Background: Potentially inappropriate prescribing (PIP) is common in older adults and is associated with increased medication costs and costs of associated adverse drug events. PIP also affects almost 1/5 of middle-aged adults (45-64 y), as defined by the PRescribing Optimally in Middle-aged People's Treatments (PROMPT) criteria.However, there has been little research on PIP medication costs within this age group.Aims: Calculate the medication costs of PIP for middle-aged adults according to the 22 PROMPT criteria and compare with the cost of consensus-validated, evidencebased (adequate) alternative prescribing scenarios. Methods: Adequate alternatives to the 22 PROMPT criteria were created via literature review. A Delphi consensus panel of experts was recruited (n = 16), supported by a patient and public involvement group, to achieve consensus on the alternatives. A retrospective repeated cross-sectional study from 2014 to 2019 was then conducted utilising pseudonymised primary care data from Lambeth DataNet in South London (41 general practices, n = 1 185 335, using Lambeth DataNet May 2020 extract) to calculate the cost of PIP. Results: The cross-sectional study included 55 880 patients. The total PIP cost was £2.79 million, with adequate alternative prescribing costing £2.74 million (cost savings of £51 278). Duplicate drug classes was the most costly criterion for both PIP and alternative prescribing. Conclusion: This study calculated the medication costs of PIP and created alternative prescribing scenarios for the 22 PROMPT criteria. There is no substantial cost difference between adequate prescribing vs. PIP. Future studies should investigate the wider health economic costs of alternative prescribing, such as reducing hospital admissions.

Results 198 cases were reviewed. In 79/198 (40%) the initial skeletal survey was negative. There were suspicious findings in 33/198 (17%) patients, 17 (9%) of which were ruled out as normal variants on the second skeletal survey, therefore identifying additional fractures in 16/198 (8%) patients.Follow up skeletal surveys were performed in 131/198 patients (66%), this increased to 104/141 (74%) after new guidance in 2017. In 78 (60%) cases repeat surveys were performed within the recommended 11-14 days. Three follow up surveys showed new suspected fractures which were ruled out with plain filDuring another repeat survey a head swelling was clinically apparent. CT head showed a new skull fracture, however, as per protocol, this was not imaged in the follow up skeletal survey. Additional findings were identified in 2/131 (1.5%) secondary skeletal surveys: a radial head dislocation of uncertain significance, and rib fractures in a patient with previously described multiple rib fractures. The impact of these findings on safeguarding investigations is unclear. Conclusion ConclusionWe found a significant reduction in additional findings on follow up skeletal surveys compared to the literature, with new findings described in 1.5% of second surveys. No new findings were found on second skeletal surveys where the initial survey was normal. The repeat survey was most useful to clarify if suspected abnormalities on the initial survey represented fractures. We note that as clinicians are following guidance to have a low threshold for initial and follow up skeletal surveys the proportion of children with non-accidental injury, and thus the detection of occult fractures, may have reduced. We also consider double reporting by paediatric radiologists may have contributed to improved detection of fractures in the initial survey.We suggest further investigation into results of follow up skeletal surveys following the introduction of new guidance. If our results are mirrored in other paediatric settings, then a review of the guidance would be warranted. More targeted follow up imaging for equivocal fractures could reduce the burden of repeat skeletal surveys to children, their families and the NHS. REFERENCE 1. Harper NS. 'The utility of follow-up skeletal surveys in child abuse'.

Although there were no significant differences in mortality between OP and controls, OP mortality was high at 25.0% compared to 8.3%. However, the deaths among the OP cohort were not directly related to OP itself. Patients with OP had higher risk of having moderate to severe intraventricular haemorrhage (IVH grades 2-3 by Volpe classification) OR 5.00 (p<0.05) and combined moderate-severe IVH with mortality, OR 5.86, p<0.01. Conclusions OP is a rare complication among smaller VLBW infants. There was a high incidence of mortality of 25.0%, air leak syndrome and moderate to severe IVH.

adaptable proforma letter which should be implemented to ensure clearer information on discharge. The frequency of long-term sequelae in this series highlights the need for continued research into this area and appropriate support following discharge.