Royal Liverpool Hospital Research Articles

Quantification of Fundus Autofluorescence Features in a Molecularly Characterized Cohort of More Than 3500 Inherited Retinal Disease Patients from the United Kingdom.

To quantify relevant fundus autofluorescence (FAF) image features cross-sectionally and longitudinally in a large cohort of inherited retinal diseases (IRDs) patients. Retrospective study of imaging data (55-degree blue-FAF on Heidelberg Spectralis) from patients. Patients with a clinical and molecularly confirmed diagnosis of IRD who have undergone FAF 55-degree imaging at Moorfields Eye Hospital (MEH) and the Royal Liverpool Hospital (RLH) between 2004 and 2019. Five FAF features of interest were defined: vessels, optic disc, perimacular ring of increased signal (ring), relative hypo-autofluorescence (hypo-AF) and hyper-autofluorescence (hyper-AF). Features were manually annotated by six graders in a subset of patients based on a defined grading protocol to produce segmentation masks to train an AI model, AIRDetect, which was then applied to the entire MEH imaging dataset. Quantitative FAF imaging features including area in mm 2 and vessel metrics, were analysed cross-sectionally by gene and age, and longitudinally to determine rate of progression. AIRDetect feature segmentation and detection were validated with Dice score and precision/recall, respectively. A total of 45,749 FAF images from 3,606 IRD patients from MEH covering 170 genes were automatically segmented using AIRDetect. Model-grader Dice scores for disc, hypo-AF, hyper-AF, ring and vessels were respectively 0.86, 0.72, 0.69, 0.68 and 0.65. The five genes with the largest hypo-AF areas were CHM , ABCC6 , ABCA4 , RDH12 , and RPE65 , with mean per-patient areas of 41.5, 30.0, 21.9, 21.4, and 15.1 mm 2 . The five genes with the largest hyper-AF areas were BEST1 , CDH23 , RDH12 , MYO7A , and NR2E3 , with mean areas of 0.49, 0.45, 0.44, 0.39, and 0.34 mm 2 respectively. The five genes with largest ring areas were CDH23 , NR2E3 , CRX , EYS and MYO7A, with mean areas of 3.63, 3.32, 2.84, 2.39, and 2.16 mm 2 . Vessel density was found to be highest in EFEMP1 , BEST1 , TIMP3 , RS1 , and PRPH2 (10.6%, 10.3%, 9.8%, 9.7%, 8.9%) and was lower in Retinitis Pigmentosa (RP) and Leber Congenital Amaurosis genes. Longitudinal analysis of decreasing ring area in four RP genes ( RPGR, USH2A, RHO, EYS ) found EYS to be the fastest progressor at -0.18 mm 2 /year. We have conducted the first large-scale cross-sectional and longitudinal quantitative analysis of FAF features across a diverse range of IRDs using a novel AI approach.

Development and validation of Ran as a prognostic marker in stage I and stage II primary breast cancer

PurposeExisting prognostic biomarkers are inadequate for stratifying breast cancer patients with the highest risk of tumor progression at the time of diagnosis. Here, we demonstrate that the small GTPase Ran has predictive value for breast cancer (BC) patients as a whole, and for specific BC subtypes. Patients and methodsRan expression was quantified by immunohistochemistry in 263 patients with primary breast cancer diagnosed at the Breast Unit, Royal Liverpool Hospital. Additionally as an independent validation, we also analyzed the mRNA expressions of Ran, ER, PR, and Cerb-2, the triple-negative endocrine receptors, and their associations with patient survival in a combined patient cohorts of multiple public datasets (n = 1079). We analyzed the data with Spearman's rank correlation and Kaplan-Meier plots coupled with Wilcoxon-Gehan tests, respectively. All statistical tests were two-sided. ResultsRan nuclear, cytoplasmic, and total staining are substantially associated with poor survival, independent of conventional prognostic markers such as estrogen receptor (ER), human epidermal growth factor receptor 2 (HER2), and lymph node status. According to the datasets, Ran was significantly correlated with distant metastasis-free survival (DMFS) and relapse-free survival (RFS). ConclusionWe found that Ran expression is a unique predictive biomarker for patient survival, metastasis, and tumor relapse. This biomarker could be used for diagnostic purposes, using formalin-fixed, paraffin-embedded tumor biopsy samples from breast cancer patients in the early stages.

Serum protein electrophoresis and rheumatoid factor analysis is an effective screening strategy for cryoglobulinaemia

Accurate serum cryoglobulin detection is important to allow prompt treatment but laboratory testing requires stringent pre-analytical conditions and has long turnaround times. Serum protein electrophoresis (EPG) for paraproteinaemia and rheumatoid factor (RF) analysis may offer an effective initial screening strategy for the presence of cryoglobulinaemia. We retrospectively assessed the sensitivity of ancillary EPG and RF testing for the presence of serum cryoglobulinaemia in 586 eligible cryoglobulin positive samples received at the Royal Prince Alfred and Liverpool Hospital immunopathology laboratories over an 11-year period. Ninety-one percent of all cryoglobulin positive samples had either a detectable paraprotein or RF activity, with greatest sensitivity for type I and type II cryoglobulins (97% and 98%, respectively). The sensitivity remained high irrespective of whether EPG and RF analysis was performed with the same, or different, pre-analytical collection conditions to the cryoglobulin collection (92% vs 90%, p=0.46). Only two patients with detected cryoglobulins and no associated paraprotein or RF activity had clinical features of cryoglobulinaemia and neither required treatment. This study demonstrates that serum EPG and RF analysis has high sensitivity for the detection of clinically relevant cryoglobulinaemia, even when not collected under ideal pre-analytical conditions, and potentially offers a prompt and effective screening strategy.

Maria Helena Gilleece

Maria Helena Gilleece was a distinguished and talented student, attaining scholarships, winning the Henry Cohen and W.F Jones year prizes in medicine and general practice, and intercalating with a BSc...

CPAP delivered outside critical care during the second wave of COVID-19: outcomes from a UK respiratory surge unit

BackgroundNHS England recommends non-invasive continuous positive airway pressure (CPAP) as a possible treatment for type 1 respiratory failure associated with COVID-19 pneumonitis, either to avoid intubation or as a ceiling...

In memory of Dr Maria Helena Gilleece MD, MBChB, BSc Hons (Biochem), MRCP, MRCPath, PGCMed (27th November 1959-24th June 2021).

In memory of Dr Maria Helena Gilleece MD, MBChB, BSc Hons (Biochem), MRCP, MRCPath, PGCMed (27th November 1959-24th June 2021).

P232 Assessing effectiveness and patient perceptions of a novel electronic medical record for the management of inflammatory bowel disease

Abstract Background There is an increasing prevalence of chronic disease worldwide, resulting in multiple management challenges. Inflammatory bowel disease (IBD) is an exemplar chronic disease requiring optimal longitudinal coordinated care. We propose that Crohn’s Colitis Care (CCCare), a novel IBD-specific electronic medical record intended to improve IBD care is effective and acceptable to patients. We aimed to assess both the effectiveness of CCCare for data capture and patients’ acceptability of CCCare. Methods Methods: The study was conducted at two tertiary Australian hospitals with dedicated IBD services: Royal Adelaide Hospital and Liverpool Hospital. The effectiveness of CCCare was examined by comparing IBD-specific data completeness between pre-existing medical records and CCCare. Acceptability was assessed with quantitative and qualitative feedback through the CCCare patient portal and with standardized paper-based questionnaires administered to a convenience sample of IBD clinic patients in two unmatched pre-CCCare and post-CCCare exposure cohorts. Descriptive statistics and multivariable regression models were applied to specifically examine overall ratings of CCCare acceptability using a 10-point numeric scale; factors associated with acceptability before exposure to the system and whether exposure or security concerns influenced its acceptability. Results In all 73 cases reviewed, there was data gain when using structured CCCare fields compared to IBD documentation in usual medical records. Acceptability assessment through the patient portal feedback of 287 patients showed that the majority were very likely to recommend it to others (score, 8.56 ± 2.2 on a scale of 0–10). Common themes of concern among the 22 respondents with qualitative feedback were related to the novelty and limited experience of CCCare. Study questionnaires indicated that the overall acceptability in the combined cohort (n=310) was very high (8.4 ± 2.1; scale of zero to ten) with more than three-quarters of patients rating acceptability as at least 8 out of 10. Self-reported information technology (IT) literacy was positively associated with acceptability. Exposure had a small positive affect on acceptability while the level security concerns had little impact on acceptability. Conclusion The IBD-specific electronic medical record CCCare is effective in facilitating enhanced completeness of IBD-specific data capture in comparison to pre-existing medical records. It is highly acceptable to patients, especially those with reasonable IT literacy. Patient concerns about privacy and security of EMRs did not significantly influence acceptability.

298 Incidence and Causes of Aneurysm Growth Following Endovascular Sealing of Abdominal Aortic Aneurysms

Abstract Objective To analyse the incidence of aneurysm growth after endovascular aneurysm sealing (EVAS) and its relationship with adherence to the instructions for use (IFU). Method This study observed the clinical outcomes of patients who had an elective infrarenal EVAS procedure performed at the Royal Liverpool Hospital between 2013 and 2018. The primary outcome measure was the occurrence of aneurysm growth after EVAS. Aneurysm growth was defined as a 5% increase in the aortic volume between the renal arteries and the aortic bifurcation from the 1-month scan to subsequent annual scans. Results There were 71 patients with a mean (standard deviation) age of 76 (6) years who were eligible for inclusion in this study. Aneurysm growth was observed in 8 of 19 (42%) within IFU and 14 of 52 (27%) outside IFU (P ¼ .35). There was no relationship between aneurysm growth and adherence to IFU. Among the patients with aneurysm growth, the median (range) increase in abdominal aortic aneurysm volume was 11% (5%-20%). Conclusions Abdominal aortic aneurysm growth occurs in a significant proportion of patients at 1 year after EVAS and is not associated with adherence to IFU. Longer follow-up on a larger sample size is essential to understand the long-term clinical outcomes after EVAS.

Advanced nursing practice in kidney care

Journal of Kidney CareVol. 5, No. 4 Association of Nephrology NursesAdvanced nursing practice in kidney careVicky AshworthVicky AshworthEmail: E-mail Address: [email protected]Advanced Nurse practitioner Royal Liverpool Hospital and Nurse Lecturer University of Liverpool, ANNUK executive board memberSearch for more papers by this authorVicky AshworthPublished Online:29 Jul 2020https://doi.org/10.12968/jokc.2020.5.4.186AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Royal College of Nursing. Advanced Level Nursing Practice. 2018. www.rcn.org.uk/ANP (accessed 30 June 2020) Google Scholar FiguresReferencesRelatedDetails 2 July 2020Volume 5Issue 4ISSN (print): 2397-9534ISSN (online): 2397-9542 Metrics History Published online 29 July 2020 Published in print 2 July 2020 Information© MA Healthcare LimitedKeywordssupportnursing voicescareer pathwaysadvanced practicePDF download

Ileo-anal pouch excision and permanent ileostomy – Indications and outcomes from a tertiary centre

PurposePouch excision is a major complication of ileoanal pouch surgery. Current practice is for this type of surgery to be performed in a specialist centre. We present a series of patients undergoing pouch excision surgery in a high volume centre in the UK and assess the outcomes in these patients. MethodsAll patients undergoing pouch excision at the Royal Liverpool Hospital between 1995 and 2015 under the care of a single surgeon were included. Demographics and outcomes were taken from patients' notes and a dedicated retrospectively compiled database. Results35 patients underwent pouch excision surgery during this period. Around half the patients had their original pouch surgery elsewhere and were referred for management of complications. Median time to pouch excision was 13 years from the original operation. Overall complication rate was 31% with 11% requiring re-intervention post-operatively. There was no mortality in this series. ConclusionPouch excision is a complex, high-risk procedure that should be carried out in specialist centres. Our series shows that in such settings, good outcomes can be achieved for these patients.

P242 Are point of care tests pricking positive people?

Background/introduction/Aims To establish whether point of care testing is being carried out in the appropriate populations. We endeavoured to see if our rapid HIV testing met the guideline specificity of 99.4% Methods We carried out a retrospective analysis of 674 patients who received point of care tests (POCTs) after attending the sexual health clinic at the Royal Liverpool Hospital between October 2014 and May 2015. We reviewed the point of care tests based upon the indication, age and sex of the patient. The outcome measures included whether the test was reactive or not and the final result of the laboratory HIV test. Indications were defined by individual staff members logging the information and if multiple indications were given, the aspect deemed to be higher risk was used Results Of the 674 patients 499 were female and 175 were male. The four most common indications were for testing were MSM (36%), Worried/Anxious (15%), PEP (11.5%) and HIV positive partner (9%). 31 tests (4.8%) were reactive and 23 tests (3.4%) produced a corresponding positive final laboratory result. This equated to a specificity of 98.77%. Positivity of indications varied remarkably-MSM, 3.7% versus Worried,0%. Discussion/conclusion The study developed our understanding of the uptake of POCTs. A larger sample could have increased the specificity to the national guidance. The variability in documentation made it difficult to categorise risk in different indications. For example, indications of “high risk” and “worried” are vague and potentially misleading.

The influence of continuous subcutaneous insulin infusion therapy vs. multiple daily injections upon the diet of those with Type 1 diabetes: A food diary investigation

There exist a number of therapeutic options for the management of Type 1 diabetes (T1D). Multiple daily injections (MDI) are one such treatment and involve 4-5 daily subcutaneous injections of insulin. This frequently used approach is widely regarded as an effective method of controlling glycaemia; however, if a patient continues to suffer disabling episodes of hypoglycaemia, or if HbA1c remains above 8.5% continuous subcutaneous insulin infusion (CSII) may instead be recommended1. This therapy employs a small programmable pump device to facilitate the administration of insulin to the patient via a cannula. Various advantages of CSII have been documented compared to MDI, including improvements in glycaemic control and reduced incidence of both hypoglycaemia and the dawn phenomenon. An additional attribute, characterised by the flexible nature of the therapy, is that a liberalised diet may be enjoyed by patients, which in turn may infer potential nutrition and quality of life aberrations. This phenomenon is surprisingly under researched and further investigations to inform both treatment and risk would therefore be beneficial. Following ethical approval and informed consent patients with T1D using either CSII or MDI from the Royal Liverpool Hospital were asked to complete a 5 day weighed food diary. Dietplan 6 software was used to process the responses and demographic data from participants’ medical records were added to the dataset. All data were then interrogated using descriptive statistics and any non-normal data were transformed logarithmically before further enquiry with t-tests or analysed non-parametrically with Mann-Whitney-U-tests. The sample comprised of 20 patients (35% male, 65% female) with 11 using CSII and 9 using MDI. The patients’ mean age was 49±16 years and the majority were overweight or obese (72.7% CSII, 55.6% MDI). Nutrient Amount per day (CSII group) Amount per day (MDI group) % energy intake per day (CSII group) % energy intake per day (MDI group) Energy 1866.6 Kcal 2110.5 Kcal N/A N/A Protein 69.0 g/day 89.9 g/day 14.8 17.0 Total CHO 232.3 g/day 251.8 g/day 46.7 44.7 Total sugars 99.8 g/day 88.6 g/day 20.0 15.7 Total fat 73.5 g/day 80.1 g/day 35.4 34.2 Saturated fat 31.6 g/day 29.8 g/day 15.2 12.7 Table. Selected food diary results from patients using CSII and MDI compared to reference nutrient intakes. Results showed mean energy intake was below the reference nutrient intake (RNI) for the CSII group; potentially suggestive of underreporting (Table)3. Patients using both CSII and MDI consumed protein above the RNI; however, this macronutrient contributed towards 14.8% of the daily energy intake of patients using CSII and 17.0% of those using MDI3. Total carbohydrate (CHO) consumption was below the RNI of 50%; however, it should be noted that consumption of total sugars was above the RNI for males and females in both groups4. Previous research by the authors suggesting habitual fruit consumption, particularly in those using CSII, may explain this5. Total fat and saturated fat consumption was mostly synonymic with RNI’s. Although no statistically significant associations were seen between any of the variables and the diets of the two populations appeared largely homogenous it is reassuring that no detrimental changes occurred. Despite this further analysis of total energy, protein and CHO quality is warranted.

PWE-106 Is functional sarcopenia associated with hepatic encephalopathy and severity of cirrhosis?

Introduction The original Child-Turcotte score to assess stage severity of cirrhosis included an assessment of nutritional status. Loss of muscle mass (sarcopaenia) is increasingly recognised in patients with end-stage liver disease (ESLD) and skeletal muscle is recognised as a source of ammonia metabolism. The aim was to determine if there was an association with functional sarcopaenia, MELD score, hepatic encephalopathy (HE) and risk of death. Method A pilot retrospective-prospective cohort analysis of inpatients with ESLD presenting at the Royal Liverpool Hospital Between January 2014–June 2014. Patients with cirrhosis had a nutritional assessment including: BMI, hand-grip strength (HGS), biochemical assessment, MELD calculation and clinical assessment for HE. End points were to assess if there was an association with HGS with liver cirrhosis severity (MELD), HE, and death. Follow-up was completed January 2015. Results 64 patients were included in the final analysis. Male 39 (61%), median age 54 (IQR47–61 yrs). Disease aetiology was: ALD 56 (87.5%), NASH 3 (4.7%), HCV 3 (4.7%), HFE 1 (1.6%), AIH 1 (1.6%). 12 patients (19%) had HE. There were 12 deaths over the study period (19%). There was no association with HE and death on fishers exact test (p=NS). On univariate analysis the following factors were assessed for risk of death: MELD p = 0.002, Vitamin D p = 0.6, HGS p = 0,16, age p = 0.21. There was a correlation between hand grip strength and MELD (spearmans test 0=0.04), and there was also a correlation between HGS strength and HE (spearmans p = 0.03). Conclusion There is a correlation with HGS with liver disease severity and HE. No association was proven with HGS and survival in this small pilot study. HGS could be used to refine prognosis in ESLD. Large studies investigating the mechanisms and role of sarcopaenia in ESLD are required. Disclosure of interest None Declared.

OC-051 Practicalities of setting up a new procedure room in endoscopy

Introduction A fifth endoscopy room was set up at the Royal Liverpool Hospital (RLH) October 2014; this was necessary to guarantee an increased capacity in order to meet current and predicted service needs. This was to accommodate the increase in activity from upper and lower GI investigation including the Be Clear on Cancer campaign, the bowel cancer screening programme (BCSP) and rise in complex endoscopy. Method Aim : This is a reflective look at a room set up. What was achieved by its set up and what lessons have been learned through the process. Prior to implementation : 4 rooms were undertaking 17,500 procedures per year with 25% inpatients 75% day-case activity. Waiting times were urgent 2 wks, routine 6 weeks, and surveillance 6 weeks. Due to the rise in referrals extra lists were being planned at weekends in order to maintain current targets. The cost of the waiting lists for the year was £400,000.00 running 200 lists in 2014. Staff often worked during the week and the weekend which impacted negatively on work life balance. Resource planning 10 extra sessions were created. A sound business case was needed to support the £375,000.00 investment. A stack system was purchased. Extra scopes purchased to support increased lists. Consideration made regarding purchase of extra stock and consumables. Further storage areas needed to be found to house equipment. Close links developed with estates teams and architects. Workforce planning and implementation. A collaborative approach between Trust, Consultants, Nurse Managers, Administration and Human Resources and nursing unions was necessary to ensure full staff engagement as job plans and contracts had to be altered. The increased workload required a long term investment of; 1 X WTE Nurse Endoscopist (for training and 6 lists), 5X WTE Nurses/6 WTE HCAs,1 X WTE Admin. Consultant endoscopists opt in to extra sessions. Operational issues: Space in recovery is premium staff now discharge all un-sedated patients directly from procedure room. New roles established, band four staff to assist in discharging. Assessment of environmental limitations, considerations need to be made on single sex pathways. Results All routine and 2ww targets have been maintained. No WLI sessions to date. Complex therapy lists have increased by two/three sessions per week. Able to facilitate an extra two lists for colonoscopy per week. Work-force flexibility and a steady communication with admin manager has meant 95% utilisation for all sessions. Conclusion An extra endoscopy room improves capacity and reduces waiting times but needs workforce planning and significant capital investment. Environmental constraints will need careful consideration. Creating a new room requires planning, leadership, workforce flexibility and a dedicated team. Disclosure of interest None Declared.

P107. Can axillary lymph node clearance be avoided in select sentinel lymph node positive patients?

P107. Can axillary lymph node clearance be avoided in select sentinel lymph node positive patients?

An investigation into the eating behaviours of adult patients with Type 1 diabetes using continuous subcutaneous insulin infusion therapy compared to those using multiple daily injections

Multiple daily injections (MDI) are an intensive method of administering an external source of basal and bolus insulin for patients with Type 1 diabetes (T1D). This therapy requires 4-5 injections per day, is regarded as an effective method of achieving glycaemic control and is commonly used. If HbA1c remains above 8.5% or if a patient is experiencing disabling hypoglycaemic episodes continuous subcutaneous insulin infusion (CSII) therapy may be recommended1. CSII provides flexible insulin administration via a small, electronic pump unit and has been associated with various benefits when compared to MDI, including increased glycaemic control, reduced occurrence of hypoglycaemia and improvements in the dawn phenomenon1,2. Furthermore, the flexible nature of CSII potentially allows patients to enjoy a liberalised diet compared to those using the relatively structured MDI regime2. There is a dearth of evidence focussing on the eating behaviours of these patients and research into this area would be useful to inform both treatment and the evaluation of risk. Following ethical approval and informed consent patients with T1D using either CSII or MDI from the Royal Liverpool Hospital were asked to complete an EPIC-Norfolk food frequency questionnaire (FFQ). Responses were processed using FETA software and demographic data from participants’ medical records were added. All data were initially analysed using descriptive statistics. Any data not normally distributed were transformed logarithmically and t-tests and Mann-Whitney-U-tests were then carried out. The study population consisted of 60 patients (33.3% male, 66.7% female) with 40 using CSII and 20 using MDI and a mean age of 48±16 years. The majority of patients were overweight or obese (71.4% CSII, 57.1% MDI), however energy intake was below the reference nutrient intake (RNI) for both CSII and MDI groups. Patients using both CSII and MDI consumed protein above the RNI for males and females3. Despite this protein contributed towards 18.6% of the daily energy intake of patients using CSII and 19.0% of those using MDI. Total carbohydrate (CHO) consumption was below the RNI of 50%, however it should be noted that consumption of total sugars was above the RNI for males and females in both groups. This may be partly explained by the consumption of fruit which was also higher in those using CSII. Total fat and saturated fat consumption was marginally above the RNI’s. There were no statistically significant associations between any variables and the diets of the two populations appear largely homogenous, despite slight deviations of some nutrients from RNI’s. Further analysis of total energy, protein and CHO quality is warranted.

PTH-058 A Centres Experience Of Setting Up A New Bowel Cancer Screening Centre And Preparing For Bowel Scope

IntroductionThe population served by the Merseyside and North Cheshire Programme was 1.7 million based at University Hospitals Aintree was asked to split because of the imminent introduction of Bowel scope....

PWE-107 Accuracy Of Magnetic Resonance Enterograpgy In Predicting Anastomotic Stenosis In Recurrent Crohn’s Disease

IntroductionUp to 80% of patient with Crohn’s disease (CD) undergo intestinal resection, commonly an ileocaecal resection. Eighty percent of patients develop endoscopic recurrence at the anastamotic site at 1 year...

Abstract T P344: Clopidogrel Resistance in Stroke Patients (The CRISP Trial)

Background: Clopidogrel is a thienopyridine with ADP antagonising effects that is widely used in the secondary prevention of ischemic strokes and transient ischemic attacks (TIAs). Despite this some patients will go on to have recurrent strokes or TIAs. Cardiology trials have identified patients with clopidogrel resistance, defined as a vasodilator-stimulated phosphoprotein (VASP) index of >50% after at least 7 days of clopidogrel treatment. This was associated with recurrent cardiac events. The VASP-index measures phosphorylation of VASP in the resting state and activated states using flow cytometry techniques. As phosphorylation of VASP is dependent upon activation of the platelet P2Y12 receptor that is targeted by clopidogrel the difference in phosphorylation between the two states provides an indirect measure of platelet inhibition. Previous trials have shown a prevalence of clopidogrel resistance in stroke patients of between 8 and 18%, but no study to date has shown whether this is associated with significantly more recurrent cerebrovascular events. We are testing the hypothesis that amongst patients treated with clopidogrel for secondary prevention of cerebrovascular disease, those with resistance are more likely to have recurrent Strokes or TIAs. Should this hypothesis be confirmed, then further research would be needed to identify treatment strategies that may minimise this risk. Design A prospective cohort study recruiting 120 patients from the acute stroke unit at the Royal Liverpool hospital with a diagnosis of stroke or TIA that will be commenced on clopidogrel therapy and expected to continue it for at least one year. We will compare outcomes between those found to be 'clopidogrel responders' and 'clopidogrel resistant'. A sample size of 120 patients was chosen based on the concept of 'reproducibility probability', taking into account the number of patients needed for similar studies in cardiology patients, the prevalence of 'clopidogrel resistance' amongst stroke patients and the potential for patients to later be excluded. Outcome Recurrent cerebrovascular event within 6 months of entering trial. Trial Status Recruitment ongoing.

CLINICAL CHARACTERISTICS AND RISK FACTORS FOR BILE SALT MALABSORPTION

IntroductionBile acid malabsorbtion (BAM) is a known cause of chronic diarrhoea. The condition is easily diagnosed by performing a selenium homocholic acid taurine (SeHCAT) test, with 7-day retention of <10%...