BAPIOAC19-01
Gene expression analysis of oncogene transcript in aberrant crypt foci, in comparison to the normal colonic mucosa and colorectal carcinoma, from formalin fixed paraffin embedded tissue samples
Mohamed Sulaiman, Jayati S, Ghosh S, Gupta B, Ejaz, Ahuja V, Pal S, Sahni P, Datta Gupta S, Panda SK.
All India Institute of Medical Sciences, New Delhi, India 
correspondence to md.sulaiman89@gmail.com
cite as: Sulaiman M, Jayati S, Ghosh S, Gupta B, Ahuja EV, Pal S, Shahni P, Datta Gupta S & Panda SK. Gene expression analysis of oncogene transcript in aberrant crypt foci, in comparison to the normal colonic mucosa and colorectal carcinoma, from formalin fixed paraffin embedded tissue samples. ThePhysician 2020 vol4;issue1: ab01

Background and aims: 
Aberrant Crypt Foci (ACF) are early microscopic mucosal lesions in the colon which can be detected by magnified chromoendoscopy. The main purpose of this study was to develop an ex-vivo model of identifying the ACF-like lesions on grossly normal looking colonic mucosa so that the model resembles the chromoendoscopic procedure. We investigated the comprehensive gene expression analysis in ACF to understand them better. Further, correlation between genetic alterations amongst various topographic ACF-groups were also analysed. 
Methods: 
A total of 35 positive cases with numerous ACF (more than 4 per 2 sq mm mucosal fragment) and corresponding tumor cases were selected out of 302 colectomy specimens received in the department. Another 20 cases were selected retrospectively as controls from colectomies performed for causes with no malignant potential. Gene expression analysis by Real Time polymerase chain reaction (RT-PCR) was performed on ACF in relation to control and tumor, and immunohistochemical test was performed to correlate the gene expression and protein expression for some of the transcripts. Gene expression data was correlated with the clinical parameters, as site and size of the tumors, tumor stage and lymph node metastasis, histological and topographical types of ACF etc. 
Results: 
In comparison to the controls, ACF positive samples showed significant alterations in KRAS, CDKN1A, CDKN2A, MLH1, VEGFA, and CCL5 genes. Similarly, alteration in CDKN2A, PTEN, and SMAD4 genes were noted in ACF positive samples compared to tumor. No correlation between gene expression and ACF characteristics were noted. 
Conclusion: 
Irrespective of morphological characteristics any ACF-like lesions needs to be addressed seriously with regular screening and follow up. Pathogenesis of such early neoplastic lesions in human colon is multifactorial and complex. Further studies may throw light on identifying prospective pathways which can be targeted to prevent the progression of these lesions.
BAPIOAC19-02
Importance of communication in reducing sepsis risk in children via administration of antibiotics in the golden hour
Vivian Praveen Ignatius, Regina Divya & Rajeev Gupta
Barnsley NHS Foundation Trust, Barnsley, UK
correspondence to: vivian.praveen@nhs.net
Cite as: Ignatius VP. Divya R & Gupta R. Importance of communication in reducing sepsis risk in children via administration of antibiotics in the golden hour. The Physician 2020; Vol4; Issue1;ab02

Background: Sepsis is a preventable cause of death. According to NICE guidelines, the first hour of diagnosing sepsis is considered the golden hour as the outcomes are better if the treatment is started at this hour. This observational study was conducted at a district general hospital to assess the compliance of the antibiotic administration within the first hour of diagnosis of sepsis. 
Methods: This study was conducted at Paediatric Department of Barnsley District general hospital and the data was collected from all the admissions to children’s ward between October 2018 and June 2019 with a diagnosis of SEPSIS. Data was collected regularly and analysed every month by a team comprising of Paediatric doctors, antimicrobial pharmacist, patients safety team members and microbiologist. Periodic communication and feedback was sent to all the members of the team to reinforce the importance of the golden hour in sepsis management. Also, it was discussed in the handover and emphasised in induction. Results: Analysis of the data revealed that 77 children out of the 90 children (86%) received the first dose of antibiotics within 1 hour as per the NICE guidelines. Most common reason for missing the 1 hour deadline was difficult intravenous cannulation. It was observed that the children who were admitted to children’s ward from A+E were more likely to get the 1 st dose of antibiotic within the first hour of sepsis diagnosis than the children who were admitted through the Children’s Assessment unit. Conclusions: The percentage of children receiving the first dose of antibiotic within 1 hour of diagnosing sepsis increased when everyone in the team were reinforced about the importance of the golden hour in sepsis. According to a previous study conducted in our hospital in the year 2018, the percentage of children receiving antibiotics within 1 hour of diagnosis was just under 60 %. Hence, it can be concluded that by periodic communication via emails and feedback during the handover / teaching improved the compliance of antibiotic in the golden hour thereby improving patient safety.
BAPIOAC10-03
To develop a non-invasive technique as a preliminary tool to determine type 2 diabetes
Kshama Rahul Joshi & Pervez Haris
DeMontefort University, Leicester, UK
correspondence to P12232168@my365.dmu.ac.uk
Cite as: Joshi KR & Haris P.  To develop a non-invasive technique as a preliminary tool to determine type 2 diabetes. The Physician 2020 Vol4;Issue1;ab03

Background and aims: A study was designed to understand a three-dimensional cause and effect relationship among ethnicity-based diet, relevant macro, and micro-nutrients obtained from diet, and prevalence of type 2 diabetes. If such relationship exists, then this link can be used to develop a preliminary non-invasive screening technique to determine if the patient needs any further invasive techniques. 
Methods: A questionnaire and lab-based techniques were used to gather data and samples from 400 participants from community services and NHS GP practices within Leicester, UK. 
Results: Out of 400 participants, Indian (61%), Pakistani (19%), White British (9%) were the top three ethnicities in the research. From the total Cohort, 188 (47%) were diagnosed with type 2 diabetes (T2DM) of which 86% were managing their condition through oral medication, and maximum number of respondents (87%) were unaware of the fact as T2DM preventable and potentially reversible. Ethnically diverse non-diabetes subjects were consuming a high carbohydrate, protein-rich diet. Fat intake was high among non-diabetes Indian, Pakistani, Bangladeshi, and African except White British. Using FETA technique, average food intake of 14 food groups and dependent key elements were found. Magnesium and Zinc which are important for T2DM management were high in non-diabetes subjects whereas Selenium, which acts as an antioxidant in case of T2DM, was found in low concentration within both T2DM & non-diabetes population. Currently, this research is in a lab work analysis phase to determine how the scalp hair and toenail samples using elemental techniques provide the level of macro and micro-nutrients within cohort. 
Conclusion: By accessing dietary data, it is possible to determine the status of nutrients and its importance in prevalence of T2DM.
BAPIOAC19-04
Lead The Way. Developing the Next Generation of Healthcare Leaders: The Role of Emotional Intelligence in Primary Care 
Parisah Hussain, Aisha Chaudry, Simran Halari, Abdulwahab Ikar, Terrell Okhiria, Aran Sivapalan, Sohini Thakor & Edgar Meyer. 
Imperial College, London, UK
correspondence to ph918@ic.ac.uk
Cite as; Hussain,P, Chaudry A, Halari S, Ikar AW, Okhira T, Sivapalan A, ThakorS & Meyer E. Lead The Way. Developing the Next Generation of Healthcare Leaders: The Role of Emotional Intelligence in Primary Care. The Physician 2020 Vol4; Issue 1; ab04

Background The need for leadership within 21st Century healthcare is ubiquitous, with better leadership being shown to improve health outcomes. Whether that be leading a ward round, an MDT meeting, or even a cardiopulmonary resuscitation; leadership is a vital necessity in a healthcare setting. When it comes to Primary Care, there is currently a huge demand from patients, colleagues and the NHS, that GPs must meet. With over 50% of medical students in the UK progressing to specialise in Primary Care, developing leadership skills within this field is vital. Emotional intelligence (EQ) is a core skill found to combine over 12 competencies of leadership. However, soft skills such as EQ have been overlooked during medical training. Our research explores the impact and importance of EQ for leaders in Primary Care. 
Methods A systematic review highlighted the importance of EQ for healthcare leaders and assesses its impact on key performance indicators. Appropriate search terms were used to systematically search five databases for literature published after 2014. Inclusion and exclusion criteria were applied to screen abstracts and full texts. Final articles included a focus on EQ within healthcare leaders with impact on at least one performance indicator. 
Results The search produced 3638 articles of which 44 were included for full text screening. We found that EQ in healthcare leaders had an impact upon key performance indicators: Job Satisfaction, Patient Satisfaction, Stress, Worker Burnout. Limitations of the literature were that studies used different tools for measuring EQ. Methods Primary data collection with GPs was conducted in the form of semi-structured interviews (SSIs) in order to understand the impact of EQ on workplace behaviours and attitudes within Primary Care. Purposive sampling was used to select potential study participants with the aim of providing the most credible information to the study. GPs were recruited through the Royal College of General Practitioners (RCGP) and the Faculty of Medical Leadership and Management (FMLM) and inclusion and exclusion criteria were used to screen participants. Ethical approval was received from Imperial College Research Ethics Committee. Interviews were then transcribed, and thematic analysis was used to generate codes and overall themes. Thematic analysis was conducted by analysing each written transcript, generating initial codes, searching for themes and categorising them into overall sub-themes and higher themes. Results A total of 15 SSIs were conducted with GPs across London. From the thematic analysis, 3 higher themes were generated (Patients, Primary Care as an Organisation, and General Practitioners) and 10 sub-themes which portrayed that EQ has a positive impact on job satisfaction, interpersonal relationships, teamwork and levels of burnout for GPs. In addition, EQ was described as being beneficial for patient consultations and thus improving patient satisfaction. With regard to leadership in Primary Care, EQ was found to play a positive role towards change in organisational culture. Multiple barriers and facilitators to developing emotional intelligence in primary care were also identified. From identifying barriers and facilitators, recommendations and solutions to overcoming the barriers were implemented. 
Conclusions EQ is a widely endorsed skill required for leaders within Primary Care, shown to play an important role for 21st century healthcare. Research determining the efficacy of EQ and its impact in Primary Care can simmer the dispute regarding the importance of EQ within healthcare and ultimately, provide an evidence base to support the creation of EQ training schemes within Primary Care.
BAPIOAC19-05
Innovation in ADHD care pathway in a DGH setting
Swasti Shekhar & Prashant Mani
Mid-Yorkshire NHS Trust, Wakefield, UK
correspondence to swastishekhar@gmail.com
Cite as: Shekhar S & Mani P. Innovation in ADHD care pathway in a DGH setting. The Physician 2020 vol4;issue1;ab05

Background: In UK, the prevalence of ADHD in children (age 5 to 16 years) is 3-5%. Symptoms of ADHD should meet the diagnostic criteria in DSM-5 or ICD-10. Children with ADHD would benefit from improved organisation of care and better integration of child health services, CAMHS and adult mental health services (NICE guidelines 2008). We describe changes made in the ADHD pathway at a DGH hospital to improve the patient journey. 
Methods: 1. GP referrals did not contain relevant information, hence referrals from school/SENCO was introduced. To improve the quality of school report and support provided, ADHD study day was organised (attended by 120 SENCO/school teachers). 2. ADHD nurse specialists have been trained to help with improved communication and follow up of patients. 3. Qb test (a computerised test to look quantitatively at hyperactivity, impulsivity and inattention) is done to ensure comprehensive assessment. 4. A clinic performa was developed to ensure compliance with NICE guidelines. 5. A study day was organised for GPs to improve adherence to shared care guidelines. 6. We liaised with Adult ADHD services to improve transition clinics, and CAMHS team to manage co-morbidities. 
Results: Improved efficiency- Reduction in clinic time needed for a diagnosis (25 new ADHD assessments in 2018 needed 30 clinic appointments, 60 clinic appointments needed in 2015). Reduction in ADHD assessment waiting times to 8 weeks (16-18 weeks in 2015). Patient satisfaction - DNA rates have decreased from 22% in 2015 to 4-5% in 2018. Feedback forms have shown significant improvements. Audit looking at compliance to NICE guidelines (NG87) for assessment, counselling, drug treatment, monitoring and transition has shown an improvement across all parameters. All GP surgeries do prescriptions according to shared care guidelines. 
Conclusions: The new innovative ADHD care pathway has led to safe, effective, efficient and sustainable delivery of ADHD services.
BAPIOAC19-06
Patient information leaflets: Our clinic experience in using QR codes and bit.ly for STI and contraception leaflets 
Venkateshwaran Sivaraj, Ruslan Artykov, James Drysdale, Sarah Cox, Cindy Sethi, Ranjababu Kulasegaram, Anatole Menon-Johansson.
Guys & St Thomas' Hospital NHS Trust, London, UK 
Correspondence to drsvenkateshwaran@gmail.com
cite as: Sivaraj V, Artykov R, Drysdale J, Cox S, Sethi C, Kulasegaram R, Menon-Johansson A..Patient information leaflets: Our clinic experience in using QR codes and bit.ly for STI and contraception leaflets. The Physician 2020 vol4;issue1: ab06

Introduction: An innovative approach to deliver patient information leaflets for STI and contraception through QR code to smart phones was initiated as a quality improvement project in our sexual health clinics. 
Methods: A survey was conducted among sexual health clinic staffs on tools used for distribution of patient information leaflets and acceptability of QR code and short url for usage. QR codes linking to official BASHH and FPA online patient information leaflets were created from trust Microsoft word software and displayed as small stickers at clinic rooms for usage. Results: On initial baseline survey of our clinic staffs (n=22, 9 Doctors, 7 Nurses, 2 Health Advisers, 4 Receptionist) on their practice of distributing information leaflets, 28% were showing websites on computer monitor, 24% mentioned name of the website verbally, 9% gave handwritten website information, 19% were using other methods.Survey also showed 81% agreed for bit.ly and 76% agreed for QR codes as tools to distribute patient information leaflets. Feedback from staff on QR code usage (n=10) revealed QR code an acceptable tool which is easy to use, faster, secure, reliable during consultation for distribution of patient information leaflets. It worked only in clinic area with good mobile network and if patient using a smart phone. On second stage of the project, bit.ly codes were created for different clinic sites (bit.ly/srhbs, bit.ly/srhwr, bit.ly/srhsh) and were incorporated to second version of QR codes. Virtual monitoring of leaflet distribution was created through bit.ly portal. The total budget for this project was zero. 
Discussion: Newer generation smart phones have camera with built in QR code scanner. Bit.ly codes are widely used by NHS trusts. Both these tools can be safely and effectively used for distribution of patient information leaflets in sexual health clinics with no additional cost to the service.


BAPIOAC19-07
Combination correctors and potentiators for cystic fibrosis: a systematic review and meta-analysis 
Karol Basta & Chris John.
Imperial College, London, UK  
Correspondence to kb2014@ic.ac.uk
Cite as: Basta, K & John C. Combination correctors and potentiators for cystic fibrosis: a systematic review and meta-analysis. The Physician 2020 vol4;issue1;ab07

Background: The most common cause of cystic fibrosis (CF) is the Phe508del mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) protein, resulting in CFTR’s reduced trafficking, targeted by correctors, and reduced functioning, targeted by potentiators. For the majority of CF patients, the combination correctors and potentiators (CCPs) lumacaftor/ivacaftor and tezacaftor/ivacaftor, are the only treatments licensed to target the disease origin. 
Objectives: To assess the effects of CCPs on clinical efficacy outcomes, adverse events (AEs) and quality of life in CF patients. Methods: Electronic databases and clinical trial registries were searched before March 31st for randomised controlled trials comparing CCPs to placebo in CF patients. Bias assessments were conducted and data extracted for primary outcomes; change in percentage predicted forced expiratory volume in 1 second (ppFEV1), pulmonary exacerbations (PEx) and change in the respiratory domain of the cystic fibrosis revised questionnaire (CFQ-R-RD). AEs and discontinuations were analysed as secondary outcomes. Meta-analyses were conducted with subgroup stratification by CF mutation type and CCP drug. 
Results: 9 studies were included (n=2543) lasting 4-24weeks. Overall CCPs compared to placebo decreased PEx, relative risk (RR)=0.69 [95%CI=0.60,0.80], increased ppFEV1, mean difference (MD)=3.03 [95%CI=1.61,4.45] and increased CFQ-R-RD scores, MD=5.07 [95%CI=2.30,7.83]. All efficacy outcomes were significant in Phe508del homozygotes, whilst only CFQ-R-RD increases were significant in Phe508del heterozygotes. In Phe508del heterozygotes with a residual function mutation increases in CFQ-R-RD scores and ppFEV1 were significant. Overall participant completion was >95% but discontinuations due to AEs were higher with CCPs, RR=1.87[95%CI=1.10, 3.19]. This was significant with lumacaftor/ivacaftor but not with tezacaftor/ivacaftor. 
Conclusion: Overall CCPs are safe and well tolerated. High quality evidence shows CCPs lead to modest improvements in ppFEV1 and reduce PEx in the short term for Phe508del homozygous patients. The clinical significance of these effects on long term outcomes for CF needs further research.

BAPIOAC19-08
A cost-utility analysis of small versus large bite sutures in the closure of midline laparotomies in the UK NHS
Shyam Gokani, Karl Elmqvist, Osman El-Koubani, Javier Ash, Sudeep Biswas, Maxime Rigaudy
Imperial College Business School, London, UK
Correspondence to shyamg@live.co.uk
cite as: Gokani S, Elmqvist K, El-Koubani O, Ash J, Biswas S & Rigaudy M. A cost-utility analysis of small versus large bite sutures in the closure of midline laparotomies in the UK NHS. The Physician 2020 vol4;issue1; ab08

Background: This study aimed to perform an economic evaluation of small bite sutures versus large bite sutures in the closure of midline laparotomies in the United Kingdom National Health Service (NHS). 
METHODS: A cost-utility analysis was conducted using data from a systematic literature review. Large bite sutures placed 10 mm from the wound edge were compared to small bite sutures 3-6 mm from the wound edge. The analysis used a 3-year time horizon in order to take into account complications including incisional hernias and surgical site infections (SSIs). Cost and benefit data were considered from the perspective of the NHS. A two-way sensitivity analysis was conducted to assess the impact of a variation in the clinical effectiveness of small bite sutures. 
RESULTS: The incremental cost-effectiveness ratio was calculated to be -£482.61 per quality-adjusted life year (QALY) using the proposed small bite suture technique, indicating a cost saving to the NHS. Sensitivity analysis demonstrated that small bites are a cost-neutral technique provided that the cost of using small bites is less than £98 per patient. Small bites cost less than £20,000/QALY when they reduce either the rate of SSIs by more than 15% or the rate of hernias by more than 3.4%. CONCLUSION: This study proposes that small bite sutures should become the mainstay suturing technique in the closure of midline laparotomies, replacing large bite sutures, which dominate current practice. The financial savings accompanied by the decrease in SSI rates and herniation warrant the use of this new technique. The sensitivity analysis demonstrates that findings hold true for a wide range of levels of clinical effectiveness for small bites.


BAPIOAC19-09  
THIRD PRIZE - ORAL PRESENTATION

Investigating the link between trisomy 21 and acquired mutations in the GATA1 gene 
Triya Chakravorty, Irene Roberts. 
University of Oxford MRC Weatherall Institute of Molecular Medicine, Oxford, UK  
Correspondence to triya.chakravorty@queens.ox.ac.uk
cite as: Chakravorty T & Roberts I. Investigating the link between trisomy 21 and acquired mutations in the GATA1 gene. The Physician 2020 vol4;issue1:ab09

Background: Children with Down syndrome (DS) due to trisomy 21 (T21) are at an increased risk of developing the neonatal preleukaemic disorder transient abnormal myelopoiesis (TAM), which may transform into childhood acute myeloid leukaemia (ML-DS). Leukaemic cells in TAM and ML-DS have acquired mutations in the GATA1 gene. Although it is clear that acquired mutations in GATA1 are necessary for the development of TAM and ML-DS, questions remain concerning the mechanisms of disease. TAM mostly resolves spontaneously within three months; only ~1 in 10 cases progress to ML-DS, and this transformation always occurs before age four years. This suggests that the fetal cellular environment created by T21 may be important for the acquisition of GATA1 mutations. 
Methods: To investigate the importance of the fetal cell context in TAM and ML-DS, GATA1 mutational analysis was carried out using next generation deep sequencing on blood samples collected from DS children enrolled into the Oxford-Imperial Down Syndrome Cohort Study. 
Results: Here it is shown that children with GATA1 mutations present at birth do not acquire additional new mutations in GATA1 in the first four years, and children without GATA1 mutations at birth do not subsequently acquire mutations in GATA1. Conclusions: The results suggest that the fetal cellular environment in T21 is critical for the acquisition of GATA1 mutations. It is likely that GATA1 mutant clones require factor(s) present specifically in the fetal liver microenvironment to sustain their proliferation and survival. Furthermore, screening for GATA1 mutations at birth in DS children is likely to be a reliable way of identifying those at reduced risk of developing ML-DS.

BAPIOAC19-10
A COMPARISON OF THE EFFICACY AND SAFETY OF ORAL ANTI-DIABETIC DRUGS IN CAUCASIANS AND SOUTH ASIANS: A SYSTEMATIC REVIEW AND META-ANALYSIS 
Aoife McMullen, Catriona Skarnes & Martha Richardson
Faculty of Biological Sciences, University of Leeds, UK
correspondence to um15agm@leeds.ac.uk
Cite as: McMullen A, Skarnes C & Richardson M.. A comparison of the efficacy and safety of oral anti-diabetic drugs in caucasians and south asians: A systematic review and meta-analysis. The Physician 2020 vol4;issue1:ab10

Background: Type 2 diabetes mellitus is more prevalent, and presents differently, in South Asians than Caucasians. This suggests a possible difference in the genetic disposition of South Asians for this condition. Such genetic difference could also confer a difference in the response of patients of different ethnicities to oral antidiabetic drugs (OADs). 
Methods: This systematic review, with meta-analysis, compares the efficacy and safety of OADs in Caucasian and South Asian type 2 diabetics, using randomised trials published until February 2019. A systematic search of PubMed, Web of Science, Ovid and Scopus databases was performed. 27 studies met the inclusion criteria, with nine eligible for meta-analysis. Data on the change in % glycosylated haemoglobin (HbA1c) and adverse events (AEs) was studied. 
Results: This review is limited by small number of included studies, which were often of poor quality. A significant difference in efficacy was found in only one drug. However, trends were noted with other drug classes, but the volume of data was insufficient to draw statistically test. Similarly, there was little data relating to AEs, although some trends were again noted. Conclusions: Although the results were disappointing, this study has revealed that research is often presented in a way which prevents race-specific outcomes from being measured. This paper concludes by making recommendations which would enable larger studies to be conducted, potentially finding correlations between ethnicity and drug-related outcomes. This could in turn inform prescribing, allowing patients to be given medications which are more likely to be effective, and less likely to cause them harm.

BAPIOAC19-11
Are circulating miRNAs predictive of response to therapy? 
Lava Krishna Kannappa, Mohammed Sufian Khalid, Baljit Singh, David Guttery 
University Hospitals Leicester, UK
correspondence to Lavakrishna@yahoo.com
Cite as: Kannappa LK, Khalid MS, Singh B & Guttery D.. Are circulating miRNAs predictive of response to therapy? The Physician 2020 vol4;issue1:ab11

Introduction: Colorectal cancer (CRC) is the third commonest cancer with nearly 1.4 million new cases identified throughout the world in 2012. There is a pressing need for new non-invasive blood based test to improve early detection and monitoring of CRC. MiRNAs are small non-coding RNAs involved in fundamental cell processes such as proliferation, survival and death. Studies have identified miRNAs in plasma of cancer patients in a stable form. This study aimed to evaluate whether circulating microRNAs are predictive of response to therapy. 
Methods: 44 patients with CRC were selected from our institution’s CRC surveillance programme. All selected patients at follow-up had no evidence of tumour recurrence on clinical, radiological and endoscopic assessment. Blood samples were obtained pre-treatment and at a median follow-up of 36 months. A total of 32 pairs of blood samples were matched pre- and post-treatment. Plasma RNA was extracted and target miRNAs were identified on pooled case TaqMan Low Density miRNA array (TDLA) cards and quantitative RT-PCR. 
Results: Of the nine microRNAs tested, only miR-134 (P = 0.03), miR-135b (P = 0.03) and miR-431 (P = 0.031) were statistically different in post-treatment samples using a Wilcoxon signed rank test. Comparison of each miRNA with clinicopathological features using multiple linear regression tests showed miR-135b pre-treatment and miR-431 post-treatment levels to be significantly associated with both node status (positive/negative) and number of nodes involved. Pre-treatment miR-132, miR-134, miR-21, miR-27b and miR-184 were also significantly associated with node status. Further, miR-134 post-treatment was significantly associated with gender and miR-203 pre-treatment was significantly associated with all Duke’s stages. However, multiple-linear regression of all miRNAs and clinicopathological features revealed only miR-135b levels pre-treatment to be significant in the overall model (P = 0.043). 
Conclusion: MicroRNA levels of miR-134, miR-135b and miR-431 showed a potential response to therapy with higher levels pre-treatment and lower after treatment. miR-135b pre-treatment levels correlated significantly to lymph node status and number. However, larger cohorts of patients are needed to validate these findings.


BAPIOAC19-12  
SECOND PRIZE - ORAL PRESENTATION

Effects of various treatment regimens on the survival of HER2-positive breast cancer patients with brain metastasis 
Shantal Edirappuli & Emma Beddowes.
University of Cambridge, UK
correspondence to sde29@cam.ac.uk
Cite as: Edirappuli S & Beddowes E.. Effects of various treatment regimens on the survival of HER2-positive breast cancer patients with brain metastasis. The Physician 2020 vol4;issue1:ab12

Background: Overexpression of HER2 (human epidermal growth factor receptor 2) occurs in around 20% of breast cancers. This particular subtype is known to be very aggressive and had the worst prognosis prior to the introduction of targeted therapy. The development of anti-HER2 therapies such as trastuzumab and pertuzumab have shown to dramatically improve the prognosis of patients with HER2-positive breast cancer. Despite these improved prognoses with newer drug therapies, the development of brain metastases and subsequent intracranial progression is often fatal in patients. The traditional options for treatment of brain metastases include neurosurgical resection, whole brain radiotherapy and stereotactic radiosurgery. This study aims to provide an analysis of the various treatment regimens that are employed and their effects on overall survival in patients. 
Methods: 27 relevant patients (those with HER2-positive breast cancer and brain metastasis) were extracted from the ongoing DETECT study based in Cambridge. The effect of various parameters, including treatment regimens, was analysed using Kaplan-Meier curves. 
Results: The results showed that patients who received neurosurgical intervention had a statistically significant greater overall survival time compared to patients who had not received any neurosurgical intervention (median survival = 40.80 vs 12.35 months, p=0.011). The data further showed that neither radiotherapy nor drug therapies (chemotherapy, hormonal therapy or anti-HER2 therapy) significantly affected the overall survival. 
Conclusions: Of the current therapies employed by clinicians, neurosurgical intervention alone correlates with a significantly increased overall survival in patients. The explanations for this are varied but not limited to the specificity of this treatment in targeting intracranial tumours. Additionally, the clinical decision-making process for which patients may be considered eligible for surgery selects for those with a better prognosis. Future options for therapy include prophylactic cranial irradiation which may prove effective in targeting the, often-fatal, intracranial progression of this cancer.

BAPIOAC19-13
Risk factors of poor pregnancy outcome in living kidney donors in UK 
Shanmugapriya Basker & Sunil Daga.
NHS Digital University of Manchester, UK
Correspondence to s.basker@nhs.net 
cite as: Basker S & Daga S. Risk factors of poor pregnancy outcome in living kidney donors in UK. The Physician 2020 vol4;issue1:ab13

Background: Despite thousands of kidney donations every year across the world, there is decline in donations particularly within the BAME (Black Asian Minority and Ethnic community). Young female faces a dilemma of future pregnancy when considering decision to donate a kidney. The study aims to describe the risk in pregnancy based on ethnicity, gender and regional variations. 
Method: This project uses Hospital Episode Statistics (HES) Admitted Patient Care (APC) data from 1997/8 to 2017/18 (20 years) with pseudo-anonymous data filtered by kidney donation codes.The dataset was extremely imbalanced with total of 420 records of which 279 negative class (no risk) and 141 (risk) positive class From available 128 columns Mothers Age, Ethnicity (Black, White, South Asian and Other), Deprivation Index ( Low, Medium and High Deprivation Index), Provider Centre (Low, Medium and High provider) , hypertension before or at donation, Smoking, Obesity, Risk After Donation Days were taken as features to analyse the data. 
Results: Mother’s Age at delivery, smoking and obesity have been outlined with p-value less than 0.05 and proved to be most significant feature. The Odds Ratio showed, 1 unit increase is 1.067 times more likely to cause risk, whereas 10 unit increase is 9 times more likely to have risk in pregnancy after donation. With smoking, it was 2 times more likely to cause risk in pregnancy. The analysis showed Obesity would cause 8 times more risk in pregnancy after donation. 
Conclusions: Mother’s age at pregnancy, smoking and obesity were the significant features that would cause risk in pregnancy. Ethnicity has no relevance or influence at all.

BAPIOAC19-14
Cross-sectional survey of viral testing on nasopharyngeal aspirates by laboratories in the UK – Is targeted testing the way forward? 
Varathagini Balakumar, Paul Turner & Siba Paul.
School of Medicine, Cardiff University, Cardiff, UK & Torbay and South Devon NHS Foundation Trust, Torquay, UK
Correspondence to siba@doctors.org.uk 
Cite as: Balakumar V, Turner P & Paul S. Cross-sectional survey of viral testing on nasopharyngeal aspirates by laboratories in the UK – Is targeted testing the way forward? The Physician 2020 vol4;issue1;ab14

Background Acute viral bronchiolitis is the most common cause of hospital admissions amongst infants in the UK. The diagnosis is primarily clinical with most infants requiring supportive management. RSV is the main cause and routine confirmation has, until recently, been undertaken via nasopharyngeal swabs or aspirates (NPA). This is no longer recommended by the American Academy of Pediatrics (AAP) with the exception of at risk groups. NICE guidelines confirmed the diagnosis was primarily clinical but didn't explicitly recommend against routine testing. 
Methods This study aimed to review the current practice for testing of children admitted with suspected bronchiolitis in hospitals across the UK using a structured questionnaire. 
Results In total, 199/209 (95%) laboratories responded. Of these, 140 (70%) performed NPA testing on site with the remainder undertaken elsewhere. Approximately seventy percent [N =99] of trusts performed routine testing on infants with suspected bronchiolitis. Extended viral PCR testing was offered by some trusts (30%) based on either initial negative screening tests, clinical decision making (36.4% [N=51]), or as part of a mandatory protocol (26.6% [37]). Extended viral PCR testing was not offered by 13 trusts (9.3%). Point of care (POC) testing for RSV across the UK was available at 47 hospitals. Apart from POC, 46 laboratories did not perform tests out-of-hours although 8 would if requested by a Consultant Paediatrician. 
Conclusion We recommend more consensus based on patient outcomes and cost benefits. Locally, we follow targeted NPA testing only for high risk patients in keeping with the AAP guidance.

BAPIOAC19-15
Patient satisfaction with patient led follow-up for endometrial cancer
Tanisha Sharma, 
Pinderfields General Hospital & St Georges University of London, London, UK   
Correspondence to sharmatanisha@yahoo.co.uk
Cite as: Sharma T. Patient satisfaction with patient led follow-up for endometrial cancer. The Physician 2020 vol4;issue1:ab15

Background Currently cancer follow up in the UK is 5 years. However, the 5 year survival rate for stage 1A endometrial cancers is more than 95%, so the majority will not have a recurrence. The British Gynaecological Cancer Society has suggested to consider other means of follow-up as the traditional follow-up has been shown to increase anxiety for patients, and not directly pick up cancer recurrence. 
The aim of the study was to assess patient satisfaction with patient led follow-up and identify any cancer recurrence and how it was diagnosed. 
Methods This is a retrospective study set in a DGH in England. 104 women with stage 1A, grade 1 endometriod adenocarcinoma who underwent surgery between November 2013 and January 2018 were given information about their cancer treatment, recurrence risk and symptoms of recurrence. These women were then put on a patient-led follow-up where they received a yearly phone call from the cancer team. The patients were asked a series of questions and rated their satisfaction with their current follow up out of 10. Patients had the option of returning to the traditional pathway and were brought back to clinic if they showed symptoms. 
Results 92% of patients scored ³9 on the ten-point satisfaction survey. 85% of women had a satisfaction score of 10/10. Nine women came back to the clinic due to symptoms such as pain or bleeding. Three women come back to the traditional pathway due to a language barrier or personal choice. There was no recurrence of cancer in this study population. 
Conclusions Patients are satisfied with a patient led telephone consultation follow up. There has also been no evidence of cancer recurrence in this group of patients.

BAPIOAC19-16
Neurovascular CT Angiography Image Quality: A Quality Improvement Project 
Ashik Amlani, A Pascoal, D Hodson, E Gabriel, E Barten, I Honey, U Haberland, A Roy, S Udani
Guy's and St. Thomas' NHS Foundation Trust, London UK
Correspondence to ashikamlani@gmail.com
Cite as: Amlani A, Pascoal A, Hodson D, Gabriel E, Barten E, Honey I, Haberland U, Roy A & Udani S. Neurovascular CT Angiography Image Quality: A Quality Improvement Project. The Physician 2020 vol4;issue1:ab16

Background Neurovascular CT angiography (CTA) in our hospital was observed to be of poor quality compared to scans at a local tertiary neurosurgical centre with potential risk of misdiagnosis. With the aim of improving quality, a multidisciplinary team was assembled to investigate this further. 
Methods A radiology registrar, two neuroradiologists, a CT radiographer, a CT manufacturer research scientist and two medical physicists reviewed CTA scans of 20 patients scanned locally and externally. Data collection comprised CT protocol parameters (CTDIvol, DLP, kV, mA, collimation, detector configuration, reconstruction filter and display field of view), IV contrast injection technique (flow rate and total contrast volume), as well as subjective expert visual review. 
Results Cases of missed aneurysms were reviewed and consensus was that local scans exhibited a high level of image noise. Manufacturer default protocols were in use and these provided insufficient image quality. Quantitative analysis revealed that the dose (CTDIvol) delivered by the external centre scanner was 3-4 times larger and dose to the patient (DLP) was 4-5 times larger. The average (normalised) noise level for the local studies was 2-3 times that of the expert centre studies and the contrast-to-noise-ratio was correspondingly lower by a factor of 1.3-1.6. 
Conclusions The lower radiation dose and different contrast protocols were primary causes for the non-diagnostic image quality observed. We implemented an immediate increase in the protocol dose (CTDIvol) by a factor of 2 to mitigate the suboptimal image quality and established standardised CT protocols. We also improved the image data series transferred to PACS to aid the clinical team and radiology registrars with interpretation. This has led to an improvement in image quality with immediate benefits for our patients. Further work is ongoing to assess the potential for further optimisation of CTA brain scans at our hospital.

BAPIOAC19-17  
FIRST PRIZE ORAL PRESENTATION

Characterisation of the Proline301 Leucine (P301L) Mutation in Human Tau Underlying Frontotemporal Dementia with Parkinsonism linked to chromosome 17 (FTDP-17) in a Transgenic Zebrafish Retinal Model 
Ashwin Venkatesh, Ana Lopez-Ramirez; Angeleen Fleming
University of Cambridge, UK
Correspondence to av454@cam.ac.uk 
Cite as: Venkatesh A, Lopez-Ramirez A & Fleming A. Characterisation of the Proline301Leucine (P301L) Mutation in Human Tau Underlying Frontotemporal Dementia with Parkinsonism linked to chromosome 17 (FTDP-17) in a Transgenic Zebrafish Retinal Model. The Physician 2020 vol4;issue1:ab17

Background and aims: Neurodegenerative diseases are growing in prevalence in our ageing population. Frontotemporal Dementia with Parkinsonism linked to chromosome 17 (FTDP-17) results from the P301L mutation of the tau gene. The present study represents the first characterisation of the progression of the neurodegenerative phenotype of P301L tau in a novel in vivo translational research model - the larval zebrafish retina – which could expedite the understanding and treatment of neurodegenerative disease. Since tau is a known substrate for autophagy, an intracellular degradation mechanism, the ability for autophagy induction to ameliorate the phenotype was also examined. This project aimed to explore the following questions: 1) Does this P301L tau model exhibit neurodegeneration? 2) What neuropathological hallmarks of the human tauopathy are recapitulated in this model? 3) Does autophagy induction rescue the phenotype? 
Methods: Heterozygous transgenic zebrafish overexpressing human P301L Tau(0N4R) under the rhodopsin promoter were used. Sample fixation, cryosectioning, and imaging allowed the number of rods to be quantified to measure neurodegeneration. Immunohistochemistry and thioflavin-S staining enabled characterisation of tau aggregates. Cell death and proliferation were investigated using the TUNEL assay and immunostaining respectively. Rapamycin, clonidine and nutrient supply were used as different autophagy modulators. 
Results: The P301L tau zebrafish exhibited significantly reduced rod photoreceptor numbers (P < 0.05). P301L tau was hyperphosphorylated and pathologically aggregated, culminating in cell death. The neurodegenerative phenotype was improved by rapamycin (P < 0.05) and nutrient supply (P < 0.05). 
Conclusions: This model exhibits rapid neurodegeneration, recapitulates hallmarks of the human pathology, and shows that mTOR-dependent autophagy induction holds therapeutic potential.


BAPIOAC19-18
Optimising local antimicrobial guidance for infected diabetic foot ulcers – a closed-loop audit 
Zhi-Yang Low, Arron Thind, Joseph Hogan, Emily Black, Matthew Mort, Jason Jones, Imran Qureshi
Croydon University Hospital, London, UK
Correspondence to zhi-yang.low@nhs.net
Cite as: Low ZY, Thind A, Hogan J, Black E, Mort M, Jones J & Qureshi I. Optimising local antimicrobial guidance for infected diabetic foot ulcers – a closed-loop audit. The Physician 2020 vol4;issue1:ab18
 
Background: The existing empirical antibiotic regime in our institution for infected diabetic foot ulcers is Teicoplanin, Fusidic Acid and Metronidazole. This due to a historically high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in our patient population. However, this regime lacks Gram-negative antimicrobial cover – something which has become increasingly prevalent in our examination of invasive samples. Teicoplanin dosing has been problematic and is also nephrotoxic – an undesirable side-effect in diabetic patients who often have existing renal impairment. In this QIP, we sought to determine the antibiogram of diabetic patient cultures in order to establish relevant empirical antimicrobial guidance as well as ensuring that correct prescription is occurring for the correct duration and reducing unnecessary length of stay. 
Methods: We collected data from all bone, tissue, pus and invasive samples obtained between 1st December 2017 and 1st December 2018. We then excluded all non-diabetic patients and those not treated for infection. We then assessed the antibiogram of the remaining patients and collected data of the duration of hospital stay and length of treatment. 
Results: 196 samples were collected. 31% of samples grew Gram-negative bacteria, 7% were Anaerobes, 21% were Streptococci, 15% were Staphylococcus aureus (MSSA and MRSA) and the remainder were a variety of other organisms including Propionibacterium, Candida and Coagulase-negative Staphylococci. 
Conclusion: We changed our empirical antibiotic regime to be guided by the Perfusion, Extent, Depth, Infection and Sensation (PEDIS) classification system, and have selected antibiotics which best suit our local antibiogram. We expect this to significantly decrease morbidity in our patients not only by targeting relevant organisms but also by reducing total antibiotics used and reducing overall length of stay. Closed-loop data including adherence to new guidelines and overall length of stay, will be available at time of presentation at the conference.

BAPIOAC19-19
Improving Co-Prescribing of Medication with Patient Controlled Analgesia: A Quality Improvement Project 
Kavya Pillai & Richard Stumpfle
Hammersmith Hospital, General Intensive Care Unit, Imperial College, London 
correspondence to kavya.pillai@nhs.net
Cite as: Pillai K & Stumpfle R. Improving Co-Prescribing of Medication with Patient Controlled Analgesia: A Quality Improvement Project. The Physician 2020 vol4;issue1:ab19

Background and aims: Patient-controlled analgesia (PCA) is commonly used in intensive care units (ICU) to manage post-operative pain. PCA preparations are typically opioid-based, often containing morphine and fentanyl. Hammersmith Hospital General ICU deals with complex medical and surgical patients who are often given PCA. Imperial College Healthcare Trust guidelines recommend prescribing PCA with naloxone, for patient safety, an anti-emetic and a laxative for patient comfort. Furthermore, prescription of high doses of naloxone was monitored; following a patient safety alert raised by NHS England. We undertook a quality improvement project (QIP) which aimed to improve prescribing practice for naloxone and anti-emetics with PCA. 
Methods: The initial audit was conducted from January 2019 to May 2019 with data being collected from patients who were prescribed a PCA during their ICU admission. As the initial data collection demonstrated a need for improved prescribing, we implemented multiple changes through a rapid-cycle QIP. Initially, we presented a teaching session to junior doctors, led by the senior ICU pharmacist. Subsequently, we introduced an order-set that could be co-prescribed with the PCA, allowing the admitting clinician to add on medications at an appropriate dose, frequency, and route. After a month of changes, the data were re-audited. 
Results: Fifty-one patients were identified for the initial audit. Of these, 51% (26/51) were not prescribed naloxone, 33% of patients were prescribed high doses of naloxone. Furthermore, 41% of patients were not prescribed an anti-emetic within 24 hours of being prescribed the PCA. Once we had implemented our change cycles, 20 patients were identified for the subsequent audit. Of these, 55% (11/20) patients were prescribed naloxone, and no patients were prescribed naloxone incorrectly. Similarly, 75% of patients were prescribed appropriate anti-emetic therapy. 
Conclusions: Raising awareness and introducing an order-set has improved the accuracy and frequency of co-prescription of medications with PCA.