The St.Emlyn's Podcast

Our series on critical appraisal nuggets in 5-10 mins. This week it's Randomisation. Great if you are revising for an exam in critical appraisal (e.g. FRCEM).

Rick and Simon talk blinding (and masking) for your critical appraisal delight.

See more at http://stemlynsblog.org/cans-critical-appraisal-nuggets-st-emlyns/

Prof Rick Body and Niall Morris, Clinical Research Fellow, discuss selection bias and how it can affect clinical research.

This podcast is the third in the St Emlyn's series "Clinical Appraisal Nuggets".

Another Critical Appraisal Nugget on why analysis by intention to treat is so important.

In a new podcast format Simon (@EMManchester) and Iain (@docib) discuss the month's offerings from the St Emlyn's blog and podcast (www.stemlynsblog.org).

It's been a month full of interesting posts on subjects as diverse as Thrombolysis in Stroke (Alan Grayson), The Future of Emergency Medicine in the Social Age (Simon), Cardiac Arrest Centres (Simon), Love in Critical Care (Liz Crowe), Transfers (Nat and Simon), Thrombolysis in PE (a guest post from FOAMed legend Anand Swarminathan) and Benzos in Back Pain (Janos). Head to the website for the articles themselves and all the references and links you need.

We're aiminig to make this a regular monthly podcast - let us know if it's useful and enjoyable and how we could make it even more educational.

Iain and Simon chat through our top ten trauma papers for 2016. Lots here for anyone who is interested in trauma including whole body CT, traumatic cardiac arrest, neurosurgery in severe head injury and much more. As ever we'd suggest you read the original papers, references for which along with a blogpost can all be found here http://stemlynsblog.org/top-10-trauma-papers-2016-st-emlyns/

Simon (@EMManchester) and Iain (@docib) review some of the articles from the St Emlyns blog site (http://stemlynsblog.org/) from recent weeks and chat about the current state of Emergency Medicine in the UK.

1:00 - How to declare a Major Incident - http://stemlynsblog.org/how-to-declare-a-major-incident-st-emlyns/

3:10 -  RCEM ASC 2017 – Update on the TiLLI study - http://stemlynsblog.org/rcem-asc-2017-update-on-the-tilli-study/

6:03 - The rise and SURPRISE of the DOACs - http://stemlynsblog.org/the-rise-and-surprise-of-the-doacs/

8:08 - Life as an EM Trainee in South Africa -  https://itunes.apple.com/gb/podcast/the-st-emlyns-virtual-hospital-podcast/id547326956?mt=2&i=1000393179333

9:26 - Rheum for Improvement? The physical challenge of EM training - http://stemlynsblog.org/rheum-for-improvement-st-emlyns/ Harriet's website is here  - https://www.rheumforimprovement.com/

10:47 - JC: Oxygen in ACS. A fuss about nothing? The DETO2X Trial - http://stemlynsblog.org/oxygen-in-acs-a-fuss-about-nothing/. Paper is here - http://www.nejm.org/doi/full/10.1056/NEJMoa1706222

11:57 - Is cMyC the new troponin? - http://stemlynsblog.org/cmyc-new-troponin/

13:00 - Who gets a Tetanus? You get a Tetanus! - http://stemlynsblog.org/tetanus-in-the-ed/

14:22 - Mass Casualty Incidents: Lessons from AAST - http://stemlynsblog.org/mass-casualty-incidents-lessons-aast-st-emlyns/

15:00 - The Annual Scientific Conference and the State of EM

Rick and Simon talk about critical appraisal and diagnostic studies. How does a PICTR question work and how can you use it to assess the quality of a published study, and how can it be used in research design.

Iain and Simon review the best of the blog from February 2018.

Simon Carley

Here's our round up of the best of the blog from September 2018.

The following blogs are discussed.

OOHCA and airway management. Do we need a tube?  http://www.stemlynsblog.org/jc-oohca-and-airway-management-do-we-need-a-tube-st-emlyns/

The Zero Point Survey. Optimising resuscitation teams in the ED. https://www.stemlynsblog.org/jc-the-zero-point-survey-optimising-resuscitation-teams-in-the-ed-st-emlyns/

Subacute and massive PE management https://www.stemlynsblog.org/we-call-it-massiiiiiiivve-pe-at-st-emlyns/

EMS Gathering and podcast https://www.stemlynsblog.org/ems-gathering-review-and-podcast-st-emlyns/

ResusTO: A simulation/resuscitation conference like no other https://www.stemlynsblog.org/resusto-a-simulation-resuscitation-conference-like-no-other/

Monkeypox has arrived https://www.stemlynsblog.org/monkeypox-has-arrived-is-the-panic-justified-st-emlyns/

Micro Machines: Sick neonates at RATH18 https://www.stemlynsblog.org/micromachines/

Equality and Diversity in EM. What I learned as a recovering racist. https://www.stemlynsblog.org/equality-and-global-health-what-i-learned-from-being-a-recovering-racist/

StEmlyn's at EusEM (Four posts)

• https://www.stemlynsblog.org/st-emlyns-at-eusem18-day-4/
• https://www.stemlynsblog.org/st-emlyns-at-eusem18-day-3/
• https://www.stemlynsblog.org/st-emlyns-at-eusem18-day-2/
• https://www.stemlynsblog.org/st-emlyns-at-eusem18-day-1/

Here's our round up of the best of the blog from October 2018.

In Pursuit of Excellence with Natalie May from #stemlynsLIVE https://www.stemlynsblog.org/in-pursuit-of-excellence/

A FeminEM in NY with Natalie May Part 1. https://www.stemlynsblog.org/fix18-part-one/

JC: Cricoid Pressure, Do we still need it? Simon Carley https://www.stemlynsblog.org/jc-cricoid-pressure-and-rsi-do-we-still-need-it-st-emlyns/

Teaching and Learning in Stretched Environments with Simon Carley https://www.stemlynsblog.org/teaching-and-learning-in-stretched-environments-rsm-2018-st-emlyns/

Five free strategies to improve your resuscitations Simon Carley https://www.stemlynsblog.org/stemlynslive-five-free-strategies-to-improve-your-resuscitation-practice-st-emlyns/

PTSD and me, EMDR therapy with Rusty Carroll https://www.stemlynsblog.org/ptsd-and-me-part-3-emdr-therapy-st-emlyns/

Salim Rezaie from the REBEL EM podcast takes us through the optimal management of cardiac arrest and also explores some of the controversies and difficulties that make the difference to our patients. 

You can read a lot more about the background to this talk, see the evidence and watch the video on the St Emlyn's site. Just follow this link. https://www.stemlynsblog.org/beyond-acls-salim-rezaie-at-stemlynslive/ 

November was a busy month for the St Emlyn's team with a variety of blogs on conferences, EBM, philosophy and education. Here's the podcast and the links to the blogs mentioned in November.

This is the monthly round up of blogs from the St Emlyn's team

Tribalism with Ross Fisher https://www.stemlynsblog.org/breaking-down-tribalism-onetribeemta-st-emlyns/

Conservative management of chest trauma https://www.stemlynsblog.org/jc-conservative-management-of-chest-trauma-st-emlyns/

ICS SOA day 1 https://www.stemlynsblog.org/st-emlyns-on-tour-icssoa2018/ 

Handover principles https://www.stemlynsblog.org/handover-process-practice-and-controversy-icssoa2018-st-emlyns/ 

ICS SOA day 2 https://www.stemlynsblog.org/icssoa2018-day-2-st-emlyns-on-tour/ 

ICS SOA day 3 https://www.stemlynsblog.org/icssoa2018-day-3-st-emlyns-on-tour/ 

FeminEM part 4 https://www.stemlynsblog.org/fix18-part-four/ 

PEP, PEPSE and HIV https://www.stemlynsblog.org/pep-prep-and-all-things-hiv-st-emlyns/ 

Game of Thrones https://www.stemlynsblog.org/ste-journal-club-a-christmas-games-of-thrones-issue/ 

The latest blog posts, ideas and thoughts from the St Emlyn's podcast. This month with Simon Carley and Rick Body,

Part of the critical appraisal nuggets series. You can read more here https://www.stemlynsblog.org/cans-critical-appraisal-nuggets-st-emlyns/ 

Also mentioned in this podcast

1. Definition of p-values on the bottom line https://www.thebottomline.org.uk/blog/ebm/p-value/

2. Fragility index https://lifeinthefastlane.com/ccc/fragility-index/ 

3. Confidence interval https://en.wikipedia.org/wiki/Confidence_interval 

Our regular monthly round up of the best of the blog from Feb 2019.

Here’s our regular monthly round up of the best of the blog from March 2019

Here is the latest from the St Emlyn's team

Our regular monthly round up, this month with Ian and Simon chatting through the best of the blog.

The power of peer review: https://www.stemlynsblog.org/smacc2019-the-power-of-peer-review/

Virtual reality in PED: https://www.stemlynsblog.org/jc-virtual-reality-for-distraction-from-paediatric-procedural-pain/

Wellbeing for the broken: https://www.stemlynsblog.org/wellbeing-for-the-broken-part-3-the-podcast-st-emlyns/ 

Traumatic cardiac arrest https://www.stemlynsblog.org/wellbeing-for-the-broken-part-3-the-podcast-st-emlhttps://www.stemlynsblog.org/jc-should-we-use-chest-compressions-in-traumatic-cardiac-arrest-st-emlyns/

Should we cardiovert AF in the ED or wait? https://www.stemlynsblog.org/should-we-rapidly-cardiovert-af-in-the-ed-st-emlyns/ 

Prolonged field care in the ED https://www.stemlynsblog.org/prolonged-field-care-in-the-ed/

Keppra or Phenytoin for status epilepticus in kids https://www.stemlynsblog.org/jc-enter-sandman-which-agent-as-second-line-in-paediatric-status-epilepticus/ 

This is Chris's talk from #stemlynsLIVE on GI emergencies. Remember to check out the blog for the background, references and more.

The best from the blog and podcast in July 2019. 

JC: Clot’s the Problem? Vena Cava filters in trauma patients. St Emlyn’s

Psychological performance in the resus room. Ashley Liebig at #stemlynsLIVE

JC: The Resuscitative Care Unit. St Emlyn’s

The great day paradox. St.Emlyn’s

All you need to know about Listeria. St Emlyn’s.

GI Emergencies – Chris Gray at #StEmlynsLIVE

Similar challenges, different approaches – Mass Casualty Incident training lessons from Pakistan. St Emlyn’s

Our regular round up of the best and the brightest from the St Emlyn's blog. This is a round up of our August content.

Our regular round up of the best of the blog from September 2019. A fairly quiet month for us, but some great content including a fabulous video from Cliff Reid on the Zero Point survey and on a related resus note, the concept of the UK resuscitationist with Dan Horner.

Iain is back on the podcast with Simon to talk through the best of the blog from January 2020.

Iain and Simon discuss Covid19 and more in this review of the best of the blog from March 2020.

Professor Rick Body is joined by Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynolds (NIHR Clinical Research Fellow), Prof Pam Vallely (Professor of Medical Virology), Dr Anisa Jafar (Academic Clinical Lecturer) and Prof Simon Carley (you know him...) to discuss six papers about COVID-19 infection. 

03:10 - Paper 1 – Guan et al. Clinical characteristics of Coronavirus disease 2019 in China. NEJM Feb 28 2020

https://www.nejm.org/doi/full/10.1056/NEJMoa2002032

16:54 Paper 2 – Zou et al. Single Cell RNA-SEQ Data Analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-NCOV infection. Frontiers of Medicine. Mar 12 2020.

https://link.springer.com/content/pdf/10.1007/s11684-020-0754-0.pdf

21:43 Paper 3 – Gautret et al. Hydroxychloroquine and azithromycin treatment of COVID-19: Results of an open-label non-randomised clinical trial. International Journal of Antimicrobial Agents. 20 Mar 2020

https://www.sciencedirect.com/science/article/pii/S0924857920300996?via%3Dihub

25:25 Paper 4 – Cao et al. A trial of Lopinavir-Ritonavir in adults hospitalized with severe COVID-19. NEJM Mar 18 2020

https://www.nejm.org/doi/pdf/10.1056/NEJMoa2001282

29:35 Paper 5 – Cui et al. Prevalence of venous thromboembolism in patients with severe Coronavirus pneumonia. Journal of Thrombosis and Haemostasis. Apr 9 2020 doi:10.1111/jth.14830

https://onlinelibrary.wiley.com/doi/epdf/10.1111/jth.14830

34:14 Paper 6 – Lynarts et al. Prediction models for diagnosis and prognosis of COVID-19 infection: systematic review and critical appraisal. BMJ. Apr 7 2020 BMJ 2020;369:m1328

https://www.bmj.com/content/bmj/369/bmj.m1328.full.pdf

In this podcast, Dan and Iain talk about the clinical journey of a COVID-19 patient, beyond the ED, with insights from the critical care unit. There are some concepts here that we don’t have time to do full justice to in the podcast, so there is a comprehensive set of "show notes" and all the references at www.stemlynsblog.org/covid-19-and-critical-care

Welcome to our third 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 28th April at 11am BST (10am GMT).

The panel was hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Dan Horner (RCEM Professor), Prof Pam Vallely (Professor of Medical Virology), Salim Rezaie (Emergency Physician and Founder of REBEL EM) and Prof Simon Carley (you know him…) to discuss five papers about COVID-19 infection. There will be another COVID 19 Journal Club next week (Tuesday 5th May at 11am).

Edited by Izzy Carley and Iain Beardsell

References

1. Helms J. High risk of thrombosis in patients in severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Medicine. April 2020:1-21. https://www.esicm.org/wp-content/uploads/2020/04/863_author_proof.pdf.
2. Caputo ND, Strayer RJ, Levitan R. Early Self‐Proning in Awake, Non‐intubated Patients in the Emergency Department: A Single ED’s Experience during the COVID‐19 Pandemic. Acad Emerg Med. April 2020. doi:10.1111/acem.13994
3. Garcia FP, Perez Tanoira R, Romanyk Cabrera JP, Arroyo Serrano T, Gomez Herruz P, Cuadros Gonzalez J. Rapid diagnosis of SARS-CoV-2 infection by detecting IgG and IgM antibodies with an immunochromatographic device: a prospective single-center study. April 2020. doi:10.1101/2020.04.11.20062158
4. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. April 2020. doi:10.1001/jama.2020.6775
5. Metzler B, Siostrzonek P, Binder R, Bauer A, Reinstadler S. Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. Eur Heart J. April 2020. doi:10.1093/eurheartj/ehaa314

It's been another busy month at St Emlyn's, with the publication of 15 blog posts and five podcasts, but there does seem to be an awful lot to talk about!

Of course there have been multiple posts and podcasts about COVID-19, and you can fiind all of these on our special St Emlyn's page. Highlights have included the three RCEM/St Emlyn's Webinars which we are delighted to host in podcast form.

It's not just been coronavirus though, we have also dipped out toes into exercise and nutrition, graphic design and horticulture!

Parts of the site have also undergone a bit of a redesign with the curriculum pages now easier to navigate to find that post to fioll an e-portfolio hole.

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.

They'll be much more to come in May I am sure.

Take care

Iain

Podcast edited by Izzy Carley

Welcome to our fourth 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 tool place on Tuesday 5th May at 11.30am BST (10.30am GMT). 

The panel was again 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 (Academic Clinical Lecturer), Prof Pam Vallely (Professor of Medical Virology), Prof Simon Carley and special guest Justin Morgenstern to discuss six papers about COVID-19 infection.

There will be another COVID 19 Journal Club next week (Tuesday 12th May at 11am).

References

Podcast edited from a live webinar by Izzy Carley 

Welcome to our fifth 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 12th May at 11.00am BST (10.00am GMT). 

The COVID-19 Journal Club Panel

Today’s panel was hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Prof Dan Horner, Dr Anisa Jafar, Prof Pam Vallely (Professor of Medical Virology), Prof Simon Carley and special guest Lauren Westafer (Attending in Emergency Medicine and Co-Creator of the Foamcast blog and podcast) and Ellie Hothershall (head of undergraduate medicine at the University of Dundee and an expert in Public Health) to discuss six papers about COVID-19 infection.

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

A bumper edition of the podcast where Iain and Simon discuss TXA (twice), antibiotics in appendicits, VTE, Blood products in trauma, use of ultrasound in cardiac arrest and plasma in traumatic brain injury. Oh, and COVID19 (but not for long)...

An evidence based cornucopia of aural pleasure.

Please like and subscribe (as all podcasters seem to say).

Take care,

Iain

A special festive edition of our round up podcast featuring six weeks of blog posts and plenty more besides.

From all at St Emlyn's we hope you have a very happy festive season and we cannot wait to talk to you again in 2021.

Take care,

Simon and all the team

Our regular podcast round up from February 2021. Iain and Simon highlight the key learning points from this month on the St Emlyn’s blog and podcast.

Topics discussed this month include tocilizumab in COVID19, TIA risk scores, new Emergency Care standards (targets) and TXA use in epistaxis. We also pay tribute to Dr Cliff Mann, former President of RCEM who sadly died this month. 

Please remember to subscribe to the podcast on iTunes/Google Play and please do leave us some reviews and ratings there.

After a brief hiatus we're back with more from the St Emlyn's Blog. We discuss a wide range of topics from crowding in Emergency Departments and the RePHILL trial to breastfeeding, genetic testing and diagnosing DVTs, as well as our highlights from the recent RCEM CPD Conference in Bournemouth. There really is something for everyone! 

In our new regular slot of the middle Monday of the month we're delighted to bring you the highlights from the St Emlyn's blog this month.,

Iain and Simon chat about batching in EDs, Ossilation in decision making and a whole lot more about trauma (chest drains, extrication, sex and TXA and rib fixation).

Please do like and subscribe and keep an eye out for our new sister website St Emlyn's Medical School and it's podcast series coming soon. 

A special double edition covering the blog posts from November and December and more. We discuss evidence based medicine with the DoseVF trial, and more from RECOVERY, discussion about 'what is downtime' and how we organise follow up for patients who don't live in our area and what happened at the amazing London Trauma Conference

We also announced some of the plans for StEmlynsWILD. Look out for booking details and more in the coming weeks. 

Long term listeners to the St Emlyn’s podcast may remember our series entitled ‘Critical Appraisal Nuggets’ (CANs). We are absolutely delighted to reinvigorate this project under the leadership of Professor Rick Body, with the episode on semi structured interviews.

In this easily digestible and succinct podcast Rick and Laura Howard go through the pros and cons of setting up semi structured interviews and how these can be used effectively in qualitative research.

In the latest episode, we cover a qualitative research technique: semi-structured interviews. Qualitative research might be out of your comfort zone: we’re generally more comfortable with quantitative measures – numbers and statistics. It’s something they have experience with, having previously published a paper exploring the impact of events that happen at work on the wellbeing of emergency physicians. This was a labour of love for Laura. Laura wrote a powerful blog about it here.

Semi-structured interviews are a great way to get the really rich data we need to understand something in greater depth. They allow us to ask ‘why?’ as well as just ‘what?’, ‘who?’ and ‘when?’. But reading qualitative research papers can be difficult when it takes us out of our comfort zone. In this CAN podcast, Laura and Rick take us through what semi-structured interviews are, why we might use them, how you design and conduct them, and they also have some pearls of wisdom about how to make transcribing them a lot less painful. By the end, we hope that you’ll feel confident with the basics of the technique. And if you want to practice your critical appraisal, why not put their study under the microscope?

The latest CAN is one of our brand-new 'revision editions' -- brief podcasts aimed at covering the essentials of critical appraisal for medical students and junior doctors preparing for exams.

With the help of Gregory Yates, an academic doctor based in Manchester, this episode introduces two core concepts: sensitivity and specificity. These are two ways of thinking about the accuracy of a diagnostic test. Knowing the sensitivity and specificity of an investigation will give you a decent idea of how it should be used in the emergency department.

Sensitivity (Sn) describes the chance that a test will be positive if your patient has the condition you're testing for. Some people call it the 'true positive rate' or alternatively the positivity in disease (PID) rate. If you need a hand remembering it, you can always remember that PID is a sensitive issue.

Meanwhile, specificity (Sp) considers the chance of a test being negative if the patient doesn't have the condition you're testing for. It's the 'true negative rate' or alternatively the negativity in health (NIH) rate. There are times when we particularly need a test to have a high sensitivity. This is generally when we want to be particularly confident that a test accurately identifies everyone with the relevant condition because we really don't want to miss it. We need a high sensitivity to rule out disease. (Sn-uff it out). At other times, we need to be confident that a patient with a positive test actually has the disease - for example, if the treatment is unpleasant or involves exposing patients to risk. In that case, we want a high specificity to rule in disease. (Sp-in it in).

In this CAN, we use D-Dimer as an example of a very sensitive investigation: it’s positive in nearly 100% of cases of venous thromboembolism. Specificity describes the likelihood that the test will be negative if your patient does not have the disease. We use HbA1c as an example of a highly specific investigation: it’s rarely used in the emergency department, but if it’s elevated, we can be almost certain that the patient is diabetic. HbA1c is almost never (<1%) raised in non-diabetics.

The trouble is, many patients with a positive D-Dimer do not have a venous clot, and the majority of diabetics will have a normal HbA1c! No test is perfect, and we discuss how emergency physicians weigh up sensitivity and specificity when choosing which investigations are the best "fit" for clinical decision-making. By the end of this CAN, you will be ready to do the same -- in your exams, and on the shop floor.

After a long, hot and relaxing summer (!) Simon and Iain return with all the content from the St Emlyn's blog in July and August. They discuss four papers in detail, including the ARREST trial about cardiac arrest centres, whether clinical examination can identify life threatening injuries in trauma, the TOP-ART study looking at a novel agent in trauma management and the use of REBOA. 

Please do like and subscribe and get in touch if you would like to contribute to the blog site.