Previews – RST

Respiratory | Surgery | Therapeutics

Philippe GrunsteinEmphysema
Philippe Grunstein (Consultant Respiratory Medicine)

Dr Philippe Grunstein trained in General Medicine in Amiens. He is a Consultant in Respiratory Medicine and Associate Professor at St George’s University School of Medicine. He specialises in Intensive Care and Sleep Medicine

COPD is the occurrence of chronic bronchitis or emphysema, a pair of commonly co-existing diseases of the lungs. Classically we used to differentiate between pink puffers and blue bloaters, depending upon whether they had predominantly emphysema or chronic bronchitis ( emphysema classically leading to a hypercatabolic state with hyperventilation versus the bloated cyanotic state of the bronchitic with V/Q mismatch and cor pulmonalae). In reality patients have mixed states and the important feature to note is to recognise when they are becoming hypercapnic.

This lecture by Philippe concentrates on the management of patients with emphysema, how to recognise and manage them when they deteriorate.

This is a very engaging lecture in which Philippe passes on several very useful insights into patient assessment and management.

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Philippe GrunsteinSleep Apnoea
Philippe Grunstein (Consultant Respiratory Medicine)

Dr Philippe Grunstein trained in General Medicine in Amiens.  He is a Consultant in Respiratory Medicine and Associate Professor at St George's University School of Medicine. He specialises in Intensive Care and Sleep Medicine

Philippe's talk is fascinating, and is recommended to all primary care doctors, because the subject is so important for us to recognise and manage. Notwithstanding that, we are sure that you will find Philippe's delivery unique and refreshing: "I will ask you to forget the epworth sleepiness scale, which is extremely bad... for instance it asks you whether you fall asleep at the theatre,... some people never go to the theatre...the correlation between the epworth and the index of apneoa is absolutely miserable... it is like tossing a coin"

Dig into this lecture several times, it delivers all you need to create a very effective management program for your patients. It is also a masterclass in how to take a history from a patient, as it tells you of the critical questions you need to ask patients in order to properly assess them.

Obstructive sleep apnea (OSA) is a relatively common disorder that affects people of all ages, but is most prevalent among the middle-aged and elderly. Affected individuals experience repeated collapse and obstruction of the upper airway during sleep, which results in reduced airflow (hypopnea) or complete airflow cessation (apnea), oxygen desaturation, and arousals from sleep. Adverse clinical outcomes associated with OSA include: cardiovascular disease, hypertension, non-insulin-dependent diabetes, and increased likelihood of motor vehicle and other accidents due to daytime hypersomnolence.

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Ajay KamathAsthma
Ajay Kamath (Consultant Respiratory Physician)

The majority of patients with asthma are treated in the primary care setting. It is the GP therefore who is in a key position to recognize poorly controlled asthma and to improve asthma management for these patients. With the prevalence of asthma rising it is becoming one of the mainstays of chronic disease management in primary care. Ajay Kamath is a Consultant Respiratory Physician , and his lecture here is a comprehensive and reflective account of asthma management.

In Part 1 Ajay discusses diagnosis.
In Part 2 of his lecture Ajay deals with standard management of asthma care and in Part 3 he deals with the problems of difficult to manage asthma, asthma in pregnancy and occupational asthma.

All in all, this is an essential lecture, and one well worth repeating carefully to obtain the most benefit out of it.

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Surgery

Vivek ChitreThe Management of Morbid Obesity
Vivek Chitre (Consultant Surgeon)

Vivek Chitre is a Consultant Upper Gastrointestinal, Laparoscopic & Bariatric Surgeon and Clinical Lead of Surgery at the James Paget University Hospital NHS Foundation Trust. He is also an Honorary Senior Lecturer at the Norwich Medical School.
This lecture by Vivek covers the subject of bariatric surgery.

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Jim ClarkeVascular Surgery
Jim Clarke (Vascular Surgeon)

Jim Clarke is a Consultant Vascular Surgeon, Norfolk & Norwich University Hospital NHS Trust and a Honorary Senior Lecturer at University of East Anglia

Vascular surgery services focus on the diagnosis and surgical treatment of problems and illnesses affecting blood vessels, arteries and veins. The subject is a huge one and is becoming increasingly technical, as therapies are becoming more minimally invasive. The vascular surgeon treats patients with life-threatening aneurysms and with disease entities that are stroke risks, as well as patients with peripheral vascular disease. lympoedema and  varicose veins. As GPs we will have a great deal of interest in what vascular surgeons manage.

This is a thoroughly enjoyable lecture, delivered with great enthusiasm. Jim takes us through an overview of his specialty, dealing with claudication, stroke and abdominal aortic aneurysm in a fascinating talk that will inform and update you on the history and current management techniques used in hospital medicine.

The AAA screening program is currently being roled out and this lecture discusses the background to its benefits.

Jim recorded 4 sections to his talk. The first 3 are here, the final section on varicose veins is available separately.

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Jim ClarkeTreatment of Varicose Veins
Jim Clarke (Vascular Surgeon)

Jim Clarke is a Consultant Vascular Surgeon at the Norfolk and Norwich hospital. This short lecture deals with the treatment of varicose veins, and includes a demonstration of the new treatment techniques now being employed.

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Simon DonellThe Management of Anterior Knee Pain
Simon Donell (Consultant Orthopedic Surgeon)

Simon Donell is a Consultant Orthopaedic Surgeon and the lead for research in the Department of Orthopaedics at the Norfolk & Norwich University Hospital. He holds an honorary Professorship with the Medical School at the University of East Anglia. His clinical practice is focussed on the knee, both knee replacements, including unicompartmental and patello-femoral, as well as arthroscopy and ligament work. Patellar instability and patellar syndromes are a special interest.

Professor Donell's lecture on anterior knee pain is a fascinating insight into a clinical subject that some would call an unsolved medical mystery.

You might need to watch this lecture more than once, as it is of interest on more than one level. Not only as an insight into a very interesting clinical problem, but also in seeing an orthopaedic surgeon travel " way out of his comfort zone".

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Kevin SargenColorectal Surgery
Kevin Sargen (Colorectal Surgeon)

Kevin Sargen is a Laparoscopic Colorectal Surgeon for benign and malignant disease and is Associate Medical Director for General Surgery.

The emphasis in this lecture is to update you in facts about colorectal surgery, specifically with regard to colon cancer. Of interest to GPs will be the methods used by surgeons to improve their success rates over recent years.

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Kevin SargenRectal Bleeding
Kevin Sargen (Colorectal Surgeon)

Kevin Sargen is a Laparoscopic Colorectal Surgeon for benign and malignant disease and is Associate Medical Director for General Surgery. This lecture of his discusses the  problem of rectal bleeding, as caused by non-cancerous anorectal pathology.

As GPs we are constantly dealing with patients who have rectal bleeding, and this lecture is of great help in delineating the important facts we need to know. As Kevin points out, it is the history we take that is most important as it points us in the direction of what to do next, as the term  "rectal bleed" is actually poorly defined. This lecture is a wealth of succinct facts and useful information, and a regular addition to any GPs portfolio.

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Therapeutics

Moheb GaidRehabilitation after Lower Limb Loss
Moheb Gaid (Consultant in Rehabilitation Medicine)

Moheb Gaid's lecture is a comprehensive review of how lower limb amputees are rehabilitated with prosthetics, above and below knee. The science has dramtically changed in recent years and Moheb outlines the essential features that will enable GPs to update their knowledge. The emphasis is on enabling patients to have replacement limbs rather than artificial ones.

Discussing the problems associated with replacement limbs, Moheb spends some time discussing the problem of phantom limb pain and how it is managed.

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Craig JacksonWork Related Stress
Craig Jackson (Professor of Occupational Health Psychology)

Craig Jackson is Professor of Occupational Health Psychology at Birmingham City University. This lecture is all about work-related stress and what can be done in Primary Care to help manage it.

The problem is, as we are all aware, of immense importance. Professor Jackson is a renown expert on stress and his lecture is a fascinating introduction to the subject, condensing a very large subject into an easily digestible overview. This is a lecture that will inform and stimulate.

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Willy NotcuttPain Management
Willy Notcutt (Consultant in Pain Management)

Willy Notcutt is a consultant anaesthetist and pain management specialist. He has been interested in the management of pain for the whole of his medical career. This lecture is a masterclass in understanding pain.

Willy starts by discussing the science of pain, looking at the different types of pain that exist and the pathophysiology that underpins them. His talk is very much an overview of the subject, and as he talks we can understand how deep the subject is.

He discusses pain management in broad terms and then deals with non-opiod and opioid therapy.

This lecture is action-packed. If you watch it once you will simply have to watch it again, as there are just so many ideas here that will need reflection. Think of this as a springboard, from which to launch your further search for more understanding.

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Phil WilkinsPain in Palliative Care
Phil Wilkins (Palliative Care Consultant)

Phil Wilkins is a Consultant in Palliative Care who works at the Norfolk and Norwich hospital as well as at the Priscilla Bacon Lodge Hospice, a specialist centre for palliative care. His lecture on pain management recorded here is an overview of pain management in palliative care and in advanced diseases generally. The subject is vast, and this lecture will provide you with an essential update.

Phil discusses the general concept of pain first, deals with opiate management in some depth and then discusses adjuvant therapies and treatments for neuropathic pain.

This will be a lecture that you will bring up on screen at regular intervals, as you look into different aspects of your patients management needs.

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