oral surgery poster presentation

Accepted Posters

For questions regarding posters, please contact Kimberly Shadle ( [email protected] )

Congratulations To The Top 20 Poster Submissions

Poster Coauthor(s): Rubén Muñoz , José Golaszweski

Poster Title: Versatility of the Use of the Osteomyocutaneous Fibula Free Flap in the Reconstruction of Mandibular Defects: A Retrospective Study

Coauthor(s): Nicolas Solano, Paulina Gutiérrez, Arianny Peraza, Ejusmar Rivera

Poster Title: Use of a Modified Bilateral Cheek Advancement Flap for Total Reconstruction of the Lower Lip: Case Report

Coauthor(s): Nicolás Solano, Paulina Gutiérrez, Anixa Álvarez, Greyner Dueñes

Poster Title: Hybrid Odontogenic Tumor: A Unique Presentation of 3 Different Entities.

Coauthor(s): George Mimitroulis

Poster Title: Custom Temporomandibular Joint Replacement Surgery Using a Virtual Surgical Planning Protocol: Surgical Accuracy and Pattern of Error

Poster Coauthor(s): S. Patel

Poster Title: Carotid Body Tumour Case Report

Coauthor(s): Angela Bueno de Vicente, Almeida Parra, Julio Acero

Poster Title: Impact of Intraoperative Navigation in Surgical Margins in Midface Malignancies

Coauthor(s): Endang Syamsudin, Eka Marwansyah Oli’i

Poster Title: Management of Submental Abscess in Pregnant Woman with Covid-19: Case Report

Poster Coauthor(s): Paulina Gutiérrez, Ejusma Rivera, Salomón Ramos , Medina Carlos

Poster Title: Osteoplastic Anterior Transoral Approach for Tumors of the Middle Cranial Fossa.

Poster Coauthor(s): Samuel Kim

Poster Title: Outcomes of Total Temporomandibular Joint Replacement Without a Submandibular Incision

Poster Coauthor(s): A. Johnson, D. Ho

Poster Title: Evaluation of Splatter Distribution of Irrigation Methods to Minimize Spread of Sars-cov-2

Poster Title: Colgajo Bilobulado en Defecto Nasal

View Poster

Coauthor(s): Jaime Matta

Poster Title: Manejo de Fractura en Piso de Orbita

Poster Title: Desplazamiento de Implantes Dentales Hacia el Seno Maxilar: Reporte de un Caso

Coauthor(s): Gonzalo A Herrera

Poster Title: Reemplazo Total de ATM: Efectividad de Materiales Alpola Sticos

Coauthor(s): LA Montoya-Pérez, ME Vélez-Cruz

Poster Title: Hemangioendotelioma Epiteloide: Presentación de un Caso Clínico

Coauthor(s): LA Montoya Pérez

Poster Title: Quistes Epidermoides: Presentacion de Casos

Coauthor(s): C. Núñez, P. Cerda, G. Gazitúa, A. Rojas

Poster Title: Fractura Fronto Orbitaria con Compromiso de Seno Frontal: Reporte de un Caso.

Coauthor(s): Maria Dianella Jensen, Andrea Goncalvez, Henry Garcia Guevara

Poster Title: Intubación Submental Como Alternativa Para Pacientes Politraumatizados

Poster Title: Osteonecrosis Mandibular Asociado a Medicamentos: Reporte de Caso Clinico

Poster Title: Reconstrucción Inmediata con Colgajo Rotacional de Temporal e Injerto de Fascia lata Posterior a Hemimaxilectomia por Mixoma Odontogénico

View The 2021 Electronic Poster Submissions

All accepted posters for the IAOMS/ALACIBU NextGen Online Conference may be viewed here. Click on the links below to view posters by the first letter of the first author's last name.

A  | B  |  C  |  D  |  E  | F  | G  |  H  |  I  |  J  |   K  |  L  |  M  |  N  |  O  | P  | Q  |  R  | S  |  T  |  U  | V  |  W  |  X  |  Y  | Z  

Coauthor(s): Nicolás Solano, Paulina Gutierrez, GreynerDueñes, Yenielis Chirinos

Poster Title:

Modified Labiomandibuloglossotomy Approach for Solid Tumor of the Floor of the Mouth: A Case Report

Coauthor(s): H.Y. Yusuf, E.M. Oli'I, R. Nusjirwan, L. Hasibaun

Poster Title: Management of Cervical Necrotizing Fasciitis Due to Odontogenic Infection : A Case Report

Poster Title: Survey of Patients’ Experience of Orthognathic Surgery: Health-Related Quality of Life and Satisfaction

Coauthor(s): Afrah A. Khalil

Poster Title: A Clinicopathological Study of Oral Pyogenic Granuloma in Iraq

Coauthor(s): Shelly Abramowicz, Jonathan Michel

Poster Title: Patient-specific Cutting Guide for Access to Infratemporal Fossa

Coauthor(s): N Higgs, O Mitchell, P Alam, S Madhavarajan

Poster Title: An Aggressive Destructive Lesion of the Mandible with Inconclusive Histopathological Diagnosis

Coauthors: Javianna Castellanos, Carlos Ramirezn, Matthew Radant

Poster Title: Versatility of the Radial Forearm Free Flap for Tongue Reconstruction, Literature Review and 2 Cases Presentation

Coauthor(s) Endang Sjamsudin, Winarno Priyanto

Poster Title: Gap Arthroplasty with Interpositional Temporalis Fascia in the Management of Temporomandibular Joint Ankylosis : A Case Report

Coauthor(s): Seto Adiantoro, Indra Hadikrishna

Poster Title: Management Dentoalveolar Fracture with Simple Wiring in Mild Head Injury: A Case Report View Poster

Coauthor(s): Nicolas Solano, Ariamay Castrillo, Paulina Gutiérrez

Poster Title: Management of Patient with Oral Cancer During the Covid-19 Pandemic

Poster #1 Coauthor(s): Rubén Muñoz , José Golaszweski

Poster #1 Title: Versatility of the Use of the Osteomyocutaneous Fibula Free Flap in the Reconstruction of Mandibular Defects: A Retrospective Study

Poster #2 Coauthor(s): Rubén Muñoz , José Golaszweski

Poster #2 Title: Mandibular Bone Growth in Relation to Long-term Chronological Age in Syndromic Patients Subjected to Osteogenic Distraction

Coauthor(s): Tejal Pankhania, Phillipa Matthews, Eoin Twohog, Kieron McVeigh>

Poster Title: Re-organisation of Head and Neck Skin Cancer Surgery Services During the Covid-19 Pandemic: Experience with Implementation of Alternative Strategic Operational Workflow

Poster #1 Coauthor(s): H.R. M. Veronese, V.B. Filho, Ivan Solani Martins, A.C.A. Pellizzon

Poster #1 Title: Conservative Management of Advanced Mandibular Osteoradionecrosis with Mild Clinical Presentation After 17 years of Ontological Treatment

Poster #2 Coauthor(s): H.R.M. Veronese, H. F. Koehler

Poster #2 Title: Clinical, Imaging, Histopathoogical, Mutational and Therapeutic Characterization of Refractory Ameloblstoma in the Maxilla

Poster Title: Maxillary Sinus Mycetoma in Immunocompromised Patient

Coauthor(s): Konrad Skorko

Poster Title: Challenges and Solutions in the Management of Orbital Fractures in the Emergency Department at Derriford Hospital

Coauthor(s): B. Owen

Poster Title: Improving the Consent Process For Coronectomy Procedures

Coauthor(s): Mehak Malhotra

Poster Title: Lets Reduce Post-operative Complications of le Fort I Osteotomy

Coauthor(s): Erick Geovanny Reyes Castaneda

Poster Title: Mucormycosis - Two Cases Report

Coauthor(s): B. Aslam-Pervez, S. S. Subramaniam, J. D. McMahon, J. A. McCaul

Poster Title: Non-Smoking Non-Drinking Oral Squamous Cell Carcinoma Patients: A Clinically Significant Group

Coauthor(s): Paulina Gutiérrez, Arianny Peraza, Ejusmar Rivera

Coauthor(s): R. Grillo, R. Faccio, CRP Jodas

Poster Title: Virtual Planning in Orthognathic Surgery to Treat Facial Asymmetry

Coauthor(s): C.R.P. Jodas, Marilla Leal

Poster Title: Analysis of the Articular Disc Position After Arthroscopy with Viscosupplementation by Magnetic Nuclear Resonance

Co-Author(s): Tung-Yiu Wong

Poster Title: Landmark Free Computerized Optimal Symmetric Plane System

Coauthor(s): Nicolás Solano, Paulina Gutiérrez, Salomón Ramos S, Maria Atencio

Poster Title: Rare Case of an Intraparotid Mucous Retention Cyst in an Infant Patient

Coauthor(s): Ming-yin Leung, Crystal Wang

Poster Title: Virtual Surgical Planning and Patient Specific Plates for Simultaneous Le fort III & Le Fort I Osteotomies

Coauthor(s): Agus Nurwiadh, Asri Arumsari

Poster Title: Emergency Management of Ludwig's Angina with Sepsis Complication

Coauthor(s): C.R.P. Jodas

Poster Title: Necrosis of Lower Third Face: Rare Complication Due to Sclerotherapy for Treatment of Labial Hemangioma

Poster #1 Coauthor(s): Maria Aparecida de Albuquerque Cavalcante, Giulianna Pinheiro

Poster #1 Title: Temporomandibular Joint Ankylosis Mimicking an Osteochondroma

Poster #2 Coauthor(s): Maria Aparecida de Albuquerque Cavalcante, Giulianna Pinheiro

Poster #2 Title: Alternative Approach for Treating a Lefort iii Fracture in a Patient with Acute Lymphoid Leukemia

Coauthor(s): M. Vélez-Cruz, R León Aguilar

Poster Title: Protocolo de Reconstrucciã“n Mandibular hãrida: serie de casos

Poster #1 Coauthor(s): Rafael Ruiz Rodríguez

Poster #1 Title: Proposal of the Classification of Midface Fractures Based on Anatomical Buttresses.

Poster #2 Coauthor(s): Raymundo Ramirez Lugo

Poster #2 Title: Surgical Control of Pitch, Roll and Yaw Maxillary

Coauthor(s): Brandon Owen

Poster Title: Virtual Consultations: Accessible to All?

Poster Title: Inferior Alveolar Nerve at the Proximal Fragment During Bilateral Saggital Split Osteotomy- No Re Position to Distal Fragment Required.

Coauthor(s): Pearlcid Siroraj

Poster Title: “Sooner the Better” – Immediate Placement of Wide Body Implants in Extraction Sockets of Mandibular First Molars: Assessment of Crestal Bone Level – A Pilot Study in Indian Population

Coauthor(s): R. Grillo, M.O.C.D. Leal, C.R.P. Jodas

Poster Title: The Need for the Inmediate Response of the Surgical Team in Facial Traumatism

Coauthor(s): Miguel Ángel Gonzalez de Santiago, Ebed Yonami Pimentel Madrigal

Poster Title: Gorham-stout Disease Case Report and Review of the Literature

Coauthor(s): Nicolas Solano, Carlos Medina, Betsabe Sarcos, Elvia Ríos

Poster Title: Oral Erythema Multiforme as a Paraneoplastic Manifestation of Colon Adenocarcinoma: A Case Report

Coauthor(s): M. Vavro, D. Hirjak

Poster Title: Bilateral Mandibular Coronoid Hyperplasia: A Case Report

Poster Title: Comparison of 2D and 3D Virtual Planning for Orthognathic Surgery

Poster #1 Title: Impacted Teeth Auto Transplantation After Failure of Orthodontic Extrusion (A Retrospective 5 year Follow Up)

Poster #2 Title: The Road Map to Achieve A Successful Mandibular distraction osteogenesis (An Evidence Based Approach and a Center 10 year Experience)

Poster Title: Delayed Extraction Socket Healing in Vitiligo Patient: A Case Report.

Poster #1 Coauthor(s): Humberto Fernandez Olarte

Poster #1 Title: Pedicled Tragal Chondral Flap for Irreparable Temporomandibular Joint Disc

Poster #2 Coauthor(s): Humberto Fernandez Olarte

Poster #2 Title: Modification of Blair Approach with a Modified Endaural Component to Access the Parotid Region

Poster Title: Manejo de Fractura en Piso de Órbita

Poster #1 Title: Autogenous Bilateral Wisdom Tooth Transplant Success Enhanced with Resorbable Calcium Phosphate (CaP) Substitute Material

Poster #2 Coauthor(s): Anastasia Depounti

Poster #2 Title: Dextroamphetamine-Amphetamine: A Therapeutic Treatment in Patients Suffering with Trigeminal Neuralgia

Coauthor(s): Alonso Moctezuma Alejandro

Poster Title: Effectivenes of Repair in Nasoalveolar Fissures Using Anterior Iliac Crest Graft and Plasma Rich in Growth Factors

Poster Title: Fluorosis Dental Como Anomalia de Desarrollo

Poster Title: Creating Quality Protocols for Fine Cheiloplasty Results

Poster #1 Title: Post Herpetic Neuralgia Treatment Options: Is there the best?

Poster #2 Title: Exposing Surgical Steps for Success in Porus Polyethylene Facial Implants

Poster #2 Coauthors: J.L. de la Puente, R.C.C. Cavalcante, C.R.P. Jodas

Coauthor(s): Subramanian Jaganathan

Poster Title: Primary Intraorbital b-cells Lymphoma: A challenging diagnosis; Case report and review of the literature

Poster #1 Coauthors(s): Miguel Ángel Gonzalez de Santiago

Poster Title: Management of Craneal Defects with Polymethylmethacrylate Case Report

Poster #2 Title: Zygomatic Implants in Maxillary Atrophy

Coauthor(s): Arvind Malhotra, Rakesh kumar Bansal

Poster Title: Fronto-orbital Osteotomy in the Surgical Management of Recurrent Adenoid Cystic Carcinoma Involving Anterior Skull Base.

Poster Title: Role of Multi-functional Theranostic Nano-particles in Head and Neck Oncology

Poster #1 Coauthor(s): Hisam Marwan

Poster #1 Title: The Use of Split Temporalis Muscle Flap to Prevent Temporal Hollowing

Poster #2 Coauthor(s): David Szandzik, Hisam Marwan

Poster #2 Title: Inferior Alveolar Nerve Repair Using An Umbilical Cord Membrane Nerve Wrap

Poster Title: Simulation of Sarpe Effects on Midface Soft-tissue

Poster Title: Where Were Oral Maxillofacial and Head and Neck Surgeons in Reconstruction in 1988

Coauthor(s): G. Malanche, F. Salgado

Poster Title: Adjuvant Therapy with Topic 5-Fluorouracil for Odontogenic Keratocist

Coauthor(s): Seto Adiantoro, Irra Rubianti, Bethy S. Hernowo

Poster Title: Reconstruction of Maxillary Defect with Vascularized Latissimus Dorsi Flap in Treatment of Embryonal Rhabdomyosarcoma : A Case Report

Coauthor(s): Goncalvez, Andrea, Suarez, Cesar, Garcia Guevara, Henry

Poster Title: Treatment of Gummy Smile With Botulinum Toxins – Clinical Case

Coauthor(s): Fabiola Salgado Chavarrìa, Ernesto Lucio Leonel

Poster Title: Odontogenic Myxoma Report of a Clinical Case and Review of the Literature.

Coauthor(s): Diana Elena Solís Campos

Poster Title: Combined Management of Custom Made Temporomandibular Joint Replacement and Orthognatic Surgery for Antecedent of Fibrous Ankylosis

Coauthor(s): Daniel Glikman, Kutaiba Alkeesh, Murad Abdelraziq, Imad Abu El-Naaj

Poster Title: Minimizing Antibiotics Use in Post-operative Care of Pediatric Patients Hospitalized with Odontogenic Infection

Coauthor(s): Indra Hadikrishna, Eka Marwansyah Oli'i

Poster Title: Management of Necrotizing Fasciitis : a Case Report

Coauthor(s): Farah Asnely Putri, Eka Marwansyah Oli’i

Poster Title: Tounge Edema After Cleft Palate Repair : A Case Report

Poster Title: Bioresorbable Osteosynthesis for Reconstructive Surgery of Craniosynostosis:A Comparative Study Between Absorbable Autures and a Resorbable Plating System.

Coauthor(s): Stephanie Drew

Poster Title: Intraosseous Hemangioma of the Mandible A Case Report and a Review of the Literature of the Intraosseous Hemangioma of the Facial bBones

Coauthor(s): R. Ramirez Lugo

Poster Title: Lateralization of Dental Nerve: Case report and literature review

Coauthor(s): Y.Aivanagendra Reddy, Sivanagendra R. Yaratha

Poster Title: Pfeifer's Technique of Bilaterral lip repair- A Forgotten Technique

Coauthor(s): N. Kalavrezos

Poster Title: Audit of Enoxaparin Dosing Post-operatively in Maxillo- facial Surgery Patients Undergoing Flap Procedures

Poster Title: Importantce of a Timely Diagnosis in Oral Aquamous Cell Carcinoma. Report of Clinical Case and Review of the Literature.

Coauthor(s): Madeleine Edith Vélez Cruz

Poster Title: REINTERVENCION QUIRÚRGICA ORTOFACIAL: CORRECCIÓN DE SECUELAS.

Poster Title: Reemplazo Total de atm: Efectividad de Materiales Aloplãsticos

Coauthor(s): R. Grillo, CRP Jodas

Poster Title: Comparison Between Virtual and Post-operative Planning of Orthognathic Surgery

Coauthor(s): Gursimrat Brar

Poster Title: Modified Cosmetic Genioplasty To Preserve Posterior Airway Space

Poster Title: Parotid Tumorectomy with recurrent failure , and total parotidectomy as a rescue surgery

Coauthor(s): A. Julian Castrejon

Poster Title: Facial Fractures from Dog Bite Injuries in Maxillofacial Region in Children: Case Report

Coauthor(s): Miguel Ángel González de Santiago

Poster Title: Mandibular Osteosynthesis Failure. Biomechanical Considerations and Management.

Poster Title: Efficacy of Codeine 30mg and Viminol 70mg for Acute Postoperative Pain Relief After Surgical Removal of Third Molars: A Randomized, Double-blind Study

Poster Title: A Comparative Study of the Clinical and Histopathological Features of Normal Labial Mucosa and Redundant Tissue in Double Lip

Poster Title: Paralisis facial periferica en paciente con toxoplasma gondii asociado a exodoncia de terceros molares. Rara coincidencia

Coauthor(s): R. Grillo, C.R.P. Jodas

Poster Title: Airway Permeability Post-orthognathic Surgery: Tomographic and Digital Comparison

Coauthor(s): R. Nordin

Poster Title: Type of facial soft tissue injuries and its association with underlying facial bone fracture in motorcycle associated accident.

Poster #1 Coauthor(s): LA Montoya-Pérez, ME Vélez-Cruz

Poster #1 Title Hemangioendotelioma Epiteloide: Presentación de un Caso Clínico

Poster #2 Coauthor(s): LA Montoya-Pere

Poster #2 Title: Schwannoma en la glándula submandibular: reporte de un caso.

Poster Title: Does an In-house CAD/CAM approach contribute to accuracy and time shortening in mandibular reconstruction?

Coauthor(s): G.Malanche Abdala

Poster Title: Upper Lip Pleomorphic Adenoma: A case Report and Literature Review

Coauthor(s): Rory Croft

Poster Title: Where Are My Patients? Patient Attendance and Global Implications for Trainees During the Covid-19 Pandemic.

Coauthor(s): Solano Nicolás, Gutiérrez Paulina, Alavarez Anixa, Chirinos Yenielis

Poster Title: Is it Safe to Use Bone Morphogenetic Proteins for Reconstruction of Maxillofacial Defects Caused by Oral Squamous Cell Carcinoma?

Poster #1 Coauthor(s): S. Patel

Poster #1 Title: Carotid Body Tumour Case Report

Poster #2 Coauthor(s): S. Patel

Poster #2 Title: Inter-hospital OPG Audit Using New FGDP Guidelines for Grading Criteria

Poster #3 Coauthor(s): S. Patel, Joe Gallagher

Poster #3 Title: Should We Implement Protocols for our Bugged Phones within the Health Care Environment?

Coauthor(s): Nicolas Solano, Paulina Gutiérrez, Betsabe Sarcos, Ramon Salomón

Poster Title: Alternative Approach for Frontoorbital Advancement in a Pediatric Patient with Craniosynostosis: Case Report

Coauthor(s): P. Caja, C. Andres

Poster Title: Fibular Free Flap with Cutting Guides and Prebent Plates for Maxillo-mandibular Reconstruction

Poster #1 Coauthor(s): Adrian Ali Guerrero Aranda

Poster #1 Title: Distracción Simultánea Maxilar Mandíbula en un Paciente Con Microsomía Hemifacial

Poster #2 Coauthor(s): Christian Adolfo San Juan Gonzalez

Poster #2 Title: Planeación de Osteotomía Lefort i en Cirugía Ortognática Utilizando Guías de Corte y Placas de Titanio Personalizadas

Poster #1 Coauthor(s): B.C. Lima, Maria Aparecida de Albuquerque Cavalcante

Poster #1 Title: Intrasinusal Schwanoma Recidive After 7 years

Poster #2 Coauthor(s): B.C. Lima, Maria Aparecida de Albuquerque Cavalcante

Poster #2 Title: Arteriovenous Malformation Embolization Prior to Dental Extractions in a Patient with Sturge-weber Syndrome

Coauthor(s): Peter Glen

Poster Title: Retrospective Review of Surgical Site Infection Record Keeping in Bristol OMFS Unit

Poster Title: Traumatic Mental Neuroma. An Injury After the Application of Infiltrative Local Anesthesia

Coauthor(s): Melita Sylvyana, Abel Tasman Yuza

Poster Title: Management of Neglected Fracture of Left Angle Mandible with Submandibular Abscess as its Complication: Case Report

Poster #1 Title: Manejo quirúrgico de fractura orbitocigomaticomaxilar y anterolateral de cráneo: reporte de caso.

Poster #2 Title: Fractura fronto orbitaria con compromiso de seno frontal: reporte de un caso.

Coauthor(s): Oswaldo Gahona

Poster Title: Atypical Benign Fibrohistiocytoma in the Oral Cavity: A Case Resport

Coauthor(s): H.Y. Yusuf, M. Sylvyana

Poster Title: Management Of Submandibular And Temporal Abscess Due To Multiple Odontogenic Infections : A Case Report

Coauthor(s): Claudio Roberto Pacheco Jodas, Marília de Oliveira Coelho Dutra Leal

Poster Title: Anterior Wall Fracture of the Frontal Sinus: Case Report.

Coauthor(s): Sam R. Caruso

Poster Title: Innovative Use of Dermal Substitute to Improve Post-op Pain Control in a Patient Undergoing Excision of Tongue T1 Squamous Cell Carcinoma

Coauthor(s): Endang Sjamsudin, Asri Arumsara, Fathurchman

Poster Title: Alveolar Cleft Closure with Illiac Bone Graft : A Case Report

Poster Title: 3D Planning in Mandibular Fractures Using CAD/CAM Surgical Splints – a Prospective Randomized Controlled Trial

Coauthor(s): Nicolás Solano, Paulina Gutiérrez, Ejusmar Rivera, Ana Villarroel

Poster Title: Massive Mucocele in the Paranasal Sinuses Causing Secondary Hypertelorism. A case report.

Poster Title: Odontogenic Infection - Associated Hyperglycemia : A Case Report od Submandible Abscess

Post #1 Coauthor(s): K. Donaldson, A. Ogunbowale, C. Wemyss, S. Ali

Poster #1 Title: An Unusual Dentigerous Cyst

Post #2 Coauthor(s): G. McGrath, A. Bell

Poster #2 Title: Klippel-Trenaunay Syndrome: A Rare Bleeding Risk

Coauthor(s): Miguel Angel González de Santiago

Poster Title: Cranioplasty with Prefabricated Polymethyl-methacrylate Implant After Decompressive Craniectomy. Case Report and Literature Review.

Coauthor(s): Gabriel Fernando Farrera Paredes

Poster Title: Primary Intraosseous Carcinoma of the Mandible Arising from an Odontogenic Keratocyst: A Case Report

Coauthor(s): Nicolás Solano, Paulina Gutiérrez, Ejusmar Rivera, Anixa Álvarez

Poster Title: igG4-related Disease: A Case Report of a Massive Presentation Leading to the Diagnosis of B-cell Lymphoma

Poster Title: Pediatric condylar fractures treatment: recent advances over the last 10 years

Coauthor(s): Paulina Gutiérrez, Peraza Arianny, Castrillo Ariamay

Poster Title: Use of flapless guided surgery for all-on-six and all-on-four protocol

Poster #1 Coauthor(s): Humerto Fernández Olarte, JC Munevar

Poster #1 Title: New in Silico and in Vitro Evaluation of Human Dental Pulp Stem Cells Scaffolds for Critical Bone Defects

Poster #2 Coauthor(s): Humerto Fernández Olarte

Poster #2 Title: The Morpho-functional 3D Analysis for Zygomatic Implants: A Clinical Tool With Surgical Implications

Poster #3 Coauthor(s): Arango Hernán

Poster #3 Title: Anatomofunctional Peek Reconstruction

Poster #4 Coauthor(s): Hernan Arango Fernandez, Paola Osorio Sánchezán

Poster #4 Title: Reconstruction with Custom cad / cam Prosthesis in Patients Treated for Benign Tumor Injuries

Coauthor(s): Alejandro Alonso Moctezuma, Francisco Díaz Ayala

Poster Title: Compound Odontoma with Cystic Proliferation. A Case Report

Coauthor(s): Patricia Caja Vivancos, Eduardo Pérez Fernández

Poster Title: Delayed Non-union as a Complication After le fort 1 Osteotomy

Poster Title: Peripheral ameloblastoma clinical case.

Coauthor(s): Fabiola Salgado Chavarría

Poster Title: Rehabilitation with Zygomatic Implants After Maxilectomy in Central Lesion of Giant Cells

Coauthor(s): Michael James Leslie Hurrel, Peter Virgil Ricciardo

Poster Title: Management of deformity inducing osteochondroma of the tem-poromandibular joint with an Australian made prosthesis and a compensatory sagittal split osteotomy: a case report.

Poster Title: Bilateral Mandibular Bifurcation Cyst

Coauthor(s): Atul Kusanale

Poster Title: Management of Deep Lobe Benign Parotid Tumours in University Hospital Dorset- An experience of more than 11 years

Poster Title: Digital Workflow In Orthognathic Surgery

Coauthor(s): Abel Tasman, Winarno Priyanto

Poster Title: Management of Mandibular Oblique Fracture with Exposed Plat : A Case Report

Coauthor(s): Nicolas Solano, Paulina Gutierrez, EnmanuelParra, Anixa Alvarez

Poster Title: Casual Finding of an Acquired Phlebectasia of the internal jugular vein in a patient with Sjögren’s syndrome

Poster Title: Is There a Hidden Blood Loss in Orthognathic Surgery and Should it Be Considered?

Coauthor(s): M. Sylvyana, Lucky Riawan

Poster Title: Modern Dressing for Wound Management in Cervical Necrotizing Fasciitis: A Case Report

Coauthor(s): Thomson Dcruz

Poster Title: Speed Thrills But Does it Really Kill? The Effect of Osteotomy at Two Speeds on Peripheral Bone: A Histopathological Analysis

Coauthor(s): Daniel Beteramia, Anik Saha, Dylan Hyam

Poster Title: A 21-Year analysis of the Publication Patterns and level of scientific evidence in three major Oral and Maxillofacial Surgery Journals

Poster #1 Coauthor(s): Paulina Gutiérrez, Ejusma Rivera, Salomón Ramos , Medina Carlos

Poster #1 Title: Osteoplastic Anterior Transoral Approach for Tumors of the Middle Cranial Fossa.

Poster #2 Coauthor(s): Paulina Gutiérrez, AnaVillarroel, Yenielis Chirinos, Betsabe Sarcos

Poster #2 Title: When to Perform an Excisional or Incisional Biopsy for Intraosseous Lesions of the Jaws? Algorithm for Decision Making 

Poster #3 Coauthor(s): Paulina Gutiérrez , Arianny Peraza, Elvia Rios, Ana Villarroel 

Poster #3 Title: Summers Technique: It Is Possible With Virtual Planning? 

Poster #4 Coauthor(s): Paulina Gutiérrez, Enmanue Parra, Maria Alejandra Atencio, Carlos Medina 

Poster #4 Title: Ludwig's Angina Complicated with a Massive Necrotizing Fascitis. Case Report.

Poster #5 Coauthor(s): Enmanuel Parra , Ariamay Castrillo, María Alejandra Atencio , Greyner Dueñes

Poster #5 Title: Use of Shira's Technique for the Enucleation of Cervicofacial Cysts

Poster #6 Coauthor(s): Paulina Gutiérrez, Carlos Medina, Betsabe Sarcos, María Alejandra Atencio

Poster #6 Title: Rare Case of Diphtherithic Angina in the Tongue and Floor of the Mouth. 

Poster #7 Coauthor(s): Paulina Gutiérrez , Ana Villarroel, Salomon Ramos, Yenielis Chirinos

Poster #7 Title: Minimally Invasive Approach for Drainage of Deep Cervicofacial Infections. Retrospective Study 

Poster #8 Coauthor(s): Paulina Gutiérrez, Ariamay Castrillo Greyne Dueñes, Elvia Rios

Poster #8 Title: Case Report of a Massive Orofacial Myasis. Relevance of Proper Management.

Poster #1 Coauthor(s): Samuel Kim

Poster #1 Title: Outcomes of Total Temporomandibular Joint Replacement Without a Submandibular Incision

Poster #2 Coauthor(s): Samuel Kim

Poster #2 Title: Total Temporomandibular Joint Replacement Without a Submandibular Incision

Poster Title: Versatility of Maxillary Antrum Pathology: Case Series

Poster Title: Protocol of Anthropometric Examination of Patients Before Secondary Cheilorhinoplasty

Poster Title: A New Zygomatic Minimally Invasive Technique with Piezoelectric Strumentation

Poster #1 Coauthor(s): Marília Oliveira Coelho Dutra Leal, R. Grillo, CRP Jodas

Poster#1 Title: Surgical Treatment of Obstructive Sleep Apnea

Poster #2 Coauthor(s): MOCD Leal, CRP Jodas

Poster#2 Title: Reconstruction of Mandibular Fracture by Firearm Projectile

Poster Title: Treatment Of Unfavorable Mandible Fracture With Open Reduction

Poster #1 Coauthor(s): Sebastian Zapata Ocampo

Poster #1 Title: Functional classification of Isolated Zygomatic Arch Fracture. New proposal

Poster #2 Coauthor(s): Hernán Arango Fernandez, Álvaro Andrés Rodríguez Sáenz, Sebastian Zapata Ocampo

Poster #2 Title: Complications of 1028 Sutureless Inferior Third Molars Surgeries. Dental and Medical Services of the Caribbean

Coauthor(s): AM Alejandro, CR Pablo

Poster Title: Archegonous Cystic Odontoma, A Rare Entity. A Case Report

Poster # 1 Title: Osteonecrosis Mandibular Asociado a Medicamentos: Reporte de Caso Clinico

Poster # 2 Title: Reconstrucción Inmediata con Colgajo Rotacional de Temporal e Injerto de Fascia lata Posterior a Hemimaxilectomia por Mixoma Odontogénico

Coauthor(s): B. Dvoranová, D. Hirjak

Poster Title: Periangular Approach in the Treatment of Condylar-base and Low Condylar Neck Fractures: Retrospective study

Coauthor(s): Nicolás Solano, Paulina Gutierrez, Arianny Peraza, Elvia Rios

Poster Title: When to Use Transoral or Extraoral Approaches for Benign Tumors of the Jaws? Decision Algorithm

Poster #1 Title: Treatment of Huge Mandibular Dentigerous Cyst with Enucleation after Decompression

Poster #2 Title: Presurgical Nasoalveolar Moulding (pnam) in Unilateral Complete Cleft Lip and Palate Infant

• Posters and Infographics

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Oral, Head and Neck Cancer Facts

Oral Cancer Self-Exam

Oral Cancer Awareness Poster 8.5x11

April is Oral Cancer Awareness Month - 8.5x11

April is oral cancer awareness month - 11x17.

Oral Cancer Awareness Poster - 8.5x11

Oral Cancer Awareness Poster - Spanish version - 8.5x11

Oral cancer awareness poster - 11x17.

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How to Make a Good Poster Presentation

• First Online: 02 February 2019

Cite this chapter

• Baris Kocaoglu 8 ,
• Paulo Henrique Araujo 9 &
• Carola Francisca van Eck 10  

2839 Accesses

Poster presentations are a key component of any scientific conference. They are an excellent platform for a researcher to present their study to a large audience. Therefore, it is important to prepare the presentation in a way that catches the eye of the people attending the meeting while presenting the key data in an easy to interpret format. This will encourage the audience to engage in an academic discussion, which is vital for the researcher to obtain feedback on their study. This chapter aims to help orthopedic researchers in preparation and presentation of a scientific poster. After reading this chapter, the reader should know the various different types of poster presentation, be familiar with the technical aspect of how to make their own poster, and understand what to do at the scientific meeting to get the most out of presenting their research in poster format.

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Poster Presentation at Scientific Meetings

How to Prepare a Poster

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Department of Orthopedic Surgery, Acibadem University Faculty of Medicine, Istanbul, Turkey

Baris Kocaoglu

Santa Luzia Hospital, Clínica COB, Brasília, Brazil

Paulo Henrique Araujo

Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Rooney Sports Complex, Pittsburgh, PA, USA

Carola Francisca van Eck

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Volker Musahl

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Olufemi R. Ayeni

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Jason L. Koh

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Norimasa Nakamura

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Kocaoglu, B., Araujo, P.H., van Eck, C.F. (2019). How to Make a Good Poster Presentation. In: Musahl, V., et al. Basic Methods Handbook for Clinical Orthopaedic Research. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58254-1_23

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We are thrilled to announce the 9 th Edition of International Conference on Dentistry and Oral Health (ICDO 2025) , Hybrid Event set to take place in the vibrant city of London, UK and Virtually . The conference will be held from September 18-20, 2025 , promising a dynamic gathering under the theme of The Future of Dentistry: Trends and Innovations . This prestigious event aims to bring together a global audience to explore the latest advancements and emerging trends in dentistry and oral health.

ICDO 2025 is designed to cater to a diverse audience, including esteemed professionals, pioneering researchers, dedicated educators, and passionate practitioners from various facets of dentistry and oral health. The conference serves as a platform for these distinguished individuals to share their expertise, exchange innovative ideas, and foster collaborative efforts across the field.

The conference will encompass a broad spectrum of topics addressing key elements of dentistry and oral health. Attendees can look forward to sessions on public health dentistry, cutting-edge research in oral cancer, advancements in laser and digital dentistry, and discussions on dental biomaterials and regenerative techniques. The agenda also includes sessions on pediatric and geriatric dentistry, forensic applications, and the latest in orthodontics and implantology, ensuring a holistic exploration of the field's breadth and depth.

ICDO 2025 will feature a diverse range of presentations, including keynote speeches, expert panel discussions, and interactive workshops. These sessions are designed to provide valuable insights, showcase groundbreaking research, and discuss practical applications in clinical settings. Participants will have ample opportunities to engage with thought leaders, present their findings, and contribute to shaping the future of dental science and practice.

In conclusion, ICDO 2025 promises to be an exceptional event, uniting professionals from around the world to advance the boundaries of dental science and improve oral health outcomes globally. We eagerly anticipate your participation in this exciting journey of discovery and innovation in London.

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We have successfully completed our “ 9 th Edition of International Conference on Dentistry and Oral Health (ICDO 2024)” which was held during September 02-04, 2024 as Hybrid Event at Madrid , Spain and Online.

We extend our heartfelt gratitude to our esteemed chairs: David Gillam from Queen Mary University of London, United Kingdom, Yasser Khaled from Marquette University, United States, and Preetinder Singh from the Academy of Oral Surgery, United States. The ICDO 2024 stage was graced by world-renowned speakers who shared their invaluable insights and expertise on a wide range of topics in Dentistry and Oral Health.

For ICDO 2024 Final Program: Click Here For ICDO 2024 Abstract Book: Click Here For ICDO 2024 Gallery: Click Here

Upcoming Dental Conferences : Dental Conferences 2025 | Oral Health Conferences | CE Accredited Dental Conferences | CE Dental Conferences | CE Dental Conferences 2025 | CE Approved Dental Conferences | Dental Meetings | Dental Events | International Dental Conferences | Dental Conferences | Dental Conferences 2025 | Dentistry Conferences | Dentistry Conferences 2025 | Oral Health Congress | Dentistry Meetings | Dental Events | American Dental 2025 | Dentistry 2025 | Dentistry Workshops | Dental Summit | Dental Symposium | Oral Health Events | Dental Conference | Dentistry Conference | Oral Health Meetings | Dental Conferences USA | USA Dental Conferences | Online Dental Conferences | Dentistry Webinars | Dental Meetings | Dentistry Events | Oral Health Summit

ICDO 2024 Organizing Committee: Magnus Group extends its sincere gratitude towards our eminent keynote speakers  David Gillam from Queen Mary University of London, United Kingdom, Steven J Traub from American Institute of Oral Biology, United States, Yasser Khaled from Marquette University, United States, Zvi G Loewy from New York Medical College, United States, Jaap Boehmer from Rijnstate Hospital, Netherlands, Preetinder Singh , Academy of Oral Surgery, United States, Lacy Walker from Shared Hygiene, LLC., Germany, Laurindo Moacir Sassi from Erasto Gaertner Hospital and Mackenzie Evangelical University Hospital, Brazil, Fay Goldstep from International Speaker, Canada, Maggie Augustyn from Untangle Me, LLC., United States, Rolf Ewers from University of Vienna, Austria, Andrea Scribante and Maurizio Pascadopoli from University of Pavia, Italy, Hariharan Ramakrishnan from Thai Moogambigai Dental College and Hospital, Dr MGR Educational and Research Institute, India

We also thank our speakers and young researchers for sharing their work in wide range of Dentistry and Oral Health at ICDO 2024 dais and making the event grand success.

Speakers of ICDO 2024:

Day-1 Speakers :

Day-2 Speakers :

Day-3 Speakers :

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8th Edition of International Conference on Dentistry and Oral Health  (Dental 2025) Dates:  March 13-15, 2025 Venue:  Rome, Italy 11 th  Edition of International Conference on Dentistry and Oral Health  (ICDO 2025) Dates:  September 18-20, 2025 Venue:  London, UK

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We have successfully completed our “6 th Edition of International Conference on Dentistry and Oral Health (ICDO 2022)” which was held during August 11-12, 2022 as Online Event. We extend our heartfelt thanks for our chair  David Gillam  from Queen Mary University of London, United Kingdom ICDO 2022  dais was embellished by world renowned speakers who shared their experiences and ideas in various topics of Dentistry and Oral Health.

For ICDO 2022 Final Program: Click Here For ICDO 2022 Abstract Book: Click Here

Upcoming Dental Conferences : Dental Conferences 2025 | Oral Health Conferences | CE Accredited Dental Conferences | CE Dental Conferences | CE Dental Conferences 2025 | CE Approved Dental Conferences | Dental Meetings | Dental Events | International Dental Conferences | Dental Conferences | Dental Conferences 2025 | Dentistry Conferences | Dentistry Conferences 2025 | Oral Health Congress | Dentistry Meetings | Dental Events | American Dental 2025 | Dentistry 2025 | Dentistry Workshops | Dental Summit | Dental Symposium | Oral Health Events | Dental Conference | Dentistry Conference | Oral Health Meetings | Dental Conferences USA | USA Dental Conferences | Online Dental Conferences | Dentistry Webinars | Dental Meetings | Dentistry Events | Oral Health Summit ICDO 2022 Organizing Committee: Magnus Group extends its sincere gratitude towards our eminent keynote speakers  David Gillam, Queen Mary University of London, UK;  Laurindo Moacir Sassi, Evangelical University Hospital Mackenzie, Brazil. We also thank our speakers and young researchers for sharing their work in wide range of Dentistry and Oral Health at ICDO 2022 dais and making the event grand success.

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The ICDO 2021 platform was enriched by esteemed speakers from around the globe, who generously shared their expertise and insights on a wide range of topics in Dentistry and Oral Health.

For ICDO 2021 Final Program: Click Here For ICDO 2021 Abstract Book: Click Here Upcoming Dental Conferences : Dental Conferences 2025 | Oral Health Conferences | CE Accredited Dental Conferences | CE Dental Conferences | CE Dental Conferences 2025 | CE Approved Dental Conferences | Dental Meetings | Dental Events | International Dental Conferences | Dental Conferences | Dental Conferences 2025 | Dentistry Conferences | Dentistry Conferences 2025 | Oral Health Congress | Dentistry Meetings | Dental Events | American Dental 2025 | Dentistry 2025 | Dentistry Workshops | Dental Summit | Dental Symposium | Oral Health Events | Dental Conference | Dentistry Conference | Oral Health Meetings | Dental Conferences USA | USA Dental Conferences | Online Dental Conferences | Dentistry Webinars | Dental Meetings | Dentistry Events | Oral Health Summit

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Magnus Group extends its sincere gratitude towards our eminent keynote speakers  David Gillam, Queen Mary University of London, UK;  Laurindo Moacir Sassi, Federal University of Sao Paulo, Brazil;  Robert L. Kaspers, University of Detroit, USA for your valuable presence and sharing your ideas and practices in diversified topics of  Dental Science .

We also thank our speakers and young researchers for sharing their work in wide range of Dentistry and Oral Health at ICDO 2021 dais and making the event grand success.

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Magnus Group successfully completed the Dentistry Virtual 2020  which was held during September 21-22, 2020 . The congress deliberated on the theme “ Boosting Recent Advances in Dentistry and Oral Health ” and emphasized on research, innovation, and science, as well as other scientific aspects. It also aimed to increase awareness about contemporary global issues and how they affect research approaches to address challenges.

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3rd Edition of International Conference on Dentistry and Oral Health (ICDO 2019) Report:

Magnus Group successfully completed 3rd Edition of International Conference on Dentistry and Oral Health  (ICDO 2019) during September 16-18, 2019 at London, UK. We would like to thank organizing committee and keynote speakers for sharing their expertise with our participants: ICDO 2019 would like to thank speakers for presenting and sharing their expertise and reviews with our participants.

For ICDO 2019 Final Program: Click Here For ICDO 2019 Abstract Book: Click Here For ICDO 2019 Gallery: Click Here Upcoming Dental Conferences : Dental Conferences 2025 | Oral Health Conferences | CE Accredited Dental Conferences | CE Dental Conferences | CE Dental Conferences 2025 | CE Approved Dental Conferences | Dental Meetings | Dental Events | International Dental Conferences | Dental Conferences | Dental Conferences 2025 | Dentistry Conferences | Dentistry Conferences 2025 | Oral Health Congress | Dentistry Meetings | Dental Events | American Dental 2025 | Dentistry 2025 | Dentistry Workshops | Dental Summit | Dental Symposium | Oral Health Events | Dental Conference | Dentistry Conference | Oral Health Meetings | Dental Conferences USA | USA Dental Conferences | Online Dental Conferences | Dentistry Webinars | Dental Meetings | Dentistry Events | Oral Health Summit

We thank all participants for joining annd makig the ICDO 2019 event successful at London, UK.

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Magnus Group successfully completed 2nd Edition of International Conference on Dentistry and Oral Health   (ICDO 2018 ) which was held in Rome,  Italy during September 20-22, 2018.

Dental Conference 2018 witnessed an amalgamation of outstanding speakers who enlightened the crowd with their knowledge and confabulated on various new-fangled topics related to the field of  Dentistry  and  Oral Health . The extremely well-known conference hosted by Magnus Group was marked with the attendance of young and brilliant researchers, business delegates and talented student communities representing diverse countries around the world.  Magnus Group is privileged to thank the Organizing Committee Members and Keynote Speakers for making their contributions in the form of very informative presentation.

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Overall I think it went very well and the speakers were from a wide range of disciplines and countries so it was a great opportunity once again to share experiences and network with these colleagues across the globe.

Many thanks! I had a good time and the international cast of speakers was particularly nice.

Nice days in Roma. Good and well organised congress with a lot of interesting topics. A lot of clever presentations and good discussions.

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Papers and Posters Oral and Maxillofacial Surgery

• Role Of Platelet Rich Fibrin In Oral & Maxillofacial Surgery -16th Midterm Conference Of The Association Of Oral & Maxillofacial Surgeons Of India, Mt. Abu, Rajasthan 14th June 2012.
• Use Of Collagen In Oral and maxillofacial surgery -XII National Triple “O” Symposium 2014 , Udaipur On 8th- 9th March 2014
• Evaluation Of Post Extraction Haemorrhage In Patients On Continued Antiplatelet Therapy IDENT , Pimpri -Pune ,IDA ,2015
• Management Of Condylar Fracture- Still A Controversy- 2ndannual Conference Of Rajasthan State Chapter AOMSI - Udaipur, Rajasthan On 19th And 20th February 2016
• Application of stem cells in oral and maxillofacial surgery -7th pg convention AOMSI, Chandigarh ,2017
• Unilateral left sub-condylar fracture- a case report ,7th pg convention , AOMSI,Chandigarh ,2017
• Bilateral condylar fracture- a case report, 7th pg convention , AOMSI,Chandigarh ,2017
• Role Of Platelet Rich Fibrin In Oral & Maxillofacial Surgery 37th AOMSI ,Hyderabad ,2012
• Nanaotechnology ,rajasthan state chapter , aomsi,2015
• Face transplantation , 41st ,AOMSI ,ahmedabad,2016
• Advances in Distraction osteogenesis, 7th pg convention , AOMSI,Chandigarh ,2017
• Poster-surgical management in medically compromised patients , 7th pg convention , AOMSI,Chandigarh ,2017
• Soft Tissue Injuries 18th National Mid Term Conference Of AOMSI & Pg Convention,2014
• Odontogenic Space Infections Ident 2014,Ida Pimpri Chindwad Branch ,Pimpri ,Pune,2014
• 3-D Stereolithographic Models ,39th National Conference Of AOMSI,Goa,2015
• Advances in oral and maxillofacial surgery ,41st AOMSI ,Ahmedabad,2016
• Diagnostic steps in interpretation of pre-malignant lesions ,national CDE –“an integrated approach to diagnosis , IAOMP,Pacific dental college ,udaipur , 2016
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Kristen M Quinn MD , Louis T Runge, Raphael H Parrado MD, Cynthia L Talley MD, Christian J Streck MD, Andrea M Abbott MD

Impact of Institutional Variables on Center-Level Performance in Longer Term Survival in Heart Transplantation

Weston McDonald , Khaled Shorbaji MD, Maxwell F. Kilcoyne DO, Brett Welch MBA, Arman Kilic MD

Risk Factors for Mortality Following Heart Transplantation in Obese Patients Bridged with an LVAD

Krishna Bhandari MD , Khaled Shorbaji MD, Vineeth Sama MS, Lucas Witer MD, Brian A. Houston MD, Ryan J. Tedford MD, Brett Welch MBA, Arman Kilic MD

Liposomal bupivacaine versus catheter-based blocks in patients undergoing surgical stabilization of rib fractures (SSRF)

John Lucas MD , Leeanna Clevenger MD, Alicia Privette MD, Stuart Leon MD, Mujahed Laswi MD, Evert Eriksson MD

Proteomic Profiling of Exosomes Derived from Immortal Human Bone marrow Alpha-1 Antitrypsin Overexpressing Mesenchymal Stromal Cells and Their Protective Effect at Cellular Levels

Sara Shoeibi, Hua Wei, Wenyu Gou, Erica Green, Charlie Strange, Hongjun Wang PhD

The Utility of Smartphone-Based Thermal Imaging in the Management and Monitoring of Microvascular Flap Procedures: A Systematic Review and Meta-Analysis

Todd Hudson MS, Elizabeth Hogue, Donna Mullner MD, Isis Scomacao MD, Fernando Herrera MD

Introduction of the Robotic Surgical Approach in an Academic Hernia Surgical Practice

William Dacus, Bruce Crookes MD, Stephen Fann MD, Heather Evans MD MS

Artificial interstitial fluid synergistically interacts with triblock polymers to reduce purinergic signaling in an engineered skeletal muscle implant model

Mara L. Lennard Richard PhD, Kim K. Sutton, Keshav Chandran, Michael J. Yost PhD

Generating Patient-Derived Organoid Models of Disease from Pre-treated Patients in a Clinically Certified Laboratory Setting: A Critical Step Towards Precision Medicine in Pancreatic Cancer

Haley A. Zlomke MD , Jacquelyn Zimmerman MD PhD, Toni Seppälä MD PhD, Reecha Suri MD, William R. Burns MD, Christopher Shubert MD MHA, Kelly J. Lafaro MD, Christopher L. Wolfgang MD PhD, Jin He MD PhD, Richard A. Burkhart MD

Injury characteristics associated with combined fractures of the forequarter (rib/clavicle/scapula)

Richard Slay MD , Alicia Privette MD, Stuart Leon MD, Evert Eriksson MD

Oral Presentations

2:00 - Multilevel Intervention To Improve Equity In Access To Kidney Transplant For African Americans Ammar Mahmood MD , David Taber PhD, Zemin Su, Patrick Mauldin PhD, Thomas Morinelli, Michael Casey MD MS, Joseph Scalea MD, Derek DuBay MD 2:12 - A Humanized Monoclonal Antibody to Secreted Frizzled Related Protein-2 as a Targeted Therapy for Triple Negative Breast Cancer   Julie B. Siegel MD , Dean Connor PhD, Patrick Nasarre PhD, Rupak Mukherjee PhD, Eleanor Hilliard, Ann-Marie Broome PhD MBA, Nancy Klauber-Demore MD 2:24 - Early Outcomes of Heart Transplantation Using Donation after Circulatory Death Donors in the United States   Jennie H. Kwon MD , Alexander D. Ghannam MD, Khaled Shorbaji MD, Brett Welch MBA, MHA, Z. A. Hashmi MD, Ryan Tedford MD, Arman Kilic MD 2:36 - Smooth muscle cell specific activity of SGK-1 alters pulse propagation velocity as a major indicator of wall stiffness in AAA Mario Figueroa MD , Ryan Gedney MD, Victoria Mattia, Ying Xiong, Rupak Mukherjee PhD, Jeffery A. Jones PhD, Jean Marie Ruddy MD 2:48 - Diastasis recti is associated with incisional hernia after midline abdominal surgery Alexander Booth MD , Kirkpatrick Gillen MD, Isabela Visintin MD, Wilson Ford, Mark Kovacs MD, Colston Edgerton MD, Virgilio George MD, Thomas Curran MD MPH 3:00 - Break - Please gather in the lobby for refreshments and e-poster viewing 3:15 - WNT Dependency In Patient-Derived Pancreatic Organoid Models For Precision Medicine Approaches   Haley A. Zlomke MD , Jacquelyn Zimmerman MD PhD, Toni Seppälä MD PhD, Reecha Suri MD, William R. Burns MD, Christopher Shubert MD MHA, Kelly J. Lafaro MD, Christopher L. Wolfgang MD PhD, Jin He MD PhD, Richard A. Burkhart MD 3:27 - Is there Implicit Bias in Kidney Transplant Evaluations?   Sam Kavarana , David Taber PharmD MS, Zemin Su MAS, Patrick Mauldin PhD, Thomas Morinelli, Michael Casey MD MS, Joseph Scalea MD, Derek DuBay MD 3:39 - Sex Disparities in the Treatment of Peripheral Arterial Disease with Infra-Inguinal Arterial Bypass Saranya Sundaram MD , Tyler Buckley, Sharee Wright MD, Ravikumar Veeraswamy MD, Elizabeth Genovese MD 3:51 - Hybrid Supervised and Unsupervised Machine Learning Model Improves Prediction of New-Onset Dialysis in Orthotopic Heart Transplant Patients Roshan Mathi MS , Weston McDonald, Benjamin Usry, Khaled Shorbaji MD, Brett Welch MBA, Arman Kilic MD 4:03 - Routine post-operative chest radiographs provide little diagnostic value for pediatric patients undergoing central venous catheter placement   Alice Le, David Mann MD, Richard Jones MD, Lucas McDuffie MD 4:15 - Femoral vessel occlusion increases cardiac and cerebral perfusion in a pilot cardiac arrest porcine model   Heather Holman , Jennie Kwon MD, Joshua Kim MS, Samuel Siegler, Jasmine Richards, Kris Helke PhD/DVM, Rupak Mukherjee PhD, Jeffrey A. Jones PhD, Kristen M. Quinn MD 4:45 - Awards Ceremony

Congratulations!

Best Poster:  Krishna Bhandari, MD 

Best Basic Science Presentation:  Heather Holman

Best Clinical Science Presentation:  Jennie H. Kwon, MD

Yarbrough Award:  Kristen Quinn, MD

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Oral Presentations and Poster Presentations

• Preventative health screening community events, a mechanism to target minority ethnic populations in improving primary care utilisation to improve health outcomes

DOI: 10.3399/bjgp20X711005

Preventative medicine has become a central focus in primary care provision, with greater emphasis on education and access to health care screening. The Department of Health reports existing health inequalities and inequalities in access within ethnic minority groups. Studies assessing the value of community engagement in primary care have reported variable outcomes in term of subsequent service utilisation.

To consider the benefit of community-based health screening checks to improve access and health outcomes in minority ethnic groups.

An open community health screening event ( n = 43), to allow targeted screening within an ethnic minority population. Screening included BP, BMI, BM and cholesterol. Results were interpreted by a healthcare professional and counselling was provided regarding relevant risk factors. Post-event feedback was gathered to collate participant opinion and views.

Seventy-nine per cent of participants were from ethnic minority backgrounds: 64% were overweight or obese and 53% of participants were referred to primary care for urgent review following abnormal findings. All those referred would not have accessed healthcare without the event referral. All (100%) participants believed it improved health education and access to health care.

This study clearly demonstrates the value of targeted community-led screening and education events in public health promotion. There was a significant benefit in providing community-based screening. There is a need for a longitudinal analysis to determine the impact on health outcomes and long-term access to healthcare provision.

Raza Naqvi, University of Nottingham

Octavia Gale, University of Nottingham

Address for correspondence Raza Naqvi, University of Nottingham

Email: raza.naqvi{at}icloud.com

• Bringing together child health professionals and dental experts to tackle oral health in children

DOI: 10.3399/bjgp20X711017

In the UK, poor oral health among children continues to be a major public health concern. Primary care professionals are encouraged to take a proactive approach in engaging parents and carers to develop better oral health practices for their children. Unfortunately, research has shown that patients are often exposed to inconsistent and at worst conflicting advice.

To increase the confidence of primary care professionals in their knowledge surrounding preventative oral health and ensure the delivery of consistent and proactive oral health advice.

A local dentist and dental health educator were invited to a general practice multidisciplinary meeting to deliver an educational session on oral health advice for children. Qualitative and quantitative data in form of a questionnaire was collected to analyse the impact of the education session.

The meeting was attended by 15 healthcare professionals including GPs, paediatricians, a community mental health representative, and a school nurse. There were 78% of attendees who reported that they had never received any formal teaching on oral health care prior to this session. Qualitative data highlighted specific gaps in knowledge, while confidence ratings suggest significant improvement in confidence of attendees in their knowledge of oral health in children.

Achieving good oral health for all children requires the support of a wide range of healthcare professionals. Further education sessions such as this encourages joint learning and relationship building between professionals and influences behaviour to improve child health care as part of making every contact count. The emerging Primary Care Networks provide an excellent setting to deliver this education.

Vinoshini Vasikaran, Connecting Care for Children, Imperial College Healthcare NHS Trust

Arpana Soni, Connecting Care for Children, Imperial College Healthcare NHS Trust

Mando Watson, Connecting Care for Children, Imperial College Healthcare NHS Trust

Address for correspondence Vinoshini Vasikaran, Connecting Care for Children, Imperial College Healthcare NHS Trust

Email: vinoshini.vasikaran{at}nhs.net

• The annual dementia review: exploring current practice in primary care

DOI: 10.3399/bjgp20X711029

Dementia is a global public health challenge, the significant consequences of which are recognised in global and national health policies. Despite approaches to improve the implementation of evidence-based dementia care in primary care and the inclusion of indicators for dementia in the Quality and Outcomes Framework (QOF), there is consistent evidence that people with dementia and their family carers lack access to care which meets their needs.

This study aims to explore current practice regarding the annual dementia review in primary care by investigating: 1) what ‘should’ be happening in annual dementia reviews; 2) how dementia reviews are delivered in a sample of general practices; 3) the barriers and facilitators to the implementation of evidence-based care in dementia reviews; and 4) the experience of these reviews from the perspectives of people with dementia and their informal carer(s).

Qualitative methods will be used. In the first stage, semi-structured interviews with national and regional experts in dementia policy and healthcare will be used to explore what ‘should’ be happening in an annual dementia review. In the second stage, interviews with primary healthcare team members will explore how annual dementia reviews are delivered in a sample of practices in North East England. Interviews with people with dementia and their carers will then be used to explore how reviews are experienced by service users. Thematic analysis will be used to analyse data.

Key themes from the first stage will be presented and their implications in primary care discussed.

The research plan for the second stage will be presented.

Johanne Dow, Newcastle University

Alison Wheatley, Newcastle University

Catherine Exley, Newcastle University

Louise Robinson, Newcastle University

Address for correspondence Johanne Dow, Newcastle University

Email: johanne.dow{at}newcastle.ac.uk

• Resilience in advanced cancer caregiving

DOI: 10.3399/bjgp20X711041

Family caregivers of advanced cancer patients are at risk for developing mental disorders. Despite this risk, the majority seem to adapt well, and throughout the caregiving period, their trajectory is characterised by healthy functioning. However, GPs struggle with making timely assessments of caregivers at risk for mental dysfunction, since they often fail to seek medical help for themselves and the appropriate research about resilience in cancer caregivers is scarce. Moreover, research is hampered by the lack of a universal definition or theoretical framework.

To propose a comprehensive definition and framework for further research in family caregiving for advanced cancer patients.

Inspired by the hermeneutic methodology, reviews and concept analyses on resilience following a potentially traumatic event were searched and analysed. Conforming to the hermeneutic methodology, article collection from PubMed, EMBASE, CINAHL, and PsycInfo was followed by analysis and was stopped when saturation was reached. Elements consistently arising from the definitions of resilience were listed and the theoretical frameworks were compared.

The APA definition: ‘ resilience is the process of adapting well in the face of adversity, trauma or threats ’ and Bonanno’s framework ‘ temporal elements of resilience ’ are proposed.

There is a need for studies on resilience in caregivers of advanced cancer patients. Resilience is context-dependent, hence, study results cannot be transferred as such from one clinical situation to another. Furthermore, conceptual ambiguities hinder the interpretation and comparison of study results. For further research on resilience in caregivers of advanced cancer patients, we suggest the APA definition of resilience and Bonanno’s framework.

Sophie Opsomer, KU Leuven

Jan De Lepeleire, KU Leuven

Emelien Lauwerier, Ghent University

Peter Pype, Ghent University

Address for correspondence Sophie Opsomer, KU Leuven

Email: sophie.opsomer{at}kuleuven.be

• Dermatology in primary care: an audit of the proportion of patients who present to general practice with a dermatological problem that could be self-managed

DOI: 10.3399/bjgp20X711053

A considerable proportion of GPs’ workload is dermatological. It is important to investigate what common skin conditions encountered in primary care can be self-managed, in an effort to alleviate the burden on primary care.

The purpose of the audit was to identify the proportion of consultations that are dermatological in nature and analyse potential for self-management by patients.

Data was collected using the patient electronic record system (EMIS) in general practice. A search was made for all consultations from the 17 April to 15 May 2019, which included all new presenting complaints that were dermatological in nature. The criteria for self-management included advising over the counter (OTC) medication or reassurance. On the other hand, a case was deemed not self-manageable if prescription only medication (POM) was prescribed or if a referral to dermatology was made.

There were a total of 2175 consultations, where 246 (11.31%) cases were dermatological. Of the 246, 80 cases (32.5%) could be self-managed. There were 46 different dermatological presenting complaints of which the 5 most common included: rash (51 cases), dermatitis (44 cases), acne vulgaris (13 cases), moles (12 cases), dry skin (11 cases). None of the acne or moles cases could be self-managed, whereas 23%, 68.2%, 72.7% of rashes, dermatitis, and dry skin cases, respectively, could be self-managed.

Certain dermatological conditions have more potential for self-management than others. Research into teledermatology as a means of addressing patient concern and providing clinical information is important in order to reduce unnecessary consultations.

Luamar Dolfini, St Georges, University of London

Yogesh Patel, South London and Maudsley NHS Foundation Trust

Address for correspondence Luamar Dolfini, St Georges, University of London

Email: luamar{at}hotmail.co.uk

• Improving access to appointments at Laurie Pike Health Centre

DOI: 10.3399/bjgp20X711065

Rising demand makes it increasingly difficult for patients to access appointments. Laurie Pike Health Centre (LPHC) operates a predominantly same-day booking policy in order to manage appointment requests from its 18 000 patients. We sought to quantify the number of requests, in order to estimate the unmet demand.

1) To estimate the met and unmet demand for same-day appointments; 2) To assess how capacity for same-day appointments compares to demand; 3) To analyse how well LPHC is utilising its available appointment slots.

We created a data collection tool to count the total number of patient requests by type. We grouped types into four categories: 1) medical appointment requests; 2) sick notes and results requests; 3) other appointment requests (such as healthcare assistant, nurse); and 4) admin/other. Category-specific percentages were applied to call log data to estimate the number of appointment requests per category. Capacity was measured by counting the total number of same-day GP/advanced nurse practitioner (ANP) appointment slots. Consultation records for GP/ANP appointments were analysed to assess the appropriateness of the booking.

Estimated average demand for same-day GP/ANP appointments was 222 per day. Average same-day capacity was 112 slots. After introducing pharmacist and video consultations, average capacity increased to 194 slots per day, a shortfall of 28 appointments. Consultation records indicated that 41% of GP/ANP appointments could have been seen by other practitioners; for example, musculoskeletal practitioners (14%).

GP/ANP appointments alone cannot meet patient demand but a diversified workforce might. Alongside this, efforts to improve care navigation may free up to 41% of GP/ANP appointment slots.

Jordan Moxey, Sandwell and West Birmingham Hospital Trust

Will Murdoch, Laurie Pike Health Centre

Address for correspondence Jordan Moxey, Sandwell and West Birmingham Hospital Trust

Email: jordan.moxey{at}nhs.net

• The development of palliative care education and training for GPs in Yangon, Myanmar: a workshop success

DOI: 10.3399/bjgp20X711077

Palliative care is an important but often overlooked component of primary care. In Myanmar, early emergence of palliative care is being seen, however no formal community-based services yet exist. Present challenges include resource scarcity and inadequate education and training.

Our goal was to improve understanding and approach towards palliative care by GPs in Yangon.

An initial survey was performed among 42 GPs in Yangon, Mandalay, and Meiktila in March 2019 demonstrating a gap in current training needs and willingness by GPs for this to be improved. A 2-day workshop, the first ever of its kind, was subsequently designed and held for 20 local GPs, consisting of interactive seminars delivered in Burmese.

Improvement in knowledge and confidence were used as measures of success. A true/false-style quiz was distributed pre- and post-workshop demonstrating a mean total score improvement of 15%. Self-reported confidence rating scores regarding confidence when: 1) managing palliative patients; 2) providing holistic care; and 3) breaking bad news, increased by a mean of 25%.

The greatest outcome from this workshop, by far, was the enthusiasm and awareness it generated, support was even gained from the President of the Myanmar Medical Association despite his initial reservations about developing this area. Ultimately, the workshop behaved as an advocate for the introduction of a regular palliative care lecture into the local Diploma in Family Medicine curriculum; it also spurred a group of GPs to further this work and turn the workshop into a regular teaching event.

Kerran Kandola, NHS Thames Valley and Wessex Leadership Academy

Myint Oo, General Practitioners Society of Myanmar

Address for correspondence Kerran Kandola, NHS Thames Valley and Wessex Leadership Academy

Email: kerran91{at}googlemail.com

• What influences Roma women attending NHS cervical screening? Knowledge, fear, and passive consent

DOI: 10.3399/bjgp20X711089

Recent immigration from Eastern Europe poses new challenges in engaging with women eligible to have smears. The Roma population have low socioeconomic status, low educational status, and a life expectancy 10 years lower than other EU citizens. An audit of smear uptake in four ‘Deep End’ Sheffield practices identified as having >1000 registered Roma Slovak patients, demonstrated smear uptakes between 53% to 40%, all of which are below the Sheffield CCG average of 73.5%.

To establish the barriers, facilitators and attitudes of Roma women towards accessing the NHS cervical screening.

Semi-structured interviews were recorded, transcribed, and analysed thematically using an iterative, with independent verification of emergent themes. Interviews continued to data saturation. Interviews were carried out in the patient’s home or a community centre, facilitated by a trained interpreter.

Sixteen women who self-identified as Roma, were interviewed. The overarching themes of ‘language discordance’, ‘poor educational attainment’, and ‘passivity in receiving care’, influenced the women’s likelihood of smear uptake or the need for screening. These emergent themes underpinned a longstanding distrust of the role of the state in relation to the health needs of the community.

It is vital that we develop and evaluate appropriate interventions to increase smear uptake in migrant and other vulnerable populations. There is a need for the UK to adapt screening programmes to maximise uptake within ‘hard to reach’ groups, such as the ‘Roma’, who are likely to be at the highest risk of cancer and late presentation of the disease.

David Lehane, University of Sheffield

David Kandrac, University of Sheffield

Elizabeth Walton, University of Sheffield

Caroline Mitchell, University of Sheffield

Address for correspondence David Lehane, University of Sheffield

Email: d.lehane{at}sheffield.ac.uk

General practice is ‘different’: qualitative study of acculturation experiences of East Staffordshire general practice specialty trainees

DOI: 10.3399/bjgp20X711101

Undergraduate medical education and postgraduate foundation training are largely secondary care based. General practice trainees also spend nearly half of their training in hospital rotations. Little is known about factors that support effective transition into general practice specialty training or belongingness experiences throughout training.

To explore the reported experiences of general practice trainee transition into general practice, training in hospital settings, and views of the future.

Semi-structured interviews with 18 purposively selected trainees plus observation and stakeholder discussions by a visiting Sri Lankan general practice trainee attending the vocational training scheme in a participant observer role.

Mastering core skills of general practice, undergraduate and early experience in general practice during specialty training, and general practice trainer guidance and role modelling facilitated transition. A reduced sense of belongingness during hospital rotations impacted on training and work. Building bridging social connections, personal agency initiatives to bring general practice relevance into hospital training, and secondary care affiliative behaviours were adaptive strategies. Allocation to more general practice relevant duties was thought to create value within the hospital team. General practice trainees are thriving with the support of general practice trainers and colleagues, vocational training scheme, and good work/life balance. International graduates require additional support in specific areas.

Adequate support towards transition into general practice and fostering belongingness in hospital settings is important due to the wider impact on training, patient care, and primary/secondary care integration. We propose a theoretical explanation based on Wenger’s social learning model, which may have useful practical implications.

Dinusha Perera, Faculty of Medicine, University of Kelaniya, Sri Lanka

Kay Mohanna, University of Worcester

Address for correspondence Dinusha Perera, Faculty of Medicine, University of Kelaniya, Sri Lanka

Email: dinusha{at}kln.ac.lk

• A primary care network analysis: natural communities of general practices in London

DOI: 10.3399/bjgp20X711113

Primary care networks (PCNs) are a new organisational hierarchy introduced in the NHS Long Term Plan with wide-ranging responsibilities. The vision is that they represent ‘natural’ communities of general practices with boundaries that make sense to practices, other healthcare providers, and local communities.

Our study aims to identify natural communities of general practices based on patient registration patterns, using network analysis methods and unsupervised clustering to create catchments for these communities.

Patients resident in and attending GP practices in London were identified from Hospital Episode Statistics from 2017 to 2018. We used a series of novel methods for unsupervised graph clustering. A cosine similarity matrix was constructed representing similarities between each general practice to each other, based on registration of patients in each Lower Super Output Area (LSOA). Unsupervised graph partitioning using Markov Multiscale Community Detection was conducted to identify communities of general practices. Catchments were assigned to each PCN based on the majority attendance from an LSOA.

In total 3 428 322 unique patients attended 1334 GPs in general practices LSOAs in London. The model grouped 1291 general practices (96.8%) and 4721 LSOAs (97.6%), into 165 mutually exclusive PCNs. The median PCN list size was 53 490 and a median of 70.1% of patients attended a general practice within their allocated PCN, ranging from 44.6% to 91.4%.

With PCNs expected to take a role in population health management and with community providers expected to reconfigure around them, it is vital we recognise how PCNs represent their communities. This method may be used by policymakers to understand the populations and geography shared between networks.

Thomas Beaney, Imperial College London

Jonathan Clarke, Imperial College London

Mauricio Barahona, Imperial College London

Address for correspondence Azeem Majeed, Imperial College London

Email: thomas.beaney{at}imperial.ac.uk

• Workforce Race Equality Standard survey in general practice: Lewisham 2019

DOI: 10.3399/bjgp20X711125

The NHS Workforce Race Equality Standard (WRES) was introduced in 2015 and is mandatory for NHS trusts. Nine indicators have been created to evaluate the experiences of black and minority ethnic (BME) staff compared with the rest of the workforce. The trust data published showed a poor experience of BME staff compared with non BME staff.

To introduce the concept of WRES into general practice and create a baseline from which improvement can be made. A diverse workforce will better serve its population and this will improve health outcomes.

We conducted a survey among all general practice staff members, clinicians, and non-clinicians and asked open-ended questions built around four WRES indicators most applicable to general practice, over a 6-week period in August and September 2019.

We collected 151 responses out of a total workforce of around 550. The response rate between clinicians and non-clinicians was equal 50.6% versus 49.4%. The distribution of non BME staff 51% versus BME staff 49% mirrors the diverse population of Lewisham. 54% of BME staff experienced bullying from patients, their relatives, and members of the public. 25% experienced bullying from a colleague or staff member in the workplace and 22% of BME staff changed jobs as a result of this.

BME staff in general practice report high levels of racism, especially from service users. In 22% this led to a career change. A zero-tolerance policy needs to be enforced and a multi-pronged approach is required to address this.

Sebastian Kalwij, Lewisham CCG

Address for correspondence Sebastian Kalwij, Lewisham CCG

Email: sebastiankalwij{at}mac.com

‘Would you like to join the NHS Organ Donor Register?’ A general practice feasibility study

DOI: 10.3399/bjgp20X711137

A shortage of organ donors exists in the UK and targeting family consent is key for increasing donation consent rates. Registration on the NHS Organ Donor Register (NHS ODR) facilitates this, as it guides families on their loved ones donation preference. In general practice, an opportunity to register is provided, however only to new patients. To improve access to registration opportunities, an intervention was designed where general practice staff asked their patients if they wished to register as an organ donor.

To assess an organ donation registration intervention for feasibility and acceptability in a UK general practice setting.

One general practice, in Luton, UK, conducted the intervention for 3 months (April to July 2018). Training was held in March 2018, and leaflets and posters were displayed for the 3-month period. An embedded experimental mixed-methods design was used, with data collected via SystmONE questionnaires, surveys and focus groups.

The intervention was found to be feasible and acceptable to conduct with some patients by some staff members. During the 3 months, patients were asked in 12.4% of face-to-face consultations ( n =812). Nurses and healthcare assistants were more able to conduct the intervention than doctors. Lack of time, telephone consultations, and it not being appropriate were the most common reasons for not asking. Finally, 244 patients joined the NHS ODR; 30.4% of those asked.

This study demonstrates that general practice could be a feasible location in which an intervention designed to increase NHS ODR registration could be conducted

Catrin Pedder Jones, Institute for Health Research, University of Bedfordshire

Chris Papadopoulos, University of Bedfordshire

Gurch Randhawa, University of Bedfordshire

Zeeshan Asghar, NHS Blood and Transplant

Address for correspondence Gurch Randhawa, University of Bedfordshire

Email: gurch.randhawa{at}beds.ac.uk

An exploration of stakeholders’ perceptions of the extent to which the individual and collective views of patients with long-term conditions and their carers are heard and used to inform commissioning decisions within primary care

DOI: 10.3399/bjgp20X711149

Involving patients and carers in decisions that influence the delivery of health services is a statutory requirement across the NHS. However, current evidence suggests a gap exists between the theory, legislation and policy intentions and their practical implementation.

This research aimed to identify the nature and extent of that perceived gap.

Adopting a mixed-methods approach using questionnaires and semi-structured interviews, stakeholders’ perceptions were explored regarding the extent to which the views of patients with long-term conditions and their carers are heard and used within primary care, across four clinical commissioning groups. Descriptive statistics were used to analyse the quantitative data; thematic analysis was applied to explore the qualitative data.

Data analysis demonstrated considerable difference between patients’ and carers’ perceptions and those of healthcare professionals regarding how well involvement is implemented. Three key themes emerged that were perceived to influence the effectiveness of involvement. These related to the need for effective communication of relevant, accessible information that meets people’s requirements; the need to take account of individuals’ expectations, ability, motivation, assumptions, and previous experience; and the need for organisations to provide effective systems and processes, including adequate time and focused training to support involvement, in addition to robust monitoring and evaluation of the extent to which outputs from involvement influence commissioning decisions.

The literature suggests that no existing framework addresses all three key themes. Therefore, a revised framework for involvement was developed, informed by the three key themes, that can be tested across a larger sample and different healthcare settings.

Jane Brooks, University of Portsmouth

Address for correspondence Jane Brooks, University of Portsmouth

Email: jane.brooks{at}port.ac.uk

• Identification and management of frailty in English primary care: a qualitative study of national policy

DOI: 10.3399/bjgp20X711161

Policymakers are directing attention to addressing the needs of an ageing population. Since 2017, general practices in England have been contractually required to identify and code ‘frailty’ as a new clinical concept and, in doing so, support targeted management for this population with the aim of improving outcomes. However, embedding frailty policies into routine practice is not without challenges and little is currently known about the success or otherwise of the programme.

To explore the implementation of a national policy on frailty identification and management in English primary care.

Semi-structured interviews were conducted with GPs ( n = 10), nurses ( n = 6), practice managers ( n = 3) and health advisors ( n = 3). Normalisation Process Theory (NPT) and System Thinking provided sensitizing frameworks to support data collection and analysis.

Primary care professionals were starting to use the concept of frailty to structure care both within practices and across organisations, however, there was widespread concern about the challenge of providing expanded care for the identified needs within existing resources. Concerns were also expressed around how best to identify the frail subpopulation and the limitations of current tools for this, and there was a professional reticence to use the term ‘frailty’ with patients.

Findings suggest that additional focused resources and the development of a stronger evidence base are essential to facilitate professional engagement in policies to improve the targeted coding and management of frailty in primary care.

Harm van Marwijk, Brighton and Sussex Medical School

Tom Blakeman, University of Manchester

David Reeves, University of Manchester

Khulud Alharbi, University of Manchester

Address for correspondence David Reeves, University of Manchester

Email: david.reeves{at}manchester.ac.uk

• Study design of the Fasting In diabetes Treatment (FIT) trial: a randomised, controlled, assessor blinded intervention trial which examines the effect of intermittent use of a fasting mimicking diet in patients with type 2 diabetes

DOI: 10.3399/bjgp20X711173

Caloric restriction is an effective way to treat type 2 diabetes (DM2). However, chronic restriction of food intake is difficult to sustain. Intermittent total fasting exerts similar metabolic effects, but may be even more challenging for most patients. A fasting mimicking diet (FMD) was designed to achieve the metabolic benefits of total fasting, despite considerable calorie content. The effects of a FMD in DM2 patients are still unknown.

To determine the effect of intermittent use (5 consecutive days a month during a year) of a FMD in DM2 patients on metabolic parameters and DM2 medication use compared to usual care.

One hundred DM2 patients from general practices in the Netherlands with a BMI ≥ 27 kg/m 2 , treated with lifestyle advice only or metformin, will be randomised to receive the FMD plus usual care or usual care only. Primary outcomes are HbA1c and DM2 medication dosage. Secondary outcomes are anthropometrics, blood pressure, plasma lipid profiles, quality of life, treatment satisfaction, metabolomics, microbiome, MRI (for example, cardiac function and fat distribution), cost-effectiveness, and feasibility in clinical practice.

The first 70 patients are included. Follow up will be completed in April 2021.

Our results will show whether monthly cycles of a FMD are feasible in clinical practice, if they improve metabolic parameters and/or reduce the need for medication in DM2 and if this is a cost-effective intervention.

Elske van den Burg, Public Health and Primary Care, Leiden University Medical Center

Marjolein Schoonakker, Public Health and Primary Care, Leiden University Medical Center

Elske van den Akker, Medical Decision Making, Leiden University Medical Center

Ko Willems van Dijk, Human Genetics, Leiden University Medical Center

Hildo Lamb, Radiology, Leiden University Medical Center

Hanno Pijl, Internal Medicine, Leiden University Medical Center

Mattijs Numans, Public Health and Primary Care, Leiden University Medical Center

Petra van Peet, Public Health and Primary Care, Leiden University Medical Center

Address for correspondence Elske van den Burg, Public Health and Primary Care, Leiden University Medical Center

Email: e.l.van_den_burg{at}lumc.nl

• Emergency Admission Risk Prediction (EARP) tools in primary care to reduce emergency admissions to hospital: clash of evidence and practice

DOI: 10.3399/bjgp20X711185

Policy initiatives have incentivised use of EARP tools in primary care to reduce emergency admissions. A recently published trial in South Wales found that EARP increased emergency admissions and emergency department attendances without clear benefits. This cost the NHS an additional £76 per patient per year. But the use of EARP in primary care across the UK was unknown.

To assess implementation and facilitators use of EARP tools in primary care across the UK.

Structured email survey of 235 UK primary care commissioners across the UK.

There were 148 (87%) of 171 responders (73%) who reported that EARP tools were available in their areas. We identified 39 different EARP tools in use. Access to EARP tools varied widely by country: Northern Ireland (100%), Scotland (91%), England (76%) and Wales (14%). Promotion by NHS commissioners, and engagement of clinical leaders and practice managers were identified as the most important factors in encouraging use of EARP tools. Research evidence was seen as less important. Nearly 40% of areas using EARP reported that they had revised services as a result, but few reported use of EARP for service evaluation.

Though EARP tools are widely available in primary care, new evidence shows that they are counter-productive. We estimate that by delaying the dissemination of EARP for evaluation NHS Wales saved >£200 million per year. We encourage further research and discussion about next steps in use of EARP tools in emergency admission prevention in the UK.

Helen Snooks, Swansea University

Mark Kingston, Swansea University

Alison Porter, Swansea University

Hayley Hutchings, Swansea University

Ian Russell, Swansea University

Address for correspondence Helen Snooks, Swansea University

Email: h.a.snooks{at}swan.ac.uk

• Anticipatory care planning for older adults: a trans-jurisdictional feasibility study

DOI: 10.3399/bjgp20X711197

As the population of older adults’ increases, the complexity of care required to support those who choose to remain in the community has also increased. Anticipatory Care Planning (ACP) through earlier identification of healthcare needs is evidenced to improve quality of life, decrease the number of aggressive futile interventions, and even to prolong life.

To determine the feasibility of a cluster randomised trial to evaluate the implementation and outcomes of Anticipatory Care Planning (ACP) in primary care to assist older adults identified as at risk for functional decline by developing a personalised support plan.

GP practices were randomised into control/intervention groups stratified by jurisdiction [Northern Ireland (UK) and the Republic of Ireland (RoI)], and by setting (urban and rural). Participants were included if they were a) aged ≥70 years, b) 2 or more chronic medical conditions, c) 4 or more prescribed medications. The Anticipatory Care Plan consisted of home visits where the study nurse discussed patients’ goals and plans. An action plan was put in place following consultation with patient’s GPs and study Pharmacist.

Eight primary care practices participated; four in the UK and four in the RoI. Sample n = 64. Data was collected pertaining to patient quality of life, mental health, healthcare utilisation, costs, perception of person-centred care, and the use of potentially inappropriate medication.

Unique insights relating to the trans-jurisdictional delivery of healthcare services in the UK and RoI were observed which has implications on service delivery for older adults.

Dagmar Corry, Queens University Belfast

Julie Doherty, Queens University Belfast

Adrienne McCann, Queens University Belfast

Frank Doyle, Royal College of Surgeons Ireland

Christopher Cardwell, Queens University Belfast

Gillian Carter, Queens University Belfast

Mike Clarke, Queens University Belfast

Tom Fahey, Royal College of Surgeons Ireland

Paddy Gillespie, National University of Ireland Galway

Kieran McGlade, Queens University Belfast

Peter O’Halloran, Queens University Belfast

Emma Wallace, Royal College of Surgeons Ireland

Kevin Brazil, Queens University Belfast

Address for correspondence Dagmar Corry, Queens University Belfast

Email: dagmar.corry{at}qub.ac.uk

• Vitamin D deficiency is associated with increased risk of postural hypotension in older men: a cross-sectional analysis from The British Regional Heart Study

DOI: 10.3399/bjgp20X711209

There is growing interest in the role of vitamin D in extra-skeletal health, including postural hypotension. Postural hypotension is found in 1 in 5 community-dwelling adults aged 60 years and above. It increases risk of falls, fractures, cardiovascular disease and all-cause mortality. Better understanding of the aetiology of postural hypotension may help yield more effective treatment options than those that are currently available.

The aim of this study was to investigate the association between circulating vitamin D, parathyroid hormone and postural hypotension.

This was a cross-sectional analysis of 3620 community-dwelling men living in the UK (mean age 68.6 years; standard deviation 5.5 years). Vitamin D status (nmol/L) was categorised as sufficient (≥50), insufficient (≥25 – <50), or deficient (<25). Parathyroid hormone levels were categorised by quintiles. Postural hypotension was defined by consensus criteria as a decrease in systolic blood pressure ≥20 mmHg and/or diastolic blood pressure ≥10 mmHg that occurred within three minutes of standing.

Compared to sufficient levels of vitamin D, vitamin D deficiency increased risk of postural hypotension that specifically occurred within one minute of standing (OR 1.51, 95% CI = 1.06 to 2.15) in multinomial, multiple logistic regression. Neither vitamin D insufficiency, nor elevated parathyroid hormone, were associated with postural hypotension.

In this study, vitamin D deficiency was associated with increased risk of postural hypotension. Further research may help clarify whether treating vitamin D deficiency can reduce the degree of postural hypotension, or if preventing the progression to vitamin D deficiency can reduce the incidence of postural hypotension.

Artaza Gilani, University College London Research Department of Primary Care & Population Health

Sheena Ramsay, Institute of Health & Society, Newcastle University

Paul Welsh, University of Glasgow

Olia Papacosta, University College London Research Department of Primary Care & Population Health

Lucy Lennon, University College London Research Department of Primary Care & Population Health

Peter Whincup, Population Health Research Institute, St George’s, University of London

S Goya Wannamethee, University College London Research Department of Primary Care & Population Health

Address for correspondence Artaza Gilani, University College London Research Department of Primary Care & Population Health

Email: artaza.gilani{at}ucl.ac.uk

• How can referrals of patients who are obese to the local exercise referral scheme be increased? A UK based primary care quality improvement study

DOI: 10.3399/bjgp20X711221

Obesity is classified as a body mass index (BMI) >30kg/m 2 and contributes to poor health outcomes in the UK. In 2017–18, obesity resulted in 711,000 hospital admissions. The National Institute for Health and Care Excellence (NICE) recommends GPs educate patients who are obese and refer them to exercise programmes. Our practice, Brierley Park Medical Centre, (NHS Mansfield and Ashfield CCG) is in a 4 th decile most deprived region of North Nottinghamshire (UK) and serves a population of 9,288. The local exercise referral scheme (ERS) allows clinicians to refer patients to the local gym for a reduced fee at the point of access.

To calculate and increase the number of adult patients who are obese in our practice who are referred to the local ERS.

The number of adult obese patients who were referred to the local ERS scheme from October 2018 to September 2019 was calculated. An intervention comprising internal system alerts, GP education utilising Making Every Contact Count framework and targeted patient group text alerts was designed and delivered. Pre (cycle 1) and post (cycle 2) intervention data from November to February were generated and compared.

In total, 2766 adult obese patients (29.8% of practice population) were identified: 16 (0.2%) patients were referred to ERS during cycle 1.96 (1%) patients were referred during cycle 2.

The interventions that we have designed and implemented have increased the number of referrals to ERS and may be applied to similar primary care settings.

Vasudev Zaver, Sherwood Forest Hospitals NHS Foundation Trust and Brierley Park Medical Centre, Huthwaite

Stephen Wormall, Elective Clinical Lead NHS Mansfield and Ashfield CCG, NHS Newark and Sherwood CCG, GP at Brierley Park Medical Centre

Vibhore Prasad, King’s College London and Brierley Park Medical Centre, Huthwaite

Keshara Perera, Sherwood Forest Hospitals NHS Foundation Trust and Brierley Park Medical Centre, Huthwaite

Address for correspondence Vasudev Zaver, Sherwood Forest Hospitals NHS Foundation Trust and Brierley Park Medical Centre, Huthwaite

Email: vasudev.zaver{at}nhs.net

• Evaluating interprofessional education: initial learning from a domestic abuse conference

DOI: 10.3399/bjgp20X711233

The importance of multi-agency working to identify, prevent and reduce domestic abuse is widely recognised. Interprofessional learning opportunities can provide a supportive learning environment for multi-agency practitioners to explore and develop collaborative approaches to improve health outcomes for vulnerable children, young people and their families.

Participants drawn from Kent GP trainees, student Health Visitors, School Nurses, Midwives, Social Workers, student Teachers and Special Educational Needs Coordinators (SENCOs), and postgraduate Police Officers attended this sixth annual conference.

To enable participants to understand why domestic abuse is a serious public health issue; identify indicators of domestic violence and abuse; identify opportunities for safe enquiry and know how to respond; critically reflect on ethical, legal, professional and interprofessional challenges for practitioners; and reflect on and explore opportunities for inter-professional working.

Multi-disciplinary educators delivered formal presentations and facilitated interprofessional workshops.

Data from anonymised pre- and post- conference questionnaires distributed on the day, included quantitative questions using a Likert scale 1–5 and open and closed qualitative questions.

In total, 75 out of a possible 121 participants completed both questionnaires (62%). The above aims were all met. In all questions participants gave higher scores after the conference indicating increased levels of knowledge and confidence. The qualitative comments highlighted the learning benefits from interprofessional group work. 100% (average score 4.5) agreed that facilitators fostered a supportive learning environment.

The conference provided a highly valued opportunity for useful interprofessional learning about domestic abuse. Results indicated that it increased participants’ knowledge and confidence about their own and others’ roles and responsibilities.

Cheryl Yardley, Christchurch Canterbury University

Karen Hynes, Christchurch Canterbury University

Andrew Charley, Health Education England Kent, Surrey & Sussex

Sari Sirkia-Weaver, Christchurch Canterbury University

Julie Critcher, Medway NHS Trust

Lorna Hughes, Christchurch Canterbury University

Emma Banks, Kent Police

Jane Arnott, Christchurch Canterbury University

Tim Woodhouse, Kent County Council

Anne Lyttle, Rising Sun Domestic Violence & Abuse Service

Address for correspondence Andrew Charley, Health Education England Kent, Surrey & Sussex

Email: a.charley{at}nhs.net

What do patients want? A qualitative exploration of patients’ needs and expectations regarding online access to their primary care record

DOI: 10.3399/bjgp20X711245

Primary care records have traditionally served the needs and demands of clinicians rather than those of the patient. GP contracts in England state practices must promote and offer registered patients online access to their primary care record and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients’ needs and expectations regarding online access.

To explore patients’ views about accessing online primary care records and to find out how patients would like to interact with their records and what support they may need.

Interviews and focus groups with a sample of 50 patients from a variety of socio-demographic backgrounds who were either; eligible for the NHS Health Check; had multimorbidities or were carers. Thematic analysis of data identified major themes impacting upon patients’ wishes and needs as well as highlighting population-specific issues.

Participants highlighted a wide range of views about the benefits and drawbacks of accessing their records online. The majority of participants indicated that they would be more likely to access their online primary care record if improvements were made to the design, reliability and functionality of existing online record services . Carers found accessing online records particularly useful.

Consultation with patients and carers about their experiences of accessing online records; support needs and preferred functions can provide useful insights to inform the future design of online record services.

Gail Davidge, The University of Manchester

Caroline Sanders, The University of Manchester

Rebecca Hays, The University of Manchester

Rebecca Morris, The University of Manchester

Helen Atherton, The University of Warwick

Freda Mold, The University of Surrey

Brian McMillan, The University of Manchester

Address for correspondence Brian McMillan, The University of Manchester

Email: brian.mcmillan{at}manchester.ac.uk

• MULTIPAP Study: Improving healthcare for patients with multimorbidity

DOI: 10.3399/bjgp20X711257

The steady rise in multimorbidity entails serious consequences for our populations, challenges healthcare systems, and calls for specific clinical approaches of proven effectiveness. The MULTIPAP Study comprises three sequential projects (MULTIPAP and MULTIPAP Plus RCTs, and the MULTIPAP Cohort). Results of MULTIPAP RCT are presented.

To evaluate the effectiveness of a complex, patient-centred intervention in young-old patients with multimorbidity and polypharmacy.

Pragmatic cluster-randomised clinical trial in a primary healthcare setting. GPs were randomly allocated to either conventional care or the MULTIPAP intervention based on the Ariadne Principles with two components: GPs e-training (that is, eMULTIPAP addresses specific, key concepts on multimorbidity, polypharmacy and shared decision-making) and GP–patient-centred interview. Young-old patients aged 65–74 years with multimorbidity and polypharmacy were included. Main outcome: difference in the Medication Appropriateness Index (MAI) after 6-month follow-up between groups. Secondary outcomes: MAI, quality of life, patient perception, health services use, treatment adherence and cost-effectiveness after 12-month follow-up.

117 GPs from 38 Spanish primary health care recruited 593 patients randomly assigned to the intervention/control groups. Difference in MAI scores between groups in the intention-to-treat analysis after 6 months’ follow-up: −2.42 (−4.27 to −0.59), P = 0.009 (adjusted difference in mean MAI score −1.81(−3.35 to −0.27), P = 0.021). Secondary outcomes: not significant, including quality of life (adjusted difference in mean EQ-5D-5L (VAS) 2.94 (−1.39 to 7.28), P = 0.183, EQ-5D-5L (index) −0.006(−0.034 to 0.022), P = 0.689).

The intervention significantly improved medication appropriateness. The observed quality of life improvement was not significant. GPs e-training in multimorbidity has shown to be feasible and well accepted by the professionals. Future studies may test whether this format facilitates implementation.

Alexandra Prados-Torres, EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute, Miguel Servet University Hospital, Zaragoza, Spain

Isabel del Cura-González, Primary Care Research Unit, Gerencia de Atención Primaria. Department of Preventive Medicine and Public Health, University Rey Juan Carlos, Madrid, Spain

Juan Daniel Prados-Torres, Multiprofesional Teaching Unit of Community and Family Atention ‘Distrito Atención Primaria Málaga-Guadalhorce’, Málaga, Spain.

Christiane Muth, Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt/Main, Germany

Francisca Leiva-Fernández, Multiprofesional Teaching Unit of Community and Family Atention ‘Distrito Atención Primaria Málaga-Guadalhorce’, Andalusian Health Service, Málaga, Spain

Juan A Lopez-Rodriguez, Primary Care Research Unit, Gerencia de Atención Primaria. Department of Preventive Medicine and Public Health, University Rey Juan Carlos, General Ricardos Primary Health Care Centre, Madrid, Spain

Francisca González-Rubio, EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute, Aragón; Miguel Servet University Hospital, Delicias-Sur Primary Care Health Centre, SALUD, Zaragoza, Spain.

Address for correspondence Alexandra Prados-Torres, EpiChron Research Group on chronic diseases, Aragon Health Sciences Institute, Miguel Servet University Hospital, Zaragoza, Spain

Email: sprados.iacs{at}aragon.es

GPs’ experience of safeguarding in care homes: what do they see and what do they do?

DOI: 10.3399/bjgp20X711269

Abuse of older people in care homes is an on-going problem. GPs, as the most frequent practitioner group visiting care homes, have an important role in detecting and reporting abuse. However, there is little research about GPs’ experiences of working in care homes and how they work to safeguard residents.

To explore the challenges experienced by GPs working in this unique environment and how these impact on safeguarding.

An online survey collected qualitative data about GPs’ experiences as visiting professionals to care homes, with an emphasis on safeguarding. A thematic analysis identified key themes.

In total, 58 completed surveys were returned, with a range of practitioner experience represented (1–30 years). Approximately 70% were GP partners, with the remainder salaried and locum doctors. Over one third reported they had witnessed signs of definite or possible abuse within care homes. Emerging themes related to the complex care home context, in which residents had multiple health needs and GPs had to build multiple relationships with managers, carers, families, and residents. Difficulties in accessing information were reported; residents could not always provide information, GPs had to rely on others for information, and rarely had access to electronic records.

GP work in care homes is a complex and skilled role, in which GPs encounter evidence of poor care and abuse. Key themes in respect of barriers and facilitators of good care were highlighted. The reliance on others for information and the need to build relationships with staff/managers may raise tensions in respect of safeguarding practice.

Elisabeth Alton, East Riding of Yorkshire CCG

Caroline White, University of Hull

Address for correspondence Elisabeth Alton, East Riding of Yorkshire CCG

Email: elisabeth.alton{at}nhs.net

• If GPs who teach medical students were assisted to be good role models might this influence the medical career the students choose?

DOI: 10.3399/bjgp20X711281

Most patients are cared for in the community by GPs, and workforce planning for the UK NHS suggests that 50% of medical school graduates need to train as GPs. While there is pressure on medical schools to provide more student teaching in general practice, general practice must be prepared for this increase in workload and teachers should have appropriate training.

This study examined the influence that teachers as role models can have on the development and career choices of medical students and whether GPs who teach medical students might benefit from assistance in developing positive attributes.

A literature search was carried out. Relevant papers were those that examined the influence of a doctor as teacher role model for medical students, both in assisting in professional development and clinical skills, and in influencing career choice.

The review identified eleven papers. There was evidence of association between a student having an influential role model as teacher and choosing specialty training in that area, although evidence of a causative connection is less convincing. A recurring theme is the recommendation that teachers should be aware of the influence they can have as role models, both positive and negative.

As medical student teaching moves into general practice GPs who teach will need to be helped to understand and develop positive role model attributes, to promote general practice as an attractive career to the students. Further research needs to identify the extent of assistance required and whether medical schools are prepared for this extra responsibility.

Address for correspondence Jonathan White, University of Exeter

Email: jcwhite{at}doctors.org.uk

• Quantifying empathy levels among UK undergraduate medical students: an online survey

DOI: 10.3399/bjgp20X711293

Empathy is a key health care concept and refers to care that incorporates understanding of patient perspective’s, shared decision making, and consideration of the broader context in which illness is experience. Evidence suggests experiences of doctor empathy correlate with improved health outcomes and patient satisfaction. It has also been linked to job satisfaction, and mental wellbeing for doctors. To date, there is a paucity of evidence on empathy levels among medical students. This is critical to understand given that it is a key point at which perceptions and practices of empathy in the longer term might be formed.

To quantify the level of empathy among UK undergraduate medical students

An anonymised cross-sectional online survey was distributed to medical students across three universities. The previously validated Davis’s Interpersonal Reactivity Index was used to quantify empathy. The survey also collected information on age, sex, ethnicity, year of medical school training and included a free-text box for ‘any other comments’.

Data analysis is currently underway with high response rates. Mean empathy scores by age, sex, year of study and ethnic group are presented. A correlation analysis will examine associations between age and year of study, and mean empathy sores.

These data will help to provide a better understanding of empathy levels to inform the provision of future empathy training and medical school curriculum design. Given previous evidence linking experiences of empathy to better health outcomes, the findings may also be significant to future patient care

Sarah Garnett, University of Southampton

Hajira Dambha-Miller, University of Southampton

Beth Stuart, University of Southampton

Address for correspondence Hajira Dambha-Miller, University of Southampton

Email: hajiradambha{at}doctors.org.uk

Patients’, healthcare providers’, and health insurance employees’ preferences for knee and hip osteoarthritis care: a discrete choice experiment

DOI: 10.3399/bjgp20X711305

Despite the wide range of treatment options for knee and hip osteoarthritis (KHOA), suboptimal care, low uptake and low adherence to treatment is widely seen. We need to gain insight into preferences for KHOA treatment.

To determine patients’, healthcare providers’ and healthcare insurance employees’ preferences for existing health care for KHOA.

A survey containing a discrete choice experiment (DCE) was conducted. Patients with KHOA, healthcare providers (orthopaedists and GPs), and insurance employees had to choose scenarios that differed in six attributes: waiting times, out of pocket costs, travel distance, involved healthcare providers during consultation, length of consultation and access to specialist equipment. A (panel latent class) conditional logit model was used to determine the relative importance of the attributes and trade-offs that responders made, and to explore preference heterogeneity.

A total of 648 patients completed the DCE. All six attributes played a significant role in patients’ choices. On average, out of pocket costs were deemed undesirable by patients. A GP with an orthopaedist during the consultation was preferred compared to a GP alone. Healthcare providers ( n = 76) and insurance employees ( n = 150) showed similar preferences, with respect to out of pockets costs being valued less important. Latent class analysis identified four classes of patients varying in their preferences.

Patients prefer less out of pocket costs and a GP with an orthopedists during consultation for KHOA care. Four subgroups of patients were identified that vary in preferences for KHOA care. These subgroups could provide opportunities to improve uptake, adherence and effectiveness of KHOA care.

Ilgin Arslan, Department of General Practice, Erasmus MC, University Medical Center, Rotterdam

Samare Huls, Department of Health Economics, Erasmus University, Rotterdam, The Netherlands

Esther de Bekker-Grob, Department of Health Economics, Erasmus University, Rotterdam, The Netherlands

Rianne Rozendaal, Department of General Practice, Erasmus MC, University Medical Center, Rotterdam

Sita Bierma-Zeinstra, Department of General Practice, Erasmus MC, University Medical Center, Rotterdam; Department of Orthopaedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

Dieuwke Schiphof, Department

Address for correspondence Ilgin Arslan, Department of General Practice, Erasmus MC, University Medical Center, Rotterdam Email: i.arslan{at}erasmusmc.nl

• Chest discomfort at night and risk of acute coronary syndrome: cross-sectional study of telephone conversations

DOI: 10.3399/bjgp20X711317

During telephone triage it is difficult to assign the adequate urgency to patients with chest discomfort. Considering the time of calling could be helpful.

To assess the risk of acute coronary syndrome (ACS) in certain time periods and whether sex influences this risk.

Cross-sectional study of 1,655 recordings of telephone conversations of patients who called the out-of-hours services primary care (OHS-PC) for chest discomfort. Call time, patient characteristics, symptoms, medical history and urgency allocation of the triage conversations were collected. The final diagnosis of each call was retrieved at the patient’s general practice. Absolute numbers of patients with and without ACS were plotted and risks per hour were calculated. The risk ratio of ACS at night (0 am to 9 am) was calculated by comparing to the risk at other hours, and was adjusted for gender and age.

The mean age of callers was 58.9 (SD ± 19.5) years, 55.5% were women and in total, 199 (12.0%) had an ACS. The crude risk ratio for an ACS at night was 1.80 (CI = 1.39 to 2.34, P <0.001); 2.33 (1.68 to 3.22, P <0.001) for men, and 1.29 (0.83 to 1.99, P = 0.256) for women. The adjusted risk ratio for ACS of all people at night was 1.82 (1.07 to 3.10, P = 0.039).

Patients calling the OHS-PC for chest discomfort between 0–9 am have almost twice a higher risk of ACS than those calling other hours, a phenomenon more evident in men than in women. At night, dispatching ambulances more ‘straightaway’ could be considered for these patients with chest discomfort.

Loes Wouters, Julius Center for Health Sciences and Primary Care

Dorien Zwart, Julius Center for Health Sciences and Primary Care

Carmen Erkelens, Julius Center for Health Sciences and Primary Care

Esther de Groot, Julius Center for Health Sciences and Primary Care

Roger Damoiseaux, Julius Center for Health Sciences and Primary Care

Arno Hoes, Julius Center for Health Sciences and Primary Care

Frans Rutten, Julius Center for Health Sciences and Primary Care

Address for correspondence Loes Wouters, Julius Center for Health Sciences and Primary Care,

Email: l.t.c.wouters-2{at}umcutrecht.nl

• Missed acute coronary syndrome during telephone triage at out-of-hours primary care: lessons from a case-control study

DOI: 10.3399/bjgp20X711329

Serious adverse events (SAE) at out-of-hours services in primary care (OHS-PC) are rare.

It most often concerns missed acute coronary syndromes (ACS). Root cause analyses highlighted errors in the triage process, but these analyses are hampered by hindsight bias.

To compare triage calls at the OHS-PC of missed ACS with matched controls with chest discomfort but without a missed ACS; and to assess predictors of missed ACS.

A case-control study with triage recordings of calls of a missed ACS registered between 2013–2017. Controls were from the same period. Cases were matched 1:8 with controls based on age and gender. Clinical, patient and call characteristics were assessed, and 15 expert GPs rated the triage safety and quality, being blinded to the final diagnosis. We applied conditional logistic regression analysis.

Fifteen missed ACS calls and 120 matched control calls were included. Cases used less cardiovascular medication (38.5% versus 64.1%, P = 0.05), and more often experienced retrosternal chest pain (63.3% versus 24.7%, P = 0.02) than controls. Consultation of the supervising GP (86.7% versus 49.2%, P = 0.02) occurred more often in cases than controls. Experts rated the triage of cases more often as ‘poor’ (33.3% versus 10.9%, P = 0.001), and ‘unsafe’ (73.3% versus 22.5%, P <0.001) than that of controls.

It seems nearly impossible to differentiate missed ACS at the OHS-PC from others with chest discomfort based on symptom presentation.

Address for correspondence Carmen Erkelens, Julius Center for Health Sciences and Primary Care

Email: d.c.a.erkelens{at}umcutrecht.nl

• The Moving Healthcare Professionals Programme

DOI: 10.3399/bjgp20X711341

Healthcare professionals (HCPs) are estimated to see nearly 500 000 patients during their career. Evidence demonstrates that one in four patients would be more active if advised by their GP. However, there is a lack of engagement between HCPs and patients regarding the benefits of physical activity (PA). PA is not discussed with 80% of patients, with 75% of GPs feeling they lack knowledge to advise their patients.

Moving Healthcare Professionals Programme (MHPP) aims include increasing awareness and skills in PA for prevention and management of ill health; changing clinical practice in the promotion of activity; and evaluating impact to identify ‘what works’.

GPs were recruited as Physical Activity Clinical Champions (PACCs) to deliver peer-to-peer training to HCPs nationally. Additionally, relationships were developed with undergraduate medical schools to embed PA into curriculum. A PA advice pad was developed as a local GP pilot, while the ‘Moving Medicine’ online resource was created.

Over 22 000 HCPs were trained to date, with evaluation demonstrating an increase in knowledge, skills and confidence, and over 18 000 completions of our eLearning modules. PA coverage was expanded across the undergraduate curriculum at multiple medical schools, while feedback on the e-advice pad pilot has informed a further digital pilot. Additionally, there were >3000 monthly users of ‘Moving Medicine’.

This work demonstrated scope for significant improvements in HCP engagement in multiple clinical settings. Working with GPs has proved crucial to this success across various workstreams, with their participation a continued focus moving into Phase 2.

Michael Brannan, Public Health England, Physical Activity Team

Matt Hughes-Short, Public Health England, Physical Activity Team

Address for correspondence Matt Hughes-Short, Public Health England, Physical Activity Team

Email: matthew.hughesshort{at}phe.gov.uk

• A qualitative evaluation of a prescribing e-learning package for general practice

DOI: 10.3399/bjgp20X711353

The GMC PRACtiCe study identified a 1 in 20 error rate in prescriptions issued in general practice and identified a need for further training in prescribing. As a result, an e-Learning prescribing package was designed and launched to healthcare professionals through the Royal College of General Practitioners in January 2014.

This part of the study explored the longer-term impact on prescribing knowledge, attitudes and behaviours of practitioners completing the eLearning prescribing package.

On completion of the e-Learning package, participants were asked to indicate their willingness to be contacted for a telephone interview. Semi-structured interviews were conducted which were audio recorded, transcribed verbatim and analysed using thematic analysis, aided by NVivo. Interviewees were invited to enter a prize draw to win Stockley’s Drug Interaction textbook (provided courtesy of the Royal Pharmaceutical Society).

Of the 120 participants who expressed an interest in being followed up for interview, seven prescribers were interviewed in 2014 and 2015. Reasons for completing the course were explored, and interviewees gave examples of changes made to their prescribing practice as a result of completing the e-Learning. This included the adoption of specific strategies to enhance safe practice, and enacting enhanced vigilance in key areas such as renal function monitoring. Some changes to the course content and presentation were also recommended.

These interviews have highlighted the potential for using e-Learning for prescribing training and to achieve long-term changes in prescribing practice. However, further work is needed to generate substantive evidence of its impact on prescribing.

Richard Knox, University of Nottingham

Nde-Eshimuni Salema, University of Nottingham

Naomi Clement, University of Nottingham

Brian Bell, University of Nottingham

Gill Gookey, Rushcliffe CCG

Glen Swanick, University of Nottingham

Anthony Avery, University of Nottingham

Address for correspondence Richard Knox, University of Nottingham

Email: richard.knox{at}nottingham.ac.uk

• Awareness and use of online appointment booking in general practice: analysis of GP Patient Survey data

DOI: 10.3399/bjgp20X711365

General practices are required to provide online booking to patients in line with policy to digitise access. However, uptake of online booking by patients is currently low and there is little evidence about awareness and use by different patient groups.

To examine variability in awareness and use of online appointment booking in general practice.

Secondary analysis of two questions from the GP Practice Survey data (2018) asking about awareness and use of online booking of appointments. Multivariable logistic regression was used to examine associations with age, gender, ethnicity, deprivation, the presence of a long-term condition, long-term sickness and being deaf.

In total, 43.3% (277 278/647 064) of responders reported being aware of being able to book appointments online, while only 15% (93 671/641 073) reported doing so. There was evidence of variation by all factors considered, with strong deprivation gradients in both awareness and use (for example, most versus least deprived quintile OR for use: 0.63 (95% CI = 0.61 to 0.65). There was a reduction in awareness and use in patients >75 years of age. Patients with long-term conditions were more aware and more likely to use online booking.

While over 40% of patients know that they can book appointment online, the number that actually do so is far lower. With the constant push for online services within the NHS and the roll out of the NHS app, practices should be aware that not all patient groups will book appointments online and that other routes of access need to be maintained to avoid widening health inequalities.

Mayam Gomez-Cano, University of Exeter Medical School

John Campbell, University of Exeter Medical School

Abi Eccles, The University of Warwick

Jeremy Dale, The University of Warwick

Leon Poltawski, University of Exeter Medical School

Gary Abel, University of Exeter Medical School

Address for correspondence Gary Abel, University of Exeter Medical School,

Email: g.a.abel{at}exeter.ac.uk

Interpreter costs across clinical commissioning groups in England 2017–2018: a cross sectional survey using ‘freedom of information’ requests

DOI: 10.3399/bjgp20X711377

Professional interpreters are considered to be the gold standard when meeting the needs of patients with limited English proficiency (LEP) in primary care. The models by which CCGs supply interpreting services (IS) vary. Many CCGs use external commercial IS, while other CCGs commission ‘not for profit’ services such as the Advocacy and Interpreting Service in Tower Hamlets, the Sussex Interpreting Service, and the decommissioned Sheffield Community Access and Interpreting Service. Research on comparative costs and needs of the LEP population is lacking.

To compare the costs of interpreting services between CCG’s in England.

A cross-sectional study involving CCGs in England. A standardised request was sent to 195 CCGs inviting comment on how much the CCG spent (2017–2018) on IS. The data were plotted against a number of demographic variables ( https://fingertips.phe.org.uk ) and analysed using regression analysis.

Survey response rate: 86% of CCGs ( n = 169). Of those CCGs who responded, 39% ( n = 66) did not hold IS cost data. NHS England spent £2 951 348.16 for IS services for the year 2017–2018. A positive correlation was noted with increased cost of interpreting services when plotted against increasing percentage BME or percentage birth to non-UK parents. However, there were wide variations around correlation of best fit indicating variation in spending between CCGs for similar populations.

Inter CCG variation in correlations between demographic variables and expenditure suggests further research is needed to determine how to optimise and resource safe and equitable IS across the UK population.

Philip Oliver, University of Sheffield

Christopher Burton, University of Sheffield

• Determinants of primary care workforce variation in England

DOI: 10.3399/bjgp20X711389

The General Practice Forward View (GPFV) outlined how the government plans to attain a strengthened model of general practice. A key component of this proposal is an expansion of the workforce by employing a varied range of practitioners, in other words ‘skill mix’. A significant proportion of this investment focuses on increasing the number of ‘new’ roles such as clinical pharmacists, physiotherapists, physician associates, and paramedics.

The aim of this study is to examine what practice characteristics are associated with the current employment of these ‘new’ roles.

The study uses practice level workforce data (2015–2019), publicly available from NHS Digital. The authors model FTE of specific workforce groups (for example, advanced nurse) as a function of deprivation, practice rurality, patient demographics (total list size and percentage of patients aged >65 years) and FTEs from other staff groups.

Although analysis is ongoing, initial estimation suggests that the employment of ‘new’ roles has occurred in larger practices (in terms of list size), in practices with a higher proportion of patients living in deprived areas and practices with a larger proportion of patients aged >65 years. FTE for advanced nurses is negatively associated with GP FTE.

A negative correlation between advanced nurse FTE and GP FTE is potentially suggestive of substitution between roles, deliberate or otherwise. For example, practices may employ ‘new’ roles if they are unable to recruit GPs or they may recruit staff to free up GP time. Further work is needed to confirm these findings and to explore the reasons behind practice employment decisions.

Jon Gibson, University of Manchester

Sharon Spooner, University of Manchester

Matt Sutton, University of Manchester

Address for correspondence Jon Gibson, University of Manchester

Email: jon.m.gibson{at}manchester.ac.uk

Motivating factors behind skill mix change: results from a practice managers’ survey in England

DOI: 10.3399/bjgp20X711401

The expansion of the primary care workforce by employing a varied range of practitioners (‘skill mix’) is a key component of the General Practice Forward View (GPFV). The extent of skill mix change and where that has occurred has been examined using publicly available practice level workforce data. However, such data does not provide information regarding specific motivating factors behind employment decisions for individual practices nor future workforce plans.

To identify key motivating factors behind practice workforce decisions and their future workforce plans.

An online questionnaire was sent to practice managers in England. Data collection is ongoing; however, 1000 practices have responded to the survey so far. The questionnaire was composed of questions related to current workforce, motivating factors behind employment decisions, planned future workforce changes, financial assistance with employing staff (for example, HEE or CCG funding) and ideal workforce.

Early results indicate that practices that have employed physician associates have done so to increase appointment availability (78% of practices) and release GP time (68%). Sixty-six per cent of practices who have employed pharmacists have received some form of financial assistance with 21% of practices still receiving assistance. When asked to construct an ideal workforce, ‘new’ roles accounted for 20% of that workforce on average, which is a significantly larger proportion than those roles currently account for.

Although data collection and analysis are ongoing, the results of the survey provide novel insights into the underlying motivating factors behind employment decisions, specifically for new roles such as pharmacists, PAs and paramedics.

Imelda McDermott, University of Manchester

Mhorag Goff, University of Manchester

Kath Checkland, University of Manchester

Damian Hodgson, University of Manchester

Anne McBride, University of Manchester

Mark Hann, University of Manchester

Time for change? A comparative analysis of GPs’ opinions on appointment length

DOI: 10.3399/bjgp20X711413

The research on the benefits, disadvantages and factors that affect appointment length in general practice is fragmented. There is a need to draw the evidence together and who better to assess this than those on the front line.

To investigate GPs’ opinions on appointment length, including the factors that affect appointment length, its impact on doctors and the validity of increasing appointment length.

A questionnaire was sent to six general practices in Bristol and was completed by 30 GPs (response rate = 100%). Analysis of current appointment length, satisfaction and the ideal length was undertaken, alongside thoughts about the advantages and disadvantages of longer appointments. Ethical approval was successfully sought from Student Research Ethics Committee.

Most doctors have 10-minute appointments ( n = 29); however, 90% ( n = 27) wished for 15 minutes. Appointments overrunning was described as a constant problem and resulting in stress. Longer appointments were due to multiple problems in a single consultation, mental health and multimorbidity. There did not appear to be any variation in viewpoints with practices, clinician experience and session length. The benefits of a longer appointment were a greater ability to deal with complex conditions, improved decision making, stress reduction and time to talk about interventions. However, 93.3% ( n = 28) of doctors were concerned that there would be less appointments available if appointment lengths increased.

Most doctors would like longer appointments. In light of the concern about appointment availability, there needs to be research into whether this would substantiate.

Katherine Murdoch, University of Bristol

Address for correspondence Katherine Murdoch, University of Bristol

Email: km14870{at}bristol.ac.uk

• In situ deteriorating patient simulation in general practice

DOI: 10.3399/bjgp20X711425

GP practices have limited access to medical emergency training and basic life support is often taught out of context as a skills-based event.

To develop and evaluate a whole team integrated simulation-based education, to enhance learning, change behaviours and provide safer care.

Phase 1: 10 practices piloted a 3-hour programme delivering 40 minutes BLS and AED skills and 2-hour deteriorating patient simulation. Three scenarios where developed: adult chest pain, child anaphylaxis and baby bronchiolitis. An adult simulation patient and relative were used and a child and baby manikin. Two facilitators trained in coaching and debriefing used the 3D debriefing model. Phase 2: 12 new practices undertook identical training derived from Phase 1, with pre- and post-course questionnaires. Teams were scored on: team working, communication, early recognition and systematic approach. The team developed action plans derived from their learning to inform future response. Ten of the 12 practices from Phase 2 received an emergency drill within 6 months of the original session. Three to four members of the whole team integrated training, attended the drill, but were unaware of the nature of the scenario before. Scoring was repeated and action plans were revisited to determine behaviour changes.

Every emergency drill demonstrated improved scoring in skills and behaviour.

A combination of: in situ GP simulation, appropriately qualified facilitators in simulation and debriefing, and action plans developed by the whole team suggests safer care for patients experiencing a medical emergency.

Joanna Lawrence, Brighton and Sussex Medical School

Petronelle Eastwick-Field, Health Education Thames Valley

Anne Maloney, Health Education England Thames Valley

Helen Higham, Health Education England Thames Valley

Address for correspondence Petronelle Eastwick-Field, Health Education Thames Valley

Email: petronelle1{at}hotmail.co.uk

• GP views on the routine identification of older people living with frailty in primary care

DOI: 10.3399/bjgp20X711437

To meet the challenges of an ageing population, the updated 2017/18 NHS GP contract requires primary care providers to use evidence-based frailty identification tools to risk-stratify all patients aged >65 years. Those patients flagged as moderately or severely frail should be clinically reviewed and if severe frailty is confirmed, providers have been asked to consider offering relevant interventions, with the overall aim of enabling these patients to live well for longer. However, there is limited knowledge about how this frailty contractual requirement is being operationalised in primary care.

To improve understanding of the barriers and facilitators GPs encounter when routinely identifying, risk-stratifying and providing interventions for people living with frailty in primary care.

This was a two-part study: an initial survey via online questionnaire, with participants selected by maximum variation sampling to be followed up with a semi-structured telephone interview. All GPs working in the East Midlands region (Derbyshire, Leicestershire, Lincolnshire, Nottinghamshire, and Northamptonshire) were eligible to take part. The online questionnaire was analysed using descriptive statistics. Interview transcripts were analysed using framework analysis to identify key themes.

In total, 188 GPs responded to the survey. Eighteen GPs were interviewed. Four themes were identified: 1) beliefs about stratification and pro-active identification of frailty; 2) frailty stratification tools; 3) managing complexity, resources and models of care; and 4) drivers of GP behaviour.

The study findings will inform the further development of NHS England policy on the frailty contractual requirement for primary care providers.

Ebrahim Mulla, University of Nottingham

Elizabeth Orton, University of Nottingham

Denise Kendrick, University of Nottingham

Address for correspondence Ebrahim Mulla, University of Nottingham

Email: e_mulla{at}hotmail.co.uk

Poster Presentations

Healthcare professionals’ perspectives on lung cancer screening in the UK: a qualitative study

DOI: 10.3399/bjgp20X711449

Lung cancer screening with low-dose CT has been shown to decrease mortality. Low lung cancer survival rates in the UK, driven primarily by late-stage presentation, provide the impetus for implementing screening. Nascent guidance on screening in the UK recommends primary care case-finding. However, the potential impact and acceptability on primary care, and the opportunistic utilisation of other case-finding routes such as pharmacies, smoking cessation services and respiratory clinics, have not been fully explored.

To explore healthcare professionals’ views and perspectives about lung cancer screening and their preparedness and willingness to be involved in its implementation.

A qualitative study was carried out with semi-structured interviews conducted with GPs, pharmacists and staff from smoking cessation services within Southwark and Lambeth and from respiratory clinics in Guy’s and St. Thomas’ NHS Trust in London in 2018. Sixteen participants were interviewed, and the interview transcripts were analysed thematically.

Participants described lung cancer screening as an important diagnostic tool for capturing lung cancer at an earlier stage and in increasing survivorship. However, the majority expressed a lack of awareness and understanding, uncertainty and concerns about the validity of screening, its misuse and the potential impact on their patients and workload.

Study participants had mixed opinions about lung cancer screening and expressed their concerns about its implementation. Addressing these concerns by providing resources and effective and detailed guidelines for their use may lead to greater engagement and willingness to be involved in lung cancer screening.

Charikleia Margariti, King’s College London

Maria Kordowicz, King’s College London

Gillian Selman, Guy’s and St Thomas’ NHS Foundation Trust

Arjun Nair, University College London Hospitals NHS Trust

Yvonne Akande, Guy’s and St Thomas’ NHS Foundation Trust

Azhar Saleem, Lambeth Clinical Commissioning Group

Tiago Rua, King’s College London

Address for correspondence Charikleia Margariti, King’s College London

Email: xaroula88{at}hotmail.com

• Achieving better quality care in general practice: are incentives the answer?

DOI: 10.3399/bjgp20X711461

The introduction of financial incentives, such as the quality and outcomes framework (QOF), historically lead to improvements in standardising practice. However, with shifting demands on healthcare providers, are these schemes still enough to drive high-quality care?

To explore current incentives, intrinsic and extrinsic, their role and effectiveness in improving quality of care and how they are perceived by GPs.

Mixed methods study using two systematic literature reviews including 44 papers and 18 semi-structured interviews with GPs.

In the literature, QOF was associated with reduced socioeconomic inequalities, decreased mortality and improved outcomes. However, the absence of control groups and the simultaneous analysis of multiple indicators complicates the findings. GPs agreed with the literature and viewed financial incentives as beneficial, however, they felt the key driver in providing good-quality care was their intrinsic motivation. Financial incentives were found to contribute to depersonalised care, diluted provision of non-incentivised activities and hindered overall practice. The results from the second literature review were in keeping with the views of the participants. They illustrated the importance of managing factors contributing to physician burnout, reduced performance, and low job satisfaction, which can result in the provision of low-quality care.

Financial incentives have the potential to induce behaviour change, however, their use in quality improvement is limited when used alone. If used in an environment that nurtures intrinsic motivation, healthcare providers will be more driven to achieve a higher quality of care and will be better able to cope with shifting demands.

Kanwal Ahmed, Imperial College London

Salma Hashim, Imperial College London

Mariyam Khankhara, Imperial College London

Ilhan Said, Imperial College London

Amrita Shandakumar, Imperial College London

Sadia Zaman, Imperial College London

Andre Veiga, Imperial College London

Address for correspondence Kanwal Ahmed, Imperial College London

Email: ka2415{at}ic.ac.uk

• 2017 Cancer Prevalence Dashboard for London

DOI: 10.3399/bjgp20X711473

As cancer incidence increases and survival improves, the number of people living with a cancer diagnosis is increasing. People living with cancer have 50% more contact with GPs 15 months after diagnosis than a population of similar age, sex and locality; 70% have another long-term condition.

To aid service providers’ understanding of the cancer prevalent population by creating a publicly available visualisation tool that both describes patients’ demographics and length of time lived with cancer, and compares counts of nationally registered cancer survivors to GP-maintained registers.

Using National Cancer Registration and Analysis Service (NCRAS) data, prevalence rates and counts were generated for London patients diagnosed 1995–2017 and alive 31 December 2017, overall and for lower-level geographies. GP-recorded Quality and Outcomes Framework (QOF) prevalence at Clinical Commissioning Group (CCG) level was compared to NCRAS counts for the same period.

On 31 December 2017, 231 740 (2.6%) people were living with cancer in London; 33% were diagnosed 5–9 years prior and 31% were diagnosed ≥10 years prior. Prevalence was higher in women ( P <0.001) and dramatically increased with age for London ( P <0.001); >12% of >75 year olds were living with a cancer diagnosis in every lower-level geography. Completeness of GP QOF cancer registers against NCRAS prevalence counts ranged from 75–108% across CCGs.

Local understanding of the cancer prevalent population is needed, with a concerted effort to interpret large discrepancies between QOF and NCRAS registers, which may arise from differences in coding practice. Ensuring patients are identified in primary care is a first key step to managing cancer as a long-term condition.

Amy Zalin, Public Health England and Transforming Cancer Services Team Partnership

Sophie Jose, Public Health England and Transforming Cancer Services Team Partnership

Jason Petit, Transforming Cancer Services Team — Healthy London Partnership

Liz Price, Transforming Cancer Services Team — Healthy London Partnership

Tania Anastasiadis, NHS Tower Hamlets CCG

Address for correspondence Amy Zalin, Public Health England and Transforming Cancer Services Team Partnership

Email: amy.zalin{at}phe.gov.uk

• How do you diagnose asthma? A multiple case study design to understand and explain current use of national guidelines by primary care clinicians

DOI: 10.3399/bjgp20X711485

Clinical guidelines for asthma are available to UK clinicians but implementation is not straightforward. Diagnostic and treatment inadequacy contribute to patient morbidity and mortality and lack of adherence to guidelines is a component of this.

This qualitative study sought to explore and understand the use of asthma guidelines by primary care clinicians in two geographically bounded regions of Wales.

Multiple case study design was used. Data was collected using semi-structured interviews with a purposively sampled group of clinical staff from GP practices. Interview transcripts were thematically analysed to produce a detailed picture of practice.

Asthma care in the studied areas operated as a social network of clinicians who often used guidelines as boundary objects. Practice and local service design was influenced and dependent on regular input from local secondary care providers. Clinicians looked to British Thoracic Society and Scottish Intercollegiate Guideline Network (BTS/SIGN) 2016 guidelines. There was limited use of National Institute for Health and Care Excellence (NICE) 2017 guidelines. Barriers to guideline recommended diagnostic asthma care included: lack of acceptability, financial costs and disempowerment of nursing staff.

The findings from this study replicate and reinforce the findings of previous work. It is striking and concerning that the thematic outcomes of this study bear a strong resemblance to that which was demonstrated over a decade ago. The guideline-implementation gap in asthma diagnostics will likely persist unless there is significant restructuring, financial investment and greater empowerment of nursing staff in primary care.

Fiona Hares, Betsi Cadwaladr University Health Board

Daniel Menzies, Glan Clwyd Hospital

Paul Brocklehurst, Bangor University

Sion Williams, Bangor University

Address for correspondence Fiona Hares, Betsi Cadwaladr University Health Board

Email: fionahares{at}doctors.org.uk

• The prevalence of musculoskeletal presentations in general practice: an epidemiological study

DOI: 10.3399/bjgp20X711497

It is estimated that 28.9% (17.8 million) of the UK population live with a musculoskeletal (MSK) condition. They are a major cause of morbidity, and a significant reason for presentation to primary care.

The primary aim of this study was to determine the prevalence of MSK conditions presenting for consultation in general practice. The secondary aim was to determine specifically which MSK conditions present most frequently in general practice.

A total of 545 consultations were reviewed at an urban community general practice, which included evaluating morning consultations over a 1-week period taken from each of January, April, July and October 2018. This encompassed all morning consultations from all GPs present. The number of MSK consultations were recorded and, within that, the different presentations and their management plan.

A total of 115 of all consultations were regarding an MSK presentation yielding an overall prevalence of 21.1%. The commonest MSK presentations included the lumbosacral spine (18.3%) and the knee (17.4%). Re-presentations of original condition accounted for 73.9% of all MSK consultations. Steroid injections were administered in 33% of knee related consultations.

This study demonstrates that MSK presentations account for a large proportion of GP workload. There are no current mandatory training requirements in orthopaedics as part of the GP curriculum. Structured MSK education for GPs is important and would reduce the burden of re-presentations, particularly that of the lumbosacral spine and knee. Competency in joint injection is also a valuable skill for GPs.

Ruairi Keavy, South Tyneside and Sunderland NHS Foundation Trust

Address for correspondence Ruairi Keavy, South Tyneside and Sunderland NHS Foundation Trust

Email: ruairi.keavy{at}nhs.net

• A scoping review of community holistic interventions for older people with multimorbidity

DOI: 10.3399/bjgp20X711509

In many areas, new regional community-based services have been established to provide holistic care to patients with high physical, mental and social needs. Older people represent a group with multimorbidity and high healthcare needs that may benefit from holistic care, although uncertainty remains whether such an approach is effective.

To review evidence for community holistic interventions in older people with multimorbidity.

The authors screened studies referenced by an earlier Cochrane Review and Academy of Medical Sciences report, both of which looked at interventions and populations more broadly, and their own searches of Medline, EMBASE, trial registration databases and hand-searching of journals since 2015. The authors included controlled community-based studies of holistic interventions with data for people aged at least 60 years.

Studies found (five published, two ongoing) were heterogeneous. The only significant improvement relating to physical or mental outcomes occurred in self-rated health scores, seen in two studies. One consisting entirely of diabetics showed developing a self-management plan improved self-rated health ( P = 0.023), and Mental Component Summary ( P = 0.03). The other used a multidisciplinary-team-guided personal care plan and found self-rated overall health improved ( P = 0.02). Three studies looked at service usage, only one seeing a benefit, and only in the second year.

Community-based holistic interventions for people with multimorbidity tended to focus on disease management or medication modification, and resulted in few significant benefits, almost entirely in self-rated health measures. Research into interventions focused on those with the highest needs, for example, multimorbidity with frailty; high number of comorbidities may be more likely to demonstrate meaningful benefits.

Timothy Smith, University of Central Lancashire

Tahera Patel, University of Central Lancashire

Asangaedem Akpan, University of Liverpool

Andrew Clegg, University of Central Lancashire

Dame Caroline Watkins, University of Central Lancashire

Catherine Elizabeth Lightbody, University of Central Lancashire

Umesh Chauhan, University of Central Lancashire

Address for correspondence Timothy Smith, University of Central Lancashire

Email: tsmith10{at}uclan.ac.uk

• Continuing professional development for GPs in Myanmar: a pilot programme

DOI: 10.3399/bjgp20X711521

The quality of general practice in Myanmar is currently highly variable. No formalised system of revalidation yet exists and so engagement with continuing professional development (CPD) activities and motivation to further one’s own knowledge is sporadic.

To train GPs in three key areas; 1) recording CPD activities and maintaining a portfolio logbook; 2) reflecting on learning; and 3) what a future formalised CPD credit system may involve.

Sixty-one GPs were recruited in March 2019 and given training on the above. Logbooks were issued, which were completed by the GPs while attending a simultaneous 3-month ‘GP CPD Refresher’ course, organised by the GP Society of Myanmar. The logbooks were then marked and individualised feedback given before issuing CPD accredited certificates.

All GPs agreed the pilot helped them to better understand how to maintain a CPD logbook and the importance of doing so (retention rate = 67%). All GPs also reported they would now be more likely to continue to keep a portfolio. Finally, all GPs surveyed felt a credit reward system, used as tangible evidence of CPD participation, would positively influence their future engagement with CPD.

Improving general practice is a key component in helping Myanmar develop its healthcare system; one step required is making engagement with CPD compulsory for the revalidation of clinicians. This pilot has highlighted existing inadequacies within current training of GPs, as well as the potential benefits of implementing a CPD credit reward system.

• Antibiotic resistance of uropathogenic Escherichia coli and ESBL prevalence in general practice patients over 10 years

DOI: 10.3399/bjgp20X711533

Bacterial susceptibility to antibiotics changes over time. Knowledge of the susceptibility is important for antibiotic treatment guidelines in general practices.

To determine the antibiotic-susceptibility of E. coli from uncomplicated UTI among women in general practices in the Netherlands and to compare the results with those collected in 2004 and 2009.

Urine samples were collected from women with symptoms of uncomplicated UTI, in 30 sentinel GP practices of the Nivel Primary Care database. Patient characteristics, E. coli susceptibility and ESBL prevalence were analysed.

In total, 689 samples were collected. E. coli was the most isolated uropathogen (83%). Antibiotic susceptibility was stable over time except for ciprofloxacin (96%, 97% and 94% in 2004, 2009 and 2014, respectively; P <0.05). The susceptibility to co-amoxiclav was 88%, 87% and 92% in 2004, 2009 and 2014, respectively. The prevalence of ESBL producing E. coli increased from 0.1% in 2004, to 2.2% in 2014 ( P <0.05). Susceptibility for co-trimoxazole was the highest in the West (88%) and the lowest in the North (72%, P = 0.021). Ciprofloxacin susceptibility was related to antibiotic use in the past 3 months (97% no use versus 90% use, P = 0.002) and those aged >70 years ( P = 0.005). In 2014, prescription of fosfomycin increased compared to 2009 (14.3% versus 5.6%) at the expense of co-amoxiclav, co-trimoxazole and ciprofloxacin ( P <0.05).

The antibiotic susceptibility percentages to the agents tested were stable over the 10-year period, except for ciprofloxacin as was the prevalence of ESBL producing E. coli . Surveillance with regular intervals is warranted.

Antoinette van Driel, Erasmus University Medical Center

Address for correspondence Antoinette van Driel, Erasmus University Medical Center

Email: antoinet20{at}hotmail.com

• Cancer treatment decisions for people living with dementia: experiences of family carers

DOI: 10.3399/bjgp20X711545

Dementia and cancer are both diseases associated with older age. The National Cancer Data Audit in England found that 4.4% of people diagnosed with cancer also had cognitive impairment. Decisions about cancer treatment can be very complex when someone already has dementia. Often someone’s closest relative may be asked to make decisions on their behalf. Little is known about the psychosocial impact that this has on carers, or what their support needs are during this time.

To explore the experiences of family carers who have been involved in making cancer treatment decisions on behalf of a relative with dementia, in particular identifying challenges and support needs.

The authors are conducting semi-structured interviews with carers of people with dementia who have been involved in making decisions about cancer treatment on their behalf. Data is being thematically analysed using an inductive approach. Two researchers will independently verify themes.

The authors expect to have completed 14–18 interviews and will report their preliminary findings. Family carers experience many difficulties in the context of cancer and dementia, including lack of support when coping with the aftereffects of cancer treatment, lack of awareness among healthcare professionals regarding the authority granted by a lasting power of attorney and the anxiety created by feeling responsible for identifying cancer recurrence.

This study will highlight that supporting someone with dementia through cancer treatment, and having to make decisions about it on their behalf, creates unique challenges for carers. Currently there is a significant lack of support for those facing this distressing experience.

Catherine Hynes, University of Sheffield

Lynda Wyld, University of Sheffield

Address for correspondence Catherine Hynes, University of Sheffield

Email: c.hynes{at}sheffield.ac.uk

• Exploring patient preference regarding interpreter use in primary care

DOI: 10.3399/bjgp20X711557

Effective communication is considered an essential component of delivering health care. Trained, professional interpreters are the gold standard for overcoming language barriers with those with limited English proficiency (LEP). However, LEP patients often use unqualified interpreters such as family members and friends. Existing literature explores the rationale behind choosing different interpreters, but rarely from the patient perspective.

To explore the patient perspective on the type of interpreter best suited for primary care consultations.

Participants self-identified as having LEP were recruited from four GP practices in areas of Sheffield with high proportions of black and minority ethnic (BME) residents. The participants were from Urdu-, Arabic-, or Romani-speaking ethnic groups. Semi-structured interpreted interviews were recorded, transcribed, and analysed thematically with independent verification of emergent themes. Interviews continued to data saturation.

All participants expressed a preference for face-to-face interpreters. Urdu and Arabic participants highlighted the importance of using an interpreter with the same dialect; Roma participants were passionate about the need for qualified Roma interpreters. Most participants also identified trust and sex as important factors. However, interpreter preference varied between participants: some valued the continuity of family members, whereas others favoured the professionalism and linguistic accuracy associated with qualified interpreters.

This study identified conflicts between patient preferences and guidance for healthcare professionals; all of the participants disliked telephone interpreting, and many recognised the benefits of untrained interpreters. The study highlights the complexities of interpreter preference in primary care and suggests that the decision should be flexible, and patient centred.

Heather Steele, University of Sheffield

• A case study evaluation of a community multidisciplinary team in South East England using a mixed-method approach

DOI: 10.3399/bjgp20X711569

Community multidisciplinary teams (MDTs) represent a model of integrated care comprising health, social care, and the voluntary sector where members work collaboratively to coordinate care for those patients most at risk.

The evaluation will answer the question, ‘What are the enablers and what are the restrictors to the embedding of the case study MDT into the routine practice of the health and social care teams involved in the project?’

The MDT was evaluated using a mixed-method approach with normalisation process theory as a methodological tool. Both quantitative and qualitative data were gathered through a questionnaire consisting of the NoMAD survey followed by free-form questions.

The concepts of the MDT were generally clear, and participants could see the potential benefits of the programme, though this was found to be lower in GPs. Certain professionals, particularly mental health and nursing professionals, found it difficult to integrate the MDT into normal working patterns because of a lack of resources. Participants also felt there was a lack of training for MDT working. A lack of awareness of evidence supporting the programme was shown particularly within management, GP, and nursing roles.

Specific recommendations have been made in order to improve the MDT under evaluation. These include adjustments to IT systems and meeting documentation, continued education as to the purpose of the MDT, and the engagement of GPs to enable better buy-in. Recommendations were made to focus the agenda with specialist attendance when necessary, and to expand the MDT remit, particularly in mental health and geriatrics.

Jessica Wyatt Muscat, South Kent Coast CC

Address for correspondence Jessica Wyatt Muscat, South Kent Coast CC

Email: jessica.wyatt-muscat{at}nhs.net

• Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice

DOI: 10.3399/bjgp20X711581

Opioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.

An audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.

A search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine’s best-practice guidelines were used.

Demographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. Indications: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. Review: 56% 4-week, 70% past year.

Opioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

Charlotte Greene, King’s College London, GKT School of Medicine

Alice Pearson, King’s College London, GKT School of Medicine

Address for correspondence Charlotte Greene, King’s College London, GKT School of Medicine

Email: charlotte.greene{at}kcl.ac.uk

• Inequalities in suicide rates associated with deprivation in England from 2004 to 2019

DOI: 10.3399/bjgp20X711593

Although addressing inequality has been a public and political priority for decades, inequalities in health, wealth, and other societal domains persist in England. In Ireland, rates of suicide are twice as high in the most deprived decile of society compared with the least deprived. Trends in the association between deprivation and suicide in England are unclear.

To describe the relationship between deprivation and suicide in England in 2019 and analyse trends in this relationship over time.

Data on rate of suicide and Index of Multiple Deprivation (IMD) for each local authority in England for 2018 and 2004 were obtained from the Office for National Statistics’ publicly available databases. The mean suicide rate for each quintile of deprivation was calculated, and means compared using ANOVA. The correlation coefficients between IMD and suicide rate were calculated for both 2004 and 2019. Steiger’s test was used to compare coefficients over time.

In 2019, the suicide rate in the least deprived quintile was 8.7 per 100 000 person-years, compared with 8.3 in 2004. This increased across each quintile to 11.1 suicides per 100 000 person-years in the most deprived quintile in 2019 (ANOVA: P <0.001), and to 11.7 in 2004 (ANOVA: P <0.001). The correlation coefficient between IMD and suicide rate in 2004 was 0.43, compared with 0.33 in 2019. Steiger’s test demonstrated no significant difference between coefficients over time ( P = 0.16).

Suicide is associated with deprivation in England. Despite significant research and policy effort, there has been no improvement in this association between 2004 and 2019.

Sam Hodgson, University of Southampton

Jack Hodgson, NHS Digital

Address for correspondence Sam Hodgson, University of Southampton

Email: samcbhodgson{at}gmail.com

Blood tests in general practice: the use of routine data to characterise venous blood testing in North West London, 2016–2018

DOI: 10.3399/bjgp20X711605

Laboratory testing is an integral diagnostic tool, contributing to 70% of diagnoses in the NHS today. Its use has been steadily increasing despite estimates that ≤40% of blood tests ordered are unnecessary. Understanding blood-testing patterns is a fundamental step to tackling overuse.

To characterise the volume, type, and per patient frequency (PPF) of venous blood testing reported in general practice in North West London, 2016–2018.

Following ethics clearance, aggregate data of blood tests reported in general practice in North West London between 2016 and 2018 were extracted from the Discover database. Non-venous blood test codes and codes not used within the designated time period were excluded. Codes reporting the same analyte were aggregated. Overall volume and PPF were calculated per analyte.

Three hundred and thirty-six individual analytes were reported and grouped into 35 recognised panels or groupings. Blood testing increased by 16.5% over the 3-year period. Full blood count, urea and electrolytes, liver function tests, and lipid profile accounted for 80.4% of all venous blood tests. Requests for HbA1c increased by 52.8% and non-HDL cholesterol by 148.7%, whereas glucose decreased by 13.3% and urea by 15.7%. The PPF remained unchanged over the 3-year period at 1.29 blood tests per person per year. The coagulation assay had the highest PPF at 3.0.

Routine general practice data revealed important trends in blood testing. Trends uncovered can inform innovative and targeted solutions to reduce unnecessary blood testing.

Marize Bakhet, Imperial College London

Zia Ul-Haq, Imperial College Health Partners

Tahereh Kamalati, Imperial College Health Partners

Amanda Lucas, Imperial College Health Partners

Azeem Majeed, Imperial College London

Austen El-Osta, Imperial College London

Address for correspondence Marize Bakhet, Imperial College London

Email: m.bakhet{at}imperial.ac.uk

• Management of gout and adherence to current guidelines in general practice surgery

DOI: 10.3399/bjgp20X711617

Gout is one of the most common inflammatory joint diseases in the UK managed by GPs. The recent (2017) guideline of the British Society for Rheumatology (BSR) changed the recommendation for urate-lowering therapy (ULT) and now advises it after the first episode of gout, whereas it previously recommended after the second one. Moreover, the BSR now also recommends screening and management of risk factors of gout.

To audit contemporary management of gout and adherence to the new BSR guideline in a large GP practice.

The audit identified all patients diagnosed with gout between 1 July 2017 and 1 May 2019. Pharmacological gout management, lifestyle advice, and management of risk factors were assessed, including body mass index (BMI), systemic blood pressure (BP), and HbA1c.

The audit included 104 patients, 26.9% female, mean age 63.8 years at the age of diagnosis. Uric acid was raised in all patients (mean 469 um/L). Most patients (68%) had abnormal BMI (mean 30.4), whereas BP, cholesterol, and HbA1C were normal in the majority of patients (in 78%, 75%, and 90%, respectively); however, all of these parameters were normal in just 17% of patients. Lifestyle advice was given to 46 (44.2%) patients while allopurinol was prescribed, and overall in 21 (20.2%) patients. More patients were managed with colchicine (40.2%) and naproxen (56.7%).

Most patients diagnosed with a first gout attack have risk factors of gout and require their management. Overall, allopurinol is prescribed in a fifth of patients, which may be related to patients’ preferences, strict adherence to lifestyle modification only, or presence of contraindications to allopurinol. This requires, however, further assessment.

Agnes Kempny, Hartley Corner Surgery

Jamie Martin, Hartley Corner Surgery

Address for correspondence Agnes Kempny, Hartley Corner Surgery

Email: agnieszka.kempny{at}gmail.com

• Evaluation of a novel anxiety and trauma intervention at the Edinburgh Fringe

DOI: 10.3399/bjgp20X711629

Anxiety and psychological trauma are common presentations in general practice and may lead to long-term prescribing and/or time-consuming talking therapies.

To assess the efficacy and acceptability of short ‘Gazetherapy’ interventions.

‘The Anxiety Experiment’ was delivered as a show at the Edinburgh Fringe Festival from 1–25 August 2019. Gazetherapy interventions were explained using props to describe polyvagal theory and cranial nerve and cerebellar/hippocampus anatomy and function. BabyGaze (reducing anxiety in the moment), da Vinci Gaze (attenuating stress), and Accessory Gaze (resolving simple trauma) were delivered to audiences of between six and 51 people during <10 minutes of the 50-minute presentation. Subjects were given a card bearing a QR code to link to an online survey containing validated short screening questionnaires: GAD-2 for probable anxiety disorder and PC-PTSD for probable post-traumatic stress disorder (PTSD).

Efficacy: 73 (9.8%) attendees completed the survey, of whom 39% screened positive for anxiety and 26% screened positive for PTSD. Those screening negative in both tests (52%) were designated a control group, with 36% of them feeling better after the presentation. Fifty-nine per cent of probable anxiety ‘cases’ and 68% of probable PTSD cases felt better after the presentation; none felt worse. Acceptability: 95% reported a ‘definite’ or ‘probable’ intent to use the techniques in the future, with 5% (all non-cases) stating that they probably would not. No responder said they would definitely not use the techniques.

The acceptability and effectiveness of a new therapeutic approach were demonstrated by presenting them in a show at the Edinburgh Fringe.

Andrew Ashworth, sessional GP

Address for correspondence Andrew Ashworth, sessional GP

Email: drandy{at}me.com

• Appropriate secondary prevention of stroke and transient ischaemic attack with antithrombotics: an audit in general practice

DOI: 10.3399/bjgp20X711641

Stroke is a major cause of death and disability worldwide. Major advances have occurred in secondary prevention of stroke/transient ischaemic attack (TIA) during the past three decades. Primary care is a critical point of contact with patients in the implementation of secondary prevention, with the majority of patients with past stroke/TIA being managed in the community.

To assess current practice at the New Queen Street and Stanground Surgeries, Peterborough, in reference to the National Institute for Health and Care Excellence guidelines on secondary prevention of stroke/TIA.

An audit at the above practices was undertaken by searching the SystmOne computer system for adult patients with previous stroke/TIA (311), excluding those with haemorrhagic stroke and those on aspirin. The patient records of the remaining group (37) were investigated to find whether they were on appropriate antithrombotic therapy and, if not, why.

Of post-stroke/TIA patients, 234/236 were receiving antithrombotic therapy unless contraindicated. For those not on antithrombotics, risk of bleeding was the reason given in 10/13 of cases, though many of these patients did not have active bleeding (exact number unclear due to poor documentation). In 2/13 cases there was no documented reason given and informed dissent in one of the 13 cases.

It was found that both practices implemented the guidelines to a satisfactory degree. However, to further improve secondary prevention outreach, bleeding risk should be assessed using a tool such as S2TOP-BLEED before withholding antithrombotic therapy, as, on balance, antithrombotic therapy may still be preferable. In addition, accurate and detailed documentation of the indications/contraindications to anticoagulation is paramount for such assessment.

Isabelle Williams, University of Cambridge

William Smith, University of Cambridge

Edward Nash, University of Cambridge

Ajay Patel, New Queen Street and Stanground Surgeries

Address for correspondence Isabelle Williams, University of Cambridge

Email: ijmw2{at}cam.ac.uk

• A pilot project on the management of osteoporosis in primary care: results of the audit cycle

DOI: 10.3399/bjgp20X711653

Osteoporosis is a major public health problem with the ageing population in the UK. However, there is no known national algorithm for the management of osteoporosis in primary care. Therefore, a treatment pathway was developed in secondary care for patients in the community.

This audit cycle investigates whether patients at a GP practice with a population of 14 000 have been appropriately identified, coded as osteoporosis, treated, and have followed the recommended pathway.

A search of the practice clinical system was undertaken for three groups of patients coded as: patients currently on the existing osteoporosis register; patients with a code of ‘osteoporosis’ or ‘fragility fracture’ but not prescribed an osteoporosis treatment; and patients currently prescribed an osteoporosis treatment with no coding for ‘osteoporosis’ or ‘fragility fracture’. The words ‘osteoporosis’, ‘fragility fracture’, ‘QOF’, and all individual drug names were used in the search engine.

The completed audit cycle shows an increase in the proportion of patients following the local guidelines pathway, from 75% in 2018 to 81% in 2019, emphasising the importance of having a guideline for GPs to follow in order to optimise treatment and prevent future fragility fractures.

This is a pilot project to assess the ability to identify patients who have osteoporosis and review their treatment pathway. The results are promising as the analysed data indicate that GP practice lists can be used to identify and treat high-risk patients for osteoporosis and assess the adherence to the pathway. Using the pathway, GPs can more efficiently diagnose and manage patients.

Sindhuja Jothimurugan, Barts and the London School of Medicine and Dentistry

Subramanian Jothimurugan, Maylands Healthcare

Deepali Sanganee, Maylands Healthcare

Thushani Wickramaratne, Barking, Havering and Redbridge University Hospitals NHS Trust

Myo Lynn, Barking, Havering and Redbridge University Hospitals NHS Trust

Address for correspondence Sindhuja Jothimurugan, Barts and the London School of Medicine and Dentistry

Email: s.jothimurugan{at}smd14.qmul.ac.uk

• Should diverticulitis be managed in primary care? An audit on the management of diverticulitis in primary care

DOI: 10.3399/bjgp20X711665

The prevalence of diverticulosis and acute diverticulitis is increasing in developed countries. For those with diverticulosis the lifetime risk of developing acute diverticulitis is about 4–25%. Mild, uncomplicated diverticulitis can be, and often is, managed safely in a primary care setting, avoiding unnecessary admission.

To evaluate management of suspected diverticulitis in primary care against standards set by the National Institute for Health and Care Excellence (NICE) and review admission rates following primary care management.

An electronic search on EMIS Web using Read codes ‘diverticulitis’, ‘diverticulosis’, and ‘diverticular disease’, with a specified period of 2017–2019. All consultations with suggestions of an infective flare of diverticular disease were included in the study. Clinical data from the consultations were extracted and retrospectively audited.

A total of 64 patients were identified with diverticular disease or diverticulosis. Of those, 42% ( n = 27) presented to primary care with presenting complaints suspicious of diverticulitis. A total of 64 consultations were reviewed, as several patients presented more than once in the study period. Of the consultations reviewed, 12.5% ( n = 8) resulted in referral to the surgical assessment unit. Antibiotics were prescribed after 68.4% ( n = 39) of consultations. Bloods for inflammatory markers were performed after 19.3% ( n = 11) of consultations. Only 3.5% ( n = 2) of patients were reviewed within the recommended 48-hour timeframe. Only 3.5% ( n = 2) of patients subsequently deteriorated and required admission.

The management of diverticulitis in this primary care centre is not fully concordant with NICE guidelines. There is a need to improve adherence, in particular antibiotic regimen when deciding to prescribe antibiotics.

Miraen Kiandee, University Hospital North Midlands

Rajani Sripada, Tean Surgery

Address for correspondence Miraen Kiandee, University Hospital North Midlands

Email: miraen.mk{at}gmail.com

• Multiple risk behaviour intervention to prevent depression in primary care

DOI: 10.3399/bjgp20X711677

Primary care is the ideal setting for promotion and prevention intervention. Multiple risk behaviour interventions present several advantages over single-risk lifestyle interventions. Multiple risk behaviour interventions could be easily implemented in primary care to prevent non-communicable disease and depression.

To test the effectiveness of a multiple risk behaviour intervention to promote Mediterranean diet, physical activity, and/or smoking cessation in people attending Spanish primary health care with incidence of depression and symptoms of depression.

This was a secondary analysis of the EIRA study that aims to test the effectiveness of a multiple risk behaviour intervention to promote healthy lifestyles. Twenty-six primary care centres were randomised to receive multiple risk behaviour intervention or usual care. The multiple risk behaviour intervention included individual sessions, group sessions, communitarian activities, and SMS reception. Participants were followed for 10–14 months. The primary outcomes of this study were incidence of depression and reductions of depressive symptoms.

Three thousand and sixty-seven participants were included. Females accounted for 45.13% and 93.88% were Spanish. Age varied between 45 and 75 years old. The effectiveness of the intervention will be calculated using the Patient Health Questionnaire (PHQ-9) and the Composite International Diagnostic Interview (‎CIDI)‎ depression section. Linear and logistic regression will be used to create predictive models.

Primary care is the most accessible service in the health system for patients. Hence primary care is the ideal setting for health education, promotion, and prevention interventions. This study will provide high-quality evidence about the effectiveness of multiple risk behaviour interventions over depression prevention.

Irene Gómez-Gómez, Universidad Loyola Andalucía

Patricia Moreno-Peral, Network for Prevention and Health Promotion in Primary Care

Tomás López, Network for Prevention and Health Promotion in Primary Care

Ana Clavería, Network for Prevention and Health Promotion in Primary Care

Barbara Oliván, Network for Prevention and Health Promotion in Primary Care

Ruth Marti, Network for Prevention and Health Promotion in Primary Care

Joan Llobera, Network for Prevention and Health Promotion in Primary Care

Jose-Angel Maderuelo-Fernández, Network for Prevention and Health Promotion in Primary Care

Emma Motrico, Universidad Loyola Andalucía

Address for correspondence Irene Gómez-Gómez, Universidad Loyola Andalucía

Email: igomezg{at}uloyola.es

• Association between screen-time and school performance of secondary school children in Karachi, Pakistan

DOI: 10.3399/bjgp20X711689

Electronic media are playing a negative role in people’s lives and yet people are unaware of the hazardous effect.

To show that screen-time of >1 hour had detrimental associations with school performance.

A population-based, cross-sectional survey of 363 students, mean age 14.2 years (grades 5–8), from both government and private-sector schools in Karachi was conducted. A total of 363 students (210 males [57.9%] and 153 females [42.1%]) were included in the study. Of these students, 193 (53.2%) belonged to government schools and 173 (46.8%) to private schools. A questionnaire form was filled in. Weekday, weekend television, and video game screen-time was looked at. The main outcome was self-report of school performance (grades A, B, and C). Ordinal logistic regression analysis was used to test the independent effects of each variable, adjusting for demographics, child personality, and parenting style.

Television content measurement showed that 69 (19%) students watched sports channels regularly while 30 (8.3%) and 3 (0.8%) watched educational and action programmes, respectively. The viewers of entertainment TV programmes (268 [73.8%]) and news programmes (159 [43.8%]) were in the majority. In terms of school grades, 154 students (42.4%) attained grade A, 180 students (49.6%) scored grade B, and 29 (8%) obtained grade C. Data showed no association between increased screen-time of ≤1 hour (weekdays as well as weekends) with poor school performance ( P =0.46 and P =0.58, respectively).

Screen-time of ≤1 hour does not have any detrimental associations with poor school performance.

Kashan Niazi, Sulaiman Al Rajhi Colleges

Address for correspondence Kashan Niazi, Sulaiman Al Rajhi Colleges

Email: kashy1981{at}gmail.com

Revolutionising participants’ health and wellbeing through neuro-reprogramming via the Slimpod ® app: a randomised controlled trial

DOI: 10.3399/bjgp20X711701

Obesity is a global pandemic that threatens the health of the population and the sustainability of publicly funded health care. This randomised controlled trial addresses the gap in the literature surrounding unconscious persuasion and its use in weight loss and weight management. The Slimpod ® tool is unlike any of those currently available on the market. Using breakthrough research in ‘nudge’ thinking, it is designed to retrain an adult’s habitual and emotional response to foodstuffs. This therapeutic model allows unconscious thought to be shaped into a manner more consistent with a healthy lifestyle. Candidates can then take control of their eating behaviours to induce a holistic state of wellbeing.

To assess the effectiveness of an audio unconscious-persuasion weight loss/weight management intervention (Slimpod ® ) compared with audio relaxation (control).

Eighty-two overweight adults were randomised to intervention ( n = 41) and control groups ( n = 41). Weight was assessed at trial commencement, mid-trial (12 weeks), and trial end (24 weeks). Secondary outcomes were assessed using the Eating Self-Efficacy Scale (ESES), Exercise Confidence Scale (ECS), and Quality of Life Index Generic Version III (QLI-G3) at the start and end of the trial.

Reports found a statistically significant difference in mean weight loss between intervention group (1.7 kg at 12 weeks and 4.3 kg at 24 weeks) versus control (0.6 kg and 1.2 kg respectively) at P <0.001. ESES scores showed greater self-efficacy ( P = 0.008) in intervention at 24 weeks. No significant differences in ESES negative affect sub-scale score or ECS were observed.

Slimpod ® was effective at reducing weight and increasing eating self-efficacy in overweight adults.

Richard Kyle, School of Health and Social Care, Edinburgh Napier University

Stephen Jones, Independent Statistical Consultant

Sandra Roycroft-Davis, Wellpods International

Address for correspondence Sandra Roycroft-Davis, Wellpods International

sandra{at}thinkingslimmer.com

• Evaluating the relational continuity of care of four GP practices, one of which uses personalised lists

DOI: 10.3399/bjgp20X711713

Continuity of care is a fading type of care because GPs are working more flexibly and at reduced working hours. The GP Contract gave a financial incentive to provide prompt GP appointments, but to the detriment of continuity of care. Increased patient demand for appointments has seemingly led to patients favouring ‘any’ appointment with a GP rather than ‘an appointment with the same GP’. Continuity of care in general practice is associated with greater patient satisfaction and is the preferred type of care for patients with chronic disease or psychological problems. In the Northeast of England there is a multi-partner GP practice that operates a true personalised list system. Other GP practices in the area do offer a degree of continuity of care, but this has not been measured.

To measure and compare the relational continuity of care index of four matched GP practices, one of which operates a personalised list.

A written protocol enabled the authors to extract comparable anonymised data from four GP practices over a year (January to December 2019). Two standardised indexes of continuity of care (UPC and SLICC) were calculated and compared.

Continuity of care was consistently higher with personalised lists. UPC index results show that all GP practices provide surprisingly high continuity of care, albeit not with patients’ assigned GPs. Higher monthly UPC scores versus overall scores indicate patients are receiving continuity of care in relation to their condition.

Continuity of care is still observed in GP practices that do not have personalised lists.

Riaan Swanepoel, North Tyneside CCG

Address for correspondence Riaan Swanepoel, North Tyneside CCG

Email: riaanswanepoel{at}nhs.net

• Decision making on clinical care choices including end-of-life decision making for older adults in an acute care setting

DOI: 10.3399/bjgp20X711725

The Scottish Government’s vision for older people is that ‘Older people are valued as an asset; their voices are heard and they are supported to enjoy full and positive lives.’ In the health and social care setting in Scotland it is increasingly recognised that there is a need for careful planning of care for older patients with complex comorbidities, and that this should involve the patient where possible via a process of shared decision making (SDM).

To establish what future planning for healthcare decision making and end-of-life care was undertaken in the care of the older patients in a secondary care facility, and how much they participate in this process.

An audit was conducted across four wards in the care of the older patient setting in a hospital for older patients in Scotland. Over a 2-week period, all patients’ charts ( n = 82) were reviewed, and evidence was examined on whether the following documents were in place: a do not resuscitate order; an escalation of medical care plan; and an assessment of capacity/incapacity.

The majority of patients (55%) had a resuscitation plan in place. An Incapacity Statement was also in place for the majority of patients who required it (90%). The escalation of medical care plan was only completed for a minority of patients, mainly those on the palliative care ward.

Plans for decision making around resuscitation were reasonably well developed. However, planning for other, more complex, future medical care needs was less well defined or explored with older patients.

Sinead O’Reilly, Ayrshire and Arran NHS Trust

Address for correspondence Sinead O’Reilly, Ayrshire and Arran NHS Trust

Email: sineadoreilly3112{at}gmail.com

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• General practice is ‘different’: qualitative study of acculturation experiences of East Staffordshire general practice specialty trainees
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Article Contents

Introduction, general presentation, side effects of the most common procedures, short-term complications, late complications, management of acute major complications, acknowledgements, author contributions.

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Emergency care of metabolic bariatric surgery patients

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Roxanna Zakeri, Ellen Andersson, Cynthia M Borg, Ronald S L Liem, Emergency care of metabolic bariatric surgery patients, British Journal of Surgery , Volume 111, Issue 9, September 2024, znae233, https://doi.org/10.1093/bjs/znae233

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Although complication rates after metabolic bariatric surgery are low, increasing caseloads result in more patients presenting acutely to emergency departments

Metabolic bariatric surgery patients with acute pathology may present with few symptoms and seemingly little pain, but still be critically unwell

Tachycardia is the most common clinical sign of surgical complications after metabolic bariatric surgery, followed by tachypnoea and fever

Patients presenting with complications after metabolic bariatric surgery should preferably be transferred to a specialist bariatric centre, but urgent surgery should never be postponed when patients are severely ill

Metabolic bariatric surgery (MBS) is the most effective treatment for severe obesity, resulting in long-term weight loss and remission of obesity-related co-morbidity. MBS is safe, with perioperative mortality below 0.25% 1 . Postoperative complication rates are low, but increased caseload volume means a higher prevalence of MBS patients presenting with acute problems to emergency departments.

To assist healthcare professionals in the assessment and management of post-MBS emergencies, the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) European Chapter developed an emergency room poster ( Fig. 1 ), adapted from an earlier version by the Dutch Society for Metabolic and Bariatric Surgery.

IFSO-EC emergency care poster

IFSO, International Federation for the Surgery of Obesity and Metabolic Disorders; EC, European Chapter; RYGB, Roux-en-Y gastric pass; AGB, adjustable gastric band; VBG, vertical banded gastroplasty; RBC, red blood cells; IV, intravenous; IBS, irritable bowel syndrome; Hb, hemoglobin; PPI, proton pump inhibitor; ERCP, endoscopic retrograde cholangiopancreatography; MRCP, magnetic resonance cholangio-pancreatography; CBD, common bileduct; PTC, percutaneous transhepatic cholangiography.

MBS patients with acute pathology may present with few symptoms and seemingly little pain, but still be critically unwell. Tachycardia is the most widely reported clinical sign of surgical complications after MBS, followed by tachypnoea and fever 2 . Tachycardia alone may be an indication for a diagnostic laparoscopy. Though nausea is a common early side effect after MBS, vomiting is rare and should prompt investigation to exclude complications. The absence of clinical signs does not rule out pathology and is common, even in patients with peritonitis 2 . Localizing signs of peritoneal irritation are rarely provoked on palpation due to abdominal wall thickness. A high level of suspicion is warranted, as MBS patients typically have lower physiological reserves than the general population of abdominal surgery patients.

Side effects of MBS differ between procedures. The most common are presented in Fig. 1 .

Whilst all MBS procedures may result in varying degrees of impaired micronutrient, protein, and fat absorption, highly hypoabsorptive procedures, such as biliopancreatic diversion/duodenal switch (BPD/DS) and single anastomosis duodenal-ileal bypass with sleeve (SADI-S), confer a higher risk. Gastro-oesophageal reflux is common after sleeve gastrectomy (SG) and bile reflux is common after one anastomosis gastric bypass or SADI-S 3 , 4 . In patients who have undergone endoscopic procedures, such as intragastric balloon insertion, nausea, vomiting, and reflux may occur.

Severe complications within 30 days of MBS may occur in 2.8% of patients 5 . Risk factors include male sex, older age, revisional procedures, open surgery, preoperative co-morbidity, and higher BMI.

Bleeding occurs in 1.4% of cases 5 . It may be endoluminal, usually originating from staple lines and anastomoses, or intra-abdominal, secondary to injury or incomplete haemostasis. When patients are stable enough, contrast-enhanced Computer Tomografie (CT) of the abdomen can be helpful; however, a negative CT cannot exclude pathology and a CT should not delay urgent endoscopic or surgical intervention. After gastric bypass procedures, bleeding may occur within the gastric remnant, typically inaccessible by transoral endoscopy.

Leakage usually occurs at anastomoses or staple lines, but may result from iatrogenic perforations. A meta-analysis of 56 146 patients revealed a 30-day leak incidence of 1.15% 6 . Associated sepsis should be treated promptly with broad-spectrum antibiotics and drainage and/or surgical washout. Nutrition needs to be optimized, with nasojejunal or parenteral feeding, and oral intake restricted. Abdominal CT with oral and intravenous contrast is useful to identify the location of a leak.

Pulmonary embolism (PE) should be considered in the differential diagnosis of acutely unwell patients after MBS, as it increases 30-day mortality by more than 50-fold 7 . Though most cases of PE develop a few days post-surgery, the risk persists for several months 6 .

Gastrointestinal obstruction may lead to perforation, leakage, or strangulation. Mechanical causes, such as internal herniation, anastomotic stricture, or technical errors, need to be excluded. Jejunojejunal obstruction may present with deranged liver enzymes and dilated gastric remnant and biliary tree on imaging.

Awareness and proper management of late complications are important to minimize late morbidity and mortality related to MBS.

Gallstone formation increases with rapid weight loss. In the presence of common bile duct stones, the approach to duct clearance depends on the MBS procedure, as regular endoscopic retrograde cholangiopancreatography (ERCP) may not be possible after procedures with gastrointestinal diversion.

Upper abdominal pain or gastrointestinal bleeding may be caused by gastric ulceration, typically located in staple lines or anastomoses. Gastroscopy is recommended and treatment with a open capsule proton pump inhibitor, Helicobacter pylori eradication, smoking and alcohol cessation, and sucralfate may be indicated. Ulcers are sometimes associated with stenoses/strictures, warranting endoscopic dilatation or a surgical revision. Severe dyspepsia unresponsive to pharmacotherapy may indicate bile reflux or internal herniation. After gastric bypass procedures, the remnant stomach and duodenum are inaccessible by regular gastroscopy. Whilst push endoscopy and laparoscopically assisted transgastric gastroduodenoscopies may be feasible, the procedures are technically challenging.

Patients presenting with sudden onset of severe abdominal pain often warrant CT to exclude gastrointestinal perforation. Perforations are rare, but typically occur at anastomoses or as a blowout of the remnant stomach after gastric bypass procedures. Patients with perforation should be treated surgically without delay.

Gastrointestinal obstruction may be caused by stenoses/strictures in anastomoses after gastric bypass and by narrowing, most often located at the incisura angularis, after SG 8 . Vomiting of food should be considered pathological after gastric bypass, as the fast passage of food into the jejunum does not usually allow food to be kept in the proximal part of the gastrointestinal tract. Management varies, depending on the cause of obstruction, and can range from endoscopic dilatation to revision surgery.

Patients with adjustable gastric bands and signs of obstruction should have band deflation. Gastroscopy, an upper gastrointestinal series, or abdominal CT should be performed promptly to locate the band and detect potential band-related complications, such as band erosion, slippage, or migration. When symptoms do not settle with deflation, surgical band removal may be required.

After any MBS procedure involving small intestine diversion, internal herniation can occur. CT with oral and intravenous contrast, to detect indirect signs, such as a mesenteric vessel swirl, signs of ileus, or a dilated remnant stomach, may confirm the diagnosis. Negative CT should not exclude surgery when there is clinical suspicion of internal herniation.

Kinking of the enteral anastomosis can cause abdominal pain, typically located in the left hypochondrium 9 . Since the introduction of mesenteric defect closure in gastric bypass, the long-term rate of internal herniation has decreased, but seemingly at the cost of a higher rate of early reoperations caused by kinking of the jejunojejunal anastomosis 10 . Surgical interventions should preferably be performed by a bariatric surgeon.

Overeating and food bolus impaction can cause transient abdominal pain. Abdominal discomfort caused by irritable bowel syndrome may also be present after MBS. CT is usually performed, but good clinical judgement is advocated in patients with multiple visits to the emergency room because of abdominal pain for whom previous CT images or previous diagnostic laparoscopies have not yielded a diagnosis.

Dumping can occur after gastric bypass and to a lesser extent after SG. Early dumping presents with palpitations, sweating, and flushing within 1 h of food ingestion. Late dumping, or late postprandial hypoglycaemia, commences 1–3 h after a meal and may, in severe cases, result in unconsciousness caused by neuroglycopenia. Patients may be suspected of having epileptic seizures or cardiac arrhythmias when presenting to the emergency room, as blood sugar levels have often returned to normal on arrival. Consultation with a bariatric dietitian is recommended, followed by referral to a bariatric physician.

Malnutrition and nutritional deficiencies can occur after all MBS procedures and may present with a wide range of symptoms. Vitamin B1 deficiency should be suspected and treated empirically in patients who have frequent vomiting after MBS due to the risk of Wernicke–Korsakoff encephalopathy. Testing blood samples to diagnose deficiencies of vitamin B1, vitamin B12, vitamin D, iron, calcium, and protein is recommended during follow-up after MBS. Iron-deficiency anaemia is common. In hypoabsorptive procedures, vitamin A, E, and K deficiencies and severe protein malnutrition may occur. When planning nutrition for severely malnourished patients, the risk of refeeding syndrome must be considered.

Patients presenting with complications after MBS should preferably be transferred to a specialist bariatric centre. The index centre where the primary procedure was performed should be consulted early to confirm the diagnosis and decide on the suitability for transfer. Urgent surgery should never be postponed when patients are severely ill. When an MBS surgeon is not available, damage control surgery may be a good option, with transfer to an MBS centre for definitive management once stable. It is also important to consider that patients may suffer from diseases unrelated to their MBS procedure.

The authors have no funding to declare.

The authors would like to thank the members of the IFSO European Chapter Multinational Advisory Group for their contribution to the development of the IFSO European Chapter emergency poster: Tadeja Pintar, Ronald Liem, Ramon Villalonga, Marc Schiesser, Jerome Dargent, Harry Pappis, Felix Langer, Nasser Sakran, Paulina Salminen, and Gerhard Prager. R.Z. and E.A. share first authorship.

Roxanna Zakeri (Writing—original draft, Writing—review & editing), Ellen Andersson (Writing—original draft, Writing—review & editing), Cynthia M. Borg (Supervision, Writing—review & editing), and Ronald S. L. Liem (Conceptualization, Project administration, Resources, Supervision, Visualization, Writing—review & editing)

The authors declare no conflict of interest.

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