Belfast City Hospital Research Articles

Isabella Barbour 'Ella' Pirrie (1857-1929): Pioneering contributions to British nursing.

Miss Isabella "Ella" Barbour Pirrie (1857-1929) made substantial contributions to nursing through her work in Belfast and Edinburgh. Born to a notable medical family, Pirrie's inclination toward nursing was influenced by her father's profession. She trained at the Liverpool Royal Infirmary and was mentored by Florence Nightingale, whose guidance shaped her nursing philosophy and practices. Notably, Pirrie's role in the Belfast Union Workhouse Infirmary was transformative; she championed the implementation of standardized nursing uniforms, enhancing the professional standing and recognition of nurses. Her efforts led to the establishment of a formal nursing training program in Belfast, despite facing significant resistance and challenges. In 1894, Pirrie moved to Edinburgh to become the First Matron at the Lady Grisell Baillie Memorial Hospital. Her tenure there was marked by significant advancements in nursing education, including the establishment of a community and district nursing department. By the end of her service, over 140 nurses had been trained, with many pursuing international missions. Despite her resignation in 1914 due to health issues, Pirrie continued her work as the superintendent of the Deaconess Rest Home in Edinburgh until her death in 1929. Her legacy is commemorated by a statue at Belfast City Hospital and a plaque at Greyfriars' Charteris Sanctuary, reflecting her profound impact on nursing education and the professionalization of the field.

Phase-Type Survival Trees to Model a Delayed Discharge and Its Effect in a Stroke Care Unit

The problem of hospital patients’ delayed discharge or ‘bed blocking’ has long been a challenge for healthcare managers and policymakers. It negatively affects the hospital performance metrics and has other severe consequences for the healthcare system, such as affecting patients’ health. In our previous work, we proposed the phase-type survival tree (PHTST)-based analysis to cluster patients into clinically meaningful patient groups and an extension of this approach to examine the relationship between the length of stay in hospitals and the destination on discharge. This paper describes how PHTST-based clustering can be used for modelling delayed discharge and its effects in a stroke care unit, especially the extra beds required, additional cost, and bed blocking. The PHTST length of stay distribution of each group of patients (each PHTST node) is modelled separately as a finite state continuous-time Markov chain using Coxian-phase-type distributions. Delayed discharge patients waiting for discharge are modelled as the Markov chain, called the ‘blocking state’ in a special state. We can use the model to recognise the association between demographic factors and discharge delays and their effects and identify groups of patients who require attention to resolve the most common delays and prevent them from happening again. The approach is illustrated using five years of retrospective data of patients admitted to the Belfast City Hospital with a stroke diagnosis.

Does Nasopharyngeal and Oropharyngeal Swabbing for COVID-19 Increase the Risk of Acquisition of Invasive Meningococcal Disease?

Laboratory for Disinfection and Pathogen, Elimination Studies, Northern Ireland, Public Health Laboratory, Nightingale (Belfast City) Hospital, Belfast, Northern Ireland, United Kingdom [email protected] The authors disclose no conflict of interest.

Steps to healthier habits

Purpose: Lower levels of physical activity are associated with patients with haemophilia. A recent audit confirmed this for patients attending the Haemophilia Centre at Belfast City Hospital. This, together with higher obesity levels, contributes to additional health issues for Patients. The aims of this inititative were: (1) to increase awareness of the benefits of healthy eating and increasing physical activity levels, and (2) to signpost patients towards opportunities to facilitate a more active lifestyle.

We placed our lives in the hands of a hero: a transplant story

Living organ donation is a hot topic at the moment. Jo-Anne Dobson, ambassador of Kidney Care UK in Northern Ireland, has been a long-term advocate of this cause. She tells about how the live kidney donor programme at Belfast City Hospital made it quick and straightforward for her to donate a kidney to her son Mark when his first transplanted kidney started to shut down.

A successful strategy for achieving minimal cold ischemia time for Donation after Circulatory Death in Belfast City Hospital

A successful strategy for achieving minimal cold ischemia time for Donation after Circulatory Death in Belfast City Hospital

Abstract OT3-01-01: Chemoprevention in BRCA1 mutation carriers (CIBRAC): A proof of concept clinical trial

Abstract Introduction Currently, risk management options for BRCA1 mutation carriers include risk-reducing mastectomies (RRM), and selective oestrogen receptor modulators (SERMs). However, the majority of BRCA1-associated tumours are oestrogen receptor negative (ER-ve). SERMs do not reduce the incidence of ER-ve tumours, therefore are unlikely to be effective in this group of women. Oestrogen and its metabolites have been shown to cause DNA damage, resulting in genomic instability in BRCA1 deficient breast cells, an early hallmark of BRCA1-related cancers. Based on this, we hypothesise that oestrogen suppression in BRCA1 carriers may reduce DNA damage in breast tissue, and thereby potentially reducing breast cancer risk. Trial Design The study is an interventional, non-randomised, crossover study without masking. The primary purpose is to assess the impact of these drugs on suppression of DNA damage and therefore their potential for use as chemopreventive agents in this setting. Pre-menopausal BRCA1 mutation carriers will be recruited from the Family History Clinic at Belfast City Hospital. The proportion of women who receive information packs who progress to trial entry will be recorded, with target recruitment of twelve women to the trial. Participants will complete quality of life questionnaires, provide blood and urine samples and undergo baseline ultrasound-guided breast biopsy. Half of these women will receive a SERM (tamoxifen) for 3 months, whilst the other half receives oestrogen suppression therapy (goserelin and anastrazole), and then provide repeat questionnaires and samples (blood, urine and breast biopsy). Treatment groups will cross over for a further 3 months treatment, with a final set of questionnaires and samples taken. Compliance with treatment and adverse events will be monitored throughout the study. Eligibility Criteria Inclusion criteria: · Female · Age ≥18 years · Premenopausal · Known pathogenic BRCA1 mutation · Intact ovaries · No previous breast/ovarian/other carcinoma · No previous use of chemoprevention · Willingness to use non-hormonal methods of contraception Exclusion criteria: · BRCA1 mutation of uncertain significance · Contraindications to study drugs or breast biopsies · Pregnancy or breastfeeding · Inability to give informed consent · Patient awaiting risk reducing surgery Specific Aims The primary objective is to assess the feasibility of treatments by measuring successful recruitment rates and compliance. The secondary objective is to establish tolerability of interventions through quality of life measurements and adverse event occurrence. Exploratory objectives will assess the potential of treatments to reduce DNA damage through analysis of breast biopsies using comet assays and immunohistochemistry for 53BP1 and γH2AX (markers of DNA double-strand breaks). Oestrogen and metabolite levels will be measured in blood and urine samples using UPLC-MS/MS. Statistical Methods Not applicable due to nature and size of pilot study Present accrual: 1 participant Target accrual: 12 participants Contact information for people with specific interest in trial: aideen.campbell@qub.ac.uk or s.mcintosh@qub.ac.uk Citation Format: Campbell AM, Savage KI, McIntosh SA. Chemoprevention in BRCA1 mutation carriers (CIBRAC): A proof of concept clinical trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-01-01.

Alistair G.S. Philip, MD: Mentor, Teacher, Colleague, Friend

Alistair G.S. Philip, MD, has retired as editor-in-chief of NeoReviews . From my perspective, Alistair has retired twice, once in 2004 when he was awarded emeritus status at Stanford University, and recently in 2017, when he made the decision to leave his editorial role at the journal. However, I suspect that this time, his family and golf may have finally taken the Scot from us—although not his legacy. Nonetheless, I also trust that we will still see him occasionally at our professional gatherings or hear from him from time to time through an editorial or commentary, if he thinks we need some further tutoring in some manner of our practice, which I am sure he will decide is necessary. Alistair has never deviated from a career trajectory of continuing education. He was an early immigrant from the United Kingdom, more specifically Scotland, and has maintained a bit of the manner and brogue of the Scot to this day—besides being a decent golfer. He received his medical education at the University of Edinburgh Medical School, achieving his MB, Ch.B in 1961. His Doctor of Medicine degree (MD) was also awarded in Edinburgh, in 1983, after completion of a thesis based on original research. He was an intern at Belfast City Hospital in Northern Ireland, and he served as a resident between 1962 and 1963 at the American Hospital of Paris, Neuilly-sur-Siene, France. The latter experience was evidence of the first expression of his “gene for adventure,” which ultimately would lead him to us at Stanford. Indeed, he was allured by the West early in his career, beginning in 1963 to 1964 when he was a pediatric resident at the Kauikeolani Children’s Hospital in Honolulu, Hawaii. Between 1964 and 1969, he moved between various medical training experiences in Edinburgh, Boston, and Paris, …

Reviewing deaths within 30 days of systemic anti-cancer therapy: Driving quality in a regional chemotherapy service.

112 Background: Systemic anti-cancer therapy (SACT) administration rate at the end of life has been deemed a key metric for assessing quality of cancer care. A structured peer review process has been developed within the Cancer Centre, Belfast City Hospital, to discuss all patient deaths occurring within 30 days of SACT across Northern Ireland at a monthly, multidisciplinary, educational mortality meeting. We aimed to review cases discussed, characterising patients, causes of death and the role of SACT in patients’ deaths. Methods: A retrospective analysis was undertaken of 282 solid tumour patients, whose deaths were discussed at the mortality meetings from January 2013 to August 2016. Results: The 30-day mortality rate for the Cancer Centre was 4.5%. Most commonly represented tumour sites were gastrointestinal (39%), lung (22%) and breast (17%) with 96% receiving palliative treatments. WHO Performance Status (PS) was 0-2 at final SACT cycle in 83% (8% PS 3, unknown 9%). 43% of patients were receiving their first cycle and 56% receiving first line treatment for advanced disease. 77% of deaths occurred in hospital with 57% attributed to progressive disease. Other causes of death included infection (7% neutropenic, 11% non-neutropenic) and thromboembolism (12%). In 10% SACT was deemed to have caused or hastened death whereas in 65% SACT was non-contributory. In 25% SACT did not play a major role, but a contributory role could not be confidently excluded. Conclusions: SACT related death rate appears comparable to other institutions’ published routine outcomes. Robust review of SACT mortality encourages service improvement and individual reflection. Prescribers are reminded of the critical importance of carefully balancing patients’ needs and concerns with realistic outcomes and treatment risks, particularly in heavily pretreated or poor PS patients. Case discussions have generated service improvements including site and regimen specific prepopulated consent forms, a standardised SACT assessment proforma and mandatory response assessments as part of SACT protocols. Neutropenic sepsis remains the leading cause of SACT related mortality and further innovative improvements in care are required.

Improving the safety of chemotherapy prescribing in oncology through the introduction of an assessment proforma

Chemotherapy remains a high risk treatment with the potential to cause significant patient morbidity and mortality. In the UK the Manual for Cancer Services: Chemotherapy Measures provides national quality measures...

Obituary – Emerita Professor Valerie Anne Hall BSc PhD FSA FHEA (1946–2016)

Abstract Professor Emerita Valerie Hall died on 28th July, 2016, in Belfast City Hospital after a long battle with cancer. Valerie was a renowned and highly esteemed inter-disciplinarian, who began her career in botany and palynology but made a truly international mark in the field of cryptotephrochronology. Between us, we knew her as a student, a supervisor, an examiner, a mentor, a colleague, a role model, and, above all, a wonderful, kind-hearted and generous friend. She touched the hearts and earned the respect of Quaternary scientists around the world. Here, to honour her memory, we reflect briefly on the great woman and scientist that she was.

Arterial stiffness and arteriovenous fistula failure of maturation.

Increased arterial stiffness is a common finding in patients with end-stage renal disease. Following creation of an arteriovenous fistula (AVF), appropriate dilation of the feeding artery must occur to facilitate AVF maturation. Arterial stiffness may impair the arterial dilation required to facilitate AVF development and contribute to subsequent failure to mature (FTM). The aim of this pilot study was to investigate the association between measurements of central and peripheral arterial stiffness, and AVF FTM. Patients undergoing AVF creation in a single centre (Belfast City Hospital, UK) between January and December 2015 were invited to have their carotid-femoral pulse wave velocity (PWV), brachial-radial PWV and augmentation index (AI) measured prior to AVF creation. Subsequent AVF outcomes were identified. Fifty-nine patients who had an AVF procedure were included in the final analysis (mean age 62 years); 50.8% had diabetes mellitus. The mean pre-operative arterial diameter for all AVFs was 3.9 mm. Average values for carotid-femoral PWV were 9.5 m/s, brachial-radial PWV 7.7 m/s and AI 25.6%. Using logistic regression, these arterial stiffness parameters did not predict AVF FTM: carotid-femoral PWV (P = 0.20), brachial-radial PWV (P = 0.13), AI (P = 0.50). This is the largest study to date exploring the association between arterial stiffness and AVF FTM. The measured central and peripheral arterial stiffness parameters were not associated with AVF FTM. Further research is needed to define if non-invasive arterial physiological measurements would be clinically useful in the prediction of AVF FTM.

Investigating clinical predictors of arteriovenous fistula functional patency in a European cohort.

BackgroundArteriovenous fistula (AVF) failure to mature (FTM) rates contribute to excessive dependence on central venous catheters for haemodialysis. Choosing the most appropriate vascular access site for an individual patient is guided largely by their age, co-morbidities and clinical examination. We investigated the clinical predictors of AVF FTM in a European cohort of patients and applied an existing clinical risk prediction model for AVF FTM to this population.MethodsA prospective cohort study was designed that included all patients undergoing AVF creation between January 2009 and December 2014 in a single centre (Belfast City Hospital) who had a functional AVF outcome observed by March 2015.ResultsA total of 525 patients had a functional AVF outcome recorded and were included in the FTM analysis. In this cohort, 309 (59%) patients achieved functional AVF patency and 216 (41%) patients had FTM. Female gender [P < 0.001, odds ratio (OR) 2.03 (CI 1.37–3.02)] and lower-arm AVF [P < 0.001, OR 4.07 (CI 2.77–5.92)] were associated with AVF FTM. The Lok model did not predict FTM outcomes based on the associated risk stratification in our population.ConclusionsIn this European study, female gender was associated with twice the risk of AVF FTM and a lower-arm AVF with four times the risk of FTM. The FTM risk prediction model was not found to be discriminative in this population. Clinical risk factors for AVF FTM vary between populations; we would recommend that units investigate their own clinical predictors of FTM to maximize AVF functional patency and ultimately survival in dialysis patients. Clinical predictors of AVF FTM may not be sufficient on their own to improve vascular access functional patency rates.

The prevalence of CALR mutations in a cohort of patients with myeloproliferative neoplasms.

To investigate the prevalence of calreticulin (CALR) mutations in JAK2- and MPL-non-mutated patients with suspected myeloproliferative neoplasm (MPN) from a large MPN clinic and confirm a diagnosis of MPN. JAK2/MPL-non-mutated patients from the Belfast City Hospital (BCH) with either of the MPNs - ET or MF - and diagnosed between 1988 and 2014 were selected for CALR screen. All cases were validated according to the WHO 2008 classification for MPNs. Statistical analysis was performed with Minitab 16 Statistical Software package. Exon 9 of CALR was amplified by PCR using genomic DNA, and mutations were detected by fragment analysis. Of the 62 JAK2/MPL-non-mutated MPN patients screened, 57 had ET and 5 had MF; 34 patients (53.1%) carried CALR mutations. Three of 5 MF patients were CALR positive. Thirty-one ET patients (54.3%) harboured CALR mutation, whereas 26 (45.7%) were classified as 'triple negatives'. Detection of CALR mutations in a cohort of JAK2/MPL-non-mutated patients with suspected MPN confirmed the diagnosis of MPN in around 53% of cases. This is lower than initially reported, but similar to subsequent studies. However, a sizable cohort of patients remains lacking a specific molecular marker.

4 Complex PCI across the belfast trust over a 2 year period: Abstract 4 Table 1

Introduction It is well recognised that the prevalence of coronary artery disease and risk of myocardial infarction increases with age. An ageing population and increasing co-morbidity means that the frequency of complex percutaneous coronary intervention (PCI) is increasing. This is due to: Ageing population Surgical turn down for CABG Improvement in operator technique/equipment Evidence to support complex percutaneous intervention particularly in the elderly Methods The total number of PCI procedures performed within the Belfast trust (Belfast City Hospital and Royal Victoria Hospital) between 1st September 2012 and 31st August 2014 were collated from the local database. The indication (elective/ acute coronary syndrome/ST elevation MI) and complexity* of the procedure were recorded along with patient demographics including age, gender, ejection fraction and renal function. *The procedure was defined as complex if it involved at least one of the following: PCI of left main stem Use of high speed rotational atherectomy Chronic total occlusions 2 consultant operators. Results A total of 5356 PCI procedures were performed. 1209 procedures were complex. This represents 23% of the total number of procedures performed across the trust. 27% of PCI performed in patients over the age of 80 was complex. Obviously not all complex PCI performed involved only one criterion Below is a table showing the percentage breakdown of complex PCI. PCI for all acute coronary syndromes, Belfast City Hospital 909 procedures had indication as acute coronary syndrome 137 (15%) defined as complex Of the complex procedures 55 (40%) involved HSRA PCI for all acute coronary syndromes, Royal Victoria Hospital 1908 procedures had indication as acute coronary syndrome 184 (10%) defined as complex Of the complex procedures 67 (36%) involved HSRA PCI for ST elevation MI, Royal Victoria Hospital Within the ACS cohort: There were 973 PCI procedures with indication recorded as ST elevation MI 63 (6.5%) procedures were defined as complex 11 (1.3%) procedures involved HSRA Summary In the Belfast trust over a 2 year period there were 5356 PCI procedures: Average age was 66; average age complex PCI was 70 12% cases were patients over 80 23% of all cases were defined as complex 27% of cases in over 80s were complex 2817 procedures for ACS (53%) 11% of ACS cases were complex Conclusions Routine PCI is becoming increasingly complex with nearly 1 in 4 cases performed in the Belfast trust fulfilling complex criteria. Over 1 in 10 ACS cases were complex. Interventionalists should be proficient in HSRA use, invasive imaging modalities such as IVUS/OCT to define anatomy and left main PCI.

WS09.10 “Writing for the future”, addressing the challenges of family communication at the end of life in cystic fibrosis

Objectives Three hundred patients attend the Adult CF Centre in Belfast. There are around 100 children who have a parent with CF. There is an unmet need in individuals with disease progression and facing end of life as to how best to communicate this difficult situation to their children and how to prepare for life without them. Our objective was to develop a personal “writing for the future” book that could be shared between patients and their children. Methods We engaged with a volunteer counsellor who was supported by the Belfast City Hospital and the UK CF Trust. We identified 5 patients approaching the end of their life and offered this service, all engaged. The counsellor and patient undertook several conversations that were recorded. Various themes emerged depending on the individual but could include their own childhood, challenges they faced, happy events and advice for their children as they grow up without them. Results This “writing for the future” was transcribed and presented in a professionally bound book with photographs. The patients then shared this with their families. A patient on reflection with his daughter said, “She will always be secure in the knowledge of my love for her”. Following the patients’ death their children had a tangible memory book and found great comfort in the words. Conclusions We have had overwhelming support from patients and their families for this initiative. This novel approach can sensitively aid the challenging conversations within a family at end of life and helps to prepare their children for the future. We continue to develop this service and would support its initiation in other CF centres.

75 Evaluation of Diagnosis and Management of Cardiac Implantable Electronic Infection in a Tertiary Referral Centre: Abstract 75 Table 1

<h3>Introduction</h3> Cardiac implantable electronic device (CIED) infections have been shown to be associated with significant morbidity and mortality. Diagnosis can prove clinically challenging particularly in patients with a remote history of CIED implant. The aim of this study was to evaluate the diagnosis and management of patients with CIED infections in a tertiary referral centre. <h3>Methods</h3> CIED infections were retrospectively identified from electronic device databases and hospital discharge coding between July 2010 and January 2014. Data was collected from device databases, electronic care records and laboratory records. CIED implantations took place on two sites (Royal Victoria Hospital and Belfast City Hospital) by seven operators and included permanent pacemakers, implantable cardioverter defibrillators and cardiac resynchronisation devices. <h3>Results</h3> Forty three cases of CIED infection were identified. Methicillin sensitive staphylococcal was the most common causative organisms cultured whilst a wide range of organisms were cultured. Six cases were culture negative (14%). The CIED was explanted in all 43 cases, the mean time to explantation was 12.6 days with a range of 1–78 days. The average duration of antibiotic therapy was 32 days (range 3–100 days). 15 patients (35%) suffered a complication associated with the CIED infection (Table 1). 27 (62%) patients had a further device implanted. In-hospital mortality was 7% with a six-month mortality of 16%. <h3>Discussion</h3> Mortality remains high with CIED associated infections. Complications are common and may be related to the CIED infection or its treatment. The diagnosis can be difficult only 13 (30%) of patients had positive blood cultures and often patients presented with an indolent course. Management of CIED infections are complex and there is a wide variation in time to explantation, antibiotic duration and time to reinplantation. Unifying patient management in line with current guidelines may improve morbidity and mortality and merits further investigation.

292 Cystic fibrosis and transition to adult care in Northern Ireland

Background Transition from paediatric to adult care for patients with chronic disease is challenging. Transition should be holistic, patient centred, coordinated, gradual, involve parents and promote autonomy. Adolescents in the paediatric CF unit are reviewed at joint transition clinics with one of our adult CF physicians. In their 18 th year they attend a final transfer clinic (attended by both paediatric and adult multidisciplinary teams). Objective and Methods A questionnaire was distributed to patients aged 18–25 years in the adult CF centre in the Belfast City Hospital to evaluate patients' experience of transition. Results Eighty-five patients were identified with 40 respondents (24 female, 16 male). The average age was 21 years. Twenty-five percent found transition difficult. All valued being seen by the paediatric and adult teams together. All of the males felt ready to take responsibility for their own health, rather than relying on parents, however 38% admitted that they found this difficult in practice. The majority of females (79%) also felt ready to self-care, but 50% acknowledged difficulty in practice. 33% of respondents reported that parents struggled with transition (85% of these found self-care difficult). The majority of patients settled in to the adult service quickly, but 43% took months-years; these were patients who found it difficult to take ownership of their own care. Conclusion Our model facilitates gradual transition through close cooperation with paediatrics. Based on the above results we plan to introduce a patient information pack to improve the service further, which will address the psychosocial and educational needs of adolescents.

Advanced teamworking in emergency surgical situations: Improving patient safety through the design of a multi-professional, multi-disciplinary course focusing on non-technical skills

Advanced teamworking in emergency surgical situations: Improving patient safety through the design of a multi-professional, multi-disciplinary course focusing on non-technical skills

Mitomycin C guidelines: An improvement in department adherence through the process of audit, led by junior doctors

s / International Journal of Surgery 12 (2014) S13eS117 S104 0328: MITOMYCIN C GUIDELINES: AN IMPROVEMENT IN DEPARTMENT ADHERENCE THROUGH THE PROCESS OF AUDIT, LED BY JUNIOR DOCTORS Gerard Walls , David Curry, Hugh O'Kane. Regional Urology Unit, Belfast City Hospital, Northern Ireland, UK. Introduction: The authors intended to establish adherence to guidelines regarding time to administration of intravesical chemotherapy postTURBT, in the Regional Urology Unit. EORTC recommends Mitomycin C (MMC) instillation within 6 hours in eligible patients this reduces recurrence rates by 39%. Methods: Prospective audit of time to administration in all eligible patients during a 3 month period. Results were discussed at departmental level with a three tiered approach to improvement. Primarily, initiation of in-theatre instillation (Mostafid et al). Second, a training programme for ward staff in handling cytotoxic agents. Finally, awareness of the problem was raised to trainee urologists at the Regional Audit Meeting. A repeat three month audit series was performed six months later. The latter two processes had been implemented with plans for in-theatre administration on-going. Results: Initially, in 19 patients (40 eligible) the mean time to MMC administration was 18.3hrs (2.3-28.2hrs). 15.7% patients received MMC 3mm, first time. Unanimous, unequivocal histopathological diagnoses were achieved. Conclusions: Few biopsy devices provide satisfactory, representative and consistent samples for diagnosis. We experienced an unpredictable outcome with a 25% re-biopsy rate with various devices, however with BIGopsy forceps accurate histopathological diagnoses were achieved with a significant impact on the timely treatment for urothelial malignancies. 0401: HOW CLINICAL AUDIT HAS LED TO REDUCED RATES OF POST TRUS BIOPSY SEPSIS IN OUR TRUST Nicholas Gill , Michael Onyema, Anne Dyas, Vincent Koo, Paul Rajjayabun. Alexandra Hospital, Redditch, UK. Introduction: We recently reported the findings of a regional audit which identified rates of sepsis increasing to 1.8% following transrectal ultrasound guided prostate biopsies (TRUS). Following this audit I.V. Gentamicin 160mg was introduced as additional prophylaxis for patients undergoing TRUS biopsy. Our aim was to assess the impact of adding Gentamicin to the TRUS antibiotic prophylaxis bundle since implementation in August 2013. Methods: Analysis of all patients who underwent TRUS biopsy across our Trust between August-December 2013 with minimum 1-month follow up. Our findings were compared against our previous audit data and published literature. Results: Therewere 246 TRUS biopsy procedures carried out across the Trust following the introduction of our new antibiotic prophylaxis regime. Median age of the population examined was 67 years (range 42-84). Only 1 patient was admitted to Secondary care with significant sepsis (0.4%), 3 patients had positive urine cultures performed inPrimarycare but didnot require hospital admission (1.2%). There were no ITU admissions or mortalities. Conclusion: We conclude that the addition of I.V. Gentamicin has dramatically reduced the incidence of significant sepsis post-TRUS biopsy. This is an example of howwe have utilised audit tomodify clinical practice for the benefit of our patients. 0403: PROGNOSIS FOLLOWING PERCUTANEOUS NEPHROSTOMY INSERTION FOR MALIGNANT OBSTRUCTIVE UROPATHY: ONE CENTRE'S EXPERIENCE Nicholas Gill , Kevin Williams, Phil Holland, Chris Phillips, Fabio Conti, K. Wong, L. Delaney, L. Moore, Paul Rajjayabun. Alexandra Hospital,