Tag Archives | Research

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.

httpv://www.youtube.com/watch?v=7oekncvAXGs

 

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.

httpv://www.youtube.com/watch?v=7jdjSAiiCmc

 

 

 

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Rural Mentoring Survey: Results

Many thanks to everyone who took part in the mentoring survey, which closed tonight after 2 weeks.  This was kindly hosted by RCGP.  Over fifty rural medical practitioners responded, with some useful and insightful results.

The raw data are presented below.  If you can’t see anything, you can also download a PDF file here.  Apologies that this is slightly clunky – and please note that comments are presented at the end of the PDF.  If you have a large screen, it may be worthwhile opening up two windows so you can follow the questions and free text answers at the same time.

Further analysis will be carried out to summarise the main conclusions.  It is hoped to present this on RuralGP.com in the next few weeks.  In the meantime, I have made the following observations on what could be considered the ‘next steps’:

  • Development of a profiles page, giving details of rural GPs who are prepared to act as mentors for committed trainees. (With some time for thought about how this should be co-ordinated and supported).
  • Development of a scholarship scheme for medical student electives.
  • Play down the role of social media, and improve quality student/trainee access to good rural practice experience.

Discussion can take place via the various email groups, or post a comment below.

 

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Community Hospitals: Research Opportunity

(c) RuralGP.com

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:

http://www.netscc.ac.uk/hsdr/commissionedcalls.html?src=COLD_call_alert_oct_12_01

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3rd EURIPA Rural Health Forum

Island of Pag

Due to unforeseen circumstances, the 3rd EURIPA Rural Health Invitational Forum will now be held on the island of Pag, Croatia, instead of the original venue Porto.

A website detailing the programme and travel details is currently being put together at http://3rd-euripa.conventuscredo.hr/

From the looks of things, Zadar airport – 90 minutes away from the venue – is the best airport to aim for, with 1-stop flights available from airports including Edinburgh and Manchester.

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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

james.douglas2@nhs.net

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.

[podcast]http://www.ruralgp.com/wp-content/uploads/2011/03/mcnicol-interview-mp3.mp3[/podcast]

 

 

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Wellcome Trust: Rural medicine witness seminar

Please note this event has been cancelled.

News just in of a Wellcome Trust event to be held on January 29th 2010 in London…

“Remote and Rural Medicine (RARM) began to emerge as a medical specialty and as a political force in the final decades of the twentieth century.  The problems of delivering primary and secondary care to remote and rural areas have engaged practitioners and medical educators around the world, in developing, re-structuring and developed countries.

This witness seminar, with participants principally, but not exclusively, from the UK and Ireland, will examine, inter alia, some of the historical issues associated with the development of ‘rural medicine’ as a distinct specialty; the provision and maintenance of resources and services nationally and internationally; and how the specialised educational needs of medical students destined for rural practice have been identified and addressed. The meeting will also discuss the evolution and scope of initiatives referred to as ‘Rural and remote’, ‘Community oriented’, ‘Community based’ and ‘Community engaged’ and the concept of ‘Social accountability’ in medical and health professional education.

Professor Roger Strasser, Northern Ontario School of Medicine, is assisting us with the organisation.

Space is limited, so to register please contact Mrs Wendy Kutner. Tel: 020-7679-8106; Fax: 020-7679-8194; E-mail: w.kutner@ucl.ac.uk.

Please note that all meetings are from 2pm to 6pm and will be held on the 6th floor at the Wellcome Trust, Gibbs Building, 215 Euston Road, London NW1.

All earlier published Wellcome Witness Seminar transcripts are freely available online at www.ucl.ac.uk/histmed/ following the links to Publications.”

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Study: Rural Placements for UK Medical Students

It’s increasingly recognised that rural practice can offer undergraduate medical students excellent learning opportunities, with higher-than-average satisfaction compared with their urban counterparts.  There can be many reasons for this, not least that students are often forced into immersing themselves in the local community, as a rural placement will normally involve staying within the locality, instead of being able to return home from an urban practice which is normally easier to commute to.

Furthermore, there is good evidence that giving students a good experience of rural practice during the early stages of their careers, stimulates a considerable number of them to seriously consider taking up rural posts once more qualified.  That’s certainly the case in my experience, when a fulfilling 5 week placement at the Group Practice in Stornoway made me think more about rural general practice as a career option.

However, how rural practice is offered to undergraduates, is implemented in many different ways across the UK.  Of course, that is no bad thing, but we are starting to better understand the relationship between early student experiences and later career choice.

This piece of research from the IRH considers the rural practice opportunities for students at Keele University, and reports on some of the key findings from conversations with students who have benefitted from such placements.

>> Rural and Remote Health Journal – View Article.

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