RCGP-2014-poster-abstracts

More documents

Recommendations

Info

• The index of suspicion amongst frontline clinicians for potentially lethal sepsis in children has been raised • Assessment, decision-‐making and management plans are evidence-‐based and protocol-‐driven • Early clinical management – basic life support, investigations and empiric antimicrobial prescribing – should now be the same for all health staff region-‐wide • Sepsis-‐related mortality has significantly reduced since the introduction of the procedure • Social and micro-‐economic healthcare burdens have reduced • There is scope to build on these successes and further validate the clinical intervention strategy by studying, for example, the effects of the broadened use of empiric antibiotics (Ceftriaxone, Gentamycin) on bacterial ecology. After spending 7 years living in Bangladesh and working across the south Asian sub-‐continent, the Kimberley seems to me to be a Fourth World almost on its own. Any research from elsewhere will have to be intelligently interpreted before it can be considered relevant, applicable and without risk of bias. It is easy to find criticism of this tool: over-treatment; inappropriate treatment of viral disease; risk of developing antimicrobial resistance. Yet so far, in trying to address the WHO’s fourth Millenium Development Goal here in remote Australia, the Kimberley Unwell Child Procedure seems to be making a difference saving children from dying from bacterial sepsis. [1] Source: World Federation Paediatric Intensive & Critical Care Societies. Sepsis Initiative (<strong>2014</strong>). Available at http://www.wfpiccs.org/projects/sepsis-‐initiative/ [2] Compliance in measuring and recording each step of the Procedure for febrile children who fitted the criterion of “no evident source of infection” was low – 25%. [3] Childhood Mortality in the Kimberley Region, 1 July 2010 to 30 June 2013: An Audit of Mortality Incidence by Age, Causality and Locality. John Boulton, Agi D’Amico; Western Australia Country Health Service. November 2013. P047 Rheumatic fever: Feasibility of a population-‐based screening programme targeting school children in a rural village in Nepal Sindhu Pathmabaskaran; Sarayu Sanguhan London Deanery GP trainees Objectives: To demonstrate the feasibility of a local screening program for ARF and GAS pharyngitis in school aged children in a rural village of Manthali, located in central Nepal.MethodPopulation based study targeting the prevention of rheumatic heart disease through early detection of ARF using the resources available. 479 school children aged between 7-‐17 years old from two local private schools were selected for the screening programme. Laboratory investigations, data collection and analysis were performed at Tamakoshi Cooperative Hospital, Manthali. The initial stage of the screening programme was comprised of clinical examination and standardised history taking. Children found to have a cardiac murmur were then asked to attend Tamakoshi Cooperative hospital for blood tests. Diagnoses of suspected cases of ARF and GAS pharyngitis were made using the Modified Jones criteria. Results: Of the 479 children screened in the programme, just over a third (164/479) were found to have a murmur. To date, 31.7% children have returned for blood tests. Of those, 11 children had clinical evidence suggestive of GAS pharyngitis and were treated with a short course of antibiotics in line with the primary prevention protocol. Two children had clinical evidence suggestive of ARF and were treated with a course of antibiotics followed by referral to Shahid Gangalal National Heart Hospital, Kathmandu. Conclusion: The implementation of this practical screening programme in a resource poor region with high rates of ARF and RHD is a feasible and affordable public health measure. P048 care Circumcision – an evaluation of post-‐operative complications in neonatal males circumcised in primary Zoya Kiani; Tahmeena Dean University of Manchester Background: Circumcision is the most frequently performed surgical procedure in human history. The most common post-‐operative complications of removing the foreskin include bleeding, swelling and dysuria. Method: Medical records of all children circumcised at the practice since the service began in November 2013, were analysed. 173 records were reviewed for evidence of post-‐operative complications. 38
Results: 10% reported a post-‐operative complication. The most common complication was the plastic ring not falling off within a week. In some boys, this was because the ring had slipped on to the shaft of the penis, and the excess swelling was not allowing the ring to slide off. In some boys the glans of the penis became so swollen that the swelling had not gone down even a week later, therefore the plastic ring had to be removed manually. 2% had a complication requiring referral to secondary care. 90% of patients did not return for a follow up appointment. In those who did not return for follow up, it is assumed that they had an uncomplicated recovery. Conclusion: The majority of complications that were seen at the practice were due to the PlastiBell clamp that was used. The introduction of routine follow-‐up appointments for all boys circumcised at the practice, and looking into other possible methods of circumcision, may bring down rates of post-‐operative complications. P049 What challenges does general practice face in managing chlamydia Rehan Chaudary Heatherwood and Wexham Park Hospitals NHS Trust Introduction: Chlamydia is the commonest STI in the UK (46% of diagnoses in 2012). Guidelines on chlamydia management are naturally of great importance to General Practice, which has the greatest opportunity to address this issue. Sexual health clinics provide an invaluable source of data to determine the challenges faced in implementing these guidelines and reveal lessons useful for primary care. Aim: To use data collected from a tertiary sexual health clinic to assess the practicalities and difficulties of implementing chlamydia guidelines to assist General Practice in service provision. Method: Patients diagnosed as chlamydia positive over a 4 week period in a sexual walk-‐in clinic in Slough, UK had their records reviewed to assess compliance with the British Association of Sexual Health and HIV (BASHH) and Medical Foundation for HIV & Sexual Health (MEDFASH) guidelines for management of chlamydia. Results: Results (65 population) showed 87% were first time presentations, of which only 73% had HIV screening. 51% asymptomatic and treated with azithromycin within an average of 4 days (in accordance with guidelines). Only 69% given advice about unprotected sex with insufficient numbers of contacts receiving treatment (58%). 1.22 female to male ratio. 95% heterosexual and 5% homosexual. Average age was 25. 65% of patients of white UK ethnicity. Discussion: This study highlighted the difficulty in HIV screening patients with concurrent STDs; this is a crucial area where General Practice is on the front line. Sexual health advice also appears difficult with insufficient numbers given advice about unprotected sex and contact tracing. This difficulty will only be increased in primary care and thus GPs should be aware of the need to ensure systems are in place to help. The demographics of high risk populations (25 year old heterosexuals of white UK ethnicity) was in keeping with current guidelines and, combined with the fact that half of patients were asymptomatic, shows it is of importance for primary care doctors to be aware of this and offer screening/testing to this group in particular. P050 Chlamydia screening in times of austerity Sebastian Kalwij NHS Lambeth Lambeth in South London has a very successful chlamydia screening programme. 50 practices are taking part since 2003. Since 2010. GPs in Lambeth contributed more than 40% of all community based tests for Chlamydia; this is the highest rate in the country for the third consecutive year. A strategy combining educational outreach and a financial incentive worked well. In 2011 it was decided to terminate the Local Enhanced Service due to changing financial priorities, from the 1st of October onwards. GP support continued but practices were no longer reimbursed for tests. We compared the number of tests in the period before, October 2009-‐September 2011 and the period afterwards October 2011-‐September 2013 to evaluate long-‐term effects. We also conducted a short survey amongst GPs in 9 practices in Lambeth. We compared data from Lambeth with neighbouring Southwark. Lambeth and Southwark have a long history of working together and their chlamydia screening programme are similar. The only difference is that in Southwark GPs continued getting paid after October 2011 but no longer received practice support. Results: Pre-‐Lambeth: 7657, post Lambeth: 8592. Pre-‐Southwark: 6932, Post-‐Southwark: 6486. Testing and diagnosis rates are higher in the post-‐intervention period in Lambeth. 39
Page 2 and 3: Clinical P001 The role of Cent
Page 4 and 5: P061 Sharing treatment informati
Page 6 and 7: P117 Bisphosphonate holiday -
Page 8 and 9: P171 Audit of the initial mana
Page 10 and 11: P221 Professional interventions
Page 12 and 13: P270 The academic fellows progr
Page 14 and 15: P329 Sociolinguistic factors aff
Page 16 and 17: P388 GP referral letters-‐ar
Page 18 and 19: standard is that 100% of these
Page 20 and 21: Discussion: Knowledge of practic
Page 22 and 23: Conclusion: There was success i
Page 24 and 25: Aims: To help understand the r
Page 26 and 27: P022 General practitioners’ vi
Page 28 and 29: Quality assured content and nav
Page 30 and 31: There is an imperative for GPs
Page 32 and 33: P035 Re-‐prescribing regular
Page 34 and 35: • No patient had tried to ob
Page 36 and 37: Community identified needs inclu
Page 40 and 41: Conclusion: In Lambeth, removing
Page 42 and 43: Extraskeletal primary myxoid cho
Page 44 and 45: P060 Referrals to children’s
Page 46 and 47: Discussion around barriers to v
Page 48 and 49: Conclusion: A significant propor
Page 50 and 51: IHA's were carried out with su
Page 52 and 53: their Caucasian counterparts. NI
Page 54 and 55: Background: PCOS is an endocrin
Page 56 and 57: shown to have better coping me
Page 58 and 59: age, as indicated by higher up
Page 60 and 61: Relevance/impact: By conducting
Page 62 and 63: University of Birmingham Backgro
Page 64 and 65: Analysis and discussion: Listed
Page 66 and 67: • Prior sputum MC&S suggested
Page 68 and 69: Conclusion: Recommendations for
Page 70 and 71: anticoagulation and the assessme
Page 72 and 73: Content: The presentation will
Page 74 and 75: Aims & objectives: To assess h
Page 76 and 77: [2] Wood DA, Wray R, Poulter
Page 78 and 79: made to update schizophrenia po
Page 80 and 81: 150 patients were included with
Page 82 and 83: evidence of Centor symptoms, an
Page 84 and 85: Pulmonary rehabilitation is a n
Page 86 and 87: I found there were 26 paediatr
Page 88 and 89:
Aims/objectives: To analyse pati
Page 90 and 91:
• The DMS should maintain a
Page 92 and 93:
A literature review and audit
Page 94 and 95:
The commonest sites for lesions
Page 96 and 97:
• GPs' confidence in their ab
Page 98 and 99:
severe hypoglycaemic events were
Page 100 and 101:
Discussion: Reception staff’s
Page 102 and 103:
Outcomes: GPs lacked confidence
Page 104 and 105:
identified as major challenges
Page 106 and 107:
Aims: To investigate challenges,
Page 108 and 109:
percentage change (p
Page 110 and 111:
improved glycaemia, blood pressu
Page 112 and 113:
Division, Mount Sinai Medical C
Page 114 and 115:
egarding circulation. Prior to
Page 116 and 117:
P224 ‘One size doesn’t fit
Page 118 and 119:
Results: Year 13 students have
Page 120 and 121:
Aim: To systematically review t
Page 122 and 123:
eathers in sleeping time (MBS)
Page 124 and 125:
Discussion: ‘Evidence flowers
Page 126 and 127:
Aims and objectives: This surve
Page 128 and 129:
Relevance: Medical education sup
Page 130 and 131:
• Patient, Doctor, and Consult
Page 132 and 133:
onset of cardiovascular disease
Page 134 and 135:
this is kept as a reward and
Page 136 and 137:
P270 The academic fellows progr
Page 138 and 139:
in the system especially in pa
Page 140 and 141:
diagnosis can represent a 'teac
Page 142 and 143:
Results: The study found that
Page 144 and 145:
The findings showed that averag
Page 146 and 147:
with other doctors can be very
Page 148 and 149:
• Map existing quality and sa
Page 150 and 151:
• A reduction in non-‐elec
Page 152 and 153:
It is imprtant to learn lesson
Page 154 and 155:
• Deliver teaching on; literat
Page 156 and 157:
Toby Holland; Colette Davey; Lo
Page 158 and 159:
Aims/objectives: i) Gain insight
Page 160 and 161:
model or negative peer percepti
Page 162 and 163:
Anecdotal feedback suggests that
Page 164 and 165:
Background: There is much debat
Page 166 and 167:
Summary of work: A short surve
Page 168 and 169:
Content: The planning, delivery
Page 170 and 171:
practice in a primary care uni
Page 172 and 173:
P358 “When should I worry" G
Page 174 and 175:
tool; initial cohort was patien
Page 176 and 177:
educational network to provide
Page 178 and 179:
P372 Clinical induction workshop
Page 180 and 181:
to 5 (fully achieved). Marks f
Page 182 and 183:
P382 Primary care ethics: a Li
Page 184 and 185:
length for this learning experi
Page 186 and 187:
Method: The aim of the study
Page 188 and 189:
Summary of work: Participants a
Page 190 and 191:
Lesley Morrison; John Gillies S
Page 192 and 193:
Aim: To increase the involvemen
show all

RCGP-2014-poster-abstracts

Create successful ePaper yourself

Delete template?

Save as template?