The ePoster will describe research underway in Scotland to identify elements of excellence in providing advanced practice supervision in remote and rural health and care .The poster will highlight the need for the findings from this research to be used to develop the first Rural Practice Supervision Hub to support the development of rural Family Medicine and Advanced Nurse Practitioners.

The poster will provide a visual presentation of the both the rationale and research methods employed in this integrative review and thematic synthesis of the published literature relating to health and care practice supervision in international remote and rural geographies.

The Remote and Rural Healthcare Education Alliance (RRHEAL) , NHS Education for Scotland have developed the Rural Advanced Nurse Practitioner (RANP) Capability Framework the first of its kind in the country .The RANP Capability Framework provides the foundation for the new and unique Masters’ level Rural ANP qualification which will be delivered in 2023. The aim of the research and the establishment of the new postgraduate qualification and the Rural Practice Supervision Hub is to ensure rural practitoners are well supported in undertaking training and development within remote and rural settings. The research project described in this presentation will highlight the evidence based approach being taken to identifying and meeting the specific educational needs of practitioners working in remote and rural settings.

The development of the Rural Workplace Practice Supervision Hub is underway in addition to the delivery of the new RANP programme. The poster will describe the importance of ensuring that rural practitioners are supported to become rural practice supervisors and the need for rural practitioners to have ready access to good quality rural supervision in addition to rural specific education programmes.

1. The rationale for developing a Rural Practice Supervisory Hub
2. An understanding of the research being conducted to support rural primary care practice supervision.
3. The value of supporting practitoners to develop their skills as supervisors

Definite factors for the manifestation of dengue haemorrhagic fever (DHF) are yet unconfirmed. This study attempted to understand the factors that may lead to severe dengue by evaluating sociodemographic factors, home and herbal remedies, primary care related therapeutic and diagnostic factors and the past medical history in patients with dengue.

Descriptive cross-sectional study was carried out among 876 admitted to National Hospital of Sri Lanka (n=553), and Lady Ridgeway hospital for children (n=323) from September 2020 to August 2021. Data was collected using a questionnaire and the patients were followed up until discharge. Using SPSS V 25 the data was analysed with Chi squared, Fisher’s exact test and Binary logistic regression analysis.

The mean age of the total population was 23.02 years and there was a significant male predominance (P=0.05). The commonest bite prevention method was mosquito nets 460, (52.5%), skin repellents used by 20 patients, (2.3%). Only 55, (6.3%) of them practiced source reduction by cleaning breeding places. Of the total sample 182, (20.8%) were diagnosed as having DHF.
According to the bivariate analysis, Moor ethnicity (p=0.037), children of parents with low education (p=0.020), obesity (p=0.014), children with history of dengue (P=0.009) and patients who used corticosteroids (P<0.001) had increased odds of getting DHF.
Of the sample 796 (90.8%) visited a doctor, 708 (80.8%) had been investigated and 667 (76.1%) had been followed up by a primary care doctor. Patients who developed DHF were reviewed more by the doctor (p=0.041).
Multiple logistic regression showed, age below 14 years (aOR=1.67), platelet count below 100,000 on admission (aOR=14.69), history of dengue (aOR= 1.840) and hypertension (aOR=3.122) to have an increased risk of getting DHF.
All the factors associated with DHF in this study were already present in the patient prior to the development of dengue, except for corticosteroids and platelets <100,000.

1. Factors associated with DHF
2. Health seeking behaviour and management of dengue at primary care

Definite factors for the manifestation of dengue haemorrhagic fever (DHF) are yet unconfirmed. This study attempted to understand the factors that may lead to severe dengue by evaluating sociodemographic factors, home and herbal remedies, primary care related therapeutic and diagnostic factors and the past medical history in patients with dengue.

Descriptive cross-sectional study was carried out among 876 admitted to National Hospital of Sri Lanka (n=553), and Lady Ridgeway hospital for children (n=323) from September 2020 to August 2021. Data was collected using a questionnaire and the patients were followed up until discharge. Using SPSS V 25 the data was analysed with Chi squared, Fisher’s exact test and Binary logistic regression analysis.

The mean age of the total population was 23.02 years and there was a significant male predominance (P=0.05). The commonest bite prevention method was mosquito nets 460, (52.5%), skin repellents used by 20 patients, (2.3%). Only 55, (6.3%) of them practiced source reduction by cleaning breeding places. Of the total sample 182, (20.8%) were diagnosed as having DHF.
According to the bivariate analysis, Moor ethnicity (p=0.037), children of parents with low education (p=0.020), obesity (p=0.014), children with history of dengue (P=0.009) and patients who used corticosteroids (P<0.001) had increased odds of getting DHF.
Of the sample 796 (90.8%) visited a doctor, 708 (80.8%) had been investigated and 667 (76.1%) had been followed up by a primary care doctor. Patients who developed DHF were reviewed more by the doctor (p=0.041).
Multiple logistic regression showed, age below 14 years (aOR=1.67), platelet count below 100,000 on admission (aOR=14.69), history of dengue (aOR= 1.840) and hypertension (aOR=3.122) to have an increased risk of getting DHF.
All the factors associated with DHF in this study were already present in the patient prior to the development of dengue, except for corticosteroids and platelets <100,000.

1. Factors associated with DHF
2. Health seeking behaviour and management of dengue at primary care

Informative presentation
Rawiporn Charoensawat.//(2022).// Efficiency of 3 types of medical grade Cannabis as an adjuvant therapy in medical cannabis clinic at Nan hospital.//
Objectives: To compare the efficacy of 1.7%THC ,2.7%THC : 2.5%CBD and 10%CBD cannabius drop as adjuvant therapy in neuropatic pain , vomiting ,anorexia ,insomnia and rididity in palliative care patients for 12 weeks.
Study Design: Prospective observations,Cross sectional study
Setting: Out-patient clinic of medical canabius clinic, Nan Hospital
Subjects: The 55 patients with palliative performance scale > 40% who attended to treat symptoms between August to November 2021 were recruited and assigned to 3 group of medical cannabius.
Methods: Medical cannabius were applied one time a day via sublingual respectively for every 4-wk treatment period,then all subjects completed the Thai-form of Edmonton Symptom Assessment System(ESAS).The last week of research carried out blood exam for Glomerular Filtration Rate(GFR) ,alanine aminotransferase(ALT) and aspartate aminotransferase (AST).
Results: The 1.7%THC group showed significant diminished in the total score and the present pain intensity ,anorexia and insomnia (p<0.001 ,p <0.001p=0.002, respectively), and the mean difference of total score are 4.27,4.95,2.2(p<0.001all) . Results indicated GFR before and the 12th week after treatment of 2.7%THC :2.5%CBD group significantly decreased
(p<0.001). The 10%CBD group showed significant increase in ALT/AST level especially in the present of the 12th week (p<0.05).
Conclusion: The medical cannabius as an adjuvant therapy showed better results in improvement of chronic nonspecific neuropatic pain,anorexia and insomnia symptoms than to use only conventional medicine.
Key words: THC, CBD, palliative care

1.How to titrate medical canabius properly in palliative care patients.
2.How to prevention severe adverse effect of medical cannabius.
3.The advantage of start medical cannabius as an adjuvant drug of neuropatic pain,vomiting ,anorexia and insomnia.

Lumps and bumps are relatively common presenting problems in the primary-care/general practice, and their differential diagnoses diverse with anatomical location. Clinical and imaging diagnosis of soft-tissue lumps are challenging at times, when it is not commonly expected lipoma or epidermoid cyst. Sometimes, routine punched biopsy may not determine a diagnosis.

Author/s here will present how to taper down from commonly expected lumps to how to proceed further steps for management of other (unexpected) lumps. This will be included differential diagnoses of body-surface lumps, pertinent history and examination, available imaging and tips for colleagues practising in rural/remote or small-town areas. Methods of biopsy, incision and excision depending upon individual practice’s resources and location will also be addressed.
Keywords: Lumps and bumps, Soft tissue lumps, Body surface lumps, Schwannoma,

References: 1 – 10 on request.

1. How to manage the soft-tissue lumps from a GP: a full management including total excision in the practice, or establishing a diagnosis prior to referral.
2. Following relevant history and examination, ultrasonography is useful as a next step non-invasive tool to be able to appreciate the size, attachment, and vascularity of the lump prior to procedure, and also confirmation of common lumps such as lipoma or cyst.
3. The use of punch biopsy for subcutis lumps may yield a false-negative report from inadequate tissue sampling.