Retrospective Review Of Electronic Patient Research Articles

The Diagnostic Utility of Lip Biopsy in Paediatric Crohn's Disease: A 10-year Single-centre Retrospective Study

BackgroundOral manifestations of paediatric Crohn's disease (CD) are reported in up to 60% of cases. Lip biopsy can be used to histologically diagnose oral CD. We evaluated the utility of lip biopsy in children under initial investigation for potential CD. MethodsA 10-year retrospective review of electronic patient records at a single tertiary paediatric surgery centre was performed. All patients aged ≤16 years who underwent lip biopsy were included. Clinical features, histology, and diagnostic details were extracted. ResultsForty-two children underwent lip biopsy. Median age at biopsy was 13.3 years (11.0–14.9). Final diagnosis was CD in 21/42 (50%) children, indeterminant colitis in 3/42 (7%), orofacial granulomatosis (OFG) in 3/42 (7%), coeliac disease in 1/42 (2%), and eosinophilic oesophagitis in 1/42 (2%). Thirteen children (31%) received no formal diagnosis. The most common symptoms reported were oral ulceration (33/42, 79%), lip swelling (21/42, 50%), and abdominal pain (19/42, 45%). Lip biopsy histology was normal in 11/42 (26%). In 24/42 (57%), non-granulomatous inflammation was seen. In 7/42 (17%) lip biopsy identified granulomatous inflammation: three (7%) had endoscopic biopsies concordant for CD, three (7%) had negative endoscopic biopsies but were diagnosed with CD, and one was diagnosed with OFG (2%). Sensitivity was 29% and specificity was 95%. ConclusionLip biopsy has low sensitivity but high specificity for diagnosing CD. Lip biopsy diagnosed CD in 7% when endoscopic biopsies were negative, enabling treatment. LB is a useful diagnostic test for CD in children presenting with oral symptoms. Level of EvidenceIII.

P31 Eyeing up: dupilumab-associated ocular surface disease in children with eczema in a tertiary paediatric hospital in London

Abstract Dupilumab blocks interleukin (IL)-4 and IL-13 and has demonstrated significant clinical benefit in eczema. Dupilumab-associated ocular-surface disease (DAOSD) has been described in adults but literature on the paediatric population is scarce. We conducted a retrospective review of electronic patient records of patients receiving dupilumab for eczema from April 2019 to July 2022. Outcome measures included incidence of DAOSD, patient/drug-related risk factors, ocular signs and symptoms, time to develop DAOSD, severity and treatments. Forty-six patients (median age 12 years, range 9–14) were identified; of these 12 (26%) developed DAOSD. Only one patient (8.3%) had pre-existing eye disease. The median time to DAOSD development was 3 (1–9) months. All patients were referred to ophthalmology, nine have been reviewed and three are awaiting appointments. All but one was symptomatic with ocular irritation (92%). In the nine patients reviewed by ophthalmology, ocular signs included bilateral bulbar conjunctival injection (n = 9, 100%), follicles (limbal or forniceal, n = 4, 44%), diffuse tarsal–conjunctival thickening (n = 3, 33%), cicatrization (n = 2, 22%). Four patients (44%) had moderate eye findings with peripheral corneal opacification; the symptoms were not always proportionate to the signs. The remaining five patients had mild ocular findings. Topical treatment for DAOSD included protopic to eyelid (n = 1), ciclosporin (n = 2), steroid (n = 4), lubrication (n = 5) and chloramphenicol (n = 2). No patients stopped treatment because of DAOSD. DAOSD in this cohort was higher than that reported in RCTs with similar timeframe to DAOSD development. Almost half of our patient cohort had moderate DAOSD but were only mildly symptomatic. No DAOSD predictive factors were identified.

MP55-09 NATURAL HISTORY OF ATYPICAL SMALL ACINAR PROLIFERATION (ASAP): A 10-YEAR CONTEMPORARY SERIES

You have accessJournal of UrologyCME1 Apr 2023MP55-09 NATURAL HISTORY OF ATYPICAL SMALL ACINAR PROLIFERATION (ASAP): A 10-YEAR CONTEMPORARY SERIES Thineskrishna Anbarasan, Mutie Raslan, Kanchan Ghosh, Philip Macklin, Claudia Mercader, Tom Leslie, Freddie Hamdy, Richard Colling, Clare Verrill, Richard Bryant, Francisco Lopez, and Alastair Lamb Thineskrishna AnbarasanThineskrishna Anbarasan More articles by this author , Mutie RaslanMutie Raslan More articles by this author , Kanchan GhoshKanchan Ghosh More articles by this author , Philip MacklinPhilip Macklin More articles by this author , Claudia MercaderClaudia Mercader More articles by this author , Tom LeslieTom Leslie More articles by this author , Freddie HamdyFreddie Hamdy More articles by this author , Richard CollingRichard Colling More articles by this author , Clare VerrillClare Verrill More articles by this author , Richard BryantRichard Bryant More articles by this author , Francisco LopezFrancisco Lopez More articles by this author , and Alastair LambAlastair Lamb More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003308.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Atypical small acinar proliferation (ASAP), found in 5% of prostate biopsies, represents a focus of atypical cells. There is a paucity of high-quality evidence on follow-up of ASAP with repeat biopsies. We aim to assess the incidence of ASAP and detection of PCa, particularly the proportion which are clinically significant (csPCa). METHODS: We conducted a retrospective review of electronic patient records (OSF protocol registration ID: CU96T) for all consecutive patients between Jan 2010 and Nov 2021 at a single tertiary institution. csPCa was defined as any Gleason pattern 4 disease. Between group median PSA levels were compared using the Kruskal-Wallis test. RESULTS: Approximately 13000 prostate samplings were performed (11000 needle biopsy and 2000 HOLEP/TURP specimen). ASAP was identified in 617/13000 (4.7%) biopsy samplings involving 523 patients. Of these, 10 (1.9%) and 41 (7.8%) patients had concurrent or a history of PCa respectively and were excluded from further analysis (N=472). At detection of ASAP, the median age was 66 years (IQR:61-71) with a median pre-biopsy PSA of 7.25ng/mL (IQR: 5.35-10.75). A total of 237 (50.2%) patients had a repeat biopsy within a median of 92 days (IQR:56-283). Median PSA after 3-6 months of ASAP detection was higher among patients who subsequently underwent repeat biopsy (6.70 vs 5.08ng/mL, p=0.001). Of 237 patients who underwent repeat biopsies within 2 years, csPCa was found in 57 (24.1%) patients (18 high grade vs 39 intermediate grade) at a median interval of 128 days (IQR:61-260). Clinically insignificant PCa was more common on follow-up, detected in 77 (32.5%) patients. The incidence of csPCa was lower in those younger than 65 years (0.20 vs 0.32, p=0.026) (Figure 1). csPCa was detected on the ipsilateral side of ASAP diagnosis in 46/57 (80.8%) patients. When including patients who did not undergo repeat biopsies and had stable PSA on follow-up (<10 ng/mL over 2 years; n=78), overall incidence of csPCa was 18.1% (57/315). CONCLUSIONS: PCa detected in follow-up biopsies in patients with ASAP was clinically significant in approximately one quarter of cases. Ipsilateral side with ASAP should be adequately sampled owing to association with detection of csPCa. Current guidelines should be revised to consider resampling following detection of ASAP. Source of Funding: NIL © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e766 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thineskrishna Anbarasan More articles by this author Mutie Raslan More articles by this author Kanchan Ghosh More articles by this author Philip Macklin More articles by this author Claudia Mercader More articles by this author Tom Leslie More articles by this author Freddie Hamdy More articles by this author Richard Colling More articles by this author Clare Verrill More articles by this author Richard Bryant More articles by this author Francisco Lopez More articles by this author Alastair Lamb More articles by this author Expand All Advertisement PDF downloadLoading ...

How common are ear, nose and throat disorders in children with Noonan syndrome and other RASopathies?

Noonan syndrome and related conditions (RASopathies) are known to be associated with abnormalities in many organ systems. It is our impression that few otolaryngologists are familiar with the manifestations of these syndromes and we therefore reviewed our hospital's patient cohort to identify the prevalence of ear, nose and throat disorders in these children. We cross-referenced various hospital department databases (otolaryngology, audiology, cardiology, haematology and genetics) to try to identify as many children with Noonan and other RASopathies as possible. We then performed a retrospective review of electronic patient records. We identified 67 children with Noonan, Costello, LEOPARD and other RASopathy syndromes. Around half have been seen in otolaryngology and audiology clinics. Otitis media with effusion requiring ventilation tubes occurred in 4% of children. 10% have suffered recurrent acute otitis media. 9% have a sensorineural hearing loss. 7% have undergone adenotonsillectomy for obstructive sleep apnoea. Airway anomalies and head and neck malformations occur but are rare. Children with Noonan and other RASopathies present commonly to otolaryngology and audiology clinics. The prevalence of sensorineural hearing loss is high and audiological screening is likely to be worthwhile. Surgeons should be aware that complications of surgery are common and can be very severe, especially in those with cardiac anomalies.

Lithium Monitoring Within NHS Forth Valley 2020

AimsThe aim of this audit is to improve the monitoring of appropriate parameters in patients within the health board who are prescribed lithium, including lithium level, urea and electrolytes, thyroid function tests, calcium. It will also look at whether the same patients are appropriately referred to renal services.MethodsA retrospective review of electronic patient records of 100% of the patients in Forth Valley Health Board who have collected a lithium prescription in the 6 months between March and August 2020.Results69% of patients had a lithium level checked within the time period set out in the NICE guideline. Only 43% complied with the guideline on renal referral and 63% on calcium. Compliance with assessment of urea and electrolytes was better at 90%, and thyroid function tests at 85%.ConclusionPart of the decline in compliance with guidelines is likely in relation to the availability of face-to-face appointments during the pandemic, and reduction in outpatient appointments. As a result of this there is a planned further audit looking at how lithium monitoring is reviewed in outpatient psychiatry. This is intended to increase the involvement of psychiatry and the patient in ensuring appropriate monitoring is completed rather than relying solely on the GP.

Inclusion body myositis and dysphagia. Presentation, intervention and outcome at a swallowing clinic.

This study reviewed patients with inclusion body myositis who were referred for assessment of dysphagia at a tertiary swallow clinic. It describes symptoms at presentation, imaging and management strategies. A retrospective review of electronic patient records was performed between 2016 and 2020. Twenty-four patients were included, with a mean age of 72 years. Baseline modified Sydney Swallow Questionnaires identified problems with hard or dry food, food sticking, and repeated swallowing. Twenty-two patients had a Reflux Symptom Index score that could indicate significant reflux. Video swallow identified specific problems, including tongue base retraction (96 per cent) and residual pharyngeal pooling (92 per cent). Seven patients (30 per cent) had features of aspiration on imaging despite a median penetration-aspiration scale score of 2. Four patients received balloon dilatation, and two patients underwent cricopharyngeal myotomy. This study helped to profile features of dysphagia in patients with inclusion body myositis. More evidence is needed to determine the most effective management pathway for these patients.

What can we Learn from Patients who Died from Covid-19 Following Escalation to a Respiratory High Dependency Unit for Trial of Non-Invasive Respiratory Support?

Background: Covid-19 infection is associated with significant risk of death, particularly in older, comorbid patients. Emerging evidence supports use of non-invasive respiratory support (CPAP and high-flow nasal oxygen [HFNO]) in this context, but little is known about its use in patients receiving end-of-life care. Methods: This was a retrospective study of 33 patients who died of Covid-19 on the Respiratory High Dependency Unit at the John Radcliffe Hospital, Oxford between 28/03/20 and 20/05/20. Data was sourced via retrospective review of electronic patient records and drug charts. Results: Patients dying from Covid-19 on the Respiratory HDU were comorbid with median Charlson Comorbidity Index 5 (IQR 4-6); median age 78 (IQR 72-85). Respiratory support was trialled in all but one case with CPAP being the most common form of first line respiratory support (84.8%) however, was only tolerated in 44.8% of patients. Median time to death was 10.7 days from symptom onset (IQR 7.5-14.6) and 4.9 days from hospital admission (IQR 3.1-8.3). 48.5% of patients remained on respiratory support at the time of death. Conclusions: End-of-life care for patients with Covid-19 remains a challenge. Patients tend to be frail and comorbid with a rapid disease trajectory. Non-Invasive Respiratory Support may play a key role in symptom management in select patients, however, further work is needed in order to identify patients who will most benefit from Respiratory Support and those for whom withdrawal may prevent unnecessary distress at the end of life or potential prolongation of suffering.

Can Routine Patients Be Safely Discharged After Neodymium-Doped Yttrium Aluminium Garnet Laser Posterior Capsulotomy?

BackgroundNeodymium-doped yttrium aluminium garnet (Nd:YAG) posterior capsulotomy is a common treatment for posterior capsular opacification. Practice varies regarding routine follow-up. In this study, we reviewed follow-up rates and treatment-related complications from a district general hospital’s ophthalmology unit to assess areas for improvement and cost-effectiveness.MethodologyWe conducted a retrospective review of electronic patient records for all patients treated with Nd:YAG capsulotomy in 2019 at our hospital. Primary outcomes included visual acuity, complications, and follow-up data. Secondary outcomes included medication prescribing and the grade of surgeon.ResultsIn total, 912 eyes of 744 patients were included. Overall, 536 (58.8%) eyes were discharged immediately following their laser. Complication rate was 4.3% (39 eyes). Junior training grades had a higher rate of medication prescribing (40/46 eyes; 87.0%) and follow-up (36/40 eyes; 78.3%).ConclusionsCertain selected patients may be safely discharged following capsulotomy with safety-netting advice. This strategy increases the capacity to follow-up patients at higher risk of complications. Higher rates of follow-up among junior ophthalmologists offers potential for training.

P452 Tofacitinib Effectiveness and Safety as Therapy for Ulcerative Colitis

Abstract Background Tofacitinib is an oral small molecule directed against the JAK/STAT pathway. It is the first JAK inhibitor approved for the treatment of ulcerative colitis (UC) and is licenced for use in moderate to severely active disease. This study aims to evaluate tofacitinib effectiveness and safety in real-world clinical practice for moderate-to-severely active UC. Methods Consecutive patients receiving Tofacitinib for UC in four Irish tertiary referral centres were identified. Baseline clinical data and information on therapy outcomes were collected by retrospective review of electronic patient records. Patients included in the study cohort were older than 18 years of age, had a confirmed diagnosis of UC, had received at least one induction dose of tofacitinib, and had available clinical follow-up. The primary study endpoint was 6-month corticosteroid-free remission rate. Secondary endpoints included 3-month clinical response, inflammatory biomarkers responses to tofacitinib therapy, rates of tofacitinib discontinuation, and side effects. Continuous variables are presented as median [range]. P values &amp;lt; 0.05 were considered significant in all analyses. Results Fifty-three UC patients were included; age 40.4 [33.3 – 53.9] years, 66% male, disease duration 5.7 [2.6–10.9] years; follow-up 8.7 [6.4–14.1] months. 43%, 40% and 17% of patients had extensive, left-sided disease and proctitis respectively. At baseline, clinical Mayo subscore was 7 [5–8], CRP 4.0 [1.0–16.7] mg/L and faecal calprotectin 914 [444.0–1000] mcg/g. The 3-month clinical response and 6-month corticosteroid-free remission rates were 69% and 43%, respectively. Following tofacitinib therapy, compared with baseline values, a significant reduction in 3-month clinical Mayo score, 3-month CRP, and post-induction faecal calprotectin was observed, p &amp;lt;0.03 for all comparisons. 36% of patients (n=19) discontinued tofacitinib during study follow-up (time to Tofacitinib discontinuation 1.9 [0.5–18.9] months). Side effects occurred in 26% percent of patients with the majority minor and self-limiting. No cardiovascular or venous thromboembolic events were observed and no hospitalisations occurred due to therapy-related side effects Conclusion These data are in concordance with prior studies of tofacitinib effectiveness and safety in real world practice. They demonstrate that, in a cohort of UC patients with significant prior therapy exposure, tofacitinib is an effective therapy with an acceptable safety profile.

Compliance with Driver and Vehicle Licensing Agency guidance in a psychiatric inpatient setting

AimsDriving is complex, requiring adequate: attention and concentration, memory, insight and understanding, judgement, planning and the ability to self-monitor1. Psychiatric illness, and associated medications, may affect patients’ ability to drive safely. The DVLA is responsible for determining individuals’ safety to drive and produces guidance specific to psychiatric disorders. Patients must comply with relevant guidance and clinicians must determine patients’ driving status and offer appropriate advice about medications and any need to inform the DVLA. This audit aimed to determine the compliance with DVLA guidance on a single inpatient psychiatric ward within Merseycare NHS Foundation Trust, UK.MethodA retrospective review of electronic patient records was completed. Clerical staff identified all patients admitted to Windsor House from 1/8/20–30/11/20 (n = 42). Data relating to driving status and driving advice were collected onto individual patient audit proformas, and uploaded to the online Audit Management and Tracking (AMaT) system.Result100% of patients had diagnoses that would require the DVLA to be informed and 100% were prescribed medication with potential side effects that could impair ones’ ability to drive safely such as dizziness, drowsiness or impaired concentration2. Driving status was only documented for 12 patients (29%) and type of vehicle driven for only 6 patients (1 of whom had an HGV licence).Discussion of DVLA guidance within the last 3/12 by the mental health team was documented in 17% patients. Of these patients, appropriate driving advice was given to 86%. All patients advised to cease driving were willing to. No patients were advised about side effects of medications on driving. No notes evidenced if the DVLA had been informed of patients’ admission, diagnosis or medication regimes.ConclusionDiscussing diving status and DVLA advice with psychiatric patients is important but may not always happen in inpatient settings, despite most patients having a relevant diagnosis. Failure to determine driving status may mean some patients are not being given appropriate guidance as required. Counselling on medication side effects in relation to driving should be encouraged as the majority of patients are taking prescribed medication that can potentially impair driving. Recommendations to improve compliance include: adding “driving status” to admission clerking and ward review proformas, educating staff to actively discuss driving with inpatients and create discharge checklists which prompt discussing driving status, medications and driving advice, and to re-audit in 6 months time.

Vitamin D monitoring and management within men's secure services

AimsTo audit the investigation, identification and treatment of Vitamin D deficiency within Men's Secure Services.BackgroundVitamin D and/or vitamin D deficiency has been suggested to play a role in the pathogenesis of mental illness. There is evidence that Vitamin D inadequacy is pandemic among rehabilitation patients in inpatient settings. Patients within secure hospitals are similarly considered to be at high risk, due to their limited solar exposure during often lengthy admissions. It has been suggested that these patients should be considered an ‘at-risk’ cohort, for whom Vitamin D supplementation should be routine. Men's secure services in Birmingham comprise of two medium secure units and a low secure rehabilitation unit. Here we present an audit of Vitamin D monitoring and treatment completed in 2019.MethodA three year retrospective review of electronic patient records, for all inpatients admitted within men's secure services as of 1 September 2019 (n = 188). Standards were based on the Trust accepted guidelines for management of Vitamin D deficiency.ResultKey findings included:- The majority of inpatients were Caucasian (43%) and African-Caribbean (24%). Ages ranged from 18 to 70, with a mean age of 39.Approximately two-thirds (65%) had been in hospital for over a year, of which 44% had been admitted for more than 3 years. The average length of admission was 885 days.Only 47% of patients had their Vitamin D level checked within the study period.Of those checked, 24% were tested within 1 month of admission. The mean duration between admission and Vitamin D testing was 464 days.Results ranged from 10.3 to 118.5nmol/L. A high rate of Vitamin D deficiency was identified (54%), whilst a further 16% had ‘inadequate’ levels.23% of those identified as requiring treatment did not receive any supplementation, whilst 59% of those with sufficient Vitamin D were prescribed treatment.Only 48% had their levels rechecked following treatment; of these, only 59% now had an adequate Vitamin D status.ConclusionThis audit demonstrates limited Vitamin D monitoring within male forensic inpatients. There was a high prevalence of Vitamin D insufficiency in this population, yet a substantial proportion of patients with identified deficiency were not prescribed any treatment. Ongoing monitoring and review of treatment effectiveness was poor. We argue that more consideration should be given to this population, with robust guidelines introduced for the treatment of this specific ‘at-risk group’.

An audit of vitamin D monitoring and management of deficiency in women's secure services

AimsTo audit the investigation, identification and treatment of vitamin D deficiency within Women's Secure Services.BackgroundIt has been suggested that vitamin D and vitamin D deficiency may play a role in the pathogenesis of psychiatric illness. There is evidence that vitamin D inadequacy is prevalent among patients in long-term hospital settings. Patients within secure hospitals are considered to be at high risk due to their often lengthy admissions, having been transferred from other hospital or prison settings. Ardenleigh in Birmingham is a blended female secure unit. Here we present the findings of an audit, completed in 2019, of vitamin D monitoring and treatment in this service.MethodA retrospective review of electronic patient records, for all inpatients admitted within women's secure services at Ardenleigh as of 1st September 2019 (n = 27). Standards were based on the Trust accepted guidelines for management of vitamin D deficiency.ResultKey findings included:-The majority of inpatients were Caucasian (44%) and African-Caribbean (41%). Median age was 31 years (range 20–56).Approximately two-thirds (60%) had been in hospital for over a year.89% of patients had their vitamin D level checked at some point during admission.Of those checked, 25% were tested within 1 week of admission. Seven patients were tested after being in hospital for over one year (30%).Only 25% of patients tested were found to have adequate vitamin D levels. Nine patients were found to have insufficient levels of vitamin D (37.5%) or deficiency (37.5%).89% of those identified as requiring treatment were prescribed supplementation, of which the majority was prescribed at the correct dose for the appropriate duration (94%). One patient refused treatment. Of those with sufficient levels, 67% were prescribed ongoing maintenance treatment due to previously detected deficiency.Of those found to have sufficient vitamin D in the last 12 months (n = 14), 71% were continued on maintenance treatment.ConclusionWe identified a high prevalence of vitamin D insufficiency in women admitted to secure services. Testing was delayed for a number of patients from the point of admission. However, once identified, the vast majority of those in need of treatment were managed appropriately by the medical team. We advise that vitamin D be considered an essential routine blood test at the point of admission to minimise delays in identifying those with deficiency and establishing necessary supplementation.

P162 Incidence of neutropaenia and infections in lupus patients on immunosuppression

Abstract Background/Aims Neutropaenia occurs in 20-40% of patients with systemic lupus erythematosus (SLE) and is attributed to a combination of autoimmune and complement-mediated destruction of white cells, increased neutrophil apoptosis and medication side-effects. Commonly when patients become neutropaenic (&amp;lt;2x10^9/L), immunosuppressant doses are reduced or discontinued. However, studies have not consistently shown an increased risk of infection in SLE patients that suffer neutropaenia while taking immunosuppressants. This retrospective case note review aimed to examine the association between degree of neutropaenia and rates of infection in SLE patients. Methods Data was collected for 100 patients attending an SLE clinic in a tertiary London hospital between May 2019 and August 2020. Patients completed a questionnaire reporting the number and nature of infections they had suffered in the previous year, and whether antibiotics and/or hospitalisation was required. Clinical data was collected by retrospective review of electronic patient records including immunosuppressant therapy and neutrophil counts. Sustained neutropaenia was defined as a neutrophil count &amp;lt;2x10^9/L for &amp;gt;3 months, and severe neutropaenia defined as a neutrophil count of &amp;lt; 1x10^9/L). Results 95% of patients were female with a median age of 42 years (range 18-87). 55 (55%) of our patients were prescribed an immunosuppressant - 32 mycophenolate mofetil, 14 azathioprine, 4 rituximab, 4 methotrexate, 4 ciclosporin, 3 cyclophosphamide and 1 leflunomide. This cohort was more likely to develop neutropenia (n = 19, 35% vs n = 10, 22%, OR 1.8, p = 0.13), report one or more infections (n = 29, 53% vs n = 19, 42%), require antibiotics (n = 19, 35% vs n = 10, 22%) or inpatient treatment (13% vs 7%). However, immunosuppressed patients with neutropaenia &amp;gt;1x10^9/L (8/19) did not experience more infections than those without neutropaenia (21/36) (42% vs 58%, OR 0.5, p = 0.2). Chest, urine and upper respiratory tract were the most commonly reported infections. 29 (29%) patients had sustained neutropaenia, with only 2 (2%) patients experiencing severe neutropaenia - both latter patients experienced recurrent viral infections and were only taking hydroxychloroquine. Conclusion Immunosuppressive therapy was correlated with an increased prevalence in the absolute number of reported infections, antibiotic prescriptions and hospital admissions. Although there were more cases of infection and neutropenia in patients receiving immunosuppressants, rates of infection were not higher amongst neutropenic patients whose counts were above 1x10^9/L. Our data suggest that the increased risk of infection in our patients receiving immunosuppressants may be independent of the risk of neutropenia. Rates of infection, antibiotic use and hospital admission were not increased in patients with sustained neutropenia. There were few cases of severe neutropenia in our cohort, and in the absence of immunosuppressant use, this may have been driven by the SLE itself. Disclosure S. Manou-Stathopoulou: None. W. Hann: None. A. Pakozdi: None. R. Rajakariar: None. M. Lewis: None. A. Cove-Smith: None. D. Pyne: None.

P24 Audit reviewing viability of removing pre-operative Group and Save Tests prior to Transurethral Prostate Surgery during the COVID19 pandemic

IntroductionCOVID19 has stressed and stretched healthcare resources to the limit, thus the rational deployment of any resource should be necessary and of patient benefit. This retrospective audit aims to ascertain if a policy of two valid group and save tests prior to transurethral prostate surgery is necessary and if this resource can be redistributed safely during the ongoing pandemic.MethodsA retrospective review of electronic patient records for patients that underwent transurethral prostate surgery from June 2017 to June 2018. During a single admission for surgery it was identified how many pre-operative group and save tests, and if a post-operative blood transfusion patients underwent.Results146 patients underwent transurethral prostate surgery between June 2017 to June 2018.97 patients had two valid group and save tests prior to surgery. 49 patients did not have 2 valid group and save tests. 21 patients had expired tests, 20 had only one valid sample, and 8 had no group and save test at all.No patient underwent a blood transfusion during their admission for transurethral prostate surgery.ConclusionThis single centre study illustrates pre-operative group and save tests before transurethral prostate surgery are unnecessary as no patient required an associated blood transfusion during admission; and can safely be omitted. The clinical time and resource could be redirected elsewhere for greater patient benefit. £2855.00 of efficiency savings could be made foregoing unneeded group and save tests.A policy omitting pre-operative group and save before transurethral prostate surgery will be implemented under COVID19 pandemic conditions and re-audited in 6 months.

Designing a continuous data-driven feedback and learning initiative to improve electronic prescribing: an interdisciplinary quality improvement study

Abstract Introduction The WHO Global Patient Safety Challenge aims to reduce severe avoidable medication-related harm by 50% by 2023[1]. Research suggests that providing timely, trusted feedback that incorporates relevant action can improve practice. However, a key barrier is lack of prescribing error data. Hospital electronic prescribing (EP) data may help address this gap. Aims To explore approaches for continuously monitoring medication safety signals using existing or new EP data, and to deliver personalised prescribing feedback and learning to improve patient safety. Methods We conducted a feasibility study (November 2019 - February 2020) on a 28-bed adult gastroenterology. This ward was chosen because of a high prescribing error rate. All foundation year 1 and 2 doctors, and pharmacists on the ward, participated in the study. The study team comprised pharmacists, doctors, quality improvement experts and clinical analysts, and used a quality improvement approach to design and test (i) methods for extracting electronic data to calculate prescribing accuracy rates, (ii) ways to refine a paper-prototype of an electronic pharmacists’ interventions form, (iii) potential digital medication safety indicators, and (iv) approaches for feedback for doctors to augment existing verbal feedback from pharmacists. Data were documented in accordance with local information governance and analysed using Excel. Acceptability and usability was assessed through verbal feedback from participants during weekly huddles. Outcome measures: feasibility of using EP to determine prescribing accuracy, user acceptability and usability of data collection, feedback and learning by pharmacists and doctors. We also measured changes in prescribing accuracy rate, pharmacists’ interventions, and quality of prescribing for targeted problematic medications. Results Extracting EP data required multiple data linkages to be configured and validated, and not all required data were available. Potential digital medication safety indicators: utility of the reason code ‘prescribed in error’ and actions by pharmacists to modify medications were limited by underuse and lack of data granularity. After testing different ways to extract relevant EP data, we eventually used a combination of EP and manual retrospective review of electronic patient records to determine prescribing accuracy rates. An intervention form was redesigned to tally interventions and capture details for contextual learning for email feedback to doctors and weekly prescribing improvement huddles. Doctors reported emails as timely and helpful for gaining new prescribing- and system-related knowledge. Pharmacists reported intervention data as providing invaluable evidence to drive improvement. Statistical process control charts showed no special cause variation around a mean prescription accuracy rate of 98% for inpatient orders, and 87% for discharge orders. By contrast, pharmacists recorded a mean of 10 interventions/day with 7 special cause variation (above upper control limit of 19) in the first two months. Omission of venous thromboembolism prophylaxis was identified as a priority medication issue. Specific prescriber- and system-based improvements were suggested (Jan 2020), some implemented (Feb 2020) and others fed back to the thrombosis committee (Feb 2020). Conclusion Harnessing the potential of EP data to improve medication safety requires the workforce to have a deeper understanding of the EP data structure and processes. Using a quality improvement approach, we developed a feedback and learning model that is acceptable and useful to pharmacists and doctors. Further research should explore adapting the approach to other clinical areas. Reference 1. Sheikh, A., Dhingra-Kumar, N., Kelley, E., Kieny, M. and Donaldson, L. The Third Global Patient Safety Challenge: Tackling Medication-Related Harm. Bulletin of the World Health Organization. World Health Organisation. 2017;95:546-546A.

Use of single-bed rooms may decrease the incidence of hospital-acquired infections in geriatric patients: A retrospective cohort study in Central Denmark region.

Patients accommodated in single-bed rooms may have a reduced risk of hospital-acquired infections (HAIs) compared to those in multi-bed rooms. This study aimed to examine the effect of single-bed accommodation on HAIs in older patients admitted to a geriatric ward. A retrospective cohort study of patients admitted to geriatric wards in a university hospital in Central Denmark Region linked to a move to a newly built hospital, involving all consecutively admitted patients aged 65 years and over from 15 September to 19 December 2016 and a similar cohort admitted in the same three months in 2017. We compared the incidence of HAIs in patients in single-bed accommodation to those in multi-bed accommodation using retrospective review of electronic patient records, with all infections verified microbiologically or by X-ray with onset between 48 hours after admission to 48 hours after discharge from hospital. In total 446 patients were included. The incidence of HAIs in multi-bed accommodation was 30% compared to 20% in single-bed accommodation. The hazard ratio was 0.62 (95% Confidence Interval 0.43-0.91, p = 0.01) for single-bed accommodation. This finding remained robust after adjustment for age, sex, infection at admission, risk of sepsis, use of catheter, treatment with prednisone or methotrexate, and comorbidity index. Accommodation in single-bed rooms appeared to reduce HAIs compared to multi-bed rooms in two geriatric wards. This finding should be considered as hypothesis-generating and be examined further using an experimental design.

A clinical and molecular characterisation of CRB1-associated maculopathy

To date, over 150 disease-associated variants in CRB1 have been described, resulting in a range of retinal disease phenotypes including Leber congenital amaurosis and retinitis pigmentosa. Despite this, no genotype–phenotype correlations are currently recognised. We performed a retrospective review of electronic patient records to identify patients with macular dystrophy due to bi-allelic variants in CRB1. In total, seven unrelated individuals were identified. The median age at presentation was 21 years, with a median acuity of 0.55 decimalised Snellen units (IQR = 0.43). The follow-up period ranged from 0 to 19 years (median = 2.0 years), with a median final decimalised Snellen acuity of 0.65 (IQR = 0.70). Fundoscopy revealed only a subtly altered foveal reflex, which evolved into a bull’s-eye pattern of outer retinal atrophy. Optical coherence tomography identified structural changes—intraretinal cysts in the early stages of disease, and later outer retinal atrophy. Genetic testing revealed that one rare allele (c.498_506del, p.(Ile167_Gly169del)) was present in all patients, with one patient being homozygous for the variant and six being heterozygous. In trans with this, one variant recurred twice (p.(Cys896Ter)), while the four remaining alleles were each observed once (p.(Pro1381Thr), p.(Ser478ProfsTer24), p.(Cys195Phe) and p.(Arg764Cys)). These findings show that the rare CRB1 variant, c.498_506del, is strongly associated with localised retinal dysfunction. The clinical findings are much milder than those observed with bi-allelic, loss-of-function variants in CRB1, suggesting this in-frame deletion acts as a hypomorphic allele. This is the most prevalent disease-causing CRB1 variant identified in the non-Asian population to date.

Walking ability in patients with glioblastoma: prognostic value of the Berg Balance Scale and the 10meter walk test.

Primary brain tumors frequently cause considerable functional impairments and the survival time when diagnosed with glioblastoma is 14.6months. The aim of this study was to examine if baseline postural control and walking ability in patients with glioblastoma could predict long term walking ability and 1year mortality. Data were gathered from prospective recordings in a brain cancer database supplemented by retrospective review of electronic patient records. We included 109 patients with glioblastoma, 47 women and 62 men with mean age 65years. At admission 84 patients were tested with Berg Balance Scale and 57 were tested with 10meter walk test. Binary logistic regression analysis showed no statistical significance in favour of the 10meter walk test. Berg Balance Scale showed an ability to predict walking ability 4-8months after admission. The risk of dying within a year was 6.9 times higher in patients who lost their ability to walk within 4-8months of the first admission. This study showed that Berg Balance Scale has some ability to predict the loss of walking ability 4-8months after admission. This could be an important indicator pin pointing patients most in need of more intensive specialized neurorehabilitation efforts early in the disease course.

PTH-079 6-Thioguanine as An Alternative Therapy in Inflammatory Bowel Disease? - Experience in A London District General Hospital

<h3>Introduction</h3> Conventional thiopurines (Azathioprine/6 Mercaptopurine) remain the cornerstone of maintaining remission in steroid-dependent inflammatory bowel disease (IBD). Despite the well-documented efficacy of these drugs, more than 50% of patients discontinue treatment due to adverse events or therapy resistance. Over the past decade, there has been renewed interest in the use of 6 thioguanine (TG), an agent historically used in haematological malignancy. With a shorter metabolic pathway, TG possesses a favourable side effect profile and it’s use as an alternative thiopurine in IBD is growing. We report our experience in tolerability, safety and efficacy of TG use in a London District General Hospital. <h3>Methods</h3> A retrospective review of electronic patient records including clinic letters, blood tests and endoscopic findings were carried out on patients commenced on TG between 2012 and 2015. Data was collected on patient demographics, indication and duration of therapy, response rates and reasons for treatment failure. <h3>Results</h3> A total of 28 patients received TG 20 mg once daily and median treatment duration was 14 months (range 1–40). Therapy was equally distributed amongst males and females (14:14), and mean age was 44 years (range 19–67). 14 (50%) patients had Ulcerative colitis (UC), 13 (46%) Crohn’s disease (CD) and 1 (4%) Indeterminate colitis. 24 patients (86%) received TG due to adverse reactions to conventional thiopurines vs. 3 patients (11%) who were non-responders. Treatment with TG resulted in clinical remission in 86% (19/22) patients at 6 months and 75% (12/16) at 12 months. In total, 6 patients (21%) discontinued TG – 4 failed treatment (2 continued alternative medical therapy and 2 had surgery) and 2 suffered adverse events (headaches and confusion). Tolerability and efficacy rates were similar in both UC and CD groups. All patients underwent blood monitoring and no abnormalities in liver function tests were detected. Of those who underwent MRI liver there was no evidence of nodular regenerative hyperplasia. <h3>Conclusion</h3> TG was well tolerated with comparable remission rates to conventional thiopurine therapy. We advocate the use of TG therapy in selected cases where conventional thiopurine therapy has failed or resulted in adverse reactions. Larger prospective trials are required to further evaluate the efficacy and safety of TG, with a view to potentially incorporate it’s use into clinical guidelines. <h3>Disclosure of Interest</h3> None Declared

PTU-076 Bile Sampling to Ensure Appropriate Antibiotic Treatment of Infection in Patients Undergoing Percutaneous Transhepatic Cholangiography and Biliary Drainage

Introduction Biliary sepsis and cholangitis are frequent complications of percutaneous transhepatic cholangiography and biliary drainage (PTCBD). Due to bacterial resistance, biliary infection is often difficult to eradicate. The aims of this audit were to evaluate the frequency of bile sample collection during PTCBD for culture and antibiotic sensitivity tests. Further, whether antibiotic management of biliary infections post-procedure are appropriate. Methods A retrospective review of electronic patient records were conducted for 138 patients that underwent PTCBD for management of malignant biliary obstruction from 2012–2015 in the Interventional Radiology departments of the Oxford University Hospitals NHS Trust. Due to limitations of the electronic system, drug histories were only accessible from the 45 patients that underwent PTCBD in 2015. Results Of the 138 patients, 36% had samples cultured during the procedure. Of the positive bile samples, 61% had antibiotic sensitivities reported. Organisms identified included mixed faecal flora (33%), anaerobes (12%), aerobic gram-positive cocci (23%), aerobic gram-negative (14%), Pseudomonas (7%) and Candida (7%). In 2015, 53% that underwent PTCBD received antibiotics for biliary infection, of these, 46% had bile cultures and of the positive samples, 33% were tested for antibiotic sensitivity. Antibiotics administered included: amoxicillin/clavulanic acid (30%), metronidazole (33%), gentamycin (14%), piperacillin/tazobactam (9%), ceftriaxone (9%), ciprofloxacin (5%). Conclusion Thus, antibiotics to treat biliary infection following PTCBD are often prescribed without knowledge of the infective organism or its resistance and therefore may not be appropriate. Additionally, many of the treatments administered do not provide complete coverage of organisms identified in bile, notably Pseudomonas and Candida. Bile sample collection during PTCBD should become a standard procedure to delineate infective organisms and drug susceptibilities, hence driving a more targeted treatment in the event of biliary infection post-procedure, which may reduce mortality and costs associated with bacterial resistance. Disclosure of Interest None Declared