CotEcast
By Emma Fisken
Part of AEME, the Association for Elderly Medicine Education.
aeme.org.uk
CotEcastDec 06, 2014
"What we've learnt this week..." Episode 11
"What we've learnt this week..." Episode 10: Silver Trauma
"What we've learnt this week..." Episode 8
Welcome to the 8th episode in the series of "What we have learnt this week...". Tonight Vicky, Emma and Christina talk about UTI guidelines in the over 65s, AF and anticoagulation risk calculators, DOLs and antibiotics in the older patient.
Useful links this week:
PHE UTI in >65s: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/755890/PHE_UTI_flowchart_-_Under_65_women.pdf
CHADsVASc and HASBLED scoring systems: https://www.chadsvasc.org
Anticoagulation risk in falls: Risk of Falls and Major Bleeds in Patients on Oral Anticoagulation Therapy; Donze, J; Clair, Carole; The American Journal of Medicine; Volume 125, Issue 8; August 2012,Pages 773-778
BMA guidance on DOLS: https://www.bma.org.uk/advice/employment/ethics/mental-capacity/deprivation-of-liberty-safeguards
E-LFH learning module on DOLS: https://www.e-lfh.org.uk/programmes/deprivation-of-liberty-safeguards/
G4J18 Top Tips
"What we've learnt this week..." Episode 5
"What we've learnt this week" Episode 4
"What we have learnt this week...." Episode 1
This week we discuss a useful analogy for frailty, myth-busting MSUs, a brief review of fluid prescriptions and top tips of managing patients with Parkinson's disease .
Useful links:
Paper Boats BGS blog at britishgeriatricssociety.wordpress.com/2018/07/09/the-paper-boat/
MSU and fluid Mini-gems at aeme.org.uk/mini-gems/
NICE fluid guidelines at www.nice.org.uk/guidance/cg174
PD medication calculator at www.pdmedcalc.co.uk
How to make managing your patient's pain less painful!
The AEME gang sit down to discuss the recently updated British Geriatric Society guidelines on the assessment of pain in the older patient.
Discussion topics:
1. Do we assess pain in the older patient well? If not, why not?!
2. What are the barriers to eliciting a good pain history?
3. What analgesics should you start and how?
4. Are there any non-pharmacological options for pain relief out there?
Our CotEcast Commandments:
1. Do not think pain is part of the normal ageing process
2. Remember to ask about pain
3. Start low and go slow
4. Remember to regularly reassess response and side effects of analgesia
References, Links and Resources:
The Assessment of Pain in Older people: UK National Guidelines; Pat Schofield, Age and Ageing, Volume 47, Issue supp_1, 1 March 2018
OPMentor CotECast
The whole AEME team get together to discuss progress with our OPMentor scheme. If you want to find a mentor in your area then check out our website at http://aeme.org.uk/opmentor. If you are interested in becoming a mentor sign up at http://aeme.org.uk/opmentor/application.
'Med Reg' Revisited
Vicky, Pete, Nick and Emma talk about the realities of being the med reg on-call – it’s not as bad as you think! We also discuss different reasons for going out of programme during geriatric training.
Let us know your thoughts!
Join in the discussion online using the hashtag #cotecast
Links:
Geriatrics for Juniors 2017: Post conference COTEcast
Pete and Nick are joined by AEME founder Mark Garside and long term AEME friend Zoe Wyrko. At the end of the conference they reflect on Geriatrics for Juniors 2017 including what they learnt from the day.
Academic training in Geriatrics
Pete and Nick are joined by Claire McDonald and Sarah Richardson who are both academic geriatricians. Together, they talk about how to get into academic work and research within geriatrics including academic clinical fellow posts.
Polypharmacy for junior doctors
Pete and Nick are joined by geriatric registrars Emma and Chris. In this COTEcast we are tackling the issues around polypharmacy in the elderly. We discuss why it is a problem and how to manage it. We also offer some tips for junior doctors who are starting new jobs soon on how to approach a patient with polypharmacy.
Links:
STOPP/START tool:
Deprescribing Canadian initiative:
http://deprescribing.org/resources/deprescribing-guidelines-algorithms/
Antichol
Technology in Medical Education
"Nick and Mark are joined by Lewis Potter, founder of geekymedics.com. Together they talk about the pros and cons of technology in medical education as well as the future of technology based learning. Lewis also tells us what geekymedics.com has to offer"
Links:
1. www.geekymedics.com
2. http://conferences.ncl.ac.uk/thedarkside/ : The dark side of technology in medical education
Reflections from the British Geriatrics Society Spring conference
Pete, Vicky and Nick are live at the British Geriatrics Society Spring Conference and are joined by ACCS acute medicine trainee Lily Shevlin. They discuss what they have learned from the conference, important topics such as DNACPR forms and treatment escalation plans, fears of being the medical registrar and how to attract more junior doctors to the field of geriatric medicine.Links:
1. Recommended Summary Plan for Emergency Care and Treatment (RESPECT) http://www.respectprocess.org.uk/
2. Our COTEcast series on the worries doctors have about the medical registrar role: http://aeme.org.uk/fear-loathing-and-the-med-reg/
3. OPMentor, our online mentorship scheme for junior doctors: http://aeme.org.uk/opmentor/
4. Why geriatric medicine? A survey of UK specialist trainees in geriatric medicine:
Inpatient management of Patients with Cognitive Impairment
Nick is joined by consultant geriatrician with a specialist interest in dementia and delirium Emily Lyon, and geriatric registrar Jude Randall. Together they discuss how to improve the management of inpatients with dementia as well as how to spot delirium and manage acutely agitated patients.
NOACs vs Warfarin
CotEcast returns in a new shorter format, designed to get listeners thinking and talking about issues related to the care of older patients.
Pete, Mark and Nick discuss the pros and cons of warfarin vs NOACs in AF, strategies for choosing the most appropriate anticoagulants, and how to involve patients in shared decision-making.
Agree, disagree, or have anything to add? Join in the discussion online using the hashtag #cotecast
Links:
NICE AF Anticoagulation Resources
https://www.nice.org.uk/guidance/cg180/resources
How do we keep patient with PD safe in hospital?
How do we keep patient with PD safe in hospital?
CotEcast returns in a new shorter format, designed to get listeners thinking and talking about issues related to the care of older patients.
Mark, James and Vicky discuss common issues that clinical staff encounter when managing inpatients with Parkinson’s Disease, and consider practical strategies to improve care.
Agree, disagree, or have anything to add?
Join in the discussion online using the hashtag #cotecast
Links:
Management of Parkinson’s disease in the acute hospital environment
https://www.rcpe.ac.uk/sites/default/files/macmahon.pdf
PD Drug Treatment Pocket Guide:
http://www.parkinsons.org.uk/sites/default/files/m023_drugtreatmentsforparkinsons_pocketguide.pdf
PD Med Calc
Culture Club
The FaSS and the Furious
Title: The FaSS and the Furious
Hosts: Vicky Gibson, Mark Garside
Guest(s): James Frith
Opening question: What was your most embarrassing fall?
Main Topic: Falls and Syncope
Discussion Points:
- Why are falls an issue?
- Why are some patients resistant to seeking help?
- What are the common and easily overlooked causes of falls?
- How should you assess someone who has presented following a fall?
- What can be done on the wards to prevent falls?
- What happens in a Falls and Syncope department (and what exactly is a Tilt Table Test)?
- What are the current advances in falls/ongoing projects?
- Where can juniors spend more time to get more experience, and what services are available as an outpatient/in the community?
CotEcast Commandments:
- Never write “Mechanical Fall"
- Take a careful history
- Review the meds, & refer to ph
Med Reg Fears Part 3 - Views from the Other Side
Title: Med Reg Fears Part 3 - Views from the other side
Host(s): Mark Garside, Pete Brock
Guests: Donna Kelly (Anaesthetics & Critical Care), Peter Coyne (Surgery), Fiona Leith (Emergency Care)
Opening Question: Which Disney character would you most like to be?
Main Topic: What do other specialties think about the Med Reg role?
Discussion Points:
- Who considered being a med reg?
- What puts people off, and is this fair?
- What do you want from a med reg? Examples?
- What makes a good med reg?
- What makes a bad med reg?
- Tips for interacting with other specialties
CotEcast Commandments:
- Don’t be overwhelmed by being on-call
- Communicate clearly and effectively
- Use your resources - the buck doesn’t stop with you!
Help us to improve CotEcast - please complete this brief online survey:
CotE On-Call
Title: CotE On-Call
Host(s): Mark Garside, Pete Brock, Vicky Gibson
Opening Question: What song would you not want to hear on hospital radio?
Main Topic: Covering the Geriatrics Wards Out of Hours
Discussion Points:
- Suggestions for a general approach
- Delirium / Increasing confusion
- EWS & atypical presentations
- Requests for sedation
- Fluids
- Falls
- Things not to miss
CotEcast Commandments:
- Don’t miss hypoactive delirium
- Think when prescribing analgesia
- Always ask why!
References, Links, Resources:
Help us to improve CotEcast - please complete this brief online survey:
Top of the POPS
Title: Top of the POPS
Host(s): Mark Garside, James Fisher
Guest(s): Andrew Deane, Philip Braude
Opening Question: What’s the best medical TV theme song/tune?
Main Topic: Issues to consider for junior doctors involved in preoperative care of older patients
Discussion Points:
- What is POPS?
- Why/how is this different from orthogeriatrics?
- Why are older patients at risk?
- What special considerations should be made in the medical care of these patients (e.g. Pain management, IV fluids)?
- How can you get training?
- How can juniors doctors make a difference?
CotEcast Commandments:
- Think about the medications when prescribing them
- Remember you are not alone
- Talk about the what’s happening on the wards
References, Links, Resources:
- Perioperative Care of the Elderly – ‘Anaesthesia’ Journal (Open Access)
Stroke Medicine - FAQs for FY Docs
Title: Stroke Medicine - FAQs for F1s
Host(s): Pete Brock
Guest(s): Mark Garside, Gemma Smith, James Muggleton & Eve Braithwaite
Opening Question: If for 24 hours you could do any other job in the hospital, what would it be?
Main Topic: Addressing the issues related to stroke we commonly find difficult
Discussion Points:
- Assessing patients who will not comply with your examination
- What are the stroke mimics
- Face a bit droopy, speech a bit slurred, bit confused – is this a stroke?
- How do you diagnose posterior circulation strokes?
- What happens in a stroke unit?
CotEcast Commandments:
- Think stroke, and act quickly - time is brain!
- It’s a bleed until proven otherwise
- Say what you see
References, Links, Resources:
How to Become a Geriatrician - Tips for Specialty Applications and Interviews
CotEcast #7 - Shownotes
Title: Applying to ST3 - and Geriatrics!
Date: 20/01/2015
Host(s): Pete
Guest(s): Mark & Vicky Gibson
Opening Question: What would you call a group of Geriatricians?
Main Topic: Applying to be a Geriatrics Reg
Discussion Points:
- Why pick Geriatrics over other medical specialties?
- The application form: tips on how to score well on audit, presentations, publications, teaching
- Commitment to specialty - how to show you have some
- Interview experiences and tips
References, Links and Resources:
RCPE Conference - Pushing the Boundaries of Geriatric Medicine
Breaking Bad Bones
CotEcast #6 - Shownotes
*Apologies for slight noise/feedback issues in this episode - it was due to a technical issue that has now been resolved*
Title: Breaking Bad Bones
Host(s): Mark/Pete
Guest(s): Iain Wilkinson, Francis Collin
Opening Question: What is your biggest pet hate when watching medical dramas?
Main Topic: Orthogeriatrics
Discussion Points:
- Overview of orthogeriatrics (what is it, why is it needed, evidence?)
- National targets - Blue book (2007)
- All patients with hip fracture should be admitted to an acute orthopaedic ward within 4 hours of presentation
- All patients with hip fracture who are medically fit should have surgery within 48 hours of admission, and during normal working hours
- All patients with hip fracture should be assessed and cared for with a view to minimising their risk of developing a pressure ulcer
- All patients presenting wi
The F Word
CotEcast #5: Shownotes
Title: The F Word
Host(s): Mark & James
Guest(s): Matt Rudd (Geriatrics Specialty Trainee), Zoe Wyrko (Consultant Geriatrician)
Opening Question: Which medical eponym would you re-name after yourself?
Main Topic: Frailty and FrailSafe
Discussion Points:
- What is frailty?
- Discussion around the common misconceptions, why is it important to recognise, and whether it can be measured
- Overview of Frailsafe project, including explanation, aims, and discussion of why needed
- How people can get involved, and hopes for the future
- Practical suggestions for generalists to improve recognition/care of frail elderly patients
CotEcast Commandments:
- Think ‘frailty’ for every patient that you see
- Get collateral history about usual level of function
- Beware iatrogenesis!
References, Links and Resources:
'Med Reg' Fears part 2 - The morning after the night shift before
Title: The morning after the night shift before (Med Reg fears, part 2)
Date: 8th October 2014
Host(s): Mark
Guest(s): Pete, Vicky Gibson (ST3 Geriatrics)
Opening Question: What’s the best thing you’ve ever eaten in a hospital canteen?
Main Topic: Confessions of new Medical Registrars
Discussion Points:
- Why did you want to be a med reg? (or why did it not put you off?)
- What were your worries about it before starting?
- Did you do anything to prepare?
- Tell us about your first on-call shift
- Any new fears that you didn’t have before?
- Best/worse moments so far?
- What would you say to junior colleagues not sure about the role?
CotEcast Commandments:
- Don’t let fear of on-calls overshadow your enjoyment of your day job
- Don’t expect too much of yourself
- Don’t think you can’t be a med reg
Twitter Usernames:<
Fear, Loathing , and the 'Med Reg'
CotEcast #3 - Shownotes
Title: Fear, Loathing and the 'Med Reg’
Date: 28th August 2014
Host: Pete
Guest(s): Mark, James, Kelly
Opening Question: When you were a child, what did you really want to be (and don't say a doctor!)?
Main Topic: Addressing the 'Med Reg' issue
Discussion Points:
G4J data identified that being a Med Reg put people off applying
Geriatrics and the GMC
CotEcast #2 - Shownotes
Title: Geriatrics and the GMC
Date: 18/08/14
Host(s): Mark Garside (ST7 Geriatric Medicine), Pete Brock (ST3 Geriatric Medicine)
Guest(s): Rachel Woodall (GMC Regional Liaison Advisor)
Opening Question:What is your favourite medical TV show?
Main Topic: Geriatric Medicine, E-Learning, and the GMC
Old Tricks for New Dogs
CotEcast #1 - Shownotes
Title: Old Tricks for New Dogs
Date: Mon 14th July
Host(s): Mark Garside, James Fisher, Pete Brock
Guest(s): Sean Ninan
Opening Question: Which fictional doctor would you most like to be?
Main Topic: Top tips for new doctors dealing with older patients
Discussion Points:
Each participant to identify one ‘top tip’ and one ‘pet hate’ (inc. how to avoid doing it)
James
- Pet Hate: "As far as I'm aware"
- Top Tip: Rule of 'stuff'
- Know your stuff
- Give a stuff
- Take no stuff and
- Remember, that despite all of this, stuff happens...
Pete
- Pet Hate: Fluids - too much or too little
- Top Tip: There is always something you can do to help a delirious patient
Sean
- Pet Hate: Unfounded diagnosis of UTI
- Top Tip: Get to know your patients