Polypharmacy is the new epidemic of our time
ICU admissions – how to make decisions
Lung cancer care for UK patients is improving
Electrolyte balance disorders monitoring
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Guest editor:
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Doctors who have not received adequate training in chest drain insertion are at risk of causing serious injury to patients according to patient safety experts. The National Patient Safety Agency published a report in 2008 on 12 deaths and 15 cases of severe harm from chest drain insertion that had been reported to them by healthcare
staff. It said true rates of harm to patients was likely to be substantially higher, given that healthcare staff are known to under-report incidents. Subsequent national audits in the UK and globally have continued to show ongoing concern about rates of mortality and morbidity associated with the procedure, says Dr Nasir Siddique Consultant in Respiratory Medicine at Kettering General
The first three patients that died under Dr Matt Inada-Kim’s care succumbed to sepsis. Now he is on a mission to introduce a standardised national early warning score (NEWS) in all NHS health settings.
A consultant acute physician at the Royal Hampshire County Hospital, Winchester, and national clinical advisor for sepsis and deterioration, Dr Inada-Kim says for too long, we
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Dr Nasir Siddique Consultant in Respiratory Medicine, Kettering General Hospital Hospital and Honorary Associate Professor, University of Leicester. Examples of patient harm include bleeding and internal organ injury due to poor siting of drains, excessive use of dilators, loss of guidewires in seldinger drain insertions and pleural or drain site infection.
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National drive to standardise the management of deterioration and sepsis
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Serious injury is a risk when inserting a chest drain
Autumn 2018 • Issue 21
Dr Matthew Inada-Kim, Consultant Acute Physician, National Clinical Advisor, Hampshire Hospitals
GIM training compromised by workforce shortages By: Mike Broad, Hospital Dr A census of physicians reveals that ongoing problems with rota gaps, unfilled posts and high levels of reported sickness absence in the NHS are reducing training opportunities. The report, based on the responses of over 8,500 medics, says that junior doctors are being prevented from receiving appropriate training in General Internal Medicine, and it is affecting their perception of the role. 86% of higher trainees said they always or often enjoyed working in their specialty, but only 40% said the same of General Internal Medicine (GIM). This figure had risen from 25% in the previous year, however.
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Contents 3
Polypharmacy is the new epidemic of our time
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Invest in the workforce to ensure quality care in difficult times
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Acute & General Medicine Programme
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ACUTE & GENERAL MEDICINE TEAM Sarah Bray - Marketing Manager Marlon Doyley - Delegate Relationship Manager Yemi Ibidunni - Show Manager Mike Broad - Programme Director CONTACT US 14 Exhibition House Addison Bridge Place Kensington W14 8XP
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CONTINUED FROM PAGE 1 have allowed unnecessary variation to occur in critical processes across the NHS. “This is particularly evident in the assessment of patients admitted with emergency conditions, and during communication and handover, as patients commonly traverse multiple healthcare settings. Currently, hospitals across England don’t use a standardised early warning system to identify patients at risk of deterioration or sepsis, or in need of intervention. No other safety-critical industry would tolerate this. The NHS has evolved into tribes which use different dialects to describe sickness both internally and externally,” he says. In a talk at the Acute & General Medicine conference Dr Inada-Kim will explain why all acute trusts and ambulance services should adopt the new National Early Warning Score (NEWS2), introduced in December 2017. It contains improvements on the previous version. For example, the chronic hypoxia sub chart helps to better tailor escalation to baseline oxygen levels in those with respiratory disease. “We are trying to standardise the language of deterioration
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EDITORIAL TEAM Francesca Robinson
across the whole of the NHS and as a result people working in acute and general medicine are pivotal to the dissemination of NEWS2 across the pathways of local units and regions. It’s a national mandate and has to be achieved by March 2019 in every single acute trust and every single ambulance service. “The NEWS and sepsis pathways have now effectively been combined into one pathway and that’s a better reflection of what we actually see when patients come in. The new pathway highlights the sick patient and ensures that the appropriate, competent senior clinician sees them at the earliest opportunity. It’s all about ascertaining which patients are at high risk of death or bad outcomes using physiology and all the other components of an assessment,” he says. Don’t miss Dr Inada-Kim’s talk on 20th November at Acute & General Medicine. Secure your discounted pass for just £310+VAT before rates increase to £399+VAT after the 28th September using discount code NEWSP310. Book online www.agmconference.co.uk/ newspaper2 or call 0207 348 1851.
Dr Siddique, who is concerned about these patient safety issues, will be giving a talk about the pitfalls of the procedure and how to get it right, at the Acute & General Medicine conference. To be fully trained to insert a chest drain, doctors should undergo an accredited one day course then be supervised doing between five and seven procedures, says Dr Siddique. “The aim of my talk is to raise awareness about the potential injuries that inserting a chest drain can cause. A lot of people are unaware of the dangers of this procedure because they are not widely publicised. “I run the chest drain course for junior doctors in my hospital in Kettering but many consultants have also attended it to refresh their knowledge with the latest information. You can always learn something new - after doing this procedure for a number of years, I am still learning.” Multiple award winning teacher, Dr Siddique has just launched a new one day course on chest drain insertion, accredited by the Royal College of Physicians and Royal College of Emergency Medicine with 6 CPD points, to be run in London. Don’t miss Dr Nasir Siddique’s talk on 20th November at Acute & General Medicine. Secure your discounted pass for just £310+VAT before rates increase to £399+VAT after the 28th September using discount code NEWSP310. Book online www.agmconference.co.uk/ newspaper2 or call 0207 348 1851.
HBP – an early marker of organ dysfunction in sepsis Sepsis is a global healthcare problem both in terms of patient health and economic burden. Despite increasing awareness of the condition, the incidence and mortality rates remain high. Early identification of high-risk patients and appropriate intervention are key to improving the chances of recovery but non-specific clinical symptoms and the lack of adequate biomarkers (1) hampers the accurate assessment of susceptible patients. In patients with an infection and signs of a systemic response, the risk of developing sepsis can be up to 25%(2), however, there is a need to improve the cost: benefit relationship associated with non-essential admission and antibiotic use versus the failure to detect patients at a high health risk. Additional data in the form of a specific prognostic biomarker is therefore an extremely useful
adjunct to the clinical picture in helping clinicians to decide the patient pathway. Heparin Binding Protein (HBP) is a new biomarker which exhibits improved predictive value over existing tests. In a recent study (3) of 759 patients who presented to the Emergency Department with suspected infection and signs of a systemic response, HBP was shown to be an early indicator of progression to infection-related organ dysfunction within 72 hours, with a specificity of 76.3% and a sensitivity of 78.0%, outperforming other current market-leading tests. The negative predictive value of 89.5% for HBP indicates a high probability for excluding the progression to sepsis in an otherwise clinically stable infected patient. For more information please visit us at booth B45 at the Acute and General Medicine Conference.
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CONTINUED FROM PAGE 1 The findings challenge the Shape of Training’s vision of increasing the number of doctors with general medical skills. In 2013, the influential Shape of Training Report (STR) called for a move towards generalism and greater flexibility in medical training. With an ageing population and a greater number of patients with comorbidities, the STR’s author Prof Greenway warned against creating more specialists in the NHS and urged the Government to train more doctors in general medicine. But, due to the current pressures in the NHS, many trainees would like to turn their back on GIM. The census reveals a worrying 59% of trainees would not train in GIM if they had their training period again. The reasons for the dissatisfaction became apparent when the trainees were asked what would improve the quality of their GIM training.
87% said no rota gaps; 82% a better balance between service and training; and 72% called for protected time for professional development. The Focus on Physicians: 2017–18 Census is the Royal College of Physicians, Royal College of Physicians of Edinburgh and Royal College of Physicians and Surgeons of Glasgow’s most recent survey on the physician workforce in the UK. The findings are particularly important in 2018 as Health Education England (HEE) and its partners develop a 10-year health and care workforce strategy for England. •
Encourage your trainees to attend Acute and General Medicine Conference so that they can receive the training in GIM that they and your patients deserve
KEY FINDINGS FROM THE CENSUS: • 45% of advertised consultant posts went unfilled • 53% of consultants and 68% of trainees said rota gaps occurred frequently or often • Trainees reported that fellow juniors were absent due to sick leave in 46% of their on-calls • Both consultants and trainees said they worked 10% more than they were contracted to
Polypharmacy is the new epidemic of our time
In the UK over 1 billion prescription items are dispensed in the community each year and more than 1 million people are on 8 or more medicines. Polypharmacy is associated with an increased risk of adverse reactions, hospital admission, medication errors and lack of adherence to treatment so needs to be addressed and prevented where possible, says Professor Baker. For some patients polypharmacy will improve their quality of life but a number of people get stuck on drugs such as antidepressants or pain killers that may not be working for them. “It’s really important that we prescribe medicines to optimise the patient’s chance of feeling well as they live with their long-term conditions. But we should think about not only starting drugs but also stopping some of them. This means reviewing medicines and thinking about why they have been prescribed, highlighting to the GP that the patient needs a medicines review, or referring them on to a medicines specialist,” she explains. Professor Baker says the problem for doctors on the acute take is that they rarely have time to review and optimise patients’ medication. “If someone who is taking 15 drugs is admitted those medicines are
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Polypharmacy, the use of multiple medicines, is a new epidemic of our time, according to Professor Emma Baker, Professor of Clinical Pharmacology, at St George’s University of London.
Professor Emma Baker, Professor of Clinical Pharmacology, St George’s University of London probably just written up for them. A doctor may stop two or three temporarily if, for example, the patient is in kidney failure, or they might stop some of the drugs just when they come in. But the trend is that a patient tends to accumulate 1 to 2 medicines per hospital admission and go home with more drugs than they started on.” Professor Baker will be giving a talk on tackling polypharmacy at the Acute and General Medicine conference which she says will be relevant for doctors from all grades and all specialties. “Polypharmacy is a longitudinal process and people accumulate drugs as they get older so it’s an issue for the whole clinical workforce and we all need to be aware of it,” she says. Her talk will explain the natural history of polypharmacy and give guidance on primary prevention. Professor Baker will also use case studies to explain how medicines can be optimised in patients with established polypharmacy.
Doctors from all grades and specialties are invited to
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The emergency medical workforce must be valued, supported and invested in to ensure that safe, quality care is provided during difficult times, Dr Taj Hassan, President of the Royal College of Emergency Medicine (RCEM), will tell delegates at the Acute and General Medicine conference. An emergency medicine consultant at Leeds General Infirmary, he says the NHS has had two of the toughest winters in the last 20 years and there is every indication that the coming winter will be equally harsh. Medical and nursing staffing are already working under significant pressure but Dr Hassan says he is optimistic that high standards of NHS care can be maintained. The RCEM is working with NHS England, NHS Improvement and Health Education England to implement a workforce strategy, which will affect the next decade and Dr Hassan says he is heartened by comments by Matt Hancock, the new Health Secretary, that the workforce is top of his priority list.
One of the key areas the workforce strategy is currently focusing on is reducing the £400 million a year spending on locum and agency staff in emergency departments. “Our workforce strategy is very clear that we need to invest in and build medium-term planning for workforce so that we can transform that £400 million per year into high quality and substantive posts - that is important,” says Dr Hassan. In addition to investing in the workforce he says there is a need to focus on optimising patient flow and to develop wider system engagement so that everybody is taking responsibility for the parts of the system that they are responsible for. Clinical staff are there to deliver safety, time critical clinical care and to optimise the patient experience. System performance is the responsibility of policy makers and managers. “It’s their job to decide how much money they can give us to deliver adequate staff and adequate hospital and community care beds. If they don’t provide the resource then both safety clinical care and the patient experience will be horrendously
ICU admissions – how to make better decisions Deciding whether to escalate the treatment of a deteriorating patient to intensive care is one of the hardest decisions doctors have to make and one for which they have very little training. It is a topic that Dr Chris Bassford has been studying for the last three years as chief investigator on an NIHR study looking at how people make decisions about whether a patient should be referred or admitted to intensive care. A consultant in intensive care medicine at University Hospital Coventry, Dr Bassford will be sharing the lessons learned from this research with Acute & General Medicine conference delegates. He will be explaining the background to the complex decision making process of admitting patients to ICU and the behavioural science and cognitive processes surrounding that decisionmaking. He will talk about how doctors make decisions and some of the factors that influence their decisions. One of the uncomfortable issues, for example, which doctors need to guard against when making decisions about ICU admissions is ICU bed availability. He says there are tools and cognitive processes that can help to mitigate for these pressures when making decisions about admitting patients to ICU. Dr Bassford will set out a framework, developed from the research, which will help doctors to
structure their thinking to ensure that they are doing the best for their patients, that they articulate the decisions they make and also that their decisions are defensible and in line with best practice. Dr Bassford and his colleagues are working with the Faculty of Intensive Care Medicine and the GMC to develop some training and guidance surrounding this sort of difficult decision-making. In the long run he says the aim is to develop a cohesive set of national guidance. “We are not intending to set out whether individual patients should or should not be admitted to ICU, but to show that these important decisions, which have life-or-death consequences for patients, are made in the best possible way. Ultimately we hope that this will mean that patients who will benefit from the treatment on ICU are more likely to be admitted to ICU, and those that will not benefit are not subjected to unnecessary and unhelpful treatment,” he says. This talk will be for doctors working at all levels who are involved in the care of deteriorating patients. Don’t miss Dr Chris Bassford’s talk on 21st November at Acute & General Medicine. Secure your discounted pass for just £310+VAT before rates increase to £399+VAT after the 28th September using discount code NEWSP310. Book online www.agmconference.co.uk/ newspaper2 or call 0207 348 1851.
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Invest in the workforce to ensure quality care in difficult times says senior emergency medic
Dr Taj Hassan, President, Royal College of Emergency Medicine compromised - that’s what the quality conundrum is for me,” says Dr Hassan. Dr Hassan will be speaking in a debate: “Avoiding another Mid Staffs – how can we promote quality in difficult times?”, with Professor Ted Baker, Chief Inspector of Hospitals, CQC, Professor Stephen Prowis, Medical Director, NHS England and Dr Neil Bacon, Chief Executive of iwantgreatcare.org. Don’t miss Dr Hassan’s talk on 21st November at Acute & General Medicine. Secure your discounted pass for just £310+VAT before rates increase to £399+VAT after the 28th September using discount code NEWSP310. Book online www.agmconference.co.uk/newspaper2 or call 0207 348 1851.
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CONFERENCE PROGRAMME: TUESDAY 20TH NOVEMBER TIME
THEATRE 1 Acute oncology
09:00 09:35
Dr Thomas Newsom-Davis, Consultant Medical Oncologist, Chelsea & Westminster Hospital, London
Acute ophthalmology
09:45 10:20
John Sharp, Post-CCT Corneal Fellow, King’s College Hospital NHS Foundation Trust
THEATRE 2 Headaches: when to worry
Dr Pooja Dassan, Consultant Neurologist, London North West Healthcare NHS Trust and Imperial College Healthcare NHS Trust
Stroke: improving diagnosis and treatment Dr Anthony Pereira, Consultant Neurologist, St George’s Hospital
THEATRE 3
THEATRE 4
Pulmonary hypertension: who should you refer?
Missed cases in the ED
An opportunity to standardise the management of deterioration and sepsis
Ambulatory care
Dr John Wort, Consultant and Reader, Royal Brompton and Harefield NHS Trust and Imperial College, London
Dr Matthew Inada-Kim, Consultant Acute Physician, National Clinical Advisor, Hampshire Hospitals
Dr Zul Mirza, Consultant in Emergency Medicine, Chelsea and Westminster Hospital NHS Foundation Trust; Honorary Senior Clinical Lecturer, Imperial College School of Medicine
Dr Clarissa Murdoch, Consultant in Care of Older People and Acute Medicine, Whittington Health NHS Trust
10:20 - 11:00 BREAK Headaches: when to worry
11:00 11:40
Endocrine emergencies
Session sponsored by BMS Pfizer
Dr Pooja Dassan, Consultant Neurologist, London North West Healthcare NHS Trust and Imperial College Healthcare NHS Trust
Dr Francesca Swords, Consultant in Endocrinology, Norfolk and Norwich University Hospitals Foundation Trust
Tailored protection for your patients requiring anticoagulation
Acute heart failure
Guide to irrelevant tests on AMU - the director’s cut
Assessing and managing the main disorders of potassium and sodium balance
Acute heart failure
Session sponsored by Mylan
Session details coming soon
Session sponsored by Janssen
11:40 - 12:00 BREAK
12:00 12:40
Dr Raj Patel, Consultant Haematologist, Clinical Thrombosis Centre, King’s College Hospital, London, UK
Professor Andrew Clark, Chair of Clinical Cardiology; Honorary Consultant Cardiologist, Castle Hill Hospital, University of Hull
Acute oncology
Dr Thomas Newsom-Davis, Consultant Medical Oncologist, Chelsea & Westminster Hospital, London
Pulmonary hypertension: who should you refer?
Dr John Wort, Consultant and Reader, Royal Brompton and Harefield NHS Trust and Imperial College, London
12:40 - 13:30 BREAK 13:30 14:05
Dr Kevin Jones, Consultant in Acute Medicine, Bolton Hospitals NHS Foundation Trust
Session sponsored by MPS
Professor Sunil Bhandari, Consultant in Nephrology, Hull and East Yorkshire Hospitals NHS Trust; Honorary Professor, Hull York Medical School
Professor Andrew Clark, Chair of Clinical Cardiology; Honorary Consultant Cardiologist, Castle Hill Hospital, University of Hull
14:15 14:50
Stroke: improving diagnosis and treatment
Dr Anthony Pereira, Consultant Neurologist, St George’s Hospital
USS at the front door interesting cases
Dr Sarbjit Clare, Clinical Lead Acute Medicine, Sandwell and West Birmingham Hospitals NHS Trust
14:50 - 15:15 BREAK Ambulatory care
15:15 15:50
Dr Clarissa Murdoch, Consultant in Care of Older People and Acute Medicine, Whittington Health NHS Trust
16:00 16:40
Dr Zul Mirza, Consultant in Emergency Medicine, Chelsea and Westminster Hospital NHS Foundation Trust; Honorary Senior Clinical Lecturer, Imperial College School of Medicine
Missed cases in the ED
Ageing well: The national approach to frailty
Inpatient falls: reducing the numbers and harm
Session details coming soon
Update on overdose management for post-take ward round
The acute abdomen on the medical take
Guide to irrelevant tests on AMU - the director’s cut
Professor Martin Vernon, Consultant Geriatrician, National Clinical Director for Older People, NHS England
Dr Stephen Waring, Consultant in Acute Medicine and Toxicology, York Teaching Hospitals NHS Foundation Trust
Dr Wallace Tan, Chair of Falls Group; Consultant Geriatrician, Croydon University Hospital NHS Trust
Dr Alex Di Mambro, Consultant Gastroenterologist and Clinical Lead for Nutrition, Gloucestershire Hospitals NHS Foundation Trust
Dr Kevin Jones, Consultant in Acute Medicine, Bolton Hospitals NHS Foundation Trust
16:40 - 17:05 BREAK Inpatient falls: reducing the numbers and harm
17:05 17:40
Dr Wallace Tan, Chair of Falls Group; Consultant Geriatrician, Croydon University Hospital NHS Trust
Exhibition & networking time
17:50 18:30
The acute abdomen on the medical take
Dr Alex Di Mambro, Consultant Gastroenterologist and Clinical Lead for Nutrition, Gloucestershire Hospitals NHS Foundation Trust
Assessing and managing the Tackling the perils of main disorders of potassium and polypharmacy Professor Emma Baker, Professor of sodium balance Professor Sunil Bhandari, Consultant in Nephrology, Hull and East Yorkshire Hospitals NHS Trust; Honorary Professor, Hull York Medical School
THE BIG DEBATE: Avoiding another Update on overdose Mid Staffs – how can we promote management for post-take ward round quality in difficult times
Dr Neil Bacon, CEO, iwantgreatcare. org; Prof Stephen Powis, Medical Director, NHS England; Prof Ted Baker, Chief Inspector of Hospitals, CQC; Dr Taj Hassan, President, Royal College of Emergency Medicine
Dr Stephen Waring, Consultant in Acute Medicine and Toxicology, York Teaching Hospitals NHS Foundation Trust
Clinical Pharmacology, St George’s, University of London
Exhibition & networking time
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CONFERENCE PROGRAMME: TUESDAY 20TH NOVEMBER TIME
THEATRE 5
Hyponatraemia and the acute take 09:00 Dr Francesca Swords, Consultant in Endocrinology, Norfolk and University Hospitals 09:35 Norwich Foundation Trust
09:45 10:20
10:30 10:50
11:00 11:40 11:45 12:05
Acute PE Dr Phil Marino, Consultant in Pulmonary Hypertension & Respiratory Failure, St Thomas’ Hospital, London
Embedding a learning organisational culture to support the management of clinical performance issues and drive improvements in patient safety Denise Chaffer, Director of Safety and Learning, NHS Resolution; Karen Wadman, Acting NCAS Director and Lead Adviser, NHS Resolution
The chest drain: how not to get it wrong Dr Nasir Siddique, Consultant in Respiratory Medicine, Kettering General Hospital; Honorary Associate Professor, University of Leicester
Dr Sally Old, Medico-legal Adviser, The Medical Defence Union
It’s all about patient safety
13:30 14:05
14:15 14:50
and Hillingdon Hospital NHS Foundation Trust
09:45 10:20
Dr Elizabeth Haxby, Adjunct Reader, National Heart and Lung Institute; Lead Clinician in Clinical Risk, Royal Brompton Hospital
11:00 11:40
12:00 12:40
14:15 14:50
15:15 15:50
16:00 16:30
16:00 16:40
16:40 17:00
TB on the take
Dr Sarbjit Clare, Clinical Lead Acute Medicine, Sandwell and West Birmingham Hospitals NHS Trust
17:05 17:40
Dr Ovidiu Bedreag, General Secretary, Romanian Society of Anaesthesiology and Intensive Care; Anaesthesiology and Intensive Care Department, Clinical County Hospital - Timisoara, Romania
Surgical management of IBD complications anything new? Dr David Lacasa, Consultant, General and Digestive Surgery, Hospital El Bierzo Ponferrada Leon, Spain
Pneumothorax – management for the Acute Physician Dr Jaymin Morjaria, Respiratory Medicine Consultant, Harefield Hospital - London, UK
Goals and unmet needs in acute and general medicine training and practice Sessions’ overview and structure Vincenzo Costigliola, MD, President, EMA, Brussels, Belgium
Focus on innovative practice in clinical research European Medical Association
Stephen Minger, Director, SLM Blue Skies Innovations, Ltd
Future topics and challenges Miguel Santos, Principal Investigator, Instituto de Tecnologia Química e Biológica António Xavier, Univ. Nova de Lisboa (ITQB NOVA), Portugal
European Medical Association
Sebastiano Mercadante, Director, Department of Palliative Medicine, La Maddalena Hospital Palermo, Italy
Non-invasive ventilation in acute and general medicine: in oncology and beyond Rosario Squatrito, Director of Internal and Emergency Medicine Department, Fondazione Istituto G. Giglio, Cefalù, Italy
NHS Pensions – an overview Angela Williams, Stakeholder Engagement Manager, NHSBSA Pensions
Adequacy of anaesthesia concept - what should a non-anaesthetic doctor know?
Early palliative care Palliative pain management in oncology
Professor Onn Min Kon, Consultant Respiratory Physician, Imperial College Healthcare NHS Trust
The patient with chest pain
Professor Dr Dorel Sandesc, President, Romanian Society of Anaesthesia and Intensive Care, Vice-Rector, “V. Babes” University of Medicine and Pharmacy, Timisoara; European Society of Anaesthesiology (ESA) Anaesthesia & Intensive Care Department, County Emergency Hospital, Timisoara Romania
Regenerative medicine Where we were, where we are
14:50 - 15:15 BREAK 15:15 15:50
Dr Georgios Karagiannis, MD, PhD, FESC, FHFA, Consultant Cardiologist, Hillingdon and Harefield Hospital, London
Professor Guglielmo Trovato, MD, Media and Scientific Press Relations, European Medical Association EMA, Brussels
Gaining USS accreditation – how to avoid the pitfalls Dr Chris Duncan, Anaesthesia and Critical Care trainee, Birmingham
Difficult ECGs in the emergency department
Beyond ventilation in mechanical ventilation: nutrition and metabolism
13:30 14:05
Confidentiality (in light of GDPR)
THEATRE 6
Haematological emergencies 09:00 Dr Ketan Patel, Consultant Haematologist, Royal 09:35 Brompton and Harefield NHS Foundation Trust
Session sponsored by Mallinckrodt
12:05 - 12:45 BREAK 12:45 13:05
TIME
17:50 18:30
European Medical Association
EMA session (General Assembly) European Medical Association
MIX AND MATCH STREAMS TO CREATE YOUR TAILOR-MADE CLINICAL PROGRAMME ACUTE MEDICINE CARDIOLOGY CLINICAL PHARMACOLOGY CRITICAL CARE DIABETES & ENDOCRINOLOGY GASTROENTEROLOGY HEPATOLOGY HOT TOPICS MEDICAL ESSENTIALS NEUROLOGY RENAL MEDICINE
ELDERLY MEDICINE EMERGENCY MEDICINE RESPIRATORY MEDICINE RHEUMATOLOGY
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CONFERENCE PROGRAMME: WEDNESDAY 21ST NOVEMBER TIME
THEATRE 1 Managing IBD
09:00 09:35
Dr Stuart Bloom, Chair, UK IBD Registry; Consultant Gastroenterologist, UCL Hospitals NHS Foundation Trust
Managing delirium
09:45 10:20
THEATRE 2
THEATRE 3
THEATRE 4
Acute respiratory presentations
Parkinson’s: management on the take and on the wards
HIV: the challenge of acute management
Dr Omar Usmani, Reader and Consultant Physician, National Heart and Lung Institute, Imperial College London & Royal Brompton Hospital
Dr Christos Proukakis, Senior Lecturer and Honorary Consultant Neurologist, University College London, Royal Free London NHS Foundation Trust
Dr Emma Devitt, Consultant Physician in Infectious Diseases, Chelsea and Westminster NHS Foundation Trust
Session sponsored by
COPD update for the generalist
Acute dermatological presentations
Dr Nicholas Hopkinson, Reader in Respiratory Medicine, Imperial College; Honorary Consultant Chest Physician, The Royal Brompton Hospital
Dr Rachael Morris-Jones, Dermatology Consultant, Kings College Hospital, London
Dr Annabel Price, Consultant Liaison Boehringer Ingelheim Psychiatrist, Cambridgeshire and Peterborough NHS Foundation Trust, Addenbrooke’s Hospital Cambridge
10:20 - 11:00 BREAK 11:00 11:40
HIV: the challenge of acute management
Acute dermatological presentations
Acute respiratory presentations
Risk management: top tips to stay out of trouble
Dr Emma Devitt, Consultant Physician in Infectious Diseases, Chelsea and Westminster NHS Foundation Trust
Dr Rachael Morris-Jones, Dermatology Consultant, Kings College Hospital, London
Dr Omar Usmani, Reader and Dr Jo Nixon, Medico-legal Adviser, Consultant Physician, National Heart The Medical Defence Union and Lung Institute, Imperial College London & Royal Brompton Hospital
Handovers: art and science
Session sponsored by BMS Pfizer
11:40 - 12:00 BREAK 12:00 12:40
Dr Adam Chesters, Consultant in Emergency Medicine and PreHospital Emergency Medicine, Cambridge University Hospitals
Sepsis - the silent killer
Managing IBD
Dr Andrew Conway-Morris, Senior Research Associate and Honorary Consultant in Intensive Care Medicine, University of Cambridge
Dr Stuart Bloom, Chair, UK IBD Registry; Consultant Gastroenterologist, UCL Hospitals NHS Foundation Trust
12:40 - 13:30 BREAK 13:30 14:05
Early diagnosis of acute coronary syndromes
Parkinson’s: management on the take and on the wards
COPD update for the generalist
Rheumatology at the front door
Professor Richard Body, Professor and Honorary Consultant in Emergency Medicine, The University of Manchester
Dr Christos Proukakis, Senior Lecturer and Honorary Consultant Neurologist, University College London, Royal Free London NHS Foundation Trust
Dr Nicholas Hopkinson, Reader in Respiratory Medicine, Imperial College; Honorary Consultant Chest Physician, The Royal Brompton Hospital
Dr Catherine Mathews, Consultant Rheumatologist and Deputy Director of Medical Education, Lewisham and Greenwich NHS Trust
Sepsis - the silent killer
Update on NAFLD
Legacy after critical illness from survival to living
Session sponsored by Abbott
Dr Stuart McPherson, Consultant Dr Andrew Conway-Morris, Hepatologist, The Newcastle upon Senior Research Associate and Honorary Consultant in Intensive Care Tyne Hospitals NHS Foundation Trust Medicine, University of Cambridge
14:15 14:50
Amy Chan-Dominy, Cardiothoracic & Paediatric Intensivist, Royal Brompton Hospital, London
14:50 - 15:15 BREAK 15:10 15:45
15:55 16:30
Managing delirium
ECG masterclass
Dr Annabel Price, Visiting Researcher, Department of Psychiatry, University of Cambridge; Consultant in Liaison Psychiatry for Older Adults, Addenbrooke’s Hospital
Dr Simon Fynn, Consultant Cardiologist Dr Stuart McPherson, Consultant Hepatologist, The Newcastle upon and Clinical Director for Cardiology, Tyne Hospitals NHS Foundation Trust Papworth Hospital, Cambridge
Update on NAFLD
Handovers: art and science Dr Adam Chesters, Consultant in Emergency Medicine and PreHospital Emergency Medicine, Cambridge University Hospitals
Rheumatology at the front door
Early diagnosis of acute coronary syndromes
Superbugs - what you need to know at the front door
Exhibition & networking time
Dr Catherine Mathews, Consultant Rheumatologist and Deputy Director of Medical Education, Lewisham and Greenwich NHS Trust
Professor Richard Body, Professor and Honorary Consultant in Emergency Medicine, The University of Manchester
Dr Sarah Logan, Consultant in Acute Medicine and Infectious Diseases, University College London Hospitals NHS Foundation Trust
MIX AND MATCH STREAMS TO CREATE YOUR TAILOR-MADE CLINICAL PROGRAMME ACUTE MEDICINE CARDIOLOGY CLINICAL PHARMACOLOGY CRITICAL CARE DIABETES & ENDOCRINOLOGY GASTROENTEROLOGY HEPATOLOGY HOT TOPICS MEDICAL ESSENTIALS NEUROLOGY RENAL MEDICINE
ELDERLY MEDICINE EMERGENCY MEDICINE RESPIRATORY MEDICINE RHEUMATOLOGY
Book before 28th September for £310+VAT before the price increases to £399+VAT! Use code NEWSP310: www.agmconference.co.uk/newspaper2 or call 0207 348 1851
20-21 NOV EMB
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CONFERENCE PROGRAMME: WEDNESDAY 21ST NOVEMBER TIME
THEATRE 5
The neuro examination Dr Fatemeh Geranmayeh, Post-doctoral clinical Research Fellow 09:00 and Neurology Registrar, Hammersmith Hospital 09:35 Echocardiography in the critically ill
09:45 10:20
TIME
Travel medicine. Innovation and excellence in the practice of medicine
09:00 09:35
European Medical Association
Evidence and practice for enhancing healthy lifestyles Healthy nutritional profiles and Mediterranean Diet
Dr Ben Creagh-Brown, Consultant and Clinical Senior Lecturer, Royal Surrey County Hospital NHS Foundation Trust
09:45 10:20
Inotropes and vasoactive agents
11:00 11:40
Dr Amy Chan-Dominy, Cardiothoracic & Paediatric Intensivist, Royal Brompton Hospital, London
Session details to be confirmed
11:45 12:05
Addressing comprehensively lifestyle changes Gianluca Tognon, Nutrition Coach; Food Scientist and Epidemiologist, The Food Scientist Organization, Göteborg (Sweden)
Exercise is a therapy. Benefits, barriers and caveats of cardiovascular rehabilitation A worldwide overview
11:00 11:40
Nidal Tourkmani, Cardiologist; Consultant, ABL, Swiss Prestige International Medical Centre-Guangzhou, China
Comprehensive approaches and challenges Professor Guglielmo Trovato, MD, European Medical Association - EMA, Brussels European Medical Association
Rapid response systems in acute and general medicine
Dr Jo Nixon, Medico-legal Adviser, The Medical Defence Union
Session sponsored by MPS
Francesca Rubulotta, Honorary Senior Lecturer - Intensive Care Medicine, Imperial College, London
12:00 12:40
12:45 13:05
Recommendations John Welch, President International Society for Rapid Response Systems, University College London Hospitals
Sustainability Chris Subbe, Clinical Senior Lecturer, School of Medical Sciences Bangor University, Gwynedd, Wales
ICU admissions – making better decisions Dr Chris Bassford, Consultant in Intensive Care Medicine, University Hospital Coventry
European Medical Association
Advance neoplasm, what palliative surgery can do
13:05 - 13:30 BREAK 13:30 14:05
Raffaele Palladino, MD, Honorary Consultant in Public Health Medicine, Department of Primary Care and Public Health at the Imperial College London
European Medical Association
Confidentially (in light of GDPR)
12:15 12:35
A panel discussion chaired by Vincenzo Costigliola, MD, President, European Medical Association, Brussels, Belgium
Dr Claire Colebourn, Consultant Medical Intensivist, Oxford University Hospitals
How not to provide NIV
10:30 10:50
THEATRE 6
Ivan Tomasi, Consultant Surgeon, St Thomas’ Hospital - London, UK
13:30 14:05
Lung cancer: improving diagnosis and treatment
14:15 14:50
Dr Paul Beckett, Consultant Respiratory Physician, Derby Teaching Hospitals NHS FT
14:50 - 15:15 BREAK
Pitfalls in the diagnosis of cerebrovascular events
14:15 14:50
Dr Evangelos Vasileiadis, Consultant Stroke Lead, Assistant Clinical Director - Non-Acute Medicine, Hillingdon Hospital NHS Foundation Trust
Acute kidney injury in critical care
15:15 15:50
Dr John Prowle, Senior Clinical Lecturer, Barts and the London School of Medcine and Dentistry, Queen Mary University of London
Dr Cristiana Coneru, Emergency Medicine Physician, Northwick Park Hospital
Beginners guide to ECGs
16:00 16:30
A new old ancient cure – propolis
Dr Simon Fynn, Consultant Cardiologist and Clinical Director for Cardiology, Papworth Hospital, Cambridge
15:10 15:50
Book before 28th September for £310+VAT before the price increases to £399+VAT! Use code NEWSP310: www.agmconference.co.uk/newspaper2 or call 0207 348 1851
20-21 NOV EMB
DELEGA
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New guidance defines safe doctor staffing levels in hospitals By: Mike Broad, Hospital Dr Ground-breaking guidance on safe medical staffing levels in hospitals has been released.The guidance, by the Royal College of Physicians, will allow trusts to map their current staffing levels against the recommendations to ensure they are providing safe care for patients. Guidance on Safe Medical Staffing has assessed in detail the time needed to diagnose, treat and manage patients in a variety of hospital settings. The working party report divides clinicians into three clear tiers based on levels of knowledge,
Major advances in the classification, diagnostic pathway and treatment of lung cancer have been achieved in the past decade, Dr Paul Beckett, consultant respiratory physician at Derby Hospitals Foundation Trust, will tell Acute & General Medicine show delegates. “UK outcomes for lung cancer have been quite poor for many years compared to the rest of the world but these new developments means there is a lot of optimism about lung cancer at the moment,” he says. Earlier diagnosis is key to improving outcomes and national campaigns to raise awareness of symptoms has been alerting the public to the need for earlier presentation. In addition the introduction of the National Optimal Lung Cancer Pathway is speeding up the patient’s journey from presentation through to diagnosis and treatment. Research, which has unlocked the secrets of how lung cancers behave and develop, has resulted in new personalised treatments which can successfully target lung cancers with genetic mutations and keep tumours under control for relatively long periods of time. The emergence of immuno oncology is providing another new field of treatment which harnesses the immune system to attack cancers. “These new treatments, plus improvements in
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Lung cancer care for UK patients is improving
experience and responsibility, and calculates how much time is needed from clinicians in each tier. It ranges from Tier 1, which includes foundation year doctors, to Tier 3, which includes consultants. The report then applies the tier model to hospital care settings, such as the medical assessment and admission team, and the medical ward team. It makes specific recommendations on the amount of hours needed from each tier of clinician in each setting. In the medical assessment and admission team, for example, to assess 10 patients satisfactorily, it will require 15 hours of Tier 1 time; 9.5 hours of Tier 2 time; and, 4.25 hours of Tier 3 time. This is based on a system of consultant-led
Dr Paul Beckett, Consultant Respiratory Physician, Derby Teaching Hospitals NHS FT
care. There might not be an immediate consultant presence in the emergency department and acute medical unit (AMU) but there would be consultantled post-take ward rounds. These figures would be 15 hours of Tier 1 time; 7 hours of Tier 2 time; and, 6.5 hours of Tier 3 time – if the system employed involved partly consultant delivered care, with consultant presence and early involvement in the emergency department and AMU. The calculations in the report will enable hospitals to map their current provision against the recommendations to ensure they are able to provide safe care for patients. The RCP will work with hospitals to pilot the recommendations in real-life situations. RCP registrar and president-elect Dr Andrew Goddard said: “The variation in the numbers of doctors per bed in the UK is staggering. At last we have a way we can benchmark medical staffing levels to ensure that patients will know if the wards they are on have safe staffing levels.”
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surgical techniques, better selection of patients for surgery, earlier diagnosis and new developments in radiotherapy are all playing a role in improving outcomes. “There are now many more options for patients even with advanced lung cancer which are having quite important benefits in terms of quality of life and survival from their disease. Twenty years ago the five year survival for a lung cancer patient was around 6% and now it’s up to 17% - it’s still not very good but it’s more than double what it was 10 years ago,” says Dr Beckett. This talk will benefit doctors from all the general and acute medical specialties who will be seeing lung cancer patients presenting in different ways. “It will be helpful for these doctors to know what the bigger picture is so that when they encounter these patients they will be able to explain to them what the treatment pathways and options are for this disease,” says Dr Beckett. Don’t miss Dr Paul Beckett’s talk on 21st November at Acute & General Medicine. Secure your discounted pass for just £310+VAT before rates increase to £399+VAT after the 28th September using discount code NEWSP310. Book online www.agmconference.co.uk/ newspaper2 or call 0207 348 1851.
@AGMConfUK /AGMConference Acute & General Medicine
Book before 28th September for £310+VAT before the price increases to £399+VAT! Use code NEWSP310: www.agmconference.co.uk/newspaper2 or call 0207 348 1851
20-21 NOV EMB
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Healthcare
Identify earlier. Respond faster. Philips is focused on improving people’s lives across the health continuum – from healthy living and prevention, to diagnosis, treatment and home care. Applying advanced technologies and deep clinical insights, Philips delivers integrated solutions that improve people’s health and enable better outcomes. Philips will be offering hands on training for both non-invasive ventilation and ultrasound in the Philips training zone, visit stand B58 for more details and to see our latest innovations in non-invasive ventilation, ultrasound and patient monitoring.
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Hands-on training workshops
AIRWAY WORKSHOP Difficult airway workshop training sessions providing opportunities to learn more about the benefits of using advanced single-use visualization equipment for management of the difficult airway. Delivered by experienced Ambu Clinical Educators, these sessions will teach how aScope™ can enhance patient safety, reduce infection risk at hospitals and help to control costs. Topics covered include: • Current Challenges in Airway Management • Overview of clinical evidence and current guidelines • Clinical use of single-use scopes • Cross-contamination, advantages and disadvantages of single-use scopes • Cost efficiency of single-use scopes • Practical demonstrations of Ambu aScope 4 Broncho system
MEDICAL NON-INVASIVE VENTILATION WORKSHOP
NON-INVASIVE VENTILATION WORKSHOP
Dräger Medical will be providing delegates an opportunity to learn more about this increasingly popular form of ventilation through stimulating and interactive ‘hands-on’ NIV workshops.
In a recent study by NCEPOD, they identified that major improvements in the provision and care of patients receiving Non-Invasive Ventilation (NIV) are required.
Providing insight into the theory behind NIV and how to apply it in the acute point of care, the workshops will consist of: • NIV introduction: benefits, and contraindications. • What to consider when selecting a NIV ventilator (leak adaptation and compensation). • Selecting the right patient interface NIV masks – types, pros and cons, correct fitting. • The opportunity to see “live” changes in distribution of ventilation inside the patient’s lungs using innovative EIT technology.
• An overview of where Ambu products fit in to difficult airways
Delivered by:
The h a on tra ndsbooki ining n will b g system e ope n the A utumn in
Delivered by:
The aim of this session is to address these issues and offer expert, experienced education to help you provide solutions for effective NIV provision, providing the best possible quality care to the patient, utilising the Philips Gold Standard Standalone NIV devices and consumables.
ULTRASOUND WORKSHOP With a passion to improve people’s lives, Philips has been a leader in introducing meaningful innovation for over 125 years. Visit their training zones or the opportunity to see Philips’ ultrasound solutions come to life. Expect training sessions complete with both theoretical and hands-on practice, which would give you a comprehensive overview of the most common ultrasound scans you face in clinical practice. Delivered by:
Book before 28th September for £310+VAT before the price increases to £399+VAT! Use code NEWSP310: www.agmconference.co.uk/newspaper2 or call 0207 348 1851
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Hone your skills and learn new ones
BODY COMPOSITION ANALYSIS WORKSHOP Why is body composition analysis an effective tool for preventing disease? The Inbody training sessions will educate participants about the ‘new BIA technology’ used by InBody and how this differs to conventional BIA methods. Learning outcomes include: • Why is body composition analysis so important? • What is the difference between conventional BIA and the ‘new technology’ of BIA used by InBody? • How does body composition analysis help Doctors to care for their patients? In less than 60 seconds, InBody can provide easy-to-understand and accurate measurements. Doctors and nurses can use the InBody to: • Monitor muscle and fat • Assess muscle distribution to determine patient-specific health risks • Identify fluid imbalances • Track changes for effective longterm risk identification Delivered by:
ULTRASOUND WORKSHOP Siemens Healthineers offers focused hands-on skills training for CORE clinical applications (in support of the CORE (Level 1) ultrasound curriculum of the College of Emergency Medicine). • Focused Assessment with Sonography in Trauma (FAST) • Assessment of the Abdominal Aorta for Aneurysm (AAA) • Focused Echocardiography in Life Support (ELS) • Ultrasound Guided Vascular Access (VA) Each session will be supported by Dr Richard Parris, MBChB, MRCP, FCEM, Consultant in Emergency Medicine, Bolton Hospitals NHS Foundation Trust, and a clinical ultrasound specialist. Delegates will have an opportunity to refresh their clinical context and application of the CORE examination and then have hands-on practice using the Siemens Healthineers ACUSON Juniper and ACUSON NX3 Elite Ultrasound systems.
Delivered by:
INFLUENZA POINT OF CARE TESTING Abbott offers the broadest selection of diagnostic solutions globally, including rapid point-of-care (POC) tests that provide immediate and actionable information that helps improve patient outcomes and healthcare value. With the acquisition of Alere in 2017, Abbott became the number one POC diagnostics in the world, offering best-in-class tests and services across key health and therapeutic areas, including: infectious disease, cardiometabolic & informatics, toxicology and consumer diagnostics. The Alere™ i Influenza A & B 2 assay delivers molecular flu results in 13 minutes or less on our unique Alere™ i platform; making it significantly faster than other molecular methods and more accurate than conventional rapid tests.
Delivered by:
Book before 28th September for £310+VAT before the price increases to £399+VAT! Use code NEWSP310: www.agmconference.co.uk/newspaper2 or call 0207 348 1851
20-21 NOV EMB
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Hands-on training workshops
ZONE 1: ADVANCES IN CENTRAL LINE PRACTICE WORKSHOP
The h a on tra ndsbooki ining n will b g system e ope n the A utumn in
INVASIVE VENTILATION WORKSHOP
The key outcomes of this session will be to: Provide an update on current best practice and an opportunity to discuss key implications on the safe and effective management of central line placement and maintenance. To include;
Delivered by:
Positon – the Importance of correct line positioning Location – utilizing ECG tip location Fixation – importance of safe and effective securement Infection control – importance of strategies to maximise reduction in infection rates
PLANNING A REUNION? ZONE 2: ARROW® EZ-IO® INTRAOSSEOUS VASCULAR ACCESS - RIGHT PATIENT, RIGHT TIME, RIGHT LINE WORKSHOP • ASSESS - Indications, Contraindications and cautions. • SITE - Selecting the correct insertion point and appropriate land marking. • NEEDLE – Assessing tissue depth and selecting the correct needle. • FLUSH – The importance of flushing the line prior to delivering any medication or fluids. • COMFORT – Pain management including the use of Lignocaine. The key outcome is to provide the user with the ability and confidence to use EZ-IO without delay in any situation where there is an immediate need to gain essential vascular access.
Doctors attend Acute & General Medicine in their thousands not only for the world-class training but to meet up with colleagues and peers old and new. Make Acute & General Medicine even more memorable this year by planning a reunion with old colleagues or university medical peers. How can we help? • We can arrange group discounts for six more doctors who would like to plan a reunion and attend Acute & General Medicine. • Our Delegate Relationship Manager can help you find discounted accommodation and take the stress away from coordinating your reunion. • Group bookings of ten of more will receive a £200* tab at a restaurant or bar near the ExCeL to help you kick start your reunion in the best way! Contact us today for more information by emailing training@ closerstillmedia.com and we can work with you to make it a reunion to remember! Events is our thing! Did you know we can also help you organise larger Alumni events too – call 0207 348 5271 to find out more.
Delivered by:
*This is a limited opportunity and will be granted on a first come first serve basis.
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Patients with electrolyte balance disorders need careful monitoring
Acute & General Medicin e is now on the majo ri cage’ lis ty of ‘birdt events w of approved hich NH S Trusts encoura ge their to atten staff d
This is the concern of Professor Sunil Bhandari, Consultant in Nephrology, Hull and East Yorkshire Hospitals NHS Trust, who will be giving a talk on this topic at the Acute and General Medicine Conference. Hyponatraemia is often overlooked, even levels lower than the normal range are sometimes not considered, he says. If this happens it can cause falls in patients and increased confusion. One of the most common causes of low sodium are the medications the patient is taking. Correcting the condition slowly, especially if “chronic” is crucial otherwise it can cause permanent brain damage. Hyperkalaemia is a medical emergency and if not managed correctly can lead to death. Again the cause is usually drug-related, says Professor Bhandari. His presentation will give delegates a whistle-stop tour of the main causes of disorders of potassium and sodium balance via simple algorithms and outline the basic investigations that should be carried out. The key messages will be to – look at the patient’s medications; ensure the electrolyte imbalance correction is managed carefully; and make sure the patient is monitored during the correction phase. Professor Bhandari cautions: “Something we don’t tend to do well is monitor the impact of our interventions. The clinician walks away and assumes the treatment they have
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Disorders of electrolyte balance are common in hospital patients but if they are not treated effectively it can have serious implications for patients.
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Professor Sunil Bhandari, Consultant in Nephrology, Hull and East Yorkshire Hospitals NHS Trust recommended has been given but with the current pressures and fragmentation of the NHS this may not happen in a timely fashion because everybody is very busy. It is essential to follow up the patient and review and reassess the impact of the treatment because at the end of the day you must ensure that it is going to be effective.” This talk will be aimed at junior and middle grade acute and emergency care physicians. In addition it will be relevant for physician associates, physician assistants and nurse practitioners who are increasingly taking on the role of managing these patients. Prof. Bhandari is Co-Director of UK Advanced Nephrology Course; Deputy Head of School of Medicine for Yorkshire and Humber and International Director for the Royal College of Physicians of Edinburgh. His research interests include renal anaemia, chronic kidney disease progression and the effects of iron therapy in uraemic cardiomyopathy and mitochondrial function.
Doctors from all grades and specialties are invited to attend Acute & General Medicine where they can find the support, guidance and high-quality clinical training they need at an affordable price.
20-21 NO VEMBE
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Go online and use discount code NEWSP310: agmconference.co.uk/ newspaper2
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Book before 28th September for £310+VAT before the price increases to £399+VAT! Use code NEWSP310: www.agmconference.co.uk/newspaper2 or call 0207 348 1851
20-21 NOV EMB
DELEGA
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