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Abstracts 2022

Here you can see a preview of the high quality abstracts which have been accepted for presentation at our annual meeting

Oral Presentations:

Poster Presentations:

A Aung

Muscle volume, functionality and metabolic resilience during recovery following severe COVID-19 (DYNAMO)

Lead author: Ayushman Gupta
Co-authors: Rosemary Nicholas, Jordan J. McGing, Aline V. Nixon, Joanne E. Mallinson, Sebastian Serres, James Bonnington, Tricia M. McKeever, Ian P. Hall, Paul L. Greenhaff, Susan T. Francis, Charlotte E. Bolton

 

Following hospitalisation with SARS-CoV2 infection many individuals report persistent fatigue. We studied muscle properties to understand underlying mechanisms.

 

Adults were recruited at 5-7 months following hospital discharge for severe COVID-19 (n=21), with controls (n=10) of a similar age, gender, ethnicity and body mass. Perceived fatigue was estimated using the fatigue severity scale. The short physical performance battery test determined habitual functionality, alongside isometric quadriceps strength normalised for appendicular mass and isokinetic force-loss during 20 knee extensions. Leg muscle volume, and phosphocreatine (PCr) resynthesis following plantar flexion exercise (index of muscle metabolic resilience) were quantified using MRI and 31P-MRS. Student t-test were used. All data are mean (SD).

 

Patients (P) reported greater perception of fatigue and demonstrated worse habitual functionality compared to controls (C). However, leg volume [P: 2,578 (303) vs C: 2,384 (289)cm3/m2, p=0.1], strength [P: 21.8 (4.1) vs C: 21.1 (4.5)Nm/kg, p=0.7], force-loss [P: 25% (6) vs C: 21% (10), p=0.1] and PCr resynthesis [P: 25.8 (11.3) vs C: 22.8 (8.7)mM/min, p=0.5] were not different.

 

Despite greater perception of fatigue and reduced habitual functionality in patients in recovery compared to controls, muscle properties were unaltered.

3-year retrospective analysis of benign pulmonary lesions excised for suspicion of malignancy at a regional surgical centre.

Lead author: Syed Mohammad
Co-authors: M Alashqar, H Qashlaq, C Vella, M Tufail, S Agrawal, J Bennett, R Sudhir

The aim of this study was to review patient and imaging characteristics of benign resected nodules, the surgical modality and the post op histology.

Methods
Patient demographics, diagnostic tests prior to surgery and pathology results were collected from January 2019 to December 2021. All preoperative CT examinations were reviewed for nodule number and characteristics. PET scans were reviewed for degree of avidity. Brock and Herder scores were calculated. Type of subsequent surgery was also reviewed along with post op histology.

Results
125 cases were included in the study. The median age was 68. 63/125 (50.4%) patients were male. 89/125 (71.2%) patients had a significant smoking history.

Total number of lesions was 138. Their size ranged between 4-72 mm (median 16 mm) and 115/138 (83%) were solid. 41/138 (29.7%) were reported as showing spiculation. 87/138 (63%) of lesions were in the right lung and 79/138 (57%) were in an upper lobe.
Median Brock score was 27.4% and Herder score was 63.4%. Main surgical modality was VATs (77.7%) with wedge resection accounting for 105/129 (81.4%) of all surgical procedures.

Granulomas (28.2%), aspergillomas (13%), organizing pneumonias (11.6%), hamartomas (10.8%) were the most common post op histology.

Conclusion
With current available guidelines, there remains a relatively high resection rate of benign lung lesions. Better predictive tools are required to streamline management.

Tapering courses of oral steroids after hospital admission due to exacerbation of asthma

Lead author: Richard Russell
Co-authors: Meghna Ray, Hamza Yaqub, Anna Murphy

Background

Asthma exacerbations requiring hospitalisation are treated with high-dose oral corticosteroids. Guidelines suggest tapering steroids, to avoid adrenal insufficiency, in patients whose acute course of steroids exceeds 2-3 weeks, or who take maintenance oral steroids.

 

Aims

Compare steroid tapering after asthma exacerbation to guidelines, and identify if tapering improves outcomes.

 

Methods

Asthma exacerbation discharge summaries from May to October 2021 were reviewed. Tapering steroid patients were matched to abrupt steroid cessation patients. Electronic medical records were reviewed.

 

Results

44 of 439 asthma exacerbations (10%) received tapering oral steroids.

Median duration of highest steroid dose was not significantly different between taper (7 days) and abrupt (6 days) groups. 4/44 taper and 1/44 abrupt patients had an acute course >14 days. 10/44 taper and 13/44 abrupt patients had received steroids ≤14 days before admission. 13/44 taper and 4/44 abrupt patients were prescribed maintenance oral steroids. Overall 17/44 (39%) taper patients met guideline recommendations for tapering steroids, compared to 6/44 (14%) abrupt patients.

Tapering patients had longer admissions (p=0.004) and more asthma admissions in the preceding 6 months (p=0.0039). There was no difference in time to next exacerbation.

 

Conclusion

The majority tapering steroid courses for asthma exacerbations were not indicated based on guidelines.

Exploring the effects of Kaftrio on the physiotherapists’ role and service provision for people with CF: A UK and Republic of Ireland (ROI) survey.

Lead author: Orla O'Beirne
Co-authors: Eleanor Douglas, Theresa Harvey-Dunstan, Kirsty Croft, Marie Bolton, Kate Hardiman, Sarah Millward

Objectives:

1. Identify perceived changes to the physiotherapists’ role in CF management since the introduction of Kaftrio

2. Explore physiotherapists’ perceptions of how service delivery may change in the future as Kaftrio becomes more widespread

3. Highlight new educational needs of CF physiotherapists due to Kaftrio

 

Method:

A bespoke survey was developed and distributed to the Association of Chartered Physiotherapists in CF via social media (from November-December 2021).

 

Results:

98% of the 51 CF physiotherapists who participated suggested that, before Kaftrio, their main role was the delivery of acute respiratory care (including airway clearance techniques). Since Kaftrio, an increase in exercise prescription (50%), pelvic health/pregnancy (36%) and education (26%) were reported. Reduced acute respiratory care, with an increase in community/outpatient care (including virtual delivery) was highlighted by participants qualitatively. 16/28 participants highlighted a lack of skills and confidence in MSK management of CF patients, including pain management and exercise prescription. They indicated a need for further training in these areas.

 

Conclusion:

Since UK/ROI approval, Kaftrio has already changed the role of CF physiotherapists in the care of CF patients. This shift identifies an educational need of physiotherapists to realign with the healthcare needs of CF patients taking Kaftrio.

Initiating a better delivery of care to cohort with acute exacerbation of asthma in secondary care setting

Lead author: Aye Aung
Co-authors: Hnin Aung

Introduction
Asthma Exacerbation can be life-threatening but preventable. Proper management in acute setting along with secondary prevention is crucial.

Objective
To explore the quality-of-care provision among patients admitted with acute exacerbation of asthma (AEA) in Kettering General Hospital against BTS/SIGN guideline.

Methodology
Retrospective analysis of cohort admitted with AEA (cycle 1- 01/11/2018 to 30/09/2019) 82 patients and (cycle 2- 01/01/2021 to 31/01/2022- 42 patients were performed.

Assessed:
• O2 saturation (OS), Systemic Corticosteroids (SC), Beta 2 agonists (BA), Respiratory specialist review (RSR) on admission
• Inhaled and oral corticosteroids administration, Follow-up in community and Specialist review on discharge

Results
Majority received OS measurement 62% (51/82) versus 90% (38/42). A rise from 14% (12/82) to 43% (10/42) was seen in RSR within 24 hrs of admission. During re-audit, 100% (42/42) were discharged with oral steroids. 4%(3/82) were referred for specialist review within 4 weeks and 0%(0/42) was arranged for community follow-up within 2 days of discharge but the former reached 21%(9/42) and the latter- 52%(22/42) post-intervention.

Intervention
Results were discussed in department meeting and appointed an asthma nurse along with asthma action plan and discharge bundle.

Conclusion
Our project initiated a structured approach and improvement in healthcare delivery of asthma-related hospital admissions.

Service evaluation of cardiac MRI imaging in patients presenting with undiagnosed eosinophilia

Lead author: Hnin Aung
Co-authors: Kyaw K, Habib MB , Siddiqui S

Background

Eosinophilic heart disease (EHD) can adversely affect the prognosis in patients with hyper-eosinophilia (HES). We have previously reported a semi-structured algorithm in investigating undiagnosed peripheral blood eosinophilia (PBES) ≥ 1 x109/L in secondary care. (Wardlaw A et al, PMID 34080735).

Objectives

To report cardiac MRI (CMRI) findings in patients with PBES and association with diagnostic labels and cardiac symptoms.

 

Methods

A total of 385 patients were referred to multidisciplinary HES service for protocolised evaluation at Glenfield Hospital, Leicester (2003 to 2019). Those who underwent MRI scans were analysed via a service evaluation project.

 

Results

CMRI scan was performed in 75 patients (mean age = 57 yrs., male (43/75)). The final diagnostic categories were HES (n=20), EGPA(eosinophilic granulomatosis with polyangiitis (n=20), eosinophilic pneumonia(n=9) and gastroenteritis (n=11), and reactive HES due to other causes(n = 15). Only 36% of patients had cardiac symptoms prior to the scan. Late gadolinium enhancement (LGE) compatible with EHD was present in 24% (14/75) of the scans and 45%(9/20) had EGPA ( EGPA Vs all other causes, P <0.01). LGE was associated with regional wall motion abnormalities(72%), LVH(56%), LV Systolic dysfunction(57%) and pericardial effusion(28%).

 

Conclusion

EHD is often present in patients with EGPA that do not have underlying cardiac symptoms and is often associated with other CMRI physiological or structural abnormalities. We propose that CMRI should be the standard of care in patients with EGPA and potentially other eosinophil mediated immune conditions.

Comparing cardiometabolic risk indicators between adults post-hospitalisation with COVID-19 and healthy controls

Lead author: Majda Bakali
Co-authors: Thomas Yates, Michael C Steiner, Rachael A Evans

Introduction

Adults with cardiometabolic disease (CMD) have severe acute COVID-19. This exploratory cross-sectional study aims to compare detailed cardiometabolic risk (CMR) profiling between survivors of severe COVID-19 and healthy controls.

 

Methods

Patients with COVID-19 were 3-7 months post-hospitalisation and age and sex-matched healthy controls. CMR indicators assessed resting blood pressure, fasting glucose, BMI, pulse wave velocity (PWV), exercise capacity, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and an oral glucose tolerance test (OGTT).

 

Results

38 adults post-COVID-19 (mean [SD] age 62 [9] years, 45% male) and 17 healthy controls (age 62 [9] years, 53% male) completed the study. BMI and other clinical measures (blood pressure, fasting glucose, HbA1C) indicated a higher CMR profile in adults post-COVID-19 compared to healthy controls. Measures of PWV and insulin resistance using HOMA-IR were higher in adults post-COVID-19 compared to healthy controls. Exercise capacity was reduced in the post-COVID-19 group compared to the healthy controls (MD[SD] -16.5[11.7] ml/kg/min).

 

Conclusions

Patients post-COVID-19 had a higher CMR using common clinical tests and detailed assessment of PWV, HOMA-IR and OGTT than healthy controls. This supports the need for interventions such as exercise training, which is proven to reduce PWV in adults with CMD and those at risk of CMD.

Incidental Lung Nodule MDT Coding and Referral to Nodule Virtual Clinic - 3 Months Pilot

Lead author: Yiewfah Fong
Co-authors: Sajitha Averachan, Indrajeet Das, Prajakta Pinglay, Jonathan Bennett

Background

Pulmonary nodules are common findings on CT and presents a management dilemma. UHL nodule virtual clinic is facilitated by respiratory physician and radiologist to assess and provide management guidance without needing face-to-face patient contact. An MDT code was created for incidental nodules on CT, signposting referral pathway to the nodule virtual clinic.

 

Method

Prospective data collection including number of referrals, changes to the MDT workload, outcome of the virtual clinic review, nodule size, non-incidental nodule referral, and cases with nodule MDT code not referred.

 

Results

40 new referrals in 3 months, 27 of which via MDT code. 25M:15F. Mean age 67. 27 (68%) new referrals via Nodule MDT code. Overall clinic activity of 65 cases. Average 22 per monthly clinic session. 21/40 (53%) new referrals discharged; 14/27 (52%) of the referral via nodule MDT code discharged.

 

Mean nodule size 6.5mm. 10 cases had nodule seen on prior CT. Total of 33 patients had nodule MDT codes applied to CT, 6 (18%) cases not referred to clinic, all had appropriate clinical arrangement.

 

Conclusion

Lung Nodule MDT code generated 40% of virtual nodule clinic workload, and with 50% discharge rate. Streamlining and standardisation of process leading to significant reduction of unnecessary follow up CTs.

Non-invasive respiratory support (NIRS) such as HFNO (High Flow Nasal Oxygen) or CPAP (Continuous Positive Airway Pressure) use in COVID-19 patients : can ROX score help?

Lead author: Alison Law
Co-authors: Michael Cannon, Stephen Proctor, Muhammad Nasim, Milind Sovani

Background:

Observational data of COVID-19 in-patients where a do not intubate (DNI) decision is made showed no difference in outcome when treated with CPAP compared to standard oxygen therapy.1 We wished to assess whether CPAP delivery via machine with Oxygen blender would improve outcome, and if ROX score improvement could predict survival.

 

Methods:

Retrospective analysis of data from 100 patients (50 for escalation and 50 DNI) who received HFNO and/or CPAP as a treatment for COVID-19 on an acute respiratory care unit.

 

Results:

82% survival in escalation group versus 20% in DNI group. In the DNI group, no patient who needed escalation from HFNO to CPAP survived. In DNI patients, baseline ROX score was similar in those who died or survived. Those who survived had improved ROX score at 12 hours by > 1 (5.6 to 6.8). In those who died ROX Score failed to improve (5.5 to 5.9).

 

Conclusions:

CPAP did not improve survival in DNI group and potentially prolonged suffering. Lack of improvement in ROX score by <1 could be a useful method to identify patients with poor outcomes, so that end of life care planning can be initiated in a timely fashion.

 

Reference: (Bradley,P. et al. eClinicalMedicine. 2021:40(101122))

Patient-reported respiratory outcome measures in the recovery of adults hospitalised with COVID-19: A systematic review and meta-analysis

Lead author: Sophie Middleton
Co-authors: Christos Chalitsios, Tricia. M. McKeever, Alex R. Jenkins, Charlotte. E. Bolton

Background and Aims

The morbidity associated with recovery from COVID-19 is huge with persisting respiratory and functional limitation. We investigate the persisting respiratory symptomatic and functional recovery of patients hospitalised with COVID-19 in a systematic review and meta-analysis using patient-reported outcome measures (PROMs).

Methods

Comprehensive database searches in accordance with the PRISMA statement were carried out up till 31/05/2021 where data exists for patients >8 weeks after hospital discharge. Data were narratively synthesized, and meta-analyses performed using the random-effects inverse variance method.

 

Results

Of 49 studies, across 14 countries with 2-12 months follow-up, the most common persisting symptom was fatigue with meta-analysis 36.6% (95 % CI 27.6 to 46.6, n=14) reporting at 2-4 months, and 32.5% at >4 months (95% CI 22.6 to 44.2, n=15). Modified MRC dyspnoea score ≥1 was reported in 48% (95% CI 30 to 37, n=5) at 2-4months and 32% (95% CI 22 to 43, n=7) at >4 months. Six-minute walk test at >4months was 494.7m (95% CI 457 to 532.4, n=7) There was persisting sick leave, change in their scope of work and healthcare usage.

 

Conclusion

Respiratory and functional deficits are experienced by survivors of COVID-19 hospital admission with effects on work and healthcare usage.

The Impact of the SARS-CoV-2 Pandemic on Lung Cancer Survival in England: An Analysis of the Rapid Cancer Registration Dataset

Lead author: Helen Morgan
Co-authors: Prof David Baldwin; Prof Richard Hubbard; Dr Neal Navani; Dr Emma O'Dowd

 

During the pandemic there were fewer lung cancer diagnoses and diagnoses at a more advanced stage, however the effect on survival is unclear. Using the rapid cancer registration dataset we compared lung cancer survival for 2019 and 2020 to quantify the impact.

Data were divided by COVID restrictions at the time of diagnosis. Percentage survival and hazard ratios (HR) were calculated, adjusting for age, sex, performance status, stage and comorbidities.

There was no difference in survival between 2019 and January-March 2020. 1-year survival was 45% during lockdown (26/3/20-10/5/20) and 47% in 2019. For the same period, HRs for death within 90-days were 1.16 (95% CI 1.08-1.24) and 1.00 (95% CI 0.93-1.08) for death within 91-365 days. HRs were highest for people diagnosed after 07/10/20 at 1.26 (95% CI 1.20-1.32) for death within 90-days and 1.51 (95% CI 1.42-1.60) for death within 91-270 days.

During the first National Lockdown, the greatest risk of dying was in the first 90 days following diagnosis, suggesting differences early in the patient journey are important for long term outcomes. The risk of dying was highest for those diagnosed towards the end of 2020, suggesting delays in presentation and subsequent worsening fitness had a significant impact.

Exploring the heterogeneity of Asthma Exacerbations through phenotyping.

Lead author: Ashish Pradhan
Co-authors: Needham R, Shaw K, Martin M.J, Portelli M.A, Sayers I, Harrison T

Background:

Asthma exacerbations (AE) have evidence of underlying heterogeneity yet despite this evidence they are predominately managed one-dimensionally with steroid therapy.

Aim: The Asthma Phenotyping Exacerbation studies (APEX) aims to describe exacerbations in detail in well-characterised patient cohorts.

 

Methodology:

The APEX studies include adults on GINA treatment steps 1-5. Those who have an AE 2 year prior to baseline (APEX-1) and between 2-5 years prior to baseline (APEX 2) are recruited into the cohorts.

 

Measurements include but are not limited to biomarkers of inflammation including FeNO, sputum cell counts, and nasal lavage. Lung function measurements include forced oscillation technique (FOT) and samples to identify infective aetiologies through nasal brushes are taken. These parameters are measured at baseline, AE and annual follow up.

 

Results:

200 participants have been recruited (target 300); mean age 50.4 years, females=68.8%. 50 AE have been recorded. Baseline characteristics differ between APEX-1 and 2 including in mean ACQ (1.61 vs.1.22), FEV1 (2.45 vs. 2.54L), and A&E/urgent care episodes (2.72 vs.

1.5). 48% of observed exacerbations requiring steroids (N=24) are associated with type 2 inflammation; raised FeNO (75%) and blood eosinophilia (47.7%)

Conclusion: Initial data from our studies are consistent with heterogeneous exacerbation inflammatory profiles.

Outpatient CT guided lung biopsy service with conservative management of pneumothorax

Lead author: Syed Hasan Mustafa Rizvi
Co-authors: Georgios Tsaknis, Muhammad Naeem, Avik Banerjee, Raja Reddy

Introduction:

Majority of CT-guided lung biopsies are currently performed on a day-case basis and require a bed for short recovery. We initiated a novel outpatient service integrated with our existing conservative pneumothorax pathway aiming to improve capacity.

Method:

All patients that undergo CTGB, are observed with vitals monitoring every 15 minutes, followed by CXR at 1 hour. For normal CXR/small pneumothoraces otherwise stable, patients were discharged, with advice to ring Pleural Team if they develop symptoms. Moderate/large pneumothoraces were observed for 4 hours and CXR repeated. Patients who remained stable according to the criteria: SPO2 >90% on air, Respiratory Rate<30, Systolic BP>90mmHg, WHO Performance Status (PS) ≤ 2, able to selfcare, pain controlled with regular analgesics, were discharged without any intervention on the conservative pneumothorax pathway and managed by our Pleural Team with follow up in with repeat CXRs at 24-48hours, 1 week, 3 weeks, and 7 weeks post-procedure, or until the pneumothorax has largely resolved.

Results:

From March 2021 till June 2022, 112/118 patients underwent CTGB. 6 did not have the biopsy due to resolving lesions. 24 developed pneumothoraces, of which 22 qualified for conservative management and followed conservative pathway. 2 patients with PS 3 received inpatient care. Of 22 patients managed conservatively, 1 required intervention with pleural aspiration, to speed up lung reexpansion prior to thoracic surgery for lung cancer. The biopsy was completed in 23/24 patients who developed pneumothorax and abandoned in one due to breathlessness.

Conclusion:

Post-CTGB iatrogenic pneumothoraces could potentially be managed conservatively without the need for any intervention nor admission.

Winner!

Winner!

Winner!

H Aung
M Bakali
A Gupta
A Law
O O'Beirne
A Pradhan
S Middleton
S Mohammad
H Morgan
R Russell
Y Fong
S Rizvi
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