Clinical Posters 427 – 429
427 Depression, physical health measurements and all-cause mortality at six and half years – A cohort study of 500,000 UK Biobank Participants
Aims / Objectives Depression is associated with higher risk of mortality but the joint effects of depression and abnormal physical health measurements on risk of mortality remains unknown. We aimed to examine associations between depression and physical measurements in risk prediction of all-cause mortality in UK Biobank cohort.
Content of Presentation The study was conducted using the data from UK Biobank participants (N=502462). Depressive symptoms (PHQ-2>2), BMI and systolic blood pressure (SBP) were assessed at the time of patient recruitment. Cox proportional hazards regression examined associations and statistical interactions between number depressive symptoms and physical health measurements (BMI and SBP) in the risk prediction of all-cause mortality at six and half years. Hazards ratios (HR) were adjusted for age, gender, deprivation, smoking status, alcohol consumption and number of health morbidities at baseline.
Relevance / Impact This work can inform the development of novels ways of risk assessment in patients presenting with depressive symptoms.OutcomesAt the end of follow-up, 12804 (2.5%) participants had died. Presence of depressive symptoms (HR 1.25 (Confidence intervals-CI 1.17-1.35) and very high SBP >160 (HR 1.12, CI 1.06-1.18) were associated with higher risk of death after adjusting for confounders. Presence of depressive symptoms co-existing with either very high SBP>160 or low SBP 30) and underweight (BMI<18.5) participants (p-value<0.01).
Discussion Depressive symptoms co-existing with both extremes of SBP and BMI “compounded” the risk of death. Further research is needed to study these relationships and their potential implications in clinical practice.
428 Building the Palliative Care Pyramid
Background Challenges have been identified in approaching, discussing and communictiing the transition into Palliative Care. Hollistic support is an integrated part of the palliative care pyramid; clinicians should be able to treat patients as a whole, from medical and psychosocial point of view.
Aim To identify the need for an integrated approach to palliative care to improve care in the last days of life.
Method A critique of PubMed and an internet review of the literature regarding the medical and holistic approach to palliative care and communication with patients.
Results ‘There are no precise ways of telling accurately when a patient is in the last days of life.’ Clinical indicators, based on the gold standards framework can be used to identify the palliative needs of patients. Prognostic indicators can only assist clinicians in recognising dying patients; healthcare professionals need to get to know their patients and gain an understanding of their individual disease trajectory. There are no specific communication tools for discussing patient’s prognosis, however the most important aspect to patients is to be realistic and have an individualised approach.
Conclusion Guidance on illness trajectories and prognostic indicators can only act as a rough guide in supporting patients, families and healthcare professionals at the end of life. The pyramid model of palliative care gives a visual tool to help clinician’s approach both the medical and holistic aspects of palliative care and recognise the opportunities for flexibility in moving around the pyramid to offer individualised patient care.
429 Cancer diagnosis from an unplanned emergency admission: case report and learning points
Case Description First GP Attendance: A 56 year-old Oriental man, who never smoked and drank no alcohol, consulted with a GP ST2 trainee. He presented with a 3 day history of upper GI symptoms and cough, following eating a chicken takeaway. His wife was also suffering from diarrhoea and vomiting. On examination, his observations were normal and his chest was clear. A presumed diagnosis of viral gastroenteritis was made, cyclizine was prescribed and safety net advice was given.
Second GP Attendance: He re-presented to the same trainee 2 days later with persistent vomiting and heartburn, also mentioning some recent weight loss. Examination revealed a dry tongue, pulse 100 bpm and a soft abdomen with epigastric tenderness. Buccastem and Lansoprazole Fastab were prescribed. He was advised to buy some dioralyte and go to A&E if he was not improving. The doctor had a gut feeling that something was not quite right.The patient was admitted to hospital 2 weeks later. He was in acute kidney injury and was found to have locally advanced pancreatic cancer.
Discussion A re-presentation in a man who would not normally present should prompt the clinician to undertake a broader history and examination and consider investigations and follow up. Learning points: 1 Beware of one-track thinking to avoid overlooking other aspects of the presentation; 2 Never ignore your gut instinct; 3 Consider blood tests in patients with persistent vomiting. 4 Always document the weight of a patient who complains of weight loss. 5 Trainees should discuss with their supervisor all patients who re-present with worsening symptoms. The case was shared with the primary care team and a root cause analysis was undertaken.