Previews – EGG

Eyes | Gastroenterology | GP Skills

munirajuDiabetic Eye Disease
Ramu Muniraju (Consultant Ophthalmic Surgeon)
A lecture on diabetic eye disease by Ramu Muniraju Consultant Ophthalmic Surgeon Paediatrician Ashford and St Peter's Hospitals.
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Zac KoshyRetinal Detachment
Zac Koshy (Consultant Ophthalmologist)

Mr Zachariah Koshy is a Consultant Ophthalmologist based at Ayrshire and Glasgow. He has 15 years of experience in ophthalmology with a special interest in surgical and medical retina having gained fellowships in both these fields. His practice incorporates recent advances in these areas providing the complete spectrum of the latest treatments for retinal pathology.

Mr Koshy has innovated in the technique of suture less vitrectomy and has published and widely presented on this theme as well as retinal diagnostic protocols. Suture less vitrectomy affords a significantly more comfortable and faster post operative recovery than conventional surgery. The vast majority of these cases are now done as local anaesthetic day case procedures.

Retinal detachment is a disorder of the eye in which the retina peels away from its underlying layer of support tissue. Initial detachment may be localized, but without rapid treatment the entire retina may detach, leading to vision loss and blindness. It is a medical emergency.
Retinal detachment is a rare condition. Only 1 in every 10,000 people will develop a new case of retinal detachment in any given year in the UK. As retinal detachment is associated with ageing, most cases affect older adults aged between 50 and 75.

Retinal detachment caused by an injury can affect people of any age, including children.

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Tom EkeIntroduction to Chronic Glaucoma
Tom Eke (Consultant Ophthalmologist)

Tom Eke Consultant Ophthalmologist, Norfolk & Norwich University Hospital NHS Trust, Consultant Ophthalmologist, Cromer Hospital, Honorary Senior Lecturer in Ophthalmology, University of East Anglia. He is a cataract specialist and a glaucoma specialist and his other interests include neuro-ophthalmology, vision for driving and anaesthesia for ophthalmology. His research interests are mainly around anaesthesia safety, surgical techniques and improving the patient experience for which he regularly lectures on  at numerous international conferences.

Chronic  glaucoma  is a common and potentially blinding condition which is usually asymptomatic until advanced.  Approximately 10% of  blindness registrations in the UK are attributed to glaucoma. It affects around 2% of those over 40 rising to almost 10% in people older than 75, and the prevalence increases in people of black African descent.
There are over a million glaucoma-related outpatient visits in the hospital eye service annually.

Tom's talk on chronic glaucoma is an update and overview for GPs. Patients are, on the whole, managed by opticians and ophthalmologists. However, it is GPs who are responsible for prescribing, and there are a lot of patients with glaucoma on every GP list. Lifetime risk of developing glaucoma is 2%.

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Tom EkeCataract for GP's
Tom Eke (Consultant Ophthalmologist)

Tom Eke Consultant Ophthalmologist, Norfolk & Norwich University Hospital NHS Trust, Consultant Ophthalmologist, Cromer Hospital, Honorary Senior Lecturer in Ophthalmology, University of East Anglia. He is a cataract specialist and a glaucoma specialist and his other interests include neuro-ophthalmology, vision for driving and anaesthesia for ophthalmology. His research interests are mainly around anaesthesia safety, surgical techniques and improving the patient experience for which he regularly lectures on  at numerous international conferences. He has developed a special technique for patients who are unable to lie flat for cataract surgery, performing a cataract operation with the patient sitting upright.

Cataract is the most common cause of blindness worldwide and is conventionally treated with surgery.
Those with cataract commonly experience difficulty appreciating colors and changes in contrast, driving, reading, recognizing faces, and experience problems coping with glare from bright lights.Tom performs about 600-700 eye operations or laser procedures a year, mainly for cataract and glaucoma

This lecture on cataract management is an overview of the subject for GPs, providing an understanding of what cataracts are, how they present and how they are dealt with by ophthalmologists.

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Tom EkeAcute Eye Problems
Tom Eke (Consultant Ophthalmologist)

Tom Eke Consultant Ophthalmologist, Norfolk & Norwich University Hospital NHS Trust, Consultant Ophthalmologist, Cromer Hospital, Honorary Senior Lecturer in Ophthalmology, University of East Anglia.

His lecture recorded here is a very useful update on assessing and managing the acute eye, and is organised according to a simple algorithm, to make it easy to remember.  After briefly reviewing the anatomy of the eye Tom discusses first the problem of "something in the eye-what to do?" He has some very practical advice for the common problems that arise, using a ophthalmoscope as a magnifier, everting the upper lid, irrigation and so on.

Tom deals with all of the other causes of acute eye problems, in all of the possible combinations: painful/painless, red/white, loss vision/no loss vision, acute/gradual, single/bilateral.

This is a lecture that you will return to regularly, to dip into for advice when the need occurs.

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Gastroenterology

Rawya BadreldinDyspepsia
Rawya Badreldin (Consultant Gastroenterologist)

Rawya Badreldin is a Consultant Gastroenterologist and Endoscopy Clinical Lead who has tackled this topic from the point of view of looking at the NICE guidelines and producing a lecture that will assist us in our management of dyspeptic patients.
If you are interested in the evidence for some of the common therapies, there are some surpises in store.
PPIs are dealt with in detail, their usages and foibles are exellently laid out.
The rationale for referal is discussed and a series of case histories are given that demonstrate the issues raised.
This lecture will be reassuring for many GPs and is an excellent resource and update on the tricky subject that is "dyspepsia".

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Ian FellowsAnaemia and the Gut
Ian Fellows (Consultant Gastroenterologist)

Ian Fellows is a Consultant Gastroenterologist at the Norfolk and Norwich University Hospital NHS Trust and Honorary Senior Lecturer at the University of East Anglia.
He has led the Multidisciplinary Clinical Nutrition Support Team in Norwich since 1995, providing hospital and community-based artificial enteral and parenteral nutrition. He introduced PEG and HPN in the 1990s and provides an HPN service to patients in Norfolk and East Suffolk.
He has served as Chairman of the Education and Training Committee of BAPEN and as a member of its Council. He has served as a member of the Small Bowel and Nutrition Committee of the BSG.
He has a major interest in medical education and is currently Chairman of the East of England Deanery Core Medical Training Committee. He promoted the inclusion of Clinical Nutrition in postgraduate medical curricula.

The 3 types of anaemia covered in this lecture, ( iron , B12 and folate), are very common and knowledge of them is an essential part of a GPs workload. Ian reminds us also that they form a large part of a gastroenterologists workload too, iron deficiency accounting for 10% by all accounts.

His expert knowledge comes across to reassure us about referral of anaemic patients and his insights are interesting, for instance he makes it clear why lower GI investigation is performed before upper GI investigation in patients where localising symptoms can not be made.

As GPs we are constantly finding these anaemias and deficiencies in patients. As a result this lecture will become a frequently returned to staple in any portfolio. It is also a lecture that would be well shown collectively to a group of GPs in a practice setting, as it will generate discussion about how the practice manages its patients blood test results.

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Simon GreenfieldThe Secret to Managing LFTs in General Practice
Simon Greenfield (Consultant Gastroenterologist)

Simon Greenfield is a Consultant Gastroenterologist who works at the QE2 Hospital in Welwyn Garden City and the Lister Hospital in Stevenage. His talk is about managing abnormal LFT results, something that affects all GPs on a daily basis.

In Part 1 Simon looks at a series of cases demonstrating important points about LFTs. He looks at the main liver enzymes and the significance of isolated raised readings, and the significance of commonly found combinations of raised readings.

In Part 2 Simon discusses Non-alcoholic fatty liver disease and the subject of statins in liver disease. He comes to a very interesting statement about the way in which we think about (most) abnormal LFTs, that they can be thought of as a metabolic disorder similar to diabetes. Interesting...

Liver Function Test (LFT) is a bit of a misnomer given that most do not directly assess liver function per se. LFT is a panel of tests which is used to screen for liver disease, to aid in deciding on further liver related investigations and also to monitor liver disease.

Measuring protein and albumin can help in looking at the synthetic role of the liver (although changes in them may occur through many non-liver causes!).
Bilirubin looks at an excretory role of the liver and in particular the functioning of the biliary tree.
ALT is a marker of damage to liver cells. It is relatively specific for liver as compared to another enzyme called AST which is much more widely distributed in the body.
Alkaline phosphatase is a marker of cholestasis as levels rise if there is back pressure within the biliary tree.
GGT is also a marker of cholestasis, but high levels can be seen due to drugs and ethanol.
Remember to look at the LFT results in the light of the clinical scenario and other investigations. The pattern of changes in the LFTs is often the key to their interpretation.

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GP Skills


rogers1Politeness in the Consultation
Gary Rogers (GP)

Dr Gary Rogers is a GP ...
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Pam CushingThe Management of Airways & Defibrillators
Pam Cushing (Senior Resuscitation Officer)

Pam Cushing is the Senior Resuscitation Officer at the James Paget Hospital, where she leads a comprehensive resuscitation teaching programme to ensure that all staff are provided with the necessary skills to undertake resuscitation in a safe and competent manner.

Pam Cushing provides an excellent couple of lectures here that will update your understanding of resuscitation. The first lecture deals with managing the airway in cardiac arrest. Simple and concise advice is given with clear instructions and a demonstration, which is provided in close-up. You will find yourself replaying this talk over and over again, and coming back to it at regular intervals.

The second lecture deals with using a defibrillator, again in clear and concise terms, and with the benefit of close-up camera work to help you gain an intimate understanding of "how to do it".

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James HeathcoteCSA Examination
James Heathcote (GP & Examiner)

The aim of the CSA is to test a doctor’s ability to gather information and apply learned understanding of disease processes and person-centred care appropriately in a standardised context, make evidence-based decisions, and communicate effectively with patients and colleagues. Being able to integrate these skills effectively is a key element of this assessment

The validity of the CSA resides in its realistic simulation of real-life consultations. Patients are played by trained and calibrated role-players, and cases that are written and assessed by working GPs. The format of the assessment also allows for systematic sampling from the curriculum, using a selection blueprint.

Each candidate is allocated a consulting room and has 13 ten minute consultations ( RCGP Website). James Heathcote is a GP from Bromley and an MRCGP CSA examiner.

This talk by James is an excellent introduction to the CSA exam. He discusses how the exam is undertaken and how you should prepare for it. The information and helpful tips in this talk are invaluable.

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James HeathcoteConsulting Crimes
James Heathcote (GP & Examiner)

In 15 years as a trainer and RCGP examiner, Bromley GP Dr James Heathcote has watched more than a thousand GPs consulting. Most consultations are like the curate's egg - 'good in parts', but over the years he has seen some behaviour that, if not strictly criminal, normally requires further investigation. James Heathcote targets 10 generic types of consulting behaviours that can cause problems in practice.

An essential guide for the CSA candidate and a reminder for GPs generally.

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Maria KordowiczLeadership in Primary Care
Maria Kordowicz (Director, Akord People)

Maria is currently studying towards a King's College London doctorate exploring general practice performance and regularly lectures in aspects of healthcare management. This lecture of Maria's is about leadership and attendance will provide you with:

  • An increased awareness of the theoretical and policy contexts of leadership in primary care
  • An ability to define leadership, as well as an understanding of the limitations of the concept
  • Some practical tools to lead individuals and organisations in primary care
  • An increased understanding of the impact leadership can have on others
  • more reflective approach to your own leadership practice


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Salmon OmokanyeChaperone Training
Salmon Omokanye (Consultant & Lead Clinician in Contraception & Reproductive Healthcare)

Salmon Omokanye is a consultant and lead physician in contraceptive and reproductive healthcare in Sheffield. He is the training program director who has led the chaperone training program at the Central Health Clinic in Sheffield. The recording here is intended to enable practices to operate their own in-house chaperone training program and to enable participants to play a role as a chaperone and to meet the needs of patients and clinicians for a chaperone service.

The best way to achieve this is for a GP in the practice to become au-fait with the content recorded here, and to use it to lead a training exercise in the practice. A large plasma screen or projector would be helpful, so that all participants can view the recording.

The lecture is split up into 4 parts (3 of which are here, the 4th on a separate page)

Part 1 is a straightforward informative lecture that benchmarks the subject, outlining the essential knowledge everyone should be aware of about chaperoning.

In Part 2 Salmon uses a simple technique of pausing at certain points in the talk, to ask the audience questions. The GP leading the exercise in-house can pause the recording at these points and ask the participants to discuss the issues raised.  This section of the lecture can be used as the basis for an interactive discussion.

In Part 3 Salmon gives a demonstration is given on performing genital, breast and rectal exams.

There is a Part 4 to this lecture which is available (Chaperone Training- Role Play)

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Salmon OmokanyeChaperone Training (Role Play)
Salmon Omokanye (Consultant & Lead Clinician in Contraception & Reproductive Healthcare)

Salmon Omokanye is a consultant and lead physician in contraceptive and reproductive healthcare in Sheffield. He is the training program director who has led the chaperone training program at the Central Health Clinic in Sheffield. The recording here is intended to enable practices to operate their own in-house chaperone training program and to enable participants to play a role as a chaperone and to meet the needs of patients and clinicians for a chaperone service.

This (4th) section of the lecture provides the opportunity for some role play. Good clinician with bad chaperone and good clinician with good chaperone. There is also facilitated a discussion on how breaches of confidentiality can occur, and when confidentiality can be breached. Finally there is a discussion on "what to do about untoward incidents".

It is advised that the GP leading this training in-house controls this section of the talk by pausing at suitable points and facilitating discussion amongst the participants.

Finally there are some documents to download that can be used by chaperones to organise and record their activity in chaperoning afterwards.

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Andy SumpnerAdult Basic Life Support
Andy Sumpner (Emergency Medical Technician & Resuscitation Trainer)

Andy Sumpner is a former emergency medical technician and is an experienced  Resuscitation Trainer. His talk, recorded here, is an excellent resource to refresh your skills.

Part 1 deals with the diagnosis of cardiac arrest. We live in an age where defibrillators are becoming commonplace. Defibrillators are relatively easy to operate, indeed they have been designed to be so, yet it is the diagnosis of cardiac arrest in the first place that can cause resuscitators more difficulty. In Part 2 Andy deals with the usage of defibrillators themselves. This is a detailed lecture by a skilled practitioner.

These two lectures are a useful revision for GPs. Moreso, they are important for practice staff.

If you would like your practice staff to view this lecture then you could subscribe them to the GPLectures service. However you do not have to do this. We understand that practices would benefit from having their staff view this ( and other "essential" lectures we publish) - all we ask you do is for your Practice Manager to subscribe to our service, and then use that account to watch lectures jointly on a large plasma or projector screen.

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