894 An Audit of Venous Thromboembolism Prophylaxis in A Busy ENT Department

Aim Venous thromboembolisms (VTEs) are a common and preventable cause of in-hospital morbidity and mortality. Assessment of risk factors (RFs) on admission and appropriate prescription of mechanical (e.g., TEDS) and/or pharmacological prophylaxis (e.g., low-molecular-weight heparin (LMWH)) is crucial. This is especially true in ENT where the variety of patient cohorts make a one-size-fits-all approach unsatisfactory. Guidelines from ENT UK reflect this. Method Electronic medical records were retrospectively reviewed for all emergency and pre-operative admissions (n = 173) to an adult ENT ward over 8 weeks. Adherence to the ENT UK guideline was assessed. Results 58% of patients had VTE RFs, 27% had bleeding RFs, 2% had mechanical thromboprophylaxis contraindications. VTE risk assessment was clearly carried out for 39% of admissions. 63 patients (36%) met the criteria for LMWH prescription. 22 (35%) received it. 5 received LMWH without meeting the criteria. 96 patients (55%) met the criteria for TEDS prescription. 5 (5%) received it. 1 received TEDS without meeting the criteria. Overall, 45% of admissions had both prescribed according to the guideline. Using a pro-forma (n = 148) significantly improved risk assessment rates (43% vs. 12%), but not correct prescription rates (45% vs 40%) compared to freehand clerking (n = 25). No patients developed a VTE or unexpected bleeding. Conclusions Risk assessment and prescription of pharmacological and, especially, mechanical thromboprophylaxis for those who met the relevant criteria has significant room for improvement. However, no apparent harm occurred because of this. Further work will focus on developing a departmental policy and educating staff on its application.

717 The Introduction of a Discharge Letter Proforma For Hip Fracture Patients Improves Compliance with VTE Prophylaxis Prescription on Discharge: A Closed Loop Audit

Introduction Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in inpatients; with those undergoing lower limb surgery at particularly high risk. NICE recommends that Low Molecular Weight Heparin (LMWH) or Fondaparinux should be used for VTE prophylaxis for one month following hip fracture. Our local policy is to prescribe Dalteparin for 30 days following surgery. Method A closed loop audit of VTE prophylaxis on discharge for 193 patients with hip fractures was performed. The first audit cycle established whether VTE prophylaxis was being prescribed in line with departmental policy. Following this, a template discharge letter was introduced which included a prompt for appropriate prescription of VTE prophylaxis. Results Initially, data for 93 consecutive patients was collected. It was found that 13% had not received VTE prophylaxis in line with guidelines. Of these, six patients had no documented contraindication or alternative prophylaxis prescribed. Results were disseminated locally. After introduction of the template discharge letter, data for 100 consecutive patients was collected. Re-audit showed a marked improvement in adherence to local policy with 95% of patients now receiving appropriate VTE prophylaxis on discharge. Conclusions Introduction of a template discharge letter prompts the documentation of contraindications to prophylaxis and improves compliance with local policy.

Assessment of the Adherence Rate of Acute Chemotherapy Induced Nausea and Vomiting Prophylaxis Regimens by Medical Team to NCCN Clinical Recommendations: Cross-Section Observation

Background: Chemotherapy induced nausea and vomiting (CINV) is still distressing adverse effect for patients. Thus, we conducted this study to assess the compliance of CINV prophylaxis patterns with NCCN guideline. Methods: 136 Patients with any kind of malignancy who undergoes chemotherapy in Shahid Ghazi hospital, Tabriz, Iran, were included in this study. Adherence rate to the NCCN guideline of antiemetic therapy for different emetogenic potential chemotherapy regimens was evaluated. Results: All patients received their prophylaxis 30 min before chemotherapy, which is completely adherent to guideline. Hematological malignancies were associated with higher adherence rate (P=0.032). For high and moderate emetic risk patients, dexamethasone and ondansetron were remarkably under-dosed, whereas Granisetron was over-dosed. Adherence rate to guideline in high and moderate and minimal emetic risk chemotherapy was 72.3%, 22.9% and 69.2% respectively. None of low emetic risk patients received guideline compliant prophylaxis. In all emetic risk levels, 50 (36.8%) patients received guideline adherent prophylaxis. Conclusion: As results indicated, adherence rate wasn’t optimal. Available dosage form of a medication has great impact on appropriate prescription. Thus, it is suggested for pharmaceutical companies to be informed about recent guidelines’ updates and subsequently produce proper dosage forms for different indications.

Vitamin D: Do We Need More Than Sunshine?

There is an astounding amount of conversation and research about vitamin D. It carries many claims, and there is controversy as to what adequate levels should be, how to ensure reaching appropriate serum levels, and what the consequences are of vitamin D insufficiency. This article describes the role of vitamin D, reviews some of the evidence, and provides the current recommendations for vitamin D supplementation, including if a daily walk in the sun is the most appropriate prescription or do we need something more?

Deprescription: a global need to rationalize drug prescribing

Appropriate prescribing and deprescription of unwanted medicines are a global concern. Polypharmacy is common in old age due to multiple comorbidities. This poses many risks that can be prevented by deprescription as a measure of planned reduction in number of medicines no longer needed. For articles to be included in this narrative review, a non-systematic search of deprescription and related term was conducted at PubMed and Google Scholar database. Articles detailing deprescription in general were included whereas those about deprescription in a particular disease or of particular drug groups were excluded. The review discusses about related terms, process of deprescription, when it is to be planned, which patients need deprescription, tools available for appropriate prescription, importance of patient oriented deprescription, actual steps involved in deprescription, present scenario, future scope of trials and formulation of guidelines for deprescription, and finally current state of deprescription in India and actions needed.

Interior of the horizon of the Bañados-Teitelboim-Zanelli black hole

A quantum scalar field inside the horizon of the non-rotating BTZ black hole is studied. Not only the near-horizon modes but also the normal modes deep inside the horizon are obtained. It is shown that the matching condition for the normal modes of a scalar field at the horizon does not uniquely determine the normal-mode expansion of a scalar field inside the horizon. By choosing a certain appropriate prescription for removing this ambiguity, an integral form of a new scalar propagator for points on both sides of the horizon are obtained. A similar problem may arise in higher-dimensional black holes.

Establishing Running Intensities of Elite Field Hockey Players During Competitive Match-Play

Field hockey requires players to perform at varying intensities throughout a competitive match, involving high-speed running combined with tactical skills in order to outscore the opposition. A greater understanding of specific running demands imposed by competitive match-play may aid coaches in appropriate prescription of training and adequate recovery programmes. Purpose: to determine peak duration- and position-specific running intensities during field hockey competition, using a rolling average method. Methods: twenty one elite male field hockey players were analysed through 15Hz Global Positioning System (GPS) technology across a 16 match competitive season. Peak values for relative distance (m·min-1) and high-speed distance (m·min-1) were calculated, placed in a velocity-time curve and analysed using a rolling average method across ten different durations (1, 2, 3, 4, 5, 6, 7, 8, 9, 10 min) for each playing position. Results: Forwards and midfielders covered significantly (p < 0.05) more relative distance than defenders for averages 1 to 6, with the forwards covering the greatest maximum relative distance and high-speed relative distance. There was a substantial decrease in relative distance and high-speed distance as the length of the rolling average increased, presenting small to moderate differences between durations 4 to 10 min, with the magnitude of differences between lengths decreasing as the rolling average length increased. Conclusion: These findings suggest that match-play running demands are significantly more intense than previously reported for all positions. As forwards exhibited a greater running intensity throughout, position specific training drills should replicate the most demanding phases of field hockey competition.

Antibiotic resistance in urinary tract infections: A re-visit after five years and experience over two sites

Objective The aim of this study was to repeat a previous audit, performed from 2009 to 2013, for the cohort of 2018 to determine how the resistance rates in urinary pathogens in women over 18 years of age have changed. A secondary aim of the study was to use resistance data from a different UK hospital in the same year to compare differences in resistance rates across different geographic locations Study design This was a retrospective study of all positive urine cultures grown from female patients attending two different hospitals in the year 2018. Resistance patterns were analysed. Results The resistance rate to co-amoxiclav continues to increase with amoxicillin retaining high resistance patterns. There are some significant differences in resistance patterns between the different locations. Conclusion Antimicrobial resistance is a significant problem in the UK particularly in antibiotics used to treat UTI. These patterns can vary across different geographical locations and over time; therefore, up-to-date knowledge of local anti-biotic resistance is essential when making an appropriate prescription choice.