CotEcast

Welcome to the latest episode in our new CotECast series: “Ask the Expert“. This series delves deeper into some hot topics in geriatrics, with stroke being our first. This is the final episode in our Stroke mini-series and as usual we are bombarding Dr Chris Taylor with all our questions; this time about haemorrhagic stroke. 

Welcome to the fourth episode in our new CotECast series: “Ask the Expert“. This series we will be delving deeper into some of the hot topics in geriatrics and have started with a stroke mini-series! Dr Chris Taylor is back with Jonny and Emma to discuss both the complications that may develop in patients admitted with stroke and secondary prevention. 

Welcome to our new CotECast series: "Ask the Expert". This series we will be delving deeper into some of the hot topics in geriatrics and we are going to be starting with a stroke mini-series! This is the thrid episode in this mini-series and Dr Chris Taylor is back to discuss acute treatment of ischaemic strokes.  

Welcome to the second episode in our new CotECast series: "Ask the Expert". In this series we will be delving deeper into some of the hot topics in geriatrics and we have started with a stroke mini-series! Today we are joined by Dr Chris Taylor, stroke physician, to discuss imaging in patients with suspected stroke.   

Welcome to our new CotECast series: "Ask the Expert". This series we will be delving deeper into some of the hot topics in geriatrics and we are going to be starting with a stroke mini-series! Today we are joined by Dr Chris Taylor, stroke physician, to discuss diagnosis and assessment of patients with a suspected stroke.    Useful Links: Shake,rattle and roll: The Epley Manoeuvre (and Dix Hallpike) MiniGem: https://www.youtube.com/watch?v=d4XHPWFajQs&t=113s   Peter Johns HINTS examination educational video: https://www.youtube.com/watch?v=1q-VTKPweuk

Welcome to the fourteenth episode in the "What we've learnt this week..." series. These are short 15 minute or so podcasts where we discuss topics we have encountered in the preceding weeks; whether it be on the wards, in a journal, at teaching or even on Twitter! Join Christina, Dilani, Emma and Hannah this week as they discuss an unusual cause of medication related hypernatraemia, CT head scans as part of delirium work up, FRAX and progressive supranuclear palsy.  Useful links this week:  FRAX: https://www.sheffield.ac.uk/FRAX/ Sign Guideline 157: https://www.sign.ac.uk/media/1423/sign157.pdf PSP Association: https://pspassociation.org.uk/information-and-support/what-is-psp/  

Welcome back to CotEcast! Having had a little break from recording due to Covid-19 the AEME gang are back with the thirteenth episode in the “What we’ve learnt this week…” series. These are short 15 minute or so podcasts where we discuss topics we have encountered in the preceding weeks; whether it be on the wards, in a journal, at teaching or even on Twitter! This week Chris, Christina, Dilani, Hannah and Emma discuss tips for assessing and managing delirium in inpatient and patients at the end of life; serotonin syndrome; stroke myth busting and highlighting how our elderly patients often have atypical presentations.  Useful links this week: https://madeinheene.hee.nhs.uk/PG-Dean/Faculty-of-Patient-Safety/Delirium-Project/Delirium-Educational-Events/Delirium-Marchathon-1-17-March-2021 https://www.sps.nhs.uk/wp-content/uploads/2018/08/UKMi_QA_Whatisserotoninsyndrome_FINAL2020.pdf    

Christina, Dilani, Emma and Hannah get together this week to talk about their top tips for the new doctors! 

Welcome to the twelfth episode in the "What we've learnt this week..." series. These are short 15 minute or so podcasts where we discuss topics we have encountered in the preceding weeks; whether it be on the wards, in a journal, at teaching or even on Twitter!   This week Chris, Christina, Dilani, Hannah and Emma discuss clues pointing to malabsorptive syndromes, the MUST score, the HALT-IT trial, the short-comings of an erect chest xray and alcohol histories in our older patients! 

Welcome back to CotEcast! After a bit of a break from recording Chris, Emma, Christina and Dilani are back to reflect on some of the learning points they have taken from away looking after older people during the Covid-19 pandemic.    Useful links this week:    1. Covid 19 in the older adult poster BGS website, Dr Lara Mitchell  https://www.bgs.org.uk/sites/default/files/content/attachment/2020-06-02/COVID19intheolderadultposterFINAL.pdf 2. Health Education England SupportT digital resources/webinars https://www.hee.nhs.uk/our-work/doctors-training/supporting-doctors-returning-training-after-time-out/supportt-digital-online-resources   3. Newcastle COVOP (COvid Vulnerable Older People) Report https://research.ncl.ac.uk/ageresearchgroup/coronavirus/   4. Action on Hearing Loss - Communication tips for healthcare professionals  https://actiononhearingloss.org.uk/information-and-support/support-for-health-and-social-care-professionals/communication-tips-for-healthcare-professionals/  

Welcome to the eleventh episode in the "What we've learnt this week..." series. These are short 15 minute or so podcasts where we discuss topics we have encountered in the preceding weeks; whether it be on the wards, in a journal, at teaching or even on Twitter! This week Nick, Christina and Emma discuss causes of vertigo, how to correctly take a bisphosphonate, managing diabetes at the end of life and restless leg syndrome.   Useful links: Vertigo: https://www.bmj.com/content/366/bmj.l5215/infographic Mini-gem: http://aeme.org.uk/mini-gem-shake-rattle-and-roll-the-epley-manoeuvre/ NECN palliative care guidelines:  http://www.northerncanceralliance.nhs.uk/wp-content/uploads/2018/11/NECNXPALLIATIVEXCAREX2016-1.pdf.

Welcome to the tenth episode in the "What we've learnt this week..." series. These are short, 15 minute podcasts where we discuss topics that we have encountered the preceding week; whether it be on the wards, in a journal, at teaching or even on Twitter! This week Nick, Christina and Emma discuss silver trauma.   Useful links:   https://www.rcem.ac.uk/RCEM/Quality-Policy/Clinical_Standards_Guidance/RCEM_Guidance.aspx?WebsiteKey=b3d6bb2a-abba-44ed-b758-467776a958cd&hkey=862bd964-0363-4f7f-bdab-89e4a68c9de4&RCEM_Guidance=5.   https://www.rcemlearning.co.uk/foamed/silver-trauma/.   https://mobile.twitter.com/hectorcares?lang=en  

Welcome to the ninth episode of "What we have learnt this week…..”. These are short, 15minute, podcasts where we discuss topics that we have encountered the preceding week; whether it be on the wards, in a journal, at teaching or even on twitter! This week Chris, Emma and Vicky are recording during lunch at their regional geriatrics teaching day. They will be discussing myeloma and MGUS; attendance and carers allowance and dual anti platelet therapy in minor stroke and high risk TIAs.   Useful links this week are: https://www.gov.uk/attendance-allowance https://www.gov.uk/carers-allowance https://b-s-h.org.uk/guidelines/guidelines/investigation-of-newly-detected-m-proteins-and-the-management-of-mgus/ https://www.stroke.nih.gov/documents/NIH_Stroke_Scale_508C.pdf https://www.bmj.com/content/363/bmj.k5130/rr-0        

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/

The AEME team catch up over a few drinks post G4J 2018 to discuss a few of the top tips we will take away from the conference. Useful links: www.pdmedcalc.co.ukm.youtube.com/watch?v=Lp3pFjKoZl8www.nuemblog.com/blog/hints

Welcome to the 6th episode in the "What we've learnt this week" series. Nick and Emma are in Berlin for the European Geriatric Medicine Society International Congress and share some of the top tips they have picked up from the conference. Heard of "prognostic paralysis"? "Theraputic illusion"? Gamification in medical education? We hadn't either!   Useful links this week: 1. https://www.jamda.com/article/S1525-8610(17)30130-5/fulltext Morin L, Vetrano DL, Grande G, Fratiglioni L, Fastbom J, Johnell K. Use of medications of questionable benefit during the last year of life of older adults with dementia. J Am Med Dir Assoc. 2017;Epub. 2. http://www.deliriumexperience.nl/ You have to pay for the full game but the trailer is experience enough! 3. https://academic.oup.com/ndt/article/32/1/9/2931168  European Renal Best Practice Group summary document on Management of older patients with chronic kidney disease  

Join Vicky, Pete and Emma in the first of our new series of CotEcasts entitled "What we have learnt this week....". These are short, 15minute, podcasts where we discuss topics that we have encountered the preceding week; whether it be on the wards, in a journal, at teaching or even on twitter! 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 atbritishgeriatricssociety.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

Join Pete, Christine and Emma for the fifth episode in the "What we've learnt this week.." series. We've got some useful tips on iron supplements, urological conditions in the elderly and renal impairment. Let us know your thoughts @ElderlyMedEd    

Welcome to the fourth episode of "What we've learnt this week..." Vicky, Emma and new AEME member Christina discuss confusing C.Diff results, alcohol in the elderly, geriatric trauma and consider the language we use when talking to relatives of patients with dementia.   Useful links this week: https://www.nhs.uk/live-well/alcohol-support/calculating-alcohol-units/ https://www.bgs.org.uk/resources/silver-book http://www.heftemcast.co.uk/wp-content/uploads/2015/07/About-HECTOR.pdf https://twitter.com/dr_shibley?lang=en

Welcome to the third episode of "What we have learnt this week…..”. These are short, 15minute, podcasts where we discuss topics that we have encountered the preceding week; whether it be on the wards, in a journal, at teaching or even on twitter! This week Chris, Emma, Pete and Nick are discussing steroid therapy in pneumonia; tips for picking up dysphasia; drooling in Parkinson's disease and online tools to aid shared decision making in relation to medication ie. Statin therapy   Useful links this week: https://statindecisionaid.mayoclinic.org/ https://www.cochrane.org/CD007720/ARI_treatment-corticosteroids-beneficial-and-safe-people-pneumonia

Listen to Pete, Emma and Nick talk through their top tips in the 2nd episode of "What we have learnt this week.....". These are short, 15minute, podcasts where we discuss topics that we have encountered the preceding week; whether it be on the wards, in a journal, at teaching or even on twitter! This week we talk about sick day rules; antidepressants in the elderly; potentially inappropriate medications and mobility assessment centres.    Useful links this week: Polypharmacy Guidance, Realistic prescribing: https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf Drug burden in older people approaching the end of life: https://britishgeriatricssociety.wordpress.com/2018/05/29/drug-burden-in-older-people-approaching-end-of-life/#more-5388 STOPPFrail https://academic.oup.com/ageing/article/46/4/600/2948308 Mobility Advice and Assessment Centres: http://www.olderdrivers.org.uk/driver-assessment/find-a-driver-assessment/england/north-east/

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  https://doi.org/10.1093/ageing/afx192   Guidance on the management of pain in older people; Age and Ageing 2013; 42: i1–i57. doi: 10.1093/ageing/afs200   http://www.bgs.org.uk/pdfs/pain/age_ageing_pain_supplement.pdf  

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. 

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: https://www.copmed.org.uk/publications/the-gold-guide https://www.rcpe.ac.uk/college/journal/being-med-reg-exploration-junior-doctors-perceptions-medical-registrar-role  

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.

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: https://www.networks.nhs.uk/nhs-networks/nhs-cumbria-ccg/medicines-management/guidelines-and-other-publications/Stop%20start%20pdf%20final%20Feb%202013%20version.pdf   Deprescribing Canadian initiative: http://deprescribing.org/resources/deprescribing-guidelines-algorithms/ Anticholinergic burden score calculator: http://www.agingbraincare.org/uploads/products/ACB_scale_-_legal_size.pdf

"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

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: https://academic.oup.com/ageing/article-abstract/doi/10.1093/ageing/afx009/2970256/Why-geriatric-medicine-A-survey-of-UK-specialist?redirectedFrom=fulltext 5. Mouth care matters: http://www.mouthcarematters.hee.nhs.uk/ 6. Slido: https://www.sli.do/ 7. Geriatrics for juniors conference 2017: http://aeme.org.uk/g4j17/

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.

Will we still be using warfarin in 5 years time? 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? 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 http://www.pdmedcalc.co.uk Mini-GEM: My Patient With PD Can’t Swallow Their Meds https://www.youtube.com/watch?v=JYJPrlLjpNQ&feature=youtu.be

CotEcast returns in a new shorter format, designed to get listeners thinking and talking about issues related to the care of older patients.     Do we have an attitude problem towards older patients on hospital wards?   Mark, Pete and Vicky debate whether there is still a cultural problem in NHS hospitals with regards to older patients, and discuss ways that individual clinicians could help to make a difference.   Links: King's Fund: Continuity of Care for Older Hospital Patients - A Call for Action Alzheimer's Society - Hospital Care Factsheet Paper: “Acopia” and “social admission” are not diagnoses: why older people deserve better     Agree, disagree, or have anything to add? Join in the discussion online using the hashtag #cotecast

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 physical and occupational therapists References, Links, Resources: - aeme.org.uk/mini-gems- https://www.futurelearn.com/courses/falls- http://www.ageuk.org.uk/health-wellbeing/keeping-fit/falls-prevention/exercise-regularly/ Help us to improve CotEcast - please complete this brief online survey:http://www.aeme.org.uk/survey

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: http://www.aeme.org.uk/survey

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: aeme.org.uk/mini-gems aeme.org.uk/g4j15   Help us to improve CotEcast - please complete this brief online survey: http://www.aeme.org.uk/survey

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)http://onlinelibrary.wiley.com/doi/10.1111/anae.12524/abstract BAPEN GIFTASUP IV Fluid Guidelineshttp://www.bapen.org.uk/professionals/education-research-and-science/bapen-principles-of-good-nutritional-practice/giftasup BGS Summary - Peri-operative Care for Older Patients Undergoing Surgeryhttp://www.bgs.org.uk/index.php/topresources/publicationfind/goodpractice/2402-bpg-pops Enhanced Recovery After Surgery Society (UK)http://www.erasuk.net More BGS Resourceshttp://www.bgs.org.uk/index.php/popsresources RCoA Perioperative Medicine Programmehttp://www.rcoa.ac.uk/perioperativemedicine Preoperative Medicine MSchttp://www.ucl.ac.uk/prospective-students/graduate/taught/degrees/perioperative-medicine-mscGeriatric perioperative medicine in older people syllabus (section 44): http://www.jrcptb.org.uk/sites/default/files/2010%20Geriatric%20Medicine%20%28amendment%202013%29.pdf Age Anaesthesia Associationhttp://www.ageanaesthesia.com/ Surgery in the Older Person online course http://www.cardiff.ac.uk/learn/training/courses/school-of-medicine/surgery-in-the-older-person/ Guy's and St Thomas' POPS team website (with lots of resources in the menu section)http://www.POPSteam.co.uk Seeing the Whole Picture: BGS bloghttps://britishgeriatricssociety.wordpress.com/2014/10/16/seeing-the-whole-picture Help us to improve CotEcast - please complete this brief online survey: http://www.aeme.org.uk/survey    

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: Thrombolysis Mini-GEM (https://www.youtube.com/watch?v=_lsHXmw_dVg) STARS e-learning modules (stroketraining.org)

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 - 

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 with a fragility fracture should be managed on an orthopaedic ward with routine access to acute orthogeriatric medical support from the time of admission All patients presenting with fragility fracture should be assessed to determine their need for antiresorptive therapy to prevent future osteoporotic fractures All patients presenting with a fragility fracture following a fall should be offered multidisciplinary assessment and intervention to prevent future falls What would an ideal service look like? Biggest annoyances/areas for improvement CotEcast commandments: Treat hip fracture as a medical emergency Bring the clinical team together Take a proper falls history References, Links and Resources: Blue Book National Hip Fracture Database Fascia Iliac Block Training (via BGS blog) Closure those taking issues with 'Scrubs' opening sequence (thanks to @GerisJo for the link) Twitter Usernames: AEME: @ElderlyMedEd Mark: @garside80 Pete: @petebrock7 Iain: @geriatricsdoc Email cotecast@aeme.org.uk with comments, questions, suggestions

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: frailsafe.org.uk 'Frailty in Elderly People'; Clegg, Lancet, 2013 BGS Blog on Teaching Frailty BGS ‘Fit for Frailty' document Twitter Usernames: AEME: @ElderlyMedEd Mark: @garside80 James: @drjimbofish Zoe: @geri_baby Failsafe: @frailsafe Email cotecast@aeme.org.uk with comments, questions, suggestions 

Title: The morning after the night shift before (Med Reg fears, part 2)Date: 8th October 2014Host(s): MarkGuest(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 RegistrarsDiscussion 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: AEME: @ElderlyMedEd Mark: @garside80 Pete: @petebrock7 Email cotecast@aeme.org.uk with comments, questions, suggestions Subscribe to CotEcast in iTunes

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 to Geriatrics, so we are going to try and address some of these issues. The guests will be challenged with each med reg fear and have to convince the host they can be overcome. Fear: How do I manage so many unwell patients at once? Fear: What if I cannot do a practical procedure that a patient needs quickly? i.e. Chest drain, pacing (Fran Denham) Fear: I will have no life, endless nights, terrible inflexible rotas and all that stress Fear: How do I trust my juniors when I know I make mistakes? Fear: Criticism or lack of co-operation from consultants Fear: That the buck stops with me and I will get blamed when things go wrong Fear: What if I don't know what is going on with a patient Fear: Everyone says it is awful, surely that is for a reason Fear: What I say over the telephone is not what is getting written in the notes (Jenni Harrison) Fear: I will know nothing about the surgery the patient I am reviewing has had! (Jenni Harrison) Fear: If a shift is going horribly, I have no one to confide in Review of fears allayed and fears still existing Top Three CotEcast Commandments Work with your team Face your fears Be nice to everybody References, Links and Resources: Who Would Be a Medical Registrar https://www.youtube.com/watch?v=k6rhSRiJGmM RCP Document: "Supporting the Acute Take" (http://www.rcpe.ac.uk/sites/default/files/supporting_the_acute_take-_advice_for_nhs_trusts_and_local_health_boards.pdf) RCP Document: "The Medical Registrar: Empowering the unsung heroes of patient care”(https://www.rcplondon.ac.uk/projects/medical-registrar-empowering-unsung-heroes-patient-care) RCP Acute Care Toolkit 8: "Supporting the Medical Registrar" (https://www.rcplondon.ac.uk/sites/default/files/acute_care_toolkit_8_the_medical_registrar_on_call_maximising_clinical_experience_training_and_patient_care.pdf)

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 Discussion Points: General state of e-learning resources related to Geriatric Medicine Benefit of GMC site signposting to other resources GMC’s ‘Better Care for Older People' resource (why & how it was developed, and who it’s aimed at) The use of reflective diaries What could be added/improved in future Most recommended parts of the resource Wider discussion of role of GMC in education and clinical standard-setting (not just 'fitness to practice'!)   References, Links and Resources: Better Care for Older People:http://www.gmc-uk.org/guidance/23756.asp Mini-GEMS: http://www.aeme.org.uk/mini-gems Twitter Usernames: AEME: @ElderlyMedEd Mark: @garside80 Pete: @petebrock7 Rachel: @WoodallRach GMC: @gmcuk Email cotecast@aeme.org.uk with comments, questions, suggestions  Subscribe to CotEcast in iTunes

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 Mark Pet Hate: No collateral hx from confused pts Top Tip: Open questions, and give time to answer (eg. How are your waterworks/Tell me about your bowels, rather than 'Have you got any problems with') - Remember to ask this in the systemic enquiry Top Three ‘CotEcast comandments': Don't diagnose UTI without good evidence Remember the rule of 'stuff' If you don’t know, ask! References, links and resources: Sean's blog post - http://sean9n.wordpress.com/ BGS blog on 'Geriatrician's Profanisaurus' - http://britishgeriatricssociety.wordpress.com/2013/12/23/the-geriatrics-profanisaurus-words-and-phrases-we-should-ban/#more-1954 Failed Care Pathway (video) - http://www.youtube.com/watch?v=Fj_9HG_TWEM&sns=tw 'Myths and MSUs' Mini-GEM - http://www.youtube.com/watch?v=JPzz6fcmxoIDelirium Mini-GEM - http://www.youtube.com/watch?v=1iKe-6lc5b0 NICE IV Fluid guidelines - http://www.nice.org.uk/guidance/CG174 Twitter handles: AEME: @ElderlyMedEd Mark: @garside80 James: @drjimbofish Pete: @petebrock7 Sean: @sean9n Email cotecast@aeme.org.uk with comments, questions, suggestions