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ObjectivesTo assess how different trusts across EoE region assess patient knowledge, skills and understanding of diabetesTo identify diabetic specific resources being used in the region.Whether a specific resource was predominantly used and we can consider adopting thisTo assess if the knowledge gap is identified, how it is addressed & further education delivered.To assess team members involved in the delivery of further education.Methods17 hospitals in East of England were surveyedResults are based on 12 responses (13 responses received but one hospital responded twice and as answers were similar we have counted it as one).Survey was sent via survey monkey and consisted of 14 questions.Responses were collected over 5months February 2022– July 2022Results58% used paper checklist, 17% used an electronic checklist to assess patients diabetes knowledge & self-management skills50% use Ready steady go as their resources/toolkit, 8% use Novo Nordisk, 25% have no specific resources, and 17% use a combination of Ready Steady Go and transition guidelines and local resource. Figure 1 shows resources being used.Abstract 6843 Figure 150% had to adapt the resources/toolkit to suit the needs of the diabetes serviceThe assessment is done over a period of 1–3years prior to tansfer of young person to adult service.If there are areas of skills or knowledge identified in the CYP as needing further education, this education is delivered by 34% separate individual session,8% Separate group session,8% as a written leaflet as illustrated in figure 2Abstract 6843 Figure 2Team members providing the education sessions are 58% combination of PDSN, PDD doctors, 17% PDSN only. 67% have a parental engagement policy for the transition service58% have a coordinator of the transition & transition clinicConclusionReady set go was used by majority (50%), 8% used Novo Nordisk, 25% had none toolkitsThe assessment is done over a period of 1–3 years of time prior to the transfer of the young person to the adult serviceIf there are areas of knowledge gap identified needing further education, this education is delivered by separate individual session(34%), other (50%) combination of all58% Trust have a coordinator of the transition & transition clinicWe have novo nordisk for education and ready set go for transition we need to adapt to one for education and transition for our trust.

ObjectivesTo compare the symptom burden of patients before and after commencement of medications following diagnosis of POTS (Postural orthostatic tachycardia syndrome)MethodsPatients completed the Malmo POTS score questionnaire at diagnosis and 12 months following medications. Additional information was collected from the clinical records. The responses were then analysedInclusion criteriaChildren who have been diagnosed with POTS following active stand test or Head up tilt test as per criteria and commenced on medicationsExclusion CriteriaWhere the diagnosis of POTS is not confirmed or if they haven’t been commenced on medications or if they haven’t completed both sets of questionnaireResults34 patients completed both sets of Malmo POTS questionnaires (scores between 0–10). There were 26 girls and 8 boys in the study with the age range being between 13- 17 years at the start of the study. These were the results obtained:Abstract 6204 Table 1 Symptom Average Score at start Average Score at 12 months Dizziness in upright position or while standing up 8.6 3.5 Dizziness, feeling that you are going to faint 8.9 1.6 Palpitations, high pulse, or feeling heart beating irregularly 4.7 0.8 Difficult breathing/dyspnoea, both at effort and rest 3.1 2.2 Chest pain 3.9 2.0 Headache 5.9 3.5 Concentration difficulties and/or problems with thinking 6.6 5.6 Muscle pain 3.1 3.3 Nausea 4.7 4.0 Gastrointestinal problems (stomach-ache, diarrhoea, constipation) 4.6 4.2 Abnormal tiredness that persists after rest 6.7 6.3 Insomnia 3.2 2.1 ConclusionThere is a high burden of dizziness, pre-syncopal symptoms, brain fog and fatigue in children with POTS. There was significant improvement in the score for dizziness, pre- syncopal symptoms and palpitations following medications. There was not much improvement in other symptom burden. This study helps to outline the likely treatment benefits against expectations during discussions before commencement of medications.

AimsTo look at the individual experiences amongst paediatricians in DGH (District General Hospitals) with regards to the management of PIMS-TS (Paediatric Multisystem Inflammatory syndrome) over the last 2 years.MethodsA survey was sent to paediatricians via a survey link. The survey asked for multiple questions regarding the respondents’ individual experiences in the management of children presenting with PIMS TS.Results38 completed responses were obtained and analyzed. Among the 38 respondents, each had seen between 2-20 patients with PIMS-TS over the last 2 years. 40% of the cases were predominantly cardiovascular, 30% were gastrointestinal and 30% were mixed. 50% of the respondents said that <25% of their patients were transferred to PICU, 22% said around 50% of patients were transferred, 18% said 90% of their patients were transferred and 10% of the respondents said 100% of their patients were transferred to PICU. 66% of respondents had no problems getting a PICU bed or retrieval services however 33% of the respondents agreed to some difficulties. 92% of the time patients were discussed with the infectious diseases (ID) team and 8% of the time this wasn’t discussed with the ID team. 17% of the respondents used steroids in all their patients whereas the rest used in varying numbers. 40% of the respondents said they used IVIG in 75% of their patients whereas the rest used it in varying numbers. Inotropes were used in 25% of the patients whilst in DGH, on average 25% of the patients needed peripheral noradrenaline and no complications were reported. Comfort levels in the management of PIMS TS were in the moderate range amongst paediatricians in DGH. Around 60% of the patients had echocardiography within 48 hours of presentation. Some of the other difficulties encountered were nursing training in regards to administering nor-adrenaline, interpreting cardiac biomarkers, follow-up arrangements, and education.ConclusionPIMS TS is still a new clinical entity and often these patients present to District general hospitals in varying circumstances of clinical instability. Some of these patients need PICU transfer which can be challenging at times. Around 25% of these patients need inotropes predominantly noradrenaline with no reported complications. There are still wide variations in the management of these patients, and further education and clear guidelines would be helpful to ensure the management of these complex children is done safely & effectively.

AimsTo look at the presentation, signs, investigations, and management of children diagnosed with Orthostatic Hypotension (OH).MethodsWe looked at the case notes of 23 children diagnosed with Orthostatic Hypotension in regards to their presenting symptoms, signs, investigations, and management.ResultsOf the 23 children, there were 15 girls and 8 boys with the age ranges being between 11 to 17 years. Their presenting symptoms were predominantly dizziness and syncope. All children had symptoms lasting over more than 3 months. Of the 23 patients, 12 patients had co-morbidities including migraine, gastric complaints, sleep issues, and pain. On examination, 7 patients had hypermobile joints. All 23 patients had a head-up tilt test which confirmed the diagnosis of OH with either a systolic BP fall or an episode of loss of consciousness with a fall in blood pressure. Of the 23 patients, 11 were managed with non-pharmacological treatment, and 12 needed different medications including slow-release sodium chloride tablets, fludrocortisone, or midodrine.ConclusionChronic Orthostatic hypotension can be a problematic condition in adolescent children. Symptoms are predominantly dizziness, syncope, pre syncopal symptoms, or headaches. Some children have other co-morbidities. A tilt test can be useful in confirmation of diagnosis, management, and explanation to the child and parents. Non-pharmacological management and advice might be enough in some children however if symptoms continue to be problematic despite this then pharmacological treatment might be needed.

AimsTo determine if thyroid function tests are useful in the investigation process of a child presenting with palpitationsMethodsWe looked at 87 children presenting with palpitations to the paediatric outpatient clinic over a 2 year period. We selected the children who had thyroid function tests done as a part of their investigations. We excluded children with known thyroid problems either hypo or hyperthyroidismResultsOf the 87 children, there were 52 females and 35 males. The median age was 13 years with patients ages ranging between 6-17 years. The presenting complaint was palpitations and all of them had blood tests including thyroid function tests either done by GP or the paediatrician. None of the patients had a note of goiter or other symptoms of hyperthyroidism. Of the 87 patients, 75 had completely normal thyroid values. 12 patients had a high TSH ranging between 4.3-6.4. All 12 patients were reviewed and followed up with thyroid functions normalizing or considered to be within acceptable ranges. None of the patients had tests suggestive of hyperthyroidism.ConclusionHyperthyroidism is known to cause palpitations in children. Although thyroid function tests are requested routinely as part of investigations of children with palpitations either in primary care or hospital they have a poor yield in terms of diagnosis of hyperthyroidism. Occasionally the thyroid function tests might show slightly deranged levels of TSH which might then worry their parents and necessitate further investigations. Given this study, we feel routine use of thyroid function tests is unnecessary in a child presenting with palpitations and unless there are other clinical features of hyperthyroidism then these tests should not be undertaken.

AimsIntroductionEffective transition is a gradual process of empowerment that equips young people with the skills necessary to manage their own healthcare in paediatric and adult services1 NICE guideline recommends that the transition should be a joint clinical action between paediatric and adult service, with at least 1 joint consultation and a clear action plan for conducting a review after the young person has transferred into the adult service.2 Aims and ObjectivesTo evaluate and provide recommendations to the Paediatric Epilepsy service regarding the smooth and efficient transition process to Adult Epilepsy service.We assessed if an epileptic child with normal development completed the transition process by 17th birthday, whereas an epileptic child with neuro-disability and learning difficulty completed the transition process by 19th birthday.We also determined the reason for the delay in transition and the number of patients in whom transition did not happen in ideal condition (seen by a specialist nurse and joint transition clinic)MethodsWe conducted a retrospective study where case notes of all the patients in our epilepsy service between 15-20 years of age were reviewed between February and September 2021.ResultsThe total number of patients was 110, 56 were Females and 54 were Males.8 patients were excluded from data who were nonepileptic and 1 patient unfortunately died during this period.Out of 101 patients, 31 patients fully transitioned whereas 36 patients did not complete the process (5 patients commenced the transition but did not complete it). 23 patients were discharged to GP with good seizure control. 11 patients’ transition status was unknown due to either loss in follow up, or they did not attend a clinic (frequent DNAs) or there was no documentation in the notesOf those who completed the transition (31 patients) 14 patients had at least one joint clinic whereas 17 patients transitioned without a joint clinicWe also assessed the time taken to transition; 12 patients transitioned in <6 months, 17 patients took 6-12 months, and 2 patients required 13-24 months to complete the process of transition (figure 1).We also looked at stage of transition at various age groups and found that by 20 years of age all of them had fully transitioned (figure 2).The reasons for the delay in transition were frequently DNAs, clinic cancellation due to COVID pandemic, and lack of availability of joint clinics with adult neurology service.Abstract 918 Figure 1Stage of transition graphAbstract 918 Figure 2Time taken to transition graphConclusionRecommendationsJoint clinics with the adult team are ideal but the transition should not be delayed due to the non-availability of an adult team.The young person and their carers should start the Ready Steady Go programme at around 11 years of age, if developmentally appropriateTo consider the introduction to ‘Ready Steady Go progamme’ through an introductory video and the ‘Transition: moving into adult care’ information leaflet

Air pollution is strongly tied to climate change. Industrialization and fossil fuel combustion are the main contributors leading to climate change, also being significant sources of air pollution. Malaysia is a developing country with a focus on industrialization. The preference of using private cars is a common practice in Malaysia, resulting in the after-effects of haze and transboundary air pollution. Hence, air pollution has become a severe issue in Malaysia in recent times. Exposure to air pollutants such as ozone and airborne particles is associated with increases in hospital admissions and mortality. For the past few years, the focus of the research is moving towards air quality and the impacts of air pollution on health in Malaysia. In this study, we establish the definition of air pollution, the motivation to study it, and its impacts and sources of air pollution and climate change. We discuss the air quality monitoring system in Malaysia and compare Malaysian ambient air quality standards with global standards. We also look comprehensively on the health impacts of air pollution globally and in the Malaysian context. We discuss where the health impact studies in Malaysia are lacking and what are the gaps in the research. The role of the Malaysian government concerning air pollution and its impacts is discussed. Lastly, we look into the future work and research opportunities with a focus on engineering, estimation, predictive models and lack of research projects.

Although guidelines recommend low-density lipoprotein cholesterol (LDL-C) to be < 70 mg/dL in patients with atherosclerotic cardiovascular disease (ASCVD), the rate of achieving this goal remains suboptimal. We sought to understand real world contemporary practice patterns of LDL-C management in patients with ASCVD, and whether LDL-C testing influenced management across US health systems. A retrospective cohort study utilizing electronic medical record data from five health systems participating in the CardioHealth Alliance was performed on patients with an LDL-C measurement in 2021 and prior ASCVD. Multivariable regression modeling was used to determine the relationship of clinical factors with achievement of guideline directed LDL-C target. Changes in lipid lowering therapy (LLT) after LDL-C testing were also described. Among 216,074 patients with ASCVD, 129,886 (60.1%) had uncontrolled LDL-C (i.e. ≥ 70 mg/dL). Compared with participants with controlled LDL-C (< 70 mg/dL), those with uncontrolled LDL-C were more frequently female (50.9% vs. 35.1%), or Black (13.7% vs. 10.3%), and less commonly had coronary artery disease as the form of vascular disease (73.0% vs. 83.5% %), heart failure (21.3% vs. 29.1% %), diabetes (34.1% vs. 48.2%), atrial fibrillation (19.3% vs. 26.1%), or chronic kidney disease (25.1% vs. 32.2%). In multivariable analyses, the factors most strongly associated with failure to achieve LDL-C control were female sex (RR 1.13 [95% CI 1.12-1.14] P < .001) and Black race (1.15 [1.14-1.17] P < .001). Among the 53,957 (41.5%) of those with uncontrolled LDL-C ≥70 mg/dL not on lipid lowering therapy (LLT) at baseline, only 21% were initiated on any LLT within 6 months of the uncontrolled LDL-C value. Within 5 diverse large health systems in the CardioHealth Alliance, more than half of the patients with ASCVD had uncontrolled LDL-C with significant disparities based on sex and race at baseline. The vast majority were not initiated on any lipid lowering therapy within 6 months of an elevated test result indicating persistent gaps in care that will likely worsen health inequities in outcomes. This highlights the urgent need for implementation efforts to improve equitable care.

To further reduce the burden of cardiovascular disease (CVD) and expand prevention efforts, the American Heart Association (AHA) introduced in 2010 the concept of Ideal Cardiovascular Health (ICH), which includes 7 metrics (smoking status, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting plasma glucose). Limited data exist on the relation between ICH and long-term CVD risk. The Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study cohort was used to examine the relation between ICH and incident major adverse cardiovascular events (MACE: first occurrence of death, myocardial infarction, stroke, acute ischemic syndrome, or coronary revascularization). The 7 factors of the ICH were scored at study entry on a 0 to 2 scale, resulting in possible range of 0 to 14, with higher scores representing “better” health. Cox regression analyses were used to estimate hazard ratios (HR) of MACE, along with 95% confidence intervals. Over a median follow-up of 12 years, the study population (n = 1,863, 67% women, 42% Black race, mean age 59 years [range 45 to 75]) had 218 MACE. In unadjusted analysis, the ICH score (per 1 unit) was associated with an estimated 12% lower risk of MACE (HR [95% Confidence Interval]: 0.88 [0.82, 0.93]). Adjusting for demographics, education, and quality of life, ICH score was associated with a 10% lower risk of MACE (HR 0.90 [0.84, 0.96]). In a community-based sample of adults, the AHA ICH construct, which includes 7 modifiable CVD risk factors, appears to be a valid measure for predicting long-term risk of MACE.

All variables were self-reported and prevalence values were weighted to reflect the sampling methodology.2 All analyses were conducted using Stata version 13.1 (StataCorp, College Station, Texas). More educated individuals who are aware of the health risks of cigarette smoking may resort to vaping as a potential safer alternative. [...]lower income earners demonstrate lower prevalence and a decrease in prevalence over time.