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IntroductionMicroscopic colitis (MC) is a prevalent and treatable cause of chronic, non-bloody, watery diarrhoea. In MC, the colon is usually macroscopically normal therefore the BSG and European guidance call for right and left colon biopsies to be taken for histological examination to make the diagnosis. There is no established guidance on biopsy protocol.This retrospective, multi-centre study looked at our biopsy practice and whether there is a pattern that leads to higher diagnostic yield for diagnosis of MC.MethodsThe endoscopy reporting systems in six trusts across Kent, Surrey, Sussex and Cambridge were searched for all colonoscopies in patients aged 18 or over with the indication chronic diarrhoea performed between 1 January 2020 and 31 March 2020. All diagnosis of cancer or macroscopic inflammatory disease were excluded. The endoscopy and histology reports were analysed to see how many biopsies were taken and their histological diagnosis.Results363 reports were analysed. The age range was 18 to 90. Male to female ratio was 1:1.8. Biopsies were taken from both the right and left colon in 83.5%. Biopsies of the rectum were taken in 10.5%.The number of biopsies taken ranged from 0 to 17, most commonly taken as 4 right and 4 left colon biopsies (18.5%). The most common distribution was random right and left colon biopsies (22%) followed by colonic series biopsies* (9.6%).The diagnosis of MC was made in 20 cases. The age distribution was 30 to 80 (median 67.5) with male to female ratio 3:7. All had biopsies taken from both right and left colon amounting to 3 to 13 biopsies in total. The most common biopsy pattern in those diagnosed with MC were 5-6 biopsies taken as colonic series (25%) or 2-4 biopsies taken from both right and left colon (45%). Distribution in number of biopsies is shown in Table 1.Abstract PTU-62 Figure 1Biopsies taken in those diagnosed with MCConclusionThere was a large variation in the sites and number of biopsies taken to investigate for MC reflecting the lack of established guidance on biopsy protocol. Excessive biopsy samples have negative impacts on our green footprint, increase workload for histopathology colleagues and potential risk in bleeding and perforation risk for patients.We propose that the BSG should implement MC diagnostic biopsy protocol for standardisation of our practice. From the results of our data we advocate for either 5-6 biopsies as a colonic series or 2-4 biopsies to be taken from both right and left colon. Biopsies should not be taken from the rectum in a macroscopically normal colon.*Multiple biopsies ordered from proximal to distal colon

Membership of the Royal College of Physicians (MRCP) is compulsory for Internal Medical Trainees (IMTs) moving into higher specialty training. The practical component of MRCP – the PACES (Practical Assessment of Clinical Examination Skills) exam – requires extensive preparation. No structured PACES teaching programme existed at St Helier Hospital, UK. In the authors’ experience, local PACES preparation courses are often organised by those who themselves sat the exam many years ago, whereas trainees with recent exam experience are in an excellent position when it comes to providing preparation support.The authors, at the time all IMTs with recent PACES experience, designed and delivered a teaching programme over a three-month period. The course consisted of weekly bedside and simulated teaching sessions tailored to candidates’ specific needs, and a pan-London mock PACES exam to give candidates the opportunity to practise their skills in an environment closely resembling the real-life experience.Direct feedback was obtained both pre and post course, and following each individual session. Questions focussed on such issues as ease of access to PACES teaching and perceived exam preparedness. Pre-course feedback indicated that 86% of candidates felt teaching was difficult to obtain, whereas post course 100% felt this was now easily available. Perceived preparedness across all stations increased from 2.3-3.9 on a 10-point scale pre-course, to 7.8-8.7/10 post-course.The success of this project stressed the importance of realising that leadership is not so much a matter of seniority as it is of experience. Having only recently sat the exam themselves, the authors were in a unique position to identify the needs of PACES candidates and lead a successful preparation programme. Not only is this beneficial for exam candidates; it offers junior trainees the opportunity to develop and display leadership skills that will prove invaluable throughout the rest of their careers.

To document current management of blood glucose in Australian and New Zealand intensive care units (ICUs) and to investigate the association between insulin administration, blood glucose concentration and hospital outcome. Practice survey and inception cohort study in closed multi-disciplinary ICUs in Australia and New Zealand. Twenty-nine ICU directors and 939 consecutive admissions to 29 ICUs during a 2-week period. Data collected included unit approaches to blood glucose management, patient characteristics, blood glucose concentrations, insulin administration and patient outcomes. Ten percent of the ICU directors reported using an intensive insulin regimen in all their patients. In 861 patients (91.7%) blood glucose concentration was greater than 6.1[Symbol: see text]mmol/l, 287 (31.1%) received insulin, and the median blood glucose concentration triggering insulin administration was 11.5 (IQR 9.4-14) mmol/l. Univariate analysis demonstrated that non-survivors had a higher maximum daily blood glucose concentration (12 mmol/l, 9.4-14.8, vs. 9.5, 7.6-12.2) and were more likely to receive insulin (47% vs. 28%). Multiple logistic regression analysis showed age (OR per 5-year decrease 0.93, 95% CI 0.87-1.00) and APACHE II (OR per point decrease 0.87, 95% CI 0.84-0.90) to be independently associated with hospital mortality. After controlling for age and APACHE II both daily highest blood glucose (OR 0.95, 95% CI 0.90-1.00) and administration of insulin (OR 0.62, 95% CI 0.39-1.00) were independently associated when added to the model alone; neither was independently associated when they were simultaneously included in the model. Few Australian and New Zealand ICUs have adopted intensive insulin therapy. In this study, insulin administration and highest daily blood glucose concentration could not be separated in their association with hospital mortality.