evaluating the evidence for clinical practice and QOF
Wednesday 26th to Friday 28th November 2008
BMA House
Based on our popular and highly-evaluated previous medical meeting, this exciting, new course has updated objectives specifically covering key areas of the QOF targets. Speakers are national experts involved in the production of speciality guidelines. Learning objectives are directly relevant to you and general practice. Sessions are interactive and designed to provide maximum time for questions and discussion.
Stroke, Chronic Kidney Disease and Diabetes
Heart Failure, Arrhythmia, CHD, Lipids & Hypertension
Course fee: £175 per day for up to two days, £160 per day for three days
Further information available at www.gpmasterclass.com or contact Liz Banks,
Conference Organiser on 020 8346 1838 or [email protected]
Stroke, Chronic Kidney Disease and Diabetes
• Importance of BP control. (CKD2, CKD3)
• Therapeutic approaches to chronic kidney disease.
• The value of ACE inhibitors or ARBs. (CKD5) 9.30am Session 1
• Prescribing in chronic kidney disease.
Dr Anthony Rudd. Consultant Physician. Elderly Care Unit, St CKD1. Register of patients aged 18 years and over with Stage 3 to 5 CKD CKD2. Record of blood pressure CKD3. Last blood pressure reading is 140/85 or less CKD5. Percentage of patients on CKD register with hypertension and
• Definition. Incidence, prevalence and risk factors.
Transient Ischaemic Attack.
• Assessment and treatment (STROKE1, STROKE13) 2.00pm Session 3
• Aspirin, lipids and blood pressure (STROKE5, STROKE6, STROKE7, STROKE8, STROKE12)) Dr Mark Vanderpump. Consultant Endocrinologist, Royal Free Acute Management of Stroke Diabetes (Session 1)
Evidence for urgent CT or MRI scan(STROKE13) Incidence, aetiology and pathogenesis
Viral infections and nutritional factors. Genetics.
The burden of obesity (DM2)
• Effective ways to rehabilitate following a stroke.
Diagnosis (DM19) Secondary Prevention
Fasting glucose. Glucose tolerance test.
• Risk factors: behavioral and physiological
What’s the evidence for current practice?
• Antiplatelet agents – which treatment or combination is
• Who should be screened, how often and what methods?
best? (STROKE12, AF3)
• Intensive diabetic control. What are the benefits and
• Benefits of anticoagulation in AF. When to start
• Routine and annual checks (DM11, DM12). Retinal screening (DM21), peripheral vascular disease (DM9), neuropathy (DM10),
• Is blood pressure reduction effective? (STROKE5, STROKE6)
nephropathy (DM13, DM22) DM19. Register of Type 1 and Type 2 diabetics aged 17 years and over
• Statins for people with no history of coronary heart disease?
DM2. BMI recorded (STROKE7, STROKE8) DM21. Record of retinal screening
• Carotid endarterectomy – do the benefits outweigh the
DM9. Record of the presence or absence of peripheral pulses DM10. Record of neuropathy testing
• Diabetic control and other measures (STROKE10) DM11. Record of the blood pressure DM12. Last blood pressure is 145/85 or less STROKE1. Register of patients with stroke and TIA DM13. Record of micro-albuminuria testing STROKE13. The percentage of new patients with a stroke or TIA who have DM22. Record of estimated glomerular filtration rate (eGFR) or serum
been referred for further investigation.
STROKE5. Record of blood pressure DM18. Influenza immunisation STROKE6. Last blood pressure reading is 150/90 or less STROKE7. Record of total cholesterol STROKE8. Last measured total cholesterol is 5 mmol/l or less STROKE12. Non-haemorrhagic stroke, or a history of TIA, taking anti-platelet 4.00pm Session 4
agent or an anti- coagulant. STROKE10. Influenza immunisation Dr Mark Vanderpump. Consultant Endocrinologist, Royal Free AF3. Currently treated with anti-coagulation or anti-platelet therapy. Treatment of Diabetes (Session 2)
• Diet. Implementation and monitoring. (DM5, DM20, DM7) 11.30am Session 2 Dr Cormac Breen. Consultant Nephrologist, Guy’s Hospital. Proteinuria and haematuria
• Other medication. ACE inhibitors and statins for everyone?
Urine dipstick testing. (DM15,DM16,DM17)
• False negatives and false positives.
• A practical approach to monitoring the diabetic patient in
• Asymptomatic haematuria. Distinguishing renal and
DM5. HbA1c recorded
• Asymptomatic proteinuria. What must not be missed?
DM20. Last HbA1c is 7. 5 or less DM7. Last HbA1c is 10 or less Assessment of renal function (CKD1) DM15. Diagnosis of proteinuria or micro-albuminuria treated with ACE
Blood tests. The abnormal “U&E”. How to proceed.
• Urine tests. Spot and 24 hour urine collections.
DM16. Record of total cholesterol
• Calculation of GFR and relevance of stages 1 to 5.
DM17. Last measured total cholesterol within previous 15 months is 5 mmol/l Chronic kidney disease in general practice
• Monitoring of GFR in general practice. When to refer?
9.30am Session 1 2.00pm Session 3 Prof Neil Barnes. Consultant Chest Physician, Royal London Dr Lieske Kuitert. Consultant Chest Physician, Royal London Asthma and COPD (Session 1) Symptoms and Signs of Respiratory Disease in General Epidemiology and Pathogenesis of Asthma and COPD Practice (Session 1)
• What are the differences between asthma and COPD?
These two sessions will use a problem-based approach to the
management of common respiratory symptoms & signs. Areas to
Diagnosis
be covered include cough, shortness of breath, haemoptysis,
• How to distinguish between COPD and asthma (COPD1,
excessive sputum production and the abnormal chest x-ray.
ASTHMA1)
• Lung function tests: spirometry, reversibility testing and
steroid challenge. (COPD12, ASTHMA8)
• Extra-thoracic asthma – sinus disease and GI reflux.
4.00pm Session 4 Dr Lieske Kuitert. Consultant Chest Physician, Royal London COPD1. Register of patients with COPD COPD12. Percentage of all patients with COPD diagnosed after 1st April 2008
in whom diagnosis has been confirmed by post bronchodilator spirometry
Symptoms and Signs of Respiratory Disease in General ASTHMA1. Register of patients with asthma Practice (Session 1) ASTHMA8. Patients aged eight and over with measures of variability or
These two sessions will use a problem-based approach to the
ASTHMA3. Patients between the ages of 14 and 19 in whom there is a record
management of common respiratory symptoms & signs. Areas to
be covered include cough, shortness of breath, haemoptysis,
Smoking 1. Record of smoking status
excessive sputum production and the abnormal chest x-ray.
Objectives will be finalised shortly. 5.30pm Close 11.30am Session 2 Prof Neil Barnes. Consultant Chest Physician, Royal London Hospital. Drug Treatment of Asthma and COPD
• Value of smoking cessation (Smoking1)
• What drugs are available and how do they act?
• What’s new? Combination treatments. Leukotriene receptor
• Devices and drug delivery. Use of home nebulisers.
• Differences in treatment of children and adults
Management Plans in Asthma and COPD
• BTS guidelines and their relevance to general practice.
• Patient education, diary cards and compliance.
• Monitoring. Use of FEV1 (COPD10, COPD11, ASTHMA6) COPD10. Record of FEV1 in the previous 15 months COPD11. Inhaler technique has been checked COPD8. Influenza immunisation ASTHMA6. Record of asthma review
Heart Failure, Arrhythmia, CHD, Lipids & Hypertension
9.00am Registration 9.30am Session 1 2.00pm Session 3 Dr Howard Swanton. Former President, British Cardiac Society. Dr Jonathan Morrell. GP and Hospital Practitioner in Cardiology,
Consultant Cardiologist, The Heart Hospital.
Heart failure and arrhythmias Heart failure
Who to treat? Setting population-based treatment
Diagnosis (HF1). How predictive are clinical features?
BNP v echocardiography (HF2)
What is the key measurement? What is the value of total
cholesterol? Should we routinely measure Cholesterol:HDL
ratio? The significance of triglycerides.
Risk factor assessment. Which are the most significant in
Beta-blockers. ACE inhibitors. Spironolactone (HF3)
reducing the risk of coronary events? (CHD7, CHD8, STROKE7, STROKE8, DM16, DM17) Arrhythmias in general practice
• How effective is diet and weight loss?
• Atrial fibrillation (AF1, AF4)
• Warfarin and antiplatelet therapy. (AF3)
• How low should we aim? Does very low cholesterol cause a
HF1. Register of patients with heart failure. HF2. Confirmed by an echocardiogram or by specialist assessment.
• Which statin? What doses are equipotent? Which is the
HF3. Currently treated with an ACE inhibitor or Angiotensin Receptor Blocker
most cost effective? Side effects and monitoring.
AF1. Register of patients with atrial fibrillation.
• How often should lipid levels be monitored?
AF3. Currently treated with anti-coagulation or anti-platelet therapy.
• What about fibrates, cholestyramine and fish oils?
AF4: Percentage of patients with atrial fibrillation diagnosed after 1 April 2008
• What combinations of lipid lowering agents are acceptable?
with ECG or specialist confirmed diagnosis.
CHD7. Total cholesterol measured. CHD8. Last measured total cholesterol is 5 mmol/l or less STROKE7. Record of total cholesterol STROKE8. Last measured total cholesterol is 5 mmol/l or less 11.30am Session 2 DM16. Record of total cholesterol DM17. Last measured total cholesterol within previous 15 months is 5 mmol/l Dr Stephen Rex. Consultant Cardiologist based in Windsor and
Ascot and the Royal Brompton Hospital in London.
Angina and Myocardial Infarction
• Investigation of chest pain. (CHD1, CHD2) 4.00pm Session 4
Reliability of symptoms, role of RACPC, which tests to
use and what is the Calcium score all about?
Dr Aroon Hingorani. Senior Lecturer, Centre for Clinical
Pharmacology, University College London.
• Statins, betablockers and ACE/ARB (CHD7, CHD8, Hypertension CHD10, CHD11)
• Everyone below 135/80? Why? (BP1, BP4, BP5)
• Aspirin, clopidogrel –one or both and when and for how
• Automatic machines – are they accurate? Which models are
long? (CHD9)
• Revascularisation – PCI or CABG – which, when and for
• What to do about isolated systolic hypertension.
• What’s the evidence for the effectiveness of current
• Acute coronary syndromes – current management strategies.
treatments? Low dose thiazides for everyone?
• What’s the hype about primary angioplasty?
• ACE versus AT2? Which ACE is the most cost effective?
Selective beta blockers. Is the outcome as good as atenolol?
• Other measures (CHD12)
What are the main benefits? Calcium antagonists and
CHD1. Register of patients with coronary heart disease CHD2. Patients with newly diagnosed angina are referred for exercise testing BP1. Register of patients with established hypertension CHD5. Record of blood pressure BP4. Blood pressure in the previous 9 months CHD6. Last blood pressure reading is 150/90 or less BP5. Last blood pressure is 150/90 or less CHD7. Total cholesterol measured. CHD8. Last measured total cholesterol is 5 mmol/l or less CHD9. Aspirin, an alternative anti-platelet therapy, or an anti-coagulant is
being taken CHD10. Treated with a beta blocker CHD11. Treated with an ACE inhibitor or Angiotensin II antagonist CHD12. Influenza immunisation
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