Previews – GIM

Gynaecology | Infectious Diseases | Medicine

simpson1The Management of Vaginal Discharge
Jane Simpson (GP)

Dr Jane Simpson is a GP with a special interest in gynaecology. Her lecture on vaginal discharge is a comprehensive outline of this common presentation to general practice.
The Management of Vaginal Discharge deals with the common causes of vaginal discharge and the management of these causes, as commonly seen in general practice. The talk centres on the 3 main causes of bacterial vaginosis, candidiasis and trichomonas and provides expert advice about how to differentiate and manage these.

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Shagaf BakourManagement Strategies for Postmenopausal Bleeding
Shagaf Bakour (Consultant Gynaecologist)

Mrs Shagaf Bakour is a Consultant Gynaecologist  at the Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Honorary Senior Clinical Lecturer in the Faculty of Medicine at the University of Birmingham, Consultant at the Priory private hospital, and a Consultant at The BMI Edgbaston Hospital.

Shagaf runs general obstetric and  gynaecology services, including laparoscopic and hysteroscopic surgery, and she performs a specialist scanning and post menopausal service in her NHS practice. She has an interest in managing menstrual disorders and postmenopausal problems and is the lead clinician for training and education at her HNS Trust.

Post-menopausal bleeding (PMB) represents one of the most common reasons for referral to gynaecological services, largely due to suspicion of an underlying endometrial malignancy. Endometrial cancer is present in approximately 10% of patients referred with PMB. Formerly, the principal means of hospital investigation was by dilatation and curettage (D&C), but newer methods of investigation such as outpatient endometrial biopsy, transvaginal ultrasonography and hysteroscopy have superseded D&C. However, there is professional uncertainty concerning the most accurate, acceptable and efficient diagnostic approach.

Shagaf's lecture is an excellent review of post-menopausal bleeding and it's management, concentrating as she does on the evidence.

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Janine ElsonInfertility
Janine Elson (Consultant Gynaecologist)

Janine Elson is a consultant gynaecologist and a subspecialist in reproductive medicine at Leicester NHS Trust. Her lecture will provide you with a comprehensive understanding of infertility management.

It has been estimated that at some time in their reproductive lives at least a quarter of couples experience a period of infertility lasting over 1 year. Some of these couples continue to be unable to conceive, leading to at least 1 in 6 couples seeing an infertility specialist at a hospital. After assessment by the specialist, many couples can be reassured that they do not need treatment, just more time with regular sex. Others may require some form of treatment to assist with conception

Starting with the basics  Janine discusses the definition and causes of infertility, and then progresses to preconceptual advice and history taking,  examination, lifestyle advice and finally when to refer couples.

In Parts 2 and 3 Janine talks about female amd male infertility in detail and in Part 4 she discusses assisted techologies.

There is a great deal of information covered in this lecture.

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Badatunde A. GboladeTermination of Pregnancy
Badatunde A. Gbolade (Consultant Gynaecologist)

In the UK, under The Abortion Act 1967, abortions can only be carried out in a hospital or a specialist licensed clinic.
It is legal for termination to be carried out up to 24 weeks of pregnancy, but most hospitals and clinics will not consider termination beyond 18 to 20 weeks. For this reason alone, if a woman is considering termination, then she should discuss the situation with a doctor sooner rather than later.

Babatunde Gbolade is a Consultant Gynaecologist and Director of the Fertility Control Unit at St James University Hospital in Leeds. He talks in detail about the subject of termination of pregnancy.

In Part 1 Babatunde discusses the law in relation to termination of pregnancy, the latest termination of pregnancy figures and pre-termination procedures.
In Part 2 he discusses the range of methods of termination of pregnancy
In Part 3 he discusses the important aspects of care and service standards expected of a provider.

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Jo NietoCervical Cancer
Jo Nieto (Consultant Gynaecologist)

Jo Nieto is a Consultant Gynaecologist at the  Norfolk & Norwich University Hospital, Honorary Senior Lecturer at the  University of East Anglia and Associate Professor Obstectrics and Gynaecology at the  University of Pamplona (Spain).
Every year in the UK, over 3,000 women will be diagnosed with cervical cancer and nearly 1,000 women will die from the disease. Cervical cancer is the most common cancer in women aged 35 and under.

Cervical cancer, almost exclusively, is caused by persistent infection with the human papillomavirus.

This lecture will provide a detailed look at cervical cancer, how it behaves, how screening works, and how it is managed. In the second part of his lecture he discusses the new HPV vaccines and how they work.

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'Funso OlarindeGenital lumps and bumps
'Funso Olarinde (Consultant Physician)

'Funso Olarinde is a Consultant Physician at the department of GU Medicine, Royal Hallamshire Hospital in Sheffield.
When patients present with genital 'lesions', it is important to distinguish between normal anatomical variants. Often, patients simply require reassurance that their \'lesions\' are just a normal variation or a harmless anomaly of no significance.

In this short lecture 'Funso discusses and provides examples of these common conditions and normal variants, and also provides an overview of pre-malignant and malignant lesions that we should all be aware of.

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Alison WrightGenital Ulceration
Alison Wright (Genital Urinary Consultant)

Alison Wright is a consultant in genitourinary medicine at the Royal Hallamshire Hospital in Sheffield. Her lecture is  primarily about herpes infections, primary and recurrent, as well as other causes of genital ulceration.

As expected, the insights from this lecture are invaluable, coming as they do from a clinician with regular exposure to these problems.

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Infectious Diseases

Christine BowmanThe Role of Primary Care in managing HIV
Christine Bowman (Clinical Director)

Christine Bowman is a Consultant physician in Genito-Urinary Medicine and is clinical director for the academic directorate of communicable diseases, Sheffield Teaching Hospitals NHS Foundation Trust. This short lecture is an succinct yet comprehensive update into HIV care and an introduction to how primary care is involved.

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Christine BowmanSyphilis in the 21st Century
Christine Bowman (Clinical Director)
Christine Bowman is a Consultant Physician in GU Medicine and is Clinical Director of the Academic Directorate of Communicable Diseases, Sheffield Teaching Hospitals NHS Foundation Trust.
This lecture is an important update and reminder that syphilis is a disease that is on the increase in the UK , with an incredible 607% increase in cases over the first decade of this new century ( 2000 to 2009)
Christine discusses the new advances in diagnosis and testing. She then looks at the presentation of syphilis and the clinical features that each stage presents with.

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Dorothy ChakaniStaphylococcus aureus (MRSA & MSSA)
Dorothy Chakani (Infection Prevention & Control Practitioner)

Dorothy Chakani is an Infection Control officer from Maidstone & Tunbridge Wells NHS Trust Kent & Medway CLRN. Her lecture on MRSA and MSSA infection provides an overview of staphylococcus infection control in healthcare today.

For those of us in primary care MRSA is usually identified to us in pre-operative patients or those patients recently discharged, and as such we do need to be prepared and aware of the basics of management.

This lecture is a timely introduction for all practice staff.

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Ann ChapmanDiagnosing Tuberculosis
Ann Chapman (Consultant Infectious Diseases)

Ann Chapman is a consultant in Infectious Diseases and Tropical Medicine at the Royal Hallamshire Hospital in Sheffield. Her lecture here is of great interest to those of us that work in primary care, principally because of the large population of patients with latent TB that are present in our communities. Especially in those communities that have a large immigrant population and amongst specific at-risk groups.

Ann talks about how active TB is diagnosed and how this differs from the diagnosis of latent TB, and discusses the NICE recommendations for screening for latent TB.

By the 1970s it had almost been eradicated, but in the last 30 years there has been a major re-emergence of the disease, which is airborne and spread through close contact with others. TB rates in Britain have increased rapidly and now stand at around 9,000 cases – the highest level since the 1970s. Between 2001 and 2010 more than 4,800 people died of TB in the UK. The Health Protection Agency has forecast that if the rise in TB continues at its current rate then by 2015 Britain will have more new cases each year than in the whole of the US. The interferon gamma release assay (IGRA) is a newer type of blood test for TB that is becoming more widely available.

The IGRA may be used to help diagnose latent TB:

  • if you have a positive Mantoux test
  • as part of your TB screening if you have just moved to the UK from a country where TB is common
  • as part of a health check when you register with a GP
  • if you are about to have treatment that will suppress your immune system
  • if you are a healthcare worker


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Nelson DavidClinical HIV Infection
Nelson David (Lead Consultant Genitourinary Medicine)

Nelson David is the Lead Consultant in Genitourinary Medicine at the Norfolk and Norwich Hospital. Nelson takes us through the current management approach to HIV infection.

His update begins with a discussion on the natural history and the benefits of knowing a personal status. He covers seroconversion illness, the indicators of HIV infection and demonstrates these graphically. Common AIDs presentations are discussed and the basics of treatment, monitoring and managing resistance. He completes his talk with pre-HIV test councelling and post-exposure prophylaxis.

This short lecture is recommended to all GPs who want to update their knowledge on HIV infection.

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Nelson DavidBacterial Sexually Transmitted Infections
Nelson David (Lead Consultant Genitourinary Medicine)

Nelson David is the Lead Consultant in Genitourinary Medicine at the Norfolk and Norwich Hospital.

In this comprehensive lecture Nelson discusses the important bacterial STIs, outlining and updating the essential management points.

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David DockrellManaging pneumonia in primary care
David Dockrell (Dept of Communicable Diseases, Sheffield University)

David Dockrell is a Professor of Infectious Diseases and a consultant in the department of Communicable Diseases at the Royal Hallamshire Hospital with an interest in HIV medicine and infections in immunocompromised hosts.

The identification and management of adults presenting with pneumonia is a major challenge for primary care health professionals. Diagnosis and decision on hospital referral in primary care is based on clinical judgement and the CRB-65 score. Unlike some other respiratory infections (e.g. acute bronchitis) an antibiotic is always indicated when a clinical diagnosis of pneumonia is made

This lecture covers the causes and management of community acquired pneumonia, an essential subject for GPs. Not only does this lecture succinctly address current best practice it also offers insights into future developments that we may well see affecting our management.

David summarises the approach to diagnosis and the rationale behind obtaining a CXR and asking for microbiological cultures. There are a few surprises here about assessment, with a discussion on urinary antigen testing and the CURB65 tool.

David discusses vaccination, and poses the thought that we might, as data starts to emerge, be using the protein conjugate vaccine ( currently being used in children) in selected groups rather than the standard polysaccharide version. He also alludes to how such vaccines might be used in asthmatics in the future. Indeed his talk is important to GPs as it suggests that the future of vaccination in reducing the burden of community acquired pneumonia and invasive pneumacoccal disease will be the correct identification of susceptible groups and the correct use of appropriate preventitive measures.

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Julia GreigHIV and Hepatitis co-infection
Julia Greig (Consultant Infectious Diseases)

Dr Julia Greig practices at Royal Hallamshire Hospital, specialising in Infectious disease

Coinfection with HIV and the hepatitis C virus (HCV) or hepatitis B virus  is a growing public health concern. Because the diseases are spread in similar ways, notably through shared use of needles to inject drugs and sexual activity, many people are coinfected with HIV and HCV, HIV and HBV, or even all three viruses. Coinfection can complicate treatment. People with liver damage due to chronic hepatitis are more likely to experience hepatotoxicity related to anti-HIV drugs. In addition, drugs used to treat HIV and hepatitis can interact and side effects may be exacerbated

HIV/HCV coinfection is increasingly recognized as a growing public health problem. Early in the HIV/AIDS epidemic most people with HIV were expected to die from AIDS, and less attention was devoted to other long-term conditions. Because chronic hepatitis C progresses so slowly, many HIV positive people who were infected with HCV in the 1970s or 1980s are only now beginning to develop advanced liver disease.

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Ogra MarufuAntimicrobial prescribing in the community
Ogra Marufu (Infection Prevention & Control Nurse)
Ogra Marufu is a Clinical nurse specialist with experience in all aspects of infection prevention and control within a holistic framework.

Good infection prevention and control are essential to ensure that people who use health and social care services receive safe and effective care. Effective prevention and control of infection must be part of everyday practice and be applied consistently by everyone

The Care Quality Commission inspection programme on cleanliness and infection control in NHS Trusts, Compliance criteria 9, specifies that in relation to antimicrobial prescribing, local clinical guidance, procedures and audit are in place to ensure prudent prescribing and antimicrobial stewardship.

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Ogra MarufuClostridium difficile
Ogra Marufu (Infection Prevention & Control Nurse)
This lecture will make you aware of the risk factors associated with C. difficile infections in the community setting.

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Mike McKendrickRecognising and Managing Herpes Zoster in Primary Care
Mike McKendrick (Emeritus Consultant)
Professor Mike McKendrick, Emeritus Consultant, Sheffield Teaching Hospitals NHS Foundation Trust. Consultant in Infectious Diseases and Tropical Medicine in a large regional unit in South Yorkshire for over 30 years.
This lecture by Professor McKendrick covers in a short lecture the important points of varicella zoster and shingles. As GPs we often think that we know all about this common disease, but there are some very interesting points and insights that Prof McKendrick makes.
The Hope-Simpson model makes shingles perhaps the most important discovery in medicine by a GP over the last century.
Diagnosis is relatively simple but there are some variants of presentation which are interesting to know about.
We are introduced to the understanding why shingles is more common in the elderly, and we get to understand the importance of discriminating between the immunocompetent and immunocompromised.
Treatment with antivirals is reviewed, and the rationale for using the newer medicines is reviewed.
There are a few old beliefs that are challenged in this lecture. Infectivity and transmission rates and the time to which treatment can be started are covered, and there are some surprises in emphasis that are made.
urgent referal advice for complications is given. the impact that New vaccine management can have, as well as the rationale for their usage, is discussed.

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Ben StoneFever Assessment for travellers
Ben Stone (Consultant Infectious Diseases)

Ben Stone is a Consultant in Infectious Diseases at Sheffield Teaching Hospitals and this talk he has recorded on assessing fever in travellers is a proficient  and succinct overview of the process.

Your surgery is proceding happily and you are keeping good time, when out-of-the-blue a patient arrives who is unwell and who has just returned from an exotic clime. You are immediately placed in an uncomfortable position, out of your comfort zone. Ben\'s lecture here will enable you to comfortably cope with this scenario. The problem we all have to manage is to decide whether the patient has a minor self-limiting problem or a severe life-threatening one.

Firstly, Ben will discuss the range of infectious diagnoses to consider in a returned traveller with infection. He will then show you how to assess such a patient and to know which patients need referal onwards for specialist assessment.

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Ben StoneDiagnosing Hepatitis C
Ben Stone (Consultant Infectious Diseases)

Ben Stone is a Consultant in Infectious Diseases at Sheffield Teaching Hospitals and his talk on "Diagnosing Hepatitis C" is an adept overview of the process.

The talk deals initially with the importance of making the diagnosis, and then with the details of who to test, how to test and who to refer for treatment. Finally Ben talks about what the treatment options are and what can be expected regarding prognosis.

The statistics are that 1 in 200 people in the UK currently are infected, the majority of whom are unaware of their status. This burden of illness is starting to cause increasing hospital admissions and deaths. Ben talks about the predictions for future liver disease effects, and how Hepatitis C management is a key component of the National Liver Disease Strategy.

This a key lecture for GPs and watching it with reflection will efficiently familiarise you with the important points needed to manage hepatitis C diagnosis in practice.

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Ben StoneRecognising life threatening infections
Ben Stone (Consultant Infectious Diseases)

Recognising life threatening infections. By the end of this lecture, you should be able to recognise the following life-threatening infections:

  • Meningococcal septicaemia
  • Meningitis
  • Encephalitis

Ben discusses these important infections and brings you up-to-date with current management

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Anne TunbridgeScreening Immigrants for Infection
Anne Tunbridge (Consultant Infectious Diseases)

Anne Tunbridge is a consultant in Infectious Diseases, and in this lecture she presents a screening program that has been set up in Sheffield in primary care. The Mulbery Practice has been specifically setup to offer services to asylum seekers and refugees. Anne desrcibes how the service runs, how it screens patients and how they are managed.

Rather than using the old mantoux test the screening tests employed are the new interferon gamma release assays, Anne describes the advantages of these. Anne describes how this program could be setup in any GP practice. She presents the results of the first years operation at the Mulbery practice.

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Alicia VedioDiagnosis and management of Hepatitis B
Alicia Vedio (Speciality Physician)

Alicio Vedio is a specialty physician who works at the  Department of Infectious Diseases and Tropical Medicine in Sheffield. She delivers here a short talk about the diagnosis and management of Hepatitis B, concentrating on some basic concepts. Alicio covers the basic features of infectivity and epidemiology and explains the concepts behind chronicity of infection and the relationship to disease expression.

Going further she discusses the importance of placing patients with chronic infection into one of the 4 immune phases, and she explains how important this is to determining what treatment a patient requires. Alicio then discusses the treatment options for patients in the different immune phases of chronic infection.A couple of case histories are presented and finally a short discussion on what general advice patients need.

This is a short lecture that will succinctly update your knowledge of how to diagnose and manage Hepatitis B.

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Medicine

Philippe GrunsteinEmphysema
Philippe Grunstein (Consultant Respiratory Medicine)

Dr Philippe Grunstein trained in General Medicine in Amiens.  He is a Consultant in Respiratory Medicine and Associate Professor at St George’s University School of Medicine. He specialises in Intensive Care and Sleep Medicine

COPD  is the occurrence of chronic bronchitis or emphysema, a pair of commonly co-existing diseases of the lungs. Classically we used to differentiate between pink puffers and blue bloaters, depending upon whether they had predominantly emphysema or chronic bronchitis ( emphysema classically leading to a hypercatabolic state with hyperventilation versus the bloated cyanotic state of the bronchitic with V/Q mismatch and cor pulmonalae). In reality patients have mixed states and the important feature to note is to recognise when they are becoming hypercapnic.

This lecture by Philippe concentrates on the management of patients with emphysema, how to recognise and manage them when they deteriorate.

This is a very engaging lecture in which Philippe passes on several very useful insights into patient assessment and management.

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Ajay KamathAsthma
Ajay Kamath (Consultant Respiratory Physician)

The majority of patients with asthma are treated in the primary care setting. It is the GP therefore who is in a key position to recognize poorly controlled asthma and to improve asthma management for these patients. With the prevalence of asthma rising it is becoming one of the mainstays of chronic disease management in primary care. Ajay Kamath is a Consultant Respiratory Physician , and his lecture here is a comprehensive and reflective account of asthma management.

In Part 1 Ajay discusses diagnosis.
In Part 2 of his lecture Ajay deals with standard management of asthma care and in Part 3 he deals with the problems of difficult to manage asthma, asthma in pregnancy and occupational asthma.

All in all, this is an essential lecture, and one well worth repeating carefully to obtain the most benefit out of it.

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Willy NotcuttCannabis - An Old and a New Medicine
Willy Notcutt (Consultant in Pain Management)
Willy has been investigating the clinical application of cannabis for many years and is a world renown expert. His talk reviews the historical place of cannabis in medicine, and how it can be used clinically nowadays. His discussion on the endocannabinoid system is enthralling, as is his discussion on the possible clinical entities that could be helped with this treatment. There is strong evidence  which supports the use of cannabinoids for chronic pain, but more research is needed to determine how it can be integrated into practice.
Currently Sativex has a licence to be used in MS treatment, and Nabilone has a licence to be used in chemotherapy-induced nausea and vomiting.

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