Today, we're taking a close look at one of ANZCA's latest professional documents - PG67: Guideline for the care of patients at the end-of-life who are considered for surgery or interventional procedures 2022.

Resources for this episode:

PG67: Guideline for the care of patients at the end-of-life who are considered for surgery or interventional procedures 2022

PG67 BP: Guideline for the care of patients at the end-of-life who are considered for surgery or interventional procedures Background Paper 2022

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you!

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.

Thanks for listening, and happy studying!

Today, we're tackling the absolutely mammoth topic of hyponatremia after JAMA recently published a fantastic article about its diagnosis and management.

Part 2's episode focuses on determining the cause of a patient's hypotonic hyponatremia. From here we also go on to discuss the pathophysiology of both the Syndrome of Inappropriate ADH secretion (or SIADH) and cerebral salt wasting before discussing the markedly different managements for these two conditions.

Lastly, we talk through the principles of managing hyponatremia.

Resources for today's episode:

Diagnosis and Management of Hyponatremia - A Review by Adrogue, H.J., Tucker, B.M. and Madras, N.E. (JAMA)

Hyponatremia StatPearls

Up to Date articles:

• Causes of hyponatremia without hypotonicity
• Causes of hypotonic hyponatremia in adults
• Diagnostic evaluation of adults with hyponatremia
• Overview of treatment of hyponatremia in adults
• Pathophysiology and aetiology of the syndrome of inappropriate antidiuretic hormone secretion (SIADH)
• Treatment of hyponatremia: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and reset osmostat
• Cerebral salt wasting

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you!

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.

Thanks for listening, and happy studying!

Today, we're tackling the absolutely mammoth topic of hyponatremia after JAMA recently published a fantastic article about its diagnosis and management.

We start with a review of some relevant physiology before talking about the ways in which hyponatremia can present, and the approach to determining the underlying cause of the hyponatremia.

In this episode, we specifically talk about determining whether the patient has either hypertonic, isotonic or hypotonic hyponatremia, as well as a discussion of the causes of hypertonic and isotonic hyponatremia. From here, we go on to focus on the relevant history and examination when working up a patient with hypotonic hyponatremia in order to further sub classify their hypotonic hyponatremia as being hypovolaemic, euvolaemic or hypervolaemic.

Resources for today's episode:

Diagnosis and Management of Hyponatremia - A Review by Adrogue, H.J., Tucker, B.M. and Madras, N.E. (JAMA)

Hyponatremia StatPearls

Up to Date articles:

• Causes of hyponatremia without hypotonicity
• Causes of hypotonic hyponatremia in adults
• Diagnostic evaluation of adults with hyponatremia
• Overview of treatment of hyponatremia in adults
• Pathophysiology and aetiology of the syndrome of inappropriate antidiuretic hormone secretion (SIADH)
• Treatment of hyponatremia: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and reset osmostat
• Cerebral salt wasting

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you!

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.

Thanks for listening, and happy studying!

Today, we share our fourth and final discussion in our four part series about statistics with Dr Shannon Morrison. 

In this episode, we discuss the following topics:

• the research methodology for designing a clinical trial
• pilot trials
• bias and confounding
• ethics committees and the process of ethics approval
• Forest plots

Resources for today's episode:

Zedstatistics (youtube channel) - short videos explaining various concepts in statistics from an Australian Statistician

Johns Hopkins Coursera Short Course - Biostatistics in Public Health (this course has free enrolment and takes approx 4 months to complete - it commenced on January 30th)

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you!

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.

Thanks for listening, and happy studying!

Today, we share our third discussion in our four part series about statistics with Dr Shannon Morrison. 

In this episode, we discuss the following topics:

• sensitivity and specificity
• positive predictive values (PPV) and negative predictive values (NPV)
• risk ratios
• odds ratios
• number needed to treat (NNT) and number needed to harm (NNH)

And here are the calculations for Shannon's working example of sensitivity, specificity,  PPV and NPV (looking at diagnostic tests for the covid-19 pandemic):

Part 1 - PCR tests for Covid-19 (2020):

Let’s say that the prevalence of COVID was 1 in 100,000 people.  PCR testing has (roughly) sensitivity of 90% and specificity of 99%.

That means, if you took 1,000,000 people and did a PCR test for COVID:

• 10 people actually had COVID
• 9 of those 10 people would test positive (sensitivity 90%) - and that means 1 of those 10 people would test negative
• 999,990 people did not have COVID
• 989,990 of those people would correctly test negative (sensitivity 99%)
• So that means 10,000 people would incorrectly test positive

From those numbers:
10,009 people tested positive
9/10,009 correctly tested positive - so the PPV is 0.09%

And:
989991 people tested negative
989990/989991 correctly tested negative - so the NPV is 99.99%

Part 2 - PCR tests for Covid-19 (2022):

Now let’s say that 1 in 100 people have COVID.  Let’s say we do a PCR test on one million people again.

Now:

• 10,000 people have COVID, and 9,000 of them test positive (so 1,000 of them test negative)
• 990,000 people do not have COVID - 980,100 of them test negative (and 9,900 test positive)
• PPV = 9000/(9000+9900) = 47.6%
• NPV = 99.89%

The test hasn’t changed - but now if you get a positive result, there is a 47.6% chance of it being true. 

So for the same test: as the prevalence increases, the PPV increases (0.09% ⇒ 47.6%) and the NPV decreases (99.99% → 99.89%).

Part 3 - RAT tests for Covid-19:

Let’s just accept an overall sensitivity of 60% and specificity of 99%.  

We’re going to test a million people again.

10,000 people have COVID
6000 will correctly test positive (sensitivity 60%)
That means 4000 incorrectly test negative

990,000 people do not have COVID
980,100 of them will correctly test negative (99% specificity)
9,900 will incorrectly test positive

As the sensitivity decreases, the number of false positives don’t change, but the number of false negatives increases - in this case, from 1000 to 4000.

And (you can take my word for this one!) - as the specificity decreases, the number of false negatives doesn’t change but the number of false positives increases.

Resources for today's episode:

Zedstatistics (youtube channel) - short videos explaining various concepts in statistics from an Australian Statistician

Johns Hopkins Coursera Short Course - Biostatistics in Public Health (this course has free enrolment and takes approx 4 months to complete - it commenced on January 30th) 

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you!

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.

Thanks for listening, and happy studying!

Today, we share our second discussion in our four part series about statistics with Dr Shannon Morrison. 

In this episode, we discuss the following topics:

• sample size, power and hypothesis testing
• type I and type II error (further discussion)
• levels of evidence and what this means
• the different types of clinical trials

Resources for today's episode:

Zedstatistics (youtube channel) - short videos explaining various concepts in statistics from an Australian Statistician

Johns Hopkins Coursera Short Course - Biostatistics in Public Health (this course has free enrolment and takes approx 4 months to complete - it commenced on January 30th)

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you!

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.

Thanks for listening, and happy studying!

Today, we're having our first discussion of our four part series about statistics with Dr Shannon Morrison. 

In this episode, we discuss the following topics:

• types of data (quantitative vs qualitative)
• descriptive statistics (measures of central tendency and measures of variability)
• Central Limit Theorem
• hypothesis testing
• type I and type II error
• p-values 
• parametric and non-parametric tests for data analysis

Resources for today's episode:

Zedstatistics (youtube channel) - short videos explaining various concepts in statistics from an Australian Statistician

Johns Hopkins Coursera Short Course - Biostatistics in Public Health (this course has free enrolment and takes approx 4 months to complete - it commenced on January 30th)

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you!

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.

Thanks for listening, and happy studying!

Deep Breaths returns next Monday February 6th with a wonderful selection of topics that we're sure will help with exam prep, and will keep your practice up to date. We'll also be joined by more wonderful guests this season and we can't wait to share their expertise with you all, so be sure to tune in and experience the learning revolution! 

Lahiru Amaratunge's Viva Boot Camp (live Zoom course) - Anaesthesia Collective Link:
https://www.anaesthesiacollective.com/viva-boot-camp/

Lahiru Amaratunge's Viva Boot Camp online course (for those unable to make it to the live Zoom sessions):
https://anaesthesia.thinkific.com/courses/FinalExam 

Please forgive us - we made an error when recording (oopsie!). The online course is actually $111.00 but is only $55.00 when the deepbreaths50 discount code is applied. There are only 100 of these discount codes available for use so book now and don't miss out!

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you!

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.

Thanks for listening, and happy studying!

Deep Breaths returns on Monday February 6th with our fortnightly release schedule that we hope you're all still enjoying. We hope you take the time over the holiday break to rest up and refill your energy stores before 2023 kicks off.

Season 6 will see us tackle more new topics that we hope will keep you up to date in your practice, and to help our exam candidates prepare for the ANZCA part 2 anaesthetic exam. We're excited to introduce some new guest interviewees that are masters in their practice and who are keen to share what they know with us all.

Feel free to email us at [email protected] with any questions, comments or suggestions. 

Until next season, happy studying and thanks for listening. 

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you!

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.

Thanks for listening, and happy studying!

In today's episode, we discuss some recently published guidelines in the journal Anaesthesia regarding the provision of environmentally sustainable anaesthesia. 

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you!

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode. 

Thanks for listening, and happy studying! 

Resources for today's episode:

Principles of environmentally-sustainable anaesthesia: a global consensus statement from the World Federation of Societies of Anaesthesiologists 

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you!

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.

Thanks for listening, and happy studying!