Blackburn, D

Carroll, C

Cheesman, A

Coebergh, J

Cohen, A

Sokhi, D

Wong, SH

Woolmore, J

English

We introduce the ABN Sustainability SIG. We present our aims &amp; objectives, and practical ways of implementing sustainability strategies in Neurology.At the 2016 ABN annual meeting, a keynote speech by Dr. David Pencheon, then director of the National Health Service Sustainability Development Unit, highlighted the relevance and importance of Sustainability in Neurology. This planted the seed for our SIG’s formation. Initial interest was gathered from an ABN newsletter notice, via word-of-mouth and informal discussions at ABN annual meetings (2017, 2018). A series of teleconferences &amp; email discussions enabled the formation of SIG byelaws and application to the ABN council.Our aims and objectivesTo be a positive force within the ABN to highlight issues surrounding global environmental sustainability.To provide a forum to consider the impact of choices made in neurology practice on global environmental sustainability. This will cover all aspects of neurology including, but not limited to, clinical practice, service provision, technological and digital developments, meetings and ABN resources and investments.To identify areas where the choice made could impact positively on global environmental sustainability and disseminate this information to the ABN membership to inform their decisions.</jats:sec

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characterises a cohort of neurosarcoidosis patients with focuson CSF analysis and whether this could help distinguish thesetwo conditions.Methods We enrolled 80 patients with a diagnosis of neurosar-coidosis based on stringent diagnostic criteria. The CSF andserum oligoclonal IgG patterns after iso-electric focusing werecompared.Results 80 patients had a probable or definitive diagnosis ofneurosarcoidosis. MRI findings were leptomeningealenhancement (35%) and white matter and spinal cordinvolvement (30% and 23%). PET was positive in (62%) ofisolated neurosarcoidosis. CSF analysis showed that oligoclo-nal bands were rare (3% had CSF alone,11% with mirrorpattern). No patient with definite neurosarcoidosis had CSFoligoclonal bands. Only 14% of patients with definite neu-rosarcoidosis had elevated serum ACE, CSF ACE was absentin all.Discussion Large elevations in CSF protein, WCC and ACEoccur in neurosarcoidosis, but are rare in MS. However, mini-mal changes may occur in both conditions. Intrathecal oligo-clonal IgG is a powerful discriminator as it is rare inneurosarcoidosis but common in MS (95–98%). We suggestcaution in making a diagnosis of neurosarcoidosis when intra-thecal oligoclonal IgG synthesis is found.Parallel session 2: Quality11.15 ABN SURVEY 2016: GEOGRAPHIC VARIATIONS INSERVICE PROVISION1Peter Fernandes, 2Cath Mummery. 1University of Edinburgh; 2ABN10.1136/jnnp-2019-ABN-2.5Introduction The 2016 ABN Acute Neurology survey providesa wealth of data on geographic variations in the provision ofneurological services. In this abstract we discuss differences inaccess to neurological care and services with respect to the 19ABN regions.Methods 2016 ABN survey data were analysed by region withbed data obtained from ONS records. Missing data werechecked where possible but otherwise assumed to be negativeresponses.Results Across the UK there are 263 beds/FTE consultant,ranging from 455 (Wales) to 154 (SW Thames). Neurologyinpatients as a proportion of total patients differ 16-foldbetween South West (0.016) and Wales (0.001). There arewide variations in acute neurological services (ward consul-tants, acute clinics, MAU ward-rounds). Only East Angliaand Northern Ireland regions have on-site stroke thrombol-ysis in all hospitals. Involvement in acute stroke thrombol-ysis ranges from 2.5 neurology consultants/hospital(Wessex) to 0 (NW Thames and Mersey). Access to investi-gations differs widely for 24/7 MRI (35% all hospitals,regional ranges 0% to 83%); EEG (61% [38%-85%]);NCS/EMG (57% [20%-85%]); and on-site neuro-radiology(38% [17%-71%]).Conclusion These data show considerable differences in a vari-ety of metrics between ABN regions, with implications forequitability of care.Parallel session 2: Quality11.27 UNDERSTANDING VARIABILITY IN UK ACUTENEUROLOGY SERVICES: WHAT WORKS, AND WHATDOESN’T?1,2Jonathan Best, 3Salwa Kamourieh, 2Cath Mummery. 1Stroke Research Centre, Institute ofNeurology, University College London; 2National Hospital for Neurology and Neurosurgery,University College London Hospitals NHS FT; 3Neurology Department, Charing CrossHospital, Imperial College Healthcare NHS Trust10.1136/jnnp-2019-ABN-2.6Background The 2017 ABN Acute Neurology Survey showedacute neurological services in the United Kingdom to varywidely, even between otherwise-similar departments. Focussingon positive outliers, we conducted qualitative research tounderstand this.Methods Through the 2017 survey, we identified DGHs andneurology/neuroscience centres which indicated high overallacute neurology service provision or outstanding performancein a particular area. From 39 hospitals meeting our criteria,we asked 15 clinical leads from throughout the UK to com-plete a questionnaire on their service model and develop-ment. We also analysed free text comments from the 2017survey.Results We received 9 responses, 6 from DGHs. Successfulinnovations included a neurology take, seven-day consultant-delivered reviews, and an ‘acute neurologist of the week’.Respondents viewed a well-functioning acute clinic as impor-tant, and we profiled how this was achieved. In DGHs, acutecare was mainly delivered by consultants, who described heavyworkloads.Of 120 comments from the 2017 survey, 37.5% describedacute clinic arrangements. Overbooking of urgent patients intoroutine clinics was common. After this, the most frequentthemes were understaffing (13.3%) and excessive workload(10%).Discussion Our qualitative data identifies difficulties facing UKacute neurologists, and highlights successful approaches whichmay inform future service development.Parallel session 2: Quality11.39 ASSOCIATION OF BRITISH NEUROLOGISTSSUSTAINABILITY SPECIAL INTEREST GROUP (ABNSUSTAINABILITY SIG): FORMATION, OBJECTIVES ANDINVITATION1Ann Cheesman, 2Daniel Blackburn, 3Camille Carroll, 4Anna Cohen, 5Jan Coebergh,6Dilraj Sokhi, 7Sui H Wong, 8John Woolmore. 1Southend University Hospital; 2SheffieldInstitute for Translational Neuroscience; 3University of Plymouth Faculty of Medicine andDentistry; 4Royal Free and Luton and Dunstable Hospitals; 5St George’s University Hospital;6Aga Khan University Medical College of East Africa; 7Moorfield’s Eye Hospital; 8QueenElizabeth Hospital, Birmingham10.1136/jnnp-2019-ABN-2.7We introduce the ABN Sustainability SIG. We present ouraims & objectives, and practical ways of implementing sustain-ability strategies in Neurology.Abstractse8 J Neurol Neurosurg Psychiatry 2019;90(12):e1–e65Library A. Henderson-Lib & Media Ser. Protected by copyright. on May 18, 2020 at University of Plymouth -http://jnnp.bmj.com/J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp-2019-ABN-2.7 on 14 November 2019. Downloaded from At the 2016 ABN annual meeting, a keynote speech byDr. David Pencheon, then director of the National HealthService Sustainability Development Unit, highlighted the rele-vance and importance of Sustainability in Neurology. Thisplanted the seed for our SIG’s formation. Initial interest wasgathered from an ABN newsletter notice, via word-of-mouthand informal discussions at ABN annual meetings (2017,2018). A series of teleconferences & email discussionsenabled the formation of SIG byelaws and application to theABN council.Our aims and objectives1. To be a positive force within the ABN to highlight issuessurrounding global environmental sustainability.2. To provide a forum to consider the impact of choices madein neurology practice on global environmental sustainability.This will cover all aspects of neurology including, but notlimited to, clinical practice, service provision, technologicaland digital developments, meetings and ABN resources andinvestments.3. To identify areas where the choice made could impactpositively on global environmental sustainability anddisseminate this information to the ABN membership toinform their decisions.Parallel session 2: Quality11.51 INTRODUCING ATRAUMATIC NEEDLES TO THENEUROLOGY AMBULATORY DAY CASE UNIT – AQUALITY IMPROVEMENT PROJECTDaniel White, Will Scotton, Zohra Shah, Tagore Nakornchai, Tamsin Critchlow,James Mitchell, Alex Sinclair, John Woolmore. Queen Elizabeth Hospital Birmingham10.1136/jnnp-2019-ABN-2.8Introduction Atraumatic needles are associated with adecreased incidence of postdural-puncture headache. Theyalso reduce the need for additional treatment and havesimilar efficacy to conventional needles. The aim of thisQuality Improvement Project (QIP) was to encourage theuse of atraumatic needles in Neurology ambulatory care bydeveloping a sustainable Lumbar Puncture (LP) trainingmethod.Methods A specialised atraumatic needle training video wasguru.kumar@nhs.net created for junior doctors starting inNeurology. This accompanied further teaching and opportuni-ties to practice LPs on a simulation mannequin under supervi-sion. Atraumatic needles were added to standard stock andsupply was ensured.Two audit cycles recorded the number of LPs performedusing an atraumatic needle. Patient age, body mass index,length of stay, pain experienced and any need for image guid-ance were also recoded. Junior doctor confidence was meas-ured before and after training.Results 81 LPs were performed in the first cycle, 83 in thesecond. Atraumatic needle use increased from 26% to 50%between cycles. Junior doctor confidence increased with train-ing from 2/10 to 8/10 (p=0.02).Conclusions Dedicated induction teaching and observed simula-tion practice increased junior doctors’ confidence in, and fre-quency of, the use of atraumatic needles.Parallel session 2: Quality12.03 ACUTE NEUROLOGY: A TWO WEEK SNAPSHOT IN ADISTRICT GENERAL HOSPITALMeneka Kanagaratnam, Ajay Boodhoo, Bridget MacDonald, Arani Nitkunan. CroydonUniversity Hospital10.1136/jnnp-2019-ABN-2.9Neurological illnesses are a common cause of hospital admis-sions, yet most patients are not primarily managed by neurol-ogists. Acute neurology services also vary across the UK.During a 2 week period in a district general hospital with a 5day inreaching neurological service (a consultant deliveredservice with a neurology nurse coordinator but no inpatientbeds), the number of patients admitted with a neurologicalproblem, as well as the proportion of those patients whowere seen by the hyperacute neurology team was assessed byreviewing the diagnostic codes. It was established there was atotal of 2242 admissions during the study period, and ofthose, 491 (22%) had neurological codes. Careful analysis ofthe 491 hospital electronic records revealed that 229 (10%)were truly neurologically relevant. Of those, 14% patients hada neurological opinion – despite a relatively comprehensiveservice (compared to many other district general hospitals),only a small proportion of acute neurology is being seen byneurologists.Parallel session 2: Quality12.15 VARIATION IN NEUROLOGY TRAINING: EXPERIENCESFROM SITES ACROSS THE UK1Samuel Shribman, 2Sian Alexander, 3Angelika Zarkali, 1Thomas T Warner,4Anthony Pereira, 5Tom Hughes, 3Catherine J Mummery. 1Reta Lila Weston Institute, UCLQueen Square Institute of Neurology; 2Department of Neurology, Addenbrooke’s Hospital,Cambridge; 3Dementia Research Centre, National Hospital for Neurology and Neurosurgery;4Department of Neurology, St George’s Hospital, London, UK; 5Department of Neurology,University Hospital of Wales, Cardiff10.1136/jnnp-2019-ABN-2.10There is little evidence-based consensus on how to approach,structure or deliver neurology training. The General MedicalCouncil conducts a National Trainee Survey in the UK on anannual basis and, while the results suggest significant variationin the quality of neurology training, they do not provide anexplanation for this variation. In order to better understandhow to train a neurologist we used the National Trainee Sur-vey to identify four of the highest and lowest performing sitesfor neurology training across the UK and visited them to con-duct semi-structured interviews with groups of trainees and,separately, local trainers. We identified common themesbetween the two groups of sites across a range of differentaspects of neurology training. These included supervision,competency-based training, clinic attendance, subspecialtyexposure, local teaching programmes and the educational cul-ture within departments. Here, we present our findings,including case studies from top performing sites, and providerecommendations with specific examples for how to train aneurologist.AbstractsJ Neurol Neurosurg Psychiatry 2019;90(12):e1–e65 e8Library A. Henderson-Lib & Media Ser. Protected by copyright. on May 18, 2020 at University of Plymouth -http://jnnp.bmj.com/J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp-2019-ABN-2.7 on 14 November 2019. Downloaded from 

11.39 Association of british neurologists sustainability special interest group (ABN sustainability SIG): formation, objectives and invitation

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ASSOCIATION OF BRITISH NEUROLOGISTS SUSTAINABILITY SPECIAL INTEREST GROUP (ABN SUSTAINABILITY SIG): FORMATION, OBJECTIVES AND INVITATION

ASSOCIATION OF BRITISH NEUROLOGISTS SUSTAINABILITY SPECIAL INTEREST GROUP (ABN SUSTAINABILITY SIG): FORMATION, OBJECTIVES AND INVITATION

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