Clinical practice poster session 8
Track 8
| Thursday, October 26, 2023 |
| 1:30 PM - 2:05 PM |
| Exhibition Hall |
Speaker
Ms Kathryn Thorburn
Phd Candidate, Medicine & Health
University of New South Wales
Co-designing a Physical Health Conversation Guide to support physical health consultations with mental health consumers in primary care
Summary
Aim:
This research aimed to determine the feasibility of co-designing an intervention for improving mental health consumers’ physical healthcare in primary care settings. It also explored the co-design process, how outcomes were achieved and the co-designers’ experiences.
Content:
General practice plays a significant role in the physical healthcare of people diagnosed with mental illness, which has only increased due to COVID-19. However, mental health consumers and general practitioners report significant barriers to (respectively) accessing and providing physical healthcare, with challenges at the individual, practice, and systems levels. Co-design provides a forum where service users and providers can collaborate to improve healthcare services and relationships.
This online co-design involved mental health consumers, families/carers, general practitioners, mental health peer workers, and a representative from the primary health network (PHN). Data included records from co-design activities, and co-designers’ experiences of the process obtained via group and individual interviews. Transcribed audio-recordings of individual and group interviews, project documentation and images were coded and analysed thematically.
Thirty barriers to physical healthcare and 12 potential solutions were identified through the co-design. From these, a Physical Health Conversation Guide to support consultations between mental health consumers and general practitioners was selected to be prototyped and tested. The research identified key co-design processes that supported relationship building, knowledge co-creation, and negotiating action towards better primary care systems and practice.
Research that enhances our understanding of online co-design will support effective co-design planning and facilitation in primary care and other healthcare settings. This research has implications for anyone interested in collaborative approaches to practice and systems change.
Goals:
To describe a co-design involving general practitioners and mental health consumers that aimed to support physical health consultations in primary care settings.
To explore mechanisms contributing to effective co-design for practice and systems improvement and innovation in primary care.
This research aimed to determine the feasibility of co-designing an intervention for improving mental health consumers’ physical healthcare in primary care settings. It also explored the co-design process, how outcomes were achieved and the co-designers’ experiences.
Content:
General practice plays a significant role in the physical healthcare of people diagnosed with mental illness, which has only increased due to COVID-19. However, mental health consumers and general practitioners report significant barriers to (respectively) accessing and providing physical healthcare, with challenges at the individual, practice, and systems levels. Co-design provides a forum where service users and providers can collaborate to improve healthcare services and relationships.
This online co-design involved mental health consumers, families/carers, general practitioners, mental health peer workers, and a representative from the primary health network (PHN). Data included records from co-design activities, and co-designers’ experiences of the process obtained via group and individual interviews. Transcribed audio-recordings of individual and group interviews, project documentation and images were coded and analysed thematically.
Thirty barriers to physical healthcare and 12 potential solutions were identified through the co-design. From these, a Physical Health Conversation Guide to support consultations between mental health consumers and general practitioners was selected to be prototyped and tested. The research identified key co-design processes that supported relationship building, knowledge co-creation, and negotiating action towards better primary care systems and practice.
Research that enhances our understanding of online co-design will support effective co-design planning and facilitation in primary care and other healthcare settings. This research has implications for anyone interested in collaborative approaches to practice and systems change.
Goals:
To describe a co-design involving general practitioners and mental health consumers that aimed to support physical health consultations in primary care settings.
To explore mechanisms contributing to effective co-design for practice and systems improvement and innovation in primary care.
Takeaways
At this conclusion of this presentation, attendees will take away:
1. A Physical Health Conversation Guide co-designed to support physical health consultations between mental health consumers and general practitioners.
2. An example of online co-design, how it was experienced by mental health service users, general practitioners and other stakeholders, and implications for planning and facilitating co-design in primary care.
3. An understanding of how co-design processes can inform collaborative approaches to practice and systems development in primary care.
1. A Physical Health Conversation Guide co-designed to support physical health consultations between mental health consumers and general practitioners.
2. An example of online co-design, how it was experienced by mental health service users, general practitioners and other stakeholders, and implications for planning and facilitating co-design in primary care.
3. An understanding of how co-design processes can inform collaborative approaches to practice and systems development in primary care.
Biography
Kath Thorburn, B App Sc (OT), M Ed (Adult Ed), has over 30 years’ experience as a mental health clinician, educator, facilitator and consultant and is recognised for her work in co-design and co-production, project management, curriculum development and delivery, and curating innovative mental health events and projects. Kath has experience working in public mental health services and educational institutes, and co-founded a mental health consultancy with a reputation for collaborative and lived experience led approaches. Kath is a PhD candidate at the UNSW Centre for Primary Health Care and Equity, researching a co-designed approach to improving the physical health of people with lived experience of mental health issues in primary care settings.
Ms Fukuko Matsumoto
Jichi Medical University Saitama Medical Center
Advanced anaplastic carcinoma of the pancreas resulted in the Sister Mary Joseph's node: An autopsy case.
Summary
Introduction: Sister Mary Joseph’s nodule (SMJN) is an umbilical skin metastasis originating from abdominopelvic malignancy. This report presents a rare case of anaplastic carcinoma of the pancreas (ACP) with SMJN, and aims to provide new insights into its clinical presentation.
Case report: A 67-year-old woman presented with periumbilical pain persisting for a month. Physical examination revealed an umbilical dark red nodule of 10 mm diameter, which was suspected to be SMJN. An abdominal computed tomography (CT) revealed an umbilical tumor and many peritoneal disseminated nodules. An 18F- fluorodeoxyglucose positron emission tomography (PET)-CT scan identified masses in the pancreatic body and the umbilical region. Biopsies from these two lesions confirmed a poorly differentiated adenocarcinoma. The patient was diagnosed with advanced pancreatic cancer. However, the four tumor marker levels, namely of cancer antigen 125 (CA125), Duke pancreatic monoclonal antigen type 2 (DUPAN-2), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA) were within normal ranges. She decided against chemotherapy, then passed away two months after the initial consultation. The autopsy revealed the primary tumor to be a 30×50 mm diameter ACP of the pancreatic body with a metastatic umbilical skin lesion, peritoneal dissemination, and multiple organ metastasis.
Discussion: This rare case of advanced ACP presenting normal levels of CA125, DUPAN-2, CA19-9, and CEA with SMJN provides three important clinical insights. First, SMJN can be found as a rare initial presentation of primary pancreatic cancer accounting for 7 to 9% of all SMJN cases. Second, ACP is a very rare histological subtype of pancreatic carcinoma characterized by a more aggressive clinical course. Finally, some tumor markers were not elevated in advanced ACP and were not helpful for diagnosis.
Conclusion: Possibility of ACP as a cause for SMJN cannot be ruled out even without increased levels of tumor markers.
Case report: A 67-year-old woman presented with periumbilical pain persisting for a month. Physical examination revealed an umbilical dark red nodule of 10 mm diameter, which was suspected to be SMJN. An abdominal computed tomography (CT) revealed an umbilical tumor and many peritoneal disseminated nodules. An 18F- fluorodeoxyglucose positron emission tomography (PET)-CT scan identified masses in the pancreatic body and the umbilical region. Biopsies from these two lesions confirmed a poorly differentiated adenocarcinoma. The patient was diagnosed with advanced pancreatic cancer. However, the four tumor marker levels, namely of cancer antigen 125 (CA125), Duke pancreatic monoclonal antigen type 2 (DUPAN-2), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA) were within normal ranges. She decided against chemotherapy, then passed away two months after the initial consultation. The autopsy revealed the primary tumor to be a 30×50 mm diameter ACP of the pancreatic body with a metastatic umbilical skin lesion, peritoneal dissemination, and multiple organ metastasis.
Discussion: This rare case of advanced ACP presenting normal levels of CA125, DUPAN-2, CA19-9, and CEA with SMJN provides three important clinical insights. First, SMJN can be found as a rare initial presentation of primary pancreatic cancer accounting for 7 to 9% of all SMJN cases. Second, ACP is a very rare histological subtype of pancreatic carcinoma characterized by a more aggressive clinical course. Finally, some tumor markers were not elevated in advanced ACP and were not helpful for diagnosis.
Conclusion: Possibility of ACP as a cause for SMJN cannot be ruled out even without increased levels of tumor markers.
Takeaways
1. Sister Mary Joseph’s nodule (SMJN) can be found as a rare initial presentation of primary pancreatic cancer.
2. Anaplastic carcinoma of the pancreas (ACP) is a very rare histological subtype of pancreatic carcinoma characterized by a more aggressive clinical course.
3. Some tumor markers are sometimes not elevated in advanced ACP and are not helpful for diagnosis.
2. Anaplastic carcinoma of the pancreas (ACP) is a very rare histological subtype of pancreatic carcinoma characterized by a more aggressive clinical course.
3. Some tumor markers are sometimes not elevated in advanced ACP and are not helpful for diagnosis.
Biography
Fukuko Matsumoto is a medical doctor at Jichi Medical University Saitama Medical Center. She completed the 2-year foundation programme in March of 2023, and has thereafter commenced her specialty training to work as a general practitioner. Although she enjoys traveling and has visited several international destinations including Sydney when she was a medical student, this submission marks her first participation in an international conference as a physician. She expects this experience will be valuable for her clinical training.
Dr Catarina Ramos
Usf
"ACUTE LOWER LIMB ISCHEMIA: the importance of recognize the first symptoms "
Summary
Introduction:
Acute limb ischaemia (ALI) is a sudden decrease in limb perfusion that causes a time-critical threat to its viability. In spite of being a rare diagnose, the prognosis is poor with high rates of amputation. This article aims to alert all General Practitioners (GP) about this silent disease. By discussing a case of a young woman diagnosed with ALI, it is our intent to review how important its first signs are. Those include: pain, pallor, pulselessness, perishingly cold, paraesthesia and paralysis.
Methods:
The patient of this case study is a 47 years old woman who is a smoker and has hypertension. She was brought to her GP after noticing right foot pain during the previous month, triggered by activity with no relief at rest or when lying down. On examination she was normotensive (136/90 mmHg), heart rate of 70 bpm. Right limb examination demonstrated coldness, numbness of the foot, paralysis, and erytrocyanosis of the 1st and 3rd toes. Dorsalis pedis, posterior tibial and popliteal pulses were not palpable on both legs which triggered the decision to send her to the emergency room.
Results:
ALI diagnose was confirmed at the hospital using a doppler ultrasound and angiography. The patient was submitted to pharmacological thrombolytic therapy and mechanical thrombectomy as treatment for the peripheral arterial disease in the right limb and had no complications. She was medicated with apixaban 5 mg twice a day.
Discussion:
We believe this case emphasizes the value of proper examination and how crucial it is to listen to the patient’s symptoms even in young people. GP’s have a crucial role in both diagnosis and outcome of such a disease where recognition of subtle signs is fundamental for proper treatment and to avoid limb loss.
Acute limb ischaemia (ALI) is a sudden decrease in limb perfusion that causes a time-critical threat to its viability. In spite of being a rare diagnose, the prognosis is poor with high rates of amputation. This article aims to alert all General Practitioners (GP) about this silent disease. By discussing a case of a young woman diagnosed with ALI, it is our intent to review how important its first signs are. Those include: pain, pallor, pulselessness, perishingly cold, paraesthesia and paralysis.
Methods:
The patient of this case study is a 47 years old woman who is a smoker and has hypertension. She was brought to her GP after noticing right foot pain during the previous month, triggered by activity with no relief at rest or when lying down. On examination she was normotensive (136/90 mmHg), heart rate of 70 bpm. Right limb examination demonstrated coldness, numbness of the foot, paralysis, and erytrocyanosis of the 1st and 3rd toes. Dorsalis pedis, posterior tibial and popliteal pulses were not palpable on both legs which triggered the decision to send her to the emergency room.
Results:
ALI diagnose was confirmed at the hospital using a doppler ultrasound and angiography. The patient was submitted to pharmacological thrombolytic therapy and mechanical thrombectomy as treatment for the peripheral arterial disease in the right limb and had no complications. She was medicated with apixaban 5 mg twice a day.
Discussion:
We believe this case emphasizes the value of proper examination and how crucial it is to listen to the patient’s symptoms even in young people. GP’s have a crucial role in both diagnosis and outcome of such a disease where recognition of subtle signs is fundamental for proper treatment and to avoid limb loss.
Takeaways
1. To emphasize the value of proper examination even in young people.
2. To review the signs of Acute limb ischaemia- 6P: pain, pallor, pulselessness, perishingly cold, paraesthesia and paralysis.
3.GP’s have a crucial role for both diagnosis and outcome.
2. To review the signs of Acute limb ischaemia- 6P: pain, pallor, pulselessness, perishingly cold, paraesthesia and paralysis.
3.GP’s have a crucial role for both diagnosis and outcome.
Biography
Catarina is a professor in Nova Medical School and a resident in a primary care center in Lisbon, Portugal.
Dr Soumya Soumya
GP Fellow
The University Of Adelaide
Do patients with prediabetes managed with metformin achieve better glycaemic control? A national study using primary care medical records
Summary
Aims: To estimate the effect of metformin on glycaemic parameters among patients with incident prediabetes attending Australian general practices.
Methods: Retrospective cohort study using electronic health records of regular patients (3+ visits in two consecutive years, with at least one consultation in each of these two years) attending 383 Australian general practices (MedicineInsight). Patients with ‘incident’ prediabetes (newly recorded diagnosis 2012-2017) and their glycaemic parameters (HbA1c [%] or fasting blood glucose-FBG [mmol/L]) at 6, 12, and 18-24 months post diagnosis (unexposed) or post-management with metformin (treatment) were identified from the database. The effect of metformin management on glycaemic parameters was explored using linear regression and average treatment effect (ATE) models.
Results: Of the 4,770 patients with ‘incident’ prediabetes, 10.2% were managed with metformin. HbA1c and FBG levels at baseline were higher among those managed with metformin than their peers (+0.3% and +0.23 mmol/L, respectively). Patients receiving metformin experienced attenuation in their HbA1c and FBG levels at 6-12 months. In comparison to those unexposed to metformin, there was no difference in the mean HbA1c levels at 6-12 months (ATE 0.00, 95%CI -0.05;0.05) or 12-18 months (ATE -0.02, 95%CI -0.09;0.06) among patients that were prescribed metformin. At 18-24 months, patients with prediabetes who received metformin had lower mean HbA1c (ATE -0.09, 95%CI -0.16;0.00) than those unexposed to metformin. Patients managed with metformin also had lower mean FBG at 6-12 months (ATE -0.14, 95%CI -0.24;-0.04) but similar FBG levels at 12-18 months (ATE 0.02, 95%CI-0.08;0.12) and 18-24 months (ATE -0.07, 95%CI-0.25;0.11) post metformin initiation than those who were not treated pharmacologically.
Conclusion: The higher HbA1c and FBG baseline levels among patients with ‘incident’ prediabetes managed with metformin improved within 6-12 months, and the beneficial effect persisted for up to 24 months. Management with metformin could prevent further deterioration of glycaemic levels.
Methods: Retrospective cohort study using electronic health records of regular patients (3+ visits in two consecutive years, with at least one consultation in each of these two years) attending 383 Australian general practices (MedicineInsight). Patients with ‘incident’ prediabetes (newly recorded diagnosis 2012-2017) and their glycaemic parameters (HbA1c [%] or fasting blood glucose-FBG [mmol/L]) at 6, 12, and 18-24 months post diagnosis (unexposed) or post-management with metformin (treatment) were identified from the database. The effect of metformin management on glycaemic parameters was explored using linear regression and average treatment effect (ATE) models.
Results: Of the 4,770 patients with ‘incident’ prediabetes, 10.2% were managed with metformin. HbA1c and FBG levels at baseline were higher among those managed with metformin than their peers (+0.3% and +0.23 mmol/L, respectively). Patients receiving metformin experienced attenuation in their HbA1c and FBG levels at 6-12 months. In comparison to those unexposed to metformin, there was no difference in the mean HbA1c levels at 6-12 months (ATE 0.00, 95%CI -0.05;0.05) or 12-18 months (ATE -0.02, 95%CI -0.09;0.06) among patients that were prescribed metformin. At 18-24 months, patients with prediabetes who received metformin had lower mean HbA1c (ATE -0.09, 95%CI -0.16;0.00) than those unexposed to metformin. Patients managed with metformin also had lower mean FBG at 6-12 months (ATE -0.14, 95%CI -0.24;-0.04) but similar FBG levels at 12-18 months (ATE 0.02, 95%CI-0.08;0.12) and 18-24 months (ATE -0.07, 95%CI-0.25;0.11) post metformin initiation than those who were not treated pharmacologically.
Conclusion: The higher HbA1c and FBG baseline levels among patients with ‘incident’ prediabetes managed with metformin improved within 6-12 months, and the beneficial effect persisted for up to 24 months. Management with metformin could prevent further deterioration of glycaemic levels.
Takeaways
At the conclusion of my presentation attendees will take away
In Australia, GPs prescribe metformin to one in 10 adults with a recent prediabetes diagnosis.
The blood sugar levels of patients managed with metformin returned to normal within 6-12 months. These patients also had slightly better blood sugar levels at 18-24 months than those not managed with metformin.
Using metformin for patients with prediabetes could help prevent progression to diabetes
In Australia, GPs prescribe metformin to one in 10 adults with a recent prediabetes diagnosis.
The blood sugar levels of patients managed with metformin returned to normal within 6-12 months. These patients also had slightly better blood sugar levels at 18-24 months than those not managed with metformin.
Using metformin for patients with prediabetes could help prevent progression to diabetes
Biography
Dr Soumya is a medical doctor and trainee of the Royal Australasian College of General Practitioners. Graduated from the University of Adelaide in 2015, she currently works as a doctor in Aboriginal health in the northeastern suburbs of Adelaide, South Australia. Soumya completed a Master of Clinical Science in 2020 at the JBI and is currently undertaking a Master in Public Health at James Cook University.
Soumya is a keen researcher who has conducted various studies in the fields of surgery and medicine, as well as systematic reviews of the literature and meta-analyses. Her main interests are preventative medicine, Indigenous health, health inequalities, chronic disease prevention and management, and quality of life. She aspires to focus her research career on the implementation of evidence-based medicine in primary care. To achieve these objectives, she will be working with researchers from the Discipline of General Practice and the Primary Care and Health Services Research Group at the University of Adelaide.
Mr Gary Smith
Armchairmedical.tv
What continuing medical education can learn from Netflix
Summary
Aim:
To share strategies from Netflix that can and should be applied to continuing medical education
Content:
Netflix and it's fellow streamers have revolutionised the way the world consumes video content, with many individual videos obtaining over 100 million hours of viewership. Viewers are not awarded points for viewing content and yet eagerly consume massive amounts. Data will be shared from a "Netflix like" medical education platform that shows the impact of applying these strategies to GP continuing education in Australia.
Goals:
Following this presentation, attendees will take away key insights they can apply when creating or choosing CPD strategies.
To share strategies from Netflix that can and should be applied to continuing medical education
Content:
Netflix and it's fellow streamers have revolutionised the way the world consumes video content, with many individual videos obtaining over 100 million hours of viewership. Viewers are not awarded points for viewing content and yet eagerly consume massive amounts. Data will be shared from a "Netflix like" medical education platform that shows the impact of applying these strategies to GP continuing education in Australia.
Goals:
Following this presentation, attendees will take away key insights they can apply when creating or choosing CPD strategies.
Takeaways
1. Continuing medical education should be easy to consume
2. Continuing medical education should incorporate easy search functionality and opportunities for 'chance discovery' of topics
3. If education providers want GPs to consume more education, they should consider adopting strategies used by consumer facing companies such as Netflix.
2. Continuing medical education should incorporate easy search functionality and opportunities for 'chance discovery' of topics
3. If education providers want GPs to consume more education, they should consider adopting strategies used by consumer facing companies such as Netflix.
Biography
Gary Smith is the founder of ArmchairMedical.tv. He is an innovative thinker, serial entrepreneur and has been involved in the education of General Practitioners for over 30 years.
