Lung Ultrasound for Diagnosis of Primary Graft Dysfunction in Lung Transplantation Recipients (2024)

Type of publication:
Conference abstract

Author(s):
O'Brien E.; Curry S.; Rubino A.; Barker A.; *Miller A.; Parmar J.

Citation:
Journal of Heart and Lung Transplantation. Conference: ISHLT 44th Annual Meeting and Scientific Sessions Prague Congress Centre. Prague Czechia. 43(4 Supplement) (pp S345), 2024. Date of Publication: April 2024.

Abstract:
Purpose: To determine if lung aeration scores calculated using LUS correlate with the identification and grading of PGD in lung transplantation recipients identified on bedside chest radiography (CXR) and PaO2/FiO2 as the reference standard. Method(s): This is a two-year, single-centre, prospective observational study investigating lung transplantation patients admitted post-operatively to Critical Care at Royal Papworth Hospital (RPH). LUS assessments to examine 12-lung regions were conducted at specified timepoints and scored retrospectively. Differences between LUS aeration scores for PGD and non-PGD were tested for and correlation of LUS score and PGD grading was assessed. Result(s): To date, data has been collected from 29 consecutive adult patients in 12 months. A total of 816 lung ultrasound clips have been collected for analysis. The mean aeration scores in PGD patients was higher than non-PGD (t(42) = 4.58, p < 0.001). PGD severity grading and LUS score shows a moderate positive linear association r(42) =.67, p < 0.01. Conclusion(s): This interim data analysis demonstrates exciting potential of LUS as an imaging modality in this cohort for PGD. This study is set to continue for a further 12 months, to allow for a larger sample size and further analysis of the utilisation of LUS in this cohort.

Psychological distress in lung cancer: patient selfassessment versus lung cancer nurse specialist (LCNS) judgement (2023)

Type of publication:
Conference abstract

Author(s):
Walker S.; Lamonby V.; Orwin R.; *McAdam J.; Bate G.; Vick J.; Elrick N.; Shepherd P.; Flint A.; Dalrymple P.

Citation:
Lung Cancer. Conference: 21st Annual British Thoracic Oncology Group Conference 2023. Belfast United Kingdom. 178(Supplement 1) (pp S76), 2023. Date of Publication: April 2023.

Abstract:
Aims: Distress Thermometer (DT) tool compares LCNS' clinical judgment of patients' psychological distress to patients' self-reported assessment. Method(s): Few studies examine nurses' abilities assessing distress in patients, only one focusing lung cancer. They suggest Nurse Specialists within cancer settings struggle identifying distress using clinical judgement. The Distress Thermometer, a self-reported validated tool, can be used to screen for distress in cancer patients, but cannot replace comprehensive assessment. LCNUK members were surveyed May 2022. 44% used validated assessment tools and 75% confirmed these influenced management. LCNS each assessed 12 patients using The Distress Thermometer, face to face or telephone, occurring following first patient contact. The LCNS used DT tool assessing their perception of patient's distress level. Patients were asked to assess themselves using the same tool. Result(s): 45% assessments scored were identical 36.7% LCNS scored higher than patient 18.3% LCNS scored lower than patient 68.3% LCNS assessments within one DT point of patient Average difference of score between patient and LCNS was 0.4. 93.8% telephone assessments within 1 DT point 54.5% F2F assessments within 1 DT point Conclusion(s): LCNS's have excellent clinical judgement assessing patient distress, comparable to patient's self-assessment in most cases.

Improving Specialist Knowledge and Skills in Complex Airway Management In Critical Care (2023)

Type of publication:
Service improvement case study

Author(s):
*Ashley Timms, with support from *Elaine France, *Matt Quarmby, and the *Critical Care Practice Education Facilitators.

Citation:
SaTH Improvement Hub, 2023

Abstract:
Following patient safety incidents it became clear that there was a need to focus on complex airway management and upskill the existing critical care teams across both sites.

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Crucial, complex, caring: a new professional development framework for Lung Cancer Nurse Specialists (2022)

Type of publication:Conference abstract

Author(s):Roberts J.; Barton P.; Clayton K.; Fenemore J.; Ivey S.; *McAdam J.; Shepherd P.

Citation:Lung Cancer. Conference: 20th Annual British Thoracic Oncology Group Conference 2022. Virtual, Online. 165(Supplement 1) (pp S40), 2022. Date of Publication: March 2022.

Abstract:Introduction: Lung cancer specialist nursing is a varied, valuable and rewarding career, and the need for lung cancer nurse specialists (LCNS) is increasing. Lung Cancer Nursing UK (LCNUK) wants to encourage nurses to aspire to becoming an LCNS, and to support those already working in lung cancer teams to flourish professionally. We want employers to recognise LCNS' capabilities and to recruit and reward them accordingly. LCNUK therefore set out to draft the first professional development framework for LCNS. The Framework is intended to guide nurses, line managers and employers on the core skills, knowledge and expertise that LCNS will gain and demonstrate as they progress in role. Method(s): LCNUK convened a working group which reviewed exemplars and supporting literature. The team produced a draft framework setting out the qualifications, skills and capabilities needed by nurses operating at different levels, aligned with the (Figure Presented) four pillars of advanced practice. Feedback on the draft was sought from expert stakeholders before the final document was approved by the LCNUK Steering Committee. The Framework was developed in a collaboration between LCNUK and MSD, who funded a policy consultancy to provide secretariat support. LCNUK retained editorial independence of the framework content. Result(s): The Framework sets out the qualifications, clinical skills, knowledge, leadership and management and research capabilities that LCNUK expects aspiring and existing LCNS to demonstrate or be working towards. It includes case studies of nurses' career journeys and an example of a successful case for job matching and re-banding. The Framework is available on the LCNUK website at www.lcnuk.org. Conclusion(s): The Framework asserts the crucial role of LCNS in managing safety-critical and complex patient care and in leading service delivery and improvement. We hope it will prove a valuable tool to nurses, employers and policymakers in understanding the complexity and importance of this essential role.

Improved efficiency and safety Chest Drain boxes (2022)

Type of publication:
Service improvement case study

Author(s):
*Leanne Barkess, *Shirley Pickstock, *Jackie Jones

Citation:
SaTH Improvement Hub, February 2022

Abstract:
Chest Drain kits are no longer available to order and the medical team spend time locating the equipment needed to perform pleural procedures. The equipment is often not easily accessible, and the team frequently have to leave the ward to gather the required kit. As part of the improvement, a chest drain kit was created using Set-Up Reduction.

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Impact of COVID-19 on patients with chronic lung disease (2021)

Type of publication:Conference abstract

Author(s):*Etel E.; *Chapman T.; *Moudgil H.; *Srinivasan K.; *Makan A.; *Crawford E.; *Ahmad N.

Citation:European Respiratory Journal 2021; 58: Suppl. 65, PA3265.

Abstract:Background: Patients with chronic lung disease especially Asthma and/or Chronic Obstructive Pulmonary Disease (COPD) are at an increased risk of acquiring COVID-19. Hence, these patients have been asked to shield in the United Kingdom (UK) during the pandemic.
Aims: Our objective was to look at the severity of COVID and in-hospital mortality, in patients that had COPD and/or Asthma and were admitted to our rural district general hospital with a positive PCR for SARS-CoV2.
Method: We carried out a retrospective analysis from the 3rd and 4th week of January 2021, on patients in our hospital with COVID-19 and COPD and/or Asthma. The severity of COVID was defined by their need for O2+ devices (Non-invasive ventilation in the form of BiPAP, CPAP or CPAP HOOD and High flow nasal cannula). We used MS Excel for data analysis.
Results: 247 patients were in hospital, 52% males(n=129) with a mean age(SD) 73 (14.7) years. We excluded 127 who tested negative for SARS-CoV2 and then a further 92 who had tested positive for SARS-CoV2 but did not have COPD and/or Asthma.
In total, 28 patients were included in the study. 79% males(n=22). Mean age(SD) 75 (11.5) years. 29(n=8) had severe disease and needed treatment with O2+ device. Of these, 50%(n=4) died during admission. Overall unadjusted mortality was 25%(n=7) and these patients had on an average 3 comorbidities with a mean age(SD) of 80 (14) years.
Conclusion: Retrospective analysis in our cohort of COVID-19 patients’ showed 23% have underlying COPD and/or Asthma and within this group
1) 1 in 3 patients will have severe disease needing O2+ treatment
2) 1 in 4 patients will die
3) Mean Age of 80 years and ≥ 3 comorbidities will carry a poor prognosis.

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Is there an endotype to the treatable eosinophilic trait of chronic obstructive pulmonary disease (COPD) (2021)

Type of publication:Conference abstract

Author(s):*Walsh O.; *Marathe M.; *Moudgil H.; *Srinivasan K.; *Crawford E.; *Makan A.; *Ahmad, N.

Citation:European Respiratory Journal 2021; 58: Suppl. 65, PA3425.

Abstract:Introduction: There has been much interest in defining phenotypes in COPD particularly in relation to eosinophils and whether it is a treatable trait. Augusti el al (1) have suggested defining an endotype of COPD and moving away from clinical measures, when it comes to offering treatment. An endotype in eosinophilic COPD remains to be explored. Our main aim was to define an endotype for the treatable eosinophilic trait of COPD particularly focusing on the Body Mass Index (BMI), as previous reports have shown this trait may have a BMI>=25 kg/m2(2). Methods and Aims: A retrospective analysis was done reviewing the results of all COPD patients with an FEV1: FVC ratio <0.7, discussed at the local Multi-disciplinary Team meeting in 2019 and 2020. We excluded patients with Asthma and Overlap syndrome. Serum eosinophil levels over the past 3 years and BMI were obtained from the local electronic portal and MDT pro forma. We compared highest 3 year eosinophil counts (EC) in those with BMI < and >=25 kg/m2. We used MS Excel and Vassar stats for statistical calculations. <br/>Result(s): 168 patients were reviewed of which 24 patients were excluded based on the inclusion criteria, leaving 144 patients for analysis. The mean age (SD) was 57 (6.8) years. 58% (n= 84) were males. 39% (n=56) patients had BMI<25 kg/m2 (Group A) and 61% (n=88) patients had BMI>=25 kg/m2 (Group B). Mean (SD) of EC was 0.16×109/L (0.08) in Group A v Mean (SD) of EC 0.34 x109/L (0.14) in Group B [95% CI 0.14-0.21; p < 0.0001]. Our data show that patients with a BMI>=25 kg/m2 is an endotype of COPD patients who have EC>0.2 x109/L. Further research into this endotype and targeted treatments for eosinophilic COPD needs to be carried out.

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Improving understanding, care and management of tracheostomy and laryngectomy patients amongst Foundation Year (FY) doctors -A Quality Improvement Project (QIP) at a district general hospital (2021)

Type of publication:
Poster presentation

Author(s):
*Samsul Islam, *Elaine France, *Nawaid Ahmad

Citation:
International Tracheostomy Symposium, September 2021

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'There's a frog in my throat': bilateral prolapsing lung apices presenting as a neck lump (2021)

Type of publication:Journal article

Author(s):*Ahmed R.A.; *Yang D.; *Nedham M.; *Osborne M.S.; *Ahsan S.F.

Citation:Annals of the Royal College of Surgeons of England; Sep 2021; vol. 103 (no. 8)

Abstract:This case report discusses an unusual presentation of a voluntarily produced neck mass, caused by the rare case of lung herniation. Lung herniation is associated with increased intrathoracic pressure that can be caused by chronic chough, straining and continuous positive airway pressure ventilation. An association with Ehlers-Danlos syndrome 1 also exists. We present a case of lung herniation that was multifactorial in nature and was identified at a head and neck clinic. The female patient presented with a voluntarily expandable anterior neck mass on Valsalva manoeuvre. Computed tomography imaging with and without Valsalva manoeuvre demonstrated bilateral anterior lung herniation and findings of spinal spondylosis.

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Multidisciplinary team approach to diagnosing lymphangioleiomyomatosis (2021)

Type of publication:
Journal article

Author(s):
Okoh, Magnus; Khan, Rosina; *Ahmad, Nawaid

Citation:
BMJ Case Reports; Aug 2021; vol. 14 (no. 8)

Abstract:
A 42-year-old woman with chronic obstructive pulmonary disease was referred to the respiratory team due to shortness of breath on exertion and significant deterioration in pulmonary function tests. Her symptoms were progressively getting worse. This prompted a referral to the specialist team where further investigations were undertaken including a high-resolution CT scan followed by lung biopsy, which eventually revealed a diagnosis of lymphangioleiomyomatosis (LAM). Successful referral to the National LAM Centre in Nottingham provided the key therapeutic approach required to manage this rare condition. Diagnosing this rare condition was due to the multidisciplinary team approach, which involved input from the general practitioner, radiologist and
respiratory consultant. The patient has been making good progress with pharmacological management.

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