In amongst busy shifts, I’ve been tweeting about HCS Week 2018, and chatting to other scientists about their experiences. Yesterday, I tweeted a picture of Helen, a specialist Echocardiographer, whilst she was hard at work analysing pulse wave data, and today I’m sharing the answers she gave to a couple of questions I asked her about what she remembers about the history of her job in her 30 years of experience, and her feelings on the changes she’s seen over the years.
With 30 years under your belt, you must have noticed changes in your profession. What’s different now, compared with when you started?
Firstly, my job title has changed. I was a “Cardiac Technician” and began as a student working in Cardio-Respiratory, with a full-time, guaranteed job at the end of my training. I studied on a day-release basis for an ONC then HNC, eventually topping up to BSc when this became compulsory.
Technology has had a big impact on advancement of procedures, which is better for patient quality of life, etc; Cardiac Techs performed all the ECG’s in the hospital, carrying a crash bleep for A&E, and now, of course, there is provision for ECG’s on every ward and dept.
Procedures such as angioplasty and bi-vent pacemakers were not as widely available, either; most CAD patients went on to undergo CABG and only relatively basic bradycardia devices were on offer. Obviously this is all change now.
Alongside this, we are now much busier than ever before and our roles have changed massively. We now carry out duties which years ago only consultants could do. I think this is good for everyone but does mean we have much more responsibility, in addition to greater autonomy. We are, however, still part of a team, which is vital to remember.
Did you have any reservations about the changing nature of your specialism?
I used to worry that becoming more busy and more academic would threaten our profession, that less qualified staff would have to take on more of our roles. Fortunately, routes into this career seem to be more widely available and thus, accessible. Emphasis seems to be more about finding the right person for the job, and training is focused, usually by specialist Scientists who understand the needs of both the students and patients.
It’s important to realise that anyone can be shown how to perform an ECG or assist in a cath lab, but qualities such as initiative, kindness and compassion are inherent traits which cannot be taught, and are absolutely vital in this profession.
It’s been a little while since I’ve posted to the blog, but Healthcare Science week seems like as good a time as any to do pick it up again. I’ll try my best to upload here or to Twitter, each day, be it information on what might be happening up and down the country, or things going on within my own Trust. I’ve also roped some colleagues into answering a couple of questions, too.
HCS week is an annual event celebrating all 85 specialisms within the discipline. As the oft-overlooked scientists within the NHS, it falls to us to put ourselves out there, and this week is the time to do it! Biomedical Scientists, Physiologists (there are a few different types of this particular scientist), Audiologists, Vascular Scientists, and many, many more are showcasing what they do for patients they treat in the NHS, and using the hashtags #HCSWeek18, and #HCSWeek2018, they’re getting it to the masses. We need to inspire the next generation of scientists to join our ranks, so HCSWeek gives us the perfect opportunity to show students and potential scientists exactly how far-reaching their options are.
Today, I spoke to my colleague Oli, who like me, is a newly-qualified Physiologist, about why he opted to undertake a career as a Physiological Scientist, and what he plans on doing, moving forward.
What attracted you to this particular scientific career in the first place?
It’s as simple as being able to help people, really. Clinical Physiology allows for patient-facing tests to be performed, so I felt like it would let me make an immediate difference.
Now that you’re qualified, and are well-versed in the basics of the job, are there aspects that you appreciate more from a post-graduate perspective?
Definitely. Every day presents a different challenge, because every patient is different. In the RUH, we have a wide array of clinical skills we have to learn, and as a result, I find that I’m adding to my knowledge every day.
Where do you see your career heading, moving forward?
I’m hoping to specialise in Cardiac Imaging, and have applied to the STP programme to help with that speciality. There are a wealth of options, even after that, so whilst I’m not entirely sure at this stage, I may look at the Higher Specialist Training after that!
Myself and some of my colleagues recently relinquished a Saturday off, and braved the icy cold (read: British) weather to try to meet with the public, and raise awareness of atrial fibrillation through a project spearheaded by the AF Association.
I didn’t organise the event, but was kindly invited along, and jumped at the chance to help some of my amazing Cardiology workmates by checking pulses, and recording rhythm strips using the AliveCor mobile ECG monitor (which I have previously reviewed here).
AF is an atrial arrhythmia, wherein the sinus node does not cause appropriate, rhythmic depolarisation as it normally would. Rather, multiple foci activate, facilitating a motion akin to ‘quivering’, which raises the risk of embolism through the inefficient pushing of the blood into the ventricles. It’s an incredibly dangerous problem if left untreated, so it’s vital that it gets detected, and preferably this would happen early.
I go into detail about AF, it’s mechanisms and ECG presentation in this study guide, so have a look at that if you want to understand it further.
As you may or may not be aware, atrial fibrillation is, globally, the most common clinically significant cardiac arrhythmia, and it is thought that whilst 1.2 million people (a conservative estimate) in the UK are known sufferers of the sinus node disorder, a 500,000 have it, and live undiagnosed. The estimated cost of AF to the NHS was somewhere in region of £2.2 billion, in 2008, and given that the prevalence of the arrhythmia has increased year on year, this number may well be higher now.
Obviously, this is far from an exhaustive exploration of AF, but hopefully it gives some insight into why it’s so important to detect and treat, and why initiatives such as this one are a good idea.
We set up shop in Frome’s Westaway shopping centre at around 10am, where members of the public who’d read about the event in the local newspaper were already queueing. We four clinical scientists proceeded to advise and check 85 people throughout the day. We had a surprise visit from Cardiologist’s Kitchen, too!
Many people we talked to had little-to-no idea what the condition was, its risks, or how it was treated, so we used literature, ECG examples, and a scale model of a heart, to educate, and taught people how to check their own pulse before performing quick rhythm recordings which we analysed on the spot. More than a few people who attended had known AF, and their questions largely involved their current treatment, and the potential impact AF might have on their life. Most, however, visited so they could get checked over, hopefully putting their mind at rest, and learning something in the process.
We didn’t find any new atrial fibrillation (although we did discover two cases of previously undiscovered AV Block), but of equal importance to arrhythmia discovery, was the community engagement, particularly in a public setting. In clinics it’s easy to fall into a cycle with patients, due to schedules and time pressures, and whilst we all try our hardest to make sure everyone is treated individually, seeing the problem before the person is always possible. Interacting with patients on “their turf” meant the ball was in their court, if you like, and the sheer volume of people who expressed an interest meant it couldn’t have been further from a wasted day.
The feedback we received was overwhelmingly positive, and there was a recurring theme in the gratitude people felt for the healthcare environment coming to them, as oppose to the other way around. Many of those to whom we chatted understand the strain that hospitals and GP surgeries are under, and felt that visiting to be checked for AF, and other such things, would be inappropriate. In many ways, I suppose they’re right, too; regardless of the importance of finding these things, especially as they do not always present with obvious symptoms, healthcare centres, unfortunately, cannot cope with the demand a service such as this would present. To this end, I was glad to have ventured out to participate in this, an outdoor clinic of sorts, and educate the public on what to look for, as well as how they can guage their own heart rhythm and take some more control over their own health. I sincerely hope to do it again soon!
The AFA is a fantastic charity, so it’d be great if you were to find out a bit more about them by visiting them here.
I’d like to thank my colleagues for asking me to participate, and generally being fantastic people, those who visited us and asked lots of challenging questions, and the kind souls who bought us ginger ale and flapjacks when the temperature reached what *felt* like sub-zero levels.
The statistics used in this post are taken from the BHF. If you want to take a look for yourself, visit the British Heart Foundation, here.
When Cardiologist’s Kitchen put forward its Health Foundation application, it stated that it would run patient workshops at Neston Park Farm & Kitchen to engage patients with professionals and good, healthy food.
Neston head chef Steve Mercer cooked a fabulous 2-course meal for guests, and after a brief interlude by Ali Khavandi and Mary Fifield, there were some indroductions for myself, nurses in Cardiac Rehabilitation and the CardioFITr team (more on these guys in the future), as well as local food producers Fussels, and Fresh Range, whose ingredients made up some of the food.
The workshop wasn’t about us, however; it was a patient-centred event, so the real stars of the evening came in the form of the service users themselves. A select few were gracious enough to share their stories regarding the improvements that Cardiologist’s Kitchen had made to their lives. One had lost a considerable amount of weight and thus, could do normal, everyday things that she had previously found difficult as a result of her (now greatly improved) angina, another was part of the CardioFITr programme, which, run by healthcare professionals and in conjunction with Cardiologist’s Kitchen, uses evidence-based science and medicine to improve physical fitness and promote a continued change in lifestyle. He too, had seen a considerable and positive reduction in weight and blood pressure, and was almost ready to cease his medication for the latter. This is a particularly palpable achievement for the scheme, and proves it actually supports patients to persevere.
A 2010 paper by Curtis Triplitt of The University of Texas titled Improving Treatment Success Rates for Type 2 Diabetes cites clinical inertia as the biggest barrier to treating the condition, so by beginning to see positive results in this manner, initiatives like this really do matter with regards to health and wellbeing. It’s long been known that diet and exercise have a massive impact on health, but anyone who’s struggled with dieting, knows that support is one of the most important factors in sticking to whatever regime one is using to better their health.
As I chatted to patients and heard their stories, I became aware of just how thankful they were for Cardiologist’s Kitchen, and the positive impact it was having on their lives. Many of them had been rushed to the Catheterization Laboratory with a suspected infarct, and regardless of the findings had assumed their lives were irrevocably altered. The advice and specific support given by CardioKit meant they were now turning a corner and seeing measurable changes in their own health. The best part was knowing that they had essentially been encouraged to do it themselves with their own willpower.
Barely a month goes by without a national newspaper displaying words like “science says _________ is bad for your health”.
I concede that *some* of these headlines might be correct, but it’s worth taking them with a pinch of salt, if you’ll pardon the pun; firstly, “science” isn’t an all-powerful being that performs every possible study single-handedly, so it’s difficult to know exactly who has put forth the particular claim and how many people through whom the information has passed before it gets to the news media, and secondly, “science says…” doesn’t necessarily mean it’s double-blind, peer-reviewed, evidence-based or ethically funded, so between the debunked results of Andrew Wakefield’s infamous autism/ MMR study and big pharmaceutical companies potentially protecting their interests by omitting unfavourable study data, it isn’t a great idea to believe that eating bacon causes your lips to fall off, simply because the junior science editor for The Daily Expresstells you it does.
What, then, do you believe? Nobody wants to find themselves being brought into a Cath Lab, and they don’t want the uncertainty that comes with not knowing whether the food that they’re eating is going to help put them in that position. This is where Cardiologist’s Kitchen comes in; Consultant Interventional Cardiologist Ali Khavandi would rather intervene well before you’re being consented for an invasive procedure, and addresses issues with cholesterol, weight, blood pressure and diet by way of a pre-emptive strike using evidence-based dietary and lifestyle changes.
Not unlike this site, the initiative began as a humble health-based blog in 2015, featuring advice and recipes, and was borne through personal, clinical experience. Khavandi’s passion for both cardiology and cooking pushed him to create a resource, and seek a wider market using the same mechanisms employed by the media and the food industry, but using an evidenced basis in cardiovascular wellbeing. The Health Foundation has since granted the Cardiologist’s Kitchen project an award that has allowed the trial of this innovative approach to healthcare to really take off!
Currently, Cardiologist’s Kitchen has partners in GP surgeries, a restaurant and various South West England food suppliers that combine to make conduit for the project’s entire message. Despite still being in relative infancy, Cardiologist’s Kitchen has made headway, and continues to open up avenues via which to get the message out there.
Patients with new or existing high blood pressure can get a CardioKit pack at affiliated GPs. I got one to sample, which contained some money off vouchers, health advice and information about the project. In addition, The Bunch of Grapes gastropub, found in Bradford on Avon, just outside Bath, offers some menu heart-healthy menu items devised by both Ali Khavandi and head chef Steve Carss (I’ve sampled some of these too; they’re delicious).
The website is the real central feature of the initiative, with healthy recipes, incentives for transforming your attitude to heart health, and evidence-based discussion on food fact, cutting through scaremongering in the bad science which can sometimes surround food.
Rather marvellously, it encourages the use of local suppliers by offering deals and home delivery on their seasonal produce. They’re also in the process of developing ready meals specifically designed to improve cardiovascular health.
By using CardioKit, the aim is to lessen the need for medication, and support local business as well as your own heart. If you’re reading this, and it applies to you as a patient, then I urge you to have a look. If you’re a practitioner, definitely do the same, and get in contact with the CardioKit team to see how you can get involved.
Inspired by the advice presented on Cardiologist’s Kitchen, I made a rather lovely Jamaican beef curry, the (really easy) recipe for which I will share here:
250g lean diced beef
4 banana shallots, thinly sliced
1 x jalapeno chili, diced. (Leave the seeds in if you’re a daredevil)
1 x carrot, peeled and chopped
1 x small sweet potato, peeled and diced
1/2 mango, diced
2 garlic cloves, sliced
1 box passata
1 tbsp. jerk paste (jerk seasoning will do fine, but add 2 tbsp.)
1tbsp garlic granules
1 tsp. tomato puree
100ml chicken stock
Flat leaf parsley, roughly chopped
Salt and Pepper, to taste
Rice, any kind, and enough to feed 2 people
With a little oil, brown the beef until sealed sufficiently. Add the shallots, sweet potato, and sliced garlic, and cook for another few minutes. Throw in all of the other ingredients and reduce heat. Simmer for 60 mins, or until the beef is tender, and use this time to cook your rice. Serve with some chopped parsley and a dollop of yoghurt.
I recently spent the day inside the catheterisation laboratory, specifically in the pacing lab. After a few relatively straightforward implants, we reached the final case of the day; a pacemaker change. The patient in question had 4 months of reported battery life left on his pulse generator, so on paper, it was merely a case of opening the pocket in which his old device was housed, and switching it out for a new one that would stimulate his heart for the years to come.
Textbooks are great, in that they detail a procedure from start to finish, usually from everyone’s perspective, covering all bases regarding technique, equipment, potential emergencies, and possible troubleshooting options should the need arise.
These emergencies range from device malfunction to cardiac complications, and cover most things in between. I haven’t read a textbook that outlines what should be done if the patient suffers from dementia, however…
The procedure began late due to the difficulty in cannulating the individual, given they didn’t really understand where they were, and began thrashing around wildly in confusion as soon as the needle was introduced, but eventually they were brought into the lab and set up on the table. Local anaesthetic was administered whilst myself and other members of staff present tried to ensure that the patient was as calm as possible.
This proved rather difficult, as the patient was understandably scared; bright lights and masked strangers staring down at you aren’t a pleasant experience for anyone, so add a severe perception deficiency into the mix, and it’s only going to be worse.
Once the procedure proper had begun, it got so much worse.
If you’ve ever been in a lab or theatre when an electrocautery is being used, you’ll know how loud it is. Trying to keep a confused patient calm, and focussed on your voice alone, is incredibly difficult when you’re being drowned out by a deafening beeping noise. The consultant performing the change was having to work 3 times harder than normal whilst completing his task, because of the patient’s inability to understand what was happening, and more importantly, why it was happening.
There were 6 staff in the operating lab, and of those six, the only one able to fully focus on their job was the consultant. The rest of us tried to hold a limb each, to stop them from flailing and causing potential injury.
The chief priority was the patient’s overall well being, so when the radiographer received a rather nasty set of deep scratches, she endured the pain and tried to reassure the patient.
When the registrar’s fingers were being held so tightly together that they almost broke, she quietly asked if I could free them using one of my available hands, and continued talking to the patient.
When I was struck in the face as a result of removing a hand from the patient’s leg in order to do the above, I didn’t make a sound, as I didn’t want to frighten the patient anymore.
In this patient’s mind, we were causing discomfort for no reason, and as a result, this patient was fighting as though his life depended on it, but nobody said anything that might give cause to further agitate him no matter how much was thrown at them in that situation, because the fact is, we were there to help the patient and their safety came before our own.
No amount of reading could have prepared me for that situation, but even a small amount of warning, or advice, would have been a boon. To that end, I’ll say this;
Scenarios such as the above WILL happen. It’s inevitable. Just stay calm, communicate with everyone around you and never forget why you’re there. Of course it’s not right that you sustain an injury on the job, but the bigger picture comes first and then you can set about producing system changes.
Beyond Verbal, an Israeli company leading the market in voice/emotion analysis software are making headlines thanks to their study with the Mayo Clinic, that shows that voice analysis can indicate the presence of coronary artery disease (CAD).
CAD is responsible for one of the highest cardiovascular mortality rates in developed countries globally, and whilst lower in developing countries, this figure is quickly rising. With this in mind, inexpensive, low-risk and non-invasive screening methods are a very desirable prospect. Currently, ECG, Exercise Tolerance Testing (ETT), Radionuclide testing and Pharmaceutical Stress Testing are the most common procedures used to screen for CAD, but, aside from ECG, each has contraindications, and/or is fairly invasive. Again, aside really from a simple ECG, each has a middling to significant associated cost attached to it. Technology that could reduce these costs and the potential for unnecessary testing presents a possible alternative to patients being referred to chest pain clinics and such, without a sure fire reason to do so.
Beyond Verbal have already used their vocal analysis software to find audio characteristics associated with Parkinson’s disease and autism, and have now turned their technology to CAD.
The Beyond Verbal/ Mayo Clinic study hypothesised, due to the association coronary atherosclerosis has with other systemic pathologies, that vocal processes and the structures responsible may also be affected.
150 patients, 120 of which presented for angiography of the coronary arteries and 50 healthy, or non-cardiac control patients had their voice recorded prior to the test. Beyond Verbal then used a variety of their analytical software to record three 30 second voice clips from each patient; the first (R1) was a predetermined script, R2 was a description of a positive experience, and R3 was personal like R2, only a negative experience.
The analysed results show a 19-fold increase in the likelihood of CAD in R3, the negative voice clip, irrespective of traditional cardiac risk factors such as age, suggesting there is indeed a link between CAD and voice.
BV hope that future development of this technology can be used to screen patients telephonically.