Scottish Society of Physicians 59th Annual Meeting,Thursday 26 and Friday 27 October 2017: abstract book

Available accessAbstractFirst published online February, 2018

Scottish Society of Physicians 59th Annual Meeting,Thursday 26 and Friday 27 October 2017: abstract book

Volume 63, Issue 1https://doi.org/10.1177/0036933017744515

Abstract

Scottish Society of Physicians 59th Annual Meeting

Thursday 26 and Friday 27 October 2017

ABSTRACT BOOK

Venue

Drumossie Hotel, Inverness

Contents

Oral presentations:
Session 1 – page 3

Session 2 – page 4

Session 3 – page 5

Session 4 – page 7

Index of Poster Presentations – page 11

Poster Abstracts – page 12

Thursday 26 October 2017 Oral presentations

Session 1

Chair: Professor Mark Strachan

The role of thrombectomy in acute stroke

Professor Keith Muir

SINAPSE Chair of Clinical Imaging, University of Glasgow, Glasgow, UK

Abstract

Endovascular procedures to remove thrombus in stroke caused by occlusion of a large intracranial vessel (the intracranial internal carotid artery (ICA) or middle cerebral artery (MCA)) have been established in eight randomised controlled trials completed since 2015 as a highly effective intervention. The absolute proportion of patients making an independent recovery is increased by around 20% compared to best medical care, a number needed to treat (NNT) of five; improvement in disability outcomes is seen with NNT of three.

Time windows are short – reperfusion within 5.5 to 7 h after onset of symptoms is necessary; treatment is available only through highly specialised interventional facilities, necessitating redesign of acute stroke pathways. Brain and vascular imaging play a critical role in appropriate case selection, and in selected cases, the time window for intervention may be considerably longer than among those selected on the basis of standard imaging alone.

Diabetes and technology

Dr Fraser Gibb

Consultant Endocrinologist, Royal Infirmary of Edinburgh, Edinburgh, UK

Abstract

People with type 1 diabetes in Scotland lose, on average, 11 years of life compared to the general population. Despite the recognition that intensive glycaemic control substantially reduces mortality in type 1 diabetes, achieving this goal remains elusive for three quarters of Scottish people with the condition. The management of diabetes, particularly type 1 diabetes, has the prospect of being revolutionised by advances in technology. Continuous glucose monitoring (CGM) devices diminish the need for painful ‘finger-prick’ glucose testing and are associated with improvements in both HbA1c and hypoglycaemia frequency. Similarly, continuous subcutaneous insulin infusion (‘insulin pumps’) is associated with improvements in key diabetes outcomes, including mortality. The greatest promise, however, is reserved for the combination of these two technologies (pumps and CGM), where initial studies assessing so-called ‘closed loop’ systems have been highly positive. Our next challenge is likely to be ensuring equitable access to these life-changing technologies.

Toxic substances and the lung

Dr Peter Reid

Consultant Physician, Western General Hospital, Edinburgh, UK

Abstract

Respiration involves the inhalation of a variety of airborne dusts, fumes and fibres and whilst the body has a variety of defensive strategies to trap, eliminate and clear much of what we inhale, for any individual an important relationship exists between the cumulative amount of inhaled particles and the ability of the lung to handle them. Lung disease occurs when respirable dusts reach the airways and alveolar capillary units in sufficient quantity to overwhelm the normal clearance and phagocytic mechanisms or trigger allergic reactions and can also play role in disease in other organ systems. Cigarette smoking remains the leading cause of toxin inhalation, but occupational exposures continue to make an important contribution to our workload and provide interesting reflections on society and the impact of work on health. As industries go out of fashion, conditions that were common in the past pass into obscurity. For others the biopersistence of retained fibres triggers the evolution of cumulative injuries such that exposures occurring several decades ago remain relevant to current practice. As new technologies are adopted and/or regulators become complacent, conditions that were on the wane may reappear. Finally, even as a series of initiatives have begun to mitigate the pervasive rise of the cigarette throughout the 20th century, relaxation of laws around cannabis may render any victories pyrrhic. Perhaps we’ll get it right when we live on the moon!

Session 2

Chair: Professor Sandra MacRury

National antibiotic prescribing strategy

Dr Andrew Seaton

Consultant in Infectious Diseases, NHS Greater Glasgow & Clyde, Glasgow, UK

Abstract

Recognition of high rates of Clostridium difficile infection (CDI) in Scottish hospitals in 2008 led to Scottish antibiotic guidance emphasising restriction of higher risk antibiotics, most notably the cephalosporins, quinolones and co-amoxiclav. Reduction in use of these agents was associated with precipitous decline in CDI across NHS Scotland. Within this presentation intended and unintended consequences of antimicrobial stewardship strategies will be discussed including impact on antimicrobial resistance and antibiotic toxicity risk. The central role of board-based Antimicrobial Management Teams and the Scottish Antimicrobial Prescribing Group (SAPG) in developing and delivering antimicrobial stewardship strategies will be emphasised. In particular, SAPG’s role in quality improvement around reducing the risk of multi-drug resistant Gram negative infection, promotion of safe use of aminoglycosides, support of prudent antibiotic use in primary and secondary care and strategies to tackle penicillin allergy mislabelling will be discussed. Promotion of a ‘national antimicrobial strategy’ in the era of realising realistic (or individualised) medicine could be seen as challenging but reducing waste/redundancy and variation in practice, improving access to medicines and developing better individualised clinical decision support are shared goals. Reduction of harm and optimisation of outcome in the individual now and in the future are at the heart of an antimicrobial stewardship programme.

Realistic ageing: frailty and the ageing population

Dr Martin Wilson

Consultant Physician, Raigmore Hospital, Inverness, UK

Abstract

The population in the United Kingdom is rapidly ageing. This presentation aims to outline common patterns of functional decline and discuss the implications these have to society as a whole and to each of us as individuals. Core factors that influence the ageing process are outlined along with suggested priorities in medical and social care to tackle the changes that ageing brings.

Fitzgerald Peel Lecture

Advances in the management of bone disease

Professor Stuart Ralston

Arthritis Research Council Chair of Rheumatology, University of Edinburgh, Edinburgh, UK

Abstract

We have witnessed major advances in understanding the pathogenesis of bone diseases and in developing new approaches to the treatment of bone diseases over the past two decades. In the field of osteoporosis, expert opinion has moved from treating on the basis of bone mineral density alone to an approach that also takes fracture risk into account with the aim of targeting treatment to those who are likely to benefit most. Bisphosphonates are still the mainstay of treatment but recent evidence suggests that the 1-34 fragment of parathyroid hormone (teriparatide) is superior to bisphosphonates in patients with severe spinal osteoporosis. Several new treatments for osteoporosis have also been developed which have targeted molecules that play key roles in regulating bone remodelling. They include denosumab, which a monoclonal antibody directed against RANK ligand, a protein that is essential for osteoclast function; abaloparatide, the 1-34 fragment of parathyroid hormone-related protein which is an anabolic drug with effects similar to those of teriparatide; and romosozumab, a potent anabolic drug which is an antibody directed against sclerostin, a key regulator of bone formation. In Paget’s disease of bone, we have learned that symptom-driven treatment is equally as effective as (and possibly safer than) intensive bisphosphonate therapy and have also discovered many of the genetic variants that predispose to this disease. Tremendous advances have also been made in the treatment of rare bone diseases; enzyme replacement therapy has been successfully introduced for the management of the previously lethal bone disease hypophosphatasia and an antibody to the phosphate regulating hormone FGF23 is under development for x-linked hypophosphataemic rickets. My lecture will review all of these developments and speculate upon where the field of bone disease will move during the next decade.

Friday 27 October 2017 Session 3

Chair: Dr Isla MacKenzie

Update on diagnosis and management of epilepsy for the general physician

Dr John Paul Leach

Consultant Neurologist & Head of Undergraduate Medicine, University of Glasgow, Glasgow, UK

Abstract

Epilepsy remains one of the commonest neurological conditions and is a frequent cause of admissions to general medicine on call.

It is important that General Physicians are aware of the advances in medication and investigation available to patients who will come under their care.

This talk will look at the improving knowledge of the pathophysiology and presentation of epilepsy, with a brief look at the new classification of seizures. The newer antiepileptic drugs will be discussed, with a review of the benefits and drawbacks they present. An overview treatment of acute seizures and Status Epilepticus will focus on the Scottish Intercollegiate Guidelines Network (SIGN) guidance and the potential for newer drugs to influence outcome and prognosis.

Improving unscheduled care in Paisley

Dr Iain Keith

Consultant in Acute Medicine, Paisley, Scotland

Abstract

Unscheduled care is a key priority of the Scottish Government and we have been tasked to sustainably deliver against the emergency access standard.

This target helps the hospital system to improve care by focusing on the reasons why our patients are waiting in the emergency department.

Using a whole system approach, from engaging with local GP’s, reviewing the referral patterns to each specialty, hospital processes and discharges, we used quality improvement methodology to test and implement not only small changes but also system wide ones to improve the standard over the last few years.

With the key elements of data collection, staff engagement and a dedicated team, we have improved and sustained our performance despite an increase in attendances, admissions and a reduction in the total beds by 5% on the site.

Key improvement tools used include Driver diagrams, flow stream mapping and the use of Pareto charts as well as using statistical process control charts to review the improvements we have made to evaluate, implement and spread the work or focus on other areas of improvement.

Here are some useful websites regarding this work:

http://www.qihub.scot.nhs.uk/quality-and-efficiency/unscheduled-care.aspx

https://learn.nes.nhs.scot/Search/SearchResults?RelationRootNode=Quality%20Improvement%20Zone&page=1

https://learn.nes.nhs.scot/803/quality-improvement-zone/improvement-journey

Remote and rural medicine

Dr Pauline Wilson

Consultant Physician, Shetland Islands, Scotland

Abstract

Almost one-fifth of the Scottish population live in a remote and rural area, scattered across 94% of the Scottish land mass. The collective term ‘Remote and Rural’ masks the variation between different areas in terms of geography and isolation from tertiary services.

The Scottish government in its quality strategy outlines the need for equitable access to high-quality health care regardless of variables that include geographic location. Centralisation and specialisation are two of the challenges facing the provision of health care in remote and rural Scotland. Promoting the role of the generalist on a background of increasing specialisation is key to the growing problem of recruitment. Teaching and training in remote and rural medicine is not only pivotal in retaining a competent workforce, but it is also equally important in ensuring future generalists fit for purpose.

This presentation will focus on the following:

• The role of the generalist, by taking the audience through a typical day of a remote and rural physician.

• The need for remote and rural teaching/training to be an integral part of medical schools’ curriculum and undergraduate training.

Session 4

Chair: Professor Stuart Ralston (presenting author underlined)

Thiazolidinediones and risk of bone fractures: a systematic review and meta-analysis of randomised controlled trials

H Azhari¹, C Haig² and J Dawson³

¹Post Grade Researcher, College of Medicine, Veterinary and Life Sciences, Institute of Cardiovascular and Medical Sciences, University of Glasgow, The Queen Elizabeth University Hospital, South Glasgow, UK

²PhD in Biostatistics, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Robertson Centre for Biostatistics, University of Glasgow, Boyd Orr Building, Glasgow, UK

³Professor of Stroke Medicine, College of Medicine, Veterinary and Life Sciences, Institute of Cardiovascular and Medical Sciences, University of Glasgow, The Queen Elizabeth University Hospital, South Glasgow, UK Emails: h.azhari.1@research.gla.ac.uk; Jesse.Dawson@glasgow.ac.uk

Abstract

Introduction: Thiazolidinediones (TZDs) drugs are used to treat diabetes.¹ Recent data show they reduce recurrent cardiovascular events in patients with recent ischemic stroke and insulin resistance and that they increase fracture risk.² This review aims to summarise all evidence concerning fracture risk with TZDs in adults, with particular emphasis on stroke patients.

Patients and methods: A systematic search of databases was conducted to identify relevant studies (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and Web of Science (from their inception to 28-week, 2016)). Published and unpublished trials comparing pioglitazone with placebo or other anti-hyperglycaemic agents (AHG) were included. We extracted data on fracture occurrence.

Results: From 860 titles, 79 studies were identified. These included 37,709 people treated with TZDs and 25,016 treated with comparator and 1232-fractures (risk ratio (RR) 1.33; 95% confidence interval (CI) 1.19–1.48; P < 0.00001, fixed-effects (FE) model. Twenty-nine studies had a high risk of bias, 18 unclear risk and 32 low risk. In 11 trials (including 11,731 participants and 440-fractures), pioglitazone increased fracture risk (RR 1.28; 95% CI 1.06–1.53; P = 0.009, FE model). Both fractures recorded as adverse events (RR 1.27; 95% CI 1.06–1.53; P = 0.01, FE model) and serious adverse events (RR 1.54; 95% CI 1.14–2.09; P = 0.005, FE model) were increased. Risk was more evident more in females (RR1.80; 95% CI 1.12–2.89; P = 0.02, FE model) than males (RR 0.85; 95% CI 0.58–1.25; P = 0.42, FE model). In 13 trials (involving 12,809 participants and 117-fractures), there was no increased risk with pioglitazone compared to other AHG drugs (RR 1.00; 95% CI 0.71–1.41; P = 0.98, FE model).

Conclusions: Pioglitazone use increases fracture risk but this was mostly driven by an increase in studies with placebo comparator and in women. These data may help stroke clinicians decide whether to use pioglitazone in selected patients after stroke.

References
1 Yau H, et al. The future of thiazolidinedione therapy in the management of type 2 diabetes mellitus. Curr Diab Rep 2013; 13: 329–341. 2 Kernan WN, et al. Pioglitazone after ischemic stroke or transient ischemic attack. N Engl J Med 2016; 374: 1321–1331.
Fitzgerald Peel prize winner

Determining the role of fitness vs. body composition in insulin sensitivity

J Wardall¹, A Sillars², J Gill³, D Freeman³, N Sattar³ and V Zammit⁴

¹Medical Student, University of Glasgow, Glasgow, UK

²Senior Lecturer, University of Glasgow, Glasgow, UK

³Cardiovascular and Medicine Sciences Professor and Honorary Consultant, University of Glasgow, Glasgow, UK

⁴Cardiovascular and Medicine Sciences Professor and Honorary Consultant, University of Glasgow, Glasgow, UK

⁵Professor of Metabolic Biochemistry, University of Warwick, Coventry, UK Email: 2063172w@student.gla.ac.uk

Abstract

Introduction: Athletes are more insulin sensitive than their sedentary counterparts. However, it is not known if this is because they are more active or because they have lower body mass. Exercise allows insulin-independent glucose uptake into muscle cells. However, exercise also contributes to weight loss. This study aimed to investigate whether diabetics should be encouraged to improve cardiovascular fitness or lose weight by reducing their body mass, to improve their insulin sensitivity (S_I). To our knowledge, there have been no previous studies comparing insulin sensitivity in those with impaired S_I compared with sedentary controls and endurance trained athletes (ETA’s). We investigated the relationship between S_I and fitness, and S_I and body composition. We then established whether S_I is determined predominantly by fitness or body composition.

Patients and methods: We recruited 34 participants divided into three phenotypically distinct cohorts. The 120-min value of glucose (mmol/L) during the oral glucose tolerance test was used to represent S_I. Fitness was determined from VO₂max, which was assessed using an incremental bicycle ergometer test. Body Fat Percentage (BFP) was calculated with BodPod (BODPOD 200 A, LMI software), which uses bio-impedance and air displacement plethysmography to calculate body composition. Statistics were calculated using Minitab 17.

Results: We recruited 16 controls, 16 ETA’s and 2 diabetics. The ETA’s had the lowest body fat percentage (mean 12.8%; ± 1.54) followed by the controls (20.2%; ± 1.15) and the diabetics (32.6%; ± 4.2). ETA’s had the highest VO₂max (54.4 mL/kg/min) followed by the controls (35.4 mL/kg/min) and then the diabetics (31 mL/kg/min). ETA’s were the most insulin sensitive, with a mean 120-min glucose value of 4.41 mmol/L. Controls had a mean 120-min glucose value of 5.17 mmol/L and diabetics had the lowest insulin sensitivity with a value of 12.18 mmol/L. Linear regression was performed. Body composition had an R² value of 35.3% and VO₂max had an R² value of 11%. Correlations were calculated. With regard to insulin sensitivity, body composition had a Pearson Correlation Coefficient of 0.594 (P = 0.002) and VO₂max had a Coefficient of −0.332 (P = 0.059). Interestingly, body composition and VO₂max had a Coefficient of −0.717 (P < 0.0001).

Conclusions: ETA’s and controls have similar insulin sensitivity (P = 0.328). Linear regression showed that body composition is a greater predictor of insulin sensitivity than fitness, in keeping with previous studies.¹ Correlations showed that body composition and VO₂max are both statistically significant predictors of insulin sensitivity, however, body composition is a greater determinant. Further work is needed to confirm if clinicians should focus on body weight reduction primarily, as opposed to increasing cardiovascular fitness in diabetic patients.

Reference
1 Segal KR, Edano A, Abalos A, et al. Effect of exercise training on insulin sensitivity and glucose metabolism in lean, obese, and diabetic men. J Appl Physiol 1991; 71(6): 2402–2411. https://www.ncbi.nlm.nih.gov/pubmed/1778939.
Earlier use of capsule endoscopy in inpatients with malaena or severe iron deficiency anaemia reduces need for colonoscopy and shortens hospital stay

DE Yung¹, A Koulaouzidis¹, S Douglas¹ and JN Plevris⁴

¹Clinical Research Fellow, Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK

²Associate Specialist, Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK

³Clinical Scientist, Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK

⁴Consultant, Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK Email: diana.e.yung@gmail.com

Abstract

Introduction: Capsule endoscopy (CE) is a well-established investigation for iron deficiency anaemia (IDA) and malaena, usually following negative upper and lower GI endoscopy. We aimed to study the effect of CE timing in the investigative pathway for inpatients with IDA or malaena at a large tertiary referral centre.

Patients and methods: We analysed inpatients undergoing CE for IDA or malaena from 2005 to March 2017, excluding those with signs/symptoms suggestive of lower GI tract pathology. Patients underwent CE following negative upper and lower GI endoscopy (Group 1) or following negative upper GI endoscopy (UGIE) only (Group 2), based on the senior clinician-in-charge’s preference.

Results: One hundred and seventy inpatients (104 M/66 F, mean age 65.8) underwent CE for IDA (n = 44) and malaena (n = 126). In Group 1, CE found 16/95 (16.8%) gastric and 12/95 (12.6%) colon findings. Three of 12 patients with colon findings required repeat colonoscopy. One hundred and three colon investigations were carried out for 95 episodes of IDA or malaena. In Group 2, there were 12/75 (16.0%) gastric and 11/75 (14.7%) colon findings. In patients with positive CE, significant colonic findings led to colonoscopy in 10/39 patients (diagnostic yield 6/10). Thirty-six patients had negative UGIE and CE; 15 underwent colonoscopy (diagnostic yield 9/15). The remaining 21/36 patients with no further colonoscopy did not develop adverse outcomes related to colonic pathology. Twenty-six colon investigations were carried out in 75 episodes. Patients in Group 2 had significantly shorter mean times from admission to CE compared to patients in Group 1 (5.08 ± 3.80 vs. 6.38 ± 3.80 days; P = 0.02) and shorter overall admission length (10.5 ± 9.58 vs. 12.5 ± 11.4 days; P = 0.04).

Conclusions: Earlier use of CE in inpatients with malaena or IDA, no signs of lower GI pathology and negative UGIE resulted in shortened hospital stays, significant Diagnostic Yield (DY) from both small bowel and upper GI tract, and 2/3 less unnecessary colon investigations without affecting clinical outcomes.

Association of primary care practice characteristics with positive patient response rates to invitation to participate in a multi-centre randomised controlled clinical trial

T Anbarasan¹, JW Kerr Grieve², A Rogers², R Barr³, S Duce³ and IS Mackenzie⁴

¹Medical Student, Medicines Monitoring Unit (MEMO), Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK

²Clinical Research Fellow, Medicines Monitoring Unit (MEMO), Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK

³Project Manager, Medicines Monitoring Unit (MEMO), Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK

⁴Clinical Reader, Medicines Monitoring Unit (MEMO), Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK Email: t.anbarasan@dundee.ac.uk

Abstract

Introduction: Adequate patient recruitment is paramount for the success of clinical trials.¹ Some clinical trials investigating interventions for chronic and prevalent diseases are designed to enrol patients within primary care practices across a wide area. Individual primary care practice commitment to help with such studies is key to their success. This study aimed to elucidate whether operational aspects, socioeconomic factors and publicly available performance measures of primary care practices in Scotland affected positive patient response rates following invitation to participate in a randomised controlled clinical trial.

Patients and methods: The ALL-HEART study is an ongoing multicentre, prospective, randomised, open-label, blinded end-point (PROBE) trial investigating the effects of allopurinol therapy on cardiovascular outcomes in 5215 patients with ischaemic heart disease in Scotland and England.² To evaluate the influence of practice-dependent characteristics on the patient Positive Response Rate (PRR) to invitation to participate in the study, practice-level patient response data collected by the trial team and publicly available data collected by Information Services Division (ISD) Scotland were analysed. Factors studied included Socioeconomic Characteristics (geographic location and level of deprivation (Scottish Index of Multiple Deprivation (SIMD)) of practice), Practice Functional Characteristics (practice workforce demographics, training commitments and practice size) and Practice Performance Metrics (e.g. Quality and Outcomes Framework (QOF) scores and GP satisfaction survey scores). PRR was calculated as the percentage of positive replies received from invitations sent to patients. Data were analysed using a univariate linear regression approach.

Results: Patient response data from 86 of 114 participating Scottish primary care practices were available for analysis at the time of this study (August 2017). Postal invitations were sent out to patients in these practices between February 2014 and April 2016. A mean PRR of 24.3% was observed in the practices analysed. Primary care practices in areas of moderate deprivation (SIMD 4–7) had a higher mean PRR (27.6% vs. 20.9%; P = 0.010) compared to practices located in the most deprived areas (SIMD 1–3). Although practices in areas of moderate deprivation also had a numerically higher mean PRR than those in least deprived areas (SIMD 8–10), this difference was not statistically significant (27.6% vs. 24.7%; P = 0.361). Practices in the South-East of Scotland region had higher mean PRR compared to other regions (P < 0.001). Practices with an average GP satisfaction survey score higher than median had a higher mean PRR (27.3% vs. 21.2%; P = 0.004). No statistically significant differences were observed in any of the other factors.

Conclusions: This study used publicly available datasets to investigate practice-level characteristics correlating with better positive patient response rates. Further analyses could identify other practice characteristics that correlate with better positive response rates in this and other clinical trials.

Acknowledgements

The ALL-HEART study is funded by NIHR HTA. This project was completed as part of a Dundee Clinical Academic Track summer studentship held by Thineskrishna Anbarasan. Recruitment to this trial in Scotland was supported by the Scottish Primary Care Research Network and Support for Science in Scotland.

References
1 McDonald A, Knight R, Campbell M, et al. What influences recruitment to randomised controlled trials? A review of trials funded by two UK funding agencies. Trials 2006; 7: 9. 2 Mackenzie IS, Ford I, Walker A, et al. Multicentre, prospective, randomised, open-label, blinded end point trial of the efficacy of allopurinol therapy in improving cardiovascular outcomes in patients with ischaemic heart disease: protocol of the ALL-HEART study. BMJ Open 2016; 6: e013774.

Index of poster presentations

Poster board No. Title of abstract Authors

PB01 Diagnosis of diabetes early after stroke: online survey among physicians M Abduljabbar, J Dawson, J Hewitt, M Walters

Best student poster prize winner (PB02)

PB02 A novel heterozygous nucleotide substitution (c.379A > G) mutation of HNF1α gene causing maturity onset diabetes of the young in a Scottish family B Aitken, R Cordiner, D Carty, R Drummond

PB03 What your patient wants: use of the Key Information Summary at the front door L Baird, JA Harrison

PB04 Does pursuing tissue diagnosis in patients with lung cancer improve prognosis? N Bezawada, A Misacas, GP Currie

PB05 Outcome of bronchial washing in patients with presumed infections in Aberdeen Royal Infirmary DA Bhuckory, W Fleming-Nouri, GP Currie, M Chetty

PB06 Lyme disease referrals to the NHS Highland infectious diseases service: a review of the clinical service S Brito-Mutunayagam, A Cochrane

PB07 Monitoring mortality on the HDU P Cameron, R Isles, D Scott, C Vincent

PB08 Using the hyperkalaemia kit: improving the management of hyperkalaemia N Cantley, T Abedin, S Lambie

PB09 Improving handover for weekend medical ward cover at Forth Valley Royal Hospital S Drummond, M Dupre, A Bridges

Best poster prize winner (PB12)

PB10 The genetic determinants of serum uric acid and their association with cardiovascular diseases: a systematic review F Elsakloul, M Walter, J Dawson

PB11 Audit and re-audit of clinical details on urine request forms submitted to Monklands microbiology laboratory 2015–2017 J Irvine, S Whitehead

PB12 Doing the right amount of endoscopy: audit of variceal screening in the liver clinic M Johnston, R Allen

PB13 Portal vein thrombosis: a common problem in the liver clinic? I Campbell, MP Johnston

PB14 Measuring the percentage of patients admitted with traumatic rib fractures to a non-trauma centre who received the appropriate standard of care: a retrospective audit in performance across all relevant specialty units S Leow, A Aranha

PB15 A retrospective review of patients with primary hyperparathyroidism, who had parathyroid imaging performed in Forth Valley Royal Hospital (FVRH), from 2013–2016 V Li, LM Buchanan, AJ Mackenzie

PB16 Evaluating the implementation and use of Hospital Anticipatory Care Plan AH Lynas, DR Taylor

PB17 Diagnosis of chest pain presenting to acute medicine K Mayne, T Watson-Fargie, D Beckett

PB18 What is the significance of a positive MPO/PR3 ANCA test in older patients? G Mcvay, G Chalmers, L McGeoch

PB19 Treat the troponin A Morrow, F Ahmad, D Murdoch

PB20 Non-elective admissions in patients with MS M Scott, B Chandler

PB22 Gestational diabetes – How important is the definition? K Sweeney, F McKenzie, R Drummond, R Lindsay, D Carty

PB23 Quality improvement project: identification of hyperglycaemia in medical inpatients prescribed steroids K Wood, S Bal