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Standardising the administration of joint injections across the Wolverhampton NHS Trust: a service improvement project in rheumatology through the lens of medical education (2025)

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Conference abstract

Author(s):

*Jayasekera H.; Agunbiade T.; Chalam S.V.

Citation:

Future Healthcare Journal. Conference: Medicine 2025: The future of medicine. RCP annual conference. 11 St Andrews Pl, London United Kingdom. 12(2 Supplement) (no pagination), 2025. Article Number: 100432. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: The Rheumatology Resident Doctors' Forum identified a pressing need to standardise steroid injection training due to varying experience and confidence levels among resident doctors. Many expressed a strong interest in learning injection techniques but faced barriers in accessing training and achieving formal competency. Addressing this gap had the potential to enhance service delivery, support professional development and reduce patient wait times. General practice trainees also highlighted the value of joint injection skills in primary care, helping to alleviate pressure on rheumatology services. The Dreyfus model of skill acquisition describes five levels of competency in skill development, ranging from 'novice' to 'competent' and eventually 'expert'.1 The model shows how individuals progress from rule-based, analytical thinking to experience-driven mastery of a skill.1 A recent study demonstrates that structured training can enhance competency in procedural skills, such as joint injections.2 Methods: A SMART aim was used to design learning outcomes. Fourteen applicants were selected at random. Pre-course surveys collected quantitative and qualitative data on performance challenges, confidence, and baseline knowledge. Process mapping (Fig 1) and radar diagrams (Fig 2) highlighted gaps for intervention. Four trained rheumatology doctors, supervised by a consultant, led a teaching program. Virtual meetings guided plan-do-study-act (PDSA) cycles and driver diagrams to ensure constructive alignment. The goal was to advance learners from the Dreyfus level of 'Novice 1' to 'Competent 1'. The course, conducted in the clinical suite, used training mannikins of knees and shoulder joints, providing real-time feedback. Teaching combined interactive lectures, small-group sessions and individualised feedback. Formative assessments maximised educational impact. Post-course data were compared to baseline, with quality improvement (QI) sustainability tools used to draw portal diagrams, highlight improvement gains and discuss long-term impacts of the project. Results and discussion: Initially, 50% of participants were novices, with none having ever injected a shoulder joint. Confidence in consenting patients increased from 14% to 100% post-course. 64% of participants were unfamiliar with medications used for injections, while 28.6% were unsure of the evidence base. Post-course, both categories improved to 100%. Additionally, 43% initially lacked confidence in clinical decision-making regarding safe joint injection. There was a 100% increase in overall confidence surrounding decision-making (43% 'strongly confident' and 57% 'confident'). All doctors passed the criterion-referenced standard assessment, acquiring formal recognition of skills in their portfolios. The course was oversubscribed and received excellent feedback. QI tools, including radar diagrams, process mapping, and PDSA cycles, had a crucial role in refining training and driving measurable improvements. The structured application of QI methodology successfully upskilled doctors, advancing them from 'Novice' to 'Competent'. Simulation-based learning, combined with real-time feedback, proved to be a highly effective strategy for accelerating skill development while enhancing clinical decision-making and confidence. By integrating this training into departmental inductions, the initiative ensured sustainability and continuous professional development, benefiting both individual practitioners and the wider healthcare service. Conclusion(s): The project led to significant improvements in confidence and competency. It demonstrated sustainability through reproducibility and was incorporated into the rheumatology departmental induction. Positive feedback highlights the course's broader applicability in QI-driven medical training.

DOI: 10.1016/j.fhj.2025.100432

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Normal creatinine-kinase levels in post-COVID myositis: insights into localised muscle involvement (2025)

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Type of publication:

Conference abstract

Author(s):

*Jayasekera H.S.; *Elshehawy M.; *Olarewaju J.; Askari A.

Citation:

Clinical Medicine, Journal of the Royal College of Physicians of London. Conference: Medicine 2025: The future of medicine. RCP annual conference. 11 St Andrews Pl, London United Kingdom. 25(4 Supplement) (no pagination), 2025. Article Number: 100437. Date of Publication: 01 Jul 2025.

Abstract:

Introduction: Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2; coronavirus 2019; COVID-19) has been increasingly implicated in post-infectious inflammatory complications, including varied presentations of inflammatory myopathies.1,2 Most literature highlights severe, systemic muscle involvement requiring immunosuppression, whereas localised myositis with normal creatine kinase (CK) levels remains underrecognised.3 This case presents a rare instance of localised paraspinal and proximal thigh myositis post-COVID-19, where CK levels remained normal, despite significant muscle involvement. Method(s): A 41-year-old previously healthy man presented with severe diffuse back and leg pain, muscle cramps, and low-grade fever for 2 weeks after confirmed COVID-19 infection. Examination revealed proximal thigh weakness (MRC Grade 3/5) and tenderness without neurological deficits. Investigations, including blood tests, magnetic resonance imaging (MRI), computed tomography (CT), autoimmune screening, echocardiography, blood cultures and electromyography (EMG) studies. were conducted.1 Management required evaluating the progression of symptoms in the light of test results to identify the aetiology of disease, considering differential diagnosis and early establishment of localised vs systemic inflammatory myopathy.2 The patient was diagnosed as post-viral myositis with a normal CK. Empirical intravenous piperacillin-tazobactam was discontinued after infection was excluded. Simple analgesia and vitamin D sufficed for symptom control. The patient showed resolution of fever, significant improvement in muscle pain and normalisation of inflammatory markers, preventing the need for immunosuppression. Results and Discussion: Laboratory findings showed elevated C-reactive protein (237 mg/L), white cell count (12.0 x 109/L), and neutrophilia (9.4 x 109/L). Alkaline phosphatase (192 U/L) and gamma glutamyl transferase (202 U/L) were mildly elevated, while CK levels were normal (22 U/L, peaking at 56 U/L). MRI revealed diffuse oedema in posterior paraspinal muscles without abscess or infection, and CT imaging confirmed intermuscular oedema in paraspinal and proximal thigh muscles without systemic involvement. Autoimmune screening (antinuclear antibodies, weakly positive; extractable nuclear antigen antibodies and anti-neutrophil cytoplasmic antibodies, negative) and echocardiogram were unremarkable. Blood cultures showed no growth and EMG displayed a myopathic pattern in the right shoulder. This case provides insight into an atypical presentation of post-COVID 19 myositis, where the CK level remains normal despite muscle weakness.3 It evaluates the diagnostic and management challenges in this scenario. Other differentials include amyopathic dermatomyositis (ADM). However, differentiating localised post-viral myositis from ADM is essential, because ADM presents with cutaneous manifestations, which are absent in this case. A detailed history of recent viral illness and advanced imaging (eg, MRI) are critical for identifying myositis and excluding systemic or infectious causes.1Conclusion(s): This case highlights that post-viral localised myositis can present with significant muscle involvement despite normal CK levels, necessitating MRI for diagnosis.1,3 Early rheumatology input can optimise management by differentiating self-limiting inflammatory myopathies from those requiring immunosuppression.

DOI: 10.1016/j.clinme.2025.100437

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Complex lupus management: when multiple organs demand precision (2025)

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Type of publication:

Conference abstract

Author(s):

*Jayasekera H.S.; Askari A.; *Chand S.

Citation:

Clinical Medicine, Journal of the Royal College of Physicians of London. Conference: Medicine 2025: The future of medicine. RCP annual conference. 11 St Andrews Pl, London United Kingdom. 25(4 Supplement) (no pagination), 2025. Article Number: 100376. Date of Publication: 01 Jul 2025.

Abstract:

Introduction: Systemic lupus erythematosus (SLE) is a complex autoimmune disease with a wide spectrum of severity, ranging from mild manifestations to life-threatening organ damage. Its multisystem involvement poses a significant treatment challenge, because interventions targeting one organ system may inadvertently impact another. The Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) is a widely used tool for assessing disease activity, with a score above 12 indicating severe disease. However, studies estimate that approximately 20% of patients present with severe manifestations at diagnosis. One of the most serious complications of SLE is lupus nephritis, which is classified into six classes by the International Society of Nephrology/Renal Pathology Society (ISN/RPS), ranging from Class I (minimal-mesangial lupus nephritis) to Class VI (advanced-sclerosing lupus nephritis). We present a case of a patient newly diagnosed with severe SLE and lupus nephritis, characterised by high disease activity and multisystemic involvement. This case highlights the complex treatment considerations necessary when managing severe lupus.

Method(s): A 62-year-old woman presented with flu-like symptoms followed by a malar rash, mouth ulcers, fatigue, alopecia and pancytopenia. She was diagnosed with SLE with lupus nephritis confirmed by renal biopsy, and SLE on skin biopsy. Management required significant consideration because of high disease activity (SLEDAI 16) complicated by pancytopenia and liver dysfunction. Therapeutic options were systematically evaluated to balance efficacy and safety given the patient's pancytopenia, liver dysfunction and renal involvement. Mycophenolate mofetil (MMF), effective for lupus nephritis, was excluded because of its potential to worsen pancytopenia. Azathioprine, suitable for mild renal involvement, was ruled out because of liver dysfunction. Cyclophosphamide, typically used for severe SLE, was contraindicated because of its haematological and hepatic toxicity. Tacrolimus was considered for renal SLE, given the biopsy Class of I, but was unsuitable for non-renal lupus without MMF. Belimumab, an FDA-approved agent with steroid-sparing effects and a favourable safety profile, was considered but deemed challenging because of its slower onset of action and approval barriers. Hydroxychloroquine (300 mg daily) and corticosteroids (40 mg prednisolone) were ultimately chosen as the safest and most effective initial therapy. Close liaision with the renal team was essential to optimise management. Results and Discussion: Laboratory results revealed low complements (C3 0.38 g/L, C4 0.03 g/L), pancytopenia (WBC 1.2 x 109/L, platelets 126 x 109/L), elevated ferritin (5,490 mug/L), and positive dsDNA. Skin biopsy was consistent with SLE and renal biopsy confirmed lupus nephritis (ISN/RPS Class I). CT-TAP imaging showed axillary lymphadenopathy without malignancy. This case highlights the challenges of managing multisystemic lupus presenting with renal and non-renal SLE symptoms of varying degree, in a patient not already established on baseline treatment. Hydroxychloroquine and corticosteroids formed the cornerstone of treatment, while other options were systematically excluded based on contraindications. Multidisciplinary collaboration was pivotal in tailoring therapy.

Conclusion(s): There are two key learning points highlighted in this case. First, that treating multisystemic lupus requires understanding the degrees of individual organ involvement to determine immunosuppressive needs. Second, that management decisions should balance efficacy and toxicity, guided by interdisciplinary input6 and renal biopsy findings to inform immunosuppression.

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39MO Genomic framework of lung carcinoid: Analysis of the AACR GENIE database (2025)

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Conference abstract

Author(s):

Immanuel A.; *Arunachalam J.; Advani K.

Citation:

ESMO Open. Conference: The ESMO Sarcoma and Rare Cancers Congress 2025. Lugano Switzerland. 10(Supplement 3) (no pagination), 2025. Article Number: 104350. Date of Publication: 01 Mar 2025.

Abstract:

Background: Carcinoid tumors, rare neuroendocrine tumors, occur in the lungs in approximately 25% of cases. The 5-year survival rate for lung carcinoid in the US is 98% for localized disease and 86% for regional disease, with a drop to 55% for metastatic cases. Patients with metastasis are often treated with temozolomide-based chemotherapy, mTOR inhibitors (everolimus), platinum-based chemotherapy, or peptide receptor radionuclide therapy. We aim to investigate potential unexplored genetic targets. We intend to explore if there is a role for immunotherapy for treatment for lung carcinoid as it is generally better tolerated and less toxic compared to chemotherapy. Method(s): Using the cBioPortal platform, we accessed the AACR GENIE version 15.0 database. Demographic data were gathered from patients with lung carcinoid. We outlined the frequency of mutated genes, copy number alterations, and structural variations in the population. Result(s): We analyzed 242 patients and 253 samples. 73.1% of the patients were females and 26.9% were males. 74.7% of samples were collected from a lung primary, while 16.2% of samples were from metastatic sites. The median age at sequencing was 62 years. The highest frequency of mutations was seen in LRP1B gene (18.4%), followed by the MN1 gene (15.8%) and the ARID1A gene (11.8%). The most structural variants were found in the MEN1 gene at 0.9% (n =2, total number of profiled samples = 226). The most common copy number alteration was PDCD1 (n=5, number of profiled samples=134) at 3.7% and CCND1 on 11q13.3 (n=4, number of profiled samples=201) at 2%. Conclusion(s): Prior studies have shown that one of the most frequently mutated pathways in pulmonary carcinoids involves MEN1 gene. We found that genomic alterations in LRP1B, ARID1A, PDCD1 and CCND1 are also frequently observed. It is well known that anti-PD1 therapy is efficient in PD1 expressing cancers. LRP1B mutation in lung cancers has been shown to affect the immune microenvironment and enhance the efficacy of immune checkpoint inhibitors. While ARID1A mutations correlate with longer median overall survival when treated with immunotherapy. The limited number of ongoing clinical trials on targeted therapies underscores the clear need to explore the genomic targets for precision therapies in lung carcinoids.

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BHSeP26 Abdominal wall reconstruction outcomes of the first 50 cases in a district general hospital (2025)

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Type of publication:

Conference abstract

Author(s):

*Gungadin P.; *Bhandari M.; *Cheetham M.; *Chakravartty S.; *Mccloud J.; *Parampalli U.

Citation:

British Journal of Surgery. Conference: 13th British Hernia Society Conference. Oxford United Kingdom. 112(Supplement 3) (pp iii6), 2025. Date of Publication: 01 Jan 2025.

Abstract:

Background: The purpose of this study was to evaluate the short-term clinical outcomes of patients undergoing reconstruction of abdominal wall following repair of complex hernias at a recently established unit. Method(s): This retrospective study included all patients who underwent abdominal wall reconstruction for complex incisional hernias between January 2022 and March 2024. Clinical data encompassing patient demographics, operative parameters, post-operative complications, length of hospital stay and 30-day mortality was analysed. Result(s): 50 patients were included with a male to female ratio of 1:1. The median age of the participants was 62 (26-82). 25% of participants had a BMI of 35. The majority of hernias were approached with a vertical elliptical incision; Fleur de Lys incision was used in 1 case and abdominoplasty incision in 3 cases. The following reconstruction techniques were used: 27 patients underwent Rives Stoppa repair and 16 patients underwent Transversus Abdominis Muscle Release. 30% patients had Botulinum toxin injection pre-operatively. The types of mesh used included: Ultrapro 80 %, Phasix 16 % and Parietex 4 %. Complications included: Surgical site occurrence 6%, cardiorespiratory complications 10%, vascular complications 2% and bowel obstruction 4%. ICU admission included 3 out of 50 patients. Length of hospital stay in 90% patients was 5 days. 60% patients had a 6-monthly follow up where 1 recurrence was noted. Conclusion(s): The early outcomes in our patients demonstrates the feasibility to achieve acceptable outcomes in a district general hospital, by following a multidisciplinary approach and optimising modifiable risk factors preoperatively.

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Description and Cross-Sectional Analyses of 25,880 Adults and Children in the UK National Registry of Rare Kidney Diseases Cohort (2024)

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Type of publication:

Journal article

Author(s):

Wong K.; Pitcher D.; Braddon F.; Downward L.; Steenkamp R.; Masoud S.; Annear N.; Barratt J.; Bingham C.; Coward R.J.; Chrysochou T.; Game D.; Griffin S.; Hall M.; Johnson S.; Kanigicherla D.; Karet Frankl F.; Kavanagh D.; Kerecuk L.; Maher E.R.; Moochhala S.; Sayer J.A.; Simms R.; Sinha S.; Srivastava S.; Tam F.W.K.; Thomas K.; Turner A.N.; Walsh S.B.; Waters A.; Wilson P.; Wong E.; Sy K.T.L.; Huang K.; Ye J.; Nitsch D.; Saleem M.; Bockenhauer D.; Bramham K.; Gale D.P.; Abat S.; Adalat S.; Agbonmwandolor J.; Ahmad Z.; Alejmi A.; Almasarwah R.; Asgari E.; Ayers A.; Baharani J.; Balasubramaniam G.; Kpodo F.J.-B.; Bansal T.; Barratt A.; Bates M.; Bayne N.; Bendle J.; Benyon S.; Bergmann C.; Bhandari S.; Boddana P.; Bond S.; Branson A.; Brearey S.; Brocklebank V.; Budwal S.; Byrne C.; Cairns H.; Camilleri B.; Campbell G.; Capell A.; Carmody M.; Carson M.; Cathcart T.; Catley C.; Cesar K.; Chan M.; Chea H.; Chess J.; Cheung C.K.; Chick K.-J.; Chitalia N.; Christian M.; Clark K.; Clayton C.; Clissold R.; Cockerill H.; Coelho J.; Colby E.; Colclough V.; Conway E.; Cook H.T.; Cook W.; Cooper T.; Crosbie S.; Cserep G.; Date A.; Davidson K.; Davies A.; Dhaun N.; Dhaygude A.; Diskin L.; Dixit A.; Doctolero E.A.; Dorey S.; Downard L.; Drayson M.; Dreyer G.; Dutt T.; Etuk K.; Evans D.; Finch J.; Flinter F.; Fotheringham J.; Francis L.; Gallagher H.; Garcia E.L.; Gavrila M.; Gear S.; Geddes C.; Gilchrist M.; Gittus M.; Goggolidou P.; Goldsmith C.; Gooden P.; Goodlife A.; Goodwin P.; Grammatikopoulos T.; Gray B.; Griffith M.; Gumus S.; Gupta S.; Hamilton P.; Harper L.; Harris T.; Haskell L.; Hayward S.; Hegde S.; Hendry B.; Hewins S.; Hewitson N.; Hillman K.; Hiremath M.; Howson A.; Htet Z.; Huish S.; Hull R.; Humphries A.; Hunt D.P.J.; Hunter K.; Hunter S.; Ijeomah-Orji M.; Inston N.; Jayne D.; Jenfa G.; Jenkins A.; Jones C.A.; Jones C.; Jones A.; Jones R.; Kamesh L.; Frankl F.K.; Karim M.; Kaur A.; Kearley K.; Khwaja A.; King G.; Kislowska E.; Klata E.; Kokocinska M.; Lambie M.; Lawless L.; Ledson T.; Lennon R.; Levine A.P.; Maggie Lai L.W.; Lipkin G.; Lovitt G.; Lyons P.; Mabillard H.; Mackintosh K.; Mahdi K.; Maher E.; Marchbank K.J.; Mark P.B.; Masunda B.; Mavani Z.; Mayfair J.; McAdoo S.; Mckinnell J.; Melhem N.; Meyrick S.; Morgan P.; Morgan A.; Muhammad F.; Murray S.; Novobritskaya K.; Ong A.C.; Oni L.; Osmaston K.; Padmanabhan N.; Parkes S.; Patrick J.; Pattison J.; Paul R.; Percival R.; Perkins S.J.; Persu A.; Petchey W.G.; Pickering M.C.; Pinney J.; Plumb L.; Plummer Z.; Popoola J.; Post F.; Power A.; Pratt G.; Pusey C.; Rabara R.; Rabuya M.; Raju T.; Javier C.; Roberts I.S.; Roufosse C.; Rumjon A.; Salama A.; Sandford R.N.; *Sandu K.S.; Sarween N.; Sebire N.; Selvaskandan H.; Shah S.; Sharma A.; Sharples E.J.; Sheerin N.; Shetty H.; Shroff R.; Sinha M.; Smith K.; Smith L.; Stott I.; Stroud K.; Swift P.; Szklarzewicz J.; Tam F.; Tan K.; Taylor R.; Tischkowitz M.; Tse Y.; Turnbull A.; Tyerman K.; Usher M.; Venkat-Raman G.; Walker A.; Watt A.; Webster P.; Wechalekar A.; Welsh G.I.; West N.; Wheeler D.; Wiles K.; Willcocks L.; Williams A.; Williams E.; Williams K.; Wilson D.H.; Wilson P.D.; Winyard P.; Wood G.; Woodward E.; Woodward L.; Woolf A.; Wright D.;

Citation:

Kidney International Reports. 9(7) (pp 2067-2083), 2024. Date of Publication: 01 Jul 2024.

Abstract:

Introduction: The National Registry of Rare Kidney Diseases (RaDaR) collects data from people living with rare kidney diseases across the UK, and is the world's largest, rare kidney disease registry. We present the clinical demographics and renal function of 25,880 prevalent patients and sought evidence of bias in recruitment to RaDaR.

Method(s): RaDaR is linked with the UK Renal Registry (UKRR, with which all UK patients receiving kidney replacement therapy [KRT] are registered). We assessed ethnicity and socioeconomic status in the following: (i) prevalent RaDaR patients receiving KRT compared with patients with eligible rare disease diagnoses receiving KRT in the UKRR, (ii) patients recruited to RaDaR compared with all eligible unrecruited patients at 2 renal centers, and (iii) the age-stratified ethnicity distribution of RaDaR patients with autosomal dominant polycystic kidney disease (ADPKD) was compared to that of the English census.

Result(s): We found evidence of disparities in ethnicity and social deprivation in recruitment to RaDaR; however, these were not consistent across comparisons. Compared with either adults recruited to RaDaR or the English population, children recruited to RaDaR were more likely to be of Asian ethnicity (17.3% vs. 7.5%, P-value < 0.0001) and live in more socially deprived areas (30.3% vs. 17.3% in the most deprived Index of Multiple Deprivation (IMD) quintile, P-value < 0.0001).

Conclusion(s): We observed no evidence of systematic biases in recruitment of patients into RaDaR; however, the data provide empirical evidence of negative economic and social consequences (across all ethnicities) experienced by families with children affected by rare kidney diseases.

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Mucus plugging and mucolytics in patients admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD); investigating impact on short term mortality (2024)

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Type of publication:

Conference abstract

Author(s):

*Abugassa E.; *Bosher O.; *Makan N.; *Crawford E.; *Saleem M.A.; *Srinivasan K.; *Moudgil H.

Citation:

European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2024. Vienna Austria. 64(Supplement 68) (pp PA3010), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Background: Although mucus plugging occluding medium to large sized airways in COPD is associated with increased long term all-cause mortality, acute exacerbations require further investigation, particularly where, despite reducing morbidity and improving quality of life, long-term use of mucolytics remains controversial. Objectives were (1) to quantify chest CT evidence of mucus plugging, (2) relate findings to mucolytics, and (3) investigate mucus plugging association with short term mortality.

Method(s): Retrospective review of 100 patients admitted with exacerbation of COPD (105 admissions).comparative analysis by chi square (x2) and logistic regression, significant p<.05.

Result(s): Mean (SD, range) age was 74.7 (10.5, 41-97) years with 54% male; mean FEV1/FVC 55% with FEV1 1.2(0.59, 0.4-3.6) litres at 49% predicted. 23 were on long term oxygen (LTOT). Mean stay was 6.3 (1-41) days. 24 died in the first 6 months. Where a historical or admission chest CT was available (n=82), 12 (15%) had mucus plugging with mucolytics prescribed to 6 (50%) compared to 32/70 (46%) without plugging (x2 0.057, NS). 9/56 (16%) with mucus plugging vs 3/26 (12%) without (x2 0.2921, NS) had emphysema and 3/13 (23%) vs 9/69 (13%) without (x2 1.016, NS) bronchiectasis. Regression investigating mortality at 6 months showed adverse outcomes for male sex, lower FEV1, and LTOT.

Conclusion(s): 15% with acute COPD admissions have current or historical evidence of mucus plugging. Mucolytics are prescribed for 45% irrespective of prior CT radiology. Mortality (24%) at 6 months is high but not shown related to mucus plugging or reduced by mucolytics.

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Cost of Tuberculosis (TB) screening and contact tracing an Eastern European immigrant population seasonally employed at an agricultural farm in the United Kingdom (2024)

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Type of publication:

Conference abstract

Author(s):

*George S.; *Moudgil H.;

Citation:

European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2024. Vienna Austria. 64(Supplement 68) (pp PA1475), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Background: Economic data inform public health measures; a co-ordinated approach to TB contact tracing, guided by Public Health England (PHE), was undertaken assessing a non English speaking Eastern European immigrant population seasonally employed at an agricultural farm and we (1) report direct costs, (2) identify cultural issues and risks employing such a population Methods: After an initial pilot study of work-based contacts of an index case, contact lists incorporating workforce in every shift pattern back-dated two years to his UK entry were identified. Direct costs included T-spot testing (Oxford Immunotec) and translators (Romanian, Polish, Lithuanian, Italian) along with secondary care charges at tariff with uniform cross-charge among providers. TB drug costs (managing latent or disease) were from the British National Formulary.
Result(s): 258/331 (78%) workers took up testing. 80 (31%) were then referred for contact screening; of these, 47 had latent and 3 active disease. 16 defaulted, 5 declined, 4 were pregnant, and 5 lost moved elsewhere. Most had no registered General Practitioner and no pre-employment health check, BCG or radiology. Anecdotally, several returned to their parent countries for healthcare advice despite measures to overcome language barriers. Main direct costs (51,497-52) equated to 199-60/person screening and 1029-95/person treated for either latent or TB disease.
Conclusion(s): Language and cultural barriers are challenges to TB screening/contact tracing. Direct costs are 200 (UK pound sterling = 1.17 Euro) per patient screened and five times this amount treating latent or active disease.

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Pleural infection presentation and timeline of events: Real-world data from a tertiary hospital in the UK (2024)

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Type of publication:

Conference abstract

Author(s):

Mannan S.; Waseem T.; Safwan N.; Ganaie M.;

Citation:

Pleural infection presentation and timeline of events: Real-world data from a tertiary hospital in the UK.

Abstract:

Background: Pleural infection remains a significant burden on mortality and morbidity in the Western world even with the advancement of clinical management.

Objective(s): This paper aims to study the clinical course of empyema thoracic patients managed in a tertiary hospital in the UK.

Method(s): We did a retrospective observational study of the hospital's electronic records of patients who were diagnosed and managed for empyema thoracic from January 2021 to December 2022.

Result(s): The total cohort was 104 empyema thoracic patients. The mean age was 60. The affected males were almost double than females (68 vs 36). We did a retrospective RAPID score of our cohort. The RAPID score could not be calculated for 35 patients due to the unavailability of pleural fluid data. High inpatient mortality (23%) was observed in the medium- risk (RAPID score 3-4) group and high 3-month mortality (25%) was observed in the high-risk (RAPID score 5-7) group. The majority of the patients were managed conservatively. No difference was noticed in the median length of hospital stay (11d) in all the risk groups. A high rate of (37%) surgical management was observed in the low-risk (RAPID score 0-2) group.

Conclusion(s): Our cohort's data comply with the predicted mortality risk of the RAPID score. We emphasize that RAPID score calculation can be a significant tool in the management of empyema thoracic patients.

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Is smoking associated with higher cardiovascular risk and increased unplanned acute medical attendance? A retrospective analysis from the Lung Cancer screening cohort (2023)

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Type of publication:

Conference abstract

Author(s):

Haider R.; Finn E.; *Zeb S.; *Bharwana F.; Fitzgerald A.; Iftikhar S.; Hussain I.;

Citation:

European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2023. Milan Italy. 62(Supplement 67) (pp PA1345), 2023. Date of Publication: 01 Sep 2023.

Abstract:

Intro: Active smoking plays a crucial role in cardiovascular disease. We looked at the rate of attendance to primary and secondary care amongst current smokers with increased QRISK and CAT scores.

Methodology: Data were drawn retrospectively from electronic medical records from a large tertiary care hospital covering Staffordshire region over a one year period 2019-2020. Data was extracted from lung cancer screening cohort.

Result(s): The data comprised of 1232 patients (516 female, 716 male). Of these, 566 were exsmokers and 666 current smokers. Average age was 62 years. Analysis was done using ANOVA. This confirms that current heavy smokers, had an increased QRISK score >10 (p value <0.05, 95% CI 0.00 to 0.02). 1 year mortality in this group was 2.8%. Heavy smokers were not at an increased risk of attending primary care (p value 0.862) or at increased risk of unplanned secondary care admissions (p value 0.09) as compared to light smokers. Median length of hospital stay was 8 (0 – 16) bed days in heavy smokers as compared to 4 bed days (0 – 8) in ex smokers. Female ex smokers had fewer hospital attendances as compared to female current smokers, male current and ex smokers (p value <0.05, tests statistic 4.207). A high CAT score was documented as >20 denoting impact of COPD on patient's life. It was not identified as a predictor of increased attendance to primary or secondary care.

Conclusion(s): Heavy smokers have a higher economic burden on acute secondary care on account of higher number of bed days. Early smoking cessation intervention may help reduce attendance into secondary care.

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