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

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Clinical Conversations

Syncope (13 Sept 2021)

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

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Pyrexia of Unknown Origin (28 March 2022)

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/

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Cognitive Bias & Clinical Decision Making (13 June 2022)

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.

Non Invasive Ventilation - NIV (14 Nov 2022)

In this episode Dr Jonathan Bardgett interviews Dr Ganesh Arunagirinathan about hyponatraemia. They discuss the importance of recognising hyponatraemia and how to manage patients presenting at the front door. 

Dr Arunagirinathan is a Consultant Physician in Diabetes & Endocrinology in Edinburgh. 

Recording Date: 12 December 2022

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Hyponatraemia (12 June 2023)

Hyponatraemia (12 Jun 2023)

In this episode, Dr Libby Sampey interviews Dr Catriona Kyle about adrenal insufficiency and steroid replacement. They discuss the different types of adrenal insufficiency and relevant physiology before exploring recognition, investigations and diagnosis, and links to other autoimmune diseases. They go on to discuss management including ‘sick day rules’, and patient follow-up. 

Dr Catriona Kyle is a Consultant Endocrinologist at the Western General Hospital in Edinburgh, and has a PhD in steroid physiology from the University of Edinburgh.

Dr Libby Sampey is a member of RCPE’s Trainees and Members’ Committee podcast team and a Foundation Year Doctor.

-- Links --

Society for Endocrinology - Adrenal Crisis Information
https://www.endocrinology.org/clinical-practice/clinical-guidance/adrenal-crisis/

Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline (Bornstein et al., 2016)
https://doi.org/10.1210/jc.2015-1710

Society for Endocrinology
https://www.endocrinology.org/

Recording date: 8 June 2023

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Adrenal insufficiency and steroid replacement (4 Sep 2023)

In this episode Dr Marilena Giannoudi discusses the approach to patients with peripheral neuropathy with Dr Louise Davidson. Dr Davidson first covers the basic anatomy and function of the peripheral nervous system and describes lower motor neurone signs. They discuss different peripheral neuropathy presentations and types. Dr Davidson emphasises the importance of a thorough history before moving on to examination, testing/investigations, and management.

Dr Louise Davidson is a Consultant Neurologist based in Edinburgh. Dr Davidson works full time for the National Health Service with interests in epilepsy, general neurology and botulinum toxin for dystonia. Dr Davidson was awarded an MD degree following her research into the diagnostics of Sporadic Creutzfeldt-Jakob Disease. During her general neurology practice, Dr Davidson has managed a number of different cases of peripheral neuropathy and has previously discussed the topic at college meetings and at general medical grand round meetings. Dr Davidson is also actively involved in medical education and is the current local programme lead for neurology training.

Dr Marilena Giannoudi is a cardiology registrar based in Leeds. She is a member of the Trainees and Members’ Committee, a Fellow of the Higher Education Academy, and is currently undertaking a PhD.

-- Related content --
RCPE Fellows & Members can explore neurology content on the Education Portal: https://learning.rcpe.ac.uk/tag/index.php?tc=1&tag=Neurology

Recording date: 26 June 2023

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Peripheral Neuropathy (2 Oct 2023)

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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A Fresh Look at the Geriatric Giants – Front Door and Beyond (26 Feb 2024)

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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Frailty for the Non-Specialist (11 Mar 2024)

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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Clinical Debriefing (08 Apr 2024)

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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Pulmonary TB (24 March 2024)

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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Hyperacute Stroke (20 May 2024)

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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Inherited Cardiac Conditions (3 June 2024)

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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Asthma (01 Jul 2024)

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/

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Recording date: 11 September 2024

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Sepsis (13 Sep 2024)

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

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Heart Failure: a HF-rEFerence Guide (4 Nov 2024)

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.

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Remote and Rural Medicine (18 Nov 2024)

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/

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Infective Endocarditis (2 Dec 2024)

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/

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Palliative Care for Hospital Inpatients: A Geriatrician’s Perspective (17 Feb 2025)

Palliative Care For Hospital Inpatients: A Geriatrician’s Perspective (17 Feb 2025)

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

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T1 Diabetes and Technology (3 Mar 2025)

T1 Diabetes and Technology (3 March 2025)

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/

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Palliative Care in Heart Failure (17 March 2025)

Palliative Care in Heart Failure (17 Mar 2025)

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

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Poisoning in the Older Adult (31 Mar 2025)

In this episode Dr Emma Spencer discusses decompensated cirrhosis with Dr Michael Williams. This discussion includes the definition of a decompensation event, how to recognise these events on the medical take and the importance of doing so. They also discuss key steps in investigating causes of decompensations of cirrhosis and how to manage these unwell patients.

Dr Michael Williams is a consultant hepatologist, working on the Scottish Liver Transplant Unit in Edinburgh. His clinical interests are liver transplantation and autoimmune liver disease.

Dr Emma Spencer is an IMT3 doctor in the South East of Scotland and a member of the RCPE's Trainees & Members' Committee (T&MC).

Recording date: 13 March 2025

-- Useful Links --
BSG/BASL Decomp Cirrhosis Care Bundle - https://www.bsg.org.uk/clinical-resource/bsg-basl-decompensated-cirrhosis-first-24-hours

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Decompensated Cirrhosis (28 Apr 2025)

In this episode of Clinical Conversations, Dr Aoife Duignan  chats with Dr Claire Steel and Dr Shelagh O'Riordan about Hospital at Home. 

They explore what Hospital at Home is, and the evidence base behind it, thinking through which patients may benefit from it. They also consider how technology can enable patients to receive care in their own homes and what a day in the life might look like. Finally they consider some top tips for becoming involved with Hospital at Home. 

Dr Claire Steel is a consultant physician in older people’s medicine in NHS Lanarkshire. She is the President of the UK Hospital at Home Society and clinical lead for Hospital at Home in NHS Lanarkshire. She works closely with Healthcare Improvement Scotland to support the growth and development of H@H in Scotland.

Dr Shelagh O'Riordan is a consultant physician and lead for the Hospital at Home service in East Kent. She is President Elect of the UK Hospital at Home Society and National Clinical Lead for Hospital at Home/Virtual Wards for NHS England. 

Dr Aoife Duignan is a geriatric medicine registrar in Edinburgh. She is also the Representation Co-Vice Chair for the RCPE Trainees and Members' Committee (T&MC). 

Recording date: 16 April 2025

-- Useful links --
Hospital at Home Society Health Improvement Scotland Toolkit - https://www.ihub.scot/project-toolkits/hospital-at-home-toolkit/hospital-at-home-toolkit/
Hospital at Home RCT - https://pubmed.ncbi.nlm.nih.gov/35129936/
PPL South East Region Virtual Wards Evaluation - https://ppl.org.uk/what-we-do/virtual-wards-consultancy/
Cochrane Review - https://www.cochrane.org/CD007491/EPOC_hospital-home-services-avoid-admission-hospital
UK Hospital at Home Society - https://www.hospitalathome.org.uk/
NHS England Virtual wards operational framework - https://www.england.nhs.uk/long-read/virtual-wards-operational-framework/

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Hospital at Home (12 May 2025)

In this episode, Dr Kat Ralston hears about a case that changed the practice of Dr Chris Tiplady. They discuss the importance of recognising when a patient may be entering the last phase of life, what we owe to patients and families in understanding what matters to them, and how we can navigate managing uncertainty and being wrong as clinicians.

Dr Chris Tiplady has been a Consultant Haematologist in Northumbria since 2001 and has held a number of roles in postgraduate and undergraduate medical education over the years. He has been a Director of Medical Education in two trusts and now leads the Master of Medical Education course at Sunderland University. He also has a regular blog published by the Royal College of Pathologists, discussing professionalism in medicine.

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: 14 April 2025

-- Useful Links --
NHS England, Last 1000 days - https://www.youtube.com/watch?v=HynytVepxZc
REDMAP toolkit for future care planning conversations - https://www.spict.org.uk/red-map/
The King's Fund, Patients' preferences matter: stop the silent misdiagnosis (May 2012) - https://www.kingsfund.org.uk/insight-and-analysis/reports/patients-preferences-matter

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Cases that changed me - why you should ask about the beetroot (26 May 2025)

In this episode, Dr Marilena Giannoudi hears about a case that changed the practice of Professor James Dear.

They discuss the challenges of caring for a patient without a diagnosis, who to talk to if you are feeling uncertain in how to treat a patient, and how you can own up to and move on from mistakes you may make.

Professor James Dear is a Consultant in Clinical Pharmacology at the Royal Infirmary of Edinburgh and Personal Chair of Clinical Pharmacology at the Centre for Cardiovascular Science at the University 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: 9 June 2025

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Cases that changed me - managing mystery diagnoses (23 June 2025)

In this episode, Dr Kat Ralston speaks to Professor Edwin Jesudason about how his experience of whistleblowing as a paediatric surgeon changed his practice. They reflect on the importance of listening and creating a shared dialogue with patients, discuss how experiencing moral injury can help clinicians better understand and navigate patient suffering and explore the art of being human in medicine.

Professor Edwin Jesudason is a Consultant in Rehabilitation Medicine in NHS Lothian. 

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: 24 July 2025

-- Useful Links --
Jesudason, 'The 4D Model: Rehabilitating Unrealistic Medicine', BJHM (2025) https://doi.org/10.12968/hmed.2024.084

Jesudason, 'Manufacturing safer medics', J Med Ethics (2022) https://doi.org/10.1136/jme-2022-108581

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Cases that Changed Me - Whistleblowing (17 Nov 2025)

In this episode, Dr Kat Ralston speaks to Dr Jane Rimer about a challenging clinical case which had an unexpected outcome. They discuss the importance of reflection with trusted colleagues and consider systems to help us cover the basics well. They explore how we can reduce the sense of isolation and vulnerability that is often encountered when we have to navigate complaints, adverse event reviews and legal processes, as illustrated by the title 'Defence against The Dark Arts'. 

Dr Jane Rimer is a Consultant Physician and Geriatrician in NHS Lothian. She  is also Associate Postgraduate Dean for Medical Training in South East Scotland. 

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: 29 July 2025

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Cases that Changed Me - Defence against The Dark Arts (3 Nov 2025)

In this episode of Clinical Conversations, Dr Marilena Giannoudi discusses cardiorenal metabolic disease with Dr Andrew Frankel. Their discussion provides an overview of this common cause of chronic kidney disease (CKD) and they focus on the management of cardiorenal metabolic disease, with Dr Frankel highlighting the importance of lifestyle management and patient education and engagement, and the pharmacotherapy 'four pillars' of RAAS inhibition, SGLT2 inhibition, blood pressure control, and MR antagonism. Explore this and more in this episode.


Dr Andrew Frankel has been working as a consultant nephrologist at Imperial College Healthcare NHS trust since 1995 and works at the Imperial Renal and Transplant Centre, which is one of the largest kidney units in Europe catering for a population base of over three million. He has experience in managing all aspects of kidney disease but has a particular interest in relation to the management of kidney disease in the context of diabetes, cardiac disease and obesity.

Dr Marilena Giannoudi is a cardiology registrar based in Leeds. She is Co-Chair of RCPE's Trainees and Members' Committee.


-- Links --

NICE Guideline (NG203) - Chronic kidney disease: assessment and management
https://www.nice.org.uk/guidance/ng203

2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes
https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/CVD-and-Diabetes-Guidelines

For Kidneys Sake Podcast - By Dr Andrew Frankel and colleagues
https://www.forkidneyssake.com/ 


Recording date: 24 November 2025


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

Cardiorenal Metabolic Disease (15 Dec 2025)

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.

An Update on Atrial Fibrillation

An Update on Atrial Fibrillation (16 November 2020)

RCPE's Podcast Series 'Clinical Conversations' by the Trainees & Members' Committee (T&MC) and 'COVID-19 Conversations'.

Royal College of Physicians of Edinburgh

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