Archive | Research

Reporting soon from WONCA Rural Conference in Dubrovnik

dubrovnik banner 492x170This week sees the 13th WONCA World Rural Health conference take place in Dubrovnik, Croatia.  It looks set to bring together rural health professionals from across the world, and just looking at the programme, it is clear that there is a lot of experience being gathered in one place.

I’m delighted and grateful that RCGP Scotland has supported me in attending the conference, and we will be presenting our ‘Being Rural‘ report on the Saturday, during Scientific Session 14.  In addition, this will be a huge opportunity to share ideas and meet similarly-challenged confreres in the world of rural health – and I hope to come back with useful, relevant ideas that have worked in other areas… to bring this back to the work we’re doing at the RCGP Scotland Rural Strategy Group and wider, and to see implementation of the things we know need to be better.

As part of this, I hope to run a daily blog report of sessions attended, and lessons learned.  Depending on wifi, I’ll be participating in the twitter coverage using the hashtag #woncarural2015.


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Retrieval 2014 – programme announced

retrieval2014Following on from last year’s successful Retrieval 2013 conference, details of Retrieval 2014 have been announced by the Emergency Medical Retrieval Service.


This year’s programme achieves a wide mix of presentations, on both prehospital and rural hospital retrieval.  Topics include major incidents (including a presentation from Arran Resilience), modern tools for training and a particularly interesting session on leadership – including input from non-health sectors.

Speakers include Professor David Lockey, Jonathan Hanson (Rural Practitioner, Skye) and Richard Lyon amongst many other well known faces, including from EMRS itself.

The conference will again be held at the Beardmore Hotel in Clydebank, Glasgow.  Booking is advised ASAP given that last year’s conference was a sell-out.

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Allen & Margaret Wilson Memorial Fund

In 1967, Drs Allen T and Margaret JI Wilson were tragically killed in a road accident.  Allen Wilson had already made his name by his contribution to the RCGP and to research in general practice.

A fund was set up in 1969 in their memory, with a two objectives:

  • to advance the education of young people resident in the Parishes of Innerleithen, Traquair and Walkerburn
  • to encourage original research work by family doctors, following the example of the Wilsons

There are three Trustees – including the Provost of South East Scotland Faculty of RCGP.  Every second year the Provost has to provide the name of a doctor in Scotland for the award.  By the Trust Dead, he has to consult the RCGP Research Committee, Scottish Council and Scottish Council Research Network.  In considering possible recipients, preference should be given to a young doctor practicing in a rural area.  The medical award is usually linked with giving a lecture under the RCGP, locally or nationally.

An award of £750 is available this year.  Please see forms/information below for further details.

Explanatory Letter Application Information


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Tranexamic Acid update

red_blood_cellsSince the CRASH2 trial was published in 2010, there has been a huge amount of work to ascertain how best to deliver tranexamic acid practically, particularly in the prehospital environment.

The benefits of tranexamic acid almost seemed too good to be true.  It’s cheap, easy to carry, has been used for decades within hospital and GP settings – and seems to offer absolute benefits in promoting haemostasis, with no side effects.  It also fits very well into the ‘damage limitation’ approach that has changed much of prehospital trauma care over the last few years.  In addition, military experience, particularly from Afghanistan, has accelerated the availability of high quality practical data on its use in challenging environments.

Now, there is some solid and pragmatic advice on the administration of tranexamic acid, including a Cochrane review which has been published in December last year:

>> Blood-clot promoting drugs for acute traumatic injury

It appears that it is now at a point that many practitioners can and should be considering its use.  Especially for areas where transfer to a surgical or major trauma unit is likely to be delayed – such as rural and remote areas of Scotland – it could offer vital life-saving benefits of reduced blood loss and extended survival times in the context of major trauma.

Administration is relatively straightforward.  Where there is evidence of a ‘positive primary survey’ – i.e. where pulse, blood pressure/capillary refill time or respiration rate are impaired due to suspected haemorrhage, resulting from trauma in the last 3 hours, the following treatment is suggested:

  • Inject two 500mg vials (1g) of tranexamic acid into a 100mL bag of normal saline.  Give this IV over 10-20 minutes (loading dose).
  • Inject two 500mg vials (1g) of tranexamic acid into a 500mL bag of normal saline.  Give this IV over 8 hours (maintenance dose).

Commonly, where transfer to hospital or extrication takes less than 30 minutes, the maintenance dose can be more safely given once the patient is in a facility that can provide an IV pump to give this over a more exact time.



Crash 3 Trial

The investigators are now busy conducting the Crash 3 trial which will look at the effects of tranexamic acid specifically on traumatic brain injury.  They’ve produced a video explaining the new trial procedure – which also highlights some of the key points of using tranexamic acid above.





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New Chair in Rural Health and Community Wellbeing

“For years the phrase ‘health and wellbeing’ has been used to describe physical and mental health, but how do we enable a community to grow its wellbeing? Are there lessons in a rural setting for health strategy and delivery if we start to look at what keeps a community healthy rather than delivering a sickness service? Can we create a strong evidence base to influence future policy development in a country committed to acting sustainably?”

Jane Davidson, Director of the Wales Institute for Sustainability at Trinity Saint David University

Photo by A Roger Davies

An exciting new opportunity in the field of rural health, the first Hywel Dda Reader/Chair of Rural Health and Community Wellbeing, is being created by a joint partnership between two well respected rurally based universities, Aberystwyth University and the University of Wales Trinity Saint David. The universities have come together with the regional health service provider, Hywel Dda Health Board, to generate an international research opportunity in rural wellbeing/health economics open to an imaginative senior researcher who wants to exert influence over policy development in a strategic way.  S/he will be responsible for leading research and policy development in relation to the following key areas:

  • Community cohesion and engagement
  • Role of health and wellbeing in rural regeneration
  • Improved access to services in a rural area
  • Service integration and workforce development models

Trevor Purt, Chief Executive of Hywel Dda Health Board  “We are delighted to work together in partnership with our colleagues in the higher education sector.  We clearly recognise the unique challenges of our large rural geography, but far from seeing this as a problem; we see it as an opportunity to specifically meet the needs of our rural communities.  This is about ensuring our services work for the people we serve and developing the national Rural Health Plan into actions that will deliver a new type of healthcare provision in a real rural area, with real people, every day.”

Prof Martin Jones, Pro Vice Chancellor of Aberystwyth University goes on to say “This is a unique opportunity for the right candidate to make a demonstrable contribution to major health and social care policy and practice and/or policy changes through the application of research. The universities are keen to be at the forefront of new sustainable ways of thinking about health, wellbeing and rural regeneration and are looking to work with the successful applicant to consolidate new research and development opportunities in beautiful West Wales. We are looking for the right person to take this prestigious new role and would welcome applications from around the world”

For more details you can download a job pack.

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Poster: Rural GP Training

Developing a skillbase appropriate to the rural and community hospital setting is a hot topic, surrounded by issues of recruitment, retention and revalidation.    This poster from RRHEAL and NHS Education for Scotland looks at the components that are important to consider, and how they might be delivered in the context of a rural GP training programme.

Education and training needs vary depending on the situation of different rural hospitals, but a common theme was the skill set required to deal with unsorted emergency presentations within rural “No Bypass Units”.

You can download the poster by clicking below.

Click to download PDF poster.

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EURIPA Forum 2013: Malta, 17-20th October

Details have just been released by Jose Lopez-Abuin (President) of the next EURIPA (European Remote and Isolated Practitioners Association) Forum.  This will be held in Attard, Malta on 17th-20th October 2013.

The meeting will be held with the EGPRN (European General Practice Research Network) and will aim to underpin research in rural practice.

The meeting will be called “Researching the rural-urban contexts of Primary Care”.

More details will be released when available.

Jose, along with John Wynn-Jones were interviewed by the Vasco da Gama team in 2011, about the benefits of networking at European level.  You can hear the interview on this YouTube video:



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Community Hospitals: Research Opportunity


News just in – the NHS National Institute for Health Research is inviting proposals for research, specifically to evaluate the activity, appropriateness and cost-effectiveness of community hospital work.

We know that community hospitals come in all shapes and sizes, varying from provision of day-care services to the elderly, to A&E and emergency admission units, capable also of delivering chemotherapy and dialysis.  This wide spectrum often makes it difficult to hone into exactly what – collectively – makes community hospitals appropriate and effective.

The brief for this opportunity seems very relevant to rural community hospital practice, and therefore we highlight this in case colleagues are interested in taking this further.

Full details are available at:

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Capturing the essence of rural practice

Dr Kevin Woodbridge, who was the GP for North Ronaldsay in Orkney, was one of the GPs to feature in the original book "Single Handed"

Dr James Douglas, a GP in Fort William, introduces an exciting new project to capture the essence of rural and remote practice in a series of recorded interviews, to complement the “Single Handed” photo-documentary published ten years ago…

The book “Singlehanded General Practitioners in Remote and Rural Areas” was published in 2000 by Rosie Donovan and John Bain.  Rosie Donovan is a black and white photographer and John Bain was Professor of General Practice at the University of Dundee.

Like all good ideas it had a classical simplicity.  John Bain had spotted a medical species which was about to become extinct and had seen some of Rosie’s previous work capturing working people in Canada.  Rosie travelled Scotland to photograph the “GP characters” and capture their thoughts on singlehanded practice.  The stories told themselves and the book became a classic to inform policy and widen understanding of remote practice in Scotland.

The photos even gained a permanent hallowed place in the Royal College of General Practitioners in Queen Street, Edinburgh.  Ten years after Single Handed and the disappearance of single-handed practice, there is a need to capture the thoughts of the current generation of remote and rural GPs in order to guide policy and educational planning in the same manner as the original Single Handed.

While black and white photographs can give an enhanced artistic perspective in portraits there seems to be a need to use new media for a new generation. Thus the recycled idea in a new form!  We hope that this first podcast will be of interest to doctors and students considering a career in remote and rural general practice in the UK.

I would be delighted to get any feedback or contributions to this project!

Dr James Douglas, GP, Tweeddale Medical Practice , Fort William

Dr Iain McNicol was the GP for Port Appin in Scotland, and a founder member of BASICS Scotland.  Dr Douglas interviewed him during a meeting of the Rural Fellowship project held at Skeabost in Skye, in January this year.




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Dot.rural aims to bring together researchers from a wide range of disciplines, in order to explore the digital challenges and opportunities for rural communities across the UK.  Based at Aberdeen University, they have focused on five channels: Accessibility & Mobilities, Healthcare, Enterprise & Culture, and Natural Resource Conservation.

They have recorded presentations and documents from their seminars and made them available as videos – worth a look.

One particular presentation from their Healthcare channel has a very direct relevance for future remote and rural medicine.  Alasdair Mort, Healthcare Research Fellow, has been working on ways of using technology to improve the prehospital emergency response, and seems to have a very pragmatic view of the challenges experienced in this field.

His presentation is available on the Dot.Rural website here (turn the volume up and fastforward a minute)… plus there is a YouTube video below with further information.


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