Annual Trainee Doctors’ Prize Day, Thursday 2nd November 2018. : Postgraduate Medical Centre, Belfast City Hospital.

Introduction: Pancreatitis is a common condition on the acute general surgical take. Common aetiologies in the UK include gallstones, alcohol excess and iatrogenesis. Hypothermia is scarcely documented in literature among the rarer causes of pancreatitis, and whilst little scientific literature exists to support this clinical observation, this case adds to the growing evidence for hypothermia as a clinically relevant risk factor for acute pancreatitis. Discussion: We present the clinical course of a 44 year-old male open water swimmer who was admitted to ICU for mechanical ventilation in view of hypoxic respiratory failure and severe hypothermia (27oC). Following cardiorespiratory stabilisation and uncomplicated extubation, the patient complained of sudden, severe epigastric pain, refractory to strong opiate analgesia. CT images were in keeping with acute pancreatitis. The patient was managed conservatively at ward level and made an uncomplicated recovery prior to discharge. Thorough clinical history and biochemical testing excluded all other typical aetiologies of acute pancreatitis. This case is unique from previous reports in literature, where the relationship between hypothermia and pancreatitis has been more ambiguous. It is essential to be vigilant in hypothermic patients and remember this uncommon link, as diagnostic delay may lead to serious local or systemic complications of pancreatitis. Introduction: This study uses eye-tracking technology to objectively assess the differences in gaze behaviours between consultant and trainee ophthalmologists before and after a taught search strategy was introduced, while interpreting retinal images. Methods: Nine trainee and 10 consultant ophthalmologists were asked to interpret 6 retinal images before and after watching a 5-minute tutorial that suggested a search strategy. Participants were asked to complete questionnaires of clinical signs seen, appropriate retinopathy grade, and confidence. Eye movements were tracked during each interpretation. Results: Overall, trainees compared to consultants demonstrated more uncertain and unstructured gaze behaviours. Trainees eye gaze metrics compared to consultants included: longer interpretation time, 36.5s(SD=6.2) vs 31.4s(SD=4.2)(P=0.024), a higher visit count, 17.38visits(SD=5.13)vs 12.18visits (SD=2.64)(P=0.01), a higher proportion of fixation, 57.0%(SD=5)vs 50.5%(SD=5) (P=0.05) and a shorter time to first fixation, 0.232s(SD=0.10) vs 0.821sec(SD=0.77)(P=0.001), respectively. The teaching intervention did result in more focused gaze patterns in both groups. Pre-intervention and post- intervention mean proportion fixation on areas of interest were 38.6%(SD=6.8) and 51.8%(SD=13.9) for the trainee group, respectively, and 39.9%(SD=4.1)and 50.9%(SD=9.3) for the consultant group(P=0.01). Conclusions: Consultants used a more systematic and efficient approach than trainees in interpreting images. After the introduction of a suggested search strategy, trainees showed trends towards the eye gaze behaviours of consultants. The implication is that eye tracking may have future use in teaching programmes and objectively assessing different teaching strategies. Introduction: FFRCT can determine the functional significance of stenosis and guide safe deferral of invasive angiography, however intermediate prognostic implications have not been assessed. Aims: The study aim was to examine the prognosis of fractional flow reserve derived from coronary computed tomography (FFRCT) in routine clinical practice. Methods: Patients referred for FFRCT analysis with stable chest pain at a single centre between October 2015 and June 2017 were retrospectively included and followed up for rates of vessel related late (>90days) unplanned revascularization, MI, and cardiac mortality. Results: 200 (mean age 62.4±10.0 years) patients were sent for FFRCT analysis. A Cox Regression model was used to determine hazard ratios from FFRCT status. FFRCT+ patients were significantly more likely to undergo invasive angiography (p<0.001) and subsequent revascularization (p<0.001). All MI’s occurred in FFRCT positive group (n=4), none in FFRCT negative group (p=0.009). Discussion: A positive FFRCT was prognostic for significantly increased risk of unplanned revascularization and MI. FFRCT negativity provided strong clinical warranty, with no deaths or MI’s at one year. Invasive Catheter Angiography can be safely deferred in the presence of a negative FFRCT result. Introduction: Nice Guideline 53 recommends standards for the transition of care between inpatient mental health facilities and community follow-up. GP`s should receive discharge summaries within 7 days. At baseline 0% of letters were completed within this timeframe within the T&F. Aim: Discharge summary should to be completed within 7 days for at least 60% of patients in the T&F hospital, and to achieve this within 12 months. Method: The baseline data for all patients admitted and discharged in the 8 months prior were also gathered prior to any intervention. 5 PDSA Cycles were used to introduce a new discharge trolley to each inpatient ward, a new discharge checklist introduced. The letter itself was restructured in a way that made it easier to read and easier to complete. Results: Changes implemented correlated with an improvement from 0% of letters complete within 7 days to over 80% completed. The mean time taken for community teams receiving letters improved from 51 days to 4 days. Discussion: This project attained sustained improvement. Microsystems meetings at a local level also allowed a time allocated to focus on this project within a QI minded approach.