CotEcast

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/

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.

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.

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.

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:

1. Never write “Mechanical Fall"
2. Take a careful history
3. Review the meds, & refer to ph

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!

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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:

1. Think about the medications when prescribing them
2. Remember you are not alone
3. Talk about the what’s happening on the wards

References, Links, Resources:

• Perioperative Care of the Elderly – ‘Anaesthesia’ Journal (Open Access)
  

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

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:

1. Think ‘frailty’ for every patient that you see
2. Get collateral history about usual level of function
3. Beware iatrogenesis!

References, Links and Resources:

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:

1. Don’t let fear of on-calls overshadow your enjoyment of your day job
2. Don’t expect too much of yourself
3. Don’t think you can’t be a med reg

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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

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

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