Clinical Conversations

In this episode, Dr Marilena Giannoudi discusses the role of the 'first fit' clinic and seizure diagnosis and management with Dr Richard Davenport. Dr Richard Davenport has been a Consultant Neurologist since 1999. While very much a general neurologist, he undertakes NHS first seizure, movement disorder and MND clinics, and has particular interests in education and training. Dr Davenport became President of the Association of British Neurologists (ABN) in May 2023. Outside of neurology, Dr Davenport enjoys cycling. Dr Marilena Giannoudi is the T&MC Podcast Lead and Vice-Chair for Careers and Communications. -- Link -- https://www.gov.uk/epilepsy-and-driving Recording date: 24 January 2023 -- 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 Jonny Bardgett discusses Guillain–Barré syndrome (GBS) with Dr Gavin Langlands. Topics include; what GBS is, when to suspect GBS and diagnose, when to start treatment and escalate and the prognosis and rehabilitation of patients. Dr Gavin Langlands is in their penultimate year of neurology Registrar training at the Institute of Neurological Sciences, Glasgow in the West of Scotland, with a developing interest in neuromuscular disorders. Recording Date: 07 December 2022 -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Jonathan Bardgett talks with Dr Zoë Fritz about treatment escalation plans and the ReSPECT process, contextualised with patient case vignettes. Dr Zoë Fritz is a Wellcome fellow in Society and Ethics, and a Consultant Physician in Acute Medicine at Addenbrooke’s Hospital, Cambridge. Her research is focused on identifying areas of clinical practice that raise ethical questions and applying rigorous empirical and ethical analysis to explore the issues and find effective solutions. This applied clinical ethics research allows her to translate ethical analysis into improving healthcare experience and outcomes. -- Links -- ReSPECT - https://www.resus.org.uk/respect REDMAP - https://www.spict.org.uk/red-map/ Recording date: 26 October 2022 -- 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 Hannah Preston interviews Dr Emma Lunan about physical activity, what advice to give patients about moving more and how doctors can get involved in the interesting field of Sports & Exercise Medicine. Dr Lunan (@emma_lunan) is a GP Partner and Consultant in Sports & Exercise Medicine and Chair of Movement for Health. --Useful Links-- Moving Medicine - https://scotland.movingmedicine.ac.uk/ Movement for Health - https://www.movementforhealth.scot/ British Association of Sports & Exercise Medicine (BASEM) - https://basem.co.uk/ Recording Date: 26 September 2022 -- 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 Amy Prideaux interviews Professor Patrick Kiely about giant cell arteritis (GCA; a.k.a. temporal arteritis), covering diagnosis and management of this rheumatology emergency. Professor Patrick Kiely is a consultant rheumatologist and Professor of Practice in Clinical Rheumatology. -- Links -- British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis https://doi.org/10.1093/rheumatology/kez672 Trial of Tocilizumab in Giant-Cell Arteritis https://doi.org/10.1056/NEJMoa1613849 Tocilizumab for treating giant cell arteritis – NICE Technology appraisal guidance [TA518] https://www.nice.org.uk/guidance/ta518 Sound issues: We apologise for the audio disturbances in this episode. Recording date: 24 August 2022 -- 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 Jonny Bardgett and Dr Jonny Guckian discuss abnormal skin lesions and how medics should approach them during the acute medical take. Dr Jonny Guckian is a dermatology registrar in Leeds. He is Co-Chair of the RCPE Trainees and Members' Committee, Director for Social Media and Communications for ASME and Podcast Associate Editor for the British Journal of Dermatology. --Useful Links-- https://dermnetnz.org/topics/seborrhoeic-keratosis - Seb K https://dermnetnz.org/topics/cutaneous-squamous-cell-carcinoma - SCC https://dermnetnz.org/topics/basal-cell-carcinoma - BCC https://dermnetnz.org/topics/melanoma - Melanoma https://dermnetnz.org/topics/abcdes-of-melanoma - ABCD https://www.royalmarsden.nhs.uk/information-gps/gp-resources/skin-cancer/skin-cancer-diagnosis - Glasgow 7 point checklist https://www.aad.org/media/stats-indoor-tanning - sunbed stats https://www.blackandbrownskin.co.uk/ and https://www.blackandbrownskin.co.uk/mindthegap - clinical signs on black and brown skin Recording Date: 21 July 2022 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Marilena Giannoudi talks with Victoria Watson about the role of the rapid access chest pain clinic (RACPC). Victoria Watson is an Advanced Clinical Practitioner in Cardiology at Bradford Teaching Hospitals and leads the chest pain service. Victoria has been qualified for 23 years always having worked in Cardiology. Dr Marilena Giannoudi is the T&MC Podcast Lead and Vice-Chair for Careers and Communications, and a clinical academic trainee in cardiology in Yorkshire and Humber. Recording date: 26 September 2022 -- 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 Lynsey Alexander gives us a valuable insight into the role, involvement and contribution of Occupational Therapists working in the Acute Medical Unit, as an essential part of the Multi-Disciplinary Team. Lynsey Alexander is an Occupational Therapist within the Medical assessment Unit. She also has a keen interest in quality improvement. Recording date: 9 August 2022 -- Follow us -- www.instagram.com/rcpedintrainees twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- events.rcpe.ac.uk/ Feedback: [email protected]

Dr Hannah Preston discusses toxidromes with Dr Euan Sandilands. In this episode of Clinical Conversations, Dr Hannah Preston discusses toxidromes (different poisoning presentations) and their management in the acute medical unit (AMU) with Dr Euan Sandilands, with a focus on hyperthermic toxidromes. Dr Euan Sandilands is Consultant Physician at the Royal Infirmary of Edinburgh, Honorary Senior Clinical Lecturer at the University of Edinburgh, and Director of the National Poisons Information Service - Edinburgh unit. Dr Hannah Preston is a Renal Registrar in Edinburgh and Co-Chair of RCPE's Trainees and Members' Committee (T&MC). -- Link -- TOXBASE: https://www.toxbase.org/ Recording date: 1 August 2022 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

This week on Clinical Conversations we have two episodes on clinical skills. In the second episode, Dr Jonathan Bardgett talks with Dr Sarbjit Clare about Point of Care Ultrasound (PoCUS) and its use in clinical practice. Dr Sarb Clare MBE is the Deputy Medical Director and Acute Medical Consultant at Sandwell and West Birmingham NHS Trust. She is the NHSEI Midlands Regional Advisor for AIM. She was the first appointed Acute Physician at City Hospital in 2008 where she set up Acute Medicine from infancy and she has been pivotal in developing acute medicine regionally and nationally. She is a national pioneer in Point of Care Ultrasound (POCUS) which she lectures and teaches on nationally. She runs a yearly course “Ultrasound at the Front Door” and has created many free online learning tools and released her first medical book “Ultrasound For the Generalist – A Guide to Point of Care Imaging” with Cambridge University Press in 2021. Recording date: 11 August 2022 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

This week on Clinical Conversations we have two episodes on clinical skills. In the first episode, Dr Jonathan Bardgett and Dr Anda Bularga talk with Professor Andrew Elder about clinical skills in postgraduate medicine. They discuss how medical education has changed over the years internationally. Professor Andrew Elder is the President of the Royal College of Physicians of Edinburgh (RCPE) and an NHS Consultant in Medicine for Older People. Since 2013 he has built collaborations with a number of centres in North America, most notably Stanford and Johns Hopkins, serving as a Visiting Scholar and Fellow at the former, where he has supported teaching and assessment of core bedside skills and co-founded the Society of Bedside Medicine to promote those skills. Recording date: 19 July 2022 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Marilena Giannoudi discusses pericardial disease with Professor Abdallah Al-Mohammad. In this episode of Clinical Conversations, Dr Marilena Giannoudi discusses pericardial disease with Professor Abdallah Al-Mohammad. Professor Al-Mohammad provides a detailed overview of pericardial disease and offers helpful insights, especially highlighting the importance of gaining detailed histories and requesting targeted investigations when receiving these patients at the front door. Professor Al-Mohammad is a Consultant Cardiologist and Professor of Cardiology for Sheffield Teaching Hospital. Their interests are in heart failure, infective endocarditis and cardiac imaging. -- 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 Kate McLaren shares her experiences with Dr Hannah Preston of non-invasive ventilation (NIV), also discussing who needs to be involved in the process. Dr Kate McLaren is a Consultant in Respiratory Medicine with a particular interest in the integrated management of chronic lung disease. Recording date: 28 June 2022.

This week on Clinical Conversations Dr Jonathan Bardgett talks with Mr James Milburn and Dr Umesh Basavaraju about jaundice and patients presenting with or without accompanying pain. By discussing cases and highlighting the surgical and gastroenterological focus, both speakers offer helpful advice and advocate for the multidisciplinary approach when treating jaundiced patients. Mr Milburn is a Consultant General & Hepatobiliary Surgeon at Aberdeen Royal Infirmary. Dr Basavaraju is a Consultant Gastroenterologist at Aberdeen Royal Infirmary. Their main interest is interventional endoscopy in biliary and pancreatic conditions. Recording date: 21 June 2022. -- 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 of Clinical Conversations Dr Jonathan Bardgett interviews Dr Gourab Choudhury on Chronic Obstructive Pulmonary Disease (COPD). Drs Bardgett and Choudhury discuss what COPD is, why it is important to recognise its symptoms and talk through a case to give advice on how to manage a COPD exacerbation in the Acute Medical Unit. Dr Choudhury is a Respiratory Consultant at the Royal Infirmary of Edinburgh and the Respiratory Managed Clinical Network Lead in NHS Lothian. Recording date: 28 June 2022. -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Drs Bardgett and Guckian in conversation about recruitment. This week, Drs Jonny Bardgett and Jonny Guckian share their experiences of medical recruitment, discuss the application points system and give advice on how to utilise your skills and experience in application and interview. --Useful Links-- Oriel - https://www.oriel.nhs.uk/Web/ IMT Recruitment - https://www.imtrecruitment.org.uk/recruitment-process/applying/application-scoring HST Recruitment - https://phstrecruitment.org.uk/recruitment-process/applying/application-scoring Recording date: 21 July 2022. -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Marilena Giannoudi discusses with Drs Jivendra Gosai and Louise Mundy, their experience of taking part in Out of Programme Opportunities, the variety of opportunities available and how to get the most out of these opportunities. -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Hannah Preston interviews Professor Tony Heagerty on the clinical management of hypertension, including lifestyle changes to lower blood pressure. Professor Tony Heagerty is Head of the School of Medical Sciences in The University of Manchester and Honorary Consultant Physician/Professor of Medicine at Manchester Foundation Trust. He is Past President of the British Hypertension Society, European Society of Hypertension and International Society of Hypertension. His research interests are in hypertension management, diabetes and obesity. Recording date: 17 May 2022 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Kate Gatenby discusses with Dr Marilena Giannoudi the various aspects of this fascinating specialty and describes her journey so far. Recording date: 18 March 2022 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Jonny Guckian and Dr Jonny Bardgett discuss the variety and severity of dermatological conditions presenting in Acute Medicine. Dr Jonny Guckian is a dermatology registrar in Leeds. He is Co-Chair of the RCPE Trainees and Members' Committee, Director for Social Media and Communications for ASME and Podcast Associate Editor for the British Journal of Dermatology. Recording date: 5 May 2022 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Jonathan Bardgett interviews Dr Damian Fogarty on why Acute Kidney Injury and Chronic Kidney Disease is so important and talk through cases to give tips on managing a patient in the acute take. Dr Fogarty is a Consultant Nephrologist in the Belfast Trust. His current post, in a tertiary referral centre, manages patients with Acute Kidney Injury and Chronic Kidney Disease including those requiring dialysis or transplantation. https://twitter.com/DamianFog --Useful Information-- This podcast although pre-recorded is a spontaneous conversation & as such recommendations and advice need taken in context with written and proof-read reviews such as within these references: Acute kidney injury: prevention, detection and management NICE guideline Published: 18 December 2019 www.nice.org.uk/guidance/ng148 PDF at https://www.nice.org.uk/guidance/ng148/resources/acute-kidney-injury-prevention-detection-and-management-pdf-66141786535621 BMJ Quality Improvement Programme Acute Kidney Injury: It’s as easy as ABCDE Caroline Forde, Jennifer McCaughan, Niall Leonard https://bmjopenquality.bmj.com/content/1/1/u200370.w326 BMJ Quality Improvement Reports 2013; 2, No. 1 u200370.w326 doi: 10.1136/bmjquality.u200370.w326 The 'ABCDE' checklist (Address drugs, Boost blood pressure, Calculate fluid balance, Dip urine, Exclude obstruction) was introduced to prompt AKI management. In NHS England there is a mandated AKI programme under the umbrella term of ‘Think Kidneys’ (https://www.thinkkidneys.nhs.uk/). As part of this there is a national audit with data collection using laboratory AKI e-alerts and managed by the UK Renal Registry-UK Kidney Association in association with NHS England. This service estimates that one in five emergency admissions into hospital are associated with acute kidney injury and potentially up to 100,000 deaths in secondary care are associated with acute kidney injury with perhaps 25-30% potentially preventable. (National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Adding Insult to Injury 2009)https://www.ncepod.org.uk/2009aki.html. AKIN stages: An increase of more than 26μmol/l above baseline (within a 48hr period) OR An increase of more than or equal to 1.5 to 2 fold from baseline An increase of more than or equal to 2 to 3 fold from baseline An increase of more than 3 fold from baseline OR Serum creatinine ≥355μmol/l with an acute rise of at least 45μmol/l OR Initiation of RRT Recording date: 30 May 2022 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

T&MC members Jonathan Bardgett and Anda Bularga interview Drs Matthew Watto and Paul Williams, founding members of the US Internal Medicine podcast ‘The Curbsiders’. The group compare the similarities and differences in medical training pathways within the United States and United Kingdom and discuss their experiences of creating a medical podcast series. --Useful Links-- Curbsiders Podcast - https://thecurbsiders.com/ https://twitter.com/thecurbsiders https://twitter.com/DoctorWatto https://twitter.com/PaulNWilliamz Recording date: 10 June 2022 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Hussun-Ara Shah interviews Dr Phil Crosbie about the Lung Health Check Pilot, the new national lung health checks and supporting patients with smoking cessation. Dr Crosbie is a Senior Lecturer and Honorary Consultant in Respiratory Medicine at the University of Manchester. His main clinical and research interest is lung cancer with a specific focus on early detection and screening. Phil is research lead for the Manchester Lung Health Check Service and co-chief investigator of the Yorkshire Cancer Research funded Yorkshire Lung Screening Trial. He is also member of the national Targeted Lung Health Check Expert Advisory Group and Early Detection lead for Cancer Research UK’s Lung Cancer Centre of Excellence. Recording date: 4 March 2022 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Anda Bularga interviews Dr Eoin O'Sullivan about cognitive bias and how it impacts on clinical decision making. Dr Eoin O'Sullivan is a Kidney Research UK Research Fellow at the University of Edinburgh and a Renal Registrar at the Department of Renal Medicine at the Royal Infirmary of Edinburgh. Recording date: 26 February 2022 -- Useful Links -- https://twitter.com/eoinrenal Society to Improve Diagnosis in Medicine - https://www.improvediagnosis.org/ -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Jonathan Bardgett interviews Dr Gill Aitken, Programme Director of Clinical Education postgraduate study at the University of Edinburgh. Gill and Jonathan discuss the difference between Medical Education and Clinical Education, mentorship and tips on creating helpful teaching sessions. -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Jim Parry talks to Dr Ashling Lillis about Acute Oncology and Oncology in the AMU. Dr Ashling Lillis is a consultant and Clinical Lead for Acute Medicine at Whittington Hospital in London and is also a National Clinical Advisor for Macmillan Cancer Support. -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Hannah Preston interviews Professor James Dear on paracetamol overdose in the Acute Medical Unit, the role of NAC and the new SNAP regime. Professor Dear is Professor of Clinical Pharmacology at the University of Edinburgh and Consultant Clinical Toxicologist in NHS Lothian and for the National Poisons Information Service. Recording date: 20 January 2022 -- Useful Links -- https://www.toxbase.org/ https://toxandhound.com/ https://twitter.com/EdinClinTox -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Patrick Kiely discusses with Dr Amy Prideaux the advances made in his career in rheumatology, what this has meant to patients, and why this is such a fascinating specialty. -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr James Parry talks to Dr Anna Olsson-Brown about Immuno-oncology and managing patients on immunotherapies during the acute take. Dr Olsson-Brown is a consultant medical oncologist at the Clatterbridge Cancer Centre. Throughout her clinical work she has been involved with the use of oncological immunotherapies, their uses and toxicities. -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Anda Bularga discusses with Dr Meghan Perry, the variety and complexity of cases which present with pyrexia of unknown origin, and how experience, clinical skill and detective work contribute in this fascinating area of medicine. Recording date: 23 June 2021 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Bardgett asks Drs Oliver Koch and Frauke Weidanz about their ongoing experiences of the COVID-19 pandemic. -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Rachel Sutherland talks to Dr Jon Miles about the importance of good management of ambulatory care patients in a same day emergency care setting. Dr Miles is a recently retired Consultant in Acute & General Medicine with particular interest in Same Day Emergency Care. Dr Rachel Sutherland is Consultant in Acute Medicine specialising in Same Day Emergency Care. -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Jonathan Bardgett interviews Dr Gillian Bain about managing Inflammatory Bowel Disease. Dr Bain is a consultant gastroenterologist at Aberdeen Royal Infirmary and is Trainee Programme Director for Gastroenterology in the north of Scotland. -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Jonathan Bardgett interviews Dr Rob Hallifax about Pneumothoraces. Dr Hallifax is an NIHR Academic Clinical Lecturer the University of Oxford. He studied an MSc in Natural Sciences in Cambridge before training in medicine at the University of Oxford. He won an MRC Clinical Training Fellowship for his DPhil: "Understanding Pneumothorax: epidemiology, physiology and outcomes". Dr Hallifax was the trial coordinator for RAMPP (Randomised Ambulatory Management of Primary Pneumothorax) - the largest primary pneumothorax trial in Europe. He has recently published on pneumothorax in JAMA and Lancet. == Recent publications == Management of primary spontaneous pneumothorax: less is more - http://doi.org/10.1016/s0140-6736(20)32676-3 Trends in the Incidence and Recurrence of Inpatient-Treated Spontaneous Pneumothorax, 1968-2016 - http://doi.org/10.1001/jama.2018.14299 Conservative versus Interventional Treatment for Spontaneous Pneumothorax - http://doi.org/10.1056/NEJMoa1910775 Ambulatory management of primary spontaneous pneumothorax: an open-label, randomised controlled trial - https://doi.org/10.1016/S0140-6736(20)31043-6 https://www.ndm.ox.ac.uk/team/robert-hallifax

Dr Bularga discusses medical training and delivery of healthcare in Malawi with Dr Isaac Chirwa, Consultant Endocrinologist in Lilogwe and Dr Michael MacKenzie, Consultant in Infectious Diseases in Lilogwe. Both Dr Chirwa and Dr MacKenzie have experience of undergraduate and postgraduate medical training in the UK and Malawi.

Dr Bularga discusses the effects of the COVID-19 pandemic in Malawi and its impact on the country's healthcare system. Dr Isaac Chirwa and Dr Michael MacKenzie share their experience over the past 18 months including the set up of the vaccination programme. We also give a timely update on the Omicron variant and its impact on the healthcare system in Malawi and other parts of Africa so far.

Dr Jonathan Bardgett interviews Dr David Breen about Parkinson's Disease. How PD is diagnosed, and discussion of different therapies used to treat, therapies to avoid, and side-effects of medications. Dr Breen is a Senior Clinical Research Fellow at the University of Edinburgh and Honorary Consultant Neurologist at NHS Lothian. He completed neurology and research training in Cambridge and London, before moving to Toronto as a post-CCT Movement Disorders Fellow. He specialises in the assessment and treatment of people with all types of movement disorders.

Dr Jonathan Bardgett interviews Dr Ollie Lloyd about the types and causes of meningitis and the approach to identifying when the patient presents, management and when to carry out a lumbar puncture and what to look for. Dr Lloyd is a registrar (ST5) in Infectious Diseases at RIDU, Western General Hospital, Edinburgh -- Resources -- https://doi.org/10.1002/14651858.cd004405.pub5 https://doi.org/10.1016/j.jinf.2016.01.007 https://doi.org/10.1136/emj.2009.075598 https://doi.org/10.1056/nejmoa040845

Dr Rachel Williamson discusses the assessment and management of patients presenting to the Acute Medical Unit with signs and symptoms of thyroid disease. Dr Williamson is a consultant endocrinologist at the Borders General Hospital, with an interest in teaching and medical education. She is also Secretary of the Scottish Society of Physicians. -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr David Ryan interviews Dr Xiao Liu about machine learning in diagnostic testing, the current state of research and use in real-world medicine. Dr Liu is an ophthalmology doctor and clinical researcher at the University of Birmingham and University Hospitals Birmingham. She is interested in clinical evaluation and implementation of digital health technologies (particularly machine learning algorithms as diagnostic tests) to improve patient care and healthcare delivery. Her recent work has been around identifying gaps in reporting and methodology in clinical AI studies, and providing guidance for clinicians to critically appraise the evidence supporting AI health systems. She led the development of the SPIRIT-AI and CONSORT-AI guidelines - new reporting guidelines for AI clinical trials. She also plays an advisory role to NHS X, the AI in health and care award and the WHO/ITU focus group for AI for Health. -- Resources -- A comparison of deep learning performance against health-care professionals in detecting diseases from medical imaging: a systematic review and meta-analysis - https://doi.org/10.1016/S2589-7500(19)30123-2 -Spirit and Consort AI- https://www.spirit-statement.org/ http://www.consort-statement.org/ In silico - by means of computer modelling or computer simulation.

Dr George Thomas interviews Dr Mike Wilkinson about the role of SAS doctors, how and why doctors might consider this type of role, and the route to the specialist register via CESR. Dr Wilkinson is an Associate Specialist in Geriatrics and SAS Tutor for Gateshead Health NHS Foundation Trust. HEE NE & North Cumbria Associate Dean for SAS Doctors & Dentists, and SAS Representative for RCPE Trainees & Members’ Committee. -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees

Dr Phil Reid, a Respiratory Consultant in Edinburgh, talks about assessing the patient with lung cancer in the acute medical admissions unit. -- Follow us on Instagram -- https://www.instagram.com/rcpedintrainees

Dr Tina Ryan interviews Dr Lara Mitchell about syncope. They discuss assessment, the importance of a history taking, driving advice, and how to setup a syncope service. Dr Mitchell is a Consultant Geriatrician at the Queen Elizabeth University Hospital in Glasgow where she setup a syncope service. -- Resources -- Syncope Unit Rationale - https://doi.org/10.1093/europace/euv115 Syncope pathway article (Br J Cardiol 2019;26:133–6) - http://dx.doi.org/10.5837/bjc.2019.040 ESC Guidelines - https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Syncope-Guidelines-on-Diagnosis-and-Management-of Nice Guidelines - https://www.nice.org.uk/guidance/conditions-and-diseases/neurological-conditions/transient-loss-of-consciousness -- Follow us on Instagram -- https://www.instagram.com/rcpedintrainees

Dr Anda Bularga interviews Dr Justin McKee, Consultant in Medical Ophthalmology in NHS Lothian. He talks about the ocular manifestations of systemic illnesses and clinical presentation and management of these patients. Dr McKee also gives an overview of the training path and a career in Medical Ophthalmology. Dr McKee works between the Princess Alexandra Eye Pavilion and Department of Clinical Neurology in Edinburgh, specialising in diabetic retinopathy, Uveitis, Thyroid eye disease and Neuro-ophthalmology. Ophthalmology specialty training - https://www.jrcptb.org.uk/specialties/medical-ophthalmology - https://www.rcophth.ac.uk/ Recording date: 9 July 2021

Dr Tina Ryan talks to Dr Rosie Baruah about microaggressions, how to recognise them and actions you can take. Dr Baruah is a Consultant in Intensive Care Medicine, Western General Hospital and Hon. Clinical Senior Lecturer, University of Edinburgh -- The Seven Acts of Allyship -- Appetite – Do you have the appetite to immerse yourself in the complex, emotive world of race equality? Ask – Ask questions about race, be curious, read, learn and educate yourself. Accept – Accept there is really a problem. More data aren’t needed. Acknowledge – Openly acknowledge that the problem needs to be dealt with. Apologise – Express sympathy that racism is affecting people of certain races. Assume – Don’t. Instead develop informed views by seeking to understand individuals. Action – Take demonstrable action steps to establish equality and be accountable. 7 A's Infographic - https://twitter.com/yvonnecoghill1/status/1280744970102636550 https://twitter.com/rosieICM

Dr Jonathan Bardgett interviews Dr Murray Blackstock, a Consultant in Intensive Care Medicine and Anaesthesia. He talks about the presentation and management of patients with subarachnoid haemorrhage (SAH) and gives some useful advice on how to refer these patients to neurosurgery and critical care. He refers to NICE guidance and his own personal experience of managing the patient with acute onset headache. NICE Guidelines - https://www.nice.org.uk/guidance/conditions-and-diseases/cardiovascular-conditions/cranial-aneurysms

Dr Jonathan Bardgett interviews Dr Snehashish Banik about the importance and practicalities of using point of care ultrasound in the acute medical admissions unit. He talks about how trainees can learn this specialist skill. Dr Banik is Consultant Physician in Acute and General Internal Medicine. He is a FAMUS (Focused Acute Medicine Ultrasound) supervisor in Scotland. www.acutemedicine.org.uk/famus/ www.famus.org.uk FAMUS YouTube - www.youtube.com/channel/UCW5COwTFePkExC2CMkgj-gA/videos

Dr David Ryan interviews Prof Emma Baker and Dr Dipender Gill about Clinical Pharmacology discussing their day to day experiences and why everyone should consider it as a specialty. British Pharmacological Society www.bps.ac.uk Professor Baker is Professor of Clinical Pharmacology, St George's, University of London with an interest in polypharmacy, translational research and education. Clinical Vice President of the British Pharmacological Society, with the remit of promoting Clinical Pharmacology and Therapeutics as a medical specialty. Training Programme Director for Clinical Pharmacology and Therapeutics in London with a passion for making sure that specialty training is excellent! Dr Gill work at St. George's Hospital and St. George's, University of London, where he is appointed as a an NIHR Clinical Lecturer. Dipender also works flexibly as a Specialist in the Genetics Department of the Novo Nordisk Research Centre in Oxford and has continued an honorary affiliation at Imperial College London, where he is supported by the British Heart Foundation Centre of Research Excellence.

Dr Martin Wilson, a Consultant in Medicine of the Elderly, talks about Frailty and Polypharmacy. Dr Wilson is a Consultant in Care of the Elderly, Raigmore Hospital, Inverness. Interest in care of the elderly in remote rural areas, community hospitals and Parkinson's Disease. Commissioner on Committee for Human Medicines MHRA. Long standing interest in Polypharmacy and involved in NHS Scotland's Polypharmacy Guideline from the outset. Polypharmacy Guidance: Realistic Prescribing, 3rd edition (2018) https://managemeds.scot.nhs.uk/

Dr Alastair MacGilchrist talks about alcohol-related liver disease and alcohol dependence. He discusses how to prevent, assess and treat patients with this disease and talks about public health initiatives on this area of medicine. Scottish Health Action on Alcohol Problems (SHAAP): https://shaap.org.uk