Clinical Conversations

In this episode of clinical conversations, Dr Kat Ralston chats with consultant toxicologist Dr Emma Morrison about poisoning in the older adult. They explore why we need to think differently about deliberate self-harm in the older adult and talk through common toxicology cases, including decision-making around escalation. Finally, they consider a common sense approach to what we can do differently as clinicians to reduce the risk of self-harm and suicide in this patient group. Dr Morrison trained in medicine at the University of Glasgow, with an intercalated BSc in Physiology. She also completed a PhD investigating to role of short RNAs as biomarkers and mediators in toxic injury. In 2020, Emma become a Consultant Physician at the Royal Infirmary of Edinburgh. Emma’s NHS work continues to support her passion of ensuring transparent and equitable decision making in prescribing, supporting the central tenets of value-based medicine. Her roles within medicines governance include Chairing Lothian’s Area Drug and Therapeutics Committee and is a committee member of the SMC. Dr Kat Ralston is a geriatric medicine registrar in Edinburgh. She is also the Education Co-Vice Chair and the joint Podcast Lead for the RCPE Trainee & Members' Committee (T&MC). --Useful Link-- TOXBASE - https://www.toxbase.org/ Recording date: 19 December 2024 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE events -- https://www.rcpe.ac.uk/events -- Become an RCPE Member -- https://www.rcpe.ac.uk/membership/join-college Feedback: [email protected]

In this episode, Dr Kat Ralston chats with Prof Miriam Johnson about palliative care in heart failure. They discuss the evidence supporting specialist palliative care input in this patient group and explore how to develop effective integrated services. They chat about holistic, needs based assessment and share top tips on the approach to the debilitating symptom of breathlessness. Professor Miriam Johnson is Professor of Palliative Medicine at Hull York Medical School, Associate Director of the Wolfson Palliative Care Research Centre at the University of Hull. She is Adjunct Professor of Palliative Medicine at the University Technology Sydney, Sydney, Australia. For twenty years (2000 to 2020), she also provided consultant palliative physician services to Scarborough General Hospital and Saint Catherine's Hospice, Scarborough where she set up one of the UK’s first integrated palliative care services for people with heart failure. Dr Kat Ralston is a geriatric medicine registrar in Edinburgh. She is also the Education Co-Vice Chair and the joint Podcast Lead for the RCPE Trainee & Members' Committee (T&MC). Recording date: 5 December 2024 -- Useful Links -- Abel et al (2024), Hospital admissions in the last year of life of patients with heart failure, https://doi.org/10.1093/ehjqcco/qcad047. Balata et al (Oct 2024), Early integration of palliative care versus standard cardiac care for patients with heart failure (EPCHF): a multicentre, parallel, two-arm, open-label, randomised controlled trial, https://doi.org/10.1016/j.lanhl.2024.08.006. Barnes-Harris et al, Barriers and facilitators for cardiopulmonary resuscitation discussions with people with heart failure, https://doi.org/10.1371/journal.pone.0314631. Campbell et al (2018), Which patients with heart failure should receive specialist palliative care?, https://doi.org/10.1002/ejhf.1240. Date et al, Modified-release morphine or placebo for chronic breathlessness: the MABEL trial protocol, https://doi.org/10.1183/23120541.00167-2023. Ekström et al, Effect of regular low-dose extended-release morphine on chronic breathlessness in chronic obstructive pulmonary disease: the BEAMS randomized clinical trial, http://doi.org/10.1001/jama.2022.20206.  Ferreira et al, The effect of regular, low-dose, sustained-release morphine on routine physical activity in people with persistent breathlessness– a hypothesis-generating study, https://doi.org/10.1183/13993003.01484-2022. Johnson et al (2024), Benefits of specialist palliative care by identifying active ingredients of service composition, structure, and delivery model: A systematic review with meta-analysis and meta-regression, https://doi.org/10.1371/journal.pmed.1004436. Jordan et al (2020), Duration of palliative care before death in international routine practice: a systematic review and meta-analysis, https://doi.org/10.1186/s12916-020-01829-x. King et al (2022), Concurrent Validity and Prognostic Utility of the Needs Assessment Tool: Progressive Disease Heart Failure, https://doi.org/10.1016/j.jpainsymman.2022.01.014. McConnell et al (2023), Integrating palliative care and heart failure: a systematic realist synthesis (PalliatHeartSynthesis), https://doi.org/10.1136/openhrt-2023-002438. Roch et al (2020), Utility of the integrated palliative care outcome scale (IPOS): a cross-sectional study in hospitalised patients with heart failure, https://doi.org/10.1177/1474515120919386. Breathing, Thinking Functioning Model - https://www.btf.phpc.cam.ac.uk/ Caring Together - https://www.mariecurie.org.uk/professionals/working-in-partnership/caring-together Scottish Palliative Care Guidelines - https://rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/ -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE events -- https://www.rcpe.ac.uk/events -- Become an RCPE Member -- https://www.rcpe.ac.uk/membership/join-college Feedback: [email protected]

In this episode, Dr Marilena Giannoudi discusses Type 1 diabetes with Dr Sam Pearson. Topics include diagnosing T1 diabetes, recognising the impact of a new diagnosis of diabetes on patients and possible treatments, including technological interventions. Dr Sam Pearson is a diabetes consultant at St James hospital in Leeds. They help look after patients with all types of diabetes mellitus but have a particular interest in helping younger adults with type 1 diabetes and how technology may help them. Dr Marilena Giannoudi is a cardiology registrar based in Leeds. She is Co-Chair of the Trainees and Members’ Committee, a Fellow of the Higher Education Academy, and is currently undertaking a PhD. Recording date: 14 November 2024 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE events -- https://www.rcpe.ac.uk/events -- Become an RCPE Member -- https://www.rcpe.ac.uk/membership/join-college Feedback: [email protected]

In this episode, Dr Kat Ralston chats with Dr Imogen Smith about palliative care in hospital inpatients. They discuss what is different about the older adult when considering palliative care, including thinking about trajectories, communicating uncertainty, and parallel planning. They explore symptom control including a practical approach to syringe drivers (continuous subcutanous infusions) for the non-specialist. Dr Imogen Smith was appointed as Consultant in General Internal Medicine and Medicine for the Elderly at St John’s Hospital, Livingston, in April 2020. Her clinical interests are in Hospital at Home, and Hospital Based Complex Clinical Care/Palliative Care. She is an educational and clinical supervisor and also clinically supervises and educates Advanced Nurse Practitioners in HBCCC/H@H contexts. During training, she was appointed to the first cohort of NHS Lothian Chief Registrars (2018-2019). And she sat on the RCPE Trainees and Members Committee (2018-2020). Dr Kat Ralston is a geriatric medicine registrar in Edinburgh. She is also the Education Co-Vice Chair and the joint Podcast Lead for the RCPE Trainee & Members' Committee (T&MC). Recording date: 20 November 2024 --Useful Links-- Scottish Palliative Care Guidelines - https://rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/ Patterns of Functional Decline at the End of Life - https://jamanetwork.com/journals/jama/fullarticle/196538 REDMAP Framework for Future Care Planning Conversations - https://www.spict.org.uk/red-map/ -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE events -- https://events.rcpe.ac.uk/ -- Become an RCPE Member -- https://www.rcpe.ac.uk/membership/join-college Feedback: [email protected]

In this episode, Dr Kat Ralston chats with Dr Nik Rae about infective endocarditis. They discuss the complexities of clinical presentation in this condition and share tips to help you in your diagnostic journey. They explore a pragmatic approach to management, including individualised decision making and the emerging evidence base for use of oral agents. Dr Nikolas Rae is a Consultant Physician in Infectious Diseases and Acute Medicine with a range of clinical interests including infections in people who inject drugs, blood borne viruses, mycobacterial and fungal infections. Dr Kat Ralston is a geriatric medicine registrar in Edinburgh. She is also the Education Co-Vice Chair and the joint Podcast Lead for the RCPE Trainee & Members' Committee (T&MC). Recording date: 7 November 2024 -- Useful Links -- Oral vs IV antibiotics systematic review - https://pmc.ncbi.nlm.nih.gov/articles/PMC8901545/ European Society of Cardiology (ESC) Endocarditis Guidelines - https://academic.oup.com/eurheartj/article/44/39/3948/7243107 WikiGuidelines Endocarditis Consensus Statement - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807791 Scottish Antimicrobial Prescribing Group (SAPG) penicillin allergy de-labelling guidance - https://www.sapg.scot/guidance-qi-tools/quality-improvement-tools/penicillin-allergy-de-labelling/ -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE events -- https://events.rcpe.ac.uk/ -- Become an RCPE Member -- https://www.rcpe.ac.uk/membership/join-college Feedback: [email protected]

This is a co-release with our sister podcast, Career Conversations. In this episode, Dr Marilena Giannoudi speaks with Dr Neil Shepherd about remote and rural medicine. Dr Shepherd highlights the benefits as well as the challenges of working in remote and rural areas and some of the professional support in place for this career path. Dr Neil Shepherd considers himself to be a rural generalist. He completed his GP training in 2014 and acute care rural GP fellowship in 2018. He currently works as a rural emergency physician in Caithness General Hospital, a Locum GP in Orkney and as training programme director for broad based training with NHS Education for Scotland. He is also a Fellow of the Royal College of Physicians of Edinburgh. Dr Marilena Giannoudi is a cardiology registrar based in Leeds. She is Co-Chair of the Trainees and Members’ Committee, a Fellow of the Higher Education Academy, and is currently undertaking a PhD. Recording date: 5 November 2024 --Useful Links-- BASICS Scotland - https://basicsscotland.org.uk/ Broad Based Training Information - https://www.scotmt.scot.nhs.uk/recruitment/broad-based-training.aspx Rural and Remote Health Credential - https://www.nes.scot.nhs.uk/news/rural-and-remote-health-credential-unscheduled-and-urgent-care/ GP Fellowships - https://www.scotlanddeanery.nhs.scot/your-development/gp-fellowships/ UCLan's National Centre for Remote and Rural Medicine - https://www.uclan.ac.uk/centres/ncrrm Disclaimer: Please always refer to official recruitment websites for the latest guidance as application dates and processes may differ to those described in this episode. -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE events -- https://events.rcpe.ac.uk/ -- Become an RCPE Member -- https://www.rcpe.ac.uk/membership/join-college Feedback: [email protected]

In this episode of Clinical Conversations, Dr Kat Ralston chats with Dr Alan Japp about heart failure with reduced ejection fraction. They discuss an approach to clinical assessment, share top tips for diuresis and explore the four pillars of heart failure therapy. Dr Alan Japp is a Consultant Cardiologist at the Edinburgh Royal Infirmary and St John's Hospital, Livingston. He is also the Clinical Lead for Heart Failure in NHS Lothian and the Local Principal Investigator for DAPA HF and IRONMAN clinical trials. Dr Kat Ralston is a geriatric medicine registrar in Edinburgh. She is also the Education Co-Vice Chair and the joint Podcast Lead for the RCPE Trainee & Members' Committee (T&MC). Recording date: 16 October 2024 -- Useful links -- European Society of Cardiology Heart Failure Guidelines (2023 focused update) : https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE events -- https://events.rcpe.ac.uk/ -- Become an RCPE Member -- https://www.rcpe.ac.uk/membership/join-college Feedback: [email protected]

In this episode, Dr Marilena Giannoudi speaks with Dr Sarah Schoeman about the genitourinary medicine (GUM) clinic. Dr Schoeman discusses the prevalence of sexually transmitted infections, provides non-GUM specialists tips on how to ask a patient's sexual health and describes some interesting cases from her clinical experience. Dr Sarah Schoeman is a GUM Consultant in Leeds based at the Leeds Teaching Hospitals Trust. She is also Clinical Lead for the Leeds Teaching Hospitals Trust HIV service. She is currently co-Chair of the GUM SAC alongside Dr Andy Williams and together they represent the GUM SAC on the BASHH board. In addition Sarah is a current clinical member of the HIV CRG, Clinical Lead for the West Yorkshire HIV Network, Clinical Lead for the Leeds Fast Tack Cities project, a BASHH Sexual Health Dermatology SIG member and BSSVD council member. Dr Marilena Giannoudi is a cardiology registrar based in Leeds. She is Co-Chair of the Trainees and Members’ Committee (T&MC), a Fellow of the Higher Education Academy, and is currently undertaking a PhD. Recording Date: 3 October 2024 -- Useful Links -- LoveGUM - https://lovegum.bashh.org Get involved in GUM - https://padlet.com/stashh1/get-involved-in-gum-kz9569d4dbswatyz -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE events -- https://events.rcpe.ac.uk/ -- Become an RCPE Member -- https://www.rcpe.ac.uk/membership/join-college Feedback: [email protected]

For Sepsis Awareness Month, Dr Marilena Giannoudi speaks with Dr Ron Daniels about sepsis. They discuss the causes, investigation, management, and prevention of sepsis. Topics include the Sepsis 6 and escalation of care, use of blood cultures, septic shock, and post-sepsis syndrome. Dr Ron Daniels is an NHS Consultant in Intensive Care, based at University Hospitals Birmingham, U.K. He’s also Founder and Chief Executive of the UK Sepsis Trust and Vice-President of the Global Sepsis Alliance. In 2016 he was awarded the British Empire Medal for services to patients. Ron’s expertise lies in translational medicine and leadership. He leads the team driving dissemination of the Sepsis 6 treatment pathway and is part of the team responsible for much of the policy and media engagement around sepsis in the U.K. and elsewhere, including as a core member of the team securing the adoption of the 2017 Resolution on Sepsis by the World Health Organization (WHO). At home, Ron’s worked with the NHS over the last 9 years to ensure that by 2019, in England, more than 80% of patients presenting with suspected sepsis were receiving appropriate antimicrobials rapidly. He is now leading a team working with His Majesty’s Government to once again drive sepsis improvement work in the post pandemic era. He’s ever mindful of the perceived conflict, and the synergies and need for collaboration, with the antimicrobial stewardship agenda. Dr Marilena Giannoudi is a clinical academic trainee in cardiology in the Yorkshire and Humber region. Her current interests include heart failure, endothelial dysfunction, and medical education. She is a Fellow of the Higher Education Academy and is currently pursuing a PhD. Dr Giannoudi is passionate about ensuring that trainees' voices are heard and that educational opportunities are available to foster confidence and independence throughout their training. She has developed core medical training (now IMT) teaching programs in hospitals across her deanery. Additionally, she uses her position on the local junior doctor body to advocate for and implement necessary changes. -- Links -- The UK Sepsis Trust's Clinical Tools - https://sepsistrust.org/healthcare-professionals/clinical-tools/ NICE guidelines on suspected sepsis - https://www.nice.org.uk/guidance/NG51 Global Sepsis Alliance - https://globalsepsisalliance.org/ -- Choose RCPE as your College of Entry for PACES -- We encourage you to sit PACES with our College. We have a friendly and experienced examinations team who expertly support candidates, and we deliver PACES at centres across the UK. Select RCPE as your College of Entry when applying online through your My MRCP(UK) online account. Recording date: 11 September 2024 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE events -- https://events.rcpe.ac.uk/ -- Become an RCPE Member -- https://www.rcpe.ac.uk/membership/join-college Feedback: [email protected]

In this episode, Professor Eylem Levelt and Dr Marilena Giannoudi discuss the early stages of cardiometabolic disease, its asymptomatic challenges, and key risk factors. They cover how junior doctors can protect at-risk patients and the prevalence of diabetes and weight issues among those diagnosed. Reflecting on trends over the past decades, they share insights into improving patient outcomes. Looking ahead, they discuss reducing heart failure and managing conditions like obesity-related heart disease. Prof Levelt offers practical advice for junior doctors on identifying and managing at-risk patients. Prof Eylem Levelt is an academic cardiologist with a specialist interest in cardiovascular imaging and diabetic heart disease. Dr Marilena Giannoudi is a cardiology registrar based in Leeds. She is Co-Chair of the Trainees and Members’ Committee, a Fellow of the Higher Education Academy, and is currently undertaking a PhD. --Links-- For clinicians: European Society of Cardiology (ESC) Clinical Practice Guidelines: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/CVD-and-Diabetes-Guidelines American College of Cardiology (ACC) Guidelines: https://www.acc.org/Guidelines For patients: British Heart Foundation (BHF): https://www.bhf.org.uk --Related listening-- Inherited Cardiac Conditions, Clinical Conversations https://podcasts.rcpe.ac.uk/show/clinical-conversations/inherited-cardiac-conditions-3-june-2024/ Women in Cardiology [Re-release], Career Conversations https://podcasts.rcpe.ac.uk/show/career-conversations/women-in-cardiology-re-release-8-march-2024/ Medical Specialties - Clinical Genetics, Career Conversations https://podcasts.rcpe.ac.uk/show/career-conversations/medical-specialties-clinical-genetics-07-jun-2023/ Demystifying PACES - Cardiovascular [Station 3], Career Conversations https://podcasts.rcpe.ac.uk/show/career-conversations/demystifying-paces-cardiovascular-station-3-29-jan-2024/ Movement Medicine, Career Conversations https://podcasts.rcpe.ac.uk/show/clinical-conversations/movement-medicine-03-apr-2023/ Follow Professor Levelt on X @EylemLevelt Recording date: 25 June 2024 -- Follow us -- www.instagram.com/rcpedintrainees twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- events.rcpe.ac.uk/ Feedback: [email protected]

This week Dr Ben Warner interviews Professor Tom Fardon on the topic of asthma. Through a case study, Prof Fardon discusses how to assess and treat a severe exacerbation of asthma and what needs to be considered when discharging patients. Tom and Ben also discuss diagnosing asthma and the treatments available to patients. Professor Fardon is a Consultant Respiratory Physician at NHS Tayside and Honorary Professor at the University of Dundee. They are also Clinical Lead for the Scottish Government's Respiratory Specialty Delivery Group. Dr Ben Warner is a Respiratory Medicine Specialty Registrar with clinical and academic experience of global public health. He is currently undertaking a PhD in multimorbidity in Malawi as part of the Wellcome-funded Multimorbidity PhD Programme for Health Professionals with the University of Glasgow. --Useful Links-- Current NICE guideline on Asthma: Diagnosis, monitoring and chronic asthma management - https://www.nice.org.uk/guidance/ng80 Current BTS/SIGN British Guideline on the Management of Asthma - https://www.brit-thoracic.org.uk/quality-improvement/guidelines/asthma/ Upcoming SIGN updates - https://www.sign.ac.uk/our-guidelines/british-guideline-on-the-management-of-asthma/ BTS Clinical Statement on the medical management of inpatients with tobacco dependency - https://thorax.bmj.com/content/79/Suppl_1/3 Treatable traits approach in asthma - https://treatabletraits.org.au/wp-content/uploads/2022/02/MJA-TT-Case-Final.pdf Environmental impact of inhalers toolkit produced by ‘Greener Practice' - https://www.greenerpractice.co.uk/high-quality-and-low-carbon-asthma-care/ Greener Practice guide on reducing the carbon footprint of inhalers - https://s40639.pcdn.co/wp-content/uploads/Reducing-Carbon-Footprint-of-Inhaler-Prescribing-v3.3.2.pdf National Review of Asthma Deaths (NRAD) - https://www.hqip.org.uk/resource/asthma-deaths-nrad-report-2014/ British Thoracic Society asthma attack care bundle - https://www.brit-thoracic.org.uk/quality-improvement/clinical-resources/asthma/bts-asthma-care-bundles/ Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial - https://doi.org/10.1016/S0140-6736(02)11679-5 Clinical remission in severe asthma with biologic therapy: an analysis from the UK Severe Asthma Registry - https://erj.ersjournals.com/content/62/6/2300819 Low Dose Inhaled Budesonide and Formoterol in Mild Persistent Asthma - https://doi.org/10.1164/ajrccm.164.8.2104102 Recording date: 22 May 2024 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

In this brief episode, Dr Marilena Giannoudi, Co-Chair of the Trainees and Members’ Committee, gives an overview of the Royal College of Physicians of Edinburgh's podcasts relevant to doctors-in-training. These include: this podcast, 'Clinical Conversations'; 'Career Conversations' including the new 'Demystifying PACES' series; and the Recently Appointed Consultants' Committee's podcast, 'Consultant Conversations', relevant to senior trainees. All RCPE podcasts can be found at https://podcasts.rcpe.ac.uk/ The 'Demystifying PACES' podcast series can be found at https://podcasts.rcpe.ac.uk/show/career-conversations/category/paces/ Recording date: 23 January 2024 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ -- Become a Member -- https://www.rcpe.ac.uk/membership/join-college Feedback: [email protected]

What happens at the Inherited Cardiac Conditions clinic? In this episode, Dr Marilena Giannoudi and Dr Anshu Sengupta discuss Inherited Cardiac Conditions (ICCs) and the ICC clinic, including who makes up this multi-disciplinary team. They discuss the approach to patients with ICCs covering investigations and management including guideline-led treatment, monitoring, risk assessment and exercise advice. Dr Anshu Sengupta is a Consultant Cardiologist in the Yorkshire Heart Centre, specialising in investigating and managing patients and families with ICCs. He has a specialist interest and training in heart failure and cardiac magnetic resonance imaging. Dr Marilena Giannoudi is a cardiology registrar based in Leeds. She is Co-Chair of the Trainees and Members’ Committee, a Fellow of the Higher Education Academy, and is currently undertaking a PhD. -- Useful links -- For clinicians: - European Society of Cardiology (ESC) Cardiomyopathy Guidelines: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Cardiomyopathy-Guidelines - American College of Cardiology (ACC) Guidelines: https://www.acc.org/Guidelines For patients: - British Heart Foundation (BHF): https://www.bhf.org.uk - Cardiomyopathy UK: https://www.cardiomyopathy.org/ - Arrhythmia Alliance: https://heartrhythmalliance.org/aa/uk/ -- Related listening -- Women in Cardiology [Re-release], Career Conversations https://podcasts.rcpe.ac.uk/show/career-conversations/women-in-cardiology-re-release-8-march-2024/ Medical Specialties - Clinical Genetics, Career Conversations https://podcasts.rcpe.ac.uk/show/career-conversations/medical-specialties-clinical-genetics-07-jun-2023/ Demystifying PACES - Cardiovascular [Station 3], Career Conversations https://podcasts.rcpe.ac.uk/show/career-conversations/demystifying-paces-cardiovascular-station-3-29-jan-2024/ Movement Medicine, Career Conversations https://podcasts.rcpe.ac.uk/show/clinical-conversations/movement-medicine-03-apr-2023/ Recording date: 22 May 2024 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

In this episode, Dr Kat Ralston chats to Dr Matt Lambert about hyperacute stroke. They discuss a targeted approach to first assessment, including how to utilise your team effectively in a time-pressured environment. They explore the evidence behind different treatment options and share practical tips on thrombolysis and thrombectomy. Dr Lambert is a consultant in Stroke and Medicine for the Elderly in NHS Tayside and was clinical lead for stroke in Tayside from 2016 until 2023. During this time they led a significant reorganisation of stroke services which led to significant improvements in the delivery of stroke care as measured by the Scottish Stroke Care Audit and laid the foundations for introducing a mechanical thrombectomy service for acute stroke in Tayside. They have an interest in quality improvement and completed the Scottish Quality and Safety Fellowship. Since late 2023 Dr Lambert has been the Stroke Specialty Advisor to the CMO and National Clinical lead for Stroke in Scotland. Dr Kat Ralston is a Geriatric Medicine Registrar and member of the RCPE Trainees and Members’ Committee, currently working in Edinburgh. -- Useful Links -- NIHSS training - https://www.ninds.nih.gov/health-information/public-education/know-stroke/health-professionals National Clinical Guideline for Stroke for the UK and Ireland - https://www.strokeguideline.org/ Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials - https://doi.org/10.1016/s0140-6736(16)00163-x Recording Date: 11 March 2024 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

In this episode Dr Ben Warner discusses multimorbidity, also known as multiple long-term conditions, with Professor Frances Mair. They discuss what multimorbidity is, how the concept differs from frailty and how the burden of treatment and health inequalities impact patients with multiple long-term conditions. Professor Frances Mair is the Norie Miller Professor of General Practice, Head of General Practice and Primary Care, and Director of a Wellcome funded Multimorbidity PhD Programme for Health Professionals at the University of Glasgow. She co-leads the NHS Research Scotland Primary Care Network, promoting research activity in primary care and is a member of the MRC Clinical Academic Research Partnerships Panel. Professor Mair is also an International Advisor to the Norwegian Primary Care Research Network and the Australian Translating Research Outcomes into the Primary Health Interface (TROPHI) Scientific Advisory Group as well as acting as a Visiting Professor at the University of Melbourne, Australia. Dr Ben Warner is a Respiratory Medicine Specialty Registrar with clinical and academic experience of global public health, having completed the LSHTM’s East African Diploma in Tropical Medicine and then worked for 18 months in rural South Africa. He is currently undertaking a PhD in multimorbidity in Malawi as part of the Wellcome-funded Multimorbidity PhD Programme for Health Professionals with the University of Glasgow. Recording date: 20 February 2024 -- Useful Links -- https://www.bmj.com/content/339/bmj.b2803 https://www.nice.org.uk/guidance/ng56 https://doi.org/10.1016/S0140-6736(12)60240-2 https://www.gla.ac.uk/colleges/mvls/graduateschool/multimorbidity/ https://www.gla.ac.uk/schools/healthwellbeing/staff/francesmair/ -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

In this episode, Dr Marilena Giannoudi and Dr Vidhya Nair discuss orthogeriatrics, including frailty and fragility fractures, osteoporosis, and falls risk assessment, and the importance of a multi-disciplinary (MDT) team throughout patient care. Dr Vidhya Nair graduated from Newcastle University in 2002 and moved down to Leeds in 2003. Dr Nair became a Consultant in Elderly Medicine specialising in Orthogeriatrics in 2011 and worked in Pinderfields General Hospital on a dedicated hip fracture unit. Since 2015 Dr Nair has worked as a Consultant in Leeds Teaching Hospitals. Dr Nair's current role is as the Clinical Lead for Orthogeriatrics based at Leeds General Infirmary, providing orthogeriatric input onto orthopaedic wards and the Major Trauma Unit. Dr Marilena Giannoudi is a cardiology registrar based in Leeds. She is Co-Chair of the Trainees and Members’ Committee, a Fellow of the Higher Education Academy, and is currently undertaking a PhD. -- Useful links -- Frailty for the Non-Specialist - 'Clinical Conversations' podcast https://podcasts.rcpe.ac.uk/show/clinical-conversations/frailty-for-the-non-specialist-11-mar-2024/ National Osteoporosis Guideline Group (NOGG) https://www.nogg.org.uk FRAX® tool - Fracture Risk Assessment Tool https://frax.shef.ac.uk/FRAX/ (and see https://www.fraxplus.org/) Recording date: 15 February 2024 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

In this episode, Dr Kat Ralston chats with Dr Emma Phillips about clinical debriefing. They talk about what clinical debriefing is (and isn’t) and why we should be incorporating this into our everyday work. They explore when and how to facilitate a clinical debrief and share tips on how we can embed clinical debriefing into our practice. Dr Phillips is an Anaesthetic Registrar working in South-East Scotland. She completed a simulation fellowship at Scottish Simulation Center in 2018 and maintains active role in simulation based education. Dr Phillips completed a Master's in 2022 with a dissertation examining attributes and evidence for use of clinical debriefing tools. She has also published and presented on a number of topics including non-technical skills in simulation, clinical debriefing, educational innovations and airway management. Dr Kat Ralston is a Geriatric Medicine Registrar and member of the RCPE Trainees and Members’ Committee, currently working in Edinburgh. -- Useful Links -- Kolbe M, Schmutz S, Seelandt J C, Eppich W J, Schmutz J B. Team debriefings in healthcare: aligning intention and impact BMJ 2021; 374 :n2042 - https://doi.org/10.1136/bmj.n2042 Phillips EC, Smith SE, Tallentire V, et al. Systematic review of clinical debriefing tools: attributes and evidence for use BMJ Quality & Safety Published Online First: 28 March 2023. - https://doi.org/10.1136/bmjqs-2022-015464 Petrosoniak A, Gabriel J, Purdy E. Stop asking if it works, start making it happen: exploring barriers to clinical event debriefing in the ED. CJEM. 2022;24(7):673-674. - https://doi.org/10.1007/s43678-022-00396-9 Walker CA, McGregor L, Taylor C, Robinson S. STOP5: a hot debrief model for resuscitation cases in the emergency department. Clin Exp Emerg Med. 2020;7(4):259-266. - https://doi.org/10.15441/ceem.19.086 Wolfe et al. (2014) Interdisciplinary ICU Cardiac Arrest Debriefing Improves Survival Outcomes - https://doi.org/10.1097/CCM.0000000000000327 Rose & Cheng (2018) Charge nurse facilitated clinical debriefing in the emergency department - https://www.cambridge.org/core/journals/canadian-journal-of-emergency-medicine/article/charge-nurse-facilitated-clinical-debriefing-in-the-emergency-department/CC224433937ACBA849491A66EBC9593D Ralston et al. (2024) Overcoming barriers to clinical event debriefing through simulation - https://doi.org/10.1111/medu.15359 Recording Date: 16 February 2024 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

In this episode, released to coincide with World TB Day 2024, Dr Ben Warner discusses pulmonary tuberculosis (TB) with Dr David Connell. Dr David Connell first explains his personal interest in TB. They then discuss pulmonary TB in depth, including: epidemiology; pathogenesis, immune response, and transmission (a 'lymphatic disease with respiratory spread'); how TB presents and differential diagnoses; latent TB infection and reactivation; and management including the importance of the multidisciplinary team (MDT) and the role of public health in contact tracing and the end goal of elimination. Dr David Connell completed higher specialist training in Respiratory and General Internal Medicine in North-West London including at St.Mary’s Hospital, where he completed a PhD in the immunology of Tuberculosis, before becoming a Consultant at Ninewells Hospital in 2017 where he has a specialist interest in Complex Pulmonary Infections and TB. He is Co-Chair of the Scottish Health Protection Tuberculosis Network and is a Clinical Service Advisor to the BTS MDR-TB Advice Service. Dr Ben Warner is a Respiratory Medicine Specialty Registrar with clinical and academic experience of global public health, having completed the LSHTM’s East African Diploma in Tropical Medicine and then worked for 18 months in rural South Africa, where he encountered the sharp end of the global TB pandemic. He is currently undertaking a PhD in multimorbidity in Malawi as part of the Wellcome-funded Multimorbidity PhD Programme for Health Professionals fellow with the University of Glasgow. Recording date: 1 March 2024 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

This week Dr Marilena Giannoudi focuses on the topic of Frailty with Dr Sean Ninan. They discuss recognising frailty, the different ways to measure the severity of frailty and the importance of adapting treatment for frail patients. Dr Sean Ninan is a Consultant Geriatrician and Clinical Lead for Dementia and Delirium at Leeds Teaching Hospitals NHS Trust. Dr Ninan is also Course Director of Leeds Frailty Education. Dr Marilena Giannoudi is a cardiology registrar based in Leeds. She is Co-Chair of the Trainees and Members’ Committee, a Fellow of the Higher Education Academy, and is currently undertaking a PhD. Recording Date: 04 December 2023 -- Useful Links -- CGA Toolkit - https://www.cgakit.com/frailty CGA in Primary Care Settings - https://www.bgs.org.uk/cgatoolkit GIRFT Geriatric Medicine - https://gettingitrightfirsttime.co.uk/medical_specialties/geriatric-medicine/ Rapid Delirium Test - https://www.the4at.com Clinical Frailty Scale - https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale.html -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

This week, Dr Kat Ralston takes a fresh look at the geriatric giants with Dr Clare Bostock. They explore frailty syndromes using the “5M’s” approach (matters most, mind, mobility, medications, and multi-complexity) and discuss the importance of a detective mindset to make the diagnosis. They share practical tips on the assessment and management of patients with frailty at the front door. Clare Bostock is a consultant geriatrician at NHS Grampian. Her areas of special interest include acute assessment, polypharmacy, falls, and quality improvement. She works in the geriatric assessment unit at Aberdeen Royal Infirmary. The geriatric medicine team at ARI started daily reviews of older people with frailty in the Acute Medical Admissions area in July 2022. She spent nearly 3 years working in the hospital at home team alongside acute work at ARI, and now works in ARI and at an intermediate care facility at Rosewell House. Dr Kat Ralston is a Geriatric Medicine Registrar and member of the RCPE Trainees and Members’ Committee, currently working in Edinburgh. --Useful Links-- Managing multiple medicines- https://rightdecisions.scot.nhs.uk/polypharmacy-guidance/ British Geriatrics Society Frailty module - https://www.bgs.org.uk/elearning/2023-frailty-identification-and-interventions Clinical Frailty Scale - https://www.bgs.org.uk/sites/default/files/content/attachment/2018-07-05/rockwood_cfs.pdf Think Delirium Toolkit-https://learn.nes.nhs.scot/2442/rrheal/education-networks/rural-teams-education-network/think-delirium-improving-the-care-for-older-people-delirium-toolkit The Geriatric 5M’s - https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.14979 Silver Book II – Geriatric Syndromes (British Geriatrics Society) - https://www.bgs.org.uk/resources/silver-book-ii-geriatric-syndromes ACB Calculator - https://www.acbcalc.com/ Managing Multiple Medicines: Anticholinergics Recommendations - https://rightdecisions.scot.nhs.uk/polypharmacy-guidance/hot-topics/anticholinergics/ Top Tips for Clinical Frailty Scale - https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale/cfs-guidance.html -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]