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5 of 128

Cases that changed me - why you should ask about the beetroot (26 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 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE events -- https://www.rcpe.ac.uk/events -- Become an RCPE Member -- https://www.rcpe.ac.uk/membership/join-college Feedback: [email protected]
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Hospital at Home (12 May 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/ -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE events -- https://www.rcpe.ac.uk/events -- Become an RCPE Member -- https://www.rcpe.ac.uk/membership/join-college Feedback: [email protected]
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Decompensated Cirrhosis (28 Apr 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 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE events -- https://www.rcpe.ac.uk/events -- Become an RCPE Member -- https://www.rcpe.ac.uk/membership/join-college Feedback: [email protected]
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Poisoning in the Older Adult (31 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 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE events -- https://www.rcpe.ac.uk/events -- Become an RCPE Member -- https://www.rcpe.ac.uk/membership/join-college Feedback: [email protected]
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42:37
Palliative Care in Heart Failure (17 Mar 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/ -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE events -- https://www.rcpe.ac.uk/events -- Become an RCPE Member -- https://www.rcpe.ac.uk/membership/join-college Feedback: [email protected]
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49:11