2 Novelty Statementa) In 2013 a revised version of national guidance on the management of DKA was published, however there are no data to show that these recommendations actually work b) This is the largest national survey on the management of DKA c) Most patients developed hypokalaemia and over 25% developed hypoglycaemia. There were also significant issues with care processes d) The management of DKA will need to change to prevent hypokalaemia but will necessitate a shift in where patients are cared for. However, as a result of moving to a High Dependency or Intensive Care environment, care processes may improve.3 Abstract AimsOutcomes for the management of diabetic ketoacidosis (DKA) remain largely unstudied. In a national survey we examined outcomes of adult patients presenting with DKA in 2014, mapped against accepted UK national guidance. MethodsData were collected in a standardised form covering clinical, and biochemical, outcome, risk, and discharge planning. The form was sent to all UK diabetes specialist teams (n=220). Anonymised data were collected on 5 consecutive patients admitted with DKA between 1.5.14 and 30.11.14 Results 283 forms were received (n=281 patients), from 72 hospitals, 71.4% used the national guidelines. 7.8% of cases occurred in existing inpatients. 6.1% of admissions were newly diagnosed diabetes. 33.7% of patients had had at least 1 episode of DKA in the preceding year. The median time to starting 0.9% sodium chloride and intravenous insulin was 41.5 minutes and 60 minutes respectively. Median time to resolution was 18.7 hours, and median length of hospital stay was 2.6 days. Significant adverse biochemical outcomes occurred; with 27.6% of patients developing hypoglycaemia and 55% reported hypokalaemia. There were also significant issues with care processes.Initial nurse led observations were well carried out, but subsequent patient monitoring remained suboptimal. Most patients were not seen by a member of 4 the diabetes specialist team during the first 6 hours, but 95% were seen before discharge.A significant minority of discharge letters to primary care did not contain necessary information. ConclusionDespite widespread adoption of national guidance, several areas of DKA management are suboptimal, being associated with avoidable biochemical and clinical risk.

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AIMSPoor communication of clinical information between healthcare settings is associated with patient harm. In 2008, the UK National Prescribing Centre (NPC) issued guidance regarding the minimum information to be communicated upon hospital discharge. This study evaluates the extent of adherence to this guidance and identifies predictors of adherence. METHODSThis was an audit of discharge summaries received by medical practices in one UK primary care trust of patients hospitalized for 24 h or longer. Each discharge summary was scored against the applicable NPC criteria which were organized into: 'patient, admission and discharge', 'medicine' and 'therapy change' information. RESULTSOf 3444 discharge summaries audited, 2421 (70.3%) were from two teaching hospitals and 906 (26.3%) from three district hospitals. Unplanned admissions accounted for 2168 (63.0%) of the audit sample and 74.6% (2570) of discharge summaries were electronic. Mean (95% CI) adherence to the total NPC minimum dataset was 71.7% [70.2, 73.2]. Adherence to patient, admission and discharge information was 77.3% (95% CI 77.0, 77.7), 67.2% (95% CI 66.3, 68.2) for medicine information and 48.9% (95% CI 47.5, 50.3) for therapy change information. Allergy status, co-morbidities, medication history and rationale for therapy change were the most frequent omissions. Predictors of adherence included quality of the discharge template, electronic discharge summaries and smaller numbers of prescribed medicines. CONCLUSIONSDespite clear guidance regarding the content of discharge information, omissions are frequent. Adherence to the NPC minimum dataset might be improved by using comprehensive electronic discharge templates and implementation of effective medicines reconciliation at both sides of the health interface.

Findings suggest that students' attitudes are more positive after they have worked together during seven weeks of IPL. Each student group view their own profession more positively than others. Views become more aligned after this IPL intervention. Time may be an important factor in allowing for attitudes to change. IPL can help foster positive attitudes between doctors, pharmacists and nurses, which may facilitate effective collaboration and thus enhance patients' medicines management.

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Myringoplasty is a safe and effective procedure in the UK. With the introduction of revalidation by the General Medical Council, participation in national audits will be mandatory in the future. This study demonstrates that a web-based audit tool would be suitable for performing such audits.

BackgroundThe UK government currently recommends that all patients receive medicines reconciliation (MR) from a member of the pharmacy team within 24 hours of admission and subsequent discharge. The cost-effectiveness of this intervention is unknown. A pilot study to inform the design of a future randomised controlled trial to determine effectiveness and cost-effectiveness of a pharmacist-delivered service was undertaken.MethodPatients were recruited 7 days a week from 5 adult medical wards in 1 hospital over a 9 month period and randomised using an automated system to intervention (MR within 24 hours of admission and at discharge) or usual care which may include MR (control). Recruitment and retention rates were determined. Length of stay (LOS), quality of life (EQ-5D-3L), unintentional discrepancies (UDs) and emergency readmission (ER) within 3 months were tested as outcome measures. The feasibility of identifying and measuring intervention-associated resources was determined.Result200 patients were randomised to either intervention or control. Groups were comparable at baseline. 95 (99%) patients in the intervention received MR within 24 hours, while 62 (60.8%) control patients received MR at some point during admission. The intervention resolved 250 of the 255 UDs identified at admission. Only 2 UDs were identified in the intervention group at discharge compared with 268 in the control. The median LOS was 94 hours in the intervention arm and 118 hours in the control, with ER rates of 17.9% and 26.7%, respectively. Assuming 5% loss to follow-up 1120 patients (560 in each arm) are required to detect a 6% reduction in 3-month ER rates.ConclusionsThe results suggest that changes in outcome measures resulting from MR within 24 hours were in the appropriate direction and readmission within 3 months is the most appropriate primary outcome measure. A future study to determine cost-effectiveness of the intervention is feasible and warranted.Trial registration numberISRCTN23949491.

Objectives: The Chronic Otitis Media Questionnaire-12 (COMQ-12) assesses patient-reported health-related quality of life. A multinational collaborative project was performed to translate and appraise the psychometric properties of the COMQ-12 across Europe, Asia, and South America. Methods: Eight otology units from seven countries (China, Colombia, France, Italy, Japan, Korea, Turkey) created native versions of the COMQ-12 by the process of translation and back-translation. Questionnaire reliability was assessed on the basis of internal consistency by calculating Cronbach's coefficient alpha. Exploratory factor analysis was performed to identify underlying correlations between individual questionnaire items. Results: This study included 478 participants from 8 countries. Calculated values for Cronbach's coefficient alpha were between 0.71 and 0.90. Exploratory factor analysis allowed the identification of three dominant factors, the primary factor (related to hearing problems) explaining 42% of the total variance, the secondary factor (related to daily activities) explaining 30% of the variance, and the third factor (related to acute disease activity) explaining 28% of the variance. Conclusions: This is a large study of patients with chronic otitis media, from centers from within many different countries spanning Europe, Asia, and South America. This study supports the use of the COMQ-12 within the individual countries where it was tested.