Archive | Telemedicine

BASICS Scotland Paediatric Tele-education Course Starts 29th January 2018

BASICS Scotland would like to announce the dates for the next Paediatric Tele-education Course, presented by Karyn Webster. This 9 week course will start on Monday the 29th January and run for 9 weeks with an additional 6 weeks of post-course giving you enough time to catch up on any recordings you have missed!

Tele-education by BASICS Scotland is an online learning resource ideal for remote and rural practitioners eager to reinforce and develop their skills in pre-hospital emergency care. The benefit of Tele-education is that participants can take part without having to leave their home or place of work. The course is delivered entirely over the web, with weekly 1-hour live sessions in a video conferencing format which participants can attend or view the recordings later at a time more convenient for them!

Topics on this course include:

  • Child with Fever & Meningitis
  • Head Injury
  • Seizures
  • Allergy & Anaphylaxis
  • Asthma
  • LRTI
  • Epiglottitis & Croup
  • Gastroenteritis & Dehydration
  • Pain Relief

If you are interested in taking part in this course or would like more information head over to the BASICS Scotland website and complete an application form today!

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Students present Bright Ideas for Rural Practice

This year, the Rural GP Association of Scotland has once again run its student conference scholarship programme.  This is a significant investment for RGPAS, which uses money raised into its Educational Trust fund to support these scholarships.  The scholarships offer heavily-subsidised tickets to enable undergraduate students in the UK to attend and participate in the annual RGPAS conference.

To apply, students were asked to submit a 60 second sound or video clip explaining their Bright Idea for Rural Practice.  We are delighted to feature the winning entries below.

A number of these will be selected for PechaKucha-style presentation at our conference in November.  You can read more about the scholarships here, and also a great write-up of last year’s conference by one of the scholarship holders then, Catherine Lawrence from Hull & York Medical School.

There is still time to sign up to the conference, which takes place from 2-4 November 2017 in Inverness.  £130 for GPs or £65 for trainees gets you two-and-a-half days of quality CPD, along with a conference dinner (and wine).  It’s a great way to catch up with like-minded colleagues, and hear updates on clinical and non-clinical topics that are relevant to rural practice in Scotland.

Well done to all our scholarship winners.  We look forward to meeting you in Inverness!

Rohan Bald (Glasgow): Tackling Loneliness

Emma Bean (Glasgow 5th Year): Drones

Josephine Bellhouse (Glasgow): Improving Use of Communication Technology

Katherine Cox (Glasgow 4th Year): Developing Videoconferencing Peer Support

David Gibson (Glasgow): Awareness of Rural Medicine as a Career

Haiyang Hu (Glasgow): Access to Mental Health Services

Saskia Loysen (Glasgow): Increasing the use of Telemedicine (and pyjama bottoms)

Eloise Miller (Glasgow): Develop Rural Medicine Intercalated Degrees

Danielle Parsons (Aberdeen 4th Year): a Rural Medical School for Scotland

Gregor Stark (Glasgow 5th Year): Rural Research Consortium

Rosslyn Waite (Dundee): Improving Connectivity

Hannah Webb (Glasgow 2nd Year): Access to Sexual Health Services

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Highland innovations in eHealth

Thanks to RGPAS member Dr Richard Weekes for highlighting some fantastic work going on in NHS Highland to innovate eHealth applications aimed at improving access to healthcare in rural settings.

Here’s an introductory video showcasing some of the projects…

…an STV news item about the PILLCAM project in Ullapool to provide easy access to endoscopy facilities – using some very novel technology…

… and more about bringing endoscopy to rural communities…

… and the RAPID project to overcome connectivity challenges in rural Scotland…

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Rural Medicine Café discusses Rural Health Research

Mayara Floss, founder of the Café

Readers might be familiar with the Rural Medicine Café, set up by budding rural GP Mayara Floss who is a medical student in Brazil.

Following the 2015 Rural WONCA Conference in Dubrovnik, she set up the virtual Café to create a relatively informal space in which rural medics from all over the world could come together for some conversation to discuss hot topics, and develop collaboration.  Mayara runs these sessions on Google Hangouts, which offers easy access and is fairly successful on most broadband connections.

So far an impressive range of topics have been discussed.  The most recent event took place on Saturday, and involved doctors and students from Brazil, the Caribbean, Halifax in Canada, Scotland and Kenya discussing ways in which research in rural health could be improved and facilitated.

An important outcome of each virtual Café is that the content can be watched later, on YouTube.  The relaxed nature of these sessions means that they can take a fair chunk of time to watch, but for rural health enthusiasts who want to catch up on the conversations, it represents an interesting resource from which to learn from practices across the world.  Where else can you engage so easily in sharing and discussing rural health issues with worldwide conferes?

For future events, take a look at the Café Facebook page.  The most recent Café (running to just over an hour) can be accessed at the following link:

https://youtu.be/SdP53qewijU?t=1s

Well done to Mayara for an impressive result to her initial ambitions to develop this project.  Do contact her via the Facebook page if would like to watch or take part in a future Café.  The next Café will discuss the WONCA Rural Medical Education Handbook on Saturday 4th February.

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BASICS Scotland reports on over 15,000 hours of tele-education

BASICS Responders provide prehospital care across Scotland, especially in rural and remote areas.

BASICS Scotland – the charity that promotes the provision of high quality pre-hospital emergency care by health professionals across Scotland – recently produced a report that brings together experience of providing over fifteen thousand hours of online educational material.  And the conclusion: it’s cost effective, it increases access (particularly to remote and rural practitioners) to high quality education, and it works.

Tele-education has been available from BASICS Scotland since 2011, and since then the team have built on their experience to improve the learner’s experience, and reflect on what makes this form of learning most accessible.

Some participants manage to join these sessions in real-time, but the sessions are also recorded so they can be viewed at a later date via the BASICS Scotland website.  The sessions are usually packaged to run over ten weeks, covering adult and paediatric emergency prehospital care respectively.  A dedicated IT Facilitator assists participants with any initial difficulties in using the Adobe Connect software – which has proven to be an effective platform on which to deliver the content.  Participants who are watching in real-time are able to ask questions or type comments, and all of this is recorded for later viewing too.

As well as tele-education, BASICS Scotland also uses this technology for its Clinical Governance meetings (open to all member responders) and for Board meetings.  Scottish rural broadband speeds continue to pose some problems, but having knowledgeable IT assistance allows some of the technicalities to be tweaked, to maximise the use of available bandwidth.

The report (PDF) can be downloaded from the button below.  Further details on the tele-education programme can be found here, along with all the other training opportunities that BASICS Scotland provides.  A BASICS Scotland tour of the Adobe Connect platform can be found here.

Download the report here (PDF 733KB)
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Register now for the BASICS Scotland Tele-Education course in Adult Emergencies

BASICSlogoBASICS Scotland are launching the next round of their acclaimed Tele-education Course in Adult Emergency Care.

Who’s it for?

This Course is primarily for doctors, nurses & paramedics delivering care in the pre-hospital environment.

How do I take part?

New evidence based topics are delivered by weekly 1 hour sessions over 9 weeks for the paediatric course and 10 weeks for the adult course. These are presented live through our internet based video conference system using Adobe Connect which can be accessed anywhere in the world that you have a computer with an internet connection and up-to-date web browser with the latest Flash Player plugin installed.

Can’t make the live sessions? Don’t worry. Each live session is recorded and made available on our E-learning website along with supporting materials so you can view them in your own time.

teleed

The BASICS Scotland Tele-education studio

The adult course covers topics such as:

Allergy & Anaphylaxis; Asthma; LVF – Adult Pneumonia; Stroke & TIA; Chest Pain & Thrombolysis; Head Injury; ENT Emergencies; Wounds, Burns & Tetanus; Pain Relief; Seizures

The first session starts on Friday 22nd April 2016.  Apply by Friday 1st April 2016.

Course cost: £150 for non-members / £135 (BASICS Scotland members) 

For more information on this course, please visit the BASICS Scotland website or contact Leah at admin@basics-scotland.org.uk or call her on 01764 663671.

basics

Feedback from previous courses:

I picked up lots of useful tips, particularly regarding the range of drugs that I should consider using in a remote pre-hospital environment and the management of wounds and minor injuries.

Excellent course, loved been able to do it online, like structure of a topic each, 2 week break worked well. I enjoyed that the sessions were interactive, learned lots of useful information, thank you,

A very useful course that has increased my confidence in emergency situations.

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Ultrasound – the future of rural diagnostic medicine?

Back in October, a chance Twitter dialogue resulted in some interesting discussion about the prospect of developing ultrasound (US) training for rural GPs – mainly in Scotland but with interest from further afield too.  As a safe, immediate, easily-transmissible and potentially game-changing imaging modality, I sometimes wonder why it isn’t in mainstream use in our community hospitals already.  I can’t help but think that in ten or so years time, medical students will be graduating with an ultrasound unit round their necks instead of a stethoscope.

It turns out that at the University of California, Irvine (USA), this is already happening…

A responsibility to innovate

For rural practice, ultrasound offers lots of possibilities.  This is not news.  In fact, one of my GP predecessors Dr Alastair Grassie was innovative in using ultrasound on Arran back in the late 1990s/early 2000s.  As well as its use in acute presentations, he offered abdominal aortic aneurysm screening long before the national aneurysm screening programme was in place in Scotland. The service was continued by my colleague Dr Greg Hamill until it gradually became too difficult to adhere to increasing competency requirements in order to continue routine scanning sessions.

However, recent developments in PoCUS (Point of Care Ultrasound) – spurred on by its exponential use in emergency and prehospital medicine settings – has opened the gates once again to the case for rural GP ultrasound.  In the context of undifferentiated presentations, being able to speed up diagnosis helps to either prioritise or indeed avoid the need for transfer – with all the potential risks and expense that transfers involve.  On Arran we are frequently in situations whereby information from ultrasound would allow us to decide whether a patient needs air transfer urgently, or if they could wait until a later ferry. There are – like any clinical test – limitations, but any aid to whittling down a differential diagnosis – particularly if more significant pathology can be ruled out – will have an absolute impact on patient safety and effective use of transfer and secondary care services.  This observation is potentiated by the escalating growth in elderly, comorbid and complex undifferentiated medical presentations.

It’s easy to look abroad to see what everyone else is doing, and a simple Google search shows some very relevant work going on in Australia.  But we don’t have to go as far as that, as in Scotland there have been some very successful ultrasound schemes set up to allow GPs to offer US in community hospitals in Grampian.  Such was the success of this, that the programme has been presented to other countries and there is current work ongoing to link Scottish work with the development of rural ultrasound in Sweden.  Hamish Greig, a Brechin GP (North East Scotland) has been particularly involved in this work and you can view one of his presentations here.

We were delighted to welcome Hamish to our annual RGPAS conference in November, and along with some wise advice and a demonstration of ultrasound, he had many of us convinced (or more convinced) that this is something we need to develop further in Scotland.

The UK’s Royal College of Emergency Medicine has an established ultrasound curriculum, and this would seem a useful basis on which to develop competences pertinent to the rural/community hospital setting.

What are the hot topics?

There are a number of hot topics in the world of ultrasound.  There is increasing work being carried out into remote US interpretation – even to the extent that a ‘lay person’ operator can be mentored quickly over Skype, and the resulting scan interpreted by centralised expertise located many miles away.  Prof James Ferguson has worked on this concept using oil rig workers, and there is a report on the success of this here.  The Centre for Rural Health in Scotland has ongoing research into the provision of satellite-facilitated remote ultrasound in ambulances, as well as looking at the possibility of trans-sphenoidal ultrasound to aid differentiation between haemorrhagic or embolic stroke – which could potentially allow stroke thrombolysis to be given before the patient reaches a stroke unit/CT scanner.  This has clear benefits for rural patients in particular.

Concerns exist regarding appropriate governance, and indeed whether rural sites have the turnover of patients to maintain skills & competence.  However these concerns can now be mediated by the fact that technology exists to allow either a first or second opinion in real-time, by a mainland-based expert e.g. consultant radiologist.  Decay of competence can also be mitigated by a well-functioning and supportive clinical governance network whereby cases can be compared, exposure maintained and quality assured.

Learning about the work above has made me reflect on the need – as always – for rural GPs to advocate for our communities. In the context of rural acute medical care, it seems that we are at a critical yet ideal point to realise the evolving possibilities of rural GP-led ultrasound.

basicsIt was a recent BASICS call for me that focussed my interest.  In the summer I was called to a young cyclist who took a different path to his bike, at high speed.  After we instigated initial treatment, the EMRS trauma team arrived by helicopter.  I was struck that their ultrasound unit was the size of an old-style flip mobile phone… and they were able to check for significant chest and abdominal injury at the roadside.  I wrote about the experience here.

I’m not suggesting here that rural GPs need to be doing prehospital trauma ultrasound – the majority of these infrequent patients need immediate medical intervention and speedy transfer to secondary/major trauma care; roadside ultrasound brings the risk of distraction by gadgets.  However if ultrasound technology can exist easily at the roadside, it shows that the technology exists for ultrasound to be easily available at the community hospital bedside.

The Future

Island and rural medicine brings occasions when helicopters are not immediately available.  Even when they are, there is a plentiful supply of clinically undifferentiated cases, where the need for transfer and/or intervention is difficult to ascertain without further imaging.  The potential exists for point of care ultrasound (whether remotely interpreted or not) offers ‘game changing’ opportunities in the provision of advanced rural medical care.

Of course, PoCUS is not the exclusive domain of the attending physician; indeed in rural areas where radiographer teams provide 24/7 cover, it may be more beneficial to train a smaller number of radiographers to be available to provide this service.  The feasibility of remote interpretation has been demonstrated in the above projects and this could potentially alleviate the challenges that presently exist in US training in accessing regular mentoring/supervision.

So what have we done?  As a result of our initial Twitter conversation, we have set up an informal Google Group to discuss the options further.  Any UK rural clinician who wants to take part in this is welcome to join (we may be focussed on development in Scotland, but that is to be clarified with time).  We may decide to meet up sometime in 2016 to take things further.

Please do join if you are interested in being involved.

Featured image (ultrasound) under Creative Commons © Nevit Dilman

Here’s a video to reflect on how ultrasound actually originated… and the fact that Prof Ian Donald of Glasgow University is attributed as one of the pioneers of ultrasound.

And finally, here’s a video all about rollout of PoCUS to Rural Primary Care Physicians in South Carolina (2011)

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Major step forward for rural GP CPD in Scotland

webcamRuralGP.com is pleased to learn that RRHEAL is set to pilot a Scotland-wide virtual education network from September.

The Rural GP VC Education network has been established by RRHEAL to share good practice and CPD opportunities amongst remote and rural practitioners in Scotland. It will deliver an initial series of three clinical meet-up sessions using video conference and Jabber to enable a wide range of participants to join from remote, rural and island locations.

The sessions have been designed to focus on selected “hot topics in rural practice” enabling rural practitioners to link up, share evidence based presentations, facilitated discussion and consider applications to clinical practice.  The first three sessions will focus on Major Trauma, Acute Coronary Syndrome and Suicide Prevention/Mental Health – with further details to follow and to be tailored to the requests of those involved.

The sessions will be available by a VC link from 12.30pm to 2.00pm on the last Tuesday of the month every 2 months with dates as follows:

  • Tuesday 29 September, Dental Lecture Theatre, Centre for Health Science
  • Tuesday 24 November, NES Boardroom, Centre for Health Science
  • Tuesday 25 January 2016, NES Boardroom, Centre for Health Science

More information can be found here or by contacting rrheal@nes.scot.nhs.uk

Add these dates to your diary and share with colleagues.  You can also visit the NHS Scotland National Videoconference Service for information on how to easily link in to these – and other – videoconferenced events.  We hope to run an article on this at RuralGP.com in the near future too.

Tip! If you want to link into these meetings via your laptop, iPad or home PC, take a look at the information on the NHS Scotland VC pages about Jabber – which allows you to connect to the NHS Scotland VC network from nearly any internet-connected device. More details available from this page or the ever-helpful support team.

This pilot originated from a discussion with Bruce Chater, a rural GP in Australia who I met at the WONCA Rural Health Conference held in Dubrovnik in April – for which my attendance was supported by RCGP Scotland.  Bruce highlighted the opportunities available from videoconferencing to establish managed educational and clinical networks between rural practitioners.  I’m grateful to Pam Nicoll and Ronald MacVicar, and subsequently NHS Education for Scotland and RRHEAL for taking the idea forward and through to this pilot stage.

The longer term aim is that we see improved (and more consistent) levels of VC literacy across rural Scotland as the technology and reliable broadband speeds are increasingly available to us all to share good practice and great ideas.  BASICS Scotland and EMRS have also stimulated lots of work in this area, and hopefully this will be another useful means by which we can reduce professional and geographical isolation – rural practice is full of innovation and good ideas.

The following video went viral last year, and encapsulates lots of the points that we want to avoid by improved use of virtual conferencing by phone or video… enjoy if you haven’t already seen it!

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New Zealand: Rural connectivity is an issue there too

nzrgpn14-logoThe New Zealand Rural General Practice Network held their annual conference last weekend.

They’ve helpfully recorded a series of video interviews with their speakers and leaders, and these are available here.

Earlier this week, we published this article about the problems faced by rural communities in accessing adequate mobile phone coverage, and fast broadband internet.

This interview with Craig Young of Chorus, a telecoms company in New Zealand, explains some of the strategies that they have adopted to improve rollout of digital connectivity to rural areas of the country.

[youtube https://www.youtube.com/watch?v=-vSgIr7nj7I ]

 

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Paediatric emergency medicine… learn by videoconference

BASICSlogoBASICS Scotland is offering another opportunity to get up-to-date with paediatric prehospital emergency medicine – delivered by internet-based teleconferencing.

The 9-session course, delivered by expert speakers, will be delivered weekly on Thursdays from 11th April 2013.   The same topic will be delivered in two separate sessions each day – 1300-1400 and 1500-1600.  This time it’s possible to link in from any computer with a webcam, microphone and broadband connection, and it’s also possible to view the sessions in your own time.

The topics include:

  • child with fever
  • meningitis
  • asthma
  • epiglottitis & croup
  • seizures
  • head injury
  • allergy & anaphylaxis
  • gastroenteritis & dehydration
  • pain relief
  • lower respiratory infections and pneumonia

Previous courses have received excellent feedback.

Very informative, execptionally useful and well delivered

Really helpful course, well worth attending!

The cost of all 9 sessions is £135 (BASICS Scotland members) or £150 (non-members).

More information is available from Kirsty at klaird@basics-scotland.org.uk – or download this poster.

 

 

 

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