SUPPORT FOR GENERAL PRACTITONERS DURING COVID-19.

BACKGROUND: Evidence of initiatives to support General Practitioners (GPs) during the Covid-19 pandemic is scant. AIM: To understand the impact of a novel method of providing support in the early stages of the pandemic. DESIGN AND SETTING: A mixed-methods study of GPs working in a socially deprived area of Belfast. METHOD: A survey was distributed to GPs who had attended a series of educational meetings at the beginning of the COVID-19 pandemic. The survey incorporated the Warwick Edinburgh Mental Wellbeing Scale and questions about the virtual meetings. Follow-up interviews were undertaken with five GPs to further explore their lived experiences and their perceptions of the virtual support forum. RESULTS: The Covid-19 pandemic resulted in a measurable diminution of emotional well-being in GPs in North and West Belfast. Attendees rated a series of virtual meetings highly and described the following themes (and subthemes): a sudden traumatic change (emotional response, fight or flight, painful reminders of the status of general practice in the NHS); a coming together (stepping up to take responsibility, sharing of information, feeling of affirmation); reflections on what worked (calming facilitation, careful selection of speakers, creating the right atmosphere, ownership and autonomy) and building future direction (defining future direction, capitalising on lesson learned). CONCLUSION: The virtual meetings harnessed the instinct to come together witnessed at the beginning of the pandemic, and as well as sharing valuable information, also provided emotional support along with a sense of comradeship, ownership and autonomy. HOW THIS FITS IN: GPs did not feel included or supported at the outset of the pandemic. Coming together with fellow professionals was a welcome source of support. Professional support can be delivered using a virtual platform. Continued professional development is more acceptable than explicit emotional support, but when done well can bolster resilience and emotional well-being.

The need for a prescribing competency framework to address the burden of complex polypharmacy among multiple long-term conditions.

The original requirement for a competency framework for prescribers was to identify the essential skills for non-medical prescribers. However, core prescribing competencies are relevant to any prescriber. The new, revised version is especially relevant for doctors/physicians. Doctors are the most frequent prescribers - prescribing is the most common therapeutic intervention. The quantity and complexity of medicine use is increasing through multiple treatment strategies/pathways for multiple comorbidities, resulting in polypharmacy - especially with long-term conditions. This is against a background of the ongoing introduction of new drugs with novel mechanisms of action with increased risks of adverse effects, compounded by drug-drug and disease-drug interactions. This has increased the need for monitoring and follow-up, including identification and management of poor adherence. It is challenging for doctors to maintain safe and effective prescribing and train other doctors and non-medical prescribers within the multidisciplinary team. The prescribing competency framework provides a systematic approach to support doctors to prescribe safely and effectively. It can be used by medical schools to teach prescribing, including preparation for the prescribing safety assessment; by F1/F2 doctors to support prescribing in early years; as part of prescribing quality improvement initiatives and as a continuing professional development framework in general practice or acute care settings.

Computed tomography pulmonary angiography: a sample of experience at a District General Hospital.

PURPOSE: Pulmonary embolism (PE) has a significant associated morbidity and mortality. The role of diagnostic imaging in PE is being increasingly undertaken by computed tomography pulmonary angiography (CTPA). An advantage of CTPA is its ability to simultaneously provide information on the lung parenchyma, mediastinum, pleural spaces, and chest wall. A sample of CTPAs was therefore reviewed to identify the types of additional pathology demonstrated. MATERIALS AND METHODS: One hundred and ninety-eight CTPA examinations were retrospectively reviewed. A record was made of the presence of PE and any additional pathology, with particular interest given to "incidental" pathology, or pathology that was unsuspected but which was significant enough to change the patient's management. A note was also made as to the adequacy of the study. D-Dimer values were recorded when available. RESULTS: PE was demonstrated in 56 studies (28.3%). Additional pathology was seen in 112 studies (56.6%), of which 17 were categorised as incidental. These included multiple pulmonary nodules, solitary lung lesions, destructive bony lesions, pancreatitis, a solid renal mass, mesothelioma, reactivated pulmonary tuberculosis, recurrent bronchial carcinoma, pulmonary fibrosis, an SVC filling defect, and a compression fracture of T10. CONCLUSION: The prevalence of PE in our sample was 28.3%, compared with a reported prevalence, mainly by pulmonary angiography, of between 19% and 79%. Secondary findings were found in 56.6% of scans, with completely incidental findings demonstrated in 17 patients (9%). This emphasizes the usefulness of CTPA in providing additional diagnostic information and alternative diagnoses in patients with suspected PE.