Podcasts about Psychosocial

In this episode, recorded live at the 51st Academy Annual Meeting and Scientific Symposium in Atlanta, host Seth O'Brien, CP, FAAOP(D), explores the psychosocial impact of scoliosis with two leading voices in the field: Megan Glahn Castille, MS, CPO/LPO, assistant professor at Baylor College of Medicine and founder of the nonprofit Scolios-us, and David Speers, CPO/L, faculty member at Northwestern University Prosthetic Orthotic Center. They delve into strategies for easing patient anxiety, the power of empathy and encouragement, and how to foster patient empowerment. The conversation also covers current bracing options, educational practices, and helpful resources for clinicians and families navigating scoliosis care.  O&P Clinical Care Insiders is produced by Association Briefings.

Did you know that up to 70% of people with prediabetes will go on to develop type 2 diabetes—but only if nothing changes? In this episode, Dr. Jedha breaks down the latest 2025 systematic review that analyzed 59 global studies to identify the strongest predictors of progression from prediabetes to type 2 diabetes. If you've been told you have prediabetes, or you're worried about your blood sugar creeping up, this episode is essential listening. You'll learn which risk factors matter most—including some surprising ones like anxiety and fatty liver—and which ones you can take action on today.You'll come away with science-backed insights and practical next steps to reduce your risk—before type 2 diabetes takes hold.CHAPTERS1:18 Your risk of developing type 2 diabetes, if you do nothing4:36 Sociodemographic risk factors8:12 Lifestyle risk factors12:19 Psychosocial risk factors14:50 Associated health condition risk factors19:31 Top 3 risk factorsFor show notes and resources, please visit: https://Type2DiabetesTalk.comTo share your questions and suggestions, leave us a voice message or email at: https://Type2DiabetesTalk.com/messageExplore our proven programs and services, visit: https://Type2DiabetesTalk.com/programsSubscribe to our free weekly newsletter for podcast updates, valuable nutrition tips and more: https://Type2DiabetesTalk.com/subscribe

In this week's episode, we speak with Anna Pannuzzo, from WorkPlace PLUS, about creating policies to uphold everyone's psychosocial safety at work. Anna speaks about how planning ahead can help to ensure that if something challenging and unexpected does happen, there is a prepared plan. Anna speaks about policies and processes for psychosocial hazards, raising concerns in your workplace and how to balance the wellbeing of staff and being empathic to service users who are facing their own challenges. Resources: WorkPlace PLUS https://www.workplaceplus.com.au/ Safe Work Australia https://www.safeworkaustralia.gov.au/ FairWork Ombudsman https://www.fairwork.gov.au/ FairWork Commission https://www.fwc.gov.au/ Speech Pathology Australia acknowledge the Traditional Custodians of lands, seas and waters throughout Australia, and pay respect to Elders past and present. We recognise that the health and social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples are grounded in continued connection to culture, country, language and community and acknowledge that sovereignty was never ceded. Free access to transcripts for podcast episodes are available via the SPA Learning Hub, you will need to sign in or create an account. For more information, please see our Bio or for further enquiries, email speakuppodcast@speechpathologyaustralia.org.au Disclaimer: © (2025) The Speech Pathology Association of Australia Limited. All rights reserved. Important Notice, Please read: The views expressed in this presentation and reproduced in these materials are not necessarily the views of, or endorsed by, The Speech Pathology Association of Australia Limited (“the Association”). The Association makes no warranty or representation in relation to the content, currency or accuracy of any of the materials comprised in this recording. The Association expressly disclaims any and all liability (including liability for negligence) in respect of use of these materials and the information contained within them. The Association recommends you seek independent professional advice prior to making any decision involving matters outlined in this recording including in any of the materials referred to or otherwise incorporated into this recording. Except as otherwise stated, copyright and all other intellectual property rights comprised in the presentation and these materials, remain the exclusive property of the Association. Except with the Association's prior written approval you must not, in whole or part, reproduce, modify, adapt, distribute, publish or electronically communicate (including by online means) this recording or any of these materials.

SHOW NOTESWhat impact does surgery have on the body?Intentional trauma Physiological response Psychosocial impact StressWhen we think about surgery, it's essential to understand that it triggers a significant reaction in the body known as the 'stress response.' This response is a complex interplay of hormonal and metabolic changes directly linked to the degree of tissue damage during surgery. It can intensify if there are any complications after the operation. Let's break it down: The whole process starts when the hypothalamic-pituitary-adrenal axis, or HPA axis, kicks into gear. This leads to a surge in hormones like cortisol, growth hormone, glucagon and catecholamines. These hormones are important because they help the body cope with stress by boosting energy availability and adjusting other bodily functions.Ebb phase (0-48hrs)Increased catabolism of stored glycogen (glycogenolysis)Suppression of insulin secretion → transient hyperglycemiaIncreased catecholamines, cortisol, and inflammatory cytokines (IL-6, TNF-α)Flow phase (3-10 days)Hypermetabolism (increased BMR)Increased protein catabolism → muscle breakdown (to provide amino acids for tissue repair and immune function)Increased lipolysis (fat breakdown) for energySustained insulin resistance → continued hyperglycemiaEnhanced GNG Pro-inflammatory response → increased cytokines and acute-phase protein productionIn the initial stages after surgery, the body releases a wave of pro-inflammatory cytokines. These cytokines jumpstart the healing process by promoting inflammation, which is important for healing surgical wounds. However, to keep this inflammation from going overboard, the body soon follows up with anti-inflammatory cytokines.These inflammatory processes have widespread effects across the body. For example, they can influence how the hypothalamus regulates body temperature or how the liver produces certain proteins that help fight infection and aid in wound healing.But here's where it gets even more interesting: other hormones like glucagon, cortisol, and adrenaline also play a role in modulating these responses. They can affect everything from your blood sugar levels to how your cardiovascular system handles the stress.So, why is all this important? Well, by understanding and managing these responses effectively, we can significantly improve how patients recover from surgery. It's all about helping the body maintain balance during a time when it's incredibly vulnerableDisruption of Metabolic Homeostasis: Surgery often disrupts the body's normal metabolic balance, notably through insulin resistance, where cells fail to respond effectively to insulin, leading to 'diabetes of the injury.' Insulin Resistance and Hyperglycemia: Insulin resistance can cause high blood sugar levels, significantly increasing the risk of surgical complications and mortality. Post-surgery, the body may enter a catabolic state, breaking down muscle instead of fat, which impairs wound healing, weakens the immune system, and reduces muscle strength. Increased Risks for Vulnerable Groups: Elderly, diabetics, and cancer patients are particularly at risk due to their compromised metabolic and inflammatory states. These groups have less physiological reserve, leading to pronounced catabolic states and increased risk of severe post-operative complications. Impact on Recovery and Outcomes: The metabolic chaos from insulin resistance to protein loss not only delays recovery but also exacerbates risks of infection and other complications. Effective management of these changes is crucial for improving surgical outcomes and ensuring that patients thrive post-surgery.ERAS helps to mitigate these by Surgery isn't just about the physical repair or removal of tissue; it triggers a cascade of stress responses in the body that can complicate recovery. These include everything from the psychological impacts of anxiety and the physiological effects of fasting to direct tissue damage and the systemic reactions to it, such as fluid shifts and hormonal imbalances.Key Components of ERAS:Comprehensive Care: ERAS isn't just a single technique but a suite of practices designed to address every aspect of the patient's journey — before, during, and after surgery. This approach aims to minimise the stress responses by controlling pain, reducing fasting times, optimising fluid management, and promoting early mobility.Minimising Fasting: One traditional practice that ERAS revises significantly is the preoperative fasting rule. Old guidelines that required fasting from midnight before surgery are now replaced with more lenient, evidence-based practices that allow intake of clear fluids up to two hours and solids up to six hours before surgery. This change helps maintain normal blood glucose levels, reduces stress, and decreases the body's shift into a catabolic (muscle-degrading) state.Nutritional Optimisation: ERAS protocols emphasise the importance of not entering surgery in a depleted state. By allowing a carbohydrate-rich drink shortly before surgery, patients are better hydrated and less anxious, which in turn reduces insulin resistance and preserves muscle mass — critical factors in speeding up recovery post-surgery. Post-operatively, oral nutrition may be delayed by the medical team until bowel function returns, typically taking close to a week. This delay is stated to reduce postoperative complications such as abdominal distension and nausea/vomiting.For the first several days post surgery fluids of limited nutritional value such as water are provided to patient until tolerance is established leading to insufficient nutrition intake during this time increasing the risk of malnutrition. The ERAS protocol promotes early oral intake within 24 hours post surgery departing from traditional fasting practices. Research suggests that between 40-50% of surgical patients have some degree of malnutrition. Pre-operative malnutrition is an independent predictor of poor post-operative outcomes. Therefore addressing malnutrition is a key component of the ERAS protocol.Immune-Enhancing Diets: Post-surgery nutrition is just as crucial. ERAS encourages diets rich in nutrients that bolster the immune system and enhance wound healing. This includes omega-3 fatty acids, which help modulate the inflammatory response; arginine, which supports protein synthesis and tissue growth; glutamine, which is vital for cellular health and recovery; and nucleotides, which are essential for rapid cell division and immune function .Immuno-nutrition is a specialised medical nutrition therapy that has been shown to adjust the body's inflammatory response: It incorporates specific nutrients like omega-3 fatty acids, arginine, polyunsaturated fatty acids, and nucleotides. It's typically recommended starting 5-7 days before surgery and continuing post-operatively for over 7 days or until oral intake meets at least 60% of the patient's nutritional requirements.How can we use this info to optimize surgical outcomes?Patient education Early nutrition pre and post surgery - Minimise fasting time What is ERAS? How does it differ from traditional care/practice?Introduced by Henrik Kehlet in 1997, the Enhanced Recovery After Surgery (ERAS) protocol has revolutionised surgical practices by optimising perioperative care. A key aspect of ERAS is its interdisciplinary approach, involving healthcare professionals from various specialties to minimise surgical stress and facilitate recovery. What is malnutrition?Malnutrition, is defined as an involuntary reduction in body weight, muscle mass and physical capabilities, affects up to 65% of surgical patients and can worsen during hospital stays. Enhancing nutritional status and promoting functional nutrition therapy is essential, even forpatients without evident malnutrition, particularly when prolonged perioperative oral intake challenges arise. Addressing malnutrition is essential for preventing surgical complications, prolongedhospital stays and higher healthcare costs. What are the benefits of ERAS for the patient?It has been shown that the key physiological benefits include:-enhances the body's anabolic processes-promotes wound healing, which is critical for patient recovery.-Reduces the risk of nutritional depletion-Minimises insulin resistance, a common issue post-surgery, allowing for better blood sugar control and improved metabolic function.-Reduce protein catabolism-And lowers the risk of pressure injuries, which can develop due to extended immobility after surgery.What are the benefits of ERAS from a healthcare perspective? From a healthcare perspective, ERAS has been shown to-shorter length of hospital stay for patients,-Lower risk of ICU transfer rates-reduce readmission rates-And all of these improvements lead to lower healthcare costs, not just for the hospital but for the overall healthcare system, as fewer complications and shorter stays reduce the financial strain.Step 1: Screen & StrengthenIf you've lost any weight unintentionally in the lead up to surgery, or been eating poorly because of a reduced appetite, you may be at risk of malnutrition and it's really important to address this prior to surgery. Research suggests that between 40-50% of surgical patients have some degree of malnutrition. Pre-operative malnutrition is an independent predictor of poor post-operative outcomes. Addressing malnutrition is a key component of the ERAS protocol and why it's effective in improving surgical outcomes for patients.Book an appointment with a dietitian who can guide you on appropriate dietary changes to minimise muscle loss, build you up and optimise nutritional status and stores pre-op. A well-nourished body tolerates surgery better, heals faster, has a stronger immune system to fight infection, and experiences fewer complications.Step 2: Consider Immunonutrition If you're planned for major surgery, especially certain cancer and abdominal surgeries, consider the use of an immunonutrition supplement in the 5-7 days pre op. These are the supplements loaded with arginine, n3s, glutamine and nucleotides to support the immune system and reduce inflammatory responses, potentially leading to fewer infections and better recovery.Step 3: Build Your Strength & Energy Stores prior to surgery Carb load with food in the days leading up to surgery - think that big bowl of pasta a footy player would have the night before the grand final. ERAS protocols have significantly reduced or eliminated long periods of "nil by mouth" (NBM) before surgery.Ask your surgical team exactly when you need to stop eating solid food – it might be much later than you think, often around 6 hours before surgery for a light meal. For clear fluids, it could be as little as 2 hours before!We'll make the most of every second to prevent unnecessary dehydration, hunger, anxiety, and preserve your body's energyStep 4: The Pre-Surgery Carb Load using clear fluidsMany ERAS protocols include a special carbohydrate-rich drink taken a few hours before surgery. Your hospital may provide this, but if they don't, we can organise orders for you or point you in the right direction.  It's usually a clear, sweet drink. Think of it as topping off your fuel tank right before the 'race'."These have been shown to reduce post-operative insulin resistance (which can slow healing), help maintain muscle strength, can reduce nausea, and improve overall wellbeing. It basically tells your body it's in a 'fed' state, not a 'starvation' state, heading into surgery.This is best done with tailor made medical nutrition drinks as they come prepped with the correct doses of maltodextrin-polymer carbs and a lower osmolality than other solutions, which essentially means they gentler on your gut and better for gastric emptying so they don't linger in your gut during surgery. Always follow surgical instructions, but ideally we're aiming for 100 grams of carbohydrate the night before surgery and about 50 grams of carbohydrate in clear fluids approximately 2 hours before anesthesia. This might look like 4 x 200ml drinks the night before, and 2 the morning of surgery If you can't access these drinks, apple or cranberry juice are reasonable replacements.  Drop us an email or message or give us a call if you'd like advice on where to get pre-op and immunonutrition supplement drinks. Then we move on to post op and Step 5 which is aiming to eat early.  ERAS encourages starting to eat and drink as soon as it's safe after surgery – often within hours, not days!As soon as your team says it's okay, try sipping water, then progress to other clear fluids, and then light foods as tolerated. Even small, frequent amounts help. This helps to stimulates your gut to start working again, reducing the risk of ileus – a slow, sleepy bowel, provides energy for healing, and can help you feel more normal, faster.If you haven't been told you can eat or drink, keep asking the question! You are your best advocate! Another tip that can help here is step 6:  Chew GumIf your team allows it, start chewing sugar-free gum several times a day once you're able. It sounds simple, but it can be surprisingly helpful in mimicking eating even when you're not allowed to, and can stimulate your digestive system to return to usual function sooner and reduce the risk of ileus.Step 7 is to Nourish to Heal This is where we bring in our good friend protein to optimise tissue repair and recovery Include protein rich food at each meal, and chat to us if you're finding this difficult because there are plenty of hacks if you're not feeling up to chicken breast and steak! And finally step 8 is to Listen to Your BodyWhile ERAS encourages early eating, we always want you to be tuned in to your body's cues and speaking up to your medical team and us if something doesn't feel right. There are plenty of interventions that can be used to keep you comfortable while still optimising your nutrition to get the best outcomes from surgery. Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Hübner, M., Klek, S., et al. (2021). ESPEN practical guideline: Clinical nutrition in surgery. Clinical Nutrition, 40(7), 4745-4761.Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Laviano, A., Ljungqvist, O., et al. (2017). ESPEN guideline: Clinical nutrition in surgery. Clinical Nutrition, 36(3), 623-650.Gustafsson, U. O., Scott, M. J., Schwenk, W., Demartines, N., Roulin, D., Francis, N., et al. (2019). Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations: 2018. Clinical Nutrition, 38(2), 576-586. (Note: The ERAS® Society website, erassociety.org, is the primary source for the most current and comprehensive suite of procedure-specific guidelines.)Ljungqvist, O., Scott, M., & Fearon, K. C. (2017). Enhanced Recovery After Surgery: A review. JAMA Surgery, 152(3), 292-298.Thiele, R. H., Raghunathan, K., Brudney, C. S., Campos, S., Candiotti, K., Chaves, S., et al. (2016). American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management in adults. Perioperative Medicine, 5, 26. (Note: This is an example of ASER/POQI consensus; look for other relevant POQI statements on specific surgical procedures and their nutritional components.)Soon, K., Levy, G. M., Cusack, L. A., Varma, S., & Nicholson, G. A. (2020). The effect of preoperative carbohydrate loading on patient outcomes in elective surgery: A systematic review and meta-analysis. Systematic Reviews, 9(1), 254.Lewis, S. J., Egger, M., Sylvester, P. A., & Thomas, S. (2001). Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ, 323(7316), 773-776.Osland, E. J., Hossain, M. A., Khan, S., & Memon, M. A. (2014). Effect of timing of oral feeding on patient outcomes after elective colorectal surgery: A systematic review and meta-analysis. Journal of Gastrointestinal Surgery, 18(5), 1039-1051.Braga, M., Gianotti, L., Nespoli, L., Radaelli, G., & Di Carlo, V. (2002). Nutritional approach in malnourished surgical patients: a prospective randomized study. Archives of Surgery, 137(2), 174-180.Marimuthu, K., Varadhan, K. K., Ljungqvist, O., & Lobo, D. N. (2012). A meta-analysis of the effect of combinations of enhanced recovery after surgery (ERAS) interventions on postoperative outcomes. Annals of Surgery, 255(4), 640-649.

On episode 252 of EHS On Tap, Dr. I. David Daniels, Founder and CEO of ID2 Solutions, LLC, talks about his new book Psychosocial Hazards are Real.

In the first episode of the podcast, hosted by Steve Bell and Nerida Jessup, we focus on a contemporary issue for Australian workplaces - psychosocial health and safety. Traditionally centred on physical risks, there has been a significant shift over the past five years towards managing non-physical risks such as bullying and sexual harassment. This now includes considerations on how work is performed, allocated, and designed to help employees thrive. This episode highlights the increased regulation and enforcement in this area more recently, emphasising the need for developing risk registers to identify psychosocial risks and implementing consistent controls. It also notes the growing expectation for HR and people and culture teams to adopt the language of work health and safety and risk management, offering practical tips on how to effectively manage these changes.

How do you lead as a woman of colour in surgery? Join us as Hannah Maple sits down with Evelyn Mensah and Sala Abdalla to discuss the experiences of women of colour in surgery from personal stories, the impact of racism, and theirjourneys towards leadership. We delve into the importance of leadership, offering advice for aspiring women surgeons, and emphasise the power of visibility and support. Don't miss this compelling conversation that challenges and inspires!Guest: Evelyn MensahEvelyn (Evie) Mensah, Consultant Ophthalmologist and WRES Expert at London North West University Healthcare NHS Trust is part of the London and Medical WRES Strategy Groups. Evie leads ophthalmology and anti-racism initiatives globally, aiming for equitable healthcare. She championsinstitutional courage. In October 2024, Evie was appointed as the President for the Ophthalmology section of the Royal Society of Medicine. During her two year tenure she hopes to foster closer relationships between ophthalmologists andthe wider multi-disciplinary team.Guest: Sala AbdallaDr Sala Abdalla is a Consultant General, Emergency and Upper Gastrointestinal (GI) Surgeon at the London North West University Healthcare Trust. Dr Abdalla is the author of numerous publications in the field of surgery and surgical education including two textbooks; 'A History of Surgery' which she co-authored with Harold Ellis CBE FRCS, showcasing her dedication to exploring the rich history of surgical practices across the globe, and 'Cracking the general surgical interviews for ST3', which serves as a valuable preparatory resource for aspiring surgeons. DrAbdalla is deeply invested in advancing global access to surgical care. She is the founder and director of a surgical charity called Operation International UK which has close collaboration with the Royal College of Surgeons of England. Her charity delivers free surgical care and education tounderserved communities around the world. She has received two national awards for her charitable work and cites her charity as one of her proudest achievements. Hosted by: Hannah MapleHannah Maple is a Consultant Transplant and Dialysis Access surgeon based at Guys and St Thomas' NHS Foundation Trust and the lead for simulation research. Hannah is the past-Chair of the Ethical, Legal and Psychosocial aspects of Transplantation section (ELPAT) of the European Society of Organ Transplantation and completed the Emerging Leaders Fellowship, awarded by the Royal College of Surgeons of England, in 2023. Resources·       Watch Evelyn Mensah's inaugural address when appointed as the President for the Ophthalmology Section of the Royal Society of Medicine: OPT01 - Equitable, Diverse and Inclusive Ophthalmology through the Eyes of a Geordie Ghanaian - Zoom·       How can I be antiracist·       Cracking the General Surgical Interviews for ST3·       The Kennedy Review·       Medical Workforce Race Equality Standard in England·       GMC data supporting the Medical Workforce Race Equality Standard in England·       NHS Workforce Race Equality StandardNews & Updates from RCS England· RCS England is celebrating the 10-year anniversary of the Emerging Leaders programme. Applications open on 15 May and closes on 1 September 2025.· RCS England: Diversity, Equity & Inclusion / Interested in getting involved or supporting our work? Please contact: diversity@rcseng.ac.uk· The 2025 UK surgical workforce census is now open. It's quick, confidential and crucial. Your voice helps us push for real change where it matters most, from tackling workforce shortages to improving wellbeing and training. Take the census now: https://www.rcseng.ac.uk/standards-and-research/surgical-workforce-census/?utm_source=Digital&utm_medium=TheTheatre&utm_campaign=Census2025Produced by: Andrea PearsonWe would love to hear from you so please do reach out to us on social media, or email us at podcasts@rcseng.ac.uk

Episode 29 - Psychosocial Hazards are Real! In this episode, we explore Psychosocial Hazards are Real! by Dr. I. David Daniels—a powerful and timely examination of the often-overlooked mental, emotional, and social challenges faced in today's workplaces, especially in high-stress professions like public safety. Drawing on personal experience and professional insight, Dr. Daniels exposes the systemic risks that harm psychological well-being and offers a path forward toward healthier, more accountable, and human-centered work environments. Whether you're a leader, peer, or policy maker, this book is a must-read.

This podcast discusses themes around terrorist incidents Dr Lise Eilin Stene in conversation with Professor Richard Williams on the subject of the recent BJPsych Open paper "Proactive psychosocial follow-up of youth exposed to a terrorist attack: longitudinal study linking interviews and register-based data". View the paper here: https://doi.org/10.1192/bjo.2024.838 Authors: Lise Eilin Stene, Kristin Glad, Synne Øien Stensland, Lisa Govasli Nilsen and Grete Dyb Follow us on X @TheBJPsych #BJPOpen Podcast transcripts available: bit.ly/3CXSijb Disclaimer: BJPsych Open is not responsible for statements made by podcast contributors. Unless so stated, the content of this podcast does not necessarily reflect the views of the Editor-in-Chief or the Royal College of Psychiatrists.

Reimagining Mental Health in Medicine with Dr. Robert C. SmithIn this episode of The Girl Doc Survival Guide, Christine hosts Dr. Robert C. Smith, a University Distinguished Professor of Medicine and Psychiatry Emeritus from Michigan State University. Dr. Smith discusses his journey from a traditionally trained internal medicine doctor to an advocate for integrating mental health care into primary care. He shares his experiences and the development of important works like Smith's Patient-Centered Interviewing and Has Medicine Lost Its Mind. Dr. Smith critiques the prevalent 'mind-body split' in modern medicine, arguing for a bio-psychosocial model that addresses both physical and mental health. He also emphasizes the importance of self-awareness for doctors and provides actionable steps for the public to advocate for better mental health care. The episode ends with Dr. Smith encouraging listeners to visit his website and engage with policymakers to drive change.00:00 Introduction to Dr. Robert C. Smith00:49 Dr. Smith's Journey in Medicine03:34 The Mind-Body Split in Medicine07:59 Bio-Psycho-Social Systems Approach12:26 Challenges in Modern Medicine17:41 Personal Reflections and Self-Awareness23:38 Call to Action and Final Thoughts

Dr. Corrie Jones, one of our sports residency instructors and our Director of Clinical Excellence answers the question:  What's the biggest realization you've come to as a physical therapy after school?  Having been practicing for nearly 14 years, Dr. Jones shares her insights as to what really makes the biigest difference in patient outcomes and executing a plan of care as a sports PT!Listen to find out what she says!

The International Psycho-Oncology Society (IPOS) deemed April 9th, 2025, the first-ever World Psycho-Oncology Day (WPOD). This day was meant to spread awareness of the importance of prioritizing psychosocial care for patients with all types of cancer as well as to honor Jimmie C. Holland, MD. Prior to WPOD, CancerNetwork® spoke with Cristiane Decat Bergerot, PhD, BS, MS, a psychologist and the head of supportive care at Grupo Oncoclinicas in Brazil, and a member of IPOS, about the importance of psychosocial care and the impact it has on patients with cancer. As stated by Bergerot and listed on the official IPOS website, the primary goals of WPOD are as follows: raise awareness, honor Jimmie Holland, engage stakeholders, promote action, and support fundraising efforts.1 These goals are geared towards paying homage to the history of psycho-oncology and pushing for a more advanced future. “We aim to empower patients, caregivers, and healthcare professionals, fostering a future where psychosocial support is an integral part of oncology worldwide,” Bergerot said.  Psycho-oncology has become more prevalent as a cancer care field since Jimmie C. Holland, MD, worked to help found it in the 1970s. Holland, a “pioneer” of psycho-oncology, was the first ever Chief of Psychiatry Services—a department that was the first of its kind anywhere in the world—at Memorial Sloan Kettering Cancer Center, and a founding member of IPOS.  Bergerot stated that, in her work, she sees that patients who receive psychological support exhibit improved pain management and quality of life. Trials now focus more on end points such as quality of life and patient-reported outcomes, and guidelines have emerged to create standards of care. The National Comprehensive Cancer Network and the American Society of Clinical Oncology each offer guidelines that detail how to manage patient distress as they progress through cancer therapy.2,3 Distress screenings and earlier recommendations for palliative care have also become more standard in treatment.  As for the future, Bergerot highlighted that psychosocial care needs to be more integrated into care as a necessary, rather than optional, component. New developments around the world, however, have created a landscape where telehealth and new research demonstrate the potential to help psycho-oncology grow rapidly.  References 1.        World Psycho-Oncology Day (WPOD). IPOS. Accessed April 2, 2025. https://tinyurl.com/43c9rr2c 2.        Distress during cancer care. NCCN. 2024. Accessed April 2, 2025. https://tinyurl.com/ycxxvnmt 3.        Andersen BL, Lacchetti C, Ashing K, et al. Management of anxiety and depression in adult survivors of cancer: ASCO guideline update. J Clin Oncol. 2023;41(18):3426-3453. doi:10.1200/JCO.23.00293

This episode marks the first in a new Ashurst series on Employment and Safety law developments in Australia. After collaborating on a landmark psychosocial risk court case, Ashurst partner Scarlet Reid and State Chambers barrister Bruce Hodgkinson AM SC reflect on what employers might learn. Along the way, Scarlet and Bruce discusses the threshold for psychosocial harm and whether stress meets that test, the complexities of what constitutes “reasonable management action” and the importance of regularly updating employer policies. They also emphasise the value of training and instruction for line managers so that they can handle sensitive discussions in a way that is legally compliant, psychologically safe, and appropriate. “There’s so much learning to come in this area,” Scarlet adds. “Guidance from courts will be very important as this area of the law continues to develop.” To listen to this and subscribe to future episodes in this series search for “Ashurst Legal Outlook” on Apple Podcasts, Spotify or your favourite podcast player. And to find out more about the full range of Ashurst podcasts, visit ashurst.com/podcasts. The information provided is not intended to be a comprehensive review of all developments in the law and practice, or to cover all aspects of those referred to. Listeners should take legal advice before applying it to specific issues or transactions.See omnystudio.com/listener for privacy information.

Chapters 00:00 Introduction to Chris Johnson and Tendon Rehabilitation 03:08 Understanding Exercise Monotherapy in Tendon Rehab 05:48 The Importance of Loading in Tendon Recovery 08:56 Chris's Journey and Mentorship in Physical Therapy 12:11 Rehabilitation Insights from ACL Injuries 14:56 Exploring Patellar Tendinopathy and Its Variants 17:55 Differentiating Tendon Pain in Athletes 20:59 Pain Management and Acceptable Levels in Rehab 23:47 The Role of Isometrics in Tendon Rehabilitation 26:58 The Debate on Pain Levels in Tendon Rehab 30:03 Conclusions and Future Directions in Tendon Rehab 36:09 Navigating Knee Rehabilitation Strategies 39:58 Exploring Neuromuscular Electrical Stimulation (NMES) in Rehab 46:41 Balancing Activity and Rehabilitation in Athletes 51:07 The Importance of Warm-Up and Cool Down 55:41 Understanding Tendon Stiffness and Rehabilitation Methods 01:00:17 Psychosocial Factors in Tendinopathy Rehabilitation 01:03:41 Compression and Loading in Tendon Health 01:06:34 The Role of Mechanical Transduction in Tendon Adaptation   Takeaways Exercise monotherapy simplifies tendon rehab by focusing on key loading strategies. Loading the tissue is crucial for effective tendon rehabilitation. Education and communication are vital in managing patient expectations and outcomes. Isometrics can be beneficial but may not work for everyone. Pain management in rehab is nuanced and should be individualized. Understanding the athlete's background helps tailor rehab strategies. Patellar tendinopathy presents differently in various athletes and requires specific approaches. The importance of restoring quad function in knee injuries cannot be overstated. Reactive tendinopathy cases can often resolve quickly with proper management. The debate on acceptable pain levels in rehab continues, emphasizing the need for individualized approaches. Consider alternative exercises like reverse Nordic for knee rehab. Gradually increase load and time to fatigue the quads. Warm-up routines can significantly impact tendon health. Compression forces are unavoidable in running; manage them wisely. Psychosocial factors play a crucial role in tendinopathy recovery. NMES can be a last resort for irritable tendons. Maintaining activity is essential for athletes during rehab. Walking warm-ups can enhance performance and recovery. Tendon stiffness is critical for injury prevention. Understanding mechanical transduction is vital for effective rehab.   Website: https://chrisjohnsonpt.com Instagram: https://www.instagram.com/chrisjohnsonthept/?hl=en Notes: https://jackedathlete.com/podcast-139-tendons-with-chris-johnson/

Episode 301: Martin Franchi & Shelly Meadows, Co-Founders of Navigation Consulting & Training, joined us to talk about the importance of mental health and psychological safety at work. They will be presenting on this topic at the 2025 Ohio Safety Congress in April at the Greater Columbus Convention Center. Now available on your favorite podcast app! For more info on OSC25, visit the website at: https://www.ohiosafetycongress.com/ To learn more about Martin & Shelly, visit their website at: https://navct.ca/ For more information about the PCSC, visit their website at:  https://portagecountysafetycouncil.com/

Season 07 Episode 11: From ‘Command & Control' to ‘Customer Service' – Beyond ‘hazard salad' in psychosocial risk management.The team revel in debate about the new Queensland state and Commonwealth government literature on psychosocial risk management. Sara is relieved to see updates to regulations on psychosocial risks (Work Health and Safety [Psychosocial Risks] Amendment Regulation 2022) because of their focus on work design. Trajce explains aspects of The Commonwealth Code of Practice: Managing Psychosocial Hazards at Work (Dec 2023) which includes “intrusive surveillance” as a psychosocial hazard, requiring employer risk management and interventions. The team reference Season 01 Episode 05: Kozorov and The Need for Purpose – an episode devoted to discussions on vicarious trauma in the workplace.Much to Alan's amusement, Sara reveals her anthem song, “Little Miss Can't Be Wrong,” by the Spin Doctors, while lamenting common central office approaches to operate like ‘command and control centres.' “That might work in times of conscription,” she says, “but it fails to incorporate service design to recognise employees as internal customers to the work experience.” She references Dart Lindsey in his view of “Work as a Product,” an idea populated in his recent Harvard Business Review publication.

In this episode of The Burnout Recovery Podcast, hosted by Dr. Jo Braid, listeners are taken on an insightful journey into the world of psychosocial risk factors in healthcare workplaces and how they contribute to burnout. Dr. Braid shares research-driven insights, personal experiences from her recent locum work, and practical strategies for both individuals and organizations to address these challenges. Tune in to discover actionable ways to navigate workplace stressors and foster a healthier, more resilient work environment.Resources:https://drjobraid.comwww.linkedin.com/in/drjobraidwww.instagram.com/burnoutrecoverydr I acknowledge that I create this podcast on the traditional lands of the Wiradjuri people, who have been the custodians of this land around Orange, New South Wales, for thousands of generations. I pay my respects to Wiradjuri Elders past, present, and emerging, and recognize the continuing connection to land, waters, and culture. This acknowledgment is a small but important step in recognizing the sovereignty of First Nations peoples and the deep historical and ongoing relationship with Country. Disclaimer: The information provided on or through our Site, products and/or services is intended to be for informational purposes only. It does not constitute or replace professional advice for individual or specific situations and nor does it take into account your specific needs or circumstances. Under no circumstances should the content made available on our Site, or regarding our products and/or services be relied upon as professional legal, medical, financial, business or other advice. You agree to obtain these services if you need these. Our Site may have articles and content that is of a general nature and is intended to be for informational purposes only. Your access to and use of they Site is subject to our Privacy Policy and Terms of Use. See omnystudio.com/listener for privacy information.

Ep 216 Adam Keen – Hip Replacement Surgery - My Personal Journey "You can regain power by learning."  www.keenonyoga.com  | @adam_keen_ashtanga Adam shares his personal journey leading to a bilateral hip replacement, discussing the reasons for his decision, the role of yoga in his injury, and the importance of understanding individual anatomy in practice. He emphasizes the need for transparency in the yoga community regarding injuries and the necessity of modifying practices to suit individual needs. The conversation also touches on the psychosocial factors influencing yoga practice and the balance between strength and flexibility. LISTEN ON PODCAST Apple podcast:  https://podcasts.apple.com/us/podcast/keen-on-yoga-podcast/id1509303411 Spotify: https://open.spotify.com/show/5iM9lcw52JskHUZ2eFvVxN WATCH EPISODES ON YOUTUBE https://www.youtube.com/@keenonyoga SUPPORT KEEN ON YOGA Subscribe, like and share our videos Buy us a coffee: https://www.buymeacoffee.com/infoRf Patrons €10 per month: https://www.keenonyoga.com/patrons/FOLLOW ADAM Website: www.keenonyoga.com Instagram:  @keen_on_yoga | @adam_keen_ashtanga KEY NOTES ·      Adam discusses his upcoming bilateral hip replacement surgery. ·      He reflects on the stigma of being a yoga teacher with injuries. ·      The importance of transparency in the yoga community is highlighted. ·      Yoga can be both healing and injurious depending on the approach. ·      Genetics and pre-existing conditions play a significant role in injuries. ·      Modification of asanas is essential for individual safety. ·      The practice of yoga was originally designed for younger bodies. ·      Psychosocial factors can impact how injuries are perceived in yoga. ·      Strength training is necessary to support joint health in yoga. ·      Adam plans to continue discussions on injuries and recovery in future episodes.   

In this episode, Australian hosts Jason and Joelle chat with Dr Leanne Faulkner, entrepreneur and small business owner. We chat about Leanne's PhD research exploring the psychosocial safety of micro-business owners and sole-traders.

Conversation recorded on the 20 February 2025

Dr Anisha Patel is a GP specializing in women's health whose world was turned upside down with a diagnosis of stage three bowel cancer. She's the author of the brilliant book Everything You'd Hoped You'd Never Need To Know About Bowel Cancer. I found this such a powerful book, with lessons for all of us whether or not we have cancer. This is a very inspiring conversation about women's health and how we can all take better care if ourselves. We talk about: - Anisha's cancer journey - How she found the strength to write her book - Vulnerability and the emotional aspects of cancer - Openness about one's health with children and family - The long-term effects and life after cancer - Surviving the survival - Psychosocial impacts and support - Anisha's work with charities to set up a life after cancer clinic to provide specialized support - Histamine intolerance and menopause - Balancing hormone therapy and histamine intolerance - Empowering women with knowledge And lots more! If you enjoyed this episode, please subscribe, share it and leave us a 5* review on iTunes or wherever you're listening. Order the ebook or audiobook (narrated by Rachel) versions of Rachel's book, Magnificent Midlife: Transform Your Middle Years, Menopause And Beyond at magnificentmidlife.com/book The paperback can be purchased on Amazon or other online retailers: UK: https://www.amazon.co.uk/Magnificent-Midlife-Transform-Middle-Menopause/dp/173981150X/ US & Canada: https://www.amazon.com/Magnificent-Midlife-Transform-Middle-Menopause/dp/173981150X/ Australia: https://www.amazon.com.au/Magnificent-Midlife-Transform-Middle-Menopause/dp/173981150X/ You can listen to all the other episodes and get the show notes at magnificentmidlife.com/podcast. Recommended by the Sunday Times. Feedspot #3 in best midlife podcasts and #14 in best women over 50 podcasts worldwide. You'll find lots of strategies, support, and resources to help make your midlife magnificent at magnificentmidlife.com. Check out Rachel's online Revitalize Experience, a 6-week intensive small group mentoring experience or 1-1 Midlife Mentoring.

The Missing Piece in Your POC - Psychosocial Factors You performed an amazing evaluation, established a beautiful plan of care, and then weeks later you feel like you're spinning your tires in the mud. Why? What can you do differently?

Join @dustinjones.dpt as he discusses one of the most neglected aspects of an evaluation that can influence your effectiveness - psychosocial variables. ------ Want more helpful resources? Check out https://mmoa.online

This episode focuses on a study that looks at how confidence in managing daily challenges (self-efficacy) and having support from others (social support), affect the overall well-being of people on hemodialysis and hemodiafiltration.

Trigger warning: themes of mental and physical abuseAmaly Khalaf and Dr Steven Munns from the Australian Public Service Commission explore psychological safety in public sector workplaces – from the desk to the frontlines – on our third best-of episode of Work with Purpose 2024.Creating workplaces which are both mentally and physically safe is a mission close to Amaly Khalaf's and Dr Steven Munn's hearts. On this episode of Work with Purpose, they talk to host David Pembroke, CEO of contentgroup, about how the public sector is working towards this – from exemplary and trustful leadership to processes grounded in evidence.Amaly, principal psychologist and lead of the APS Mental Health and Suicide Prevention Unit, shines a light on the new ADDRESS program, designed to support public sector agencies and staff in building mentally healthy workplaces. Steven, assistant commissioner, Diversity & Inclusion Branch, then connects this to how psychosocial hazards play out at the frontlines – for example at Centrelink or veteran's services – and what can be done to support staff exposed to aggressive or abusive behaviour.Key tips:Depending on what your staff are exposed to, you need to consider their different emotional well-being requirements. Have protocols in place.Create a team environment where people can safely express their thoughts and concerns.The ADDRESS model is there to support organisations – make sure to tap into the resources available to you.Show notes:Compassionate Foundations | Australian Public Service CommissionADDRESS model | Australian Public Service CommissionAPS Census | Australian Public Service CommissionViolence at Work: Reducing Assault and Abuse Experienced by Frontline Staff in Public Service Roles | Dr Steven Munns Hosted on Acast. See acast.com/privacy for more information.

Connect with Sykora ‪@Nakoomaslegacy‬ 0:00 Intro 0:10 My journey 1:10 I was adopted twice 2:00 Awareness 3:50 My feet had frost bite 5:00 Her own trauma 6:20 Take the blame 7:10 Conditioned to do it 8:00 The lady at the park 9:00 What do you sleep on 10:40 Being home school 11:00 Social Inteligence 12:10 Failure to thrive 14:40 Psychosocial dwarfism 18:50 Physical and mental abuse 19:30 severance of the maternal bond 22:00 Food triggers 22:15 Preference for stale food 28:20 Coping mechanism 31:40 Mental health 39:00 That's a hater 41:00 Red pill men 42:00 Trolling 42: 30 Amount of supression 44:00 Constant confusion 45:00 My normal 46:00 Healing mechanism 48:00 Therapy 51:00 Advice to your younger self 53:00 Learning to mask

In this special WhyM'scal Mash re-mix episode with Alan, Trajce, and Sara, we dive into the unpredictable world of psychosocial exposures at work, blending excerpts from jaw-dropping, thought-provoking stories from past episodes. From the festive chaos of a Christmas party gone awry (S01 E01: Bubbles of Trouble) to a tourism industry tale featuring unexpected and unwelcome behaviour in shared accommodations (hint: it was more than a piss up, [S02 E07: 4 Men and Women 2]), this mash-up explores the complex and sometimes bizarre challenges that arise when work intersects with human behaviour.It doesn't stop there. We tackle the broader idea of “work from anywhere,” with shocking stories like a wildlife encounter on a mine site where dingoes turned a lunch break into a harrowing ordeal, and a tragic case of a surveyor stung by a bee with devastating consequences. Whether it's working from home, navigating shared spaces, or surviving the unexpected, this episode sheds light on the psychosocial risks workers face across industries and environments.Join us as we connect the dots between these extraordinary tales, offering insights, reflections, and a touch of humour as we ask: What does it really mean to design workplaces to suit such unpredictable times

    In S 5 E 15 I am delighted to welcome Fiona McCarthy to the podcast. Fiona is an occupational therapist by background specialising in workplace injury management and return to work. After her career in Occupational Therapy, Fiona became interested in primary prevention of workplace injury. She pursued post-graduate studies in Ergonomics , Safety and Health and Latrobe University. Since then, Fiona has worked in Safety and Wellbeing roles in Government, Higher Education and Health and Aged Care. she hold accreditation as a certified OHS professional and is a full member of the Human Factors Society of Australia.        In this conversation Fiona tells me more about her career trajectory leading to the work she does now consulting in job design, workflow and assisting workplaces with a proactive and primary prevention based approach to psychosocial safety. The core part of this episode focusses on psychosocial hazards and risk, what we mean by these terms and why this matters. Fiona breaks down her approach with some real world examples and very practical pearls. In particular she shares an example of excellent proactive practice in Tasmanian Bakeries, which was a finalist in this year's AIHS awards for best WHS Health and Wellbeing Program. In the final part of the conversation we discuss emerging research on the role of routine work stress as a contributor to psychosocial risk and the relevance of this to frontline responder roles in health and emergency services. Throughout this episode Fiona shares some excellent resources, linked below. Thank you Fiona for your optimistic, evidence and action-driven approach to occupational health, safety and wellbeing. Links / References/ Resources:https://www.linkedin.com/in/fiona-mccarthy-75387abb/https://www.workps.auhttps://data.safeworkaustralia.gov.au/sites/default/files/2024-02/Psychological-health-in-the-workplace_Snapshot_February2024.pdf https://www.aphirm.org.au https://learn.fwc.gov.au/local/catalogue_search/module_overview.php?id=13 https://pmc.ncbi.nlm.nih.gov/articles/PMC3974929/ https://wellbeing.hmc.ox.ac.uk/publications/employee-well-being-outcomes-from-individual-level-mental-health-interventions-cross-sectional-evidence-from-the-united-kingdom/ https://www.blackdoginstitute.org.au/wp-content/uploads/2020/10/BDI20_Workplace_Mental-Health_Toolkit.pdf?utm_medium=email&utm_campaign=Mental%20Health%20Toolkit%20Download&utm_content=Mental%20Health%20Toolkit%20Download+&utm_so The Mind Full Medic Podcast is proudly sponsored by the MBA NSW-ACT Find out more about their service or donate today at www.mbansw.org.auDisclaimer: The content in this podcast is not intended to constitute or be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health care professional. Moreover views expressed here are our own and do not necessarily reflect those of our employers or other official organisations.

Why does change feel so difficult, even when we desperately want it? Dr. Ross Ellenhorn joins the show to explore our resistance to change, and the many good reasons we might have to stay just as we are. Forrest and Dr. Ellenhorn discuss the “fear of hope,” the allure of sameness, and what actually helps people develop the confidence to make meaningful changes in their lives. Topics include challenging conventional self-help wisdom, existential dread, dealing with disappointment, major issues in social work, psychedelics, and self-compassion. About our Guest: Ross Ellenhorn is a psychotherapist and sociologist, the owner and CEO of Ellenhorn, a community-integration program offering services for individuals experiencing addictive behaviors or extreme and complex states of mind and mood, and the author of three books including How We Change (and Ten Reasons Why We Don't). You can watch this episode on YouTube. Key Topics: 0:00: Introduction 1:00: How Dr. Ross's background in social work influences his outlook on change 6:20: What makes people want to stay the same 18:00: Self-efficacy, faith, and making hope big 24:55: Seeing your problems as solutions 30:00: Grappling with existential anxiety 34:20: The shock of recognition, and connecting with motivations through dialog 40:25: Managing disappointment 43:20: Psychosocial rehab, and the changing definition of mental health 52:55: Psychedelics and direct action 1:04:30: Recap I am now writing on Substack, check out my work there.  Support the Podcast: We're now on Patreon! If you'd like to support the podcast, follow this link. Sponsors Use promo code hanson at the link below to get an exclusive 60% off an annual plan at incogni.com/hanson. Sign up for a one-dollar-per-month trial period at shopify.com/beingwell.  Trust your gut with Seed's DS-01 Daily Synbiotic. Go to Seed.com/BEINGWELL and use code 25BEINGWELL to get 25% off your first month.  Transform your health with the ZOE Science & Nutrition podcast. Find it wherever you listen to podcasts. OneSkin focuses on delivering more than superficial results for your skin. Get started today with 15% off using code BEINGWELL at oneskin.co.  Join over a million people using BetterHelp, the world's largest online counseling platform. Visit betterhelp.com/beingwell for 10% off your first month! Connect with the show: Subscribe on iTunes Follow Forrest on YouTube Follow us on Instagram Follow Forrest on Instagram Follow Rick on Facebook Follow Forrest on Facebook Visit Forrest's website Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode, Dr Chris Davis discusses the multifaceted concept of workplace wellbeing, emphasising its importance in creating a supportive work environment. He explores the definition of wellbeing, the significance of psychosocial risks, insights from the OECD forum, challenges in measuring wellbeing, and the ethical considerations surrounding surveillance. The conversation also touches on the impact of hybrid working, future trends in workplace wellbeing, and the necessity for organisations to prioritise employee wellbeing to attract and retain talent.TakeawaysWellbeing encompasses all aspects of life, not just work.Safety and health are core components of wellbeing.Psychosocial risks are crucial to address in the workplace.The OECD forum highlighted major trends affecting wellbeing.Measuring wellbeing is challenging but essential for progress.Surveillance can be beneficial but raises ethical concerns.Hybrid working has changed perceptions of wellbeing.Younger workers demand more from their employers regarding wellbeing.Wellbeing should be viewed as a fundamental right.Organisational culture plays a key role in employee wellbeing.

Disclosures: Nicolette Burzawa, RD, LDN, CNSC is employed by Option Care Health.  She is not speaking on behalf of Option Care Health, and any opinions she expresses are her own and not necessarily those of her employer, Option Care Health.  In this episode, we explore the psychosocial impact of parenteral nutrition. Listen in as our guest and host share personal experiences related to this topic. Nicolette is a Chicago-based home nutrition support dietitian where she collaborates with a multidisciplinary team to provide care and management to home TPN patients. She is dedicated to sharing her knowledge and expertise through national speaking and research and recently published an article on the Psychosocial Impact of Home Parenteral Nutrition in the April 2024 issue of DNS DPG Support Line. This episode was recorded on 10/26/24 and is hosted by Christina M. Rollins, MBA, MS, RDN, LDN, FAND, CNSC.

How do you care for patients with penile cancer? As urologists, we're trained to think about diagnosis and treatment, but how can we help manage the psychological impacts of penile cancer? In this episode of BackTable Urology, host Dr. Ben Ayres, a urologic oncologist specializing in penile cancer, discusses the unique psychological challenges faced by penile cancer patients with bladder cancer survivor Dr. Rick Bangs and nurse Rob Cornes. --- This podcast is supported by: Photocure https://www.photocure.com/ --- SYNPOSIS This episode emphasizes the importance of awareness and peer support in reducing isolation and stigma associated with penile cancer. The conversation also explores the role of multidisciplinary care and the benefits of holistic approaches to patient decision-making. --- TIMESTAMPS 00:00 - Introduction 04:05 - Isolation in Penile Cancer 06:38 - The Role of Advocacy and Peer Support 15:29 - Shared Decision Making in Penile Cancer Care 23:22 - Value of Multidisciplinary Care --- RESOURCES Photocure https://www.photocure.com/ Global Society of Rare GU Tumors (GSRGT) https://www.gsrgt.com

Dr. Nikos Ntoumanis is Professor and Director in the Danish Centre for Motivation and Behaviour Science in the Department of Sports Science and Clinical Biomechanics at the University of Southern Denmark. In this episode, Nikos discusses important research he has been conducting on factors that are relevant for doping intentions and doping behaviors, including environmental factors like the style of coaching an athlete receives, as well as athletes' personal motivations and moral attitudes. He also discusses a recent a PCC-funded meta-analysis that provides an updated look at the evidence on personal and psychosocial predictors of doping use in physical activity settings.

Visit NurseStudy.net for more FREENursing Diagnosis, Care Plans, Study Guides.Download my Audiobook Version for FREE If you love listening to audiobooks on-the-go, you can download the audiobook version of our NCLEX Prep book for FREE (Regularly $19.95) just by signing up for a FREE 30-day audible trial! Get this book for FREE when you sign up for a 30-day free-trial with Audible Audible US: https://bit.ly/42j6grx Audible UK: https://bit.ly/3Sp7SLN Audible FR : https://bit.ly/3UnJeOb Audible Canada : https://bit.ly/4bxh7T1 ___________________________________________See all of our FREE Nursing Exams onlineGet a FREE Copy of Pass The NCLEXVisit NurseStudy.Net we have over 800 Nursing care plans available.Nursing ResourcesRecommended NCLEX Nursing School Review ProgramNCLEX Review ProgramRecommended BooksLab Values for Nurses Over 160 Test QuestionsFundamentals of Nursing Review 110 Test QuestionsFluids and Electrolytes 100 Test QuestionsNursing Diagnosis HandbookNursing Care Plans HandbookMedical Surgical NursingComprehensive NCLEX Review*Social*Web: https://nursestudy.net/Shop: https://amzn.to/36jrZCNInstagramFacebookPinterestTikTokThe description contains affiliate links and I may be compensated a small amount if you make a purchase after clicking on my links.DisclaimerThis lesson is not intended to provide medical advice. The articles on this website are intended for entertainment or educational value only. While we strive to offer 100% accuracy, we cannot guarantee the validity or accuracy of any content. Medical procedures are rapidly changing, and laws vary greatly from location.  #NCLEX #Nursing #NursingStudent

2024 has been a tricky year for many organisations and businesses – whether it be through having to make significant changes or being affected by the current economic environment. Now is a good time to stop and take stock of how the year has impacted on your people. One great way to do this is through a psychosocial risk assessment. What's a psychosocial risk assessment? It looks at all the psychological and social hazards in a workplace that can potentially cause mental or physical harm to your people. Some easy examples are: Bullying Micromanagement High workloads Less obvious examples include Job insecurity Lack of clear role description Physical work environment e.g., spending all your working day in the cab of a crane Psychosocial hazards are a leading cause of mental health problems at work (e.g., stress, depression, anxiety) and also physical health problems (e.g., musculoskeletal problems, high blood pressure, heart problems). Now is a good opportunity to look at what hazards are at your place to set your people and organisation up to perform at their best in 2025. First steps you should take: Make sure management is involved and supportive – you'll hit a ceiling in how far this can go if they're not on board. If they need any convincing, there have been a number of cases in court recently where organisations have been fined anywhere between $50k and $1.8million for not looking after the mental health of their staff Talk to staff to find out what things are really like at the coal face. Leaders can sometimes make the mistake of thinking they know all the ins and outs of an organisation and while they will know some of it, nothing beats talking to people who are actually doing the job Look at data you already have, e.g. are there areas with high levels of sick leave or with high annual leave balances – why might this be the case? Lastly, you might need to call in the external experts, which is where organisations like ours can help out. LISTEN ABOVE See omnystudio.com/listener for privacy information.

Abby and Patrick welcome writer Daniel Lavery to talk about his superb new book Women's Hotel. Lavery's novel conjures a now-vanished institution (low cost, long term residential communities for working women) in a since-disappeared landscape (midcentury New York City) and populates it with a cast of memorable characters whose entanglements, solidarities, and mixed fortunes dramatize the very contingencies of family, community, and human life itself. Abby and Patrick talk with Daniel about how he came to conceive of the project, his influences and inspiration, his method for producing such rich characterizations, the question of style, and more. It's also a chance for the three to explore the psychoanalytically rich themes and topics the book takes up, from the desire for recognition to anxieties over conflicting social mores to substance abuse to family estrangement to religious preference and much, much more. Women's Hotel is available here: https://bookshop.org/p/books/women-s-hotel-daniel-m-lavery/21024970Have you noticed that Freud is back? Got questions about psychoanalysis? Or maybe you've traversed the fantasy and lived to tell the tale? Leave us a voicemail! (646) 450-0847  A podcast about psychoanalysis, politics, pop culture, and the ways we suffer now. New episodes on Saturdays. Follow us on social media:  Linktree: https://linktr.ee/OrdinaryUnhappiness Twitter: @UnhappinessPod Instagram: @OrdinaryUnhappiness Patreon: patreon.com/OrdinaryUnhappiness Theme song: Formal Chicken - Gnossienne No. 1 https://open.spotify.com/album/2MIIYnbyLqriV3vrpUTxxO Provided by Fruits Music

In this 249th in a series of live discussions with Bret Weinstein and Heather Heying (both PhDs in Biology), we talk about the state of the world through an evolutionary lens.In this week's episode, we discuss the upcoming election, and how important it is to vote. The Democratic Party has created a two-tiered system in the Courts and in federal agencies; they have inverted basic values, including equal protection under the law, the role of families, informed consent, individual sovereignty, and our Constitution; and they have replaced truth-seeking with activism. From wars to the economy to the southern border, there is ample evidence of what the two teams actually stand for. Also: the first case report of trans-myocarditis. Then: “The Science” is still not science: federally funded research on the effects of puberty blockers on children isn't published, because the researchers don't like the results they got.*****Our sponsors:VanMan: Tallow and honey balm, deodorant, and many other amazing animal based personal care products.Go to http://www.vanmanscompany.com/darkhorse and use code darkhorse10 for 10% off your first order.ARMRA: Colostrum is our first food, and can help restore your health and resilience as an adult. Go to http://www.tryarmra.com/DARKHORSE to get 15% off your first order.Fresh Pressed Olive Oil Club: Scrumptious & freshly harvested. Go to http://www.GetFreshDarkHorse.com to get a bottle of the best olive oil you've ever had for $1 shipping.*****Join us on Locals! Get access to our Discord server, exclusive live streams, live chats for all streams, and early access to many podcasts: https://darkhorse.locals.com/Heather's newsletter, Natural Selections (subscribe to get free weekly essays in your inbox): https://naturalselections.substack.comOur book, A Hunter-Gatherer's Guide to the 21st Century, is available everywhere books are sold, including from Amazon: https://a.co/d/dunx3atCheck out our store! Epic tabby, digital book burning, saddle up the dire wolves, and more: https://darkhorsestore.org*****Mentioned in this episode:Seymour Hersh on Biden, Harris, and the 25th Amendment: https://seymourhersh.substack.com/p/leaving-las-vegasBad Storms, Bad Science: https://naturalselections.substack.com/p/bad-storms-bad-scienceNew York Times on unpublished research on puberty blockers: https://www.nytimes.com/2024/10/23/science/puberty-blockers-olson-kennedy.htmlChen et al 2021. Psychosocial characteristics of transgender youth seeking gender-affirming medical treatment: Baseline findings from the Trans Youth Care Study. Journal of Adolescent Health 68(6): 1104-1111. https://pmc.ncbi.nlm.nih.gov/articles/PMC7897328/pdf/nihms-1616464.pdfSupport the show

Welcome to the Aphasia Access, Aphasia Conversations Podcast. I'm Ellen Bernstein Ellis, Director Emeritus of the Aphasia Treatment Program at Cal State East Bay in the Department of Speech, Language and Hearing Sciences, and a member of the Aphasia Access Podcast Working Group.  Aphasia Access strives to provide members with information, inspiration and ideas that support their aphasia care through a variety of educational materials and resources. Brief topic intro I'm today's host for an episode that will feature Dr Felicity Bright. We'll discuss her research looking at factors impacting wellbeing,  engagement and hope. Guest bio   Felicity Bright is a registered speech language therapist and associate professor in rehabilitation at Auckland University of Technology in Aotearoa, New Zealand. Her research examines cultures of care, and in particular, how the cultures and practices in rehabilitation respond to the needs and priorities of patients and those who support them. She has a particular interest in stroke and in the needs and experiences of those with communication impairment through her work, Felicity seeks to support practitioners services and rehabilitation organizations and to provide better person centered care. Listener Take-aways In today's episode you will: Explore how qualitative research promotes the nuanced study of meaningful clinical practice Consider cultural differences in well-being and what this might mean for how we work with people with aphasia and their support networks Reflect on the importance of having discussions with patients about hope and well-being Discuss how culture and organizations impact healthcare practice for individuals with aphasia Show notes edited for conciseness Ellen Bernstein-Ellis Felicity, welcome to our show. Thank you for agreeing to be our guest today. Felicity Bright  Thank you for having me. It's great to be here. Ellen Bernstein-Ellis  Welcome Felicity. We're going to start today with  an icebreaker question. The one you selected for today is, “Do you have  a favorite book or movie about aphasia? Felicity Bright  It was hard to choose one. Actually, I was just looking at my bookshelf and I went back to myself as a fairly new speech and language therapist quite a few years ago now. One that was really transformative for my practice was Talking about Aphasia by Suzie Parr and Sally Bing.  It's a classic, but it was a beautifully written book that really opened my eyes to the experiences of people with aphasia beyond all the technical work that we'd learned in university and so on, but it brought to life the humanity of the people who have aphasia, and really helped me rethink why I do what I do, and what the real impacts of aphasia can be for people. Ellen Bernstein-Ellis  Yes, that's a beautiful book that brings that all to the forefront. And I want you to say the title and author again, in case I spoke over you a moment ago, Felicity Bright The book is Talking about Aphasia and the authors are Susie Parr, Sally Bing and Sue Gilpin with Chris Ireland, Ellen Bernstein-Ellis We'll put that (i.e. citation)  into the reference list on our speaker notes. So thank you. And as we start today's interview, I was wondering if you'd like to share your path from clinician to researcher, because we've had several guests who have started in clinical work and then came to their doctoral work and research a little bit later. So,  I'd love it if you could share that with our listeners. Felicity Bright Sure. So I worked as a speech and language therapist in New Zealand. We are speech language therapists. I worked in a range of neurological settings, from acute stroke neurosurgery, did a little bit of ICU, did some rehab in inpatient services and in community, and really enjoyed that work, but I'd always had a long standing interest in research. I was a bit of a geek, you know, When I was in training, that was, that was me,  I was the geek. And so I'd always kind of expected at some point I would go down the research track. It was prompted after I had my first baby, and my work required me to either go back full time or to not work. And so at that point, I chose to not go back to work full time, and a research job came up at Auckland University of Technology, and I'd followed their work for a while. We don't do speech therapy here, it was rehabilitation research, and I was offered an opportunity to be a research officer doing interventions as part of a randomized control trial with people with traumatic brain injury. And so that kind of gave me the space to bring together some clinical work, but also some research work. It gave me the opportunity to do my Masters alongside this with my fees paid. So that was fantastic. And it really solidified for me that I was quite happy and enjoyed being in that kind of clinical research space. And so I've been in the university now for 15, nearly 16 years Ellen Bernstein-Ellis  Wow, that's a great story. So now you have a 15 year old, right? Felicity Bright I have a 16 year old who is now taller than I am. Ellen Bernstein-Ellis Well, thank you for sharing that.  I'm just really looking forward to a discussion around some, what I consider critical but hard to define and challenging to research topics. like engagement, wellbeing and hope.  I want to start by asking, how did you end up researching a topic like engagement or hope? You did say during our planning meeting that you research things that you're bad at, which made me laugh. So that sounds like some courageous and reflective exploration. So maybe talk a little more about that. Felicity Bright Yeah, I am a bit of a selfish researcher. I research the things that I find tricky and a little bit hard, because for me, I want to learn how can I do better at this? How can I help my students learn how to be better in these areas? How can I help clinicians not make the mistakes that  I've made. I guess trying to be a better clinician has been at the heart of a lot of the work that I do. And you know, when I was working full time in clinical practice, I had patients who would stick with me where I just felt I let them down. They had such a short window of rehabilitation access. They were living with stroke for the rest of their lives. They maybe had eight or 12 weeks of speech therapy. There were just times when I really felt I missed the mark for them, when they didn't get the best rehab they could have had. And it was when I was working in the university in this randomized control trial of goal setting interventions after traumatic brain injury that it started to help me reflect on some of the why I was maybe having some of the challenges I was having. So in this trial, which was quite prescribed because it's a randomized control trial, I was noticing that patients seem to be engaging with these interventions a lot more than the people who I worked with in clinical practice, and that kind of surprised me a little bit. I also noticed that-- we were using Mark Ylvisaker's approach to goal setting around what  is meaningful identity based goal setting--and people were identifying hopes and goals and dreams that would have left me panicking as a speech and language therapist. What do I do about this? But it made me realize, actually, I didn't need to panic about that, and there were ways to engage with people about their hopes and dreams that honored those hopes and dreams, that kept them alive. But also, I could see ways that  I could work with this. I could bring my speech therapy hat and help people. And so it highlighted to me that maybe the things that I had perceived to be difficult or issues, didn't need to be and there were ways to think about these things differently and ways to work differently to better support people. So working on this trial, and I did some quite structured reflection around that with some of my colleagues, writing in auto ethnography around this, gave me the opportunity to reflect on these areas, but also highlighted that there was the real opportunity to do more nuanced and more detailed research that would bring to life different ways that we could support people to hold hope, to engage in rehabilitation that is meaningful and that might be able to produce some quite tangible suggestions to support clinicians and to support the people with stroke who we work with. Ellen Bernstein-Ellis  I just want to say that these intangible, some what we call intangible topics that you've tackled, you always seem to end with tangible suggestions, and that's what I have found so inspiring. And we're going to circle back to hope in a few more questions. But, I just want to say, not only has my clinical thinking been informed and inspired by your research topics, but I've also just learned so much from the variety of qualitative methodologies that you've used in your work. I was wondering if you could share how you developed your expertise in qualitative research, maybe even offer some tips to people wanting to develop their own skill set. And okay, maybe I'm being a little selfish interviewer. You just said selfish researcher, but I found this challenging, and I've been trying to dip my toe, or I've fallen in head first,  trying to develop my skill set around qualitative research. What's your advice?  Felicity Bright  I was really fortunate. I came into research, into a team that had qualitative expertise and that used a variety, but not a wide variety, of different qualitative approaches. And it was a team, and still is a team, that has really high standards for methodological rigor. So to us, it's really important to do research that is robust and rigorous and that anchors back to the underpinning theory and philosophy that underlies each of the approaches that we use. But I was also really lucky in my research that I had supervisors and bosses who really supported innovation, who didn't tell me, no, this is how we do things, who didn't expect me to come into a study and do it just as they had told me to do. But they created the space for me to explore when I was working as a clinical researcher, but also as a master's and as a PhD student. Really had no issues when I said I'm going to go to the library, and I would just sit in the library and read qualitative textbooks and come back with a completely hair brained idea, but that actually turned into something that was really interesting and meaningful. So the Voice Centered Relational Approach that I've used a number of times came from sitting in the library one afternoon and just reading Feminist Research Methodology books. And I think one of my tips would be read outside speech and language therapy. There's amazing work that is happening, not just in the health disciplines or education spaces, but I love reading health sociology journals. I get notifications of a number of different journal types that alert me to different work. One of my recent projects I used Applied Tensions Analysis, which I'd never heard of, but I had a notification come across for a paper about domestic violence settings and kind of how services work. That's not in my area of research or clinical expertise, but there was something within that abstract that made me go, oh, there's an idea there that is similar to the ideas that I'm trying to get at in my stroke research. And so reading widely, I use Twitter a lot as a way of, kind of coming up to date with different research. I use trial and error. I've tried things and got them terribly wrong. I tried Grounded Theory  for about a year for my Masters, and it was atrocious. But also I found that doing research with people with aphasia pushes you to be innovative. A lot of the methodologies as they are published don't necessarily quite fit with the types of interviews or the types of data that we have, and so for me, that's provided an opportunity to test and do things differently. Ellen Bernstein-Ellis I mean, that's an inspiring response and encouraging support. So thank you. During our planning discussion, you also referred me to the Life Thread model and the 2008 article by Ellis Hill, Payne and Ward. What a wonderful article. So thank you for that. I was particularly taken with its implications for clinical practice and how it might guide us in asking questions in a better way to help us understand the social realities of our clients, to prioritize that. To understand how important the social reality is for our clients. Could you please share with our listeners some of the core concepts of the Life Thread model and how it's informed your work? Because I do see the connection there. Felicity Bright  Yeah, I came across this, Carolyn Alice Hill, who developed it, I think, as part of her PhD, was a collaborator of one of my PhD supervisors, and so Cath put me onto it. But the Life Threads model is about identity. And Carolyn's work was in stroke, and she was kind of talking to how identity changes and develops over time. And the Life Threads model talks to how our lives and our identities are made up of many threads, and those threads, they can change over time. But when there's a traumatic event like a stroke, it can cause some threads to break or be frayed, and that can be really challenging. We know there's a lot of work around aphasia and identity construction and identity loss, that's come around. But also what we know is that stroke can also prompt people to think about what are the threads that they want to continue post stroke.  Maybe there are some threads, I found in my hope research, where people are saying,”I don't want to be that person anymore. That's not something that I value”, and for them, sometimes the stroke could be an opportunity to rethink what are the threads that I now want to bring into my life as I weave this new identity of somebody post stroke, but still continues threads that have come through from before the stroke. We know from the hope research that I was doing that it was often really hard for people to see these threads.  It kind of felt like there was a pre-stroke life and a post-stroke life, and that there was quite a disruption. Those threads were cut. And so for me, it prompted questions about how do our conversations as clinicians help people identify the threads that are important for them to thread through their life. What are the new threads that they want to pick up on? You know, some of the work I've done, and we will talk about this a bit later on, around life after stroke, has highlighted how actually a lot of the conversations that happen between clinicians focus around things like tasks and activities and doing things, but there isn't necessarily a lot of conversation about identity or about what is meaningful and what do people want to carry through, and how can clinicians support that? And I would say that if we can kind of tune into the threads that matter to people or that people want to matter in their lives, it gives us a chance to tailor therapy to be much more personalized, more meaningful and more engaging, and I would suggest, probably leads to better outcomes for people. What we know from quite a bit of the research, not just my research, but other work, is that people are often doing this identity work on their own, without support. And we know that it's really hard, because our identities are social and they're relational, and they occur through connection and through communication, all of these things that are disrupted by aphasia, often. And so I think the Life Threads model really prompts us to think how can we as clinicians, support people to engage in conversations about identity, and how can we overtly, really attend to supporting identity within the work that we do. Ellen Bernstein-Ellis  Wow, that's beautiful. And yes, I think there's been, fortunately, a growing understanding of the importance of looking at the lack of support for this identity work with us with our clients, and I can really see how the Life Threads model has played an important role in your thinking and research. I recommend our readers to the article because it has some great examples of how to maybe flex the way you ask questions to help understand the narrative better. So I think it's, a marvelous article, I just want to take a moment and let our listeners know about the fabulous interview that you did with Michael Biel on the ANCDS podcast where you discussed engagement and ways you might incorporate Goal Attainment Scaling to help our clients establish meaningful goals.  I'll put the link to that, along with the citations to all of the work we're discussing today in our show notes. That also gives me a chance to say I don't have to cover everything today, because he did a really good job on those topics. But at the end of that podcast with Michael, you highlighted what was coming next, and that was your work on wellbeing. You've been exploring, and this is a quote by you, “what does it look like to explicitly attend to holistic, long term wellbeing?” Can you discuss some of the takeaways from your 2024 article, Psychosocial Well being After Stroke in Aotearoa, New Zealand, a Qualitative Meta-synthesis with your co authors, Ibell-Roberts and Wilson. Maybe we can just start by talking about the term psychosocial wellbeing. That's an important one to understand, but it can vary depending on one's cultural context.  Just to start with that, so yeah, good luck with all of that! Felicity Bright  It's a massive question, and it's funny, I started with the term psychosocial wellbeing, and I really intentionally used the language of psychosocial to kind of move away from thinking about just psychological wellbeing, which tended to be framed more from a mood perspective. And so I really wanted to be attending to some of the emotional, and the social, and the relational elements of wellbeing. But actually, I've now dropped the psychosocial because what we found is, when we talk to our people with stroke in the community, as part of our research, that term is completely meaningless to them, but the term wellbeing is something that resonates. Wellbeing is a really, firstly, a really nebulous term, but it's also really multifaceted. And I guess the place we've come to is, we view wellbeing as kind of quite unique to an individual, but it's deeply relational, and it's influenced through connection with people, with their cultures and with their communities, and all of those areas need attention. Now, in this piece of work that you referred to, Qualitative Metasynthesis, we were looking across the literature in Aotearoa, New Zealand, when we look at all the work that's been done, looking at life after stroke, and living life after stroke, what do people say about wellbeing and that highlighted that there were a number of features. Now, one thing I want to flag is that within New Zealand, we have an indigenous population, the  Māori population of New Zealand, who have been here for centuries before Pakeha came and colonized New Zealand. And one of the things that's been really important in our work is to really make sure that we are upholding the voices of Māori, who are often either not included in research, or are involved in research that is not particularly culturally safe, or where their perspectives are kind of subsumed within the wider perspectives of the dominant Pakeha, or European culture. And so one of the things we've been really lucky to do with this is to have my colleague BJ Wilson, who was leading the Māori stream, so she engaged with our  Māori data and literature uniquely. So we upheld that in its own right. That's context, because I'm going to talk to two different ways of thinking about wellbeing, one that was general from all of the literature and one that was specific to Māori . So when we look across all of the New Zealand literature, including the  Māori literature, we kind of saw there were probably four key areas that seemed to matter for wellbeing. Having strong connections with family, with old, pre stroke friends, but also with new friends, people who had also been through stroke and had some similar experiences. The sense of self that was connected, where people had a sense of being connected to who they were before the stroke, who they are now, and have an idea of who do I want to be in the future? And there was a sense of coherence, sense of thread that went between those identities. There was, when they experienced wellbeing,  a general sense of stability in the present. So things were okay now. It didn't mean that things were perfect. Some of the literature has suggested that people have to have positive emotions if they're going to have a sense of wellbeing. But actually, this qualitative meta synthesis, and the following qualitative work we've done has suggested, no, life is never 100% positive for any of us, but it's about having a balance of, yes, maybe there are some hard times, but also there are some good times as well.  That overall, there's an equilibrium of emotions, Ellen Bernstein-Ellis  Right the duality, like be able to hold the duality Felicity Bright  Absolutely and kind of be okay with it, recognize that each of them has a time and a place. People also, when there was a sense of wellbeing, had a vision for the future, kind of a sense of moving towards that. So, yes,  they were okay in the present, but they also had a sense that the present is not my future for the rest of my life. I can see a life that is meaningful and enjoyable, and I'm taking steps towards it. But when we looked at the literature from Māori, and this was the analysis led by my colleague, Bobby-Jo, it also came through ideas like whanaungatanga and ngā hono. So whanaungatanga talks to the notion of connections, and ngā hono talks to connections and kind of belonging as well. And that was a sense of connection to whānau. So that is to people's wider kinship networks, not just blood relations like a family would be, but to kinship networks who are meaningful to the person. Having a sense of connection and belonging in their community, but also to places of meaning. So not just people, but to places. We also notice an idea around ko ahau, so being connected to their identity as Māori, to their cultural identity, in a sense that their cultural identity was recognized and was valued and supported by those around them, including healthcare professionals. Ideas of mana and wairua. So mana talks to the inherent standing and value that an individual has. And we all know that in a healthcare context, actually, that can be diminished because you become a patient in the healthcare context. But actually, for wellbeing, having that mana recognized and valued and upheld was really critical. And when one's personhood is understood and respected, that also helped with the sense of wairua, I guess, the spiritual essence of the person. And finally, was the notion of rangatiratanga, which is about autonomy and control and the ability to make decisions for oneself.  We can see that while there were similarities between our  Māori and our non-Māori groups, there were also cultural differences. So for wellbeing, for Māori, had wider integrations with their sense of whānau, their family and kinship networks, and for their culture and wellbeing was unique for each whānau within the research. Ellen Bernstein-Ellis  I'd like to take a moment and have you elaborate a little bit more on that concept of the relationship of whānau to wellbeing, and how the whānau may be impacted by the stroke and subsequent aphasia. So often our family and support network does not receive direct attention. And here, you're elevating it quite a bit, so maybe you could speak to that a bit more. This is really top of mind for me, because I just went to a think tank meeting and hearing the stories of the care providers saying, I'm not sure I mattered in this equation of my spouse's health care rehabilitation.It just really struck me to hear that. So please, let's talk a little bit more about those values. Felicity Bright  Yeah, absolutely, for all of the people in our wellbeing research and in the previous hope research and so on that I've done, kind of people's whānau, their family and their social connections were absolutely critical to their recovery. And what came through, when we were looking at Māori experiences, was particularly also the intergenerational aspect, like sometimes within stroke services, we might think about the partner a little bit, not always particularly well. And I'll talk to that in a minute. But actually, we could also hear within our  Māori whānau, kind of the impacts for generations above and generations below, like the disruption to relationships between grandparents and grandchildren, and how the grandparent who may have aphasia, would usually have a really critical role in passing on family knowledge, or passing on Matauranga, kind of Māori cultural knowledge. But actually, because of the way the stroke affected them, they couldn't do that and take that role on, and so that impacted not just on the relationship, but also kind of on the identity and how Māori culture could be passed on through a whānau unit. But we've also heard exactly what you talk about. Our services are focused around the person with stroke rather than their whānau, but our services are also really short term. And so what  we can see from the research is that the family and the whānau become the connectors and the supporters. They are the consistent people. They hold, usually, deep knowledge of the person that often the healthcare professional doesn't hold. And we're doing some work at the moment around communication access in stroke units.  And even in the context of really significant aphasia, we're hearing about how whānau, even though they don't know about aphasia, they don't know about communication strategies.  But because they know how to read the person, they know their non verbal communication, they are actually really powerful translators, and hold the expertise that, actually, we don't hold as Speech and Language Therapists.  But we also know that the whānau are key in helping people access supports outside the healthcare system, and they do a lot of that navigation work that they are left to do because the healthcare system doesn't do it very well. And like you say, that's really challenging when the whānau's well-being is impacted themselves, you know, but that isn't seen consistently, and it isn't acknowledged. They very quickly become the carer, rather than, this is this person's wife and they've been married for 45 years. Or this is this person's husband, and they've got three young children at home. What is this going to mean for their relationship as a couple, for their relationship as parents? And so the families are talking to us about the exhaustion and the grief and the shock and the loss.  The relief that the person is alive, but again, the duality, there is relief, but there is also distress from the way that the stroke is impacting. And so we would really be calling for much more focus on everybody's wellbeing in this context, because if the wellbeing of whānau is not there, that impacts also on the wellbeing of the person. And I think we need to be shifting how we think about who is our client, whose needs do we serve, and what is our role in supporting the social and relational context around the person Ellen Bernstein-Ellis  That's beautiful. You really highlighted that role, the role of the whānau. And you also identify, Felicity, some other key contributors to wellbeing, and then how those might really impact our clinical goal setting, and I know that's always such an important aspect of how we think as clinicians. You have to document because we're in a system, which we'll talk about. Maybe you can share some other factors that you identified. Felicity Bright  Yeah, so I would be encouraging people to think about what are all the things that seem to support people's long term wellbeing? And those are things, like the relationships they hold within their family, but also within their social networks and within their work networks and so on, Thinking about the different emotions that people might be experiencing. Thinking about hope and what supports people to hold hope, and what do people hope for. Think about the connections that matter to people, the connections to people.  The cultural things that matter for people's wellbeing.  The connections to community activities and roles and so on. And think about the things that matter and are meaningful for individuals that usually fall outside our traditional SMART goals that we use in New Zealand, you know? Is it smart, specific, measurable, achievable, realistic, time bound? What is it? I would be saying our goal should be focusing on what makes a good life for this person. And I would be encouraging you, if you're a clinician, looking at the goals that you're setting for the person.  Where is the good life in those goals? Is that up front and center and documented on the page that everyone can see it? That's something I learned through my goal setting research. That was my first research job, the importance of taking people's words, putting their words on a page, and keeping the words where everybody could see it. So where are the things that support wellbeing and that constitute a good life in our goal setting? Where are they in the interventions that we're doing? And I would be really encouraging people to reflect on how they are making the links explicit between the therapeutic tasks and the things that really matter to people. Because we know from the engagement work that when people can see the link between what they're doing in therapy and what matters to them in life, it is much more likely to be engaging and is much more likely to support them to persist, even when it's difficult, because they can understand this is why I'm doing this thing. Ellen Bernstein-Ellis  Right? Oh, that's beautiful. That really leads nicely into another 2024 article that you've put out focused on wellbeing.  And that's The physical wellbeing is our top priority: Healthcare professionals' challenges in supporting psychosocial wellbeing and stroke services. That article examines what seems to be a mismatch between knowing as clinicians that wellbeing is important, right, and being able to specifically address it within our clinical context. So, we say that we want to, and we know it's important, but the ability to get there, it's quite challenging. I was wondering if you could highlight some of your findings and key recommendations. And I think one of those actually addresses the graduate curriculum. I think that is really going back to the beginning, right? So, please share some of the wonderful work from that article. Felicity Bright So the context for this work is, this is part of a bigger program of research I'm doing around wellbeing after stroke. And this isn't specific to people with aphasia, but we do have people with aphasia in the research.  This research came from this issue-- we've got decades of literature that says that wellbeing is important. We've got a body of literature that says clinicians know wellbeing is important, but we are persistently not addressing wellbeing, and we've got decades of patient experience data that says this is an unmet need. So I was really interested in understanding, why have we got this persistent mismatch between what is known what matters and what is done, and so using an approach called institutional ethnography to try and get into the cultures and the structures that contribute to this, the rationale behind that is I didn't want to be creating solutions that were going to be completely unattainable in the healthcare context. And so I wanted to understand what's going on in the structure of the healthcare system, and how might we be able to work with that or push against that, to create different ways of thinking about how we work to deal with this persistent issue. So this project, this part of the research, we were looking at, why are clinicians not seeming to address wellbeing? And so we interviewed over 30 clinicians, I think, within this research for a whole range of healthcare disciplines. What came through really consistently was everybody wanted to support wellbeing. Everybody thought it was important, but there were a number of factors that made it difficult, and we traced as to why that was so. Firstly, we can look back to when the person first comes into the service. They come into the emergency department. There's often a code stroke that's called. It's a time of really busy early biomedical focus around investigating the stroke, doing assessments. The first couple of days are about intervening to prevent another stroke or to prevent complications. And dysphagia assessment is a classic in New Zealand. Dysphagia assessment is usually prioritized over communication assessment because it is seen to have particular risks and contribute to particular complications. And so we've got this really early biomedical focus as people come through the first few days. Then the focus shifts a little bit to assessments and treating impairment in function. And when we were interviewing clinicians, they were talking about wanting to give people the best chance of recovery, and that linked to ideas around neuroplasticity and the importance of early intervention for maximizing neuroplasticity and brain remodeling. There was a real focus on addressing the practicalities like toileting and dressing and what was needed to get people home. And there was a view often that emotions could wait. We need to do the practicalities first. We can do the other stuff later. This was a time of focusing on helping people survive, get through and get home, and it was in the context of really busy wards.  You know, sitting and watching nurses work, they are flat out. They are understaffed, and they have very limited time to be doing these aspects of work. But all of this contributes in this wider healthcare system that in New Zealand, and I suspect internationally, is short staffed, underfunded. We've got more demand than we've got beds. There is a really strong focus on getting people home. Now that's not inherently bad. A lot of our people that we speak to want to be home. Home is a more healing environment for many people than being in hospital. But when the focus is on getting people home, and that is usually about, is the person physically safe to be home, what can happen is other forms of work and other impacts of stroke can be devalued or be forgotten. And what we could see is people were doing work to support wellbeing within this, but it was kind of a particular form of wellbeing work. They would acknowledge a person's emotions, if they came up through interactions.  They would be responding to the emotional cues that people gave off that they were maybe feeling a bit uncertain or a bit upset. They talked about the importance of listening to the person, but that was often couched in a ‘I can listen for so long, but then I need to get on with my session', because the assessment, the treatment, the moving people forward wasn't important, and they would look to others to help. But the problem is, I would say this, this did a really good job of dealing with the tip of the iceberg, the emotions that were on the surface. But if we think back to what I've just said about what matters for wellbeing,  relationships, connection, sense of self, hope, those things are not addressed. What we saw was that wellbeing was other to the core work of any individual discipline. That didn't work for anybody. Didn't work for our patients that we spoke to. It didn't work for our clinicians as well, because we could also see the moral injury and the burnout that comes when you can't offer the services that you know people are wanting and needing. And when we think about what do we do about that? Well, yeah, it's tricky, and I don't have any great answers, but training and education is one thing. So when we think about wellbeing as seen as other to the core business of the disciplines, we need to look at, what is it that we're teaching our students? What are we saying is core work of speech therapy or of physiotherapy or of nursing. I've got the privilege of chairing the accreditation body for speech therapy in New Zealand, and we are rewriting our accreditation framework at the moment that essentially dictates what programs need to teach. We now have a requirement that programs are teaching about psychosocial wellbeing, and that programs are assessing students on how they're addressing psychosocial wellbeing. We need to look at how pathways for care develop, and where is wellbeing within policies, processes, structures, documentation, Basically, it's nowhere. But we also need to look structurally, and we can talk a little bit more about structures and organizations and cultures, because I think what this work reflects is a wider issue around the cultures and the organization of care that can make it really challenging for clinicians to work in the ways that they do. Ellen Bernstein-Ellis  Oh my gosh, it's a beautiful, beautiful response. I think my favorite quote, and there were many in that article, but the one that said “people with stroke live with the impacts of a stroke system that is designed around biomedical short term care for a lifelong condition and deserve services that support them to thrive, not just survive.” I think it's what we need to bring back into the curriculum for our students to understand. And all of this ties into the importance of understanding how cultures and organizations, like you just said, of care, might impact the therapy we provide to our clients. Why do cultures and organizations of care matter? You're alluding to that. I think we've just started to reflect on that. Felicity Bright  Yeah, I've often felt there's a real risk with the research that I do that we could end up pointing the finger at clinicians of not doing things as well as they could or as well as they should. But actually, we need to understand why is this? Why does it make sense for clinicians to prioritize dysphagia over communication? Why does it make sense to prioritize getting people home, over spending the time on addressing their wider wellbeing? And I've been really lucky to work with Deb Hersh and Stacey Attrill, we did a piece of work that looked at this in the context of how speech therapists enacted therapeutic relationships. And we started by delving into why do people work in the way that they do? We started to see the cultural elements. So the needs, for instance,  your allegiances to colleagues, to be a good team player, to maintain your legitimacy. And particularly for speech therapists, who often have a slightly tenuous role in stroke teams. Physios and OTs are important, but speech therapists often have to kind of fight to kind of have their voices heard, and so that can lead to speechies behaving in particular ways. We can also see how cultures of safety impact on what people prioritize. So Abby Foster has done some beautiful work around the cultures of aphasia care and acute care, and highlighting that actually the priority for physical safety and managing dysphagia risk is privileged over the culture of or a need to think about what is the risk associated with communication and poor communication and people not having communication access. If we understand why people work as they do, and if we understand how the cultures and the structures work, then we can start to unpack them and think about what are the ways that we might be able to do things differently. You know, these cultural factors are very real, and none of them are inherently wrong, like it's not a bad thing that we're trying to prevent people getting aspiration pneumonia. That's really, really important, but we need to understand how these things shape practice and the unintended consequences that they might have for what is not valued and for what work isn't prioritized, and what outcomes don't actually seem to really matter in these contexts. And when we start to make these visible, then that opens up space to think about, how might we be able to do things differently, where we can maybe hold all of these things. And you know, in my work that I'm doing around wellbeing, that's the next phase of our work, is working with clinicians to think about, how might we be able to do things differently, so that it's not one or the other, it's not a dichotomy.  But how do we create space for all of these things to be viewed as important and to be prioritized? Ellen Bernstein-Ellis  You've started to dig into that already, because you have yet another 2024 article that you co-authored with Kayes, Soundy and Drown,  Limited conversations about constrained futures: exploring clinician conversations about life after stroke in inpatient settings. And that examines how clinicians talk about the future with their clients. It analyzes 300 hours of observation of clinical interactions, along with 76 interviews with people with aphasia and 37 clinicians. I just want to say that's an astounding undertaking. So, as I read it, it felt like almost an extension of your 2013 and  2020 articles looking at hope, because you connected how what we say can impact how our clients see their future possibilities. Can you share some of the themes you constructed from all of that amazing data collection? I mean, I'm sorry, I thought 15 interviews were a lot, so then I saw this, and I'm like, oh my goodness, amazing. Felicity Bright  It was a pretty massive piece of work, but it was a real privilege to be able to sit and just observe interactions. And I'm so grateful to our people with stroke, many of whom were like two or three days post stroke, and they had the stranger come along and sit there and observe them for 12 hours, but also to our clinicians, who were quite vulnerable in that process of having somebody observe and analyze what they were doing. But at the same time, I think that work is really valuable for looking at what is going on. What we could see is that the conversations that were being had tended to focus on quite a short term future, and we termed this theme constrained temporal horizons. When clinicians were talking about the future, the vast majority of those conversations were about the immediate future. For doctors and nurses--for nurses, it was often what needs to happen in this shift. For allied health and for doctors, it was what needs to happen before you discharge from our service into the next service. And for some allied health, it might be the first few days at home, but there was a view that talking about the longer term future beyond that should be done by other clinicians who might have more knowledge of what life could look like at that stage. We also found that the talk about quite a constrained future was in the context of actually very limited talk, in the first place. So when we think about communication access, for instance, we think, oh, people with aphasia aren't getting very good communication. Actually, lots of people with stroke are not getting very good communication. Again, thinking about cultural factors, but actually communication is not happening well in stroke units, or, I think within the wider healthcare system.  You know, we've got a very task focused, medically focused situation. And so the conversations that were happening were on topics that were led by healthcare professionals, on the topics that they felt mattered-- the tasks they needed to do, the body structures and impairments. The goals that were set were about what needs to happen before somebody gets home. There was little talk about emotions. There was little talk about how you're feeling about what's going on, or what it might be like for you or for your family when you go home. And so this talk about the emotions and so on and future possibilities was left to patients and to families to raise. And instead, the conversations tended to focus on what the healthcare professionals saw as essential topics for the episode of care. We certainly did see some conversations about the future. So I don't want to be disparaging, and I also want to acknowledge the very partial nature of research. I did not see every single interaction. I know that a lot of these quite personal conversations often happen in things like the shower, when the nurses or the OTS are helping the person shower.  That's one of the few private spaces on the ward. And so I want to acknowledge that my analysis is based on a limited data set, and it isn't based on all the conversations that happened, but certainly there was a trend towards limited conversations. We did see that clinicians would open some doors about the future. So they would talk about possible prognosis in the context of things like upper limb prognostic testing that is offered in some hospitals in New Zealand. We would see clinicians talk about what was meaningful to people, particularly in a context where the patient was struggling to engage, but often when the clinicians were talking about this wider future in this context, it was done to try and plant seeds about what the healthcare professional thought was realistic, and it was done to try and help the person engage in rehabilitation in the context of maybe struggling to engage at the best of times. So I think what we could see was that conversations were limited. They were limited conversations about short term, constrained futures that didn't necessarily set people up with hope for the future, with a sense of possibility, with a sense of even starting that process about what matters, to thinking about what matters to me, what do I want life to look like? Ellen Bernstein-Ellis  Wow, and that really just circles us back to that concept of hope. Your work in hope has just been so meaningful to me. I've been really honored to be the guest lecturer speaking about aphasia to our counseling course that's taught by Dr Shubha Kashinath at Cal State, East Bay. And I've included, from the beginning, your work on hope. I just feel it's critical to give our students ways to understand and think about this construct and the role they can have in offering some hope building clinical interactions. I'd like to close this interview by having you discuss some of your first work that I had the honor to read, and some of the hope affirming strategies that you suggest in your 2020 article. Because I just think that's really a gift. Felicity Bright  One of the things that really fascinated me in this work was how our people with aphasia in the research talked about how they look at their clinician and they are reading them to see, are you somebody who's going to give me hope or not? And if they didn't feel their clinician was going to support their hope or was going to help give them hope, or was going to disparage their hopes, they would shut down and they wouldn't share. And so I think, one of the things is to be reflecting on yourself.  What are the messages that you are giving about how you are a safe person to talk to, about whether you are somebody that they can engage in these risky conversations about? I think there's a couple of things as well. We need to recognize that just because somebody says they hope for something doesn't mean that they expect it to happen. We all have unrealistic hopes and expectations. You know,  psychologist colleagues talk to me about how actually having unrealistic hope is part of being psychologically adjusted, and why should that be different for people with stroke? Who are we to say that we hold the expertise. Now, that's not to say that there aren't challenges. So sometimes you might need to do a bit of a balance of, oh, is this something I need to engage in a conversation about? You know, an example is, if somebody is going to invest quite a bit of money in something that actually, there's no evidence to support and could potentially be problematic. There's a really good guideline I found from Christy Simpson, who's an ethicist, who talked about what are the positive effects that this hope has for people? What would be the impacts of taking it away, both positive, but also, what are the negative things that it would do? And so actually engaging in a bit of a risk analysis to think critically about what is holding this hope doing for somebody. Linked to that in the latest paper we did around recalibrating hope, it really highlighted to me the importance of trusting people to often recalibrate their own hopes. So I went back to my original participants from my 2013 research a couple of years later, and I looked at their experiences of hope over that time. And what we found was most of them recalibrated their hopes. They hoped for different things over that time, and they had done that as they engaged in different activities, as they tried things, as they considered their progress, as they rethought what mattered to them. And so that really highlighted, to me, the need to trust people, but it also highlighted the need to think about, how do we support a context that supports people to do that recalibration. Those who were more likely to recalibrate and hold both hope and realism together were people who had social networks, who were engaging in meaningful activities, and who had a sense of purpose and possibility. One of my participants didn't have that. They had lost their social connections. They had no activities in which they were engaging in what was meaningful, and their hope had shrunk. And so it talks to me again, those earlier conversations we've had about well being, thinking about what's meaningful, what supports wellbeing, that's exactly the same thing that supports hope. How are we supporting people's social wellbeing? How are we supporting their relational wellbeing? How are we helping them connect to what is meaningful and what is possible, not just to their impairments, and maybe what is not working so well. I think it's really important to be explicitly thinking about, what is it that helps people bring joy, have joy? What brings them peace in the present? And how can we help them have that sense that things are okay, even if they're not perfect, but also help them have that sense of looking to a future that's possible. Ellen Bernstein-Ellis  Okay, we only have a minute or two left, but I'm going to throw this last question out to you. Felicity, if you had to pick only one thing that we need to achieve urgently as a community of providers, of professionals, what would that one thing be? This is almost like your elevator pitch. You got 60 seconds here. So, so Felicity Bright  So my one thing, in a long, complex sentence, is that speech and language therapists need to reprioritize communication and supporting people to live well after stroke and aphasia, and they need to consider how we model to our colleagues and to our patients and families, and how we support cultures of care that value relationships and relational work, that value and support communication, and that value and support wellbeing.    Ellen Bernstein-Ellis  Oh my goodness, well said, Felicity. Thank you so much for the honor of having this interview today. I know it's going to be impactful to our listeners, and I want to thank our listeners as well. For references and resources mentioned in today's show,  please see our show notes. They're available on our website@www.aphasiaaccess.org and there you can also become a member of our organization, browse our growing library of materials and find out about the Aphasia Access Academy, and if you have an idea for a future podcast episode, email us at info@aphasia access.org.  For Aphasia Access Conversations,  I'm Ellen Bernstein-Ellis, and thanks again for your ongoing support of Aphasia Access. Thank you, Felicity. Felicity Bright  My pleasure. Thank you for having me.   References and Resources AUT Centre for Person Centred Research: https://cpcr.aut.ac.nz/our-research Biel, M. (Host). (2016). An interview with Felicity Bright: The patient's engagement and experience with you, the speech pathologist (No. 2) [audio podcast episode). ANCDS. SoundCloud.https://soundcloud.com/ancds/ep-2-an-interview-with-felicity-bright-the-patients-engagement-and-experience?utm_source=www.ancds.org&utm_campaign=wtshare&utm_medium=widget&utm_content=https%253A%252F%252Fsoundcloud.com%252Fancds%252Fep-2-an-interview-with-felicity-bright-the-patients-engagement-and-experience  Bright, F. A., Ibell‐Roberts, C., Featherstone, K., Signal, N., Wilson, B. J., Collier, A., & Fu, V. (2024). ‘Physical well‐being is our top priority': Healthcare professionals' challenges in supporting psychosocial well‐being in stroke services. Health Expectations, 27(2), e14016. Bright, F. A., Ibell-Roberts, C., & Wilson, B. J. (2024). Psychosocial well-being after stroke in Aotearoa New Zealand: a qualitative metasynthesis. Disability and Rehabilitation, 46(10), 2000-2013. Bright, F. A., Kayes, N. M., McCann, C. M., & McPherson, K. M. (2013). Hope in people with aphasia. Aphasiology, 27(1), 41-58. Bright, F. A., McCann, C. M., & Kayes, N. M. (2020). Recalibrating hope: A longitudinal study of the experiences of people with aphasia after stroke. Scandinavian Journal of Caring Sciences, 34(2), 428-435. Bright, F. A., Kayes, N. M., Soundy, A., & Drown, J. (2024). Limited conversations about constrained futures: exploring clinicians' conversations about life after stroke in inpatient settings. Brain Impairment, 25(1). Ellis-Hill, C., Payne, S., & Ward, C. (2008). Using stroke to explore the life thread model: an alternative approach to understanding rehabilitation following an acquired disability. Disability and rehabilitation, 30(2), 150-159. Foster, A., O'Halloran, R., Rose, M., & Worrall, L. (2016). “Communication is taking a back seat”: speech pathologists' perceptions of aphasia management in acute hospital settings. Aphasiology, 30(5), 585-608. Parr, S., Byng, S., & Gilpin, S. (1997). Talking about aphasia: Living with loss of language after stroke. McGraw-Hill Education (UK). Simpson, C. (2004). When hope makes us vulnerable: A discussion of patient-healthcare provider interactions in the context of hope. Bioethics, 18(5), 428-447

Guest: Gillian Boudreau, PhD - Join Erin and Dr. Boudreau to discuss the intricacies of the psychosocial component of pediatric feeding disorders and how a caregiver's relationship with food can impact the overall dynamics of mealtime. Dr. Boudreau and Erin dive into the neurobiology of safety to help guide our understanding of what a child and caregiver truly need. We hope this episode helps you take a step back and better understand the importance of relationships and how the intimacy of eating can play a large role in how those relationships play out at mealtime.

In this episode of the MindHealth360 Show, we explore the future of healthcare with James Maskell, a pioneering advocate for functional and integrative medicine, author of “The Evolution of Medicine” and “The Community Cure” (check titles), and founder of the largest global network of functional medicine educational and practitioner groups, the  “Functional Forum”. Mr. Maskell discusses the growing burden of chronic diseases, the limitations of conventional medicine and how functional medicine addresses the root causes of illness, as well as the importance of community based care for healing. Mr. Maskell has been at the forefront of efforts to make functional medicine more accessible and effective at scale. The conversation covers the development of community-based healthcare models, such as group medical visits, which combine the power of social connection with medical care. Mr. Maskell explains how these models can enhance patient outcomes, reduce healthcare costs, and address psychosocial factors that contribute to chronic disease. He emphasises the need for a shift toward participatory and preventive healthcare, where patients are active participants in their health journey. In this episode, you'll learn about: - The Role of Functional Medicine in Chronic Disease Management: explore how functional medicine's root cause approach can reverse chronic diseases by focusing on personalised care, and lifestyle interventions while simultaneously addressing underlying physiological imbalances. - Innovative Group Medical Visits: learn about the implementation and effectiveness of group medical visits in functional medicine. These visits not only address the medical needs of patients but also provide social support, which is crucial for improving outcomes in chronic illness and mental health. - Health Economics and Functional Medicine: understand the financial implications of adopting functional medicine in healthcare systems. Mr. Maskell discusses how functional medicine can lead to significant cost savings by reducing the need for chronic disease management through medications and frequent hospitalisations. - Psychosocial and Psychospiritual Factors in Healthcare: mr. Maskell highlights the importance of addressing psychosocial determinants of health, such as loneliness and stress, which are often overlooked in traditional medicine but are critical for effective chronic disease management. - Integration of Functional Medicine into Mainstream Healthcare: discover the challenges and opportunities in bringing functional medicine into mainstream healthcare systems, including overcoming resistance from traditional medical practices and the pharmaceutical industry. - The Impact of Community in Healthcare: mr. Maskell's work demonstrates how community-based approaches can enhance patient engagement, adherence to treatment plans, and overall well-being, particularly in managing complex, chronic conditions. - The Future of Functional Medicine: insights into how technology and data-driven approaches are being integrated into functional medicine to improve diagnostic accuracy, treatment personalisation and scalability of care models. Guest's Social Media Channels: - Website: https://www.jamesmaskell.com/ - Instagram: @mrjamesmaskell -LinkedIn: https://www.linkedin.com/in/jamesmaskell/ Publications: - Maskell, J. (2014). The Evolution of Medicine: Join the Movement to Solve Chronic Disease and Fall Back in Love with Medicine - Maskell, J. (2019). The Community Cure: Transforming Health Outcomes Together  

Episode 175: Alcohol Use Disorder Basics   Future Dr. Sangha explains the clinical presentation, diagnosis, and fundamentals of the treatment of alcohol use disorder (AUD). Dr. Arreaza offers insights about the human aspect of the treatment of AUD.    Written by Darshpreet Sangha, MS4, Ross University School of Medicine. Editing and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is Alcohol Use Disorder?AUD is characterized as the inability to stop or control alcohol use despite adverse physical, social and occupational consequences. According to DSM-5, it is a pattern of alcohol use that, over 12 months, results in at least two of the following symptoms, indicating clinically substantial impairment or distress: Alcohol is frequently used in higher quantities or for longer periods than planned.There is a persistent desire or unsuccessful attempt to reduce or manage alcohol use.Activities that are required to get alcohol, consume alcohol, or recuperate from its effects take up a lot of time.A strong need or desire to consume alcohol—a craving.A pattern of drinking alcohol that prevents one from carrying out important responsibilities at work, school, or home.Sustained alcohol consumption despite ongoing or recurring interpersonal or social issues brought on by or made worse by alcohol's effects.Alcohol usage results in the reduction or cessation of important social, professional, or leisure activities.Frequent consumption of alcohol under risky physical circumstances.Continuing to drink even when one is aware of a chronic or recurrent health or psychological issue that may have been brought on by or made worse by alcoholTolerance: requiring significantly higher alcohol intake to produce the same intended effect. Withdrawal: Characterized by the typical withdrawal symptoms or a noticing relief after taking alcohol or a closely related substance, such as benzodiazepine.How can we determine the severity of AUD? Mild: 2–3 symptomsModerate: 4–5 symptomsSevere: >/= 6 symptomsWho is at risk for AUD?Note: Ancestry offers a DNA analysis to find out about your heritage. You can also send that DNA to a third party to learn about your risks for diseases and conditions (for example, Prometheus.) Anyone can find out about their risk for alcoholism by doing a DNA test. The risk factors for AUD are: Male genderAges 18-29Native American and White ethnicitiesHaving Significant disabilityHaving other substance use disorderMood disorder (MDD, Bipolar)Personality disorder (borderline, antisocial personality)What is heavy drinking?According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA), heavy alcohol use is characterized as: Males who drink > 4 drinks daily or > 14 drinks per week Females who drink > 3 drinks on any given day or > 7 drinks per weekPathophysiology of AUD.The pathogenesis of AUD is not well understood, but factors that may play a role are genetics, environmental influences, personality traits, and cognitive functioning. Also, genetic factors may decrease the risk of AUD, i.e., the flushing reaction, seen in individuals who are homozygous for the gene that encodes for aldehyde dehydrogenase, which breaks down acetaldehyde. Who should be screened?A person with AUD may not be easy to diagnose in a simple office visit, but some clues may point you in that direction. First of all, patients with AUD may present to you during their sober state, that´s why ALL adults (including pregnant patients) must be screened for AUD in primary care )Grade B recommendation). The frequency has not been determined but as a general rule, at least in Clinica Sierra Vista, we screen once a year. The USPSTF has concluded that there is insufficient evidence to recommend screening adolescents between 12-17 years old. What are the clinical manifestations of AUD?Some symptoms may be subtle, including sleep disturbance, GERD, HTN, but some may be obvious, such as signs of advanced liver disease (ascites, jaundice, bleeding disorders, etc.)If you draw routine labs, you may find abnormal LFTs (AST:ALT ratio >2:1), macrocytic anemia (MCV >100 fL), and elevated Gamma-glutamyl transferase (GGT). All these findings are highly suggestive of AUD. Patients with AUD may present in either an intoxication or withdrawal state. Signs and symptoms of acute intoxication may include “slurred speech, nystagmus, disinhibited behavior, incoordination, unsteady gait, hypotension, tachycardia, memory impairment, stupor, or coma.” Signs and symptoms of withdrawal range from tremulousness to hallucinations, seizures, and death. They are seen between 4 and 72 hours after the last drink, peaking at 48 hours, and can last up to 5 days. Alcohol withdrawal is one of the few fatal withdrawal syndromes that we know in medicine, and the symptoms can be assessed using a CIWA assessment. Treatment of AUD.There are factors to consider before starting treatment: Evaluating the severity of AUD Establishing clear treatment goals is associated with better treatment outcomesAssessing readiness to change: It can be done by motivational interviewing and using the stages of change model, which are, Pre-contemplation, contemplation, preparation, action, maintenance, and relapse.Discussing treatment of withdrawal.Treatment may be done as outpatient or it may require hospitalization. Dr. Beare sent an email with this information: “The approach to treating patients with AUD can be broken into two parts - the first is withdrawal management and the second is the long-term maintenance part. You MUST have a good plan for withdrawal treatment as it can be fatal if it's not addressed properly.” “Patients with any history of seizures due to withdrawal or a history of delirium tremens need inpatient management. If their withdrawal symptoms are typically mild (agitation, tremors, sleeplessness, anxiety) then outpatient management may be appropriate, typically with a long-acting benzodiazepine such as Librium or Ativan.”According to Dr. Beare, “the human aspect isa key element in treating alcohol use disorder. These patients arrive with tremendous amounts of suffering, shame, guilt, and fear. The relationship between the patient and provider needs to be built with compassion and understanding that this disease is horrible from the patient's perspective and using an algorithmic and calculated approach can cause significant harm to the rapport-building process, leading to lower success rates.”Treatment requires a lot of motivation and willpower. Hopefully, we can use some tools to assist our patients to be successful.-For mild disorder, Psychosocial interventions like motivational interviewing and mutual help groups like AA meetings may be enough to help our patient quit drinking.-For moderate or severe disorder: 1st line treatment is Meditation and structured, evidence-based psychosocial interventions (CBT, 12-step facilitation); which leads to better outcomesFor patients who lack motivation, motivational interviewing can be a useful initial interventionFor motivated patients: medical management, combined behavioral intervention, or a combination of both can be utilizedFor patients with limited cognitive abilities, 12-step facilitation, or contingency management can be helpful For patients who have an involved partner: Behavioral couples therapy can be utilizedMedications for AUD.The first-line pharmacological treatment is Naltrexone. It is given as a daily single dose and can be started while the patient is still actively drinking. There is a monthly dose of long-acting injectable naltrexone as well. Naltrexone is contraindicated in individuals taking opioids, and patients with acute hepatitis or hepatic failure. Alternative 1st line treatment is Acamprosate which can be used in people with contraindications to Naltrexone.AUD is a chronic problem and requires a close follow-up to evaluate response to treatment and complications. Medications need to be used along with psychotherapy and support, and medications may need to be changed or adjusted depending on the patient. It is an individualized therapy that requires full engagement of the doctor, the patient, and their families or social support. In conclusion, I would just like to add that, be compassionate because AUD is not a choice. AUD is a chronic problem like diabetes and HTN and may require a long road to recovery. Treatment includes psychotherapy, medications, and regular follow-up.Thank you for listening!Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Risky drinking and alcohol use disorder: Epidemiology, clinical features, adverse consequences, screening, and assessment, https://www.uptodate.com/contents/risky-drinking-and-alcohol-use-disorder-epidemiology-clinical-features-adverse-consequences-screening-and-assessment, accessed on August 18, 2024.Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry, Accessed on August 18, 2024.Alcohol use disorder: Treatment overview, https://www.uptodate.com/contents/alcohol-use-disorder-treatment-overview, assessed on August 18, 2024. Royalty-free music used for this episode, Grande Hip-Hop by Gushito, downloaded on Nov 06, 2023, from https://www.videvo.net

I'm delighted to speak with UEFA football coach and lecturer, James Barraclough this week. James has worked as a football coach for over 20 years. He has coached extensively in academies and holds both the UEFA B and FA Advanced Youth Awards. James has an MSc in Sport Psychology and has consulted with athletes and teams from grassroots up to world champions. He is currently undertaking a Professional Doctorate in Elite Performance examining psychosocial skills in academy football.  James teaches Sports Coaching and Sport Science at UCEN Manchester. He is also a sport performance consultant supporting a number of mixed martial artists, athletes and football teams. In this episode James and I discuss a paper he led along with Prof David Grecic and Dr Damian Harper which looked at academy managers' experiences of how psychosocial skills and characteristics are identified and developed in youth academy soccer players.

Guest: William Sharp, PhD - Dr. Sharp shares the role a psychologist takes on a feeding team and an overview of the psychosocial domain of PFD. He then shares about when an SLP should refer to a psychologist before diving into sharing about Avoidant-Restrictive Food Intake Disorder.

In this conversation, Liz Rohr and Shelby Pope discuss the importance of taking a comprehensive history of substance use, and how to assess and treat stimulant use disorder. They cover the challenges healthcare providers face in asking the right questions, and emphasize the need for open conversations and non-judgmental approaches.They cover screening for addiction, how to elicit a substance use history, including types and routes of substance use. Shelby covers the mechanism of action of cocaine and methamphetamine in the brain, the withdrawal symptoms associated with stimulant use disorder, and the next steps for primary care providers in managing patients with stimulant use disorder. They also explore the use of psychosocial interventions and off-label pharmacologic treatments for stimulant use disorder.TakeawaysOpen and non-judgmental conversations are essential when discussing substance use with patients.Screening practices, such as using screeners like PHQ-2, SBIRT, and DAST, can help identify substance misuse or struggles.Taking a comprehensive history of substance use, including the type, amount, frequency, and motivation, is crucial for providing appropriate care.Healthcare providers should be aware of the different routes of administration and the potential risks associated with each.Stimulant use disorder, particularly cocaine and methamphetamine use, can have significant adverse effects and poor outcomes. Cocaine and methamphetamine are both monoamine neurotransmitter reuptake inhibitors, increasing serotonin, norepinephrine, and dopamine levels in the brain.There is a withdrawal syndrome associated with stimulant use disorder, characterized by depression, fatigue, and sleep disturbances.In managing patients with stimulant use disorder, primary care providers should consider triage based on severity and acuity, and refer patients to appropriate resources such as rehab or the ER.Psychosocial interventions, such as cognitive behavioral therapy and contingency management, are the mainstay of treatment for stimulant use disorder.Off-label pharmacologic treatments for stimulant use disorder include mirtazapine, bupropion, injectable naltrexone, topiramate, and psychostimulants.It is important for healthcare providers to be aware of state regulations and their own comfort level in prescribing off-label medications for stimulant use disorder.For a full transcript and conversation chapters, visit the blog: https://www.realworldnp.com/blog/treating-substance-use-disorder ______________________________© 2024 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.

“We have no business treating pain If we don't treat both the sensory and emotional components .” Carolyn Vandyken Our guest is Carolyn Vandyken PT, Cert. MDT.  Carolyn is a physiotherapist, educator, researcher and advocate in the areas of low back pain, pelvic health and pain science.  She became an MDT credentialled therapist in 1999. Carolyn holds a CBT certificate from Wilfred University, and has been practicing in the field of pelvic health for the past 25 years.  She has been practicing as a physiotherapist for 39 years teaching post-graduate pelvic health courses that are steeped in pain science. Carolyn won the Medal of Distinction from the Canadian Physiotherapy Association in 2021, the distinguished Education Award from the OPA in 2015 and the YWCA Women of Distinction Award in 2004.  Carolyn presents extensively at international conferences and has co-authored multiple chapters and papers on central pain mechanisms and pelvic pain.  She is actively involved in research with Dr. Sinead Dufour (McMaster University, Canada) and Dr. Judith Thompson (Curtin University, Australia) and has published multiple studies on the connection between low back pain and pelvic floor dysfunction. Carolyn co-owns a multi-disciplinary teaching company called Reframe Rehab and is engaged in breaking down the barriers internationally between pelvic health, orthopaedics and pain science. Carolyn practices locally in the areas of pelvic health and chronic pain at Physio Works Muskoka in Huntsville, Ontario with her daughter/physiotherapist, Brittany Vandyken.

Audio Commentary by Dr. Valentin Fuster, Emeritus Editor in Chief

In our previous episode, we explored the scientifically documented benefits of ayahuasca in a deep-dive interview with Sheryl Attig, Ph.D. I recommend taking in that episode before you experience this one. This is Part Two of our discussion. Here, Sheryl expands beyond ayahuasca to include the benefits of LSD, psychedelic mushrooms, and more. As I noted last time, Sheryl is an expert on the benefits and dangers of ayahuasca and other psychedelics. She even serves as an expert witness in psychedelic-related legal matters.  I love how Sheryl's eloquence and keen intellect make all this easy to understand. I also appreciate that her years of personal experience with psychedelics give her an insider's perspective. My Resources Free video: Instant Divine Assistance: Your Free Guide to Fast and Easy Awakening, Healing, and More. I lead you through all four types of my invocations! Learn about VIP Day: your potent opportunity for profound personal transformation! Check out my #1 Amazon bestseller: Instant Divine Assistance: Your Complete Guide to Fast and Easy Spiritual Awakening, Healing, and More.  Available as an audiobook narrated by yours truly. (FREE if you're not yet an Audible member!) Also available as an eBook, paperback, and hardcover starting at $3.99, and included with Kindle Unlimited. Every month, I give away a free one-year Awakening Plus membership to an “Awaken, Heal, and Thrive!” listener. Click here to enter! “Awakening Plus” online membership Sheryl's Resources Attig, S. (under review). The spiritual significance of psychedelics. The Journal of Transpersonal Psychology. Bouso, J.C., Gonzalez, D., Fondevila, S., Cutchet, M., Fernandez, X., Barbosa, P.C.R., Alcazar-Corcoles, M.A., Araujo, W.S., Barbanoj, M.J., Fabregas, J.M., & Riba, J. (2012). Personality, psychopathology, life attitudes and neuropsychological performance among ritual users of ayahuasca: A longitudinal study. Plos One, 7(8)1-13. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0042421 Daldegan-Beuno, D., Revesz, D., Morais, P.R., Barbosa, P.C.R., & Maia, L.O. (2022). Psychosocial and drug use assessment of regular vs. non-regular ayahuasca users in a Brazilian sample: a web-based survey. Substance Use & Misuse, 57(7), 1072-1081. https://www.tandfonline.com/doi/full/10.1080/10826084.2022.2063896 Dos Santos, R.G., & Hallak, J.E. (2017). Effects of the natural β-Carboline alkaloid harmine, a main constituent of the ayahuasca, in memory and in the hippocampus: A systematic literature review of preclinical studies. Journal of Psychoactive Drugs, 49(1), 1-10. https://www.tandfonline.com/doi/full/10.1080/02791072.2016.1260189 Fonseca, A.M., Dos Santos, R.G., De Mederios, L.S., Veiga, T.A.M., Casses, F., Bruniera, C.P., Rossi, G.N., Bouse, J.C., Hallak, J.E.C., Santos, F.P., Paranhos, B.A.P.B., Yonamine, M., Rodrigues, E. (2023). Long-term ayahuasca use is associated with preserved global cognitive function and improved memory: a cross-sectional study with ritual users. European Archives of Psychiatry and Clinical Neuroscience.https://link.springer.com/article/10.1007/s00406-024-01817-9 Maia, L.O., Daldegan-Bueno, D., WieBner, I., Araujo, D.B., Tofoli, L.F. (2023). Ayahuasca's therapeutic potential: What we know – and what not. European Neuropsychopharmacology, 66, 45-61. https://www.sciencedirect.com/science/article/abs/pii/S0924977X22008847?via%3Dihub Ona, G., Kohek, M., Massaguer, T., Gomariz, A. Jimenez, D.F., Dos Santos, R.G., Hallak, J.E., Alcazar-Corcoles, M.A., & Bouso, J.C. (2019). Ayahuasca and public health: Health status, psychological well-being, lifestyle, and coping strategies in a large sample of ritual ayahuasca users. Journal of Psychoactive Drugs, 51(2, 135-145. https://www.tandfonline.com/doi/full/10.1080/02791072.2019.1567961 A 60-minute talk followed by 29 minutes of questions and answers with astrobiologist Dr. Bruce Damer. He describes growing up with Asperger's Syndrome, being healed of it with ayahuasca, harnessing his innate visioning powers, and combining it with visions given by ayahuasca -- ultimately leading him to a groundbreaking new theory about the emergence of life on earth. The focus of the talk is using psychedelics to enhance creativity and problem solving. ESPD '55 Dr. Bruce Damer presents It's High Time For Science (5/25/2022). https://www.youtube.com/watch?v=gUQCrakiRqA  

Got a question or feedback? Send me a text!Summary:In this conversation, Aaron Shaw and Dr. Alexis Sam's discuss food allergies, their impact on quality of life, and the approach to identifying and addressing food sensitivities. Dr. Alexis shares insights on the concept of food clues and the process of uncovering the root causes of food reactions. The conversation also delves into the psychosocial impact of food allergies and the potential for resolution through a holistic approach. Dr. Alexis discusses her framework for assessing and treating food allergies, including immune support, inflammatory control, and healing. She also explores the correlation between physical activity and inflammatory states, as well as the duration and maintenance of treatment programs.Keywords:food allergies, food clues, holistic health, quality of life, food sensitivities, immune response, nutrition, psychosocial impact, food allergies, immune support, inflammatory control, healing, physical activity, treatment duration, maintenance programTakeaways:Food allergies can significantly impact an individual's quality of life, leading to social isolation and limitations in daily activities.The concept of food clues involves identifying the root causes of food reactions and addressing them through a holistic approach.Psychosocial aspects of food allergies, such as social interactions and emotional well-being, are important considerations in the management of food sensitivities.Resolution of food reactions is possible through a comprehensive treatment approach that focuses on restoring the body's natural balance and function. Assessment and treatment of food allergies involve immune support, inflammatory control, and healing.Physical activity can be correlated with inflammatory states and is incorporated into treatment programs.Treatment programs have a specific stopping point with a maintenance program for continued support.The average duration for 80-100% resolution of food allergies is six to seven months.Belief in the possibility of reducing food reactions and identifying dominant food clues are actionable steps for individuals with food allergies.Sound Bites:"Resolution of food reactions is possible, and evidence supports the effectiveness of holistic treatment approaches.""The framework goes into immune support, inflammatory control, and healing.""Lymphatic work is a strong example of incorporating physical activity into the program.""The average duration for 80-100% resolution of food allergies is six to seven months."Website: https://myfooodclues.comBuy the Food Clues Book: https://myfoodclues.com/bookEmail: foodallergydoc@gmail.comInstagram: @thefoodallergydocFacebook: @dralexissamsBuy Me a Coffee - the best way to support the showHealthspan coaching consultations, programs, speaker inquiriesMonthly Healthspan PhysioCoaching Newsletter Sign-upHealthspan YouTube Channel / Video EpisodesStrava (see Aaron's training profile)Healthspan Digest Facebook GroupMusic by QubeSounds

Join us for a discussion about non-medication based treatments for ADHD.

In this week's episode of Everything Epigenetics, I am joined by Dr. Janitza Montalvo-Ortiz, Assistant Professor of Psychiatry at Yale University, who shares her journey into the world of epigenetics and psychiatry. Dr. Montalvo-Ortiz explains the pivotal role of epigenetics in understanding the genetic and environmental factors contributing to psychiatric disorders and emphasizes the importance of trauma exposure in shaping mental health outcomes.Our discussion covers her research into the epigenetic mechanisms behind psychiatric conditions, particularly in underserved populations like Latin Americans and military veterans.  She highlights the need for multi-omic approaches to fully unravel the complex interplay between genes, epigenetics, and the environment. Dr. Montalvo-Ortiz also discusses the development of epigenetic clocks like GrimAge, which assesses mortality risk and incorporates factors like DNA methylation changes due to smoking.Furthermore, Dr. Montalvo-Ortiz shares insights from her studies on how lifestyle and psychosocial factors can influence aging at the cellular level, and dives into the specific epigenomic differences in individuals with nicotine dependence. She concludes with her research on the epigenetic signatures of PTSD in US military veterans, spotlighting the potential for targeted treatments.Join us as we explore these transformative insights, which not only deepen our understanding of mental health disorders but also open doors to innovative treatment strategies.In this episode of Everything Epigenetics, you'll learn about: - What epigenetics means to Janitza - Janitza's journey- Genetic and epigenetic mechanisms associated with psychiatry disorders- How we can use epigenetics as a tool to learn more about psychiatric disorders- Using multi-omics datasets (genomics, methylomics, transcriptomics, proteomics) to better understand the underlying mechanisms and identify predictors or biomarkers for these disorders- Why it's important to look at underserved populations and how we can extend these findings to the general population- Psychosocial factors associated with GrimAge in Male US Military Veterans- Epigenomic differences between smoking and nicotine dependence in a veterans- Epigenetics in posttraumatic stress disorder in U.S. military veterans- Current challenges in epigenetics - What's next for JanitzaWhere to find Janitza:Yale School Medicine ProfileLinkedIn TwitterSupport the Show.Thank you for joining us at the Everything Epigenetics Podcast and remember you have control over your Epigenetics, so tune in next time to learn more about how.

Dr. Mrinalini Dey reports from Eular 2024 in Vienna, Austria about an abstract she will present during the meeting, POS0309.