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Applied Knowledge Test (AKT) - GPST Society

You may find you need to spend disproportionately longer revising them. Remember that doing well here could be the difference between passing or not! Practise questions are vital. Doing questions from websites, books and RCGP Innovait ...
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OPERA - Genetic Breast/Ovarian Cancer Risk Assessment Tool

Our breast cancer risk assessment tool is to assess risk for people who are worried about breast and/or ovarian cancer in their family. Visit Macmillan today
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Colorectal Cancer: Screening Guidelines

Colorectal cancer is the second most common cause of cancer death among men and woman in the United States. Routine screening of symptom-free men and women will lead to a reduction in the number of colorectal cancer cases and deaths.
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1220_2010-03-04%20Genetics%20in%20Primary%20Care.pdf

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GREAT LECTURE

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10004761IssuesBrief11July2014.pdf

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See: Care Quality Commission publish survey on ‘Hear and Treat’ & "General Medical Council (GMC) announces new Director of Education & Standards"  for interesting bits! 


>  While nearly two thirds (63%) of respondents who only spoke to one call handler felt the reasons for not getting an ambulance were completely explained to them, 27% felt this was not explained fully. 

 

Interesting - should local care be provided locally by private ambulance services?

 

 

 

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Transforming primary care

Transforming primary care | MRCGP | Scoop.it
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slide 3 has a great info-graphic on integrated care: how to win tenders seem like an important bit of skill they are teaching as is how to set up joint legal entities. Very Helpful

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Urgent_emergency_care_whole_system_approach.ashx

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TRAUMA CASE STUDY: Mr Hhowe is a 50-year-old man who received multiple stab wounds to the chest and abdomen. He was hypotensive on arrival at emergency department. Bedside ultrasound of the patient’s chest, heart and abdomen was performed by the emergency medicine consultant and revealed a left-sided pneumothorax. Needle decompression and intercostal drain were inserted by an emergency medicine consultant with resolution of haemodynamic status to normal. The patient was transferred to the CT scan after stabilisation and subsequently taken to the interventional radiology suite for embolisation of the lacerated renal vessel.

 

WOULD BE GOOD TO DO A GOOD TRAUMA AUDIT ON THIS

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phwsi_skin_care_framework_dh_bt_220509.pdf

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A great area for easy to Rx pharmaceutical conditions!

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2012-03-01-Report-Final-Clinical-Report-Urgent-Emergency-Care.pdf

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Page 10 shows a lovely mapping of the local system

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Pre-diabetes label 'worthless'

Pre-diabetes label 'worthless' | MRCGP | Scoop.it
Labelling people as having pre-diabetes is "unhelpful and unnecessary", UK and US researchers write in the British Medical Journal.
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Eating a healthy balanced diet, low in salt, sugar and fat and rich in fruit and vegetables, as well as being physically active, is the best way of reducing the risk of developing type 2 diabetes”

Barbara YoungChief executive, Diabetes UK.

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NHS England » New resource to help doctors care for the frail elderly

NHS England » New resource to help doctors care for the frail elderly | MRCGP | Scoop.it
High quality care for all, now and for future generations
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The British Geriatrics Society welcomes the NICE Delirium Quality Standards

The British Geriatrics Society welcomes the NICE Delirium Quality Standards | MRCGP | Scoop.it
Duncan Forsyth is Consultant Geriatrician in Cambridge and was a specialist adviser to the Quality Standards Development Group. On July 24th 2014, NICE published its Delirium Quality Standards to a...
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GTG40VenousThromboEmbolism0910.pdf

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While thinking about risk of Breast Ca in use of COCP (need to check this up again!) I thought to Mix it up with a bit or Risk in COCP of VTE:

 

Background level 5 per 100,000 woman-years

Pregnant - 60/100,000WY

Levenogestral / northiterone COC - 15/100,000WY

Gestodene/desogestral COC - 25/100,000WY

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chapter6cp106.pdf

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See also: http://www.bsg.org.uk/images/stories/docs/clinical/guidelines/endoscopy/ccs_10.pdf

 

http://www.uptodate.com/contents/colon-and-rectal-cancer-screening-beyond-the-basics

 

http://www.patient.co.uk/doctor/screening-for-the-early-detection-of-colorectal-cancer

 

http://www.cancerscreening.nhs.uk/breastscreen/research-family-history.html#

 

http://www.nhs.uk/ipgmedia/national/Macmillan%20Cancer%20Support/Assets/Breastscreeninginwomenunder50withafamilyhistoryofbreastcancer(CB).pdf

 

http://www.nhs.uk/Conditions/Cancer-of-the-breast-female/Pages/Screeningbreastcancer(female).aspx

 

"Breast Cancer screening Saves around 1300 Lives each year"

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2011ACMGSalarySurveyReportFINALMay2012.pdf

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Quite off topic but interesting to see the different job roles involved in genetics

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1D9FBD736344477DB36CF2E697012195.ashx

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I got too into genetics revision and thought I might GPwSI it so looked at this. Though not interested in it as a "special interest" it has been a revealing re-encounter of this typically undergraduate subject as to it's commonality in general presentation accounting for possibly 10%-15% of presentation for consultation whether it be for "definitive test" from an anxious young mum with a downs screening exploration in antenatal care (trisomy 21, ie an addition of the so called "21st chromosome" to the usual pair, leading to potential heart defects, GI disturbances and intellectual disability - with those at the higher end of the IQ spectrum more likely to be a result of Mosaicism), a demand for mastectomy (or a test for ?BRCA - genetics referral vs Mx in primary care with increased surveillance) in a women without any 1st degree relative under 50 on her maternal side with ovarian or breast cancer (would you consider a "preventative" colectomy in an instance of a man under 60 with a change in bowel habit, no PR Bleed, and no FHx of ?HAPP with ?Ackenesia Jewish Ancestry?), or a rant from a tabloid reader to come of his statins because his muscles ache a bit despite several TIA's, a total cholesterol of  >7.5, a tendon xanthoma, and a ?second degree relative suffering with cardiovascular disease with an age of onset <?50yrs.

 

The thing to remember in amidst all the dates for anatomy (late) vs. Booking (early check for gestation "baby's age" with crown-rump length), Amnio (take a few cells from the sac of fluid round baby") or CVS (take a few cells from the "umbilical chord - pre-chunk/check info with e.g. "you know (?what would you call) how baby is connected to you e.g. by a chord to give oxygen and get rid of waste") vs Triple testing early (2 hormones produced by a baby and a jelly scan to measure the thickness of a fold of skin around babies neck) or Quad testing late (?Inhibin A lol - can't even think on the detail of this") IS the patient!!! What do they actually want, are you wasting time barking up tree that can't be climbed in 3.5 minutes before the examination and after the hello trying to draw out a family tree for renal agenesis or other obscure syndrome when what is needed is a referral to genetic counselling or are you missing that zinger of a young male with muscular pains, palpitations and TATT with a FHX of HH who hasn't yet had a FBC?? 

 

So the next series of scoops are dedication to these Guidelines which essentially are risk calculator (see McMillan link) summaries because in genetics things tend to mendelian i.e. Dominant (multiple generation, male [M] affected equally to females [F], M>M transmission can occur, "There is a 1 in 2 chance the child will affected with e.g. Adult Polycystic Kidney Disease, Huntingtons, Hypercholesterolaemia, or Neurofibromatosis") v.s Recessive (skip generation so distal family important especially in high prevalence ares-1.5 cases/10,000 pregnancies for sickle cell/Thalassemia, "There is a 1 in 4 chance that the baby will be either completely OK or Affected and a 1 in 2 chance he/she will be a carrier of cystic fibrosis (1 in 25 carrier UK), haemoglobinopathies (1 in 40 carrier) or PKU/HH ") alleles autosomally, unless x-linked (where only men are affected - so could "sex test" e.g. pre-implantation embryo in in vitro fertilization after cytoplasmic injection of sperm followed by culture in a medium of mums own endometrial cells [?better than good culture with excellent environmental control] then laser hatched and artificially inseminated at day 5 in those with fertility issues; appears to skip generations e.g. Fragile X - strabismus, hypermobile joints, mitral valve prolapse, autistic features /Intellectual disability; Haemophilia A,or muscular dystrophy/red-green colorblindness).

 

SO this is quite a dodgy subject when it comes to lay folk and I am sure in the good old days I would have been smashed about a bit by my trainer for discussing variable penetrance in autosomal dominant conditions having the patient walk out the door wondering wtf i was on about.. therefore the appendix 1 in this link is quite a good way of focusing on the important issues of patient interaction!

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Attach%2011%20-%20SWL%20Review%20of%20Out%20of%20Hours%20Services.pdf

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Subcontractor OOH performance analysis - page 40 gives all the providers of call handlers e.g. 111 or base services e.g. Harmoni 

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Recruitment | Urgent Care Cambridgeshire | Urgent Care Cambridgeshire

Recruitment | Urgent Care Cambridgeshire | Urgent Care Cambridgeshire | MRCGP | Scoop.it
Want to joining UCC and become part of a committed and fast paced organisation? Take a look at our current job opportunities.
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Looks like a good place for OOH

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Kings-Fund-report-urgent-and-emergency-care.pdf

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Table 9 & 10 have interesting breakdowns of urgent care activity in terms of base visits, home visits, telephone advice and hospital attendances; no specific mention of follow up or discharge after care.

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Publication-From-Feast-to-Famine-Reforming-the-National-Health-Service-NHS-for-an-age-of-austerity.pdf

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Figure 3.1 on page 73 has some eye watering statistics!

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Independent-inquiry-GP-3-defining-and-measuring-quality-general-practice-March-2011.pdf

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Figure 1 on page 26 shows clearly how those who like to manage production lines again think of medical practice as a completely outcome managed rather than process driven reality. A reassured or relieved patient cannot be valued enough but it may not prolong life in the emergency nor even prevent loss of life in the palliative setting. and hence cannot be formally be objectified to be managed so as to pull the levers in order to provide great customer service - which could be considered to be different to medical service.

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Avoiding-Hospital-Admissions-Sarah-Purdy-December2010.pdf

Azam Bata's insight:

Is it the time to senior review which is the rate limiting step in A&E?

 

One quality standard set out by the Kings fund is that "Providers should conduct early senior review in A&E"

 

The article seems to fall short of going into detail about exactly what structured discharge planning looks like beyond the fairly obvious "individually tailored" description given; though argues with good evidenced based reports that it is nonetheless required.

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GMC | KINSHIP - Knowledge INformed Support for Health Improved Practice

Posts about GMC written by kinwahlin
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In times of change it is the learners that will inherit the future. Those who have finished learning find themselves equipped to live in a world that no longer exists (Eric Hoffer)

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