompression has become one of the most frequently performed orthopaedic procedures in the world...BUT DOES IT ACTUALLY HELP?
On this week’s episode, Prof. Teppo Järvinen (@shamteppo) joins BJSM’s Daniel Friedman (@ddfriedman) to discuss the results from his latest clinical trial – the FIMPACT trial - that was recently published in the BMJ.
Teppo is a Professor of Orthopaedics and Traumatology at the University of Helsinki and Helsinki University Hospital, and is head of the Finnish Centre for Evidence-Based Orthopaedics. He recently organised the 2018 Too Much Medicine symposium that took place in Helsinki, Finland. http://too-much-medicine.com/
In this 15 minute conversation, Prof. Järvinen addresses:
∙ shoulder impingement and subacromial decompression
∙ a brief overview of the FIMPACT trial
∙ the results of the trial and how to integrate the findings into clinical practice
∙ what does too much medicine mean for orthopaedic surgery
∙ the future of sham surgery

Further reading:
Paavola Mika, Malmivaara Antti, Taimela Simo, Kanto Kari, Inkinen Jari, Kalske Juha et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial BMJ 2018; 362 :k2860 https://www.bmj.com/content/362/bmj.k2860
FIDELITY infographic: https://www.bmj.com/content/bmj/362/bmj.k2860/F1.large.jpg
Beard, David J., et al. "Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial." The Lancet 391.10118 (2018): 329-338. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32457-1/fulltext
Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 2013;369:2515–24. https://www.nejm.org/doi/10.1056/NEJMoa1305189?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov
FIDELITY study video: https://www.youtube.com/watch?v=RaDWkJHmEB0
Savulescu, Julian, Karolina Wartolowska, and Andy Carr. "Randomised placebo-controlled trials of surgery: ethical analysis and guidelines." Journal of medical ethics (2016): medethics-2015.https://jme.bmj.com/content/42/12/776

An Update on Injury Prevention Programmes, and #SportSuisse2018, with Mario Bizzini. #352

We catch up with BJSM Deputy Editor, Physiotherapist and hugely influential researcher Mario Bizzini. We discuss everything from the evidence behind injury prevention programmes, maximising their implementation, and the upcoming #SportSuisse2018
Links below:
JOSPT Clinical Guideline https://www.jospt.org/doi/10.2519/jospt.2018.0303
Knakentroll (Swedish Group) - https://blogs.bmj.com/bjsm/2016/11/02/football-injuries-prevention-swedish-football-injury-warriors-martin-markus/
FIFA11+ https://bjsm.bmj.com/content/49/9/577
The Santa Monic Sports Medicine Research Foundation – The PEP Program: Prevent injury and Enhance Performance http://www.aclstudygroup.com/pdf/pep-program.pdf
Implementing Injury Prevention – Aspetar Journal - http://www.aspetar.com/journal/viewarticle.aspx?id=406#.W6TYAf4zbEY
Reference to Implementation Studies by Dr Alex Donaldson & colleagues in AFL https://www.ncbi.nlm.nih.gov/pubmed/30217833
#Sportsuisse2018 https://sportsuisse2018.ch/

Lifestyle management of type 2 diabetes #351

Type 2 diabetes is a complex systems disease, caused by interactions between lifestyle and genes. It is an illusion to believe that it can be cured by medication. Lifestyle change should always be at the heart of treatment.
Hanno Pijl is an internist-endocrinologist and professor of Diabetology at the Leiden University Medical Center (LUMC) In Leiden, The Netherlands. He co-authored over 250 papers in peer reviewed scientific journals, primarily related to obesity and type 2 diabetes. He has been a member of the Dutch Health Council (standing committee on nutrition) from 2008-2016. He currently co-chairs the Dutch Innovation center for Lifestyle Medicine (www.nilg.eu), a joint effort of LUMC and the Dutch Organisation of Applied Science (TNO) focusing on lifestyle interventions in health care.
 
Esther van Zuuren is a dermatologist at the Leiden University Medical Centre, but apart from that and more relevant for now is that her expertise lies in Evidence Based Medicine. She has been with Cochrane for almost 20 years, has held the position of Key Editor and
Methods editor for Cochrane Skin group for several years and conducted over 30 systematic reviews on a wide variety of topics. Furthermore, she is member of the GRADE working group, is a Recommendations Editor for DynaMed Plus (clinical evidence-based reference tool for clinicians) and Associate Editor for Systematic Reviews for the British Journal of Dermatology.
In our 20 min conversation we discuss
Dietary advice for people with type 2 diabetes
The importance of other lifestyle measures
Effects of lifestyle intervention in clinical practice
Patient preferences

Preventing overdiagnosis in 2018 with Dr Ray Moynihan Episode # 350

Do I really need this test, treatment or procedure? What are the downsides? What happens if I do nothing? And are there simpler, safer alternatives?
 
Dr. Ray Moynihan (@raymoynihan) joins BJSM’s Daniel Friedman (@ddfriedman) to discuss the growing problem of overdiagnosis and overtreatment, and what is being done to wind back the harms of too much medicine.    
 
Ray is an Australian academic, author and award-winning health journalist who completed his PhD on overdiagnosis in 2015 at the Centre for Research in Evidence-Based Practice at Bond University in
Australia, where he is also a senior research fellow. Having reported across print, radio, television and social media, Dr Moynihan has worked at the ABC TV’s investigative program, Four Corners and
the 7:30 Report, and The Australian Financial Review. He has also developed an impressive body of academic work published in the Lancet, the New England Journal of Medicine, PLOS ONE and the
BMJ.
 
Dr. Moynihan has won several awards for his investigative journalism, and his book ‘Selling Sickness’ (2005) was described in the New York Times as a “compelling case” and has been translated into a
dozen languages. His fourth book, ‘Sex, Lies & Pharmaceuticals’ was released globally in 2010 and generated widespread interest internationally.
 
Dr Moynihan hosts the very popular podcast, ‘The Recommended Dose’, that is produced by Cochrane Australia and co-published by the BMJ. https://soundcloud.com/therecodo
 
In this 25 minute conversation, Dr Moynihan explains the drivers of too much medicine and
addresses:
       embracing healthy scepticism in healthcare
       the threat of too much medicine to our health
       the problem with diagnostic labels
       his ground-breaking discovery of a dangerous new disease
       what clinicians should do to practice ‘just the right amount’ of medicine (Goldilocks Principle)

Talking physical activity and Golf and health, with Dr Andrew Murray. Episode #349

We were thrilled to catch up again with Dr Andrew Murray, the recently appointed Chief Medical Officer to the PGA European Tour, European Tour Performance Institute, and Ryder Cup Europe. He is universally known for his work promoting physical activity for health, his ultra-endurance challenges, and for leading the ‘Golf and Health project’. In this podcast he covers everything from the health benefits of golf, how to produce a consensus statement, the WHO’s GAPPA, to how to overcome various factors affecting knowledge translation #Gold
Various papers/resources are referred to throughout the podcast, links to which can be found below:
http://bjsm.bmj.com/lookup/doi/10.1136/bjsports-2018-099509
http://bjsm.bmj.com/lookup/doi/10.1136/bjsports-2018-099771
The relationships between golf and health: a scoping review
https://bjsm.bmj.com/content/51/1/12
Previous BJSM podcast on Golf & Health:
https://soundcloud.com/bmjpodcasts/andrew-murray-1
The World Health Organization’s Global Action Plan for Physical Activity: Prof Fiona Bull https://soundcloud.com/bmjpodcasts/the-world-health-organizations-global- action-plan-for-physical-activity-prof-fiona-bull?in=bmjpodcasts/sets/bjsm-1
It is time to replace publish or perish with get visible or vanish: opportunities where digital and social media can reshape knowledge translation
https://bjsm.bmj.com/content/early/2017/11/17/bjsports-2017-098367
We hope you enjoyed the podcast – get in touch with us via social media if you have any questions for @docandrewmurray

Low carb vs low fat diet for type 2 diabetes. Episode #348

Contrary to the long held contention that low fat diets are best for people with type 2 diabetes (DM2), the totality of current evidence suggests that low carb diets are at least as effective in ameliorating metabolic health in DM2. In fact, low carb seems to be somewhat
better, particularly in the short to medium term, although the evidence is of moderate certainty.
 
On this week’s episode Prof Hanno Pijl (@HannoPijl) and dr Esther van Zuuren (@Ezzoef) join Dr Aseem Malhotra (@DrAseemMalhotra) to discuss the most appropriate diet for
people with DM2
 
Hanno Pijl is an internist-endocrinologist and professor of Diabetology at the Leiden University Medical Center (LUMC) In Leiden, The Netherlands. He co-authored over 250 papers in peer reviewed scientific journals, primarily related to obesity and type 2 diabetes. He has been a member of the Dutch Health Council (standing committee on nutrition) from 2008-2016. He currently co-chairs the Dutch Innovation center for Lifestyle Medicine (www.nilg.eu), a joint effort of LUMC and the Dutch Organisation of Applied Science (TNO) focusing on lifestyle interventions in health care.
 
Esther van Zuuren is a dermatologist at the Leiden University Medical Centre, but apart from that and more relevant for now is that her expertise lies in Evidence Based Medicine. She has been with Cochrane for almost 20 years, has held the position of Key Editor and
Methods editor for Cochrane Skin group for several years and conducted over 30 systematic reviews on a wide variety of topics. Furthermore, she is member of the GRADE working group, is a Recommendations Editor for DynaMed Plus (clinical evidence-based reference tool for clinicians) and Associate Editor for Systematic Reviews for the British Journal of Dermatology
 
In our 20 min conversation we discuss
 
Efficacy of low fat versus low carb diets in the treatment of type 2 diabetes
The method of weighing the certainty of evidence we used in our systematic review
of the literature
Dietary recommendations for people with type 2 diabetes
https://academic.oup.com/ajcn/article-abstract/108/2/300/5051863

Time to get real about childhood obesity with Dr Sandro Demaio. Episode #347

Did you know that the worldwide prevalence of obesity nearly tripled between 1975 and 2016? In 2016, more than 1.9 billion adults and more than 340 million children were classified as overweight
or obese. At the individual level and in our modern, obesogenic world, weight gain has become the norm—the biological and social path of least resistance.
On this week’s podcast, Dr Sandro Demaio (@SandroDemaio) joins BJSM’s Daniel Friedman (@ddfriedman) to discuss childhood obesity and public health nutrition policy.
After recently leaving his role as the WHO’s medical officer for NCDs and Nutrition, Sandro was appointed the CEO of EAT , a non-profit startup focused on food and sustainability. Formerly an Assistant Professor and Course Director at the University of Copenhagen’s School of Global Health, and a postdoctoral fellow at Harvard, Sandro regularly shares his knowledge and ideas at international conferences, universities and public events. He founded the PLOS Global Health Blog, NCDFREE and festival21, and is currently a bestselling author and TV host.
http://sandrodemaio.com/about
In this conversation, Sandro addresses the following topics:
       Our current state of obesity
       Policies needed to address childhood obesity
       Sugar-sweetened disease and the sugar tax
       Role of the clinician in addressing the obesity pandemic
 
Further reading:
Renzella, Jessica A., and Alessandro R. Demaio. "It’s time we paved a healthier path of least resistance." (2018): bjsports-2017. https://bjsm.bmj.com/content/early/2018/03/07/bjsports-2017-098805
Murphy, Lisa, and Alessandro R. Demaio. "Understanding and removing barriers to physical activity: one key in addressing child obesity." (2018): bjsports-2017.
https://bjsm.bmj.com/content/early/2018/01/18/bjsports-2017-098546
Demaio, Alessandro. "A lifeSPANS approach: Addressing child obesity in Australia." Health Promotion Journal of Australia (2018). https://onlinelibrary.wiley.com/doi/full/10.1002/hpja.44 Demaio, Alessandro, and Alexandra Jones. "The true price of sugar-sweetened disease: political inertia requires renewed, strategic action." The Medical Journal of Australia 209.2 (2018): 1.
https://www.mja.com.au/journal/2018/209/2/true-price-sugar-sweetened-disease-political-inertia-requires-renewed-strategic
Beale, Anna L., and Alessandro R. Demaio. "Non-communicable disease risk factors: a call for primary care clinicians to act and to refer. Brief intervention, not silent abdication." (2017): bjsports-2017. https://bjsm.bmj.com/content/early/2017/10/05/bjsports-2017-098475

The demonisation of dietary fats and saturated fat: villain or hero? Episode #346

Is saturated fat good or bad? But doesn’t it cause cardiovascular disease? And what about the guidelines?
On this week’s episode, Dr. Zoë Harcombe (@zoeharcombe) joins BJSM’s Daniel Friedman (@ddfriedman) to discuss the takeaways from The BMJ’s Food For Thought conference 2018 (https://www.bmj.com/food-for-thought) and the demonisation of dietary fats.
Zoë has a PhD in public health nutrition. The full title of her thesis is: “An examination of the randomised controlled trial and epidemiological evidence for the introduction of dietary fat
recommendations in 1977 and 1983: A Systematic Review and Meta-analysis“. She researches in the fields of nutrition, diet, dietary advice, diet-related health and obesity and writes and talks about
these topics daily - http://www.zoeharcombe.com/
In this 30 minute conversation, Zoë discusses:
       The strength of evidence in nutrition research
       Facts about dietary fats
       Our current understanding of saturated fat
       Does saturated fat cause cardiovascular disease?
       Are universal dietary guidelines feasible?
 
Further reading:
Forouhi, Nita G., et al. "Dietary fat and cardiometabolic health: evidence, controversies, and consensus for guidance." BMJ361 (2018): k2139. https://www.bmj.com/content/361/bmj.k2139
Harcombe, Zoë. "Dietary fat guidelines have no evidence base: where next for public health nutritional advice?." Br J Sports Med 51.10 (2017): 769-774. https://bjsm.bmj.com/content/51/10/769
Harcombe, Zoë, Julien S. Baker, and Bruce Davies. "Evidence from prospective cohort studies does not support current dietary fat guidelines: a systematic review and meta-analysis." Br J Sports
Med 51.24 (2017): 1743-1749. https://bjsm.bmj.com/content/51/24/1743.info
Harcombe, Zoë, et al. "Evidence from randomised controlled trials does not support current dietary fat guidelines: a systematic review and meta-analysis." Open Heart 3.2 (2016): e000409.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985840/
Harcombe Z US dietary guidelines: is saturated fat a nutrient of concern? Br J Sports Med Published Online First: 14 August 2018. doi: 10.1136/bjsports-2018-099420 https://bjsm.bmj.com/content/early/2018/08/14/bjsports-2018-099420
Malhotra, Aseem, Rita F. Redberg, and Pascal Meier. "Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively
reduced from healthy lifestyle interventions." (2017): bjsports-2016.
https://bjsm.bmj.com/content/51/15/1111