Day 2 :
Hofstra Northwell Health School of Medicine, USA
Keynote: Utilizing simulation and gaming to teach primary care providers to prepare for a global health issue
Time : 09:00-09:25
Tochi Iroku-Malize is a Professor and Chair of Family Medicine at Northwell Health (formerly North Shore LIJ Health System). She received her medical training at the University of Nigeria, did her internship in Trinidad & Tobago, completed her Master’s in Public Health at Columbia University and her Master’s in Business Administration at the University of Massachusetts. She is board certified in both Family Medicine and Hospice & Palliative Care. She has developed a curriculum for global health and has been involved in Academic Medicine and Primary Care for two decades. She has presented and published on multiple topics internationally.
Recently, those in various health care settings have had to develop educational opportunities to update health care workers on the guidelines to follow, when faced with a potential patient who may have Ebola Virus Disease (EVD) and hence is classified as a person under investigation (PUI). Having familiarity with curriculum development, an obvious method of providing education in an interactive format presented itself to me. Creating case based scenarios with audience participation to review guidelines. The addition of audience practice in donning and doffing personal protective equipment (PPE) would help reinforce the information. An ideal session would have all of the participants gathered at a venue and the start of the session is an overview of what EVD is as well as the current data regarding its spread and current global guidelines for managing the illness. You would then participate in several different scenarios which would be played out as cases in which the participants are asked to answer how they would manage the situation. The correct information is provided per current guidelines. A quick review of current institutional policies as well as international policies is completed and you move onto the next case. During the session, participants will actually engage in filling out paperwork, donning and doffing PPE, answering patient and family member questions, etc. Having an interactive educational session, allows for better assimilation of information.
SEHA Dialysis Services, Abu Dhabi
Keynote: Primary care based automated detection and algorithm driven online decision support improves outcomes for patients with chronic kidney disease
Time : 09:25-09:50
Dr Richards qualified in medicine at St Bartholomew’s Hospital London in 1981; he undertook a period of research looking at the effects of cyclosporine-A on endothelial function at St Thomas’ Hospital London prior to being appointed as Consultant Physician and Nephrologist at The Queen Elizabeth Hospital in Birmingham in 1992. During his time in Birmingham he was actively involved in the development of an electronic patient record with associated drug prescribing system. He went into medical management as Clinical Director, Divisional Director and finally Director of Operations in Birmingham before leaving the NHS and taking up the position of Medical Director for the UK and Ireland for Fresenius Medical Care in 2004. He moved to his current position as the CEO and CMO of SEHA Dialysis Services in 2012. He remains actively interested in clinical research particularly in relation to epidemiology and prevention of chronic kidney disease. He has published more than 50 papers in peer reviewed journals.
Historically, more than 95% of patients presenting for dialysis in Abu Dhabi do so as an emergency. This is far higher than would be seen in Western Europe where the figure is 15-30%. Late presentation is associated with poorer outcomes and worse rehabilitation than in those patients who present early and are followed prior to commencing dialysis. In addition, importantly, late presentation does not allow for the implementation of preventative strategies which may postpone or even avert the need for dialysis in upwards of 80% of patients. This is of major benefit to the patients themselves but in addition represents a significant financial saving to the health economy. The SEHA health system in Abu Dhabi has a single unifying electronic patient record (Malaffi). This is an extremely powerful tool. In 2012, we examined the renal function of all patients seen in the Emirate which allowed us to describe the epidemiology of chronic kidney disease and to look at the time taken from identification within primary care to presentation at a secondary care clinic. This analysis demonstrated that at all age groups the prevalence of CKD was higher in the local population when compared to a Western population with a significantly older age profile. In addition, the time taken from identification to presentation to a nephrologist was excessive at all stage of CKD. To address these issues an algorithm was introduced into Malaffi which automatically calculates an estimate of kidney function (eGFR) and in addition offers online, live, decision support concerning patient management, in particular medication and indications for referral. Patients are risk stratified for the likelihood of progression on the basis of their level of kidney function and the amount of protein in their urine. In addition a team of renal nurses was placed within primary care to act as an education resource for both patients and primary care staff and to ensure that patients navigated their way through the system in a timely manner. In the 16 months to May of 2015 we have identified 53,000 patients from primary care 20,000 of which with an eGFR and a urine protein estimation, 25% of which are at high risk of progressive decline in their renal function. Since introduction of the programme, we have demonstrated that treatment with an angiotensin converting enzyme inhibitor is associated with a 35% reduction in the likelihood of progression whilst treatment with certain types of Non-Steroidal Anti-Inflammatory Drug (NSAID) is associated with a 63% greater risk of progression. The introduction of the programme has seen a reduction in the use of NSAIDs in primary care of some 30% from peak. This programme demonstrated the power of the unified electronic patient record and its ability to assist in the management of chronic disease within primary care.
University of Ottawa, Canada
Time : 09:50-10:15
Fahad Alkherayf is an Associate Professor and a neurosurgeon at University of Ottawa. He is also a neuroscientist at the Ottawa Hospital Research Institute (OHRI) with a cross appointment to the Clinical Epidemiology Program. He also directs the clinical research at the Division of Neurosurgery at the Ottawa Hospital. Additionally he directs the Spine Fellowship Program at University of Ottawa. After graduating from medical school he completed his neurosurgery training at University of Ottawa in 2010. He also completed two fellowships in complex spine surgery and minimally invasive skull base surgery. Additionally he obtained training in clinical epidemiology and biostatistics (MSc, Epidemiology and Biostatistics 2011) and he has completed the clinician investigator program by the Royall College of Physician and Surgeons of Canada (RCPSC). His clinical practice focus on complex spine surgery, minimally invasive cranial surgery and complex cranio-cervical reconstruction. His clinical research interests lie in translational primary brain tumor research, clinical trials, and spinal cord injury. He has authored and co-authored many research papers and abstracts, and spoken at many international conferences. He has been serving as an Editorial Board Member of many journals.
Low back pain (LBP) is a very common problem with up to two-thirds of adults suffering from LBP at some time in their lives. Each year between 2% to 5% of the population seek medical attention for LBP. Reported risk factors for chronic LBP include: age, sex, genetics, education level, activities, socioeconomic status, lifestyle and smoking. Unfortunately, most of those factors are unable to be modified. Nevertheless, lifestyle factors such as smoking can be modified with effective interventions. We examined the association between smoking and risk of chronic LBP among adults (20 to 59 years). We took in consideration the most likely covariates (age, sex, BMI, physical activity and education). To the authors’ knowledge, this is the first study to assess the relationship between chronic LBP and smoking exposure among adults, based on a large sample size. Our study included 78,239 participants. Back pain status, smoking level, age, gender, height, weight, level of activity and level of education were identified as well. Back pain secondary to fibromyalgia or rheumatic disease was excluded. Stratified analysis and Logistic regression analysis were used to detect effect modification and to adjust for covariates. Population weight and design effects associate with complex survey design were taken into consideration. The prevalence of chronic LBP was 20.8%. Male to female ratio was 1: 1.15. About 51% were current or former daily smoker. About 21% are classified as obese, using WHO classification. The adjusted odds ratio for former or present daily smokers was 1.57 with 95% confidence interval (1.52,1.63) and P value of <0.001 while for former or present occasional smokers was 1.1 with 95% confidence interval (1.04,1.16) and P value of < 0.001. Smoking effect seems to have a dose response, where occasional smokers have higher risk than non smoker but less than daily smokers.