Leading The Way

11116578645_3cacb41a9d_oSarah Blayney is a Clinical Fellow in the Calgary Stroke Program at Foothills Hospital, University of Calgary. In this blog, she recounts her experience of attending the first BGS Leadership Conference in November.

After nearly nine months of trying to fit into an academic neurology department, it was a huge relief to find myself surrounded by geriatricians once again. My sense of adventure took me to Canada on a stroke fellowship earlier this year, in what I thought would be a refreshing break from the trials and tribulations of life as a medical registrar in today’s NHS. The calibre of stroke training is second to none, and learning to think like a ‘Calgary stroke neurologist’ has sharpened my clinical approach far more than I anticipated.

However I have also come to fully understand the meaning of silos within healthcare, and the effect this can have for patients with multiple medical problems.  The department is well led, with highly motivated teams across acute and rehab units, outpatients, research offices and clerical staff, but it pains me every time our service backs off from the care of a frail elderly patient deemed unlikely to benefit from admission to the acute stroke unit (though occasionally I sneak one in when I can). Our response time to acute stroke patients is excellent, but for those that turn out not to be stroke, it can mean a delay in getting them to the right place as well as multiple reviews by different people along the way.

It was in this frame of mind that I returned to the UK for a fortnight of courses and conferences to ensure a smooth CCT sign-off when I return in the spring.  Word had got round about the first BGS Management Course run last year and I was keen to get back for this year’s course if at all possible; it proved to be the highlight of my trip.  We are all too aware of the problems currently facing the NHS, but the pre-course reading list opened my eyes to the volume of resources being generated to combat these problems.  I find everything I have seen so far from the King’s Fund to be particularly practical and insightful, unlike some of the political statements that come from elsewhere. This set the tone neatly for a well thought out two days of discussions and workshops. Aspirations are important, but sharing best practice and brainstorming potential pitfalls is essential when it comes to rolling up our sleeves and making these aspirations real, and the course delivered just that.

Simulation is such a useful way of making the leap from theoretical discussion to a real life interaction, so roleplay and “Dragons Den” style workshops were a fun and very practical way of exploring some of the issues we may face as future consultants. Birmingham City Council obliged in making this even more true to life by issuing a parking ticket just before one such mock ‘management meeting’, very effectively raising the frustration levels of our acting medical director! The opportunity to ask questions, as well as be put on the spot, created a stimulating environment. The course timetable had clearly been planned to reinforce this, as regular coffee breaks allowed conversations to continue and develop outside of the structured sessions.

Hearing anecdotes on the second day from our course facilitators about their own experiences in developing new services was a tidy way of drawing together the principles we had explored earlier.  It also prepared me well for the task ahead of finding the right consultant job, and clarified my thoughts as to the direction my career may take in the next five years.  My other half recently challenged me on my use of the term ‘dynamic young geriatricians’ when I described to him the BGS course faculty, and this did give me pause for thought (as a surgical registrar who has encountered Dr Wyrko at work, he has his own ideas of what dynamic might mean in this context).  The last thing I would wish would be to appear ageist towards my older and wiser consultant colleagues, many of whom have taught me a great deal over the last nine years, but I am sure they would agree that the hospital world is changing.

We as a generation of trainees have been in the thick of it when it comes to the current state of acute hospital medicine, and have developed a different expectation of what our future working life will look like as a result.  My experiences as both a UK stroke registrar and a Canadian stroke fellow have only served to strengthen my conviction that our frail elderly patients deserve faster, better care than the NHS can currently offer in many places.  My two days under the expert coaching of Drs Gordon, Wyrko, Conroy, Blundell, Long and Oliver have provided the insight and skills to play my part in making this happen.

Image credit: Ascent Magazine via flickr.

Book review – “Geriatric Medicine: An Evidence Based Approach”

9780199689644_450Philip Braude is an ST6 in Geriatric Medicine, specialising in perioperative medicine.

Geriatric Medicine: An Evidence Based Approach, edited by Frank Lally and Christine Roffe, is written by an eminent list of international experts condensing key and often difficult issues in modern geriatrics to chapters of a few pages. It aims to be a “clinical reference for health care professionals” but is certainly not a comprehensive geriatric medicine text.

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Making difficult decisions about the benefits and risks of thrombolysis treatment

Dr Aoife De Brun is a Research Associate at the Institute of Health & Society at Newcastle Universityshutterstock_114405178

An online survey investigating factors that influence clinical decision-making regarding intravenous thrombolysis for patients with acute ischaemic stroke has been launched. The project is funded by the NIHR Health Service and Delivery Research Programme and is led by researchers from Newcastle University.

We are recruiting clinicians who are involved in making the final decision regarding thrombolysis for patients with acute ischemic stroke.  By understanding how clinicians make difficult trade-offs between the potential benefits and risks of thrombolysis, we can design strategies to better support risk communication, consent and decision-making with patients in clinical practice. Continue reading

Geriatric medicine in New Zealand: the doctors

4347707680_bae6a08da0_zIn the second half of her two-part blog on geriatric medicine in New Zealand, Vicky Henstridge asks: what about the doctors? Read part one here.

It is oft quoted that New Zealand is like the UK, but 30/40/50 years behind (pick your decade). In general this is not true, we do have mobile phones, the internet and microwave ovens that defrost, pluck, stuff and roast your chook. However, in the field of geriatric medicine, there are definitely parallels to the changes that occurred in the UK over my lifetime.

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Website Review: www.strokeeducation.co.uk

Website Review: www.strokeeducation.co.uk

Website:strokeeducation.co.uk Informative/E-learning

Target Audience: Hospital Doctors, Jnr Doctors, GPs, Allied health Professionals, Medical Students, General Public

Validity:  Written by and based around a hyper-acute stroke course run by Dr D O’Kane [Clinical Stroke Lead and Honorary Senior Clinical Lecturer]. It is accompanied by relevant references and a thorough literature review. Continue reading

Only a minority of stroke victims are being seen by doctors within the recommended timeframe

Despite the recent FAST awareness campaign, just 8% of high-risk patients surveyed attended clinic within 24 hours of symptom-onsetshutterstock_115549357

In a study, published in Age and Ageing, of over 270 patients newly diagnosed with minor strokes or transient ischaemic attack (TIA), only a minority sought medical help within the timeframe recommended by the Royal College of Physicians. This is despite the high profile FAST campaign, which was taking place at the time that the study was conducted. Continue reading

Age and Ageing collection: Developments in Stroke Medicine

Dr Victoria Haunton is Clinical Research Fellow and Honorary Specialist Registrar at Leicester Royal Infirmary.

Prof Tom Robinson is Professor of Stroke Medicine at Leicester Royal Infirmary and is an Associate Editor and the Supplements Editor for Age and Ageing journal.MCA-Stroke-Brain-Humn-2A

A collection of 10 Age and Ageing papers is free to view on the journal website.

Despite the dramatic revolution in stroke medicine, levels of stroke knowledge amongst the general public remain surprisingly poor, and there are still significant difficulties in getting patients to access stroke services promptly. Stephanie Jones et al sought to try and understand these problems in their important integrative review. Worryingly, they found that people struggle to name even one stroke risk factor or stroke symptom, particularly when open ended questions are used. Knowledge is especially poor in older members of the population, ethnic minority groups and those with a lower socio-economic status, but there is also a surprising lack of knowledge amongst those who have already suffered a stroke. Furthermore, there appears to be a real paradox between what people say they would do and what they would actually do in the event of a stroke; whilst at least 47% said they would contact emergency medical services if they suspected they or a relative were experiencing a stroke, only 18% of stroke patients had actually done this. There is therefore an urgent need for further public education. In light of their findings, Stephanie Jones and colleagues suggest that the ideal campaign should minimise barriers to health services and provide cues to action. Continue reading

Welsh Stroke Conference 2012

Friday 22nd June 2012

Riverfront Centre, Newport

An exciting line-up of speakers including local colleagues showcasing recent advances in stroke service delivery with examples of good practice in Wales. Details about the final programme and registration will be available from our new website by 1st March 2012

Posters/Abstract will be along the themes of Science, Service and Clinical Cases. Information/guidance about posters/Abstract available here. Abstracts to be received by the end of March 2012 and there will be prizes for each category.

  • Medics fee: Early Bird – £150 (to end of April) or £170 (after 1 May).
  • Non medics: Early Bird – £30 (to end of April) or £40 (after 1 May).
  • Half day fees: half cost of day fee.

Please note these future stroke meeting dates:

  • Friday 21st June 2013
  • Friday 20th June 2014