Medical education and research poster session 23
Track 23
| Friday, October 27, 2023 |
| 1:20 PM - 2:00 PM |
| Exhibition Hall |
Speaker
Dr Lucas De Mendonça
Masters Of Philosophy In Primary Health Care Student
University Of Melbourne
Validation of a clinical decision support system on lung cancer screening eligibility in Australia: may the force be with GPs.
Summary
BACKGROUND: Lung cancer kills more people than any other cancer in Australia and globally. Most lung cancer diagnoses are made in advanced stages, leading to worsened prognosis. Previous high-quality research has demonstrated that screening asymptomatic high-risk patients with low-dose computed tomography is associated with reduced all-cause and lung cancer related mortality. Currently, a national lung cancer screening program has not been established in Australia but is proposed for implementation. We developed a clinical algorithm for identifying asymptomatic patients at high-risk of lung cancer based on age (50-70 years old) and those who smoke cigarettes or who quit within the last 10-years, with minimum of a 20-pack-year history using electronic medical record's (EMR) data from primary care (PC). This algorithm will be implemented in Future Health Today (FHT), a clinical decision support system (CDSS) yielding basis for future cluster trials for lung cancer screening in PC.
AIM: To validate the lung cancer screening module of FHT and report positive predictive value of the algorithm for patients with eligibility criteria using clinical audits. Secondary analyses are aimed to understand how other lung cancer risk factors are recorded in the EMR.
METHODS: Five general practices will be recruited to install the lung cancer screening FHT module. Clinical files of patients identified by the FHT module will have their EMR data audited by a clinical researcher. This study is going to be submitted to ethics approval in February of 2023. Approval is expected by April 2023. Data collection is anticipated to be completed by July 2023.
GOALS: Results will be used to optimise and validate the algorithm prior to its implementation for future use in trials to identify patients who may be eligible to lung cancer screening in PC. We want also to understand the prevalence of lung cancer risk factors in the EMR.
AIM: To validate the lung cancer screening module of FHT and report positive predictive value of the algorithm for patients with eligibility criteria using clinical audits. Secondary analyses are aimed to understand how other lung cancer risk factors are recorded in the EMR.
METHODS: Five general practices will be recruited to install the lung cancer screening FHT module. Clinical files of patients identified by the FHT module will have their EMR data audited by a clinical researcher. This study is going to be submitted to ethics approval in February of 2023. Approval is expected by April 2023. Data collection is anticipated to be completed by July 2023.
GOALS: Results will be used to optimise and validate the algorithm prior to its implementation for future use in trials to identify patients who may be eligible to lung cancer screening in PC. We want also to understand the prevalence of lung cancer risk factors in the EMR.
Takeaways
At the end of the presentation, attendees will take away:
1. The efficacy of the used algorithm to identify eligible patients using electronic health record's data;
2. The process of clinical validation of our algorithm to identify patients that are eligible to lung cancer screening using international guidelines criteria;
3. Patterns of registration on electronic health record of other non-traditional lung cancer risk factors.
1. The efficacy of the used algorithm to identify eligible patients using electronic health record's data;
2. The process of clinical validation of our algorithm to identify patients that are eligible to lung cancer screening using international guidelines criteria;
3. Patterns of registration on electronic health record of other non-traditional lung cancer risk factors.
Biography
Lucas is an academic Family Doctor graduated in Brazil that is currently a Masters Student at University of Melbourne. His thesis is on ways to improve early Cancer diagnosis in Primary Care using Clinical Decision Support Systems at a Point of Care Level. He is also an enthusiastic about how to improve data usage for Primary Care research.
Prof Oswald Peter Adams
Dean
The University of the West Indies
Risky footwear practices and utility of the Slipping Slipper Sign among a population-based sample of people with diabetes in Barbados
Summary
Introduction: Barbados has a high diabetes-related lower extremity amputation (LEA) rate, and 89% of diabetes-related hospital admissions are due to foot disease. Peripheral arterial disease, neuropathy and risky footwear practices (RFPs) are LEA risk factors. RFPs include going barefoot outdoors, and use of slippers (open-back shoes).
The slipping slipper sign (SSS) - the unrecognised loss of slippers while walking - has high specificity and sensitivity for severe peripheral neuropathy in specialist clinics in the Caribbean. The objectives of this study were to describe RFPs and determine the sensitivity and specificity of the SSS in a community setting.
Methods: A representative population sample aged ≥ 25 years with new and previously diagnosed diabetes completed a questionnaire exploring footwear practices and the question “have you ever lost your slipper from your feet when walking and not realised you have done so?” Neuropathy was detected by 10g monofilament and neurothesiometer.
Results: Of 236 participants (73.7% response rate, 33.1% male, 90.7% black, median age 58.6 years, mean BMI 30.1 kg/m2, mean HbA1c 7.1%) 50.8% had previously diagnosed diabetes, 2 had amputations and 4 had foot ulcers. Males were more likely to never use footwear inside the house (66.7% vs 29.7%, p<0.001). Females were more likely to go barefoot outdoors (15.3% vs 12.8%, p=0.136), report regular outdoor slipper use (77.8% vs 46.2%, p<0.001), and wear slippers to the assessment centre (42.7% vs 18.2%, p<0.001).
Neuropathy prevalence was 28.5% (95% CI 22.7 to 34.4) as indicated by monofilament with ≥ 1 insensate site and/or vibration perception threshold > 25 V. Among 222 slipper users, SSS had 14.3% sensitivity and 94.6% specificity for neuropathy (positive predictive value 50.0%, negative predictive value 76.6%).
Discussion: RFPs are common modifiable risk factors for diabetes-related LEA in a tropical country. The SSS is a poor predictor of neuropathy in community settings.
The slipping slipper sign (SSS) - the unrecognised loss of slippers while walking - has high specificity and sensitivity for severe peripheral neuropathy in specialist clinics in the Caribbean. The objectives of this study were to describe RFPs and determine the sensitivity and specificity of the SSS in a community setting.
Methods: A representative population sample aged ≥ 25 years with new and previously diagnosed diabetes completed a questionnaire exploring footwear practices and the question “have you ever lost your slipper from your feet when walking and not realised you have done so?” Neuropathy was detected by 10g monofilament and neurothesiometer.
Results: Of 236 participants (73.7% response rate, 33.1% male, 90.7% black, median age 58.6 years, mean BMI 30.1 kg/m2, mean HbA1c 7.1%) 50.8% had previously diagnosed diabetes, 2 had amputations and 4 had foot ulcers. Males were more likely to never use footwear inside the house (66.7% vs 29.7%, p<0.001). Females were more likely to go barefoot outdoors (15.3% vs 12.8%, p=0.136), report regular outdoor slipper use (77.8% vs 46.2%, p<0.001), and wear slippers to the assessment centre (42.7% vs 18.2%, p<0.001).
Neuropathy prevalence was 28.5% (95% CI 22.7 to 34.4) as indicated by monofilament with ≥ 1 insensate site and/or vibration perception threshold > 25 V. Among 222 slipper users, SSS had 14.3% sensitivity and 94.6% specificity for neuropathy (positive predictive value 50.0%, negative predictive value 76.6%).
Discussion: RFPs are common modifiable risk factors for diabetes-related LEA in a tropical country. The SSS is a poor predictor of neuropathy in community settings.
Takeaways
1. Risky foot practices such as the wearing of open-back slippers and walking barefoot outdoors are common among people living with diabetes in Barbados.
2. The slipping slipper sign, the unrecognised loss of a slipper while walking, lacks the sensitivity needed for use as a screening tool for diabetes-related peripheral neuropathy in community settings.
3. Primary care screening for risky footwear practices, and behavioural interventions to modify these, have the potential to reduce lower extremity amputation risk in people living with diabetes in Barbados and other tropical countries and warrant investigation.
2. The slipping slipper sign, the unrecognised loss of a slipper while walking, lacks the sensitivity needed for use as a screening tool for diabetes-related peripheral neuropathy in community settings.
3. Primary care screening for risky footwear practices, and behavioural interventions to modify these, have the potential to reduce lower extremity amputation risk in people living with diabetes in Barbados and other tropical countries and warrant investigation.
Biography
Dr Peter Adams is a Professor of Family Medicine. He was Dean of the Faculty of Medical Sciences, The University of the West Indies, Cave Hill campus between 2015 and 2023.
He completed secondary school at Queens College in Guyana, received a BSc in Biochemistry from Imperial College of Science and Technology, University of London and a MBBS and DM from the University of the West Indies. He is a primary care researcher, educator and clinician who has been practising medicine for 37 years in Barbados. Prior to becoming Dean in 2015, he coordinated both the undergraduate and postgraduate Family Medicine programmes at Cave Hill Campus. He introduced a Diploma in Family Medicine by distance with doctors in several Eastern Caribbean islands enrolled.
His research focuses on aspects of chronic noncommunicable diseases and sexually transmitted infections relevant to the practice of Family Medicine. He is the Barbados site Principal Investigator of the NIH funded Eastern Caribbean Health Outcomes Network (ECHORN) cohort project.
Prof Damilya Nugmanova
President
Kazakhstan Association Of Family Physicians
Monitoring visits, patient assessment, and reminders as noncommunicable diseases management improvement tools in remote rural areas of Kazakhstan.
Summary
The study goal was to improve noncommunicable disease management in a remote rural area of Kazakhstan. To achieve this goal KAFP experienced clinicians visited rural clinics to assist doctors and nurses in correcting treatment, consulting, observing, and supporting both healthcare providers and patients to achieve target numbers.
Methods. For monitoring and evaluation purposes we selected 9 rural GPs, their 27 nurses, and their 114 patients with arterial hypertension (AH) and 2 type diabetes (2TD). The patients were between the ages of 40 and 65. There were two simple monitoring indicators: achieving the target blood pressure level in patients with AH and achieving the target level of HbA1c in 2TD patients.
Each of the 114 patients had 3 assessment visits: initial, intermediate, and final. Anthropometric measurements, BP, and laboratory tests (fasting plasma glucose, creatinine, LDL, HDL, TC, and TG for all; and HbA1c in patients with diabetes) were taken. Statistical analysis was performed using the STATA software package.
Results. From April to November 2022 KAFP instructors completed 33 monitoring trips to Qulsary, Maikomgen, Kosshagyl, Shokpartogai, Akkiyiztogai, Turgyzba, and Zhana Karaton villages of Atyrau Oblast of Kazakhstan.
Before the study, 30% of AH patients had systolic BP below 140 mmHg. After the second and third visits 34% and 60% of them, respectively, had achieved the target SBP. Regarding diastolic BP, 45% of patients had levels below 90 mm Hg at the first visit, but this increased to 74% at the third visit.
23% of patients with diabetes initially had HbA1c within the target range (below 7%) and the proportion increased to their third visit up to 28%.
Monitoring consulting visits of experienced colleagues, case discussions, and reminders helped rural doctors and nurses to gain experience in chronic disease management
Methods. For monitoring and evaluation purposes we selected 9 rural GPs, their 27 nurses, and their 114 patients with arterial hypertension (AH) and 2 type diabetes (2TD). The patients were between the ages of 40 and 65. There were two simple monitoring indicators: achieving the target blood pressure level in patients with AH and achieving the target level of HbA1c in 2TD patients.
Each of the 114 patients had 3 assessment visits: initial, intermediate, and final. Anthropometric measurements, BP, and laboratory tests (fasting plasma glucose, creatinine, LDL, HDL, TC, and TG for all; and HbA1c in patients with diabetes) were taken. Statistical analysis was performed using the STATA software package.
Results. From April to November 2022 KAFP instructors completed 33 monitoring trips to Qulsary, Maikomgen, Kosshagyl, Shokpartogai, Akkiyiztogai, Turgyzba, and Zhana Karaton villages of Atyrau Oblast of Kazakhstan.
Before the study, 30% of AH patients had systolic BP below 140 mmHg. After the second and third visits 34% and 60% of them, respectively, had achieved the target SBP. Regarding diastolic BP, 45% of patients had levels below 90 mm Hg at the first visit, but this increased to 74% at the third visit.
23% of patients with diabetes initially had HbA1c within the target range (below 7%) and the proportion increased to their third visit up to 28%.
Monitoring consulting visits of experienced colleagues, case discussions, and reminders helped rural doctors and nurses to gain experience in chronic disease management
Takeaways
1. Physicians and nurses in Kazakhstan primary care organizations are not interested in chronic disease management
2. 2. Kazakh rural GPs and their nurses have very little knowledge regarding the importance of achieving the treatment target goals
3. KAFP monitoring visits and experience sharing helped to improve the target indicators, but needs time. Incentives are urgently needed
2. 2. Kazakh rural GPs and their nurses have very little knowledge regarding the importance of achieving the treatment target goals
3. KAFP monitoring visits and experience sharing helped to improve the target indicators, but needs time. Incentives are urgently needed
Biography
Prof. Damilya Nugmanova is well known as a Family Medicine, Primary Health Care (PHC), and evidence-based medicine (EBM) Specialist in Central Asia (CAR) and the former Soviet Union. Since the mid-90s she was one of the leaders of deep health reforms based on the PHC restructuring and independence from the hospital and specialty care. In collaboration with US and UK doctors, health finance, clinical pharmacists, and other international specialists Dr. Nugmanova has been advocating for the introduction and development of Family Medicine in Kazakhstan and CAR for nearly thirty years.
Dr. Nugmanova is a famous teacher. She has organized and taught numerous training courses for physicians, health educators, and health administrators in Kazakhstan and Central Asia. Her courses are well organized, efficiently carried through, and interesting. She has made productive use of all the conferences, training courses, and workshops she has attended to develop her teaching skills.
In 1996 Damilya Nugmanova organized the Family Medicine Trainers’ Association, which has provided training for the teachers from all the medical schools of Kazakhstan, developed the first curricula for family medicine continuous education, retraining practicing primary care Internists and Pediatricians, and then FM residency standards and curriculum.
In 1998 she with a group of enthusiastic doctors and teachers organized the Kazakhstan Association of Family Physicians, which has now hundreds of members. Since April 2003 KAFP is a full Wonca member. KAFP holds many international and local FM meetings and runs different healthcare improvement projects and epidemiological studies in Kazakhstan and neighboring countries. In November 2022 at the last KAFP meeting, 600 participants from Kazakhstan, CAR, UK, and US discussed working conditions, incentives, payment systems, and e-health problems.
Kazakhstan’s most prominent family physician has been named World organization of Family Doctors (WONCA) Global Family Doctor of the Month for August 2005.
