Coda Change

Catalina Sokoloff presents Milrinone for treatment of post-aneurysmal subarachnoid haemorrhage vasospasm (delayed cerebral ischaemia.) Catalina firsts explains the pathophysiology of delayed cerebral ischaemia. She makes the point that there is still much we do not know. Probable mechanisms at the microcirculation level include release of free radicals, lipid peroxidation, cortical depression spreading and microthrombi formation. The ideal treatment once delayed cerebral ischaemia is present is therefore unknown. Mechanical angioplasty seems to be favourable in some instances however has its shortcomings. As such it is often reserved as a rescue option. ‘Triple H’ therapy is intended to improve blood flow beyond constricted vessels; however, each component is flawed as Catalina explains. Intraarterial drugs have been tried however similarly, the evidence is lacking. This brings Catalina to Milrinone. This drug is a phosphodiesterase 3 inhibitor that has vasodilating and inotropic properties. Relevantly, the cerebrovascular smooth muscle contains large amounts of phosphodiesterase 3, making Milrinone promising. The combination of increased cardiac output, alongside decreased afterload theoretically should increase cerebral blood flow and subsequently brain perfusion. Milrinone has also been shown to be a potent anti-platelet aggregator as well as possessing anti-inflammatory properties. Both processes are likely involved in the pathophysiology of delayed cerebral ischaemia. Catalina continues to discuss the trials (both animal and human studies) that look at the effect of this drug. Whilst there are still no randomised control trials (at the time of the talk) looking at Milrinone, the early retrospective trial data is promising. There are of course still obstacles surrounding the drugs Namely, no standard dose, no guidelines regarding titration and concerns surrounding the vasodilating properties. Catalina concludes by proposing the pros of this treatment as she sees it. She argues that the apparent improvement in mortality, the non-invasive nature, and the lack of haemodynamic compromise are all indicators of the potential future of the treatment.   Please note this episode was recorded in November 2018 as part of Brain, a CICM Neuro Special Interest Group meeting click here for more info. For more like this, head to our podcast page #CodaPodcast

Communicating Science In A Pandemic (Pt. 2)   The power & presence that social media has in healthcare communication cannot be ignored. However, many are still reluctant to embrace its usefulness as a tool which can enhance education and patient connections.   IN PART 2 OF THIS PODCAST, DR JESSICA STOKES-PARISH CONTINUES TO DISSECT THE ROLE OF SOCIAL MEDIA IN SCIENCE COMMUNICATION, ALONGSIDE REGISTERED NURSES PENNY BLUNDEN (@sick.happens) & PATRICK MCMURRAY (@patmacrn).   The trio begin by addressing the negative tone that accompanies the topic of social media in the nursing community. Patrick explains how this perception should be abandoned and social media should instead be seen & used as an educational tool. Patrick integrates social media into his own role as a clinical educator and knows first-hand how effective it can be when used correctly.   The focus then turns to the importance on educating the educators. Patrick & Penny outline how medical educators must learn how to use social media to expand practice and connect with people. They can then demonstrate to their students how to use the social media tool responsibly, the same way they teach responsible use of stethoscopes or syringes.   Penny goes on to say that there is a need for greater support for nurses online, particularly with regulation. If online regulation guidelines are unclear, nurses can often become un-registered and simply give away unregulated information under the guise of being an “ex-nurse”.   PATRICK & PENNY THEN GIVE TIPS FOR ANY MEDICAL PROFESSIONALS WANTING TO UTILISE SOCIAL MEDIA FOR SCIENCE COMMUNICATION.   Penny highlights the importance of remaining authentic and not comparing yourself to others. This is the way to avoid “imposter syndrome”. She also says that it is essential to always have evidence to back up your claims. Patrick advises to not get caught up in follower numbers. Focus more on quality content and staying true to yourself.   Tune in to this unique, insightful take on science communication through social media with Jessica Stokes-Parish. Communicating Science in a Pandemic (Pt 2).   For more like this, head to our podcast page. #CodaPodcast

In Part 2 of this podcast Hugh Montgomery, Liz Crowe, and Shelly Dev along with Peter Brindley continue their discussion on wellness, resilience, burn out and being a healthcare worker in the world now. IN THIS EPISODE THE TEAM DISCUSSES THE BROADER ORGANISATION STRUCTURE AND HOW THIS CONTRIBUTES TO (OR DETRACTS FROM) TEAMWORK AND HEALTHCARE WORKER WELLNESS AND SATISFACTION. Shelly delves into the topic of the organisations and whether they are supporting the clinicians on the ground in the best possible way. Senior leadership, in her opinion, has done a major disservice to healthcare workers in their support and leadership roles. The support needed on the ground transcends yoga classes and healthy cooking recipes. Organisational support needs to acknowledge the needs and desires of healthcare staff, namely, to deliver excellent care and have good days at work in the context of a healthy life. Liz suggests that although the organisational leadership is important for the overall wellbeing of the workforce, they are one aspect of a broader picture. She believes that leaders should be mentored in leadership. Teaching people basic communication and feedback skills would make a huge difference. Similarly, fostering a culture of togetherness and unity amongst separate entities of a larger organisation would lead to greater worker satisfaction and lead to better outcomes for patients. HUGH RAISES THE POINT OF CLINICAL OUTCOMES BEING INFLUENCED BY ENGAGEMENT OF HEALTHCARE PROVIDERS BY SENIOR MANAGEMENT. Management teams engaging with clinical staff seem to increase the patient care being delivered. Hugh provides his thoughts as to why this may be the case. Without senior management support, clinicians are increasingly overworked in a system that is constantly pushing back. This can, and does, lead to staff finally breaking and resigning on the spot. The core the issue of healthcare worker burnout and dissatisfaction is simple Shelly states. In her view, everyone in healthcare at their core are good and decent people. They desire support and structures that allow them to enact this value in their everyday work. Although the solutions to the broad range of problems facing health systems across the globe are not as straight forward, remembering this fact is a good starting point. From here, the team provide some of their insights into the way forward.     Tune in to this authentic perspective on healthcare worker wellbeing with Peter Brindley, Hugh Montgomery, Liz Crowe & Shelly Dev. Overcoming the Great Resignation through Realisation: Part 2 For more like this, head to our podcast page. #CodaPodcast     This podcast is brought to you by Teleflex

This episode discusses the effect of the pandemic on healthcare professionals at an individual level, and how this has broad reaching ramifications at a team and industry level across different country contexts.   IN THIS PODCAST PETER BRINDLEY IS JOINED BY HUGH MONTGOMERY, LIZ CROWE, AND SHELLY DEV TO DISCUSS WELLNESS, RESILIENCE, BURN OUT AND BEING A HEALTHCARE WORKER IN THE WORLD NOW. THIS EPISODE EXPLORES JOB SECURITY, PUBLIC RECOGNITION, AND THE EFFECT OF THE PANDEMIC AT A PERSONAL LEVEL FOR DOCTORS AND NURSES.   In the context of the pandemic, the good comes with the bad – as Liz explains. Throughout the pandemic we have seen health care professionals experience trying work conditions the world over. However, it is one of the few industries that did not experience staff layoffs and work reduction. On the other hand, all healthcare systems in the world are imperfect. Throwing a pandemic into the mix produced even more challenges. It was therefore unlikely that the mental health and satisfaction from work was going to improve over the past two years. Hugh discusses the disposition of healthcare workers in London during the pandemic – one of the hardest hit regions in the world. Whilst the pandemic initially provided an opportunity for intensive care doctors and nurses to do what they are trained to do; the ongoing nature has proven to be challenging. The doctors in his system are weary – both mentally and physically. Shelly highlights the touching nature of working within a close team during this difficult period. In her experience there is a comradery that has been emphasised through the pandemic. However, Shelly states that even in non-pandemic times healthcare workers have struggled to cultivate a healthy relationship with the rest of their lives outside of work. Therefore, her first thoughts at the start of the pandemic were not of the intellectually interesting challenge, but rather what was going to happen with her family. On a broader scale, Shelly posits these hardships may lead to more and more healthcare professionals leaving the industry.   Tune in to this authentic perspective on healthcare worker wellbeing with Peter Brindley, Hugh Montgomery, Liz Crowe & Shelly Dev. Overcoming the Great Resignation through Realisation: Part 1 For more like this, head to our podcast page. #CodaPodcast     This podcast is brought to you by Teleflex

Communicating scientific information as a health professional is far more than just posting healthcare tips online. What can & can’t be posted? Who do we really listen to? And who is allowed to say what? DR JESSICA STOKES-PARISH CHATS WITH REGISTERED NURSES & SOCIAL MEDIA PERSONALITIES PENNY BLUNDEN (@sick.happens) & PARTICK MCMURRAY (@patmacrn) ABOUT THE BARRIERS FACING HEALTH PROFESSIONALS WHEN COMMUNICATING WITH THEIR AUDIENCES ONLINE.   Picking up where Professor Tim Caulfield’s “Great Rejection” misinformation podcast left off, Dr Jessica Stokes-Parish unpacks the challenge of communicating accurate information via social media as a health professional, specifically nurses. Penny Blunden and Patrick McMurray both have successful, widely-followed social media accounts which they use to provide useful insights into healthcare to mass audiences. Jessica states how in recent years, including during Covid, she saw a rise in scientific misinformation across social networks. Whilst there was a strong presence of doctors attempting to de-bunk these myths, input from nurses seemed to be far less visible. This is why she recruited Penny & Patrick for some authentic perceptions of the relationship between science and social media.   Both Penny & Patrick outline how their own unique experiences as health professionals led them to use social media to provide more accurate, helpful healthcare information. The group explore the role & presence of nurses online and what kind of content resonates most with audiences. They also unpack how the perception of nurses as second-rate healthcare providers left them without a strong voice for a long time - which is why online accounts like Penny’s & Patrick’s are so vital.   THE TRIO THEN DIVE INTO THE KEY BARRIERS WHICH THEY FACE AS ONLINE INFORMATION PROVIDERS. Challenges ranging from imposter syndrome & judgement from colleagues to social media policies & regulations are all investigated. Patrick states that existing on social media in a “helpful and meaningful way” must remain top-of-mind. Tune in to this unique, insightful take on science communication through social media with Jessica Stokes-Parish. Tune in to this unique, insightful take on science communication through social media with Jessica Stokes-Parish. Communicating Science in a Pandemic (Pt 1). For more like this, head to our podcast page. #CodaPodcast

Nazih Assaad provides his expertise on the treatment of subarachoid haemorrhage. Treatment for aneurysmal subarachnoid haemorrhage (SAH) is an area that has had extensive research but not a great deal of success. Promising animal studies have not turned out as hoped in clinical trials and many questions remain unanswered. Nazih guides the listener through his approach on how to address the complicated presentation of SAH. Firstly, subarachnoid haemorrhages can be graded clinically and radiologically. Clinical grades provide useful prognostic information, with poorer grades less likely to do as well as more favourable grades, despite best medical and intervention management. Nazih mentions the Fisher Scale which is useful for predicting vasospasm and how he integrates both into practise. Nazih will guide you through the four elements in the management of established SAH. Moreover, these are the four areas he believes every clinician working in this space should consider with every patient presenting with a SAH. The first is the effect of the haemorrhage itself on the patient. The sudden rise of intracranial pressure secondary to aneurysm rupture leads to dramatic clinical signs. These includes loss of consciousness and seizure like activity. There are no known agents to reverse the effects of the initial insult. Secondly, managing the degree of hydrocephalus that most, if not all, patients will have if critical. Clinical hydrocephalus is treated with CSF drainage. Thirdly, the prevention of re-haemorrhage is important. In bygone eras, patients with aneurysmal SAH did not have immediate management of the bleed. This has changed. Finally, delayed cerebral ischaemia (usually relating to vasospasm) should be addressed. Gold standard of diagnosis is digital subtraction angiography, and following this, Nazih describes his aggressive management approach.  Nazih takes the listener through what he considers the most critical aspects of managing a patient with an aneurysmal SAH. This talk explores diagnostic techniques, patient examination, surgical options, and other management considerations. He touches on the most recent guidelines and protocols around Australia and the world.  Please note this episode was recorded in November 2018 as part of Brain, a CICM Neuro Special Interest Group meeting click here for more info. For more like this, head to our podcast page #CodaPodcast

Whilst US medicine has always had issues, the pandemic sent the practice of medicine into a state of disarray. DR JUSTIN HENSLEY DISCUSSES THE STATE OF US MEDICINE THROUGHOUT THE PANDEMIC. THE POWER OF INSURANCE COMPANIES AND DESPERATE WORKING CONDITIONS IN US HOSPITALS. In this talk, Justin outlines the "idealistic" view he had of emergency care before working in the ED. However, he was not prepared for the “joyless” nature of a medical system which seemed to place profits above patients.  Through a detailed account of what it’s like to work in the US healthcare system, Justin shares his belief that US medicine is “purely, 100% a business”. He dives into the unavoidable financial struggles that patients must endure with private insurance companies for even the most basic care. Justin states that, at times, it felt as though he was just “generating a bill for the patient”. Venturing further into the issue of insurance companies, Justin takes us through his own experience of delivering healthcare to rural Americans. His patient-first philosophy led this project, only to have it shut down due to insurance companies not recognising the importance of his work. Justin goes on to tackle the issue of burnout. He explains how fear at the beginning of the pandemic saw ED patient numbers drop, meaning less cashflow and dramatic cutting of shifts. Once the patient volumes went back up, staffing failed to appropriately match the new demand. This lead to a burnout-fuelled “logistical nightmare”. Finally, Justin outlines how “embracing the suck” led him to move to Australia to pursue his current endeavour. He has reignited his passion for providing much-needed healthcare to rural patients.   Tune in to this fascinating take on international healthcare with Dr Justin Hensley. Healthcare Wellbeing: Knowing when it's time for a change For more like this, head to our podcast page. #CodaPodcast

In part 2 of The Great Rejection, Peter Brindley and Tim Caulfield return to continue their discussion of misinformation in the world of health science. This episode examines how to teach the public to think critically, how to deal with uncertainty as a clinician and how to better understand the pros and cons of transparency. How do we teach science in an ever-expanding world of knowledge and information? Tim suggests going back to first principles and reinforcing to the public that science is a process. Secondly, Tim highlights how basic educational tools can make a big difference when teaching the public to cut through the noise. Moreover, creating engaging content with accurate messaging can help turn the tide on misinformation in the public realm. This brings Tim and Peter to the idea of uncertainty and how it sits with the public. The research suggests that the public wants the scientific community to be honest about uncertainty. Reassuringly, the same research tells us that by being honest, an institution or medical body does not lose any credibility. Tim points out the incredible uptake of mask wearing in some countries. This is despite misinformation being disseminated online, an indication of the willingness to acknowledge uncertainty and still act in accordance with advice. Tim discusses the downsides of population engagement. Whilst transparency is positive on its own, it may not achieve the aims originally intended. Tim highlights public reactions to literature retractions, medical debates, and conflicting results as an example of scientific transparency being counterproductive. However, that is science! And it is messy – as such it does not always lead to good, especially in the short term. However, Tim contends that whilst the ‘backfire effect’ (the negative ramifications of debunking scientific claims) exists, the real-world implications are small. Therefore, scientists and medical professionals should not worry too much about retracting or debunking previously established evidence. Finally, for more like this, head to our podcast page #CodaPodcast For more on Tim Caulfield, click here.

Please note this episode was recorded in November 2018 as part of Brain, a CICM Neuro Special Interest Group meeting click here for more info. Oli Flower gives us a preview into the future of traumatic brain injury (TBI) management. It is late in the 21st century and a man suffers a TBI. Oli describes the on scene immediate management of this patient. Drones and closed-circuit cameras combine to provide the closest ever trauma centre, taking tissue samples and patient images. Not only that, but the samples have been analysed and referenced against a huge database, providing the awaiting critical care clinicians with an individualised and effective treatment plan for each patient. But, this future depends on information. To develop the technology that Oli envisages, we need to collect more information in the right way. Ultimately, the future of TBI management requires the development of tools to apply masses of information to the patient in a meaningful way. One such was to achieve this, is by using biobanks. A biobank is a repository of human tissues and samples with the corresponding appropriate and correct annotating data. Specifically, for TBI this primarily means blood and CSF. The tissue is annotated with prognostic information and patient centred long-term outcome data from its donor, allowing a huge pool of information that can be accessed to inform treatment moving forward. Evidently, the potential for a biobank is enormous. Oli describes rapid genomic assessment, proteomic analysis and metabolomic profiling as potentials in the near future. This data would provide a plethora of information per patient. This does however, pose a challenge, and leads to the need for advanced computer processing to interpret the data, whilst being able to factor in the dynamic and evolving processes that define critical care. Artificial intelligence no doubt has a part to play. Biobanks have started to be developed across Australia and the world. However, they requires a massive collaboration that spans across countries. In doing so, we can strive towards the future treatment of TBI. Finally, for more like this, head to our podcast page #CodaPodcast

Peter Brindley and Timothy Caulfield answer the big questions around how science and health are represented in the public sphere. What is science? When do we accept it and when do we reject it? The representation of science and medical information on social media has erupted in recent times – in large part thanks to the Covid-19 pandemic. Along the way, misinformation has come to the forefront. Why do people believe misinformation, where does it come from and what damage is it doing? These questions are not new, however in the modern world (pre- and post-Covid) they are in the public conversation more than ever. Tim believes that the spread of misinformation is one of the greatest challenges of today – sparking an ‘Infodemic’. The ideological nature of misinformation has also grown in recent times. Whilst Tim contends that it has always been there, it has become more dominant with the ever-growing popularity of social media. Social media is not going anywhere. As such, we must learn to live with it, and employ its use in such a way to be proactive and productive. Tim talks to the positives of social media, in particular its ability to decrease feelings of social isolation as well as its entertainment and information value. However, the current information environment rewards extremism, polarisation, and the spread of misinformation. So, is social media the symptom, the disease or both...? As Tim explains, it is all the above. How can healthcare professionals move towards a positive use of social media?  Tim believes engagement is constructive and he favours healthcare professionals and peak medical bodies being on social media. Finally, Tim addresses the shifting landscape when it comes to healthcare engaging on social media. Tim believes that clinicians can (and should) share valuable content online. For more like this, head to our podcast page. #CodaPodcast