RCP Medicine podcast

The RCP Medicine podcast is a weekly discussion of different topics relevant to physicians and physician associates.

The podcast is hosted by Dr Amie Burbridge, a consultant in acute medicine from Coventry, and Dr Hussain Basheer, RCP Education fellow and a respiratory registrar from Kent, Surrey and Sussex.

Each week they discuss and explore a different topic including:

  • real-life clinical cases
  • new evidence-based guidelines
  • specific physician issues in the modern healthcare environment.

The views expressed in this podcast are those of Amie and Hussain and not necessarily the RCP.

Podcast episodes

1. Pulmonary Embolism on the Acute Take

Amie explores the investigation and management of suspected pulmonary emboli on the acute take, discussing the merits of ambulatory care, with references to recent NICE and BTS guidelines.

References

  1. https://www.brit-thoracic.org.uk/quality-improvement/guidelines/pulmonary-embolism/
  2. www.nice.org.uk/guidance/cg144
2. Off Legs on a Sunday Morning

Hussain recounts a devastating neurology case from a weekend on-call. 

References

  1. Al-Hourani K, Al-Aref R and Mesfin A. Upper cervical epidural abscess in clinical practice: diagnosis and management. Global Spine Journal 2016; 6(4):383-393. [Full text for RCP members via Athens account].
  2. Chao D and Nanda A. Spinal epidural abscess: a diagnostic challenge. American Family Physician 2002; 65(7):1341-1346.
3. The Acute, Hot Joint

Amie gives us a quick run-through of the investigation and management of the acute, hot joint.

References

  1. Coakley G, Mathews C, Field M et al. [on behalf of the British Society for Rheumatology Standards, Guidelines and Audit Working Group] BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatology 2006; 45(8):1039–1041. [Full text for RCP members via Athens account].
  2. Farrow L. A systematic review and meta-analysis regarding the use of corticosteroids in septic arthritis. BMC Musculoskeletal Disorders 2015; 16:241.
  3. https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-015-0702-3
4. COPD in a Hurry

Hussain runs through the management of COPD presentations on the acute take, with some important points about smoking and vaping. 

References

  1. Stone RA, McMillan V, Mortier K et al. COPD: Working together. National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Clinical audit of COPD exacerbations admitted to acute hospitals in England and Wales 2017. National clinical audit report. London: RCP, April 2018. https://www.rcplondon.ac.uk/projects/outputs/copd-working-together-clinical-audit-2017
  2. Steer J, Gibson J and Bourke SC. The DECAF Score: predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease. Thorax 2012; 67(11):970–976. [Full text for RCP members via Athens account].
  3. www.rcplondon.ac.uk/guidelines-policy/e-cigarettes-inquiry
  4. www.rcplondon.ac.uk/news/reducing-air-pollution-uk-progress-report-2018
  5. www.nice.org.uk/guidance/ng115
5. A Difficult Day

Hussain discusses a tragic case that highlights the challenges of having difficult conversations during a busy on-call shift.

References

  1. Baile W, Buckman R, Lenzi R et al. SPIKES – A six-step protocol for delivering bad news: application to the patient with cancer. The Oncologist 2000; 5(4):302-311. [Full text for RCP members via Athens account].
  2. www.rcplondon.ac.uk/education-practice/courses/breaking-bad-news-guide-doctors
6. Just One More to See

Amie talks us through a hard-hitting case of infective endocarditis. 

References

  1. Habib G, Lancellotti P, Antunes MJ et al. 2015 ESC Guidelines for the management of infective endocarditis. European Heart Journal 2015; 36(44):3075-3128. [Full text for RCP members via Athens account]
  2. www.nice.org.uk/guidance/cg64
  3. Darjee R and Gibb AP. Serological investigation into the association between streptococcus bovis and colonic cancer. Journal of Clinical Pathology 1993; 46(12):1116-1119. [Full text for RCP members via Athens account].
  4. Li JS, Sexton DJ, Mick N et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clinical Infectious Diseases 2000; 30(4):633-638. [Full text for RCP member via Athens account].
7. To LP or not to LP

Amie investigates the evidence-base behind lumbar punctures and headaches.

References

  1. Carpenter CR, Hussain AM, Ward, MJ et al. Spontaneous subarachnoid hemorrhage: a systematic review and meta-analysis describing the diagnostic accuracy of history, physical examination, imaging, and lumbar puncture with an exploration of test thresholds. Academic Emergency Medicine 2016; 23(9):963-1003 [Open access at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5018921/].
  2. Perry JJ, Sivilotti MLA, Sutherland J et al. Validation of the Ottawa subarachnoid haemorrhage rule in patients with acute headache. Canadian Medical Association Journal 2017; 189(45):e1379-e1385. [Open access at http://www.cmaj.ca/content/190/6/E173].
  3. Royal College of Physicians. National clinical guideline for stroke, 5th ed. London: Royal College of Physicians, 2016. Available from https://www.rcplondon.ac.uk/guidelines-policy/stroke-guidelines
  4. Valle AJ, Fonseca Del Pozo FJ, Vaquero Alvarez M et al. Sudden headache, lumbar puncture, and the diagnosis of subarachnoid hemorrhage in patients with a normal computed tomography scans. Emergencias 2018; 30(1):50-53. [English abstract available at https://www.ncbi.nlm.nih.gov/pubmed/29437311].

8. Meningitis on the Acute Take

Amie recollects a serious case which highlights the importance of prompt recognition and treatment of meningitis.

References

  1. van de Beek D, de Gans J, Spanjaard L et al. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004; 351:1849-1859. [Open access at https://www.nejm.org/doi/full/10.1056/NEJMoa040845].
  2. McGill F, Heyderman RS, Michael BD et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. Journal of Infection 2016; 72(4):405-438.[Open access at https://www.journalofinfection.com/article/S0163-4453(16)00024-4/fulltext].
9. Pleural Effusions – Part 1

Hussain recalls a case presenting to the acute medical take with a unilateral pleural effusion, highlighting key initial investigations and management.

References

  1. British Thoracic Society. Pleural Disease Guideline Group. BTS pleural disease guideline 2010. Thorax 2010; 65(Suppl 2).Open access at https://thorax.bmj.com/content/65/Suppl_2
10. ‘Flu-monia’

Amie gives her take on the guidelines of pneumonia management, sometimes complicated by influenza.

References

  1. NICE. Pneumonia in adults: diagnosis and management: Clinical guideline [CG191]. London: National Institute for Health and Care Excellence, 2014. Available from https://www.nice.org.uk/guidance/cg191.
  2. Lim WS, Smith DL, Wise MP et al. British Thoracic Society community acquired pneumonia guideline and the NICE pneumonia guideline: how they fit together BMJ Open Respiratory Research 2015; 2(1):e000091. [Open access at https://bmjopenrespres.bmj.com/content/2/1/e000091].
  3. Lim WS, van der Eerden MM, Laing R et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58(5):377-382. [Open access at https://thorax.bmj.com/content/58/5/377].
  4. Jefferson T, Jones MA, Doshi P et al. Neuraminidase inhibitors for preventing and treating influenza in adults and children. Cochrane Database of Systematic Reviews 2014; Issue 4. Art. No.: CD008965. [Open access at https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008965.pub4/....
  5. Grudzinska FS, Dosanjh DP, Parekh D et al. Statin therapy in patients with community-acquired pneumonia. Clinical Medicine 2017; 17(5):403-407. [Open access  at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301923/].
  6. Muthuri SG, Venkatesan S, Myles PR et al. Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data. Lancet Respiratory Medicine 2014; 2(5):395-404. [Open access at https://www.ncbi.nlm.nih.gov/pubmed/24815805].
11. Bones, Moans, Stones and Groans

This week Amie explores the investigation and management of hypercalcaemia.

References

  1. Turner JJO. Hypercalcaemia – presentation and management. Clinical Medicine 2017; 17(3):270-273.  [Open access at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297576/].
  2. Walsh J, Gittoes N, Selby P [Society for Endocrinology Clinical Committee]. Society for Endocrinology endocrine emergency guidance: Emergency management of acute hypercalcaemia in adult patients. Endocrine Connections 2016; 5(5):G9–G11. [Open access at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5314807/].
12. Pleural Effusions – Part 2

Hussain recalls the drainage of a hepatic hydrothorax, and a rare complication.

References

  1. Echevarria C, Twomey D, Dunning J et al. Does re-expansion pulmonary oedema exist? Interactive CardioVascular and Thoracic Surgery 2008; 7(3):485-489. [Open access at https://academic.oup.com/icvts/article/7/3/485/673351].
  2. Kasmani R, Irani F, Okoli K et al. Re-expansion pulmonary edema following thoracentesis. CMAJ 2010; 182(18):2000–2002. [Open access at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001507/].
  3. du Plessis M, Ramai D, Shah S et al. The clinical anatomy of the musculotendinous part of the diaphragm. Surgical and Radiologic Anatomy 2015; 37(9):1013-1020. [Full text for RCP members via Athens account].
  4. Singh A, Bajwa A and Shujaat A. Evidence-based review of the management of hepatic hydrothorax. Respiration 2013; 86(2):155-173. [Open access at https://www.karger.com/Article/FullText/346996].
  5. Breu T. Why are right sided pleural effusions more common in patients with cirrhosis? 19 January 2019. [Twitter] Available at: https://twitter.com/tony_breu/status/1086725305937653760?lang=en
13. Hyponatraemia

Hussain and Amie compare their generalist approaches to the ‘low sodium’ result.

  1. Spasovski G, Vanholder R, Allolio D et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. European Journal of Endocrinology 2014; 170(3):G1–47. [Open access at: https://eje.bioscientifica.com/view/journals/eje/170/3/G1.xml ]
  2. Grant P, Ayuk J, Bouloux PM et al. The diagnosis and management of inpatient hyponatraemia and SIADH. European Journal of Clinical Investment 2015; 45(8):888–894. [Open access at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744950/].