Immigration detainees, like prisoners, are entitled to the same standard of healthcare as non-detained patients. When hospital attendance or admission is required, the priority for custodial staff (who for purposes of this article we refer to as 'escorts') is to prevent absconding. For that reason, they may wish to use physical restraints, such as handcuffs, and remain with the detainee at all times. This can be degrading for the patient and breach their human rights. Clinicians have professional obligations to all their patients and must object to any restraint methods that risk damaging the patient's right to confi dentiality, treatment, health or the therapeutic relationship itself. The starting presumption is that restraints ought not to be used during treatment and only in the most exceptional cases ought escorts to be present during clinical examination or treatment.

Background Enteral nutritional supplementation is widely used in preterm babies on Neonatal Units (NNUs). Common forms include breast milk fortifiers (BMF), multivitamins, folic acid and iron. There is little published evidence on evaluating their long term efficacy in preterm babies. Moreover, there are no clear indications of which preterm babies might benefit from these supplements and when they should be started and discontinued. There are no national guidelines on their use, with many NNUs setting their own standards. Aim To evaluate the current practice of enteral nutritional supplementation in level 2 and 3 NNUs in England. Methods A total of 113 level 2 and 3 NNUs in England were identified and contacted by telephone. A standardised questionnaire was used to ask neonatal nurses, advanced neonatal nurse practitioners or doctors about current practice of enteral nutritional supplementation on their unit. A response was obtained from 96/113 (85%) of NNUs. Results BMF, iron, multivitamins and folic acid supplementation were used in 96%, 98%, 98% and 56% of units respectively. Iron, multivitamins and folic acid supplementation were routinely commenced in babies < 35 weeks gestation by 73%, 68% and 39% of NNUs respectively. Iron supplements were commenced on day 14, 21 or 28 in 7%, 11% and 69% of units respectively. 49% of units commenced multivitamins when babies are on full feeds while 24% started on day 14 and 16% on day 7. 25% of units commenced folic acid when babies are on full feeds while 7% started on day 7 and 15% on day 14. 78% of NNUs only use breast milk fortification for babies that are not gaining weight. The majority of NNUs recommended discontinuing nutritional supplements when babies reach 6-12 months of age. Conclusion Despite being a universal tradition, our data demonstrates continuing variable practice of enteral nutritional supplementation in preterm babies among NNUs across England. Current use of anecdotal evidence and best guess recommendations highlights the need for a unified approach across the UK and collaborative multinational research to produce standardised guidelines.

Posters 514 study groups (*p< .05 controls vs FA at T0; °p< 0.5 FA at T0 vs FA at T1). Conclusions. ED in children with FA determine an EFA deficiency, in particular for polyunsaturated fatty acids, despite a specific nutritional intervention decided after nutritional counseling.

Background Tomorrows Doctors (2009) recommends assistantships should form part of the medical school curriculum. An assistantship is a period where a final year medical student undertakes most of the duties of a Foundation year one (FY1) doctor under supervision1. It aims to increase the preparedness of students starting FY12. Previous research has shown that prioritisation and other non-technical skills form a key part of preparing students for practise3. Previously simulation sessions for final year students at Sandwell and West Birmingham Hospitals primarily focused on dealing with one sick patient. To prepare the students for FY1 we organised a simulated on-call with several sick patients; focusing on prioritisation. Methodology Students completed a survey at the start of the assistantship assessing their preparedness for starting FY1. Results from the initial survey revealed a lack of confidence in handover and prioritising several unwell patients. Subsequently students were given the opportunity to attend a simulated on-call which focused on these reported weaknesses. In the simulation debrief students received feedback on human factors and non-clinical aspects of patient care. When finishing the assistantship, students will complete another survey to analyse whether the simulation has increased self-reported preparedness for starting FY1. Results At time of writing data is still being collected. Analysis from the initial survey revealed 54% do not feel prepared to start FY1, with 37% reporting lack of confidence in prioritising tasks. Initial feedback from the simulation has been positive. Students have reported increased confidence in prioritisation and management of patients whilst retaining situational awareness. Potential impact Students receive little training on dealing with multiple tasks prior to starting work. A simulated on-call as part of the assistantship may help students to develop their skills in the following areas in preparation for becoming an FY1: Prioritisation Situational awareness in pressurised situations Effective handover Team-working References Tomorrows Doctors: General Medical Council. 2009 (Last accessed 06.06.2014) Available at: Clinical placements for medical Students, advice supplementary to tomorrows doctors (2009): General Medical Council. 2011 (Last Accessed 06/06/2014) Available at Tallentire V et al, Are medical graduates ready to face the challenges of Foundation training? Postgraduate Medical Journal. 2011;87:590–5