Practitioner Development UK
With years of knowledge and experience behind us, PDUK provides a range of outstanding continued professional development courses for GPs, advanced nurse practitioners, junior doctors, health visitors, practice nurses, school nurses, district nurses, radiologists, paramedics, pharmacists and other healthcare providers. With legislation, best practise and medical guidelines constantly changing, it’s vital that healthcare practitioners are always at the cutting edge of their profession. Remaining confident that you’re offering the very best service you possibly can to your patients is incredibly important, both now and in the future. The training courses offered by PDUK will not only help you to keep up with new developments in your field, they allow you to build an impressive CPD portfolio at the same time.

Access all areas
Ready to get started? Why not begin with one of our excellent online eLearning courses. Enhance your knowledge quickly and easily in just an hour or two, and when you’ve completed the first one there are many more to try 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
Asthma in childhood- The essentials
Immunisation update for healthcare assistants
Minor injuries for pharmacists
Emergency contraception update


For further information visit www.pduk.net

Hands-on, tailor made training for your staff
Healthcare practitioners across all disciplines and sectors can benefit from PDUK’s in-house courses


At PDUK we understand how important it is to have access to high quality CPD courses that not only match your team’s needs but are excellent value for money too. Our expert tutors will guide your staff in the latest requirements and best practice so you can rest assured their knowledge and skills are first class.

After they have completed their training, staff will feel a renewed sense of empowerment and inspiration so that they can continue on in their careers offering patients the best standard of care possible. Programmes include:

Diabetes care in general practice
Respiratory core skills for health care support workers
Medicines optimisation and reducing polypharmacy
Guide to complex wound care
Developing your limb x-ray interpretation skills
Paediatric same day consultation
Ear care in the community: irrigation training update
Understanding head injuries: a school nurse’s guide
And more...

PDUK’s scheduled courses for Winter/Spring 2020

Sign up for our very popular scheduled courses to boost your CPD further:

Five-day patient assessment skills workshop (CPD SO Accredited)

Minor injury essentials (RCN Accredited)

Minor surgical procedures

Minor ailments essentials (RCN Accredited)

Minor illness triage essentials

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 (CPD SO Accredited)

Advanced interpretation of blood results in clinical practice

Recognising and managing acute skin conditions in primary care

Best practice in assessing & managing constipation & faecal incontinence in adults

Contraception and sexual health workshop for the primary care practitioner

Gynae core skills for first contact practitioners

Annual NMP V300 update course (CPD SO Accredited)

Polypharmacy: the conundrums of multiple drug prescribing made easy!

Telephone triage: refresh and refine

Paediatric minor illness (RCN Accredited)

Young minds in crisis: an introduction to child and adolescent mental health

The deteriorating child

6-8 Week check: update your screening skills (CPD SO Accredited)

Review and refresh your new-born screening skills

Under the microscope:

Top news:

Why high quality, affordable, sustainable sanitary protection is as important as ever

Across the world, almost 2 billion girls and women are of menstruating age - that’s around 26% of the entire population. In fact, women spend an average of 65 days each year dealing with menstrual blood flow and although it’s perfectly healthy and normal, it’s not particularly pleasant.

Thankfully nowadays there’s a broad range of sanitary protection available to choose from, including tampons, towels and more recently “Mooncups” (rubber cups which are inserted into the vagina to catch the blood before being washed out and reused). However, the fact is that not all types of sanitary wear are immediately accessible for many girls and women, and the issues behind why this is need to be addressed. Barriers in both the UK and further afield can include ignorance, costs, prejudice and safety fears including as the risk of bacterial infections or toxic shock syndrome.

Education is vital
A lack of effective and affordable menstrual products is not only miserable for girls and women but can also result in uncomfortable chaffing and embarrassing leakage. Use of poor-quality materials has also been shown to increase the likelihood of urogenital infections such as thrush and bacterial vaginosis. Menstruation, particularly for those from low-income and middle-income countries including the UK, can even negatively affect a girl’s schooling as she may be unable to concentrate in lessons due to inadequate sanitary protection or even need to miss school days altogether. This of course not only limits her opportunities to study, it can affect her chance of gaining employment later on. Add to this the fact that in some low-income and middle-income countries there can still be a lack of knowledge around hygiene, coupled with poor disposal facilities, health and education can again be affected.

The good news is that things are gradually improving with an increase in the number of new initiatives and donations of menstrual products where needed, for example in schools. To help girls and women take control and make an informed choice about their sanitary protection, more information is required on the full range of menstrual products available.

Several studies have been carried out on this subject and the findings were recently published in The Lancet. See the full article here.

On the case:

When is heavy, too heavy?
Mrs James is 44-year nulliparous women presenting with increasingly heavy menstrual bleeding which is becoming a problem at home and work. She reports feeling tired all the time and not sleeping well.

Medical History
Mrs James has well controlled hypertension. She is aware she is overweight but currently on a weight management programme. Otherwise she has no other health problems but a family history of cardiovascular disease and diabetes.

Gynaecology history
Her normal period used to last for 3 days but was irregular at times. For the last twelve months she has been bleeding for 12 days every 26 days.

She is currently bleeding and is on day 7 of her cycle. She reports using double protection (Tampons and Towels), but still experiences flooding and passing of large clots. She is not using any contraception and is up to date with her cervical screening.

Examination
• Normal vulva, vaginal and cervix
• Heavy bleeding noted coming from the cervical canal
• Bulky non-tender uterus which is mobile and anteverted
• There are no adnexal masses

What differential diagnoses would you consider? One or more may be correct.
A. Menorrhagia
B. Endometrial polyps
C. Endometrial hyperplasia
D. Uterine fibroids

Answer:

A) Menorrhagia – Heavy menstrual bleeding (HMB), is a common debilitating condition that is defined as excessive menstrual bleeding loss. It may affect physical, emotional and social quality of life. One in three women will experience HMB particularly over the age of 35 years. There is no pathological cause in 60% of cases. Medical treatment can therefore be given prior to any investigations. If ineffective after 3 months, further investigations or referral to secondary care should be considered.

B) Endometrial polyps – are not a common cause of heavy menstrual bleeding unless they are fibroid polyps. Endometrial polyps are more likely to cause intermenstrual bleeding or post coital bleeding if they are on the cervix.

C) Endometrial hyperplasia – is a thickening of the endometrial lining of the uterine cavity and associated with abnormal vaginal bleeding. It is linked with excess oestrogen and more likely in women who have no children and who are overweight. A hysteroscopy and biopsy will confirm histological diagnosis and then either progesterone will be advised to regress the hyperplasia, or a hysterectomy will be recommended to prevent progression to endometrial cancer.

D) Uterine fibroids – 25% of women over 40 years will have a benign uterine fibroid. Only a third will experience HMB and this is determined by the location and size of the fibroid. Fibroids which are within the uterine cavity (submucosal) or impinging on the cavity (intramural) are more likely to cause HMB. If an enlarged bulky uterus is noted on examination, a pelvic ultrasound is recommended. (NICE 2018) However, if endometrial pathology is suspected and the women has intermenstrual bleeding then a hysteroscopy and biopsy is recommended.

Answer:
Mrs James was found to have a large benign submucosal fibroid which was resected at outpatient hysteroscopy. A levonorgestrel releasing intra uterine device (IUS) was inserted to manage her heavy menstrual bleeding and provide endometrial protection against endometrial hyperplasia.

References- https://www.nice.org.uk/guidance/ng88

In brief...

Could you benefit from the chance for extra training?
Everyone working in the healthcare sector passionately wants to offer the very best service they can. A great way of achieving this is by keeping abreast of developments and signing up for one (or more) of Practitioner Development UK’s continuing professional development (CPD) courses.

With a great range of scheduled, online and in-house courses to choose from, they’re ideal for anyone who is looking to improve their clinical knowledge, personal attributes or patient skills – and there’s something for everyone.

Why not browse through our new brochure to find the CPD you’re looking for, including:

1 Scheduled events: workshops that take place here in London where you can meet others in your field and build on your knowledge.

2 eLearning courses: ideal for learning in your own time, our eLearning courses are perfect for people who need a quick, flexible but effective study option.

3 In-house programmes: run at a location of your choosing, our in-house programmes are great for training in groups and offer excellent value for money.

Try our Gynae core skills for contact practitioners course or our Contraception & sexual health workshop for the primary care practitioner course to keep abreast of current practice and help to offer a better patient service.

• PDUK. We help everyone get better.

Ask PDUK: Katharine Gale answers your questions:

Question 1 - My post-menopausal patient mentioned at her cervical screening that she has recently had some light vaginal bleeding. Is this of concern?

Any bleeding after the menopause is a red flag and women should be referred to secondary care via the fast track pathway. Women should be informed that any bleeding needs to be reported as soon as possible to ensure a timely referral. Only 10% of women will have endometrial cancer however it is worth carrying out a vaginal examination to assess for vaginal atrophy or cervical pathology. This can aid the referral. No pathology is found in most cases, so the patient can also be reassured. Vaginal oestrogen or vaginal moisturiser should be discussed if the bleeding is likely to be from vaginal atrophy.

Question 2 - Whilst taking a vaginal swab for a 24-year-old woman on the oral contraceptive pill, I identified an unusual appearance of the cervix and I was concerned when it bled on touch. What can cause this?

Inspection of the cervix may reveal a cervical ectropion or a cervical polyp. It’s important to ask whether the woman is experiencing any post coital or irregular bleeding. A cervical ectropion is where the endo cervical columnar epithelium is on the ectocervix. It appears as a reddish area which can produce bleeding on touch. It’s a normal physiological appearance and is associated with puberty, pregnancy or the contraceptive pill. It doesn’t need treatment but if recurrent unscheduled bleeding occurs then consider changing contraception. Cryo-cautery is an option, but the benefits are usually short lived. A referral to colposcopy rather than a cervical smear test for women under 25 is recommended. Therefore, a cervical biopsy can be taken if appearance is suggestive of precancer or invasive cancer.

About our expert:

During her 22-year nursing career, Katharine Gale has worked in women’s health since qualifying. She has worked both primary and secondary care and is currently a Nurse Consultant in the South West. She is a nonmedical prescriber, ultra sonographer, hysteroscopist and currently completing her training in colposcopy. Her specialist interests are: abnormal bleeding, recurrent miscarriage and the menopause.