Osmosis-for-nurses.co.uk

Dr. Simon OHara
The supporting information relates to the work which has been collected using the software Osmosis, to help you Chevin Medical Practice
record, collate and present authoritative evidence of your online learning throughout the year.
Reporting Period 19th Dec 2011 - 19th Dec 2012
Records (appraisal tags)
Knowledge, Skills and Performance
3 hr 15 minutes
Safety and Quality
2 hr 30 minutes
Communication, Partnership and Teamwork
0 hr 5 minutes
Maintaining Trust
0 hr 10 minutes
Learning event
4 hr 20 minutes
Patient led learning (PUNs/DENs)
0 hr 45 minutes
Significant event analysis
0 hr 0 minutes
Practice meeting - clinical
1 hr 35 minutes
Practice meeting - non-clinical
0 hr 0 minutes
Professional conversation
0 hr 25 minutes
0 hr 5 minutes
Revalidation (PSQ, MSF, Audit)
0 hr 5 minutes
6 hr 0 minutes
6 hr 35 minutes
Generated by Osmosis®
Online Records
Knowledge, Skills and Performance
Comment: looked today
Comment: Mild acne- start with topical retinoid, building
up to daily application over 2-3 week period eg adapaline
or Isotrex. Moderate - combined product topically eg Topic - catheter problems | department of urology Isotrexin- erythro and isotretinoin
Impact: Remember to use anticomedonal topicals in mild
Comment: From APCE
Topic - investigation parvovirus b19 of a pregnant woman Topic - more detailed information about left anterior with significant exposure to rash illness Comment: Immunology for parvovirus:IgG pos and IgM
Comment: left anterior fascicular block is associated with a
normal prognosis
Impact: No need for further investigation in patients with
Topic - royal college of practitioners gp enterprise awards Comment: We have entered Osmosis into the GP
Topic - primary care antimicrobial treatment guidelines Comment: 30/1/12 Lunchtime meeting 1.25 hrstalk from
meds mx PCT (Heather) on antobiotic rescribing- esp in UTIs and chest infections, avoiding cefalosporines and Comment: This is what Chaz has got
quinolones where possible
Impact: Quinolones first line rx for upper UTI with fever
Topic - lower urinary tract infection in women (no fever or Comment: Ciprofloxacin for upper UTI in women
Topic - factor v leiden mutation causing thrombophilia Comment: needs full clotting screen
Topic - cg117 tuberculosis 1 guidance national institute Topic - a practical workup eosinophilia. you can in.
Comment: Patient exposed to TB- stayed with brother in a
small flat in Hong Kong for 2 nights. Asymptomatic.
Impact: d/w infectios disease reg, advised needs
screening for TB (even though asymptoimatic and stayed in Topic - easily missed joint hypermobility syndrome Comment: Sam
Comment: In this very edition of Pulse, Osmosis was
featured as 'Online learning resource of the week' Topic - weight management service (adult overweight)referral guidance leeds pct Generated by Osmosis®
Online Records
Knowledge, Skills and Performance
Topic - leeds database you searched 'pcal'.
Topic - acne: managing patients in primary care Generated by Osmosis®
Online Records
Safety and Quality
Topic - derbyshire medicine management prescribing Topic - royal college of practitioners | rcgp Comment: APCE
Comment: Mental-status changes Autonomic
Topic - national center biotechnology information hyperactivity Neuromuscular abnormalitySecondary toseratogenic medication Impact: Not a well recognised condition
Topic - royal college of practitioners rcgp home Comment: d/w Dr Peasey BRIDifficult area, feels being
promoted in press by pharma companies. Need to do
morning 9am bloods as levels decrease throughout the day
and also check for SHBG, LH/FSH, prolactin (and PSA and Topic - evaluation of voiding dysfunction measurement of Hb as these need monitoring of starting testosterone repacelemt). Some consultants happy to prescribereplpacement if testosterone 8-12.
Impact: Make sure that all bloods done appropriately in
Topic - adult antimicrobial treatment guidelines future. Probably best to refer to endocrinologists beforetreating.
Comment: viral
Comment: Good algorythm for treating vit d deficiency
Comment: Expert in hypermobility os Dr Pauline Ho at
Manchester Royal Infirmary
Topic - raised triglycerides (secondary causes) Comment: topical LA or steroid 1st line then topical GTN
Topic - management of raised triglycerides Comment: blue/pink tinge is typical of these. Very rare. Rx
includes wide excision, LN biopsy, CT trunk, ? radiotherapy
Topic - lower urinary tract infection in men Comment: refer recurrent uti in men ( >2)
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Online Records
Safety and Quality
Topic - 6th cranial nerve lesion resources Generated by Osmosis®
Online Records
Communication, Partnership and Teamwork
Generated by Osmosis®
Online Records
Maintaining Trust
Comment: form HC1 for free prescriptions for hardship
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Online Records
Number of visits to other sites
BMJ Learning
Camurology
e-learning for health
GP Note Book
Leeds Teaching Hospitals
Patient.co.uk
Pulse Learning
Pulse Today
Wikipedia
Generated by Osmosis®
Journal Records
Learning event
03/12/2012
0 hr 5 minutes
Bipolar disorder <BR>Severe mood swings<BR>0.3-1.5% lifetime prevelance<BR>21% possible missed in unipolar depression <BR><BR>Digfast<BR>Distractibility<BR>Indiscretion- taking risk<BR>Grandiosity<BR>Flight if ideas<BR>Activity increase/xs happiness*<BR>Sleep deficit*<BR>Talkative <BR><BR>*top 2 questions to screen Risk doubles if 1st degree relative Diagnosis is in absence of organic cause or substance misuse <BR>Most common comorbidirirs are anxiety and substance misuse<BR>ICD 10 and DSM 4 diagnostic criteria. <BR>Episodes should last 3-5 days Bipolar 1 has mania<BR>Bipolar 2 hypomania <BR><BR>Ix<BR>Bloods inc prolactin Rx<BR>Olanzapine/quetiapineLithiumValproate3rd line consider carbamazepine Poor prognosis20% successful outcome in 5 years Hypomania = mania but still functioning o.n a day to day basis <BR> 08/11/2012
2 hr 0 minutes
GP-COG also worth a look and free on google Fbc b12 folate u and e lfts tfts glucose calcium Delerium is an acute confusional state and can last up to 6 months 18/09/2012
2 hr 0 minutes
Contraception talk Debbie smith 18 9 12 HDR As ovary is ripening lh surge causes release of ovary and then forms corpus luteum with raising progesterone if not fertilised UKMEC 2009 is the bible and is downloadable. Ukmec 4 in combined pill- >35 smoker, bmi>35, migraine with aura any age. Interacting drugs rifampicin, st johns wort. Thromboembolism risk with ocp doubles with bmi>30 and quadruples at 35 Can start ocp up to day 5 of cycle - or can 'quick start' but check preg test first and use extra precautions for 7 days Can run packets together quite safely 8 or 9 +. When spotting starts then that patient is likely to spot at the same stage every time Biphasic and triphasic pills not used any more Contraceptive patch= transdermal cilest. As effective as the combined pill Combined vaginal ring- meant to be 3 weekly then ring free week but can be used all the time Generated by Osmosis®
Taking pill for 2 years plus reduces ovarian cancer risk 50%+ Cerazatte is only POP to think about. Progestogenic SEs include vaginsl dryness and breast pain. Only contraindication is current Very good handout for choosing pill in certain patients LATS = method that lasts more than 1 cycle Depo provera is a big dose of progesterone- will contracept an elephant on rifampicin! Risk of osteoporosis. 70%get amenorrhea. Often 2kg weight gain per year SEs- 33% no or light bleeding, same have erratic but manageable same heavy bleeding. Ectopics much rarer with coils, but if pt with coil becomes pregnant, then 1 in 20 is ectopic Levonelle 1500- prevents 85% atv24-48h, 56% at 48-72 hours Ulipristal. Licenced for 72 hours. Just as good at 5 d as at 24 hours ICUs- can be fitted up to 5 days after ovulation in that cycle 21/06/2012
0 hr 5 minutes
Just to remind everyone that DIABETES/MICROALBUMINURIA/CKD urines are: 2) CLINICAL/CHEMISTRY PATHOLOGY (the black) forms - *NOT* microbiology blue form.
3) Ideally FIRST VOIDED urine of the day and the first bit (i.e. NOT midstream).
I'm having the odd person come for a review with a wrong form (ie. given blue form), Generated by Osmosis®
18/04/2012
0 hr 5 minutes
02/03/2012
0 hr 5 minutes
We were allowed a free stand at TARGET to promote Osmosis. Very interesting experience being on the other side, eye contact kept to a minimum! Seemed to make some progress though with several interested GPs, with increasin Patient led learning (PUNs/DENs)
12/11/2012
0 hr 10 minutes
D/w renal reg re patient with potassium 6.2 ? an afternoon sample so may be haemolysed Foods high in potassium oranges, bananas, crisps, chocolate, coffee, tomatoes 02/11/2012
0 hr 15 minutes
Patient abusing alcohol with regular binges 1 bottle vodka per day for a week requesting naltrexone therapy. d/w Dr John Roach at LAU- this is on the NICE guidelines for alcohol abise, works by reducing endorphins associated with drinking rather than by reducing cravings. Acamprosaye also in guidelines. He would like feedback in how this patient does on As soon as possible after assisted withdrawal.
Usually 1998 mg (666 mg three times a day) unless the service user weighs less than 60 kg, and then a maximum of 1332 mg per Up to 6 months, longer for those benefiting from the drug who want to continue with it3.
At least monthly, for 6 months, and at reduced but regular intervals if continued after this. Do not use blood tests routinely, but consider them to monitor for recovery of liver function and as a motivational aid for service users to show improvement.
Stop treatment if drinking persists 4â??6 weeks after starting the drug.
Initially 25 mg per day, aiming for a maintenance dose of 50 mg per day4.
Up to 6 months, or longer for those benefiting from the drug who want to continue with it.
At least monthly, for 6 months, and at reduced but regular intervals if continued after this. Do not use blood tests routinely, but consider them for older people, for people with obesity, for monitoring recovery of liver function and as a motivational aid for Draw the service users attention to the information card that is issued with oral naltrexone about its impact on opioid-based Generated by Osmosis®
Stop treatment if drinking persists 4â??6 weeks after starting the drug.
If the service user feels unwell advise them to stop the oral naltrexone immediately.
1Note that the evidence for acamprosate in the treatment of harmful drinkers and people who are mildly alcohol dependent is less robust than that for naltrexone. At the time this pathway was created (May 2011), acamprosate did not have UK marketing authorisation for this indication. Informed consent should be obtained and documented.
2At the time this pathway was created (May 2011), oral naltrexone did not have UK marketing authorisation for this indication.
Informed consent should be obtained and documented.
3At the time this pathway was created (May 2011), acamprosate did not have UK marketing authorisation for use longer than 12 months. Informed consent should be obtained and documented.
4At the time this pathway was created (May 2011), oral naltrexone did not have UK marketing authorisation for this indication or at this dosage. Informed consent should be obtained and documented.
23/10/2012
0 hr 10 minutes
The routine way of testing for whooping cough in the community setting is to take a per-nasal swab for culture for Bordetella pertussis. It is important that the correct swabs are used when carrying out this investigation. Please note that the following swab should be used when carrying out this test: Blue-capped swab with flexible wire shaft in Amies transport medium (swab code 18192C). If incorrect swabs are sent these will not be processed for B. pertussis culture, as a negative result does not exclude presence of this pathogen. Thank you for your help.
http://nww.lhp.leedsth.nhs.uk/common/e-Newsletter/detail.aspx?ID=1499 Consultant / Clinical Director of Microbiology/Pathology 03/09/2012
0 hr 5 minutes
Day 21 (or 7 days before expected bleed) progesterone (high reading confirms ovulation) Semen sample male and chlamydia screen for both 22/06/2012
0 hr 5 minutes
Patient complained of not being warned that you cannot drink grapefruit juice with felodipine. Some chemical in grapefruit juice can cause an increase in felodipine concentrations increasing side effects Practice meeting - clinical
15/10/2012
1 hr 30 minutes
Clinical meeting with Neil Harris cons urology 15/10/12 Generated by Osmosis®
Continence issue a combination of over active bladder ( urge) Aetiology of stress incontinence- predisposing, inducing eg childbirth, promoting eg obesity and decompensation eg oestrogen Examine- dip urine, hypo- oestrogenisation, prolapse Diloxetine only drug licences for stress incontinence. Nice recommends tds oxybutynin 1st line but seldom used Solifenacin propiverine tolterodine good choices. 2nd line Botox sacral neromodulation, bladder Botox lasts 6-9m - 20x1ml injections into bladder. 10% get retention and need to self catheterise until wears off International continence society is a good resource for bladder drill and physio. Jade broxham is a good nurse specialist with clinics at wgh Residual volumes of <150 ml without symptoms generally safe. Need to ensure no high pressure effect via USS on ureters and Ketamine abuse can cause neuropathic bladder in a few months of abuse Raised PSA without symps in older man >75 it is reasonable to observe and repeat in 6m Slightly raised PSA in 60s should be referred 30/04/2012
0 hr 5 minutes
1. Dementia diagnoses need all 7 bloods doing 6/12 before or after diagnosis 2. Contraception discussed/prescribed=tick the LARCS box 3. Epilepsy- always use the whole template Professional conversation
31/08/2012
0 hr 5 minutes
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For GP courses/GP Retainer Scheme/Trainer Pathway / Trainer Reapproval- Leanne.sorby@yorksandhumber.nhs.uk For Quality Assurance / Data (Rota's and Posts) / Performance - nick.sowerbey@yorksandhumber.nhs.uk For IDT's / OOP Administration / GP Induction and Refresher Scheme / Data and posts plus e-portfolio queries for DPW, Pennine schemes - joan.horsfield@yorksandhumber.nhs.uk For Data and posts plus e-portfolio queries for Airedale, Bradford and Leeds Programmes/ GP Recruitment - Esme.ross@yorksandhumber.nhs.uk For Central ARCP's - G_Coggill@yorksandhumber.nhs.uk 19/07/2012
0 hr 5 minutes
d/w cytology dept- sample from primary care needs to be in white topped bottle, brown cytology form (but will accept blue 14/05/2012
0 hr 5 minutes
M's are advanced practitioners with independent prescribing skills. Management of pts with Long Term Conditions - usually those pts with complex needs & unable to access GP surgery 04/04/2012
0 hr 5 minutes
Good outcome with good PDP for next year. A lot of positive comments from my appraiser. Increased enthusiasm as a result for the coming year. Used Osmosis PDP for the first time! 07/02/2012
0 hr 5 minutes
Discussion with Damian Riley, Medical Director Leeds PCT about the work of NCAS. This is something I would be interested in Also attended his presentation to the GP registrars on the work of a medical director.
05/03/2012
0 hr 5 minutes
Metal Hip Implants Article in BMJ- advice from MHPRA- patients with metal hip implants with a femoral diameter >36mm need 'metal ion concentrations' measuring. Levels > 7mcg/l shold be repeat tested in 3m with MRI if levels continue to rise. In practice Revalidation (PSQ, MSF, Audit)
02/02/2012
0 hr 5 minutes
Good patient survey discussing tonight with ppg. Subsequent meeting with PPG rep discussing ways of improving information for patients. He will devise a questionnaire to give to patients asking them to decide what information they would like.
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12/11/2012
6 hr 0 minutes
Supporting information- what is the purpose- should be balanced profile of info. Read GMC docs framework and supporting info for reval. Making connections campaign is to try and find out which supporting organisations drs Are associated with Dates will be allocated to docs 20% a year. Dec 12-march 13 gmc will inform docs when their date is. Reval is seen as a lever to make sure the GMP document is implemented. A strategic review of reval is being undertaken as the process goes on. 2. Dr susi Caesar, assoc director revalidation support team. A) first do no harm- positive, proportionate, appraisers should not take on inappropriate roles The whole scope of the doctors work is being looked at in appraisal now. Needs work on cpd, quality improvement activity, sea, 3 workshop- dr di jelley- gathering evidence There is a leadership framework. Includes 5 core domains.
Very good you tube consultation dr Melena stool (xtra normal) Motivational question- are you away from pain or towards pleasure? Email speaker re leadership for GP registrars - Marian somebody No evidence that choosing friends gives better feedback CFEP and edgecombe are recommended by rcgp as well as gmc questionnaires Generated by Osmosis®
Gmc questionnaires piloted and developed by CFEP Edgecombe report on quartiles, cfep do it on centile Discussing improving- PINS, ask where are you now on 1-10 scale, then focus on the observable and behaviours rather than Exeter medical school currently doing an online trial to let you compare Change is by refreshment, remediation or retirement Change the relationship between you and it.
Ask why is it still worth your commitment? If difficult to answer them may be time to leave Need to define and diagnose. Then take action Banishing burnout is a good book Leiter and Maslach Healthier life steps: a physicians guide to health Five ways to welbeing on new economics foundation website Generated by Osmosis®
03/07/2012
6 hr 0 minutes
Cpd tracker www.gp-handbook.co.uk free to all Stage 1 hypertension 135-149/85-94 if cvd risk <20% and no end organ damage do not treat Treat isolated systolic hypertension same as when diastolic also raised If still ^bp after 3 drugs add spironolactone 25 if k+<4.5 or inc indapamide if k+>4.5 and check u and e after 1m AVoid trimethoprim and spironolactone-> hyperkalaemia PPIs and clopidogrel- avoid omeprazole or esomeprazole with clopidogrel Possibly some risk with aspirin and ppis but not h2antagonists B blocker or rate limiting ccb if rate high diagnosis- 2 of random glucose >11.1, fasting >7, h a1c>6.5 If wells score <2 and normal d dimer then uss not needed Post thrombotic syndrome more likely if female older obese previous or extensive DVt 10-25% have recent normal or low suspicion cxr Symptoms are vague but present. Distension much more a concern than bloating. Generated by Osmosis®
3m level check, 6m tsh and renal function Watch out for depression mimicing hypothyroidism Max safe dose 40 mg 18-65 or 20 mg > 65 Avoid erythro with citalopram as both prolong QT Tamoxifen may be less effective with fluoxetine and paroxetine and Other ssri's. Increased death rate with them Treat with 10d penicillin. Presents at 2-5 years old Meningitis- give antibiotics only if body involvement ie if a rash or septic. If meningitis only then no antibiotics as better with Cyclizine, prochlorperazine or metoclopramide 17/05/2012
0 hr 5 minutes
it is important that serum B12 levels are normal because treatment with folic acid can precipitate subacute combined gp notebook - can reflect on it on your portfolio Generated by Osmosis®
02/05/2012
0 hr 5 minutes
20/04/2012
0 hr 10 minutes
18/04/2012
0 hr 5 minutes
http://www.bbc.co.uk/news/education-17741653 18/04/2012
0 hr 5 minutes
18/04/2012
0 hr 5 minutes
This is the first test for a practice share Generated by Osmosis®

Source: http://www.osmosis-for-nurses.co.uk/pdf/example.pdf