To identify the frequency and etiology of upper and lower gastrointestinal bleeding in patients admitted to the Pediatric Service of the Itaugua National Hospital. Material and method: Observational, cross-sectional, retrospective study, descriptive scope. Patients admitted to the Pediatric Service of the Itaugua National Hospital from January 1, 2017 to December 31, 2019 were included. Cases with incomplete information in the documentary records, hospitalized newborns and all those who did not have with endoscopic diagnosis. Protocol approved by the Ethics Committee of the Medicine School of the Universidad del Norte. Results: 60 cases were analyzed, the highest incidence in preschool and school age groups with 30% respectively. Equitable sex distribution. 85% of cases corresponded to lower digestive hemorrhages and 15% to upper ones. In 100% of the cases they presented rectal bleeding in the discharges and nausea, vomiting and hematemesis in the discharges. Endoscopic findings: eight pathologies were responsible for digestive bleeding, rectal polyps being responsible for 86% of discharges, and gastric ulcers for 33% of discharges. Mortality: 1.6%. Conclusion: No gender prevalence was found. Higher incidence of lower gastrointestinal bleeding (85%). In the symptomatology, hematemesis, nausea and vomiting are the most frequent in upper gastrointestinal bleeding and rectal bleeding in lower ones. Eight pathologies were responsible for digestive bleeding. The reported mortality is extremely low. More ambitious future studies regarding epidemiological data are recommended.

gastrointestinal bleeding, pediatrics, epidemiology of health services, endoscopy.

General practitioners (GPs) often have a small cohort of patients who frequently attend. Some have medically explainable reasons for their frequent attendance, but some cases are challengingly unexplainable in the biomedical context. In such instances, patients can feel ignored and clinicians can feel ineffective. The Australian Institute of Health and Welfare reports that over 12% of people saw their GP ≥ 12 per year compared to the average of 5.6 visits per person, per year. Similarities are found in other countries.

Frequent attending patients have increased risks of developing chronic mental or physical conditions compared to people who do not frequently attend. Frequent attendance is paradoxically associated with lower quality of life scores, increased medication use and healthcare costs across the system. Australia has indicated the desire to move to voluntary patient enrolment greater highlight the need for higher value care and ensure that unmet needs of frequently attending patients are appropriately uncovered and addressed.

This Roundtable presents the framework used at Inala Primary Care (IPC), a GP clinic in a socioeconomically marginalised suburb of Brisbane, Queensland. The framework was based on a published study. It prompts GPs with troublesome cases of frequent attendance to assess broad whole-of-person factors which could be driving the attendances. Led by a GP facilitator, regular meetings are held and the group discussion guided through the structured process. The management steps and resources that emerge are scribed and later shared with the whole clinic. Commonly seen management strategies that emerged at IPC included linking the patient with social prescribing service or multicultural health access services.

From this interactive Roundtable, you will become confident in:
1. Defining and identifying frequent attendance in your practice;
2. Be equipped with the evidence-based framework to assess, discuss and address, difficult frequent attending cases;
3. A structure to inform others in your team of the possible management steps.

Against the backdrop of a rapidly aging population, growing frailty and its complications will exert a significant burden on our healthcare and social support systems. The healthcare system is unable to adequately address weak and negative social determinants of health. Past frailty intervention programmes were observed to be over-medicalised and heavily reliant on medical personnel which is costly, hard to scale and sustain.

Western Silvercare (WSC) is an innovative programme that delivers a cost effective and integrated approach to prevent and reduce frailty in community dwelling older adults. Older adults aged 60 and above who were identified to be pre-frail or frail on the FRAIL scale were enrolled into the programme. Individuals who were home-bound, had cognitive impairment, or had prognosis less than 1 year were excluded.

The WSC ‘wellness’ model incorporates health and social care components, allowing us to integrate health promotion into every aspect of community living. Implementing this programme with social service partners has allowed us to anchor care in the community in more sustainable, and cost-effective ways while improving capabilities and capacity of our social sector partners to play pivotal roles in community health promotion.

The WSC programme is based on a holistic comprehensive needs assessment covering 5 domains (Medical, Physical, Nutritional, Cognitive, and Psychosocial). A customed intervention plan is based on the assessment. Regular monitoring and health education is provided for Seniors. These interventions are provided across the community, home, and institution-based settings, catering to individual needs and preferences, and greatly increasing access to this frailty intervention programme.

At 12 months, FRAIL scores improved by a mean of -0.43 (SD 0.92, 95% CI [-0.66 – -0.20], p<0.001). 46% had improved scores, 40% had the same scores, and only 14% has deteriorated scores (p=0.006). Self-reported health rating improved from an average of 66-72(out of 100), p=0.006).

1. Embrace digital solutions as the upcoming generations of older adults would have high digital penetration and digital literacy.
2. Invest in long-term community partnerships, cross-share skills between various sectors, and create regular platforms for coalitions to come together to discuss issues that can benefit the communities. Moving forward, health, social, security, financial and environmental issues will become even more inter-linked and only multi-agency collaboration at the local level can create the impact needed to solve these complex problems.
3. Health and social integration models should be applied to all health issues beyond frailty. Our model shows a pathway towards population health.

Aim
Influenza vaccination is suggested to all health care workers (HCW) and professionals. However, as previous research indicates, vaccination rate among HCWs is low due to certain unknown/undefined factors. Therefore, this study aimed to investigate and ascertain the
awareness, knowledge, barriers, and enablers of use of seasonal influenza vaccines by HCWs.

Content
This is ongoing non-analytical, descriptive, observational, cross sectional survey study which is going to be conducted for primary data gathering from health care providers working in 36 major
district hospitals in all the nine divisions across the Punjab Pakistan using a validated (Cronbach’s alpha = 0.88), researcher-administered questionnaire comprises of 30 items in three sections that collected information about the participants’ demographics, general knowledge,
current perceptions for accepting and rejecting the seasonal influenza vaccines.
HCWs including specialists, general medical doctors, surgeons, dentists, nurses, assistants to physicians, surgeons, dentists and nurses, physical therapists, radiologists, occupational
therapists, dieticians or nutritionists, phlebotomists, paramedics, dispensers, and support staff (porters, cleaners, and ward attendants) were included in the study population. The health care
workers who were unable to understand both languages (English and Urdu) were excluded from
the study. Agreement to participate in the survey was be affirmed by signing the informed consent form by all the participants.

Goal
The specific goals were to identify the causes of reluctance among health care workers in use of influenza vaccine, to find ways to address issues raised by health care workers and to determine factors that motivate health care workers to have influenza jab.

1- With regards to continuing professional development, the key insights of the study will be how a well-organized & effective influenza vaccination programme can reduce morbidity and mortality due to
influenza particularly in high-risk populations

2- This study will help assess and addressing lack of awareness and reluctance among HCWs and support staff in healthcare facilities. This in turn may increase use of vaccine among the above-
mentioned population.

3- Influenza vaccination among HCWs will prevent absenteeism among vaccinated cohorts compared to non-vaccinated.An intervention like this can prove to be cost effective for a low
middle income country like Pakistan

Beginning in 2012, national organizations representing medical specialists have asked their members to identify tests or procedures commonly used in their field whose necessity should be questioned and discussed. This call to action known as Choosing wisely recommendations has resulted in specialty-specific lists. Slovak Society of General Practice initiated Choosing wisely project among GPs from bottom to the top.
Using online structured questionnaire 85 active GPs (age 29-70, practicing as a GP for 1-49 years) collected over 200 possible recommendations. In the second round 20 most common suggestions were selected and circulated among 30 GP leaders and members of the national council, who scored each suggestion for recommendation between 1-10. As a result, the list of 7 top recommendations was created, published, and presented during the national conference of general practitioners. Results were also presented to health insurance companies and at the national patient´s conference.
Choosing wisely recommendations have the potential to reduce unnecessary care - to reduce overuse of diagnostic procedures and treatment. This has benefits not only on the patients but reduces the unnecessary costs of healthcare as well.

1. Prevention of overdiagnosing and overtreatment is an important issue
2. General practitioners are able to identify common, but avoidable tests or procedures
3. Avoiding unnecessary tests and procedures is of benefit for patients and reduces healthcare costs