Royal Lancaster Infirmary Research Articles

ThP2.5 - Number of lymph nodes removed in SLNB: comparison between standard technique versus Magtrace from a single-centre study

Abstract Introduction Sentinel lymph node biopsy (SLNB) is a precise method for axillary staging in early breast cancer. Historically, the standard approach used radioisotope, often combined with blue dye, for localising the sentinel lymph node (SLN). Recently, the introduction of the superparamagnetic iron oxide mapping agent, Magtrace, offers an alternative. Following the adoption of Magtrace, there was a perception that more nodes were being removed during SLNB. This study aims to compare the number of lymph nodes removed, during SLNB, between both techniques. Methods A retrospective single-centre study (2022-2023) included 316 patients undergoing SLNB at Royal Lancaster Infirmary. Before the late 2022 adoption of Magtrace, the standard technique involved radioisotope+/-blue dye. Subsequently, based on consultant preference, patients received Magtrace alone or with blue dye. The comparison focused on the number of identified SLN between the magnetic and standard techniques. Results Data from 316 patients was analysed across two periods: March to October 2022 (standard technique n=160), and March to October 2023 (Magtrace n=120; Magtrace+blue dye n=30; blue dye only n=5). Comparative analysis of the number of nodes removed produced the following results: standard technique 2.425, magnetic technique alone 2.403, magnetic technique with blue dye 2.133, and blue dye only 1.6. Conclusion Despite initial concerns regarding the perceived increase in the number of nodes removed during SLNB with the implementation of the Magtrace technique, our study reveals that the use of this technique results in a reduction in the number SLNs removed in comparison to the standard dual technique.

P043 The different roles of FRAX risk factors as predictors of fragility fractures in peri-menopausal vs post-menopausal patients: results from a large population-based cohort study

Abstract Background/Aims The marked rise in the prevalence of fragility fractures affecting both women undergoing the transition to menopause (i.e. peri-menopause), and post-menopausal women, confers a significant burden on patients’ health and quality of life. The risk factors for fractures in post-menopausal women have been previously well-explored, and tend to align with the FRAX variables. However, there is less consensus regarding the fracture risk factors in peri-menopausal women. We compare the association between FRAX risk factors and fractures across peri-menopausal and post-menopausal women, selected from the same large population-based cohort. Methods Female patients referred for a DXA scan at the Royal Lancaster Infirmary between 2004-2011 provided information relating to any previous fragility fracture(s), FRAX risk factors, and menopause status (i.e. not post-menopausal vs post-menopausal) through a questionnaire. Patients aged 41 to 51 (median menopause age in UK) who had not undergone the menopause, as per their questionnaire response, were categorised as ‘peri-menopausal’. Logistic regression modelling, which included adjustment for potential confounders, was performed using r(version 4.3.1). Results Our study included 23388 patients, including 3785 peri-menopausal patients and 20774 post-menopausal patients, with a mean age of 47.5 (SD:3.0) and 66.1 (SD:10.4) respectively. The prevalence of fragility fractures was greater in the post-menopausal than peri-menopausal cohort (42.8% vs 25.5% respectively; p < 0.001). Across post-menopausal patients, following adjustment for the other FRAX risk factors, significant predictors of increased fracture risk were age (odds ratio (OR): 1.04 (95% CI:1.03-1.04, p < 0.001), smoking (OR:1.16 (CI:1.09-1.23, p < 0.001), alcohol (OR:1.54, CI:1.36-1.74, p < 0.001), and a family history of fracture(s) (OR:1.21 (CI:1.13-1.29, p < 0.001). Comparatively, across peri-menopausal patients, only alcohol (OR:1.57, CI:1.08-2.26, p = 0.016) and smoking (OR:1.22 (CI:1.00-1.48, p = 0.045) positively predicted fracture risk. Corticosteroid use was associated with a reduced fracture risk across both post-menopausal (OR:0.84, CI:0.79-0.90, p < 0.001) and peri-menopausal (OR:0.79, CI: 0.64-0.97, p = 0.024) cohorts. Conclusion Different FRAX risk factors predict fracture occurrence across post-menopausal and peri-menopausal patients; notably, only smoking and alcohol consumption predict an increased fracture risk in the latter group. Interestingly, corticosteroids were associated with a reduced risk of fractures across both groups. This finding may be elucidated by the fact that low-dose corticosteroids can exert an anti-inflammatory effect, and may protect bone cells. However, our finding is limited by the fact that the indication, dose and duration of corticosteroids were unknown. More generally, our study is limited by the fact that patients’ peri-menopausal status was not clinically confirmed, but inferred based on patients’ age and self-reported menopause status. Our results suggest that the FRAX risk factors, which were derived from analysis of predominantly 50-80 year old patients, may require adjustment for peri-menopausal patients (many of whom are aged <50). Future studies should assess whether our conclusions apply to specific fracture sites, and are replicated across more demographically diverse patient populations. Disclosure K. Song: None. M. Bukhari: None.

P077 Bone mineral density predicts fractures when measured in more than one area: results from a large observational cohort

Abstract Background/Aims Osteoporosis is characterised by a reduction in bone mineral density (BMD). Low BMD is correlated with increased fracture risk. It is unclear whether a BMD value at a specific site is superior for predicting fracture. The Fracture Risk Assessment (FRAX™) tool is used to evaluate fracture risk, using the BMD at the non-dominant hip; focussing on the neck mean and neck total. This is despite a T score of -2.5 or below in the lumbar spine defining a patient as osteoporotic. This study aimed to determine whether the other measures of BMD that are noted are as predictive of fracture. Methods Patients referred for routine dual-energy x-ray absorptiometry (DEXA) scans at the Royal Lancaster Infirmary from 2004 to 2019 were studied. BMD data from lumbar vertebrae (L1-L4) and anatomical regions of the left and right femur were collected from DEXA images. A logistic regression model was fitted using fracture as a dependent variable and BMD values from the lumbar vertebrae, right and left femur as predictors, adjusted for age at scan and sex. Goodness of fit was assessed using a receiver operating characteristic (ROC) curve. Results A total of 31,546 patients were included in the analysis (82.9% female), of whom 37.6% had sustained a fracture, and the mean age of the cohort was 64.9 (standard deviation 12.9). Table 1 shows the results of the logistic models. Areas under the receiver operating characteristic curve (AUC) demonstrated the positive predictive ability of a reduction in BMD in the lumbar vertebrae and regions of the femur and fracture risk. BMD data from the four lumbar vertebrae were just as predictive of fracture as the right and left femur. Conclusion The study findings demonstrate that low BMD in all areas measured were equally predictive of fracture. When the non-dominant hip is not measurable, using other areas from a DEXA scan could be used to predict fracture risk. Research evaluating change in BMD over time could alter this observation. Disclosure U. Nadeem: None. M. Bukhari: None. Z. Sultan: None.

Then and Now….. Medical Staff of the Royal Lancaster Infirmary


 

1186 IMPROVED PERFORMANCE AGAINST SSNAP PARAMETERS FOR THROMBOLYSED STROKE PATIENTS FOLLOWING CHANGES IN PRACTICE

Abstract Background The CQC inspection of the Royal Lancaster Infirmary (RLI) in May 2021 rated the performance of the stroke department unsatisfactory, leading to a number of changes. A retrospective audit was performed to determine the impact of these changes for thrombolysed stroke patients. Aim This retrospective audit assessed the performance of the stroke department at the RLI against the parameters set by the ‘Sentinel Stroke National Audit Program’ (SSNAP), comparing 6-month periods before and after the CQC inspection in May 2021. Method Using electronic medical records and SSNAP data, we reviewed every thrombolysed stroke patient at the RLI between November 2020 until April 2021 and from May 2021 until November 2021, assessing 10 parameters and comparing the results with SSNAP targets. Since May 2021, changes to practice introduced included opening a new, larger stroke unit located directly opposite the Emergency Department, ring-fencing stroke beds, doubling the number of stroke specialists and stroke consultants reviewing all suspected stroke patients face-to-face within working hours. Results 46 patients were thrombolysed with 42 confirmed as having had ischaemic strokes on subsequent MRI imaging. All patients were discussed with a stroke consultant before thrombolysis. Mean time from arrival to CT improved from 51 to 34.5 minutes, admission to stroke unit from 7hr53 to 4hr36 and to thrombolysis from 2hr18 to 1hr22. The number of thrombolysis complications decreased from 5 to 2. Since the changes, the SSNAP grade for stroke unit admission improved from C to A and specialist assessments from E to B. Conclusion The changes implemented following the May 2021 CQC inspection have had a positive impact on the care of thrombolysed stroke patients and overall SSNAP grades at RLI. Improvements are still required and the next steps include improving the efficiency of thrombolysis times and further improving SSNAP grades.

Thyroid carcinoma in nodules with Thy3 cytology: Retrospective study in a district general hospital.

Background and Aim Thyroid cancer is the most common malignant endocrine tumour. Fine needle aspiration cytology plays an important role in diagnosis of these tumours. The aim of the current study was to determine thyroid cancer risk for Thy3 cytology over a seven-year period from 2015 to 2021 at Royal Lancaster Infirmary, UK. Methods 206 medical records with Thy3 cytology were retrospectively reviewed from January 2015 to December 2021. Patients were classified into two groups: Thy3a and Thy3f. Histopathology reports were compared with cytology reports in order to determine malignancy rates. Results 18.9% of male patients and 23% of female patients had a malignant histology The average overall malignancy rate was 22.2%. More specifically, 22% of Thy3a and 22.4% of Thy3f were malignant. 22 patients eventually underwent completion thyroidectomy of which 6 patients had malignancy in the contralateral lobe. Conclusion Malignancy rates at our center was lower as compared to the national data rates.

710 IPC STOCKINGS FOR VTE PREVENTION IN STROKE: BENEFITS OF INTRODUCING ELECTRONIC PRESCRIPTIONS AND WARD ROUND PROMPTS

Abstract Background A fully completed audit cycle, performed by doctors on the Stroke Unit at Royal Lancaster Infirmary (RLI) which is a combined acute and rehabilitation ward in a university teaching hospital. Introduction Deep vein thrombosis (DVT) and pulmonary embolism (PE) are common complications of hemiplegic stroke. Evidence shows that IPCs (intermittent pneumatic compression devices) reduce the risk of DVT. Recent data from SSNAP reports that IPCs are only used in 33% of all stroke patients. We aimed to improve our local standards in the prescription of IPCs for stroke patients within 3 days of admission, thus reducing the incidence of VTE (venous thromboembolism). Methods Data was collected retrospectively from patient records of all stroke patients discharged over a one-month period for each of 2 audit cycles. Prescribing is electronic based at RLI. After the first cycle we initiated a prompt on the electronic VTE pro forma to initiate prescribing. We also changed the prescribing default to regular instead of when required, requiring staff to document when they were not given and the reasons why. Results Between the first and second cycle, completion of VTE proformas improved to 100% and VTE incidence reduced from 7.6% to 0. Overall, there was a large improvement in prescribing IPCs within the first 3 days of admission. 71% of patients reviewed in the second cycle had IPCs prescribed compared to 37% in the first. Conclusion Adherence to local standards in prescribing of IPCs within 3 days of admission markedly improved after the Introduction of electronic ward round prompts and prescriptions and the incidence of VTE decreased to zero. The prescribing prompts encouraged increased documentation of administering of IPCs. There are still some issues concerning documentation and prescribing of anticoagulants which will be tackled by implementing teaching sessions and updating our electronic prescribing prompts.

The diagnosis and management of a pathological fracture: a case report

A 64 year old female patient presented to the Accident and Emergency (A&E) department at the Royal Lancaster Infirmary (RLI) with a significant left sided jaw pain. This patient reported paraesthesia and a shooting pain radiating down her left mandible. There was also marked trismus on examination. Her medical history included a history of a previously diagnosed Squamous Cell Carcinoma (SCC) of the left soft palate. This was staged at T2N0M0 and treated with radiotherapy and chemotherapy. Following a clinical examination, special investigations via imaging were obtained prior to a formal diagnosis of pathological fracture of the left mandible following previous radiotherapy for her SCC treatment.
 This case report will discuss the incidence, background, management and treatment of osteoradionecrosis (grade 3) (ORN) of the mandibular jaw bone as well as the associated pathological fractures and the detrimental effects following the use of radiotherapy to the head and neck region.

Success Rate of Wire Control-Assisted ERCP Sphincterotomy Versus Non-assisted ERCP Cannulation of Common Bile Duct in a Secondary Care Unit During the First COVID-19 Peak: A Retrospective Observational Study of 281 Patients

BackgroundThe British Society of Gastroenterology (BSG) recommended that during the COVID-19 pandemic, endoscopy units perform endoscopic retrograde cholangiopancreatography (ERCP) for obstructive biliary pathologies in an emergency. We assessed the local performance of ERCP during the first wave of COVID-19 at our local endoscopy center, in particular the technique to common bile duct (CBD) cannulation.MethodologyAll ERCP procedures performed from January to June 2020 were retrospectively assessed and compared with procedures performed between January and June 2019 at the Royal Lancaster Infirmary. The indications for ERCP, success rate, and complications were studied separately. Correlation analysis was conducted using Spearman's rank correlation coefficient. The binary logistic regression model was used to compute the factors associated with successful ERCP. Significance was established when the two-sided P-value < 0.05. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 25 for Windows (SPSS Inc., Chicago, IL, USA, 2017).ResultsA total of 281 ERCP were included in this study, with 169 and 112 performed during the first six months of 2019 and 2020, respectively. A statistically significant (0.0087) higher proportion of cases with liver dysfunction presented for ERCP before the COVID-19 outbreak (152, 89.94%). All patients before COVID-19 underwent wire control-assisted ERCP, while 82 (73.21%) received assisted ERCP during the first wave (P < 0.001). There was no statistically significant difference (P = 0.10) in the number of patients who underwent sphincterotomy before and during the first wave of COVID-19, with 97 (57.39%) and 76 (67.85%), respectively. The success rate of ERCP before COVID-19 was relatively high, accounting for 146 (86.39%) patients in contrast to 87 (77.67%) patients during the first wave (P = 0.074). Sphincterotomy (β = 2.800, P = 0.028) and stent insertion (β = 0.852, P = 0.046) were statistically significant predictors of ERCP outcomes. There was no statistically significant impact of cholangitis on the success of ERCP (β = 1.672, P = 0.109).ConclusionThe first wave of COVID-19 had a statistically proven negative impact on the expected standards of ERCP performance. Although the complication rate was significantly higher during the first wave case difficulty, the American Society of Anesthesia (ASA) status was not assessed on an individual basis. Both ASA status and case difficulty are now included in our endoscopy selection process. We recommend adding the complexity of cases and ASA to the local and national recording databases. This is a rare study on UK-based hospitals.

UNUSUAL PATHWAY OF DIAGNOSIS OF A RARE CASE: PERIPHERAL AMELOBLASTOMA

<h3>Background</h3> This case report highlights the varying differential diagnoses that finally led to the diagnosis of the peripheral ameloblastoma. It goes through the unexpected journey in reaching the diagnosis of this particular patient owing to varying presentations and unexpected findings. <h3>Discussion</h3> A 75-year-old woman was referred to the Royal Lancaster Infirmary maxillofacial surgery under the 2-week wait pathway for a right buccal swelling. The patient was referred by her general dental practitioner for a lump adjacent to the upper right maxillary tuberosity. The patient had bleeding from the lesion intermittently, raising suspicion of a possible malignancy. An incisional biopsy was performed and the initial impression for histology was cylindroma or eccrine spiral adenoma; however, the histopathologist confirmed the specimen was from the oral mucosa and a working diagnosis of low-grade salivary type neoplasm was reached. An excisional right buccal sulcus biopsy of the lesion was performed and showed infiltration of a basaloid tumor arising from squamous epithelium. The tumor islands were composed of basaloid tumor cells with peripheral palisading. There was no increase in mitotic activity. The overall appearance was consistent with an extraosseous ameloblastoma. Because of the differences between histology results, the sample was sent for further analysis and confirmation to Newcastle University, where it was confirmed to be a peripheral ameloblastoma. <h3>Conclusions</h3> The case highlights the difficult histologic appearance of a peripheral ameloblastoma and shows the need for thorough history and investigations to ensure the correct diagnosis and treatment.

P129 Predictors of low bone mineral density in rheumatoid arthritis

Abstract Background/Aims Osteoporosis (OP) is an extra-articular manifestation of rheumatoid arthritis (RA) that leads to increased fracture susceptibility due to a variety of reasons including immobility and cytokine driven bone loss. Bone loss in other populations has well documented risk factors. It is unknown whether bone loss in RA predominantly affects the femoral neck or the spine. This study aimed to identify independent predictors of low bone mineral density (BMD) in patients RA at the lumbar spine and the femoral neck. Methods This was a retrospective observational cohort study using patients with Rheumatoid arthritis attending for a regional dual X-ray absorptiometry (DEXA) scan at the Royal Lancaster Infirmary between 2004 and 2014. BMD in L1-L4 in the spine and in the femoral neck were recorded. The risk factors investigated were steroid use, family history of osteoporosis, smoking, alcohol abuse, BMI, gender, previous fragility fracture, number of FRAX(tm) risk factors and age. Univariate and Multivariate regression analysis models were fitted to explore bone loss at these sites using BMD in g/cm2 as a dependant variable. . Results 1,527 patients were included in the analysis, 1,207 (79%) were female. Mean age was 64.34 years (SD11.6). mean BMI was 27.32kg/cm2 (SD 5.570) 858 (56.2%) had some steroid exposure . 169(11.1%) had family history of osteoporosis. fragility fracture history found in 406 (26.6%). 621 (40.7%) were current or ex smokers . There was a median of 3 OP risk factors (IQR 1,3) The performance of the models is shown in table one below. Different risk factors appeared to influence the BMD at different sites and the cumulative risk factors influenced BMD in the spine. None of the traditional risk factors predicted poor bone loss well in this cohort. P129 Table 1:result of the regression modelsCharacteristicB femoral neck95% CIpB spine95%CIpAge at scan-0.004-0.005,-0.003&amp;lt;0.01-0.0005-0.002,0.00050.292Sex-0.094-0.113,-0.075&amp;lt;0.01-0.101-0.129,-0.072&amp;lt;0.01BMI (mg/m2)0.0080.008,0.0101&amp;lt;0.010.01130.019,0.013&amp;lt;0.01Fragility fracture-0.024-0.055,0.0060.12-0.0138-0.060,0.0320.559Smoking0.007-0.022,0.0350.650.0286-0.015,0.0720.20Alcohol0.011-0.033,0.0 5560.620.0544-0.013,0.1120.11Family history of OP0.012-0.021,0.0450.470.0158-0.034,0.0650.53Number of risk factors-0.015-0.039,0.0080.21-0.039-0.075,-0.0030.03steroids0.004-0.023,0.0320.030.027-0.015,0.0690.21 Conclusion This study has shown that predictors of low BMD in the spine and hip are different and less influential than expected in this cohort with RA . As the FRAX(tm) tool only uses the femoral neck, this might underestimate the fracture risk in this population. Further work looking at individual areas is ongoing. Disclosure M.A. Swar: None. M. Bukhari: None.

P119 Average percent fat is associated with decreased bone mineral density at the hip but increase at the spine longitudinally, where weight shows a positive association at all anatomical locations

Abstract Background/Aims Body composition changes are associated with changes in bone mineral density (BMD). Composite measures of body compartments, such as weight and body mass index (BMI) have a positive association with BMD. The aim was to study average percent fat from dual energy X-ray absorptiometry (DEXA) as a potentially useful clinical measurement. Methods BMD data in grams/cenitmetre2 was collected from DEXA scans after referral from secondary care to the Royal Lancaster Infirmary from 2004-2010. BMD data related to the left and right hip (the neck, Ward’s area, trochanter, and total hip), and the spine (L1-L4) was measured. Data was collected longitudinally, and BMD in g/cm2 was modelled at the regions of the hip and spine using mixed effects linear models. Average percent fat and weight (kg) were used as explanatory variables, whilst adjusting for age at scan, gender, and other risk factors such as FRAX risk factors. Results 7910 patients (88% female) were included, all with average percent fat and weight measurements. The results of the models (Table 1) all have a P value&amp;lt;0.05. Average percent fat had a significant negative association at all regions of the left and right hip, but a significant positive association at the spine. Weight showed a significant positive association with BMD at the hip and spine. P119 Table 1:Effect size estimates from mixed effects models of BMD at regions of the hip, and the spine.Anatomical locationEffect size estimate for average percent fat (95% confidence intervals)Effect size estimate for weight (95% confidence intervals)Left neck-6.63x10-4 (-9.69x10-4, -3.56x10-4)2.07x10-3 (1.91x10-3, 2.23x10-3)Left total-1.03x10-3 (-1.32x10-3, -7.41x10-4)3.45x10-3 (3.29x10-3, 3.61x10-3)Left Ward’s-1.07x10-3 (-1.38x10-3, -7.65x10-4)1.85x10-3 (1.69x10-3, 2.02x10-3)Left trochanter-1.15x10-3 (-1.46x10-3, -8.47x10-4)3.65x10-3 (3.48x10-3, 3.81x10-3)Right neck-6.91x10-4 (-9.94x10-4, -3.88x10-4)1.97x10-3 (1.81x10-3, 2.14x10-3)Right total-1.19x10-3 (-1.48x10-3, -8.96x10-4)3.39x10-3 (3.23x10-3, 3.55x10-3)Right Ward’s-1.07x10-3 (-1.38x10-3, -7.65x10-4)1.85x10-3 (1.69x10-3, 2.02x10-3)Right trochanter-1.19x10-3 (-1.52x10-3, -8.72x10-4)3.65x10-3 (3.39x10-3, 3.73x10-3)Spine (averaged L1-L4)1.76x10-3 (1.46x10-3, 2.05x10-3)1.42x10-3 (1.16x10-3, 1.68x10-3) Conclusion The negative association seen with average percent fat at the hip could reflect the potential negative endocrine effects of fat, and the effect of localized inflammation at the hip. Increased adiposity is also linked to sarcopenia, and further body compositional changes. However, the potential negative effects of increased adiposity at the abdomen and spine are potentially overridden by the increased biomechanical loading generated by the increased adiposity, highlighted by weight’s positive association with BMD at the spine. The average percent fat results are not mirrored with weight at the hip. This highlights that composite measures are not specific enough to measure changes in body composition compartments, and their resulting change in risk related to BMD. Disclosure C. Thurston: None. J. Kerns: None. F. Dondelinger: None. A. Hale: None. M. Bukhari: None.

P196 Predictors of fracture in patients with primary hyperparathyroidism

Abstract Background Primary hyperparathyroidism (PHPT) is a recognised risk factor for fractures as the persistently elevated parathyroid hormone levels are associated with lower bone mineral density (BMD). In early osteoporosis (&amp;lt;65 years), there is mainly trabecular bone loss while with increasing age, the largest loss of absolute bone mass occurs in cortical sites. Our aim was to compare cortical versus trabecular bone sites to determine which sites better predict fracture in PHPT patients referred for dual-energy X-ray absorptiometry (DEXA) scan in an observational cohort. Methods 508 patients with PHPT referred for DEXA scan at Royal Lancaster Infirmary (UK) between 2006-2016 were included in a retrospective data analysis. Data collected included femoral and lumbar BMD, age, gender, height, weight, BMI, rheumatoid arthritis, smoking, alcohol, family history of fractures, secondary osteoporosis and long-term steroid use and was used to look at predictors of fractures using BMD at different sites. Simple statistics using independent t-tests and chi-squared tests were initially used and subsequently, logistic models were fitted unadjusted and adjusted confounding variables. Results 97 males (19%) and 411 females (81%) were included, with 111 patients sustaining at least one fracture (21.9%). Mean age was 65 years (SD 0.55). Advanced age, female gender and a reduced BMD were all statistically significant factors associated with an increased risk of fractures. Smoking and long-term steroid use were also shown to increase risk of fracture however these were non-statistically significant. Adjusting for age and gender, a reduced L4 BMD was the strongest statistically significant predictor of fracture (OR 0.139, 95% CI: 0.112-0.782). Multivariate analysis revealed that a reduced L3 BMD was the strongest statistically significant predictor of fracture (OR 0.170, 95% CI: 0.071-0.72). Conclusion Overall, our study suggests that a reduced BMD at trabecular sites is a stronger predictor of fracture compared to cortical sites [Table 1]. Older age and female gender significantly increased the risk of fracture in PHPT patients. To the best of our knowledge, this is the first study looking at specific bone sites as independent predictors of fracture in PHPT patients. This analysis should be repeated using a larger cohort to validate our results. Disclosures D. Mariannis None. M. Bukhari None.

EP21 An observational study of the predictors of osteoporosis in men

Abstract Background Osteoporosis is under-recognised and under-treated in men. Previous studies and stratification tools have been limited in their generalisability and while predictors of poor bone density in men have been characterised, evidence has been contradictory. The purpose of this study is to investigate these predictors in the lumbar spine and femoral neck in men. Methods Data were collected from 3,901 men referred for DEXA scanning to the Royal Lancaster Infirmary, between 2004 and 2010. BMD was measured in the lumbar spine and femoral neck. Simple and multiple regression models were fitted to each measurement site, using each of the known predictors for poor bone health. The Variance Inflation Factor was used to quantify the severity of multicollinearity and the Akaike Information Criterion was employed to select co-variates. Results The following predictors had a significant effect in both measurement sites: age; height; weight; Body Mass Index (BMI); X-ray evidence of osteopenia; and previous fracture(s). Body fat percentage had a significant effect at the lumbar spine only, and tobacco use had a significant effect at the femoral neck only. The adjusted R squared values for the models ranged from 0.16 for the lumbar spine model, to 0.28 for the femoral neck model. Conclusion This study demonstrated that further work is needed in assessing the predictors of OP in men. This would open up an interesting observation in clinical practice and provide an opportunity for risk prediction and primary prevention of OP in men, reducing fracture risk. Future studies should include randomised samples and propensity score matching. Disclosures N. Kyrtata None. K. Davies None. A. Nune None. M. Bukhari None.

Bedside buddies - an educational and pastoral teaching programme for year 2 medical students.

Junior medical students often find starting clinical attachments daunting. Understandably, they lack confidence and are new to the hospital environment. For this reason, they may not get the most out of clinical placements. At Lancaster Medical School (LMS), year 2 students undergo their first clinical attachments at both Royal Lancaster Infirmary (RLI) and East Lancashire Hospitals NHS Trust (ELHT). The General Medical Council states that teaching doctors and students is important for the care of patients.1 Near-peer teaching (NPT) is increasingly recognised as an effective method for teaching and learning within medical education.2 A buddy system was designed and the impact of this educational strategy was evaluated by surveying near-peer learners before and after the sessions. We aimed to create a structured, informal …

Bedside buddies – an educational and pastoral teaching programme for year 2 medical students

Junior medical students often find starting clinical attachments daunting. Understandably, they lack confidence and are new to the hospital environment. For this reason, they may not get the most out of clinical placements. At Lancaster Medical School (LMS), year 2 students undergo their first clinical attachments at both Royal Lancaster Infirmary (RLI) and East Lancashire Hospitals NHS Trust (ELHT). The General Medical Council states that teaching doctors and students is important for the care of patients.1 Near-peer teaching (NPT) is increasingly recognised as an effective method for teaching and learning within medical education.2 A buddy system was designed and the impact of this educational strategy was evaluated by surveying near-peer learners before and after the sessions. We aimed to create a structured, informal …

Evaluation of the Hospital Alcohol Liaison Service (HALS) based at the Royal Lancaster Infirmary

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OC-048 Colonoscopy: What is the Number Required to Maintain Competency? – a Retrospective Audit

<h3>Introduction</h3> There has been increasing demand for gastroenterologist to maintain JAG competencies year on year.¹ However there are few studies into the adequate number required despite the bowel cancer screening programme suggesting &gt; 100 per annum. The study aims to compare competencies standards in relation to the number of colonoscopies performed in a year. <h3>Methods</h3> Data was collected retrospectively within the trust between 1/12/2010 and 30/11/2011. These include colonoscopies performed in the 3 main hospitals within the UHMBT – Royal Lancaster Infirmary, Furness General Hospital and Westmoreland General Hospital. A total of 2502 colonoscopies performed were retrieved. The endoscopy reporting system ‘Endobase’ and ‘Indigo 4 Review’ were used to retrieve endoscopy report and pathology report respectively. The caecal intubation rate (completion rate), polyp detection rate, adenoma detection rate, adequacy of bowel prep and sedation rate were set standards. Chi squared test for correlation was used to compare all standards. Two groups were formed to compare the set standards as colonoscopist who performed &gt; 100 colonoscopies per annum (pa) and those who performed &lt; 100 colonoscopies pa. Withdrawal time, polyp recovery and complication rates were not included in this audit. <h3>Results</h3> Of the 2502 colonoscopies performed, 633 were performed by colonoscopist who performed &lt; 100, 1869 colonoscopies were performed by colonoscopist who performed &gt; 100 colonoscopies. Completion rate for &lt; 100 colonscopies was 85.62% and &gt; 100 colonoscopies was 92.24% (p &lt; 0.0001). Polyp detection rate (PDR) for &lt;100 colonscopies was 17.85% and &gt; 100 colonoscopies was 30.34% (p &lt; 0.0001). Adenoma detection rate for &lt; 100 colonoscopies was 25.28% and &gt; 100 colonoscopies was 32.98% (p = 0.0003). Comparison of completion rates between both good and satisfactory bowel prep was 91.27% against poor prep 81.25% (p &lt; 0.001). Reasons for non completion in order of frequency were patient discomfort, excess looping, pathology encountered limiting progression, inadequate bowel preparation, tight stricture and instrument inadequacy. For sedation, the number of times pethidine given &gt; 50 mg was 0.15% and number of times midazolam given &gt; 5 mg was 0.05%. <h3>Conclusion</h3> Performing at least 100 colonoscopies a year statistically improves completion rate, polyp detection rate and adenoma detection rate. Good and satisfactory bowel prep statistically improves completion rate. This audit supports the JAG recommendation that a colonoscopist should perform &gt; 100 colonoscopies per annum to maintain competency. <h3>Disclosure of Interest</h3> None Declared <h3>Reference</h3> Valori R, Barton R. BSG quality and safety indicators for endoscopy. JAG: Joint Advisory Group on GI Endoscopy. 2007; 1–13.

AB0775 Predictors of osteopenia in a uk population referred for dexa scanning

BackgroundIt is acknowledged that the majority of fragility fractures occur in osteopenic individuals1. It is not known whether the traditionally defined risk factors for osteoporosis are synonymous with those of...

THU0391 Is there a Relationship between Hip Structural Analysis and Bone Mineral Density at the Hip and Spine?

BackgroundHip structural analysis (HSA) has been suggested as possible method of improving prediction of hip fracture risk above that provided by current bone mineral density (BMD) use alone. To our...