Importance: Children in acute pain often receive inadequate pain relief, partly from difficulties administering injectable analgesics. A rapid-acting, intranasal analgesic may be an alternative.

Objective: To compare the efficacy, safety, and acceptability of intranasal analgesia to intravenous and intramuscular administration; and to compare different intranasal agents.

Data sources: Cochrane Library, MEDLINE/PubMed, Embase, Web of Knowledge, Clinicaltrials.gov, Controlled-trials.com/mrcr, Clinicaltrialsregister.eu, Apps.who.int/trialsearch. We screened reference lists of included trials and relevant systematic reviews.

Data extraction and synthesis: Two authors independently assessed all studies. We included randomised trials of children 0-16, with moderate to severe pain; comparing intranasal analgesia to intravenous or intramuscular analgesia, or to other intranasal agents. We excluded studies of procedural sedation or analgesia. We extracted study characteristics and outcome data and assessed risk of bias with the ROB 2.0-tool. We conducted meta-analysis and narrative review, evaluating the certainty of evidence using GRADE.

Main outcomes and measures: Outcomes included pain reduction, adverse events, acceptability, rescue medication, ease of and time to administration.

Results: 12 RCTs were included with totally 1163 children aged 3-20, most below 10 years, with various conditions.
- There may be little or no difference in pain relief, adverse events, or acceptability between intranasal and intravenous analgesia (low certainty evidence).
- Intranasal diamorphine or fentanyl probably give similar pain relief to intramuscular morphine, and are probably more acceptable and tolerated better (moderate certainty); adverse events may be similar (low certainty).
- Intranasal ketamine gives similar pain relief to intranasal fentanyl, while having a higher risk of light sedation and mild side effects (high certainty). Need for rescue analgesia is probably similar (moderate certainty), and acceptability may be similar (low certainty).

Conclusions/relevance: Intranasal analgesics are probably a good alternative to intramuscular analgesics in children with acute moderate to severe pain; and may be an alternative to intravenous administration.

1. Intranasal analgesics are probably a good alternative to intramuscular analgesics in children with acute moderate to severe pain
2. Intranasal analgesics may be an alternative to intravenous administration
3. The choice between opioids and ketamine should depend on whether sedation is desirable

Background
One in four GP appointments are for children. Many of these appointments are for “respiratory tract infections” (RTIs). At least 1 in 3 children are prescribed an unnecessary course of antibiotics for these illnesses. Recent research from over 250,000 UK children highlighted those children who had taken two or more antibiotic courses for RTIs in the last year had around a 30% greater chance of not responding to treatment for future RTIs compared to children who had not taken no antibiotics.

Question
What is the feasibility of using a child’s antibiotic history as a data-enabled brief intervention to optimise antibiotic prescribing ?

Methods
This research has two phases. In phase 1, through a series of ‘think aloud’ workshops and interviews, we worked together with parents and clinicians on how best to design the computer screen prompt and personalised consultation print-out and whether this would be acceptable for parents and clinicians.
In phase 2, GPs/nurses have the opportunity to explore and use a prototype computer-based prompt and consultation print-out, developed from Phase 1 and integrated into the GP computer software and share their feedback through a series of ‘think aloud’ interviews.

Outcomes
We have co-developed two components of an electronically embedded intervention (computer-screen prompt, print-out) with parents of young children, clinicians and information design specialists. Phase 2 in currently in progress.

Discussion
Delivering such interventions, integrated into practice workflow, could be scaled up to promote effective antimicrobial stewardship and reduce unnecessary antibiotic use in primary care.

1. Co-design of data-enabled brief intervention
2. Feasibility and acceptability of this intervention in pilot GP practices
3. Understand the barriers and facilitators of using the prompt during GP consultations

Australian emergency departments are under increased pressure with increased demand and overcrowding. The type of urgent care services provided in general practice (GP) often overlap with the low acuity presentations in emergency departments (ED). Paediatric patients that present frequently to ED often have complex health problems independent of the triage category they are assigned at each presentation. Socio-economic factors can also impact on the use of emergency services.
General practice provides the majority of health care for patients with complex health conditions and is linked with reduced hospitalisation and improved health outcomes.
This retrospective study aims to increase understanding of patients who attend a tertiary paediatric emergency department frequently with a focus on GP involvement. The medical records of children aged under 18 years who have attended the WCH PED >5 times in 12 months over a retrospective 2-year timeframe were reviewed. An analysis of GP, Patient and Hospital factors was reviewed. GP factors: recorded GP in the hospital medical record, clinical handover and coordination with patient’s GP. Patient factors: health conditions, ethnicity, age, postcode, frequency of visits, presenting complaint. Hospital factors: admissions, cost analysis.
An increased understanding of the needs of paediatric patients who attend the ED can inform appropriate strategies to improve supports such as regular longitudinal GP care and improved coordination of care between emergency and GP health services.

1. Increase understanding of risk factors for children attending emergency departments frequently
2. Understanding current gaps in the coordination of care between hospital and GP care for children with high health needs
3. Health systems need to understand the preventive, chronic disease management and holistic care needs of children and their families and consider the role general practice in reducing demands on the emergency

Humans have always had a wonderful diversity of gender and sexuality, and we are delighted to live in a time where this is becoming increasingly recognised and supported.

We recognise that it can be difficult finding pathways to Gender Affirming Care, despite this being vital for the health and wellbeing of our local trans and gender diverse community.

We have made it a priority to educate ourselves, our registrars and our medical students about Transgender and Gender Diverse (TGD) health care to increase the supply of appropriately educated and skilled doctors in Sydney and surrounds.

It is important to us that intersex, transgender, non binary and gender diverse people have safe and welcoming experiences with us, as we know that they may not have had that with all other health professionals, family members or friends.

We have had the honour of helping many people with Gender Affirming Care, whether that be with hormone therapy, surgery, speech pathology or whatever is important to our patients. We may not know everything, but we are constantly learning!

All of the GPs and staff at KFMP are happy to support and care for all patients on their health journeys. The following doctors have undertaken additional training and education in gender affirming care.

In response to the interest in the details of the informed consent pathway to gender affirming HRT, we are releasing a copy of the KFMP guiding document for the AUSPATH staged informed consent pathway. Individual assessments are personalised, but many people will have about 3 visits to cover these stages.

1. Demonstrating how a suburban general practice can support whole practice care
2. Encourage others to also provide gender affirming care

Aim: The Lesotho Boston Health Alliance Family Medicine Specialty Training Program has identified point-of-care ultrasound (POCUS) as a key clinical competency. Registrars receive didactic and practical instruction on POCUS throughout their training. One noted benefit is the diagnostic use in HIV-associated tuberculosis. Lesotho has the highest incidence of tuberculosis and second-highest prevalence of HIV globally. Over 70% of patients treated for tuberculosis are co-infected with HIV. Children continue to be infected with HIV despite remarkable improvements in uptake of prevention of mother-to-child transmission interventions.
Content: An 11-year-old boy presented to Motebang District Hospital with primary complaints of shortness of breath and abdominal distension. He had been diagnosed with HIV two months prior and begun on an antiretroviral treatment regimen of abacavir/lamivudine/dolutegravir. At the time of presentation, he also complained of fever, cough, and two-pillow orthopnoea. Some abdominal distension had been noted at his HIV diagnosis but had dramatically worsened. Physical examination was notable for wasting, tachypnoea, and massive abdominal organomegaly.
Abdominal POCUS was added to traditional tuberculosis diagnostic tools of sputum examination and radiography. No ascites were present. The liver was enlarged with normal architecture and echogenicity. The spleen was massively enlarged with complete loss of normal architecture and presence of multiple abscesses, consistent with tuberculosis disease. Four-drug treatment for tuberculosis was begun with steady improvement in clinical symptoms. Repeat POCUS after one month showed reduction in organomegaly and normal splenic architecture.

Goals: POCUS can support clinical diagnosis and management of HIV-associated tuberculosis and many other conditions encountered at district hospitals in Lesotho. Comprehensive primary health care provision is enhanced by the inclusion of POCUS competency in the training of Family Medicine registrars in Lesotho.

1. Benefits of POCUS in clinical practice
2. Utility of POCUS in HIV-associated tuberculosis
3. Incorporation of POCUS in residency programs