Practitioner Development UK
Provides ongoing (because healthcare professionals never stop learning) continued professional development for advanced nurse practitioners, GPs, junior doctors, practice nurses, health visitors, school nurses, district nurses, radiologists, paramedics, pharmacists and other healthcare providers.

Being good at your job isn’t good enough. In 2018, you need to prove you’re committed to developing your competence as a healthcare professional and set goals for further advancement. Our training courses help you address your continuing development needs and build your CPD portfolio.

Access all areas
Ready to become more proficient today? Start now by completing one of our innovative online eLearning courses. It only takes two hours to whiz through the questions, move forward in your career and enhance your standards of patient care. We offer a wide range of online courses, including:

The first steps in recognising the acutely ill child – a free taster 

Immunisation update

An introduction to the assessment of minor head injuries

An introduction to paediatric minor injuries

Essential ophthalmic assessment in primary care

An introduction to skin infections

Dementia – understanding and dealing with challenging behaviour

For further information visit http://www.pduk.net  

Bespoke training for your staff
All healthcare practitioners can benefit from PDUK’s in-house programmes

PDUK’s in-house events set the CPD bar high by providing a tailor-made and cost-effective way to train your team. Our expert tutors will help your workforce keep abreast of current practice and fill any gaps in their knowledge and skills.

Following their training, besides deriving a sense of fulfilment from the course, staff will feel empowered in their ability to deliver the best healthcare service they possibly can to patients. Programmes include:

Leadership skills for better management

Palliative and end of life care: what you need to know

Best practice in catheterisation and catheter care

Ear care in the community: irrigation training update

Patient examination made easy

Insulin and the patient with type 2 diabetes

IV therapy workshop

Essential patient assessment skills for pharmacists

Paediatric same day consultation

Leg ulcers: essential care guide

Red dot training for radiographers

Safer pharmacology for the elderly patient

And more


PDUK’scheduled courses for Spring/Summer 2018

Hone skills and make high standards standard practice with our tried-and-tested scheduled courses:

Five-day patient assessment skills workshop CPD SO Accredited

Minor injury essentials  RCN Accredited

Minor surgical procedures

Minor ailments essentials  RCN Accredited

Understanding head injuries

Sports injuries in 8-18 year olds

X-ray interpretation of minor injuries (includes Red Dot) CPD SO Accredited

Blood results: an introduction to basic haematology and biochemistry investigations

Recognising and managing acute skin conditions in primary care

Guide to complex wound care CPD SO Accredited

Ophthalmic practice in primary care

ENT “top 10” – How to treat & manage, what to refer and when CPD SO Accredited

Contraception and sexual health workshop for the primary care practitioner
CPD SO Accredited

Gynae core skills for first contact practitioners

Diabetes care in general practice

Getting to grips with mental health

NMP essentials for common long term conditions CPD SO Accredited

Telephone triage for HCAs and receptionists CPD SO Accredited

Emergency paediatrics for the primary care practitioner

Paediatric minor illness  RCN Accredited

Practical skills for assessing the ill child

Paediatric asthma essentials

Six-to-eight-week baby check CPD SO Accredited

IH79 Examination of the new born  RCN Accredited

Immunisation and anaphylaxis essentials CPD SO Accredited

Guide to travel medicine

 

Under the microscope:

Top news:

Breathing exercises are a breath of fresh air for people with asthma

Most people with asthma find that despite receiving standard medical treatment (eg inhalers), they experience symptoms – such as wheezing, breathlessness, coughing and chest tightness.

According to a new study led by the University of Southampton, asthmatics who are taught breathing exercises experience an improved quality of life.

Many patients are interested in using non-pharmacological strategies to manage their symptoms, possibly due to concerns about taking medication long-term, particularly corticosteroids. However, although various trials have shown breathing retraining to be effective, it is not generally available to patients due to the limited availability of suitable trained physiotherapists and the logistical and financial challenges of providing this type of treatment.

Domiciliary training

Researchers wanted to discover whether breathing retraining delivered as a digital training programme that can be used in patients’ homes could be as effective as face-to-face instruction from a physiotherapist.

The team developed a self-guided programme, in the form of a DVD or online content plus a printed booklet (DVDB), and carried out a controlled trial of 655 UK adults who had reported asthma-impaired quality of life.

The findings of the study, published in The Lancet Respiratory Medicine, suggest that the DVDB programme improves quality of life scores (over 12 months) in patients compared with those receiving usual medical care, despite having little effect on lung function or airway inflammation. It does not cure asthma but does improve people’s experience of the condition. Plus, besides providing a non-drug approach, teaching breathing exercises digitally rather than in person can also be a cost-effective method of controlling asthma.

• The Breathing Freely programme is available free online through the website Breathe Study.

References
Anne Bruton, Amanda Lee, Lucy Yardley, James Raftery, Emily Arden-Close, Sarah Kirby, Shihua Zhu, Manimekalai Thiruvothiyur, Frances Webley, Lyn Taylor, Denise Gibson, Guiqing Yao, Mark Stafford-Watson, Jenny Versnel, Michael Moore, Steve George, Paul Little, Ratko Djukanovic, David Price, Ian D Pavord, Stephen T Holgate, Mike Thomas. Physiotherapy breathing retraining for asthma: a randomised controlled trialThe Lancet Respiratory Medicine, 2017; DOI: 10.1016/S2213-2600(17)30474-5

On the case:

Running on empty
Accompanied by her mother, 12-year-old Riana presents at the GP surgery with a history of irritable dry cough and difficulty in breathing when running. The symptoms have been ongoing for more than two weeks.

The child’s medical history
Usually fit and well, in a normal week Riana engages in a wide variety of sports and rides her horse regularly. Recently she has developed an ongoing irritable cough, which is worse at night.

Riana is very upset as she normally has no problems running 800 metres track but currently can’t even get round 200 metres: her chest becomes tight and she ends up in a coughing fit. She is due to represent her school next week.

Riana’s mother thought her symptoms might be linked to the high pollen count so started her on loratadine once daily but to no avail.

She is thriving in her first year at high school and is not currently on any medication. All her immunisations are up to date. Until age four, she was on loratadine daily for allergic rhinitis and Ventolin and Atrovent for recurrent wheeze. However, in the past six years she hasn’t had any breathing difficulties or needed medication.

Family history
Riana’s sibling had recurrent wheeze and until recently was on Ventolin and fluticasone. Her mother had occupational asthma in a previous job.

Examination
She is alert and interacting normally. Well perfused and talking in sentences:
RR 18, HR 112, SA02 99%, Temp 36, Ears clear view TM both, no enlarged lymph nodes felt, throat clear, good equal air entry R/L no added sounds, good symmetric breathing, no sign of respiratory compromise. When coughing sounds non-productive and non-paroxysmal, no use of accessory muscles. No clubbing. Peak flow: 230, 230, 250; after two puffs Ventolin: 280, 300, 320.

Q: What would the most likely diagnosis be?
A- Exercised-induced asthma
B- Allergic rhinitis
C- Chest infection
D- Vocal cord dysfunction (VCD)

Answer:

A- Exercise-induced asthma The most likely diagnosis is exercise-induced asthma, because a large focus of the history surrounds exercise. Riana’s evidence of mild hyperventilation and coughing during exercise could account for the trigger being inhalation of cold, dry air.

B- Allergic rhinitis Unlikely because in the history loratadine was ineffective. Also, flare-ups of allergic rhinitis do not correlate with exercise as a trigger.

C- Chest infection Although a chest infection can be exacerbated by exercise, in this case Riana has normal HR, RR, SA02 and auscultation, which makes it very unlikely to be the cause.

D- Vocal cord dysfunction (VCD) Although this mimics the symptoms of asthma, Riana’s symptoms are unlikely to be caused by VCD as there was no hoarseness, wheeze, voice change or need to frequently clear her throat. Riana doesn’t feel that her upper chest is obstructed or feel choked. VCD can be triggered by exercise; however, it does not respond positively to salbutomal treatment.

Further explanation
Exercise-induced asthma (EIA) and exercise-induced bronchoconstriction is a common occurrence in healthy school children. Research has shown that up to eight to 10 per cent can present with this condition (Wuestenfeld, JC and Wolfarth, B, 2013) and up to 40 per cent in those that also present with allergic rhinitis. Some research in adult athletics shows that the risk for EIA is higher in those who train 20 hours or more a week.

In line with NICE (2016) spirometry would be checked for bronchial reversibility. An increase in FEV of 12 per cent following salbutamol would be considered positive. However, in EIA spirometry may not necessarily produce this evidence.

Riana has a 10 per cent increase in bronchial reversibility, which the practitioner considers sufficient evidence to diagnose EIA with a trigger of pollen. Ventolin 100mcg two puffs PRN prior to exercise is prescribed.

What’s next?
Riana may be asked to undertake an exercise challenge in hospital. A positive is considered when there is a fall in FEV of 10 per cent 30 minutes after exercise.
FeNO testing may also be an option.
• Riana will now be monitored by a practice nurse.

In brief...

Want to get better at your role?
The best way to develop your expertise while boosting your continuous professional development is to complete one (or more) of Practitioner Development UK’s continuing professional development (CPD) courses.

Whether you want to gain specialist knowledge of a particular subject, improve your clinical skills or work on your personal attributes, we can help.

Our new brochure offers myriad opportunities for meaningful CPD, including:

1 Scheduled events: centrally located workshops where you can build on your knowledge and engage with likeminded contemporaries;

2 eLearning courses: a super-convenient resource that enables you to learn online, whenever and wherever you like;

3 In-house programmes: the flexible option, these are tailored for your staff’s needs and run by us at a location of your choice.

Try our hands-on Paediatric asthma essentials scheduled event. Or take advantage of a quiet hour or two to whiz through our online Immunisation update course.

• PDUK. We help everyone get better.

Ask PDUK:

Q&A: Debi Allcock, paediatric advanced nurse practitioner

Q1 Will the asthma medication stunt my child’s growth?

A1 Most steroid inhalers contain low doses of steroid, which helps reduce the inflammation. As very little of this low dose is absorbed into the body, it is unlikely to cause any growth retardation. However, taking regular oral prednisolone does present a risk to growth. Likewise, frequent short courses or high-dose alternate day systemic therapy can interfere with growth.
Research shows that as well as affecting growth, the child’s bones may thin. The adrenal glands may also be suppressed, so patients on continuous high doses should be monitored by the endocrinology team.

Q2 Can I outgrow asthma?
A2 Boys are more likely than girls to outgrow asthma when hitting the teen years. Asthma UK states that sex hormones play a role in the symptoms and severity of the condition. Asthma is often diagnosed when children are very young and as they grow their symptoms decrease, but it may recur later.

Q3 What is the relationship of asthma and allergic rhinitis?
A3
Asthma and allergic rhinitis are both atopic conditions, which means the body produces IGE immunoglobulin in response to an allergen such as pollen or mould. Research has shown that one in five people In the UK is affected by hay fever and approximately 80 per cent of asthmatics state they also have pollen allergy (Asthma UK). It’s important to consider both airways in a child presenting with nasal congestion and wheeze.

About our expert Since qualifying in 2007, advanced paediatric nurse practitioner Debi Allcock has worked as a community matron to reduce emergency admissions in respiratory and support dermatology in the community in the under 16s. In 2016 she won the prestigious ‘Nursing in Practice’ Nurse of the Year award.

References
• Asthma UK (2017) Growing out of asthma: www.asthma.org {accessed 14.8.2017}
• British Thoracic Society (2016) BTS/SIGN British guideline on the management of asthma. www.brit-thoracic.org.uk
• Bergeron C and Hamid Q (2005) Relationship between Asthma and Rhinitis: Epidemiologic, Pathophysiologic, and Therapeutic Aspects. Allergy, Asthma & Clinical Immunology. 1:81
• Wuestenfeld, JC and Wolfarth, B (2013) Special considerations for adolescent athletic and asthmatic patients. Journal of Sports Medicine.4:1-7 https://www.ncbi.nlm.nih.gov/pubmed/24379703