Significant Difference In Adequacy Research Articles

Evaluation of Knowledge, Attitude, and Practice of Community Pharmacists in Managing Chronic Diseases in Lahore, Pakistan

Background: The rising number of chronic illnesses such as asthma, diabetes, osteoarthritis, hypertension, and chronic kidney disease (CKD) presents a major danger to the worldwide health community. The ability of individuals to successfully manage their medical problems with the help of healthcare professionals is essential to the effective control of chronic illnesses. Objective: The current study focuses to evaluate the knowledge of community pharmacist’s regarding chronic disease management, their attitude, and their practice to control chronic diseases. Methods: A cross-sectional survey-based study was conducted using random sampling method in Lahore, Pakistan. The samples collected for this study was 110. However, the final sample size was 93, the remaining forms were discarded. Data was collected by visiting community pharmacies in Lahore. The filled questionnaires were analyzed by using Statistical Package for Social Sciences program software (SPSS Inc., version 21.0, IBM corp., Armonk NY, USA). P-value of less than 0.05 were considered as statistically significant values. Results: The results, with a p value of 0.001, indicate a significant difference in adequacy of knowledge between the male and female groups. Majority of the participants have bachelor’s education and are unmarried. The p-value of 0.871 for level of education shows insignificant association between the higher education and better practice scores. The most important finding in this study is significant relationship between technology proficiency and adequacy of knowledge with p-value of 0.005. This shows that those who are more proficient in the technology are significantly more likely to have adequate knowledge. Conclusion: This study concludes that the majority of community pharmacists had adequate knowledge regarding chronic disease management. But showed neutral attitude and fair practice towards the control of chronic diseases. In order to optimize the management of chronic diseases, community pharmacists need to exhibit best practices and a positive attitude.

Adecuacy of pediatric antimicrobial prescribing in the Emergency Department at discharge

IntroductionIn January 2019, the Community of Madrid’s Health Department published a guide about the use of antimicrobials in outpatient children. Taking this regional Guide as reference, this study was aimed at estimating the adequacy of the antimicrobial stewardship at discharge from a pediatric Emergency Department (ED). Secondarily, the differences in adequacy according to the diagnosis and the prescriber were studied, and the agreement between this Guide and the protocols of the ED was assessed. Material and methodsAn observational, descriptive, retrospective study was conducted on patients under 16 years old, with a diagnosis included in the regional Guide who were discharged from a pediatric ED between March of 2018 and February of 2019. Prescription was considered adequate when the indication, the antibiotic and the posology (dosage, dosing interval, length of treatment and route of administration) were correct. Results165 out of 648 (25,5%) infectious diseases processes analyzed received antimicrobial treatment. In 23 processes treated with antimicrobial, the adequacy could not be evaluated due to the absence of data necessary to assess any aspect of posology. Therapy was considered appropriate in 550/625 processes (88.0%). When antimicrobial treatment was prescribed, 70/142 (49.3%) were appropriate and no statistically significant differences in adequacy were found between prescribers. Posology was the worst handled point of the prescription (26.3%). Tract urinary infection, conjunctivitis and otitis media were the pathologies with the lowest adecuacy (44.4%; 50.0% and 52.2%) and presented the highest discrepancy between the Guide and the center protocols (κ = 0.308; κ = 0.000; κ = 0.586). ConclusionsThe adequacy of the management of infectious processes to the reference Guide in our pediatric ED was high, but it was below 50% when antimicrobial treatment was required. The degree of adequacy to the local protocols of the center was greater than to the regional Guide. This reveals a discrepancy between the 2 documents that should be analyzed and corrected according to the available scientific evidence.

Adecuación de la prescripción de antimicrobianos en procesos ambulatorios atendidos en Urgencias

IntroductionIn January 2019, Community of Madrid's Health Department published a guide about the use of antimicrobials in outpatient children. Taking this regional Guide as reference, this study was aimed at estimating the adequacy of the antimicrobial stewardship at discharge from a pediatric Emergency Department (ED). Secondarily, the differences in adequacy according to the diagnosis and the prescriber were studied, and the agreement between this Guide and the protocols of the ED was assessed. Material and methodsAn observational, descriptive, retrospective study was conducted on patients under 16 years old, with a diagnosis included in the regional Guide who were discharged from a pediatric ED between March of 2018 and February of 2019. Prescription was considered adequate when the indication, the antibiotic and the posology (dosage, dosing interval, length of treatment and route of administration) were correct. Results165 out of 648 (25,5%) infectious diseases processes analyzed received antimicrobial treatment. In 23 processes treated with antimicrobial, the adequacy could not be evaluated due to the absence of data necessary to assess any aspect of posology. Therapy was considered appropriate in 550/625 processes (88.0%). When antimicrobial treatment was prescribed, 70/142 (49.3%) were appropriate and no statistically significant differences in adequacy were found between prescribers. Posology was the worst handled point of the prescription (26.3%). Tract urinary infection, conjunctivitis and otitis media were the pathologies with the lowest adecuacy (44.4%; 50.0% and 52.2%) and presented the highest discrepancy between the Guide and the center protocols (k=0.308; k=0.000; k=0.586). ConclusionsThe adequacy of the management of infectious processes to the reference Guide in our pediatric ED was high, but it was below 50% when antimicrobial treatment was required. The degree of adequacy to the local protocols of the center was greater than to the regional Guide. This reveals a discrepancy between the 2documents that should be analyzed and corrected according to the available scientific evidence.

Comparing Diet Quality of Racial Minority Children from Low-Income Households During the Summer versus School Year: Results from the Project SWEAT Study (P04-102-19)

ObjectivesCompare the diet quality of racial minority school-age children from low-income households during the summer versus school year. MethodsTwo elementary schools in low-income urban neighborhoods of Columbus, OH were recruited. Families with children at these schools were invited to participate. Caregivers completed a demographic survey at baseline (t0). Child diet was assessed using three 24-hr dietary recalls (2 weekdays and 1 weekend day) at 3 time points: 1) baseline/beginning of summer (t0); 2) middle of summer (t1); and 3) beginning of subsequent school year (t2). Demographic data were summarized. Healthy Eating Index (HEI) 2015 was calculated: total [100] and component [Adequacy: total fruit (5), whole fruit (5), total vegetable (5), greens and beans (5), whole grains (10), dairy (10), total protein (5), seafood and plant protein (5), fatty acids (10); Moderation: refined grains (10), sodium (10), added sugars (10), saturated fats (10)]. Paired t-tests were conducted to determine differences in diet quality between time points (t0: t1, t1: t2, t0: t2). Results62 children (39 families) enrolled. Mean age was 7.08 ±0.34 yr, 80.67% were African American, and 69.35% low-income. Participant retention from t0: t1 and t0: t2 was 95.16% and 75.81%. Mean total HEI was 47.37 ± 1.57 (t0), 47.51 ± 1.22 (t1), and 51.13 ± 1.46 (t2) with significant differences between summer and school year time points (t0: t2, P = 0.02; t1: t2, P = 0.01). Significant differences in adequacy and moderation HEI component scores between the two summer time points and school year time point were observed such that child diet quality was better during the school year. Adequacy: whole fruit (t1: t2 P = 0.02), total vegetable (t0: t2 P < 0.01; t1: t2 P < 0.01), greens beans (t0: t1 P < 0.01; t1: t2 P < 0.01), and seafood and plant protein (t0: t2 P = 0.06; t1: t2 P = 0.08). Moderation: sodium (t0: t2 P = 0.07) and added sugar (t0: t2 P = 0.06; t1: t2 P = 0.02). The HEI component score for whole grains was significantly better during the summer compared to the school year (t0: t2 P < 0.01; t1: t2 P < 0.01). ConclusionsExcept for whole grains, child diet quality is better during the school year versus summer. Findings from this study provide the first insight into potential determinants of unhealthy weight gain observed among economically disadvantaged, school-age children during the summer months. Funding SourcesUSDA North Central Nutrition Education for Excellence.

PWE-134 Transjugular liver biopsy versus percutaneous liver biopsy – indications, adequacy, quality of specimens and complications

Introduction Liver biopsy (LB) can be associated with adverse outcomes including technical failures, complications and inadequate tissue for histological analysis. The indication for a chosen route of LB is variable between physicians and the impact of the chosen route of LB is often unclear. Method Retrospective review of all LB performed at a UK transplant centre over a 12 month period focussing on indication and route of LB, complications, histological adequacy and variability in operator specialty and experience. Results Over the 12 month period 570 LB were performed, of which 330 were transjugular liver biopsies (TJLB) and 240 were percutaneous liver biopsies (PCLB). A LB was categorised as being histologically adequate if a histological diagnosis could be made, or if the sample met the histological standard in the literature (a 15 mm sample, with 6 or more complete portal tracts). Overall, 94% of LB were adequate based on the histological standard, and 98% allowed histological diagnosis. There were no significant differences in adequacy when comparing TJLB vs. PCLB route; however, a consultant radiologist was more likely to provide an adequate sample than a radiology registrar (p = 0.02). The overall complication rate for a liver biopsy was 5.6%. This included 8 major complications (1.4%) and 24 minor complications (4.2%). Neither the route of LB (TJLB vs. PCLB) or operator (consultant radiologist vs. radiology registrar vs. hepatologist) was significantly associated with the development of a complication. The technical failure rate of a TJLB was 4%; these included failure to puncture internal jugular vein, failure to cannulate the hepatic vein, or an unstable sheath position. There were no technical failures in the PCLB group. Screening time for a TJLB was significantly longer if the procedure was done by a radiology registrar when compared to both a hepatologist (p = 0.01) or consultant radiologist (p = 0.003). Apart from the standard indications for a TJLB we found a patient was significantly more likely to undergo a TJLB if they were post-transplant compared to pre-transplant (p = 0.001) and if the biopsy was deemed an emergency compared to an elective procedure (p = 0.001). In our cohort we identified 130 patients who had a TJLB with no indication for this procedure. Conclusion We have demonstarted that TJLB and PCLB have no significant differences in complication rates or adequacy of histological sample. Technical failure is more common in TJLB compared to PCLB. A TJLB is our preferred method in emergency cases and post-transplant patients. Further information regarding cost and patient experience is needed to identify if a change in practice is indicated. Disclosure of interest None Declared.

Randomized controlled trial of comparison of the adequacy, and diagnostic yield of endoscopic ultrasound guided fine needle aspiration with and without a stylet in Indian patients: A prospective single blind study

Abstract Background: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is done using EUS-FNA needle with an internal stylet by most of the endosonographers. There is no data to suggest that it improves the quality of cytology specimen, and it is tedious and time-consuming. Aim: To compare EUS-FNA specimens obtained with stylet and without stylet for adequacy of the specimen, amount of blood on the slide, number of passes and diagnostic yield. Materials and Methods: Patients undergoing EUS-FNA of solid lesions by one experienced endosonographer at an Indian tertiary center from October 2013 to July 2014 were included. Totally, 115 consecutive patients with 128 lesions were randomized to undergo EUS-FNA with or without stylet. Cytology slides were evaluated by a single pathologist blinded to FNA technique. Results: EUS-FNA was done with stylet in 66 lesions (Group 1) and without stylet in 62 lesions (Group 2). Site of lesion was lymph node in 67 (52.3%), pancreas in 43 (33.6%), liver in 8 (6.2%), gastrointestinal subepithelial lesion in 4 (3.1%) and others in 6 (4.9%). The average size of the lesion was 23.7 ± 14.8. When outcomes of two groups were compared, there was no statistically significant difference in adequacy of smears (P = 1.00), amount of blood on slides (P = 0.92), number of passes (P = 0.49) and diagnostic yield (P = 0.86). Conclusions: There was no significant difference in adequacy of the specimen, amount of blood on the slide, number of passes and diagnostic yield between with and without a stylet groups. The use of a stylet does not confer any advantage during EUS-FNA.

Accuracy of Cytotechnologist Evaluation of Specimen Adequacy and Screening Interpretation of Malignancy in Fine-Needle Aspiration of the Liver

Objective: To evaluate the performance of cytotechnologists in assessing the adequacy and accuracy of the preliminary diagnosis for fine-needle aspirates of the liver. Study Design: We retrospectively analyzed 10 years of data and found 589 cases of ultrasound-guided fine-needle aspiration (FNA) of the liver with on-site evaluation of adequacy (OSEA). All the OSEA were performed by the cytopathologist because OSEA of liver FNA is not performed by cytotechnologists at our institution at present. After OSEA, the material was seen by cytotechnologists who rendered an adequacy assessment and preliminary diagnosis. We calculated the adequacy and accuracy statistics and compared the performance of the cytotechnologists with the OSEA and final interpretation. Results: There was no statistically significant difference in adequacy downgrade rate for cytotechnologist versus cytopathologist assessment during the study period (5 vs. 3%, p = 0.06). A total agreement of 88% was noted in overall diagnosis with 97% agreement in malignant cases. Conclusion: Cytotechnologists assess the adequacy of liver FNA accurately and there is therefore potential for them to perform OSEA for liver FNA.

Randomized Clinical Trial of Endobronchial Ultrasound Needle Biopsy With and Without Aspiration

Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (EBUS-TBNA) is performed with a dedicated 22- or 21-gauge needle while suction is applied. Fine-needle sampling without suction (capillary sampling) has been studied for endoscopic ultrasound and for biopsies at various body sites and has resulted in similar diagnostic yield and fewer traumatic samples. However, the role of EBUS-guided transbronchial needle capillary sampling (EBUS-TBNCS) is still to be determined. Adults with suspicious hilar or mediastinal lymph nodes (LNs) were included in a single-blinded, prospective, randomized trial comparing EBUS-TBNA and EBUS-TBNCS. The primary end point was the concordance rate between the two techniques in terms of adequacy and diagnosis of cytologic samples. The secondary end point was the concordance rate between the two techniques in terms of quality of samples. A total of 115 patients and 192 LNs were studied. Concordance between EBUS-TBNA and EBUS-TBNCS was high, with no significant difference in adequacy (88% vs 88%, respectively [P ± .858]; concordance rate, 83.9% [95% CI, 77.9-88.8]); diagnosis (36% vs 34%, respectively [P ± .289]; concordance rate, 95.8% [95% CI, 92-92.8]); diagnosis of malignancy (28% vs 26%, respectively [P ± .125]; concordance rate, 97.9% [95% CI, 94.8-99.4]); or sample quality (concordance rate, 83.3% [95% CI, 73.3-88.3]). Concordance between EBUS-TBNA and EBUS-TBNCS was high irrespective of LN size (≤ 1 cm vs > 1 cm). Regardless of LN size, no differences in adequacy, diagnosis, or quality were found between samples obtained using EBUS-TBNA and those obtained using EBUS-TBNCS. There is no evidence of any benefit derived from the practice of applying suction to EBUS-guided biopsies. ClinicalTrials.gov; No.: NCT00886847; URL: www.clinicaltrials.gov

Needle core vs open biopsy for diagnosis of intermediate- and high-risk neuroblastoma in children

Open biopsy has been the mainstay for definitive diagnosis of neuroblastoma in pediatric patients. However, needle core biopsy may represent a faster, less invasive, and safer alternative to open biopsy in children. The purpose of this study was to compare safety and efficacy between needle core and open biopsy in the diagnosis of patients with intermediate- and high-risk neuroblastoma at our institution. We retrospectively reviewed the medical records of children with intermediate- and high-risk neuroblastoma who underwent open or needle core biopsies from 2002 to 2010. Data collected included patient demographics, tumor size, sample adequacy for diagnosis and risk stratification (histology and cytogenetics), length of hospital stay, time to initiate chemotherapy after biopsy, need for repeat biopsy, and both intraoperative and postoperative complications. Mann-Whitney U and Fisher's exact tests were used for statistical analysis. During the study period, 7 patients underwent needle core primary biopsies (5 intermediate-risk primary tumors and 2 high-risk primary tumors), and 4 patients underwent needle core biopsy for metastatic tumors, whereas 21 patients had open biopsies (10, intermediate risk; 11, high risk). Median age at biopsy and median tumor size were similar in both groups. There was no significant difference in adequacy of biopsy, need for repeat biopsy, time to initiate chemotherapy, length of stay, or minor complications. The rate of major complications differed significantly between the 2 groups with 0% after needle core biopsy vs 48% after open biopsy (P = .027). In children, needle core biopsy is comparable in efficacy with open biopsy in the diagnosis of intermediate- and high-risk neuroblastoma with significantly lower rates of major postoperative complications. These findings warrant a larger scale evaluation of diagnostic needle core biopsies in pediatric patients with solid tumor.

Comparison of Ultrasound-Guided Biopsy Technique for Thyroid Nodules with Respect to Adequacy of Cytological Material

Background: Ultrasound-guided fine-needle aspiration cytology (FNAC) sampling of the thyroid represents a standard diagnostic procedure in the evaluation of thyroid nodules. The specimen can be acquired using either of two different techniques. In the first, the short axis is used with observation only of the tip of the needle whilst in the nodule. In the second technique, the long axis is used with the observation of the entire length of the needle. The decision to sample utilizing either technique was done randomly. This study is a retrospective review performed to compare these two techniques with regard to specimen adequacy. Methods: Ultrasound-guided FNACs were performed in 80 thyroid nodules between May 2008 and February 2009. One physician acquired the cytology specimens using one of these two methods after localization. Data on the type of technique and its diagnostic accuracy were collected. Results: Forty-nine of 80 thyroid nodules were sampled using the long-axis technique. The overall and deep-lesion diagnostic adequacies of specimens were significantly higher using this technique (93.9 and 95.1%, respectively, p < 0.01) than the short-axis technique. When comparing the long and short axes for superficial lesions, there was no significant difference in adequacy of the samples (p = 0.92). Conclusions: This is the first study to compare long- and short-axis techniques with regard to specimen adequacy for thyroid nodules. The long-axis technique decreased the rate of inadequate material and provided more accurate cytological evaluation for deeper lesions.

Predictors of Adequacy of Depression Management in the Primary Care Setting

Depression is most commonly treated in the primary care setting. However, most studies have shown that depression care in this setting is often inadequate. This study examined the adequacy of antidepressant treatment and overall depression management by primary care physicians and identified patient characteristics related to inadequate care. Adequacy of depression care among patients with depression who presented to a primary care office was evaluated by using physicians' self-reports and medication prescription data. Adequacy of depression care was measured in two ways: adequacy of the current medication trial was measured by using the Antidepressant Treatment and History Form (ATHF), and adequacy of overall management by the physician was measured by using an algorithm developed for this study. The association was examined between patient characteristics and adequacy of the medication trial or depression management. Data were gathered for 389 patients with depression. Overall, 71 percent of patients had adequate ATHF scores, and 75 percent were judged to receive adequate depression management. No significant differences in adequacy were seen on the basis of race, age, or gender. When depressive symptoms were almost absent or extremely severe, 91 percent of patients were adequately managed; in contrast, when symptoms were mild, mild to moderate, or moderate 69 percent of patients were adequately managed. Additionally, specific medications, such as sertraline and fluoxetine, were associated with a lower likelihood of an adequate ATHF score. A majority of these primary care patients were adequately treated for depression, with no detectable disparity related to race or age. However, mild to moderate depressive symptoms (as opposed to remitted or severe symptoms) and specific medications were associated with a lower rate of adequacy. These findings have implications for ways that primary care physicians could be trained to more adequately manage the spectrum of severity of depression.

Randomized comparison of laryngeal tube with classic laryngeal mask airway for anaesthesia with controlled ventilation

Only a prototype laryngeal tube has been compared with the classic LMA for brief periods of anaesthesia. We compared the new laryngeal tube (which had several improvements in design) with the classic LMA. We randomly allocated 72 patients to receive either the laryngeal tube or an LMA, and compared adequacy of controlled ventilation during anaesthesia (good: clear airway without complications; fair; clear airway with complications or suboptimal airway; or failed), leak pressure and the incidence of postoperative complications. Insertion was successful within 2 attempts in all 36 patients for the classic LMA and in 35 patients for the laryngeal tube. The mean leak pressure for the laryngeal tube (28 cm H(2)O) was significantly greater than that for the classic LMA (21 cm H(2)O) (P<0.001; 95% CI 3.6-10.0 cm H(2)O). Ventilation was good in 25 cases, fair in 11, and failed in no patients with the classic laryngeal mask airway; and good in 23, fair in 11 and failed in two for the laryngeal tube. There was no significant difference in adequacy of ventilation between the groups. The median peak airway pressure for the laryngeal tube (17.5 cm H(2)O) was greater than that for the classic LMA (16 cm H(2)O) (difference: 2 cm H(2)O; 95% CI 0-5 cm H(2)O). There was no significant difference in the incidence and severity of the postoperative complications between the two groups. The laryngeal tube was as effective as the classic LMA during anaesthesia with controlled ventilation. There were similar operative and postoperative complications.

Clinical Efficacy and Morbidity Associated with Continuous Cyclic Compared with Continuous Ambulatory Peritoneal Dialysis

To assess the clinical efficacy and morbidity of continuous cyclic peritoneal dialysis compared with continuous ambulatory peritoneal dialysis with a Y-connector as renal replacement therapy. Prospective, randomized study. University hospital. All new patients with end-stage renal failure consecutively entering the dialysis program from January 1988 through July 1991 were randomly assigned to receive continuous ambulatory peritoneal dialysis with a Y-connector or continuous cyclic peritoneal dialysis and were followed prospectively. Patient and technique survival, dialysis adequacy, and (infectious) morbidity. Forty-one patients (median age, 56 years; range, 18 to 86 years) started continuous ambulatory peritoneal dialysis with a Y-connector (follow-up, 688 patient-months), and 41 patients (median age, 54 years; range 21 to 76 years) started continuous cyclic peritoneal dialysis (follow-up, 723 patient-months). The two groups showed no significant differences in adequacy of dialysis (as assessed by blood pressure control and laboratory and neurologic variables) and patient or technique survival. Renal transplant was the primary reason for discontinuing the assigned dialysis technique in both groups. The average number of hospitalizations per patient-year was 1.0 using continuous ambulatory peritoneal dialysis with a Y-connector and 0.6 per patient-year using continuous cyclic peritoneal dialysis (P = 0.02), with a mean duration of 10.8 and 9.6 days per admission, respectively (not significant). Peritonitis occurred significantly less often in those receiving continuous cyclic peritoneal dialysis (0.94 compared with 0.51 episodes per patient-year; P = 0.03). No difference in causative pathogens was observed. Exit site infection rate was 0.38 episodes per patient-year in both groups. In an unselected patient group, continuous cyclic peritoneal dialysis was accompanied by significantly lower rates of peritonitis and dialysis-related hospital admission, whereas it was as effective as continuous ambulatory peritoneal dialysis with a Y-connector for patient and technique survival.

First night effects in good sleepers and sleep-maintenance insomniacs when recorded at home.

Home sleep recordings were conducted over four consecutive nights with 12 good sleepers and 12 sleep-maintenance insomniacs. Good sleepers showed decreased sleep efficiency and increased min awake after sleep onset on night 1. Insomniacs showed extended latency to onset of the first REM period and decreased REM in the first third of the initial recording night. Good sleepers and insomniacs reported no significant differences in adequacy of sleep between the first and subsequent sleep nights.

Letter: Incomprehensible explanations.

<h3>Introduction</h3> Liver biopsy (LB) can be associated with adverse outcomes including technical failures, complications and inadequate tissue for histological analysis. The indication for a chosen route of LB is variable between physicians and the impact of the chosen route of LB is often unclear. <h3>Method</h3> Retrospective review of all LB performed at a UK transplant centre over a 12 month period focussing on indication and route of LB, complications, histological adequacy and variability in operator specialty and experience. <h3>Results</h3> Over the 12 month period 570 LB were performed, of which 330 were transjugular liver biopsies (TJLB) and 240 were percutaneous liver biopsies (PCLB). A LB was categorised as being histologically adequate if a histological diagnosis could be made, or if the sample met the histological standard in the literature (a 15 mm sample, with 6 or more complete portal tracts). Overall, 94% of LB were adequate based on the histological standard, and 98% allowed histological diagnosis. There were no significant differences in adequacy when comparing TJLB vs. PCLB route; however, a consultant radiologist was more likely to provide an adequate sample than a radiology registrar (p = 0.02). The overall complication rate for a liver biopsy was 5.6%. This included 8 major complications (1.4%) and 24 minor complications (4.2%). Neither the route of LB (TJLB vs. PCLB) or operator (consultant radiologist vs. radiology registrar vs. hepatologist) was significantly associated with the development of a complication. The technical failure rate of a TJLB was 4%; these included failure to puncture internal jugular vein, failure to cannulate the hepatic vein, or an unstable sheath position. There were no technical failures in the PCLB group. Screening time for a TJLB was significantly longer if the procedure was done by a radiology registrar when compared to both a hepatologist (p = 0.01) or consultant radiologist (p = 0.003). Apart from the standard indications for a TJLB we found a patient was significantly more likely to undergo a TJLB if they were post-transplant compared to pre-transplant (p = 0.001) and if the biopsy was deemed an emergency compared to an elective procedure (p = 0.001). In our cohort we identified 130 patients who had a TJLB with no indication for this procedure. <h3>Conclusion</h3> We have demonstarted that TJLB and PCLB have no significant differences in complication rates or adequacy of histological sample. Technical failure is more common in TJLB compared to PCLB. A TJLB is our preferred method in emergency cases and post-transplant patients. Further information regarding cost and patient experience is needed to identify if a change in practice is indicated. <h3>Disclosure of interest</h3> None Declared.