The St.Emlyn’s Podcast

In this special edition of the podcast, Liz Crowe discusses with Iain how we can find contentment, despite the relentless nature of COVID19 and the impending second wave. She gives practical, realistic advice that everyone can consider and encourages us all to be kind to ourselves in these strange and difficult times. 

Welcome to our audio round up of everything on the blog during September. It's been a relatively quiet on the blog post this month, but we chat through not only blogposts on the REMAP-CAP trial, TXA in Head Injury and the ISARIC COVID Risk prediction tool, but also the situation in the North of England and the recent RCEM Virtual Conference. The numbers of Lesson Plans available continue to grow. We've had some great feedback following their use in induction. If tyou've not seen them yet, do have a look and let us know what you think. If you're interesed in learning more about Baysian thinking this Lesson Plan is a good place to start. Take care, Iain  

Interview with Ian Roberts on the pharmacokinetic trial of intramuscular tranexamic acid.   Blog link here

Welcome to our audio round up of everything on the blog during August.  As the world continues to be in the grips of the Coronavirus pandemic there have been more papers looking at all aspects of this disease. Simon reviewed the latest paper on Hydroxychloroquine and Charlie collated some of the top papers covering aspects from aerosol spread and use of CPAP to the effect on vulnerable groups and the effect on staff psychological health It's not all COVID though. Sepsis is a condition we all want to be able to treat more effectively. Sadly there doesn't seem to be any encouraging news about the use of Vitamin C, Steroids and Thiamine in this latest RCT. Many of the St Emlyn's group have special expertise in toxicology and Gareth wrote this incredibly informative post about the use of GBL. If you're not sure what "ChemSex" is then this post from a few years ago by Janos is worth a read. The anonymously written "Look at what they make you give" post really struck a chord with readers, with an astonishing number of views. There are messages here for us all. The numbers of Lesson Plans available continue to grow. We've had some great feedback following their use in induction. If tyou've not seen them yet, do have a look and let us know what you think.

Our own version of Buy One Get One Free* this month, where you get a round up of two months of blog content.   Coronavirus continues to dominate the medical (and non-medical) headlines, and we discuss the two major results from the RECOVERY trial published recently, one positive and one not so (depending on who you talk to....). Simon also catches up with Roberto Cosentini, who you'll remember from the very powerful podcast at the beginning of the pandemic.   COVID isn't the only EBM circus in town though: we've reviewed HALT-IT and Simon has given a talk about the "Ten Top Trauma Papers" of the last year and Laura reviewed a paper looking at haloperidol for headaches.   We're having to think even harder about how we communicate in the ED, both for clinical care and to deliver education. Two ideas to help learning have been featured this month: The St Emlyn's Lesson Plans and "Background Learning".    Good luck to all those starting in Emergency Medicine, and a huge thank you to all those who are moving to other areas of medicine or other departments. It's been a curious few months...   Take care,   Iain *It's actually Get One Free Get Another Free, but whose ever heard of that?

We are delighted to introduce you to the "St Emlyn's Lesson Plans", which we hope will help structure some of your education sessions over coming months (and years). Each lesson plan starts with a descrete learning outcome, to set the scene, as well as details of the RCEM curriculum item(s) that will be covered. The first tasks are aimed at aquiring some background knowledge and can either be done as part of the session, or beforehand. These utilise the vast "FOAMed" resources (including, but not exclusively, those of St Emlyn's). Our experience is that time constraints often mean that "background reading" isn't achieved before the session, so would encourage allowing time within it to complete these. They are designed to take about 30 minutes and occupy the first half of the session. Everything you need for each lesson is included in the plan. We would recommend that each learner has an internet enabled device available (with headphones) to read and listen to the background material at their own pace. The second half of the session should be facilitated by an expert. This can happen in person, but also online, via any of the interfaces that are now so familiar. In many plans we have given some case examples, but it would be even better if learners can bring cases of their own for discussion. This element is very much within the control of the facilitator (who should been fully cogniscent of the contents of the knowledge section). The session finishes off with a summary, this should emphasise again the most important learning points. To really embed the knowledge and skills the particiapants should be encouraged to reflect on what they have learned, and to even talk to thse who were unable to attend about what they missed. For learners this also gives an opportunity to easily link teaching sessions to their portfolio. You may want to record the "face-to-face" elements, so that those who were not present are able to access them when they can (and those that did can rewatch to refresh their learning). Although these plans are designed for delivery in a single centre, there is absolutely no reason why regional (or even national) teaching could take place in this way. The recent COVID19 Journal Clubs have demonstrated beautifully how a group of learners can engage with an online panel. We would be very happy to receive lessons plans to add to the collection. This is very much a collaborative effort. Please let us know what you think of these lesson plans and if you are using them in your Department. We'd love to hear your ideas about how we can take medical education forward.

St Emlyn's three professors, Carley, Body and Horner* critically appraise the Press Release regarding Dexamethasone in the treatment of COVID-19. What does this mean for the future of Evidence Based Medicine? Can we really start using a medication when the trial hasn't been peer reviewed and the full dataset not released?  The blog post by Josh Farkas, that is mentioned in the podcast, is here. *Professor Simon Carley, Professor of Emergency Medicine at Manchester Metropolitan University and a Consultant in Adult and Paediatric Emergency Medicine at Manchester Foundation Trust, Professor Rick Body Professor of Emergency Medicine in Manchester and Honorary Consultant in Emergency Medicine at Manchester Foundation Trust. Professor Dan Horner, Professor of Emergency Medicine of the Royal College of Emergency Medicine and Consultant in Emergency Medicine and Intensive Care at Salford Royal NHS Foundation Trust.

Lots to chat about on the podcast this month, and not just COVID! There's been blog posts about clots, troponin and even telly, as well as the Journal Club series.   Keep a look out for the new St Emlyn's Lesson Plans that we hope will help usher in a new era of medical education in a socially distanced world.    If you would like to donate to the fund in the memory Adel Aziz you can find the link here.   We hope you're finding all of our output useful. Please do subscribe to the website (in the top right hand corner) and rate our podcast on iTunes.    Take care   Iain Podcast edited by Izzy Carley PS You can find the Lesson Plans here. Still a work in progress, but as you've read these "shownotes" you deserve to have a sneak preview... 

Welcome to our seventh webinar and journal club reviewing recent research and featuring COVID-19 updates, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn's.   The live event took place on Tuesday 26th May. Today's panel will be hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Anisa Jafar, Prof Pam Vallely (Professor of Medical Virology), Ellie Hothershall (Consultant in Public Health), Prof Simon Carley and special guest Kelly Ann Janssens (Emergency Physician in Ireland) to discuss five papers about COVID-19 infection. This will be the last weekly journal club, but we will be back with more EBM goodness very soon. Do let us know what you like to be included at stemlyns@gmail.com References Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 — Preliminary Report. N Engl J Med. Published online May 22, 2020. doi:10.1056/nejmoa2007764 Mehra MR, Desai SS, Ruschitzka F, Patel AN. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. The Lancet. Published online May 2020. doi:10.1016/s0140-6736(20)31180-6 Gray N, Calleja D, Wimbush A, et al. “No test is better than a bad test”: Impact of diagnostic uncertainty in mass testing on the spread of Covid-19. Published online April 22, 2020. doi:10.1101/2020.04.16.20067884 Peyrony O, Marbeuf-Gueye C, Truong V, et al. Accuracy of Emergency Department clinical findings for diagnostic of coronavirus disease-2019. Annals of Emergency Medicine. Published online May 2020. doi:10.1016/j.annemergmed.2020.05.022 Ludvigsson JF. Children are unlikely to be the main drivers of the COVID‐19 pandemic – a systematic review. Acta Paediatr. Published online May 19, 2020. doi:10.1111/apa.15371 Podcast edited from a live webinar by Iazzy Carley  

Welcome to our sixth COVID-19 Journal Club Podcast.   The panel was hosted by Rick Body and included Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Anisa Jafar, Prof Pam Vallely (Professor of Medical Virology), Prof Simon Carley and special guest Liz Crowe (Advanced Clinician Social Worker and PhD candidate in health staff wellbeing in Brisbane) to discuss four papers about COVID-19 infection. We were especially pleased to welcome Liz this week, which enabled us to focus on the important topics of grief, loss and communication during the COVID-19 pandemic. References 1. Williamson E, Walker AJ, et al. OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients. May 2020. doi:10.1101/2020.05.06.20092999 2. Menni C, Valdes AM, Freidin MB, et al. Real-time tracking of self-reported symptoms to predict potential COVID-19. Nat Med. May 2020. 3. Liu Y, Ning Z, Chen Y, et al. Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals. Nature. April 2020. doi:10.1038/s41586-020-2271-3 4. Selman LE, Chao D, Sowden R, Marshall S, Chamberlain C, Koffman J. Bereavement support on the frontline of COVID-19: Recommendations for hospital clinicians. Journal of Pain and Symptom Management. May 2020. doi:10.1016/j.jpainsymman.2020.04.024   Podcast edited from a live webinar by Izzy Carley