37 Enhance GP-Geriatrician Care Homes Multidisciplinary Team

Introduction

Peterborough Care Home Support Team (CHST) have worked on a small pilot of 4 care homes with a local GP and an interface geriatrician to address the complex needs of the residents within those care homes to improve patient experience, quality of care and reduce attendances and admissions to hospital in a geographical area of 5000 care home beds.

Methods

The multidisciplinary team (MDT) consisted of a General Practitioner, Interface Geriatrician, Pharmacist from the medicine optimisation team and Care Home Support Team member with once a month meeting in the selected Care Home. We measure the impact of our intervention comparing the data predating our intervention comparing 4 selected care homes with high A&E attendances in each period 2017 and 2018.

Results

50% reduction in hospital attendances with £4985.48 cost saving following medication review in the 4 care homes under study.

Conclusions

Commissioners, Local Authorities and Care Home Providers have started to look towards more innovative solutions to improve patient experience, quality of care and reduce attendances and admissions to hospital. Our experience and results aim to consider enhance GP-Geriatrician Care Homes MDT as a good model of care.

Diagnostic capacity, and predictive values of rapid diagnostic tests for accurate diagnosis of Plasmodium falciparum in febrile children in Asante-Akim, Ghana

Background

This study seeks to compare the performance of HRP2 (First Response) and pLDH/HRP2 (Combo) RDTs for falciparum malaria against microscopy and PCR in acutely ill febrile children at presentation and follow-up.

Methods

This is an interventional study that recruited children < 5 years who reported to health facilities with a history of fever within the past 72 h or a documented axillary temperature of 37.5 °C. Using a longitudinal approach, recruitment and follow-up of participants was done between January and May 2012. Based on results of HRP2-RDT screening, the children were grouped into one of the following three categories: (1) tested positive for malaria using RDT and received anti-malarial treatment (group 1, n = 85); (2) tested negative for malaria using RDT and were given anti-malarial treatment by the admitting physician (group 2, n = 74); or, (3) tested negative for malaria using RDT and did not receive any anti-malarial treatment (group 3, n = 101). Independent microscopy, PCR and Combo-RDT tests were done for each sample on day 0 and all follow-up days.

Results

Mean age of the study participants was 22 months and females accounted for nearly 50%. At the time of diagnosis, the mean body temperature was 37.9 °C (range 35–40.1 °C). Microscopic parasite density ranged between 300 and 99,500 parasites/µL. With microscopy as gold standard, the sensitivity of HRP2 and Combo-RDTs were 95.1 and 96.3%, respectively. The sensitivities, specificities and predictive values for RDTs were relatively higher in microscopy-defined malaria cases than in PCR positive-defined cases. On day 0, participants who initially tested negative for HRP2 were positive by microscopy (n = 2), Combo (n = 1) and PCR (n = 17). On days 1 and 2, five of the children in this group (initially HRP2-negative) tested positive by PCR alone. On day 28, four patients who were originally HRP2-negative tested positive for microscopy (n = 2), Combo (n = 2) and PCR (n = 4).

Conclusion

The HRP2/pLDH RDTs showed comparable diagnostic accuracy in children presenting with an acute febrile illness to health facilities in a hard-to-reach rural area in Ghana. Nevertheless, discordant results recorded on day 0 and follow-up visits using the recommended RDTs means improved malaria diagnostic capability in malaria-endemic regions is necessary.

Polymerase chain reaction-based tests for pan-species and species-specific detection of human Plasmodium parasites

BACKGROUND

There is still a need to improve the sensitivity of polymerase chain reaction (PCR) tests for malaria to detect submicroscopic asexual stage Plasmodium infections during the early phase and chronic, asymptomatic phase of infection when the parasite burden is very low.

STUDY DESIGN AND METHODS

The inhibitory effect of hemoglobin (Hb) on PCR limits the volume of blood that can be used in the PCR-based detection of intraerythrocytic Plasmodium parasites. We lysed red blood cells with saponin to reduce the Hb concentration in extracted nucleic acid and, as a result, significantly increased the volume of blood that can be tested by PCR. The analytical sensitivity of the PCR was determined using whole blood spiked with ring-stage Plasmodium falciparum parasites, and its clinical sensitivity by testing blood film-positive and blood film-negative samples from individuals living in an endemic area in Ghana.

RESULTS

We have developed a pan-Plasmodium PCR that detects all five human Plasmodium species with the highest analytical sensitivity of two P. falciparum parasites/mL of whole blood and species-specific PCR tests that distinguished between the five human Plasmodium species. Pan-Plasmodium PCR detected 78 of 78 (100%) blood film-positive and 19 of 101 (18.81%) blood film-negative samples from asymptomatic individuals living in Ghana. Pan-Plasmodium PCR was equally sensitive with samples collected as anticoagulated whole blood and clotted blood and in blood collected by finger stick into capillaries.

CONCLUSION

We have developed PCR tests with the highest reported sensitivity to date for pan-Plasmodium diagnosis and species-specific diagnosis and detected blood film-negative asymptomatic infections in individuals living in malaria-endemic countries.

Organochlorine poisoning of ring-billed gulls in southern Ontario

Clinical, necropsy, bacteriologic, parasitologic, histopathologic, toxicologic and animal inoculation studies suggest that organochlorine (PBC, dieldrin and DDE) poisoning was an important factor in causing deaths of free-flying ring-billed gulls (Larus delawarensis) in southern Ontario in 1969 and 1973. The brains of gulls dying with clinical signs of neurologic involvement, and dead gulls with no other apparent cause of death, contained organochlorine residues of significantly greater levels than those found in healthy gulls shot for comparison.