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Interstitial lung abnormalities (ILA) can be incidentally detected in patients undergoing low-dose CT screening for lung cancer. In this retrospective study, we explore the downstream impact of ILA detection on interstitial lung disease (ILD) diagnosis and treatment. Using a targeted approach in a lung cancer screening programme, the rate of de novo ILD diagnosis was 1.5%. The extent of abnormality on CT and severity of lung function impairment, but not symptoms were the most important factors in differentiating ILA from ILD. Disease modifying therapies were commenced in 39% of ILD cases, the majority being antifibrotic therapy for idiopathic pulmonary fibrosis.

Background Research into patient experiences of living with IPF has increased. A key challenge is how to use this data intelligently to enable commissioners and providers to improve the quality of services delivered to this group of patients. This project aims to develop an IPF-PREM informed by patients’ perceptions of their healthcare experiences. The IPF-PREM is underpinned by the NHS Patient Experience Framework (NPEF); 1 National Institute for Health and Care Excellence (NICE) Quality Standards (QS15 and 79) and aligned to national initiatives integrating Patient Reported Outcome Measures (PROMs) and PREMs into NHS care. Methods A scoping exercise was undertaken with patients diagnosed with IPF on their journey through the healthcare system covering eight areas corresponding to the NPEF. 1 Twenty patients representing all stages of the disease trajectory participated in one of three focus groups. Transcripts underwent content and thematic analysis. Patient preferences were also sought on questionnaire design. Results A number of key themes emerged. See Table 1. Of particular importance were issues concerning access: to specialist centres, medication and primary care services; consistency of care to prevent confusion; coordination of care especially for patients with multi-morbidities and getting the right information at the right time in the right way. Information enabling practical self-management was highly valued. Overarching was the need for continuity of care close to home. Participants valued having a nurse to co-ordinate care and to talk to at all s tages of the care pathway. The response categories patients were keen to avoid were visual images such as smiley faces. Conclusions The IPF-PREM will provide a valuable quality indicator for IPF service delivery at all stages of the disease trajectory complementing IPF PROMs. Implementation of the PREM will enable commissioners and providers to improve the quality of the services and the patient experience of care delivered across the wider inter-disciplinary team. Reference DH 2011 NHS Patient Experience Framework.

Background Surgery necessitating cardiopulmonary bypass (snCPB) induces a systemic inflammatory response which can lead to organ dysfunction, including acute lung injury (ALI). Polymorphisms in inflammatory genes have been linked to adverse clinical outcomes following snCPB. The receptor for advanced glycation end products (RAGE) is an inflammation-perpetuating pattern recognition receptor. We investigated the hypothesis that polymorphisms in genes encoding RAGE or RAGE ligands predispose patients to a more severe systemic inflammatory response and the development of ALI after snCPB. Methods In a nested unmatched case–control study 187 UK Caucasian patients undergoing cardiac surgery necessitating CPB were genotyped for eight biallelic single nucleotide polymorphisms (SNPs) in the RAGE , S100A8 and HMGB1 genes using sequence-specific primer polymerase chain reactions. Intensive care unit length of stay, duration of level 3 care, post-operative neutrophil and white blood cell count (WCC), C-reactive protein (CRP) and PaO 2 :FiO 2 ratio were used as clinical outcome measures. Results All SNPs conformed to Hardy–Weinberg equilibrium. Patients carrying the C alleles of rs3795391 and rs3806232 SNPs, in linkage disequilibrium in the S100A8 gene, had a higher neutrophil and WCC (p=0.019, p=0.039 respectively) and a lower PaO 2 :FiO 2 (p=0.01) on post-operative day 3. Median post-operative PiO 2 :FiO 2 of patients carrying the C alleles versus those not was 123.5 mm Hg vs 204.4 mm Hg. Patients carrying the GG genotype of the rs2070600 (Gly82Ser) SNP in the RAGE gene had a higher neutrophil count on post-operative day 2 (p=0.025). Patients carrying the T allele of the RAGE rs1800624 (−374T/A) SNP had higher CRP levels on post-operative day 1 (p=0.015). Conclusion SNPs in the RAGE and S100A8 genes are associated with the intensity of the systemic inflammatory response and patient oxygenation levels in our cohort of patients following snCPB. Patients carrying the C alleles of the S100A8 SNPs had significantly impaired oxygenation in the early post-operative period compared to patients carrying the TT genotype, suggesting a genetic influence on the degree of lung injury arising as a result of snCPB. Pre-operative genotyping for polymorphisms associated with adverse outcomes may be used to stratify patients9 risk from snCPB, allowing the development of interventions designed to reduce post-operative morbidity and mortality.