NHS Foundation Trust Research Articles

Metronidazole is a chromatographic interference on a routine HPLC-UV assay for thiopurine metabolites.

Background Thiopurine metabolites, 6-thioguanine (6TG) and 6-methylmercaptopurine (6MMP), are monitored to aid therapeutic management of thiopurine drugs. At Manchester University NHS Foundation Trust (MFT), thiopurine metabolites are measured by high performance liquid chromatography with ultraviolet detection (HPLC-UV). Whole blood samples are lysed and subjected to hydrolysis with derivatisation of 6MMP before HPLC-UV detection at 304nm for the 6MMP-derivative and 342nm for 6TG. For some samples, 6MMP cannot be reported due to a chromatographic interference at 304nm co-eluting with the 6MMP peak. An investigation was performed to identify the interfering compound. Methods Patient medication histories were examined to identify candidate compounds for the interference. Candidate compounds were spiked into blood at supraphysiological concentrations and tested on the assay. Results Metronidazole was identified as being prescribed to all patients whose samples demonstrated the interference. Metronidazole and its metabolite, hydroxymetronidazole, were spiked into blood. HPLC-UV analysis of spiked blood demonstrated similar UV absorbance patterns to those seen in patient samples with the interference. Hydroxymetronidazole co-eluted with 6MMP causing interference in the measurement. Conclusion Metronidazole and its major metabolite can interfere with 6MMP measurement by HPLC-UV analysis at 304 nm.

Exploring the relationship between dissociative experiences and recovery in psychosis: cross-sectional study.

This study explored the association among dissociative experiences, recovery from psychosis and a range of factors relevant to psychosis and analysed whether dissociative experiences (compartmentalisation, detachment and absorption) could be used to predict specific stages of recovery. A cross-sectional design was used, and 75 individuals with psychosis were recruited from the recovery services of the Gloucestershire Health and Care NHS Foundation Trust. Five questionnaires were used - the Dissociative Experiences Scale - II (DES), Detachment and Compartmentalisation Inventory (DCI), Questionnaire about the Process of Recovery, Stages of Recovery Instrument (STORI), and Positive and Negative Syndrome Scale - and a proforma was used to collect demographic data. Our findings indicated that compartmentalisation, detachment and absorption, as measured by DES and DCI, do not predict stages of recovery as measured by the STORI. The results of this study suggest that there is no simple relationship between dissociative and psychotic symptoms. They also suggest a need to assess these symptoms separately in practice and indicate that special approaches to treatment of psychosis may be needed in cases where such symptoms have a significant role.

Use of the Children’s Observation and Severity Tool (COAST), an Adaptation of the Paediatric Early Warning Score, in the Emergency Department as a Predictor for Hospital Admission: A Retrospective Cohort Study

Background: Paediatric Early Warning Scores (PEWS) are designed to detect the clinically unwell or deteriorating child within a hospital setting. There is a drive within the NHS to standardise this scoring system across various settings. According to the Royal College of Paediatrics and Child Health, there is currently a national review on triage tools used within emergency departments; however, evidence to date is scarce. Within the Chelsea and Westminster NHS Foundation Trust, we utilise both the Manchester Triage System (MTS) and the Children’s Observation and Severity tool (COAST), an adaption of PEWS, in our Paediatric Emergency Department (PED). Methods: This retrospective cohort study is the largest of its kind and was performed to validate COAST, compare it to MTS and determine if it is a good predictor of hospital admission. Demographic data, initial MTS scores, initial COAST scores and admission outcomes of 41,030 paediatric emergency department attendances were analysed, encompassing 27,196 unique patients. Results: Results demonstrated that high COAST scores on arrival are strongly correlated with hospital admission, with positive predictive values of 59.52% with COAST of ≥3 and 100% for with score threshold of ≥5. In comparison with the MTS, COAST is better at predicting admission. Conclusions: We conclude that COAST performs well in correlating to and thus predicting paediatric hospital admission outcome from the PED.

Prescribing patterns of low-dose aspirin during initial maternity appointments in relation to NICE guideline recommendations: findings from two clinical audits

Two retrospective audits evaluated prescribing patterns of low-dose aspirin in relation to NICE guideline NG133 recommendations during initial maternity appointments at South Tyneside and Sunderland NHS Foundation Trust (STSFT). The first audit in September 2021 and the second in September 2022 each included the first 299 patients attending initial maternity appointments during those months. Maternity records were analysed to evaluate aspirin prescriptions for patients at moderate or high risk of hypertensive disorders during pregnancy, and prescription rates were compared between the two audits. In the 2022 audit, 49 patients were identified as meeting NG133 criteria for aspirin use, and only 31 (63%) were prescribed aspirin. Of the 18 patients (37%) not prescribed aspirin, five later received aspirin, leaving 4.5% of the total cohort (13/299) untreated. The 2021 audit showed a similar pattern, with 5.6% of patients (15/266) remaining untreated despite meeting NG133 criteria for aspirin use. Key risk factors applicable to those not prescribed aspirin included ‘nulliparous,' 'BMI >35,' and 'pregnancy interval >10 years.' Remote consultations were linked to inadequate BMI assessment, with 35% of applicable cases not evaluated. The audit highlights the necessity for ongoing efforts to enhance guideline adherence in clinical practice, especially with the growing prevalence of remote consultations. Addressing the identified discrepancies could lead to improved outcomes for pregnant women at risk of hypertensive disorders.

BHSeP34 Reducing inappropriate hernia ultrasound requests: a quality improvement project

Abstract Introduction The Royal College of Surgeons (RCS) Commissioning Guide states ‘diagnostic imaging should not be arranged at primary care level’ for suspected groin hernias. This quality improvement project aimed to evaluate the prevalence of inappropriate hernia ultrasound requests at Newcastle upon Tyne Hospitals NHS Foundation Trust (NUTH) and identify areas for improvement. Methods Data was collected from the PACS department for ultrasound (US) requests with 'hernia' in the indication or report from August to December 2023. Out of 251 requests from GP practices, 138 were relevant after excluding duplicates and non-hernia indications. Each patient’s notes were reviewed to determine the US report outcomes and subsequent clinical follow-up. Results Among the 138 US requests analysed, 95 confirmed hernias (47 small, 29 moderate, 19 large). Of these, 48 patients were referred to secondary care, with 33 seen in clinic and 24 undergoing surgery. The project identified a significant number of inappropriate scans based on RCS guidelines, resulting in an annual cost of £21 810 for 331 US slots. Conclusions Despite RCS guidelines, 331 US slots per year at NUTH were utilised for suspected hernias, incurring costs and delaying patient care. Direct referral to secondary care for clinically evident hernias could reduce costs, expedite treatment, and optimise US slot utilisation. These findings were presented at NUTH general surgery and radiology departmental meetings, with further presentations planned for local GP practices. The key recommendation is to educate GPs to refer patients with clinically evident hernias directly to secondary care, bypassing primary care imaging.

BHSeP48 A review of outcomes following the establishment of a Complex Abdominal Wall Reconstruction (CAWR) Multi-Disciplinary Team (MDT) at Medway NHS Foundation Trust

Abstract Background Medway ventral hernia patients have a high prevalence of co-morbidities, high Body Mass Index (BMI), recurrent hernias, multiple defects, mesh-explantation and stomas. Before CAWR MDT establishment, these patients were booked without standardized pre-operative pathways, experiencing delays and sub-optimal outcomes. Methods Prospective data of 55 patients were reviewed from February 2021 to February 2024 after the CAWR MDT was established. Median follow-up of 14 months. Outcome measures included compliance with Delphi consensus, MDT to surgery wait times, length of stay (LOS), complications, recurrences and EuraHS-Quality of Life (QoL) scores. Results MDT pre-operative planning achieved 99% guideline compliance. Key gaps were expert radiology, prehabilitation, and dietician input. 11 patients were unsuitable for surgery, another 6 referred to specialist centres.16 patients underwent surgery at Medway; 3 as emergencies. 42% had BMI ≥ 35, 60% required prehabilitation and median CeDAR (Carolina’s Equation for Determining Associated Risk) scores were 35% (IQR 22–43). Median time from MDT to elective repair was 6 months versus 2 months for emergencies. 38% of electives received ultrasound-guided Botulinum toxin injection into lateral abdominal wall musculature pre-operatively, median 47 days before surgery (IQR 40-61). LOS was 5.5 days for electives versus 14 days after emergency repairs (P = 0.002). Recurrence odds were 10 times higher for emergencies (95% CI 2.5, 153), with 100% complication rates (Clavien-Dindo ≥3) versus 8% for electives. QoL scores were best for elective patients (36/90) compared to those awaiting repair (60/90) and emergency patients (54/90). Elective repairs utilized mesh (retromuscular) in 82% of cases (62% biological), versus 66% and 33% in emergencies respectively. Conclusions CAWR MDT enables structured decision-making, optimizes resources and improves patient outcomes. Findings advocated for radiologist and prehabilitation input and expedited elective repairs to prevent significant morbidity in emergencies.

Longitudinal evolution of the transdiagnostic prodrome to severe mental disorders: a dynamic temporal network analysis informed by natural language processing and electronic health records.

Modelling the prodrome to severe mental disorders (SMD), including unipolar mood disorders (UMD), bipolar mood disorders (BMD) and psychotic disorders (PSY), should consider both the evolution and interactions of symptoms and substance use (prodromal features) over time. Temporal network analysis can detect causal dependence between and within prodromal features by representing prodromal features as nodes, with their connections (edges) indicating the likelihood of one feature preceding the other. In SMD, node centrality could reveal insights into important prodromal features and potential intervention targets. Community analysis can identify commonly occurring feature groups to define SMD at-risk states. This retrospective (2-year) cohort study aimed to develop a global transdiagnostic SMD network of the temporal relationships between prodromal features and to examine within-group differences with sub-networks specific to UMD, BMD and PSY. Electronic health records (EHRs) from South London and Maudsley(SLaM) NHS Foundation Trust were included from 6462 individuals with SMD diagnoses (UMD:2066; BMD:740; PSY:3656). Validated natural language processing algorithms extracted the occurrence of 61 prodromal features every three months from two years to six months before SMD onset. Temporal networks of prodromal features were constructed using generalised vector autoregression panel analysis, adjusting for covariates. Edge weights (partial directed correlation coefficients, z) were reported in autocorrelative, unidirectional and bidirectional relationships. Centrality was calculated as the sum of (non-autoregressive) connections leaving (out-centrality, cout) or entering (in-centrality, cin) a node. The three sub-networks (UMD, BMD, PSY) were compared using permutation analysis, and community analysis was performed using Spinglass. The SMD network revealed strong autocorrelations (0.04 ≤ z ≤ 0.10), predominantly positive connections, and identified aggression (cout = 0.103) and tearfulness (cin = 0.134) as the most central features. Sub-networks for UMD, BMD, and PSY showed minimal differences, with 3.5% of edges differing between UMD and PSY, 0.8% between UMD and BMD, and 0.4% between BMD and PSY. Community analysis identified one positive psychotic community (delusional thinking-hallucinations-paranoia) and two behavioural communities (aggression-cannabis use-cocaine use-hostility, aggression-agitation-hostility) as the most common. This study represents the most extensive temporal network analysis conducted on the longitudinal interplay of SMD prodromal features. The findings provide further evidence to support transdiagnostic early detection services across SMD, refine assessments to detect individuals at risk and identify central features as potential intervention targets.

P0980 Virtual chromoendoscopy is comparable to dye spray chromoendoscopy for IBD surveillance: a single centre retrospective study

Abstract Background Patients with colonic inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer (CRC) and interval surveillance endoscopy is recommended 8 years after diagnosis or symptom onset to identify premalignant lesions (considered to be dysplastic adenomas, sessile serrate lesions [SSL] or large hyperplastic polyps). To enhance detection the current gold-standard technique is dye-spray chromoendoscopy (DCE). Advancements in high-definition electronic imaging have facilitated the development of virtual chromoendoscopy (VCE) and the 2019 European Society of Gastrointestinal Endoscopy (ESGE) guidelines advise that either DCE or VCE can be used. However, there is limited data comparing DCE and VCE. Methods We undertook a retrospective review of the 197 IBD surveillance colonoscopies performed at Frimley Health NHS Foundation Trust in a 6-month period from December 2023 to July 2024 using the accepted techniques of DCE, VCE and white light endoscopy (WLE) with segmental biopsies. DCE (with an indigo carmine mix) and WLE were performed using either Olympus 260, 290 or 1500 colonoscopes, and VCE with Olympus 290 or 1500 colonoscopes using TXI (Texture and Color Enhancement Imaging) optical enhancement in addition to EndoCuff Vision, narrow band imaging (NBI) and/or Endo-Aid CADe computer aided detection where appropriate. Results Of the 197 procedures, 125 (64%) were DCE, 44 (22%) VCE and 28 (14%) WLE with segmental biopsies. 43% (n=85/197) of patients were female and 57% (n=112/197) male. The median age was 52 years (range 21-86) and mean disease duration 18 years (range 2-48). Suspected premalignant lesions were identified in 56% (n=70/125) of cases using DCE; 68% (n=30/44) using VCE; and 29% (8/28) using WLE. Both DCE and VCE were superior to WLE at detecting lesions (p= 0.0016 and p=0.0035 respectively). There was no statistical difference in lesion detection between DCE and VCE (p>0.05). Withdrawal time (median) was shorter in VCE (20 minutes, range 6-67) than DCE (26 minutes, range 10-59), but shortest in WLE (15 minutes, range 7-42). Dysplasia, SSL or hyperplasia were histologically confirmed in 49% (n=34/70) of lesions identified with DCE, 60% (n=18/30) with VCE, and 50% (n=4/8) with WLE. Conclusion VCE is comparable to DCE for lesion detection. Both DCE and VCE are statistically superior to WLE for lesion detection. Withdrawal times are shorter in VCE than DCE without detriment to lesion detection. Optical diagnosis improved with the use of VCE. Our findings support VCE as an acceptable alternative to DCE for IBD surveillance and highlight potential advantages.

Protocol for a first-in-human feasibility study of T regulatory cells (TR004) for inflammatory bowel disease using (ex vivo) Treg expansion (TRIBUTE)

IntroductionCrohn’s disease (CD) is a chronic, immune-mediated inflammatory bowel disease (IBD), presenting with symptoms of abdominal pain and bleeding from the gastrointestinal tract. There is no known cure. In vitro-expanded...

Efficiency in surgery: the Northumbria way

Discover how Northumbria Healthcare NHS Foundation Trust is redefining surgical care through innovation, high-volume robotic surgery, and a focus on staff wellbeing and team culture.

Exploring the factors influencing retention of internationally educated nurses at Torbay and South Devon NHS Foundation Trust: a service improvement project

Exploring the factors influencing retention of internationally educated nurses at Torbay and South Devon NHS Foundation Trust: a service improvement project

Implementation and impact of NHS-funded tobacco dependence services in England: a mixed-method evaluation protocol

IntroductionTobacco smoking remains a leading cause of ill-health, premature mortality and a driver of health inequalities. To support smokers in England, a comprehensive approach to treating tobacco dependence is being...

The Impact of Age and Sex on Fasting Plasma Glucose and Glycated Haemoglobin (HbA1c) in the Non-diabetes Population.

We previously reported sex differences in the distribution of glycated haemoglobin (HbA1c) for men/women aged < 50years vs older individuals, with implications for delayed diabetes diagnosis. Here, we explored whether this pattern was also seen in matched fasting plasma glucose (FPG) levels. We extracted data on same-day, paired HbA1c and FPG levels from clinical biochemistry laboratory databases from Mersey and West Lancashire Teaching Hospitals NHS Trust (n = 10,153) and Cambridge University Hospitals NHS Foundation Trust (n = 10,022) between Jan 2019 and Dec 2023. Only cases with a single, general-practice HbA1c test were utilised to minimise the risk of including non-diagnostic tests and tests from specialist care (e.g. endocrinology, antenatal services; final dataset: n = 17,271). We examined the links of HbA1c and FPG levels to age and sex. Median HbA1c levels were 1mmol/mol lower in women aged < 45years compared to men aged < 45years but not in those aged ≥ 45years. This pattern was not seen with FPG, where median levels in women were 0.1-0.2mmol/L lower across all ages. The HbA1c:FPG ratio was significantly higher in women than men in the 45-54 and ≥ 55years age groups (p = 0.004, Z-score = 2.9 and p = < 0.001, Z-score = 8.9, respectively) but not in the < 45 years age group (p = 0.649, Z-score = 0.5). We confirmed our previous finding that median HbA1c levels in women aged ≥ 55 years and 45-55years were the same as those in men (39 and 37mmol/mol, respectively) and that for women aged < 45years, the median HbA1c (34mmol/mol) was 1mol/mol lower than for men (35mmol/mol). This is reflected in the Z-scores, which showed the largest deviation from zero in the < 45years age group (- 9.1) and the smallest in the older age group (- 2.9). We showed differences in HbA1c and FPG patterns with age between men and women, with implications for the diabetes diagnostic threshold for HbA1c in pre-menopausal women, the underdiagnosis of type 2 diabetes in younger women, and missed opportunities for intervention. We propose that a suggested change to HbA1c reference ranges in this group warrants serious consideration and detailed evaluation.

An Exploration of Placement Travel and Accommodation Issues for Nursing, Midwifery and Allied Health Profession Students, Universities, and Practice Educators

Travel and accommodation challenges for student’s access to pre-registration learning environments were explored through a National Health Service England (NHSE) funded project. This was hosted by XXXX Community Health and Care NHS Foundation Trust covering the XXXXX Integrated Care Board (ICB) area. A mixed methods service evaluation was used, using three cross-sectional surveys to discover local university placement teams, practice education facilitators and practice educators and nursing, midwifery and allied health profession student views on placement transport and accommodation challenges. One student focus group was also held to explore issues in more depth. Stakeholder participants described a range of transport and accommodation concerns, including student personal safety, transport routes, timetable challenges, financial and health burdens, and working to fixed shift patterns. Recommendations for practice include flexible shift patterns, car use guidance, free car parking, personal safety training, provision of overnight accommodation to protect wellbeing, and placement costs paid in advance. The project identified the need for a greater range of bus routes from transport providers, plus consideration for a university minibus service to reach rural community settings. The findings from this study will support placement providers and universities to maximise placement opportunities and will improve the student experience across the ICB setting. The results are applicable to other regions.

Experience of conductive hearing loss and impacts of hearing aid use throughout life.

Hearing loss and Deafness/deafness affects as much as 5% of the world's population and has a considerable health and economic burden. We explored the relationship with hearing and hearing aids as well as other assistive technology for health in general with a cohort of UK adults who have conductive hearing loss. We anticipated that insights could lead to greater understanding for the delivery of assistive technology (AT) for conductive hearing loss and the participant's lived experience related to technology and society. This study presents the qualitative findings from a mixed methods study exploring the story of each participant's hearing, the impact on their lives and their experience and use of AT. A purposive sample of 33 adults with conductive hearing loss took part in semi-structured interviews. Participants were aged ≥18 years and had previously attended outpatient ENT or audiology clinic at University Hospitals Sussex NHS Foundation Trust. Transcripts underwent thematic analysis. The overarching theme was "A changing relationship over time with deafness, themselves and society". The three principle sub-themes of the interviews were "a technological world" describing the necessity of interaction with people & technology' both as children and adults, then the concept of "Normalised Marginalisation"-the struggle of childhood and school in the face of social norms' and typicality. Finally, there were issues raised about visibility and "the visible display of D/deafness", tied to aesthetics, vanity and traditional ideas about masculinity. Many participants described their adoption of new technology or devices as "transforming their life" and their quality of life without assistive technology as significantly impaired. Insights from this study described the experiences of adults with conductive hearing loss and the ways in which they have a difficult relationship with their deafness, including how they felt and viewed themselves and how they interacted with society, particularly as children and young adults. The potential for benefit of assistive technology for hearing health was deemed by many participants to be a necessary bridge integrating them in relationships with other people in society. Early notions of disability, typicality and social norms frequently persisted into adulthood and these insights should be considered by all those professional seeking to provided hearing health assistance to individuals with conductive hearing loss.

Report on an audit of two decades’ activities of a clinical ethics committee: the Newcastle upon Tyne Hospitals NHS Foundation Trust Clinical Ethics Advisory Group (CEAG)

Background‘The Clinical Ethics Advisory Group’ (CEAG) is the clinical ethics support body for Newcastle upon Tyne Hospitals National Health Service Foundation Trust. A significant change in CEAG’s way of working...

Advice and guidance clinics using remote specialist advice to support primary dental care practitioners.

Advice and guidance clinics allow one clinician to seek advice from another using the concept of telemedicine for the provision of real time care, including diagnosis, treatment planning and consulting. While advice and guidance (AAG) is more commonly used in medicine, the service is currently underutilised in dentistry. There is limited evidence regarding the patient outcomes of AAG services and the benefits and drawbacks of this service in dentistry. This paper outlines results from a pilot study implementing AAG clinics at the dental directorate at Guy's and St Thomas' NHS Foundation Trust which has been rolled out to give remote specialist advice for patients referred to restorative dentistry, periodontology and sedation and special care. The service has also been rolled out to deliver remote multidisciplinary meetings for the planning and treatment of patients with hypodontia.

Falls prevention in an older adult mental health ward through a quality improvement initiative

Falls in the inpatient units are the most frequently reported patient safety incidents and their consequences can be devastating. Risk factors for falls are broadly categorised into two factors—‘extrinsic and...

Treating eosinophilic exacerbations of asthma and COPD with benralizumab (ABRA): a double-blind, double-dummy, active placebo-controlled randomised trial

Exacerbations of asthma and chronic obstructive pulmonary disease (COPD) are important events and are associated with critical illness. Eosinophilic inflammation is a treatable trait commonly found during acute exacerbations of asthma and COPD. We hypothesised that for patients with eosinophilic exacerbations, a single injection of benralizumab, a humanised monoclonal antibody against interleukin-5 receptor-α, alone or in combination with prednisolone, will improve clinical outcomes compared with prednisolone, the standard of care. The Acute exacerbations treated with BenRAlizumab trial (ABRA) was a multicentre, phase 2, double-blind, double-dummy, active placebo-controlled randomised trial completed in the UK at Oxford University Hospitals NHS Foundation Trust and Guy's and St Thomas' NHS Foundation Trust. Patients were recruited from urgent care clinics and emergency departments of these two hospitals. At the time of an acute exacerbation of asthma or COPD, adults with blood eosinophil counts of equal to or more than 300 cells per μL were randomly assigned in a 1:1:1 ratio to receive acute treatment with: prednisolone 30 mg once daily for 5 days and 100 mg benralizumab subcutaneous injection once (BENRA plus PRED group); placebo tablets once daily for 5 days and 100 mg benralizumab subcutaneous injection once (BENRA group); or prednisolone 30 mg once daily for 5 days and placebo subcutaneous injection once (PRED group). Randomisation was performed with a centralised interactive computer randomisation service. All patients and study research staff involved in data collection were masked to study blood results and treatment allocation. The co-primary outcomes were proportion of treatment failures over 90 days and total visual analogue scale (VAS) symptoms at day 28 in the pooled benralizumab groups compared with the prednisolone alone group and analysed in the intention-to-treat population. The trial was registered on Clinicaltrials.govNCT04098718. Between May 13, 2021, and Feb 5, 2024, 287 patients were screened for study inclusion. 129 were excluded due to not having an exacerbation captured or not meeting the eosinophil exclusion criteria. 158 patients were randomly assigned at acute eosinophilic exacerbation of asthma or COPD where 86 (54%) patients were female and 72 (46%) were male with a mean age of 57 years (range, 18-84). 53 patients were randomly assigned to the PRED group, 53 were randomly assigned to the BENRA group, and 52 were assigned to the BENRA plus PRED treatment group. At 90 days, treatment failures occurred in 39 (74%) of 53 in the PRED group, and 47 (45%) of 105 in the pooled-BENRA group (OR 0·26 [95% CI 0·13-0·56]; p=0·0005). The 28-day total VAS mean difference was 49 mm (95% CI 14-84; p=0·0065), favouring the pooled-BENRA group. There were no fatal adverse events and benralizumab was well tolerated. Notably, hyperglycaemia and sinusitis or sinus infection adverse events were related to the prednisolone study drug only. Benralizumab can be used as a treatment of acute eosinophilic exacerbations and achieves better outcomes than the current standard of care with prednisolone alone. These results offer a new way of treating eosinophilic endotypes of asthma and COPD exacerbations. AstraZeneca.

A clinical audit of hypomagnesaemia management at Scarborough General Hospital

BackgroundHypomagnesaemia is a common electrolyte disturbance that can lead to severe complications, including cardiac dysrhythmias and neuromuscular instability. Despite established guidelines by the York and Scarborough Teaching Hospitals NHS Foundation Trust, there is concern that these protocols are not consistently followed, potentially compromising patient outcomes. Objective: This audit aimed to evaluate the management of hypomagnesaemia at Scarborough General Hospital, focusing on adherence to trust guidelines and identifying areas for improvement in clinical practice. MethodsA retrospective analysis was conducted on 98 patients diagnosed with hypomagnesaemia between May and December 2023. Data on patient demographics, severity of hypomagnesaemia, ECG monitoring, treatment modalities and correction times were collected and analysed. The audit compared current practices against trust guidelines, specifically assessing the frequency of ECG monitoring, daily serum magnesium level checks, and the use of parenteral versus oral magnesium supplementation. ResultsThe audit revealed that 67% of patients had mild, asymptomatic hypomagnesaemia, while 33% presented with moderate to severe forms. ECGs were performed in 66% of cases, with 13.7% showing abnormalities. Despite guidelines recommending daily magnesium level monitoring, only 66% of patients received this care. Severe hypomagnesaemia was corrected within 3.5 days on average, while mild cases required 4.5 days. The frequent use of proton pump inhibitors was identified as a significant contributor to hypomagnesaemia. Notably, only half of the severe cases received the full recommended course of intravenous magnesium sulphate, with many being switched to oral supplementation prematurely. ConclusionWhile some aspects of hypomagnesaemia management at Scarborough General Hospital align with trust guidelines, significant gaps remain, particularly in monitoring practices and adherence to treatment protocols. These findings highlight the need for targeted educational initiatives and potential revisions to existing guidelines to improve patient outcomes.