Back to work looms

I've been to a proper sit down lecture for the first time for ages. It was about how to be a good OSCE examiner, but actually I got other things out of it.

The presenter had stepped in at last minute and although not fully knowledgable on the OSCEs we were involved in was a good presenter and I got some tips for how I can improve my presentation style (did the lecture 2 weeks ago and I really wasn't great)

Not sure I've learnt any more about how to be an examiner but have had a chance to bend the ear of the Head of Medical Education, Prof Nigel Bax and I. along with the other GP tutors/lecturers should get official University recognition- as hospital staff do.

Reflections- attending talks and events is invaluable to meet colleagues and make connections to improve what one does. What you think you are going to get out of a teaching event isn't always what you actually get!

Moving piece in the Guardian magazine at the weekend. Diary of a foster mum. I knew what a tough job they do, but to read the effects on the lady, her family and the children of the system was shocking. They have little support and regular upheavals which are emotinally and physically draining. Most harrowing was her descriptino of having a pair of twins who had disclosed sexual abuse to her and she had to let them go to unsupervised visits with the abusers, the parents. She recieved little support when she told the social worker what was going on despite repeat mentions from the children and disturbed behaviour by them.   

http://www.guardian.co.uk/society/2010/nov/27/diary-of-a-foster-parent

Dabigatran

Missed this in Feb- what with snow and being heavily pregnant not a surprise I guess!

So http://www.npci.org.uk/blog/?p=1011

for info about this new direct thrombin inhibitor with has a licence for specific instances of preventing VTE and a study currently looking at replacing warfarin in AF.

First studies show equally effective as warfarin to prevent strokes but discontinuation rates higher than with warfarin due to SE and also I think it's a twice daily dosage. NICE guidance out next year.

Does CKD 3 matter?

Good Morning, a quicky following a read of the BJGP article.

So, does it? Or doesn't it??

The literature seems to suggest what I think alot of clinicians have found in practice. CKD 3 is now picked up on blood testing and has created a new entity over the past 5 years for GPs (and thier practice nurses) to manage.

Literature suggests that 3a, is a risk factor for CVD and stroke and that 10 years down the line over a quarter of those diagnosed have unchanged parameters.

A very small proportion of those with 3a and 3b move onto stage 4 &5. 3bs are far more likely to than 3as.

I think I shall be explaining it to my patients in terms of a risk factor like blood pressure for 3a.

Br J Gen Pract 2010 DOI 10.3399/bjgp10X502173

Birthday Time

 2 crazy weeks, 2 lots of teaching medical students and William's 4th birthday this week.

I gave the 2nd tutorial to the 1st years for the Community Attachment Scheme. They have been out to visit my patients and we discussed their visits.  All seem to have been a success. The tutorial went well and flew by. Unlike the alcohol seminar I gave to the Phase 3a lot. This bunch are at the end of this phase and rather weary. I chose this session to ask for feedback about the lecture. This ranged from one comment of 'Don't do it, we've done it all before' though to a couple of excellents. In between a few more constructive comments about presentation and getting the most out of the session which I'll try to take on board for when I start again in February.

In between this and making cardboard rocket ships, cakes and wrapping birthday presents I listened to the BMJ and DTB podcasts, nothing much about primary care. BMJ about regulation, comparing the UK and US. DTB mentions a couple of new drugs including the successor to clopidogrel.

Finally 2 things I mean to go back to, a radio 4 podcast about the use of the amended Meetal Health Act, how it's been used and what the changes have meant for service users and clinicians. Also the 5 mins of general practice from the BMJ which is always useful.

Oh, and I've nearly finished this months BJGP, antenatal screening discussed.  A good discussion piece about GPs role in antenatal and postnatal care now GPs have a dwindling role in intrapartum care.

Time to go and hang up some stars and make a planet, all before breakfast!

More podcasts

So, today I caught up to date with the BMJ podcast. Not alot of interest for me personally,about healthcare reforms in China.

More interesting was a podcast of a radio 4 series MedMatters 'Sugaring the Pill' which looked at the controversial topic of giving incentives to individuals in order to comply with certain health measures, such as taking up HPV vaccination and stopping smoking. The program talked to a couple of punters, a girl getting 20 quid, 5 quid and then a further 20 quid in shopping vouchers for her 3 HPV vaccines and a pregnant mum receiving shopping vouchers worth 40 quid for not smoking. If she gets up to 1 year post delivery with no fags she will have earnt herself £150. Both these interventions were successful, not only for the individuals interviewed but actually increased compliance by 50% in the NHS trusts where this was pilotted.

Another scheme giving 'pounds for pounds' paying peoples membership fee for a diet club was less successful with a high drop out rate.

NICE apparently wrote a document back in 2007 about this kind of incentive scheme and found that 2/3 of a 'citizen's focus group' of lay members of the public found such an intervention successful.

An addicition consultant specialist was strongly enthusiastic saying not using such a scheme that had been found to be so powerful and have an such a strong effect would be negligent.

Then the Coalition Government of course gave a brief press release for the program saying no way they would consider such interventions an  acceptable use of public money, surprise surprise.

http://www.bbc.co.uk/podcasts


Reading wise, today I've dipped into the BJGP, looking at GPs role in providing maternity care and how we are getting less and less involved in women's care right from the pre-conceptual stage through to the post partum stage. Also articles about managing Diabetic women in their pregnancy, and offering pre-conceptual advice to them, screening for thallesemia which I think we do routinely in Sheffield.

Time to go and play with some leaves now! Collecting and throwing all leaves that were blown off the trees in yesterday's heavy winds.

  

Here we go!

As I was dusting and simultaneously listening to the BMJ podcast, I had my regular panic, how on earth am I going to keep on top of all this?? So I've decided to blog my somewhat haphazard learning and education experiences to see if it's helpful.

1 month today I start back at work after 10 months off for my 3rd child, Robert and I'm squeezing in some medic thoughts to try and get that bit of my brain working at full strength again. I've been very lucky, as a salaried doctor in North Sheffield that my practice has supported me in the 8 years I've worked for them I've had 28 months of maternity leave!

A recently purchased Oxford Handbook of General Practice is to hand, which I'm pleased with. I had the Medicine handbook of this series as a junior doctor and decided this would be a good investment following a review in the BJGP last month.

http://ukcatalogue.oup.com/category/academic/series/medicine/oxhmed.do

So, the podcast. listening to the 22nd October edition talking about Chilean miners, the use of Hyper/Hypo and mental health in ethnic communities.

Got to stop now as 2 children climbing all over me and the computer so progress with this has been ground to a halt and anyway I'm peckish!