Abstract Aim During the pandemic, bladder outlet surgeries (TURP,Urolift,Rezum) were delayed. Operations were prioritised (P2<1month, P3<3months, P4>3months). We wanted to find out patient’s experience due to this. Method Patients identified who had surgery and on waiting list between January 2020 and June 2021. A questionnaire was designed to identify patient's experience and whether they felt their operation was delayed, if received correspondence about delays, if aware of the waiting-list grading, if attended GP/ED with issues, if felt their outcome affected by delays, listed P-grading, duration waited for operation, and overall satisfaction. Results 56 patients were identified. 50% delayed. In delayed sub-group, 45% did not feel their operation was delayed. 82% delayed received information from the hospital. 70% knew about the grading system in place according to clinical urgency. In delayed sub-group, 41% felt their operation would be more difficult or less likely to be successful compared to 15% in non-delayed sub-group. 43% who were delayed attended GP/ED with issues compared to 9% in non-delayed group. 84% were happy or very happy (Likert4/5) with their experience. Conclusions Large numbers of BOO procedures were delayed due to the pandemic. Many patients aware of the waiting list grading system and understanding of the pressures on the NHS. There was good communication between the hospital to inform patients of their delays thus most patients were happy with the service they received, despite being delayed. Delays leads to significantly higher attendances to GP/ED and patients feel their operation is more likely to be difficult or unsuccessful.

Abstract Introduction NICE and EAU guidelines recommend offering prostate biopsy for patients with PI-RADS 3 lesions in a multiparametric MRI. Employing PSA density (PSAd), to further risk-stratify these patients, is a promising approach to advocate for PSA surveillance over biopsies. Here, we appraise the ability of PSAd to risk-stratify PI-RADs 3 lesions across patients who underwent a prostate biopsy. Method A retrospective analysis was performed on all patients who had a multiparametric MRI with PI-RADs 3 lesions over 2-year period Jan 2021 – Dec 2022. Patients were divided into two groups according to their PSAd value and whether they have neoplastic features on histopathology. The data was analysed using Chi-Square to determine the association between PSAd levels and cancer incidence in PI-RADS 3 lesions. Results 116 patients out of 613 had PIRADS 3 reported (19%). 83 patients had biopsies (72%). 44 was positive for neoplasia (53%) and 39 was negative (47%). 44 patients in the biopsy arm had a PSAd of <0.15 (53%). Of these patients, 27 had no neoplasia (61.4%). 39 patients had PSAd >0.15 (47%) and 12 had no neoplasia (31%). PSAd < 0.15 PI-RADS 3 lesions were significantly associated with lower occurrence of prostatic malignancy on statistical analysis. Conclusions Out of all biopsied PIRADS 3 lesions, almost half (47%) had no neoplasia. More than half of patients with PSAd <0.15 had no neoplasia. Patients with PSAD <0.15 were statistically more likely to have no neoplasia compared to patients with PSAD >0.15. This information is useful for prebiopsy risk stratification and patient counselling.

Abstract Aim Fascia-iliaca block (FIB) is regional anaesthetic used in A&E for hip fractures; they’re performed under landmark guidance in Southport A&E. NICE recommend FIBs for hip fractures if PO/IV paracetamol/opiates provide insufficient relief; it’s shown to provide superior analgesia and reduce opiate consumption. RCEM state FIBs should be administered promptly in A&E by trained personnel and are a listed ACCS competency. The audit aim was to review the number/percentage of hip fracture patients receiving FIBs, with documentation, in Southport A&E. Hip fracture patients should have documented FIBs, the standard for the audit was ≥90% patients. Method This audit was a retrospective analysis of the 6-week period 08/08/2022-20/09/2022 for hip fracture patients at Southport DGH. Data was collected from the National Hip Fracture Database. Patients weren’t delayed to surgery on FIB administration. Online inpatient/A&E notes and drug charts were analysed for FIB documentation. Results The sample included 46 patients, 8 male and 38 female. 13 had documented FIBs on admission, 33 had no documented FIB, meaning 28.2% of patients received FIBs in A&E over 6-weeks. Conclusions This audit shows too few hip fracture patients are receiving FIBs in Southport A&E as analgesia, with 28.2% documented compared to the desired ≥90% standard. Patients are either not receiving FIBs or not having them documented. FIB use can be improved by clinical audit, and interventions are being implemented to improve use in Southport A&E, including posters, hip fracture proforma additions, and department education.

Abstract Aim Our aim was to reduce post-operative endourology infection rates by screening all patient pre-operatively with urine culture. Our local guidelines recommend single dose Gentamicin for prophylaxis prior to endourology procedures. Pre-operative urine culture can identify patients with positive cultures to be treated prior to surgery and to identify multi-resistant microorganisms to aid alternative antibiotic prophylaxis choice. Method We identified patients that underwent elective endourological surgeries in a 3-month period (July-September2021). We identified if pre-operative urine cultures were performed, if the cultures were positive and were they treated appropriately. We identified if any patients had re-admissions postoperatively within 30 days of their procedure with UTI. We identified if the microorganism grown in the culture was resistant to Gentamicin and if an alternative prophylaxis was given pre-operatively. Results 104 patients were identified. 65 had pre-operative cultures done. Of the 39 patients that did not have cultures done, 2 were re-admitted within 30 days with UTI. 14 pre-operative cultures were positive (21.5%) and was treated with a course of antibiotics per sensitivities and Gentamicin pre-operatively. 4 were resistant to Gentamicin (6.2%). An alternative prophylactic antibiotic was used per microbiologist’s advice for those resistant. No one was re-admitted with a UTI within 30 days in the group that had pre-operative cultures done. Conclusions Around 1 in 5 urine cultures done was positive for growth. Almost a third of this was resistant to Gentamicin and this aided our choice of alternative prophylactic treatment. By performing pre-operative cultures, we reduced our postoperative infection complication and re-admission rates.

In this study we address the diversity of the scyphozoan jellyfish genus Nausithoe Klliker, 1853 (Nausithoidae, Coronatae), questioning the feasibility of using some characters of the medusa stage to identify species and filling in gaps concerning species of the genus and their distributions. Like most scyphozoans, the vast majority of the 21 Nausithoe species have a metagenetic life cycle, but similarity of most polyps within the genus highlights the need for studying morphology of the medusa stage. By analyzing morphological features on preserved and live specimens (polyps and medusae) and comparing these data with the original descriptions, we were able to validate twenty species of the group, providing new information for some of them.

IntroductionCurrent British Society of Gastroenterology (BSG) guidelines recommend all patients admitted to hospital with lower gastrointestinal bleeding (LGIB) undergo an inpatient colonoscopy on the next available list as part of providing a 7-day endoscopy service. The real-world availability of a 7-day service and adherence to this guidance is unknown.MethodsPatients aged ≥16 years admitted with LGIB to 7 hospital trusts from June 1st–Aug 31st 2019 were included. Data on presentation, endoscopy, time to procedure and outcomes were recorded. We established data from participating Trusts on their current endoscopy services in relation to BSG guidance.Results407 patients across 7 NHS Trusts presenting with LGIB were included. Mean age was 59.8 (17-96), with a mean Oakland score of 14.5 (SD 6.78). 14.7% received a LGI endoscopic investigation during admission (3.4% colonoscopy, 11.8% flexible sigmoidoscopy), with 25.7% of admitted patients undergoing their LGI endoscopy as an outpatient. Median time from admission to inpatient flexible sigmoidoscopy and colonoscopy was 2.5 days (58 hours) and >3 days (80 hours) respectively. 43% (3/7) of Trusts provided daily inpatient endoscopy lists able to accommodate inpatient colonoscopies, with colonoscopies being ad hoc/no regular slots in a further 43% of Trusts. At weekends, 86% (6/7) of hospitals provided endoscopy lists, however of these, 83% stated colonoscopies were not routinely performed at weekends.ConclusionsCurrent real-world practice is not in keeping with BSG guidelines. The majority of patients admitted with LGIB do not undergo inpatient LGI endoscopy (colonoscopy or flexible sigmoidoscopy) and the waiting time for a ‘next available’ slot can be several days. LGI endoscopic assessment for LGIB is more commonly performed as an outpatient. Most Trusts do not currently provide a 7-day endoscopy service, the majority with no regular weekend or weekday colonoscopy slots for patients with LGIB.

IntroductionMany patients presenting to hospital with lower gastrointestinal bleeding (LGIB) are elderly and co-morbid. British Society of Gastroenterology (BSG) guidelines recommend LGI endoscopy for all patients admitted with LGIB. As the majority of LGIB ceases spontaneously and risks of endoscopy increase with patient age, a ‘watch and wait’ management approach may be appropriate for older patients.MethodsPatients aged ≥75 years presenting with LGIB to seven hospital trusts from June 1st– September 1st 2019 were included. Data on presentation, management and outcomes were recorded, then compared to current BSG guidelines.Results127 patients were included. 47% were male with a mean age 84 (range 75-96), 73.2% of patients had ≥2 listed co-morbidities. Mean Shock Index (SI) on presentation was 0.69, with a SI >1 being rare (7.0%) and reduced to 2.4% following resuscitation. Of stable patients (SI<1), 94.3% were classified as having a major bleed (Oakland Score >8). 96.1% of presenting patients were admitted, while 3.9% were discharged from A&E. 80% of these discharged patients had an Oakland Score >8. 21 (17.2%) of admitted patients received an inpatient lower GI endoscopy; 19% of which received endoscopic therapy. The most commonly identified cause of LGIB was diverticulosis (23.8%). Overall, 82.8% of admitted patients received no inpatient lower GI endoscopy and were managed conservatively. Comparing those who underwent LGI endoscopy versus a watch and wait approach, there was no difference in inpatient mortality (0% vs 4%, p=1.0) or 30-day re-admission rate (9.5% vs 22.8%, p= 0.24). However, undergoing inpatient LGI endoscopy was associated with greater median length of stay (8 days vs 3 days, p=0.0002) PTU-50 Figure 1Serial cholangiograms from one patietConclusionsAge and co-morbidities complicate risk stratification in the elderly as many will score highly regardless of bleed severity, limiting the role of the Oakland Score. Endoscopic assessment of all elderly patients presenting with LGIB is not performed in real world practice, may not be necessary or even appropriate. Although not in keeping with current guidelines, this watch and wait approach does not appear to be associated with adverse outcomes in the elderly.

IntroductionLower gastrointestinal bleeding (LGIB) is a common hospital presentation, from self-limiting per-rectal bleeding to a life-threatening haemorrhage. British Society of Gastroenterology (BSG) acute LGIB guidelines define a clear management approach including risk stratification for patient management. However, real-world management of LGIB in relation to this guidance is currently unknown.MethodsPatients aged ≥16 years presenting with LGIB to 7 hospital trusts from June 1st–Aug 31st 2019 were included. Data on presentation, management and outcomes of patients were recorded. These were audited against BSG guidelines.Results407 patients were included. 51% were male with a mean age of 60 (SD = 22). Mean Shock Index (SI) at presentation was 0.69, with a SI ≥ 1 being rare (6.3%). 2.2% (9/407) of patients remained haemodynamically unstable (SI >1) after initial resuscitation. Of these, 22.2% underwent a computed tomogram angiography (CTA). Within the major bleed risk patients (Oakland Score >8); 284 (85%) were admitted and 50 (15%) were discharged from A&E. For minor bleed risk patients (Oakland Score ≤8); 67.9% and 32.1% were admitted and discharged respectively. Complete Oakland Score data was unavailable for 7 patients. Of admitted patients, colonoscopy and sigmoidoscopy was performed in 4.3% and 14.6% respectively, whilst 81.8% underwent no inpatient LGI endoscopy. A bleeding site was seen in 12 (20%) patients at endoscopy, for which 2 (10%) received endoscopic therapy. 7-day rebleeding rates were higher in patients who underwent LGI endoscopy versus those conservatively managed (16.7% vs 7.5%, p=0.028). Inpatient mortality was low at 2.1%, with no difference in major vs minor bleed patients (2.1% vs 2.6%, p=1.0). Median length of stay was 5.5 days in patients who received LGI endoscopy and 2 days for those conservatively managed (p= < 0.00001). 15.3% of patients were managed in accordance with BSG guidance. The most common deviations being patients with an Oakland Score >8 being discharged and admitted patients not undergoing LGI endoscopy.ConclusionsReal world practice of managing patients presenting with LGIB is not in keeping with current BSG guidelines, with admission or discharge often not in keeping with Oakland Scores. The majority of admitted patients do not receive inpatient LGI endoscopy, in patients who do, endoscopic therapy is rarely indicated.

The purpose of the study was to explore attitudes of educators in the United Arab Emirates toward gifted education and twice-exceptional students. One thousand and seventy-five educators (81% general education teachers and 19% teachers of the gifted) participated in this study. Data were collected using an online dual-language survey instrument, which was distributed using the Qualtrics system. Findings of this study indicated that Abu Dhabi teachers have positive attitudes toward gifted education and twice-exceptional students. No significant differences were found in scores for general educators as compared to those for teachers of the gifted. The findings also indicated that Abu Dhabi educators who had no experience of teaching gifted children had a more positive attitude toward them than those who had experience.