Clinical Conversations

Dr Roger Smyth, Consultant Liaison Psychiatrist, talks about the mental health aspects of alcohol misuse, management of alcohol withdrawal syndrome and the process of liver transplantation assessment.

Dr Jack Andrews gives an overview of the recent updates in the assessment and management of patients with acute coronary syndrome. We discuss immediate management and long term risk stratification of patients with myocardial infarction. Dr Jack Andrews is a senior cardiology registrar specialising in interventional cardiology, currently working at the Royal Infirmary of Edinburgh.

Dr Vicky Tallentire discusses her career in medical education and explains how medical trainees can get involved in simulation training and research. She reflects on her time as an education fellow, an education coordinator at the Scottish Centre for Simulation and Clinical Human Factors (SCSChf) and her other roles. Dr Tallentire is a Consultant in Acute Medicine, an Associate Postgraduate Dean and a simulation enthusiast and facilitator at SCSChf. She is a passionate believer in being able to admit, understand and learn from mistakes in all aspects of life. Resources: https://www.asme.org.uk https://scschf.org/courses/ https://www.scotlanddeanery.nhs.scot/trainee-information/internal-medicine-training-imt-simulation-programme/ https://www.ed.ac.uk/medicine-vet-medicine/postgraduate/clinical-education

Dr Jonathan Bardgett interviews Prof Najib Rahman about the assessment and management of patient's presenting with pleural effusion. Professor Rahman runs the Oxford Pleural Unit and Directs the Oxford Respiratory Trials Unit. He is co-chair of the BTS Pleural Guidelines 2021, Chair of the BTS Pleural Intervention Committee, and Chair of multiple ERS guidelines on pleural disease. British Thoracic Society - Guidelines https://www.brit-thoracic.org.uk/quality-improvement/guidelines/ American Thoracic Society - Guidelines https://doi.org/10.1513/AnnalsATS.201809-620CME My Pleural Effusion https://mypleuraleffusionjourney.com/ Training Standards for Thoracic Ultrasound http://dx.doi.org/10.1136/bmjresp-2019-000552 RAPID Score for Pleural Infection https://www.mdcalc.com/rapid-score-pleural-infectionl

Dr Jonathan Bardgett talks to Dr Ingrid Hoeritzauer about functional neurological disorders, how to diagnose them and discuss the positive features necessary to make a diagnosis with patients and their families. Resources: Recognising and explaining functional neurological disorder https://www.bmj.com/content/371/bmj.m3745/infographic https://www.neurosymptoms.org https://twitter.com/FndPortal

Dr Rachel Sutherland interviews Prof Mark Strachan about how to approach the hyperglycaemic patient who presents in the acute receiving unit. Professor Mark Strachan is a Consultant Physician in Endocrinology, Diabetes and Acute Medicine at the Western General Hospital, Edinburgh and Honorary Professor of the University of Edinburgh. Dr Sutherland is a Consultant in Stroke and General Medicine in the South East of Scotland. She has an interest in integrated, real time analytics and spent some time outside of medicine working as a medical informaticist. She is a passionate advocate for Flexible working and training for doctors. Feedback and suggested future topics are very welcome, please contact us via email at: [email protected]

Dr Rachel Sutherland talks to Prof Mark Strachan about C-Peptide, and how it can be used to help identify the underlying cause of diabetes. Professor Mark Strachan is a Consultant Physician in Endocrinology, Diabetes and Acute Medicine at the Western General Hospital, Edinburgh and Honorary Professor of the University of Edinburgh. Feedback and suggested future topics are very welcome, please contact us via email at: [email protected]

Dr Claire Gordon talks about 'Leadership and management in the Acute Medical Unit' with Dr Jonathan Bardgett. Dr Gordon is an Acute Medical Consultant working South East Scotland. She shares her experience of leadership and management during the COVID-19 pandemic and discusses working with Acute Internal Medicine. Recording date: 15 February 2021

Dr Xan Hughes (pronouns they/them) talks to Dr David Ryan (pronouns he/him) about being an openly transgender doctor working in the NHS. The topics covered include an introduction to some common terminology relevant to talking about trans healthcare and about how easy changes to practices can help both trans colleagues and patients have a better experience. Dr Xan Hughes, is a Foundation Year Two (FY2) doctor working at a large London teaching hospital. Their research interests include barriers to healthcare and widening access especially to preventative care. Recording date: 14 February 2021

Dr Dominique Baker, senior Registrar in Obstetrics and Gynaecology in the South East of Scotland Deanery gives us an overview of acute medical problems in pregnancy, we talk about the clinical assessment and multidisciplinary management of these patients. Resources Maternity Early Warning Score: https://ihub.scot/media/5308/national-mews-chart_web.pdf Prescribing in pregnancy(BUMPS: https://www.medicinesinpregnancy.org Recording date: 1 February 2021

Dr James Tiernan, a Respiratory Consultant in South East Scotland, talks about the investigation and management of acute pulmonary embolism and the follow up of this disease in the current COVID-19 pandemic. PE Wells Score: https://www.mdcalc.com/wells-criteria-pulmonary-embolism Simplified Geneva Score: https://www.mdcalc.com/geneva-score-revised-pulmonary-embolism NICE Guidelines: https://cks.nice.org.uk/topics/pulmonary-embolism/ Recording date: 18 January 2021

Dr Jonathan Bardgett and Dr Francesca Moroni discuss the importance of recognising and treating malnutrition in the acutely ill patient. This episode offers practical advice on assessing malnourished patients and provides an overview on available interventions from simple dietary adjustments to artificial feeding. Particular interest is posed on recognising patient at risk of refeeding syndrome and how to prevent it. A multidisciplinary approach to the malnourished patient is key in the successful management of malnutrition with specific focus on the fundamental role of the dieticians. Dr Moroni touches upon different tubes and feed modalities and practical advice on managing high NG aspirates. A brief mention on parenteral nutrition can stimulate the listener to read more about it. The extreme malnutrition scenario is offered by patients with anorexia nervosa who require admission in acute medicine. These patients should be treated with extreme caution and involvement of gastroenterologist, dietician and psychiatrist should be priority. MUST Tool: https://www.bapen.org.uk/screening-and-must/must/introducing-must Reefeeding risks: National Institute for Health and Care Excellence. Nutrition support in adults. Clinical guideline 32: https://www.nice.org.uk/guidance/CG32 Moroni F, Metcalfe E, McKinlay A. Assessing the nutritional status of an acutely ill patient. BMJ 2017; 357 doi: https://doi.org/10.1136/sbmj.j1448 (Published 31 May 2017) MARSIPAN Guidelines: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr189.pdf Recording date: 4 January 2021

Dr Addy McLeod and Dr Paul Coulter discuss the importance of resilience training and mental wellbeing for a successful career. Dr Coulter shares his experience of a holistic approach to building resilience and confidence. Dr Addy McLeod is a senior geriatrics registrar in the North East Deanery and Chair of the Trainees and Members' Committee at the Royal College of Physicians of Edinburgh. Stories from Patient Voices open workshops http://www.patientvoices.org.uk/pilgrim.htm Help me! I'm only human... | Adam Crizzle | TEDx https://www.youtube.com/watch?v=w7JSDvJh23M

Dr Colin Stirrat, Consultant Cardiologist at the Royal Infirmary of Edinburgh gives us an overview of the updated clinical guidelines on the assessment and management of patients with atrial fibrillation. European Society of Cardiology Guidelines: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Atrial-Fibrillation-Management We discuss the recommended integrated approach to managing AF patients with stroke prevention, better symptom control and risk factors evaluation and management.

Dr Tina Ryan and Dr Neil Brain discuss the clinical assessment and management of critically unwell patients. This podcast covers some key aspects in these patients' care such as the importance of monitoring, fluid resuscitation, referral to Intensive Care Unit and life support. Dr Tina Ryan is a senior Geriatric Medicine Registrar in the West of Scotland; Dr Neil Brain is a senior Intensive Care Specialist Registrar in the West of Scotland.

Dr Ailsa Oswald interviews Dr Mark Stares. In this episode of 'Clinical Conversations', Dr Ailsa Oswald, our Vice Chair for Education and Oncology Trainee interviews Dr Mark Stares, Senior Oncology Registrar in NHS Lothian. They discuss in depth the topic of 'Cancer of Unknown Primary' and give some useful insights on the latest evidence on investigating, managing, and caring for oncology patients in whom the primary tumour is not identified. Feedback and suggested future topics are very welcome, please contact us via email at: [email protected]

Dr Tina Ryan and Dr Greg Waddell discuss quality improvement (QI) projects, the difference between clinical audits and QI projects, how to approach, and to avoid the pitfalls. QI projects are an annual requirement for trainees to undertake towards their ARCP. Dr Ryan is a Geriatric Medicine Registrar in the West of Scotland Dr Waddell is a Geriatric Medicine Consultant, QI Lead, and Scottish Quality and Safety Fellow. Feedback and suggested future topics are very welcome, please contact us via email at: [email protected]

Dr Adelina Mcleod and Dr Alisha Khanna discuss the prevalence of social isolation in an ageing population, the impacts of COVID-19 on Geriatric Medicine, and how hospital-based care could change to better support elderly patients. Dr Khanna has just completed FY1, now an FY2 working in London. Dr Mcleod is Chair or the RCPE T&MC committee, and specialty trainee in geriatrics with a specialist interest in cognition and delirium. Please share this episode with your colleagues and suggest future interviewees by emailing us at [email protected]

Dr Ailish Nimmo is joined by Dr Wilf Okoroafor, a senior renal registrar in Bristol with a keen interest in clinical education. They discuss the investigations and management of patients with proteinuria. -- Follow us -- www.instagram.com/rcpedintrainees twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: [email protected]

Dr Kerri Baker joins us for an interesting discussion on training, changes over time and some practical advice regarding Internal Medicine Training and the application process. If you want to find out more information about IMY3 application process please follow this link: https://www.imtrecruitment.org.uk/imy3/overview/ Please share this episode with your colleagues and suggest future interviewees by emailing us at [email protected] Recorded: 3 August 2020

Welcome to Clinical Conversations! This podcast series is brought to you by the Trainees & Members' Committee of the Royal College of Physicians of Edinburgh. We aim to discuss a multitude of clinical topics ranging from interesting clinical cases and diagnostic conundrums to updates on clinical guidelines. These clinical podcasts will be relevant for doctors at any stage of training and we hope you enjoy them and share them with colleagues. Feedback and suggested future topics are very welcome, please contact us via email at: [email protected]

Dr Felicity Baines and Dr Rachel Sutherland in conversation. In our twelfth and final episode of COVID-19 Conversations, Dr Felicity Baines from the Borders General Hospital discusses her experiences and tips as an FY1 during COVID-19 with Dr Rachel Sutherland. Due to the rapidly changing nature of scientific understanding and clinical practice regarding COVID-19, information here may no longer be accurate. It remains available for historical interest. Recording date: 16 April 2020

Dr Adelina McLeod interviews Dr Anna Olsson-Brown. For our eleventh episode Chair of the Trainees and Members' Committee (T&MC) Dr Adelina McLeod interviews Dr Anna Olsson-Brown, T&MC Elected Member(England & Wales) where they discuss trainee representatives during COVID-19. Due to the rapidly changing nature of scientific understanding and clinical practice regarding COVID-19, information here may no longer be accurate. It remains available for historical interest. Recording date: 3 April 2020

Dr Rachel Sutherland interviews Prof Martin Dennis. For our tenth episode, Dr Rachel Sutherland interviews Professor Martin Dennis, Chair of Stroke Medicine at The Centre for Clinical Brain Sciences, University of Edinburgh to discuss stroke and COVID-19. Due to the rapidly changing nature of scientific understanding and clinical practice regarding COVID-19, information here may no longer be accurate. It remains available for historical interest. Recording date: 9 April 2020

Dr Paolo Davide D'arienzo, Dr David Ryan and Dr Jemma Proudfoot in conversation. For our seventh episode, Dr Paolo Davide D'arienzo, CT1 Internal Medicine at Barts Health NHS Trust, Dr David Ryan, FY1 Doctor at St George's University Hospital NHS Foundation Trust and Dr Jemma Proudfoot, Academic FY2 at Liverpool University Hospitals Trust, discuss their top tips for new FY1s. Due to the rapidly changing nature of scientific understanding and clinical practice regarding COVID-19, information here may no longer be accurate. It remains available for historical interest. Recording date: 15 April 2020

Professors Liz Grant and Abraham Verghese discuss Coronavirus (COVID-19). Due to the rapidly changing nature of scientific understanding and clinical practice regarding COVID-19, information here may no longer be accurate. It remains available for historical interest. Recording date: 30 April 2020.

Dr Ailish Nimmo interviews Dr Pippa Bailey. For our sixth episode, Dr Ailish Nimmo, ST5 (renal), interviews Dr Pippa Bailey, consultant and senior lecturer in nephrology at Southmead Hospital Bristol. Together they discuss the impact COVID-19 has on renal disease. Due to the rapidly changing nature of scientific understanding and clinical practice regarding COVID-19, information here may no longer be accurate. It remains available for historical interest. Recording date: 21 April 2020

Dr Adelina McLeod interviews Dr Mike Jones. For our fifth episode, Dr Mike Jones, RCPE Director of Training and Consultant Physician and Clinical Director, University Hospital of North Durham covers questions and concerns trainee doctors may have during this time. Due to the rapidly changing nature of scientific understanding and clinical practice regarding COVID-19, information here may no longer be accurate. It remains available for historical interest. Recording date: 2 April 2020

Julie McDonald, educational psychologist, shares advice for looking after your mental health. In this episode, educational psychologist Julie McDonald shares advice for looking after your mental health. Due to the rapidly changing nature of scientific understanding and clinical practice regarding COVID-19, information here may no longer be accurate. It remains available for historical interest.

Advice from Julie McDonald, educational psychologist. In this episode, educational psychologist Julie McDonald shares advice on ways to deal with stress and uncertainty. Due to the rapidly changing nature of scientific understanding and clinical practice regarding COVID-19, information here may no longer be accurate. It remains available for historical interest.

Dr Oliver Thomas, a junior doctor, discusses ethical decision-making in the time of the COVID-19 pandemic, through scenarios, in a two-part series. Due to the rapidly changing nature of scientific understanding and clinical practice regarding COVID-19, information here may no longer be accurate. It remains available for historical interest. Recording date: 27 April 2020.

Dr Oliver Thomas, a junior doctor, discusses ethical decision-making in the time of the COVID-19 pandemic, through scenarios, in a two-part series. Due to the rapidly changing nature of scientific understanding and clinical practice regarding COVID-19, information here may no longer be accurate. It remains available for historical interest. Recording date: 27 April 2020.

Sandy Cameron and Annie Gunner-Logan in conversation. Sandy Cameron, former Director of Social Services in the Scottish Borders and South Lanarkshire, and the Chair of the board for several social care organisations in the third sector and Annie Gunner-Logan, Director of the Coalition of Care and Support Providers Scotland (CCPS), discuss social care during the COVID-19 pandemic. Due to the rapidly changing nature of scientific understanding and clinical practice regarding COVID-19, information here may no longer be accurate. It remains available for historical interest. Recording date: 24 April 2020.

Dr Rachel Sutherland interviews Dr Mike Farquhar. For our fourth episode, Vice-Chair for Career and Communications of the Trainees and Members' Committee (T&MC), Dr Rachel Sutherland interviews Dr Mike Farquhar a Consultant in Sleep Medicine at Evelina London Children’s Hospital, who discusses strategies for a better night's sleep during COVID-19. Due to the rapidly changing nature of scientific understanding and clinical practice regarding COVID-19, information here may no longer be accurate. It remains available for historical interest. Recording date: 1 April 2020

Dr Adelina McLeod interviews Dr Marcus Cassop-Thompson, FY1. For our third episode, Chair of the Trainees and Members' Committee (T&MC) Dr Adelina McLeod interviews Dr Marcus Cassop-Thompson, a recent graduate from Newcastle University talking about his perspectives on becoming an FY1 during a global pandemic. Due to the rapidly changing nature of scientific understanding and clinical practice regarding COVID-19, information here may no longer be accurate. It remains available for historical interest.

Dr Adelina McLeod interviews a GP, Dr Mike Cooke. For our second episode Chair of the Trainee and Members' Committee (T&MC) Dr Adelina McLeod interviews Dr Mike Cooke, a GP working in Newcastle, who shares the impact COVID-19 has on GPs. Due to the rapidly changing nature of scientific understanding and clinical practice regarding COVID-19, information here may no longer be accurate. It remains available for historical interest. Recording date: 31 March 2020

Welcome to COVID-19 Conversations, the Royal College of Physicians of Edinburgh (RCPE)’s podcast series which presents the latest guidance and advice on COVID-19 from physicians on the frontline. Trainees and Members’ Committee (T&MC)Chair, Dr Adelina McLeod and Vice-Chair for Career and Communications, Dr Rachel Sutherland will be interviewing colleagues from across the UK, to hear how they’re responding to the global pandemic. Due to the rapidly changing nature of scientific understanding and clinical practice regarding COVID-19, information shared in this podcast series may no longer be accurate. It remains available for historical interest.

Dr Rachel Sutherland interviews Prof Mark Strachan. For our first episode, Vice-Chair for Career and Communications, Dr Rachel Sutherland interviews Professor Mark Strachan, Consultant Physician in Endocrinology, Diabetes and Acute Medicine at the Western General Hospital, Edinburgh and Honorary Professor of the University of Edinburgh. Professor Strachan's major research interest is in cognitive impairment in Type 2 diabetes and he is one of the principal investigators of the Edinburgh Type 2 Diabetes Study. He has published over 100 original articles and book chapters. Professor Strachan and Dr Sutherland discuss the impact COVID-19 has on diabetes patients. Due to the rapidly changing nature of scientific understanding and clinical practice regarding COVID-19, information here may no longer be accurate. It remains available for historical interest. Recording date: 24 March 2020