Clinical Conversations

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

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

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

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

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

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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 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

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

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/

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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 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

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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 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

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

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

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

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

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

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

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