Scottish Society of Physicians 57th Annual Meeting

ABSTRACT BOOK

Venue:

Doubletree by Hilton Dunblane Hydro, Perthshire

Scottish Society of Physicians is a charity registered in Scotland. No. SC029462

CONTENTS

Page

Oral Presentations

• Session 1  3

• Session 2  4

• Session 3  5

• Session 4  6

Index of Poster Presentations  12

ORAL PRESENTATIONS

Friday 30 October 2015

Session 1

Chair: Dr Stuart Paterson

Upper GI bleeding and recent advances

Adrian Stanley

Honorary Associate Professor, Glasgow Royal Infirmary, Glasgow

Abstract

Upper GI bleeding remains a common cause of presentation to hospital, with a mortality of approximately 10%. Early risk assessment is important to both identify high-risk patients requiring emergency endoscopy after resuscitation and the very low-risk patients who can avoid admission. All other patients should have endoscopy within 24 h.^1,2 Proton pump therapy is of proven benefit after application of endoscopic therapy to high-risk ulcers, but is not of clear benefit prior to endoscopy. ¹ Recent studies suggest that a relatively restrictive blood transfusion strategy improves outcome, although the exact haemoglobin threshold remains unclear. If endoscopic methods fail to control non-variceal bleeding, interventional radiology (IR) should be employed, with surgery undertaken if there is delay in organising IR. ¹

Patients suspected of variceal bleeding should be given vasopressors and prophylactic antibiotics as soon as possible. ² If endoscopy fails to control variceal bleeding, placement of a temporary Sengstaken tube may be used as a bridge to repeat endoscopy or TIPSS procedure. ² Clear protocols and pathways are essential for managing patients presenting with upper GI bleeding, with 24/7 access to endoscopic therapy, IR and surgery available on-site, or via clear and agreed regional networks. ³

Acute kidney injury – information for general physicians

Colin Geddes

Consultant Nephrologist, Lead Clinician and Honorary Clinical Associate Professor, South Glasgow University Hospital, Glasgow

Abstract

AKI is a feature of severe illness in many patients under the care of physicians. This talk will address some of the common questions arising in patients with AKI including assessing fluid requirements, diuretics, intravenous contrast administration, restarting of ACE inhibitors, when to refer to nephrology and long-term follow up.

Comprehensive geriatric assessment – what a general physician should know and do when seeing an elderly/frail patient

Graham Ellis

Consultant Geriatrician & Honorary Senior Clinical Lecturer, Monklands Hospital, Lanarkshire

Session 2

Chair: Dr Allan Bridges

Diabetic for other specialists

Miles Fisher

President Elect, Scottish Society of Physicians & Consultant Physician, Glasgow Royal Infirmary

Abstract

There are now a baffling number of different treatments for type 2 diabetes. New drugs have been introduced which work in ways that are complementary to older therapies such as metformin, sulphonylureas and insulin. Several diabetes therapies have side effects that can lead to the patient being sent for detailed investigations, where a careful drug history would have been better.

Fever in travellers from West Africa – Ebola

Alisdair MacConnachie

Consultant Infectious Diseases Physician, Gartnavel General Hospital, Glasgow

FITZGERALD PEEL LECTURE

Heart failure: current and new therapies

John McMurray

Consultant Cardiologist, Queen Elizabeth University Hospital, Glasgow

Abstract

Few conditions have seen such enormous progress in treatment (and improvements in outcomes) as chronic heart failure due to left ventricular systolic dysfunction (i.e. with reduced ejection fraction – HF-REF). By the early 2000s ACE inhibitors (or angiotensin receptor blocker if intolerance) and beta-blockers had become the cornerstone of disease-modifying therapy. ¹ Thereafter, the two major thrusts of research effort were investigation of the value of devices and whether adding a third drug might improve outlook further. A decade of effort showed the effectiveness of the implantable cardioverter defibrillator in reducing the risk of sudden death and cardiac resynchronisation therapy (CRT) in reducing the risk of both death and hospital admission in selected patients with HF-REF. Similarly, initially angiotensin receptor blockers ² and subsequently, and more convincingly, mineralocorticoid receptor antagonists, ³ were shown to improve mortality and morbidity across the symptom spectrum (as was CRT). ¹

By 2012, guidelines were recommending that most patients with HF-REF are candidates for an ACE inhibitor, beta-blocker and MRA (and many for an ICD, CRT or both). ¹

The latest breakthrough has come from a different therapeutic paradigm. This not only took a different pathophysiological approach but also adopted a ‘replacement’ rather than ‘add-on’ strategy. The angiotensin receptor neprilysin inhibitor (ARNI) sacubitril/valsartan was designed not only to block the renin-angiotensin system but also, by inhibiting the enzyme neprilysin, to augment potentially beneficial, endogenous, neurohumoral pathways such as natriuretic peptides, bradykinin and adrenomedullin. In a head-to-head comparison with enalapril, sacubitril/valsartan reduced both cardiovascular death and heart failure hospitalisations by a fifth and improved patient well-being. ⁴ We now have a better alternative than a gold-standard that has stood the test of time for more than a quarter of a century. I am sure we will continue to be successful in the war against heart failure.

Saturday 31 October 2015

Session 3

Chair: Professor Miles Fisher

Delivering future hospitals

Frank Joseph

Consultant Physician & Clinical Director, Urgent Care Division, Countess of Chester Hospital NHS Foundation Trust

Abstract

The Future Hospital Commission (FHC) was launched in September 2013 with much fanfare, including being recognised by The Lancet as ‘the most important statement about the future of British medicine for a generation’. Recommendations from that report were based on the very best of UK hospital services, taking examples of existing innovative and patient-centred services to develop a comprehensive model of care.

The RCP(L) established the Future Hospital Programme to implement the recommendations of the Future Hospital Commission taking the report from page to practice. In its first year of operation it has established four development sites operationalising and implementing change around the care delivered to the acutely unwell frail elderly and a series of metrics are in place to evaluate the changes which are being implemented across the sites. The programme is currently recruiting an additional four sites to model innovative ways of improving services across health systems. The programme also hosts a wide range of projects and workstreams across the RCP doing great work under the Future Hospital umbrella. These include work to promote shared decision making and support for developing the chief registrar role.

Through the Future Hospital Programme, we are now building an active and evolving partnership network of peers, experts, academics, organisations and patients who are key supporters of the Future Hospital, implementing ideas and recommendations relating to the Future Hospital and sharing their findings. To support this network in the active sharing of tools, knowledge and experience, we are in the process of developing an online hub where members of the Partners Network will be able to access key resources related to service improvement.

We are asking clinicians to tell us about new service models that align with the Future Hospital recommendations, with the aim of providing a platform through which clinicians are able to share and learn from examples of innovative practice from across the country. This information will be collated on the RCP website through the Tell us your story database.

Rheumatoid arthritis – new models of care and new drugs. What a general physician needs to know

Sarah Saunders

Consultant Rheumatologist, Glasgow Royal Infirmary

Abstract

In the last twenty years major changes in the management of rheumatoid arthritis (RA) have resulted in significantly improved outcomes for patients living with this progressive chronic inflammatory disease.

The advent of tumour-necrosis factor antagonists and subsequently other novel biologic therapies greatly raised the bar in terms of patient and physician expectations of what could be achieved. Biologics, however, are only one of a number of interventions that have led to remission being an achievable goal in many RA patients.

The modern management of RA is underpinned by two main principles: (1) early diagnosis and initiation of disease modifying anti-rheumatic drugs and (2) the ‘treat to target’ strategy. This strategy involves setting an objective treatment target of remission (or at least low disease activity), undertaking regular formal measurements of disease activity and adjusting therapy to achieve that target. This approach is supported by an increasing evidence-base of clinical trials incorporating ‘treat to target’ principles demonstrating improved clinical, functional and radiological outcomes. These clinical trials also show that similar remission rates can be achieved with a number of different therapeutic agents, highlighting that it is the ‘treat to target’ principle that is key.

Despite significantly improved outcomes, the management of RA still presents many challenges to the rheumatologist and the general physician: potential long term toxicities with complex drug regimens, optimally caring for patients on lifelong immunomodulatory therapies and managing cardiovascular health in this at risk population. Until we can achieve drug free remission in all RA patients, these challenges will remain.

Session 4

Chair: Professor Miles Fisher

(Presenting author underlined)

Optical coherence tomography in chronic kidney disease: vasculopathy in the eye linked to kidney injury, inflammation and endothelial dysfunction

C Balmforth, T Ruijs, JR Cameron, A Czopek, M Khei H, R Kimmitt, S Borooah, L Willox, D Talwar, S Chandran, B Dhillon, DJ Webb and N Dhaun

British Heart Foundation Intermediate Clinical Research Fellow & Honorary Consultant Nephrologist, University of Edinburgh

Email: Bean.dhaun@ed.ac.uk

Abstract

Introduction: Chronic kidney disease (CKD) is strongly associated with cardiovascular disease (CVD) and there is an established association between vasculopathy affecting the kidney and eye.^1,2 Optical coherence tomography (OCT) is a novel, rapid method for high-definition imaging of the retina and choroid. Its use in patients at high CVD risk remains unexplored.

Patients and methods: We used the new SPECTRALIS OCT machine to examine retinal and retinal nerve fibre layer (RNFL) thickness, macular volume and choroidal thickness in a prospective cross-sectional study in 24 patients with hypertension, 24 with CKD and 25 matched healthy controls. The same, masked ophthalmologist carried out each study. Plasma IL-6, TNFα, ADMA, and ET-1, as measures of inflammation and endothelial function, were also assessed.

Results: Retinal thickness was reduced in CKD compared to hypertension (p < 0.01) and health (p < 0.05). RNFL thickness did not differ between groups. Macular volume was lower in CKD compared to both hypertension and health (p < 0.001 for both). Similarly, CKD was associated with a reduced choroidal thickness compared to hypertension (p < 0.001) and health (p < 0.01). Interestingly, in CKD, a thinner choroid was associated with a lower eGFR and greater proteinuria as well as increased plasma concentrations of CRP, IL-6, ADMA and ET-1 (all p < 0.05).

Conclusions: The decreases in retinal and choroidal thickness in CKD may reflect a systemic vascular injury. The associations with lower eGFR and higher proteinuria, but not blood pressure, suggest the changes may specifically reflect kidney pathology. Furthermore, the associations with CRP, IL-6, ET-1 and ADMA suggest roles for inflammation and endothelial dysfunction in this pathology.

Using PCR to help reduce admissions to an Ebola Treatment unit

T Evans, S Matthews, M Fominyam, E Bailey and Hutley

General Duties Medical Officer, 39 Royal Engineers, Kinloss, Scotland

Email: tommyevans@doctors.org.uk

Abstract

Introduction: Ebola usually begins with an acute undifferentiated febrile illness involving headache, myalgia and lethargy followed by diarrhoea and vomiting. Where there is a travel or contact history to suggest exposure to the virus it is difficult to rule out clinically.

In October 2014, a British Army field hospital deployed to the Freetown peninsula in Sierra Leone as part of the UK government’s response to the Ebola epidemic in West Africa. A 12-bed Ebola treatment unit was established for local and international healthcare workers. Approximately 50 staff were expected to have close contact with confirmed Ebola patients or samples on a daily basis, so called ‘Red Zone workers’. Hence, there was concern that red zone workers presenting with an undifferentiated fever or gastroenteritis would have to be treated as a case of suspected Ebola.

Patients and methods: Through a series of case histories, this paper will explain the utility of Multiplex PCR (BioFire FilmArray™) in avoiding admissions to an Ebola treatment unit during a gastroenteritis outbreak amongst red zone workers.

Results: Twelve patients had faecal samples sent for PCR film array analysis. A number of strains were identified including Enteroinvasive E. coli, Enterotoxigenic E. coli and Enteropathogenic E. coli. The majority of individuals were isolated locally without having to be admitted to an Ebola treatment unit.

Conclusions: Using multiplex PCR helped prevent admissions to an Ebola treatment unit and so avoided the well-documented risk of contracting Ebola from admission as a suspect case.^1,2 For patients that were admitted, it gave clinicians more diagnostic certainty and enabled early treatment and discharge, which assisted the unit in maintaining its operational effectiveness. It informed antibiotic use in diagnosed patients and allowed clinicians to formulate a case definition, which led to early empiric treatment with antibiotics and helped control the outbreak rapidly. This has been used in further outbreaks amongst clinical workers in January to March this year.

CT coronary angiography in the West of Scotland: is it reflective of NICE guidance and how does it compare with PROMISE?

M Ftouni, J Byrne, J Adams, E Philip, K Oldroyd and R Good

Medical Student, Golden Jubilee National Hospital, Glasgow

Email: richardgood@nhs.net

Abstract

Introduction: The role of CT coronary angiography for the assessment of patients with suspected cardiac chest pain continues to evolve. Since 2010, NICE guidelines ¹ have recommended CTCA as a first line investigation for patients with an estimated likelihood of coronary artery disease (CAD) of 10–29%. These guidelines do not recommend exercise testing in this patient group.

The results of the recent PROMISE ² and SCOT-HEART ³ studies, which included moderate and high risk patients have added to the debate and there remains a divergence of opinion regarding the appropriateness of CTCA in this patient group. In particular, there is a concern that CTCA may increase the number of future invasive coronary angiograms. We studied patients referred to the CTCA service in our centre and compared their predicted risk, prior stress testing and subsequent investigations to the NICE guidance and with data from the PROMISE study.

Patients and methods: Data were collected prospectively for consecutive patients undergoing CTCA over a 3-month period. Patient demographics and risk factor profile were recorded. An estimated likelihood of CAD was assigned using the tables provided by the NICE guidelines 95, ¹³ based on the Diamond and Forrester algorithms. CTCA reports were retrospectively reviewed with details recorded of the scan protocol, scan quality and severity of coronary disease. Our cardiac catheterisation database was retrospectively interrogated 3 months after the final patient underwent CTCA to document any subsequent invasive coronary angiography, PCI or CABG.

Results: A total of 226 patients underwent CTCA during the 3-month study period. The mean age was 56 ± 11 and 86/226 (38%) were male. 133/226 (59%) presented with atypical chest pain and 166/226 (74%) patients had at least one risk factor for CAD. The distribution of likelihood of CAD according the NICE guideline tables is shown in Figure 1. Only 34/226 (34%) had a pre-test probability of having significant CAD within the 10–29% category. Prior to CTCA, 153 patients (68%) had exercise ECG testing with 12/226 (5%) undergoing stress perfusion imaging. Overall, 164/226 (73%) patients had normal arteries or minimal CAD with 52 (23%) patients reported to have moderate/severe disease. 10/226 (4%) scans were non-diagnostic. 17/226 (7.5%) patients subsequently underwent invasive coronary angiography. 5 of these patients had pressure wire assessment of coronary lesions with 5/11 patients undergoing revascularisation (3 PCI, 2 CABG).

Conclusions: Only a small proportion of patients referred for CTCA to our centre were within the pre-test probability category recommended by NICE for this test. The majority of patients had undergone exercise testing prior to CTCA again suggesting limited adherence to the NICE guidelines. Despite the majority of patients having a pre-test probability >30%, only 7.5% of patients underwent subsequent invasive angiography within 90 days, less than in the patient group randomised to CTCA in the PROMISE study (12.2%). Further studies are needed to better define the population that would most benefit from CTCA. OPEN IN VIEWER

Fitzgerald Peel Prize Winner

The effect of the sodium-glucose co transporter Dapagliflozin on weight, blood pressure and lipid profiles in a Scottish Teaching Hospital

E Parker, S Mackin, BM Fisher, D Carty, JG Boyle and RS Drummond

Medical Student, University of Glasgow, UK

Email: Russell.drummond@glasgow.ac.uk

Abstract

Introduction: Sodium-glucose co-transporter (SGLT-2) therapies are not simply glucocentric but also confer weight benefits and blood pressure reduction. Therefore there are potential cardiovascular risk benefits.

We sought to ascertain the relative benefits of one of these agents, the first in class Dapagliflozin, on cardiovascular risk profile, in a planned, observational analysis of routine care in a university hospital.

Patients and methods: This study analysed the effect of Dapgliflozin upon weight, BP and HbA1c over an 18 month period in patients with T2DM. We also measured lipid profiles and using the UKPDS risk calculator were able to assess cardiovascular risk scores for coronary heart disease (CHD) before and after treatment. A t test was used to determine statistical significance and a model was utilised correcting for sex, age, duration of diabetes heart rhythm and smoking status to assess the effect on cardiovascular risk scores.

Results: Dapagliflozin (n = 94) was assessed within a population in our clinic where the mean age was 56.89 ± 8.81 years (40 males and 54 females). 39 were on insulin and 55 not on insulin. 44 had been smokers, 40 were ex smokers and 10 were current smokers. Mean BMI was 36.09 ± 7.39 and duration of diabetes 11.82 ± 5.05 years. Treatment with Dapagliflozin lowered mean Hba1c from 83.15 mmol/mol to 69.23 mmol/mol (p = 0.0001), weight (101.00 kg to 96.56 kg (p = 0.003)) as well as systolic BP 135.84 mmHg to 121.54 mmHg (p = 0.004). UKPDS risk estimate for CHD decreased from 20.28% to 17.39%

Conclusions: We have demonstrated, similar to previous trial data, ¹ that Dapagliflozin treatment is associated with reduced HbA1c, weight loss and reduced blood pressure. Additionally this was associated with a reduction in CV risk score, an effect that requires validated within randomised controlled trials.

Is home blood pressure monitoring viable within a large-scale web-based randomised trial of timing of blood pressure therapy and effect on cardiovascular outcomes?

A Rogers, I Mackenzie, D Rorie and T MacDonald

British Heart Foundation Clinical Research Fellow, Medicines Monitoring Unit (MEMO) and Hypertension Research Centre (HRC), Ninewells Hospital, Dundee

Email: arogers@dundee.ac.uk

Abstract

Introduction: Home blood pressure monitors (HBPM) are now accepted as a useful resource in clinical practice that can be cheaper and more acceptable for patients than ambulatory blood pressure (BP) monitoring.^1,2 This is important in research where participants are volunteers and inconvenience may be a barrier to recruitment and retention in studies. We aimed to determine whether home BP monitoring, using participants’ own devices, is possible and useful within a large scale randomised clinical trial.

Patients and methods: The TIME (Treatment in the Morning versus the Evening) study is a large scale, randomised trial comparing the effects of evening and morning dosing of usual antihypertensive therapy on major cardiovascular outcomes. TIME is funded by the British Heart Foundation and patients participate in the trial by registering and entering data online. Patients enrolling in the TIME study were asked if they had a home BP monitor and whether they would be willing to submit BP measurements online. Participants were given clear written instructions on how to measure their BP in accordance with current guidelines. They were then prompted at 3 monthly intervals to submit further series of measurements. Baseline characteristics of participants performing home BP measurements were compared with other TIME study participants and the quality of readings submitted assessed.

Results: Almost half of TIME study participants own their own home BP monitor (44%). The baseline characteristics of the HBPM owners were broadly similar to those of the remaining TIME study participants. HBPM owners were more likely to be male (61.9% vs. 55.1%) and had slightly lower BMIs (28.5 ± 5.7 compared to 29.4 ± 6.2).

240 different models of BP monitor were reported. 62% of participants’ monitors were validated by international protocols. 124 devices were British Hypertension Society validated.

1755 sets of home blood pressure measurements were submitted by 680 participants. To June 2015, participants had entered between 1 and 13 sets of measurements (mean 3). 550 participants have submitted at least 3 sets of measurements. 48(2.7%) sets of measurements contained insufficient information to calculate mean morning and evening blood pressures.

Conclusions: This study has demonstrated that home blood pressure monitors already owned by study participants can be used to obtain BP readings. Participants reliably submitted sufficient measurements to allow mean BP to be calculated according to accepted international guidelines.

IVC diameter predicts severity of renal dysfunction and survival in patients with heart failure

JS Singh, AH Muhammad Iqbal, B Soujeri, S Hawkey, D Levin, MZ Iskandar, G Stewart, J Sloan and CC Lang

Clinical Research Fellow and Honorary Speciality Registrar in Cardiology University of Dundee, Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital & Medical School, Dundee.

Email: jxsingh@dundee.ac.uk

Abstract

Introduction: Although heart failure is thought to cause worsening renal function (WRF) through hypoperfusion secondary to a reduction in cardiac output, there is evidence to suggest that renal venous congestion may also be a contributing factor. ¹ Invasive studies have shown that central venous pressure independently predicts WRF in heart failure patients; even in the setting of preserved cardiac output. ² However non-invasive studies investigating this relationship are scarce. ³ Potentially, assessment of inferior vena cava (IVC) diameter can be used to estimate venous congestion, as raised right arterial pressures dilate the IVC making it non-collapsible. We therefore aimed to investigate the association between IVC diameter and outcomes, including WRF, heart failure hospitalisations and all-cause mortality.

Patients and methods: We conducted a retrospective cohort study of 1078 chronic heart failure (CHF) patients from the BIOSTAT-CHF Scotland study. All CHF patients were symptomatic, requiring the use of loop diuretics, and were optimally treated on recommended therapy for CHF. Venous congestion (VC) was defined as IVC diameter >2.1 cm, identified from echocardiography at baseline review. Renal function was determined by estimated glomerular filtration rate (eGFR) using the abbreviated MDRD equation. Logistic regression models were used to examine the association between VC and eGFR. Cox proportional hazard models were applied to examine the influence of VC on all-cause mortality and CHF hospitalisations.

Results: Logistic regression models showed VC was more commonly associated with patients who had severe renal impairment (eGFR < 30 ml/min/1.73 m²) than those with eGFR > 60 ml/min/1.73 m² OR = 7.7 (95% CI 1.6–37.5; p = 0.012). Patients with VC were also shown to have a shorter time to HF rehospitalisation, although this was not statistically significant. However, multivariate analysis adjusting for age, sex, eGFR and furosemide dose showed patients with VC had significantly worse survival than those without VC; HR = 1.6, (95% CI: 1.2–2.1; p = 0.05)

Conclusions: Our findings demonstrate that venous congestion (determined by IVC diameter) among patients with CHF is associated with severe renal impairment, more frequent hospitalisations and increased mortality. We, therefore, suggest that IVC measurement as an easy to perform, non-invasive test can be used to predict renal function and prognosticate patients with CHF. Nevertheless, more research needs to be done to validate these findings.

INDEX OF POSTER PRESENTATIONS

(Presenting authors underlined)

PB01

Prognosis from malignant pleural mesothelioma: what is it and what influences it?

J Bardgett, A Marshall, HK Bayes, S Wedderburn, KM Kerr and GP Currie

Core Trainee Year 2 ACCS – Acute Medicine (Acute Care Common Stem). Aberdeen Royal Infirmary. University of Aberdeen, Aberdeen

PB02

Recognition of medical specialty patients in the acute medicine unit

A Barton, D Beckett

FY1, Forth Valley Royal Hospital, Larbert

PB03

Assessment of delirium – introducing the TIME bundle into the Geriatric Assessment Unit in Aberdeen Royal Infirmary

M Broome, L Shields, A Loo, I Gilmour, C Downham and K Douglas

FY1 Doctor, Geriatrics Aberdeen Royal Infirmary, NHS Grampian

PB04

Optimising medical cardiovascular secondary prevention – a quality improvement project with the Vascular Department

I Campbell

FY1, Forth Valley Royal Hospital, Larbert

PB05

Inter-observer variability of two classification systems for stroke aetiology

PD Collins, J Brolly and TJ Quinn

Clinical Lecturer, University of Glasgow, Glasgow

PB06

Audit of medical management of patients with Graves’ disease

C Cuddihy and D Gordon

FY2, Queen Elizabeth University Hospital, Glasgow

PB07

State-of-the-art pharmacotherapeutics of chronic HCV infection in decompensated cirrhotic patients using recently licensed novel direct-acting antivirals

F Danish

Consultant Physician, Dumfries & Galloway Royal Infirmary, Dumfries

PB08

Hepatitis E in South-East Scotland – a relationship between men, meat and medicines

MC Donnelly A Lim and KJ Simpson

Clinical Research Fellow, Royal Infirmary of Edinburgh, Edinburgh

PB09

Chronic cough prior to secondary care referral: is enough being done?

J Ferguson SL Young and G Currie

FY1 in General Surgery, Aberdeen Royal Infirmary, Aberdeen

PB10

SMC assessment of medicines for end of life care and rare conditions: the initial year’s experience of a new approach

J Fox, J Jones, A Lee, K MacFarlane A Brown and M McMahon

Chief Pharmacist, Scottish Medicines Consortium, Glasgow

PB11

A Study on the management of corticosteroid side effects in cancer patients

CJ Fsadni

Foundation Medical Officer 2 Trainee, Mater Dei Hospital, Malta

PB12

The National COPD Audit: a local Scottish perspective

J Hornsby, E McConnell, A Weidner, A Punton and FT Wood

Specialty Registrar 4 at Department of Respiratory Medicine, Forth Valley Royal Hospital, Larbert

PB13

The impact of SIGN Guidelines on stroke services in NHS Tayside

H Javed

Core Medical Trainee 1, Ninewells Hospital, Dundee

PB14

Skin protection amongst IBD patients on immunosuppressants: an audit of current practice

SL Kelly and H Jafferbhoy

FY2, Department of Gastroenterology, Victoria Hospital, Kirkcaldy

PB15

Unexpected clinical characteristics of upper extremity DVTs

S Kosar, C White, DTY Ang, T Haseler, JM Simpson, IC Stewart, JT Murchison and KA Lockman

SHO, Acute Medicine, Royal Infirmary of Edinburgh, Edinburgh

PB16

Long-term outcomes of DVT involving upper extremities

S Kosar, C White, DTY Ang, T Haseler, JM Simpson, IC Stewart, JT Murchison and KA Lockman

SHO, Acute Medicine, Royal Infirmary of Edinburgh, Edinburgh

PB17

2 in 1 – type and go – a focused electronic assessment record as an immediate discharge summary

W Lee, S Kosar, T Haseler, DTY Ang J Simpson and KA Lockman

SHO, Acute Medicine, Royal Infirmary of Edinburgh, Edinburgh

PB18

‘Beat Diabetes’ – a Legacy of the 20th Commonwealth Games in Glasgow

CJL Kueh, FG Dunn, L de Caestecker and M Fisher

ST4 Diabetes & Endocrinology, Glasgow Royal Infirmary, Glasgow

PB19

Confidence levels of junior doctors in managing hospital in-patients with diabetes; the Trainees Own Perception of Delivery Of Care (TOPDOC) Diabetes Study

Dr Rachel Livingstone, J Boyle and G McKay

Core Medical Trainee, Department of Diabetes & Endocrinology, Glasgow Royal Infirmary

PB20

Effect of haemodialysis on markers of platelet activation in diabetic and non-diabetic patients

SM MacRury, J Hall, S Lambie, SJ Leslie, W MacKinnon, A Treweeke and IL Megson

Consultant Physician, Raigmore Hospital, Inverness Division of Health and research, University of Highlands & Islands, Inverness

PB21

Accuracy of weight-based antibiotic calculations in an acute care setting

AR McCallum and D Beckett

CT1, Forth Valley Royal Hospital, Larbert

PB22

Statins in primary care; What’s holding us back?

H McCauley, J Singh and C Lang

Medical Student, University of Dundee, Dundee

BEST POSTER PRIZE: (PB23)

PB23

AKI recognition and management in the first 24 hours in FVRH

G McGrory and C Stirling

ST4, Forth Valley Royal Hospital, Larbert

PB24

AKI referrals to the renal on call service: presentation and short term outcomes

G McGrory and P Thomson

ST4, Forth Valley Royal Hospital, Larbert

PB25

The role of the chest radiograph in correctly diagnosing pneumonia and the contribution of further imaging

A Melville, S Bax and J Goldring

Foundation Year 2 doctor, Thoracic Medicine Department, Royal Free Hospital, London

Consultant, Royal Free Hospital, London

PB26

Metabolomic study of the impact of shift working in junior doctors

A Michlewski, K Docherty, S Shepherd, C Skiffington, M Wilson, T Reilly, I MacPherson, L McCallum and S Padmanabhan

GPST3, University of Glasgow, Glasgow

PB27

‘Think Delirium Write Delirium’ – recognition and management of delirium in Raigmore Hospital, Inverness

C Muir, AM Shanks, S Rayner, J Sinclair, L Platt, G Choi and M Wilson

ST2-ST3, Raigmore Hospital, Inverness

PB28

An examination of acute medical units in Scottish Hospitals

L Reid, NI Lone, ZJ Morrison, S Watson, CJ Weir and MC Jones

Clinical research fellow, Royal College of Physicians of Edinburgh and 2Post graduate MD student, Centre of Population Health Sciences, University of Edinburgh

PB29

The TIME (Treatment in Morning versus the Evening) study: a novel randomised trial of timing of antihypertensive therapy administration

A Rogers, IS Mackenzie, D Rorie and TM MacDonald

Clinical Research Fellow, Medicines Monitoring Unit (MEMO) and Hypertension Research Centre (HRC), University of Dundee, Ninewells Hospital, Dundee

PB30

Potential application of guidelines for investigation of chest pain admissions to the clinical decisions unit (CDU) – a scoping exercise

J Ross and A Krichell

ST1 Emergency Medicine, Ayr University Hospital, Ayr

PB31

Audit of the use of intermittent pneumatic compression stockings on the Acute Stroke Unit, Glasgow Royal Infirmary

A Rushton, KA Dani and C McAlpine

FY1 Acute Stroke Unit, Glasgow Royal Infirmary, Glasgow

PB32

Audit on documentation of pleural procedures in the respiratory department

K. Sapru and P Reid

CT2, Borders General Hospital, Melrose

PB33

Liver function test predicts mortality and hospitalisation among ambulatory heart failure patients

JS Singh, D Levin and CC Lang

Clinical Research Fellow, University of Dundee, Dundee

BEST STUDENT POSTER PRIZE: (PB34)

PB34

A long-term observational study on surveillance and incidence of cardiotoxicity in breast cancer chemotherapy

B Soujeri, JS Singh, S Chew, S Hawkey, M Ferguson and CC Lang

Masters Student, University of Dundee, Dundee

PB35

Is the Community Geriatric Team preventing hospital admission?

A Woodend and D Newham

FY2, Community Geriatrics, DOME, NHS Grampian

PB36

A combination of PillCam®SB2 and SmartPill® in the investigation of patients with known or suspected Crohn’s disease, referred for small-bowel assessment and their association with faecal calprotectin levels; case series

DE Yung, JN Plevris and A Koulaouzidis

FY1, Victoria Hospital Kirkcaldy