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

-- Upcoming RCPE events --

https://www.rcpe.ac.uk/events

-- Become an RCPE Member --

https://www.rcpe.ac.uk/membership/join-college

Feedback: [email protected]

This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).

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

-- 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

-- Upcoming RCPE events --

https://www.rcpe.ac.uk/events

-- Become an RCPE Member --

https://www.rcpe.ac.uk/membership/join-college

Feedback: [email protected]

This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).

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

-- Upcoming RCPE events --

https://www.rcpe.ac.uk/events

-- Become an RCPE Member --

https://www.rcpe.ac.uk/membership/join-college

Feedback: [email protected]

This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).

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

-- Upcoming RCPE events --

https://www.rcpe.ac.uk/events

-- Become an RCPE Member --

https://www.rcpe.ac.uk/membership/join-college

Feedback: [email protected]

This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).

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

-- Upcoming RCPE events --

https://www.rcpe.ac.uk/events

-- Become an RCPE Member --

https://www.rcpe.ac.uk/membership/join-college

Feedback: [email protected]

This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).

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

-- Upcoming RCPE events --

https://www.rcpe.ac.uk/events

-- Become an RCPE Member --

https://www.rcpe.ac.uk/membership/join-college

Feedback: [email protected]

This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).

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

-- Upcoming RCPE events --

https://www.rcpe.ac.uk/events

-- Become an RCPE Member --

https://www.rcpe.ac.uk/membership/join-college

Feedback: [email protected]

This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).

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

-- Upcoming RCPE events --

https://www.rcpe.ac.uk/events

-- Become an RCPE Member --

https://www.rcpe.ac.uk/membership/join-college

Feedback: [email protected]

This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).

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

-- Upcoming RCPE Events --

https://www.rcpe.ac.uk/events

Feedback: [email protected]

This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).