Iron deficiency anemia is a common problem encountered in primary care practice. Once the diagnosis is confirmed and the possible causes are identified, replacement of iron stores is indicated. Most patients respond favorably to oral iron preparations. However, therapy with intravenous iron dextran (InFeD) may be warranted in some cases. Side effects, which are usually mild, occur in 25% of patients. Test doses of undiluted iron dextran occasionally elicit anaphylactic reactions. However, affected patients still may be successfully treated intravenously with the use of prophylactic antihistamines, corticosteroids, and histamine2 blockers. Treatment of iron deficiency anemia almost always brings symptomatic improvement.

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Objectives: To determine pediatric urgent care (PUC) clinician adherence to evidence-based practice guidelines in the management of pediatric trauma and to evaluate PUC emergency preparedness for conditions such as severe hemorrhage.Methods: A questionnaire covering acute management of 15 pediatric traumatic injuries, awareness of the Stop the Bleed initiative, and presence of emergency equipment and medications was electronically distributed to members of the Society for Pediatric Urgent Care. Clinician management decisions were evaluated against evidence-based practice guidelines.Results: Eighty-three completed questionnaires were returned (25% response rate). Fifty-three physician and 25 advanced practice provider (APP) questionnaires were analyzed. Most respondents were adherent to evidence-based practice guidelines in the following scenarios: cervical spine injury; head injury without neurologic symptoms; blunt abdominal injury; laceration without bleeding, foreign body, or signs of infection; first-degree burn; second-degree burn with less than 10% total body surface area; animal bite with and without probable tenosynovitis; and orthopedic fractures. Fever respondents were adherent in the following scenarios: head injury with altered mental status (adherence: physicians, 64%; APPs, 44%) and laceration with foreign body and persistent hemorrhage (adherence: physicians, 52%; APPs, 41%). Most respondents (56%) were unaware of Stop the Bleed and only 48% reported having a bleeding control kit/tourniquet at their urgent care.Conclusions: Providers in our sample demonstrated adherence with pediatric trauma evidence-based practice guidelines. Increased PUC provider trauma care certification, PUC incorporation of Stop the Bleed education, and PUC presence of equipment and medications would further improve emergency preparedness.

of EOLC tools rose dramatically. 140 staff received EOLC training.Year 2 -Post-training, 19% of patients died in an acute setting and the ADAs suggested only 5% might have been avoided if end of life needs had been correctly identified. Uptake of EOLC tools increased with 90% of those who died having some form of ACP and nearly 80% having a valid DNACPR form. 157 staff received EOLC training Discussion The uptake of EOLC tools was the most obvious achievement and qualitative data indicated increased staff confidence as a major factor. The ability to measure a reduction in inappropriate hospital admissions was more difficult due to interventions from other in-reach projects. The importance of good engagement with GP practices was identified early on, but was outside the scope of this project. Conclusion This project demonstrated the value of EOLC training, tailored to care home staff needs. Hospices can increase opportunities for good end of life care in the community, without the need for specific patient intervention from specialist palliative care providers. Background Supporting people in the last hours of their life has a particular importance: a human presence may reduce fear, and agitation and promote a peaceful dying (1);provision of a 'sacred space' (2) performing rituals or an environment of valuing of the person's way of life and beliefs may be a consideration; and witnessing the passing from life to death. Aim LOROS developed a novel pilot service recruiting and training volunteers to work with care homes to compliment their care of dying patients. The aim was to explore the feasibility and evaluate its added value. Approach used A three day training programme was developed for 9 volunteers : learning hand massage; a focus on common features of dying; features of dementia; and discussing the role and potential impacts on the volunteer. Volunteers developed 'comfort packs' containing readings, music, massage oil and religious icons. A regular support structure was developed. P4 VALE: VOLUNTEERS AT LIFE'S END, THE LOROS CARE HOMES PROJECTFour care homes developed operational frameworks for contacting and integrating volunteers in to their team. Leaflets provided information to service users and processes were developed to discuss the service with residents and relatives. Outcomes Over seven months three of the four care homes utilised volunteers with 10 residents. Most residents who died did not need the additional support of a volunteer and some volunteers were not utilised. Where volunteers did provide support it was highly valued by staff and by relatives. Volunteers enjoyed the work and despite being needed infrequently there was no attrition. Application to hospice practice Hospice trained and supported volunteers are welcomed by care homes as part of their care team for dying patients. The need for their service is infrequent and unpredictable and when it does occur it is immediate and intensive. These practical factors make it difficult service to provide.