Ninewells Hospital Research Articles

Patient information videos via QR codes: An innovative and sustainable approach in ophthalmology.

We explore an innovative approach by transforming patient information leaflet (PILs) into Quick Response (QR) code linked patient information videos (PIVs) in ophthalmology. Our objectives are to assess the subjective utility of a PIV on glaucoma and analyse the use of QR codes as a delivery method. A prospective study was conducted in Ninewells Hospital, NHS Tayside. A glaucoma PIV was created and linked to a QR code provided to 130 glaucoma patients. Pre- and post-video questionnaires evaluated the patients' perception of using a QR code and subjective improvement in their understanding of glaucoma. Out of 102 responses collected, 55% of patients had no prior experience with QR codes. However, 81% of patients were able to watch the PIV. The average view duration of the video was 3:26, with 82.5% view retention. Statistically significant improvement in glaucoma knowledge was observed across all six areas questioned (p < 0.001) using a 5-point Likert scale. Overall, 70% of patients preferred PIVs over PILs, and 77% acknowledged that PIVs could be a sustainable alternative. QR codes for delivering PIVs were well-received, with patients finding them easy to use. Our PIV on glaucoma effectively enhanced patients' understanding of the condition.

High intensity interval training as a novel treatment for impaired awareness of hypoglycaemia in people with type 1 diabetes (HIT4HYPOS): a randomised parallel-group study

Aims/hypothesisImpaired awareness of hypoglycaemia (IAH) in type 1 diabetes may develop through a process referred to as habituation. Consistent with this, a single bout of high intensity interval exercise as a novel stress stimulus improves counterregulatory responses (CRR) to next-day hypoglycaemia, referred to as dishabituation. This longitudinal pilot study investigated whether 4 weeks of high intensity interval training (HIIT) has sustained effects on counterregulatory and symptom responses to hypoglycaemia in adults with type 1 diabetes and IAH.MethodsHIT4HYPOS was a single-centre, randomised, parallel-group study. Participants were identified using the Scottish Diabetes Research Network (SDRN) and from diabetes outpatient clinics in NHS Tayside, UK. The study took place at the Clinical Research Centre, Ninewells Hospital and Medical School, Dundee, UK. Participants were aged 18–55 years with type 1 diabetes of at least 5 years’ duration and HbA1c levels <75 mmol/mol (<9%). They had IAH confirmed by a Gold score ≥4, modified Clarke score ≥4 or Dose Adjustment For Normal Eating [DAFNE] hypoglycaemia awareness rating of 2 or 3, and/or evidence of recurrent hypoglycaemia on flash glucose monitoring. Participants were randomly allocated using a web-based system to either 4 weeks of real-time continuous glucose monitoring (RT-CGM) or RT-CGM+HIIT. Participants and investigators were not masked to group assignment. The HIIT programme was performed for 20 min on a stationary exercise bike three times a week. Hyperinsulinaemic–hypoglycaemic (2.5 mmol/l) clamp studies with assessment of symptoms, hormones and cognitive function were performed at baseline and after 4 weeks of the study intervention. The predefined primary outcome was the difference in hypoglycaemia-induced adrenaline (epinephrine) responses from baseline following RT-CGM or RT-CGM+HIIT.ResultsEighteen participants (nine men and nine women) with type 1 diabetes (median [IQR] duration 27 [18.75–32] years) and IAH were included, with nine participants randomised to each group. Data from all study participants were included in the analysis. During the 4 week intervention there were no significant mean (SEM) differences between RT-CGM and RT-CGM+HIIT in exposure to level 1 (28 [7] vs 22 [4] episodes, p=0.45) or level 2 (9 [3] vs 4 [1] episodes, p=0.29) hypoglycaemia. The CGM-derived mean glucose level, SD of glucose and glucose management indicator (GMI) did not differ between groups. During the hyperinsulinaemic–hypoglycaemic clamp studies, mean (SEM) change from baseline was greater for the noradrenergic responses (RT-CGM vs RT-CGM+HIIT: −988 [447] vs 514 [732] pmol/l, p=0.02) but not the adrenergic responses (–298 [687] vs 1130 [747] pmol/l, p=0.11) in those participants who had undergone RT-CGM+HIIT. There was a benefit of RT-CGM+HIIT for mean (SEM) change from baseline in the glucagon CRR to hypoglycaemia (RT-CGM vs RT-CGM+HIIT: 1 [4] vs 16 [6] ng/l, p=0.01). Consistent with the hormone response, the mean (SEM) symptomatic response to hypoglycaemia (adjusted for baseline) was greater following RT-CGM+HIIT (RT-CGM vs RT-CGM+HIIT: −4 [2] vs 0 [2], p<0.05).Conclusions/interpretationIn this pilot clinical trial in people with type 1 diabetes and IAH, we found continuing benefits of HIIT for overall hormonal and symptomatic CRR to subsequent hypoglycaemia. Our findings also suggest that HIIT may improve the glucagon response to insulin-induced hypoglycaemia.Trial registrationISRCTN15373978.FundingSir George Alberti Fellowship from Diabetes UK (CMF) and the Juvenile Diabetes Research Foundation.Graphical

809 Direct Referral Pilot- Speech and Language Therapy-ENT, Ninewells Hospital

Abstract Aim Ear, nose, and throat (ENT) specialists and speech and language therapists (SALT) work very closely together in management of speech and language disorders. Here at Ninewells Hospital, we have created a pilot project for a direct referral system, where voice referrals which have been vetted are referred directly to SALT, in which patients receive the necessary treatments and are then referred to ENT specialists if required. Method This is a retrospective audit. Patients who were referred directly to SALT were included in this study. A questionnaire was developed to assess patient’s satisfaction with this pathway via telephone. Five questions were asked about their satisfaction with different aspects of this study, including waiting times, concerns addressed, provided with clear explanations, patient involved in plans and overall satisfaction with ratings of between very good, good, fair, poor, very poor and prefer not to answer. Results 41 responses were obtained, out of 67 patients included in this study. Majority of patients responded with very good and good in all aspects of the questionnaire 48.8% had a very good overall satisfaction from this project. 29.3% had a good outcome and 4.9% responded with fair and poor respectively. Conclusions This study highlights that SALT play a significant role in not only improving quality of treatment for patients but also the quality of streamlining to specialist care as and when needed. More work is required to look into this pathway further and to assess its feasibility for implementation in the future and in other hospitals across the UK.

162 A Closed Loop Audit Assessing and Improving the Quality of Electronic Discharge Documents in a Neurosurgical Ward for Patient Safety and Continuity of Care

AimTo assess the quality of neurosurgical electronic discharge documents (EDDs) as per the Scottish Intercollegiate Guidelines Network's (SIGN) discharge document guidelines, and to implement interventions to ensure patient safety and continuity of care.MethodWe performed a closed loop audit on the quality of EDDs at the neurosurgical unit at Ninewells Hospital. We collected six sets of two-weeks’ worth of EDDs from the Tayside EDD system coinciding with foundation trainee changeover times for a representative sample of pre- and intra-COVID-19 EDDs. We analysed our findings and developed interventions in collaboration with the MDT. These included a copy-paste template, educational poster, and presentation, and more. We implemented the interventions and reassessed EDDs after three months.ResultsA total of 207 EDDs were included. Pre-interventions, 88% of the EDDs were inadequate in quality when compared to SIGN’s guidelines. This had 33% reduction post-interventions. The percentage of EDDs adequate in quality doubled post-interventions, from 22% to 43%. The most commonly mistaken or missed criterion pre- and post-intervention was the neurological status on admission and discharge. Others were mistaking presenting complaint for diagnosis and vice versa, and not mentioning follow-up or new medications.ConclusionsAccurate records of care, including discharge documents, are central to the principles of good medical practice outlined by the GMC. This study showed that EDD quality is compromised due to time pressures, lack of information and constant changeover due to COVID-19. We alleviated this by creating accessible interventions that assure safe patient care despite the challenges of changeover and COVID-19.

Coagulation Screening in Patients Admitted to the Acute Surgical Receiving Unit - Ninewells Hospital, Dundee, Scotland

Introduction: Establish whether compliance to guidelines for routine pre-operative coagulation screening set by the National Institute for Health and Care Excellence (2016) is used on general surgical patients. Observe set components from guidelines with respect to the admission, dependent on grade of surgery and patient’s ASA grade. To determine financial loss per year from inappropriate/unnecessary coagulation testing performed on patients. Method: Review of all coagulation screening bloods taken for general surgical admissions to the acute surgical receiving ward over a 2 week period. The cost of one coagulation screen in NHS Tayside is £2.69. Clinical notes were reviewed in order to determine if criteria was met for performing a coagulation screening on admission. The results of the initial audit were presented at the Clinical Effectiveness meeting. The audit was repeated 2 weeks following a teaching session. Results: 200 individuals were included in the first cycle of the audit. It was found that 168 tests were ordered (161 unnecessary, 7 correctly screened, and 32 patients excluded appropriately). During the re-audit 208 patients were involved, and 153 tests were performed (151 unnecessary, 2 correctly screened, 55 patients excluded appropriately. Conclusion: As a result of the audit, coagulation screen sampling had decreased from 80.5% to 72.6%, an improvement of 7.9%. This equated to a savings of £26.90 over the duration of audit period (£699.20 per annum). This audit has demonstrated a change in clinical practice with potential significant financial benefit for the NHS.

A randomized assessor‐blinded comparison of low‐irradiance and conventional‐irradiance photodynamic therapy for superficial basal cell carcinoma and Bowen disease

The inconvenience and pain of hospital-based photodynamic therapy (PDT) is sometimes limiting.1 We developed very low irradiance LEDs for ambulatory PDT. Preliminary studies showed this to be convenient and relatively painless.1-4 Here we evaluate the Ambulight® device (Ambicare Health Ltd) in a randomised controlled assessor-blinded study comparing low irradiance ambulatory PDT (APDT) with conventional PDT (CPDT) for superficial basal cell carcinoma (SBCC) and Bowen's disease (BD) (lesions ≤2cm).

An 18 year data-linkage study on the association between air pollution and acute limb ischaemia.

Background: There is limited information regarding the effects of air pollutants, such as nitrogen oxides (NOx), nitric oxide (NO2), nitrous oxide (NO) and particulate matter with a diameter smaller than 10 μm (PM10), on acute limb ischaemia (ALI), a peripheral arterial disease (PAD) often with a poor clinical outcome. Patients and methods: We conducted an 18-year retrospective cohort study using routinely collected healthcare records from Ninewells Hospital, Dundee, and Perth Royal Infirmary, in Tayside, Scotland, UK from 2000 to 2017. ALI hospitalisation events and deaths were linked to daily NOx, NO2, NO and PM10 levels extracted from publicly available data over this same time period. Distributed lag models were used to estimate risk ratios for ALI hospitalisation and for ALI mortality, adjusting for temperature, humidity, day of the week, month and public holiday. Results: 5,608 hospital admissions in 2,697 patients were identified over the study period (mean age 71.2 years, ±11.1). NOx and NO were associated with an increase of ALI hospital admissions on days of exposure to pollutant (p=.018), while PM10 was associated with a cumulative (lag 0-9 days) increase (p=.027) of ALI hospital admissions in our study. There was no increase of ALI mortality associated with pollution levels. Conclusions: ALI hospital admissions were positively associated with ambient NOx and NO on day of high measured pollution levels and a cumulative effect was seen with PM10.

EP.FRI.178 Audit of rejected radiological referrals at Ninewells Hospital, Dundee: Reasons and outcomes

Abstract Background Rejected radiology requests in emergency-settings can be time-consuming for clinical and radiological staff; and can delay or even affect patient management plans and outcomes. Inappropriate or duplicate radiological requests additionally can be resource-wasting (according to data from Fairfield Independent Hospital, BUPA, St. Helen’s) - the approximate costs / scan are £160 for Ultrasound, £450-£675 for CT, £350- £525 for MRI. Methods Results Commonest reasons for rejection: Conclusions

515 Patient Satisfaction on Drainless Outpatient Parotidectomy

Abstract Background Parotidectomy is commonly performed as an inpatient procedure due to drain insertion. However recent evidence suggests that drainless outpatient parotidectomy is a safe option with comparable postoperative complication and hospital readmission rates to inpatient parotidectomies. Aim Patient satisfaction on outpatient parotidectomy is unclear and this study aims to report patients’ perspective and satisfaction on drainless outpatient parotidectomy. Method Anonymous ‘Core questionnaire for the assessment of Patient Satisfaction’ (COPS) for general Day care (COPS-D) questionnaire survey was completed by patients who underwent drainless same day parotidectomy at Ninewells Hospital, Dundee from June 2018 to October 2020. Patient satisfaction on different aspects of their outpatient parotidectomy journey (e.g., pre-admission, admission on ward, in-theatre experience, nursing care, pain control and overall satisfaction) were scored using a five-point Likert scale. Results A total of 31 drainless outpatient parotidectomies were performed and 28 patients completed the patient satisfaction survey. The majority of patients were highly satisfied (i.e., scored 5/5) with their preadmission visit (79.5%), admission on the ward (84.5%), operating room experience (96.4%), nursing care (83.9%), medical care (87.5%), information received (75.0%), autonomy (79.8%) and discharge and after care (61.9%). Despite preferring drainless parotidectomy, 16/28 (57.1%) patients either stayed for less than 23 hours or preferred to stay overnight stay in the hospital for non-surgical reasons. Conclusions Outpatient parotidectomy is well received by patients and the majority of patients preferred drainless parotidectomy over inpatient parotidectomy with drains.

Associations between ambient air pollutants and hospital admissions: more needs to be done

Deaths from air pollution in the UK are higher by a factor of 10 than from car crashes, 7 for drug-related deaths and 52 for murders, and yet awareness seems to be lacking in local government. We conducted an 18-year retrospective cohort study using routinely collected health care records from Ninewells Hospital, Dundee, and Perth Royal Infirmary, in Tayside, Scotland, UK, from 2000 to 2017. Hospitalisation events and deaths were linked to daily nitric oxides (NOX, NO, NO2), and particulate matter 10 (PM10) levels extracted from publicly available data over this same time period. Distributed lag models were used to estimate risk ratios for hospitalisation and mortality, adjusting for temperature, humidity, day of the week, month and public holiday. Nitric oxides and PM10 were associated with an increased risk of all hospital admissions and cardiovascular (CV) admissions on day of exposure to pollutant. This study shows a significant increase in all cause and CV hospital admissions, on high pollution days in Tayside, Scotland.

LEVERAGING THOUSANDS OF POLYGENIC SCORES, FAMILY HISTORY, AND AGE-OF-ONSET INFORMATION TO OPTIMIZE RISK PREDICTION FOR PSYCHIATRIC AND NEUROLOGICAL DISORDERS

Liposuction for lymphoedematous limbs is an effective treatment for chronic lymphoedema, with excellent long-term results in well-selected patients. In 2008 NICE produced guidelines ‘Liposuction for Chronic lymphoedema’, acknowledging this treatment modality. However, there remain very few centers that provide this service in the United Kingdom. We aim to share our experience of our referral system at Ninewells Hospital, Dundee, Scotland.A 10 year prospective database from 2005 to 2014 was analysed. Referral sources, patient demographics, diagnosis and treatment offered were examined.There were 221 referrals in total, 190 (86%) female and 31 (14%) male. The mean age was 51 (range 7–86 years). 127 (58%) were referred via their general practitioners, 72 (33%) from a hospital consultant and 22 (10%) from a lymphoedema nurse specialist. 153 (69%) referrals were from Scotland, 61 (28%) from England and 7 (3%) from Northern Ireland. The majority of patients 165 (75%) were referred with lower limb swelling. Following assessment in clinic, 146 (66%) were found to have lymphoedema whilst the rest were deemed to have other non-lymphoedematous diagnoses which include lipoedema (47, 21%), dependent oedema (8, 4%) and obesity (5, 2%). 131 (59%) were offered liposuction- 74 (34%) have received liposuction, 18 (8%) are awaiting their procedure, 3 (1%) have declined surgery, 27 (12%) are awaiting funding approval and 9 (4%) have been declined funding by their primary care trust/clinical commissioning group (PCT/CCG). 4 (2%) are awaiting investigations to further evaluate the cause of their swelling, whilst the remaining 86 (39%) were felt unsuitable for surgery and were treated conservatively.Chronic lymphoedema is a challenging condition to treat, with few specialist centers offering surgical treatment. We hereby share our referral process, diagnosis and management.

METHODOLOGICAL AND PERFORMANCE IMPLICATIONS OF ADDING POLYGENIC RISK SCORES TO EHR-BASED PREDICTION MODELS

Liposuction for lymphoedematous limbs is an effective treatment for chronic lymphoedema, with excellent long-term results in well-selected patients. In 2008 NICE produced guidelines ‘Liposuction for Chronic lymphoedema’, acknowledging this treatment modality. However, there remain very few centers that provide this service in the United Kingdom. We aim to share our experience of our referral system at Ninewells Hospital, Dundee, Scotland.A 10 year prospective database from 2005 to 2014 was analysed. Referral sources, patient demographics, diagnosis and treatment offered were examined.There were 221 referrals in total, 190 (86%) female and 31 (14%) male. The mean age was 51 (range 7–86 years). 127 (58%) were referred via their general practitioners, 72 (33%) from a hospital consultant and 22 (10%) from a lymphoedema nurse specialist. 153 (69%) referrals were from Scotland, 61 (28%) from England and 7 (3%) from Northern Ireland. The majority of patients 165 (75%) were referred with lower limb swelling. Following assessment in clinic, 146 (66%) were found to have lymphoedema whilst the rest were deemed to have other non-lymphoedematous diagnoses which include lipoedema (47, 21%), dependent oedema (8, 4%) and obesity (5, 2%). 131 (59%) were offered liposuction- 74 (34%) have received liposuction, 18 (8%) are awaiting their procedure, 3 (1%) have declined surgery, 27 (12%) are awaiting funding approval and 9 (4%) have been declined funding by their primary care trust/clinical commissioning group (PCT/CCG). 4 (2%) are awaiting investigations to further evaluate the cause of their swelling, whilst the remaining 86 (39%) were felt unsuitable for surgery and were treated conservatively.Chronic lymphoedema is a challenging condition to treat, with few specialist centers offering surgical treatment. We hereby share our referral process, diagnosis and management.

POLYGENIC EMBRYO SCREENING: SCIENCE FICTION OR SCIENCE FACT?

Liposuction for lymphoedematous limbs is an effective treatment for chronic lymphoedema, with excellent long-term results in well-selected patients. In 2008 NICE produced guidelines ‘Liposuction for Chronic lymphoedema’, acknowledging this treatment modality. However, there remain very few centers that provide this service in the United Kingdom. We aim to share our experience of our referral system at Ninewells Hospital, Dundee, Scotland.A 10 year prospective database from 2005 to 2014 was analysed. Referral sources, patient demographics, diagnosis and treatment offered were examined.There were 221 referrals in total, 190 (86%) female and 31 (14%) male. The mean age was 51 (range 7–86 years). 127 (58%) were referred via their general practitioners, 72 (33%) from a hospital consultant and 22 (10%) from a lymphoedema nurse specialist. 153 (69%) referrals were from Scotland, 61 (28%) from England and 7 (3%) from Northern Ireland. The majority of patients 165 (75%) were referred with lower limb swelling. Following assessment in clinic, 146 (66%) were found to have lymphoedema whilst the rest were deemed to have other non-lymphoedematous diagnoses which include lipoedema (47, 21%), dependent oedema (8, 4%) and obesity (5, 2%). 131 (59%) were offered liposuction- 74 (34%) have received liposuction, 18 (8%) are awaiting their procedure, 3 (1%) have declined surgery, 27 (12%) are awaiting funding approval and 9 (4%) have been declined funding by their primary care trust/clinical commissioning group (PCT/CCG). 4 (2%) are awaiting investigations to further evaluate the cause of their swelling, whilst the remaining 86 (39%) were felt unsuitable for surgery and were treated conservatively.Chronic lymphoedema is a challenging condition to treat, with few specialist centers offering surgical treatment. We hereby share our referral process, diagnosis and management.

CLINICAL RELEVANCE OF GENOTYPE-PHENOTYPE ANALYSES WITHIN BIPOLAR DISORDER AND ACROSS THE MOOD AND PSYCHOSIS SPECTRUM

Liposuction for lymphoedematous limbs is an effective treatment for chronic lymphoedema, with excellent long-term results in well-selected patients. In 2008 NICE produced guidelines ‘Liposuction for Chronic lymphoedema’, acknowledging this treatment modality. However, there remain very few centers that provide this service in the United Kingdom. We aim to share our experience of our referral system at Ninewells Hospital, Dundee, Scotland.A 10 year prospective database from 2005 to 2014 was analysed. Referral sources, patient demographics, diagnosis and treatment offered were examined.There were 221 referrals in total, 190 (86%) female and 31 (14%) male. The mean age was 51 (range 7–86 years). 127 (58%) were referred via their general practitioners, 72 (33%) from a hospital consultant and 22 (10%) from a lymphoedema nurse specialist. 153 (69%) referrals were from Scotland, 61 (28%) from England and 7 (3%) from Northern Ireland. The majority of patients 165 (75%) were referred with lower limb swelling. Following assessment in clinic, 146 (66%) were found to have lymphoedema whilst the rest were deemed to have other non-lymphoedematous diagnoses which include lipoedema (47, 21%), dependent oedema (8, 4%) and obesity (5, 2%). 131 (59%) were offered liposuction- 74 (34%) have received liposuction, 18 (8%) are awaiting their procedure, 3 (1%) have declined surgery, 27 (12%) are awaiting funding approval and 9 (4%) have been declined funding by their primary care trust/clinical commissioning group (PCT/CCG). 4 (2%) are awaiting investigations to further evaluate the cause of their swelling, whilst the remaining 86 (39%) were felt unsuitable for surgery and were treated conservatively.Chronic lymphoedema is a challenging condition to treat, with few specialist centers offering surgical treatment. We hereby share our referral process, diagnosis and management.

IN VIVO PERTURB-SEQ: STUDY GENE FUNCTION AT SCALE IN DEVELOPING TISSUES

Liposuction for lymphoedematous limbs is an effective treatment for chronic lymphoedema, with excellent long-term results in well-selected patients. In 2008 NICE produced guidelines ‘Liposuction for Chronic lymphoedema’, acknowledging this treatment modality. However, there remain very few centers that provide this service in the United Kingdom. We aim to share our experience of our referral system at Ninewells Hospital, Dundee, Scotland.A 10 year prospective database from 2005 to 2014 was analysed. Referral sources, patient demographics, diagnosis and treatment offered were examined.There were 221 referrals in total, 190 (86%) female and 31 (14%) male. The mean age was 51 (range 7–86 years). 127 (58%) were referred via their general practitioners, 72 (33%) from a hospital consultant and 22 (10%) from a lymphoedema nurse specialist. 153 (69%) referrals were from Scotland, 61 (28%) from England and 7 (3%) from Northern Ireland. The majority of patients 165 (75%) were referred with lower limb swelling. Following assessment in clinic, 146 (66%) were found to have lymphoedema whilst the rest were deemed to have other non-lymphoedematous diagnoses which include lipoedema (47, 21%), dependent oedema (8, 4%) and obesity (5, 2%). 131 (59%) were offered liposuction- 74 (34%) have received liposuction, 18 (8%) are awaiting their procedure, 3 (1%) have declined surgery, 27 (12%) are awaiting funding approval and 9 (4%) have been declined funding by their primary care trust/clinical commissioning group (PCT/CCG). 4 (2%) are awaiting investigations to further evaluate the cause of their swelling, whilst the remaining 86 (39%) were felt unsuitable for surgery and were treated conservatively.Chronic lymphoedema is a challenging condition to treat, with few specialist centers offering surgical treatment. We hereby share our referral process, diagnosis and management.

Improving accessebility to psychiatry in NHS Tayside

AimsOur aim is to improve the accessibility of Psychiatry to other specialties when being contacted for review and advice, both in hours and out of hours.BackgroundFrom clinical contact and informal conversations, other specialties sometimes have difficulties contacting psychiatry for advice/review. The aim of this is quality improvement project is to determine how accessible we are to other specialties and work on improving how we communicate with the general hospital.MethodWe created a questionnaire for colleagues from other specialties to fill in from 26/9/19 for 6 weeks. We gathered information regarding their grade, work site, previous contact with psychiatry, whether they knew where to find our contact information and if they could identify the correct method to ask for advice from general adult psychiatry (GAP), Psychiatry of old age (POA) , and out of hours psychiatry (OOH). We also asked colleagues to put in free text comments regarding their experience in contacting psychiatry. We also asked if our colleagues were aware of how to perform an Emergency Detention Certificate as this is advice we sometimes give which does not always need our input immediately.ResultThere was a total of 39 responses, 29 from Ninewells Hospital (NW) and 10 from Perth Royal Infirmary (PRI). There was a mixture of staff grades from Foundation Doctors to Consultants. 23/39 colleagues knew where to find contact information for Psychiatry, 14/39 colleagues correctly answered how to contact GAP (Phone), 15/39 colleagues correctly answered how to contact POA (Email), 15/39 colleagues correctly identified who to contact OOH, and 16/34 colleagues who could do emergency detentions (FY2+) knew how to do one. Free text comments often referred back to the difficulty of finding the right grade of staff first try, Feedback from PRI where there was no dedicated Liaison Service and relies on a duty doctor system was less positive, with terms ‘tricky’, ‘difficulty’, ‘awkward’ used in majority of responses.ConclusionFrom our results we can conclude that contacting Psychiatry in NHS Tayside can be confusing for other specialties. Taking this forward, we will utilize the ‘referral finder’ system in NHS Tayside and review the existing information available, and to update the contact information for our subspecialties to make contact ourselves more streamlined and accessible. We will also review appropriate clinical protocols that we can link to our page on referral finder to help save time for our colleagues as well.

Unintentional consequences of artificial intelligence in dermatology for patients with skin of colour

Recently, there have been concerns that dermatology resources and education lack sufficient material regarding patients with skin of colour(SOC) in the Western world.1 In the UK, we have an increasingly diverse population, of which 14% have non-Caucasian skin types, necessitating a shift in our educational focus to reflect our changing environment in order for dermatologists to feel comfortable managing conditions in SOC.2.

Christine Joy English

Christine Joy English (nee Myerscough) grew up in Edinburgh and attended the Mary Erskine School, where she became head girl before studying medicine at St Andrews and Dundee universities. She...

Training in Scotland During COVID-19: The Dental Core Trainee Perspective

The first confirmed case of COVID-19 in Ninewells hospital in Dundee was on the 2nd March 2020, the first ventilated case was 20th March 2020. The Oral and Maxillofacial department (OMFS) quickly changed the daily routine to set up for the global pandemic. The reduction of footfall within the hospital and reduced contact with routine patients was advised by the Government. Published evidence stated that surgeons and physicians who, by the nature of their practice, have close face to face contact are at high risk of contracting COVID-19. OMFS fall within this category. Our department cancelled all non-essential clinics. Decision on cancellations was dependent on diagnoses and urgency of referral. OMFS department undertakes aerosol generating procedures; under guidance all dento-alveolar treatment was cancelled. Telephone consultations with these patients, allowed advice to patients in relation to emergency treatment during COVID times.

Improving the use of the ‘COUGH’ bundle in Surgical High Dependency Unit, Ninewells Hospital, Dundee

Developing respiratory complications postoperatively is one of the major determinants of longer hospital stay, morbidity, mortality and increased healthcare costs. The incidence of postoperative respiratory complications varies from 1% to...