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1. Clinical Characteristics of Non-Malignant Effusions: Results from the ERS International Collaborative Effusion (ICE) Database

Author

Welch, Hugh, primary, Kerkhoff, J, additional, Janssen, J, additional, Bielsa, S, additional, Civit, C, additional, Porcel, J, additional, Fjaellegaard, K, additional, Petersen, J, additional, Bodtger, U, additional, Grabczak, E, additional, Krenke, R, additional, Ellayah, M, additional, Addala, D, additional, Hallifax, R, additional, Wrightson, J, additional, Rahman, N, additional, Jackson, K, additional, Pellas, E, additional, Khan, I, additional, Chohan, M, additional, Aujayeb, A, additional, Labarca, G, additional, Dhaliwal, I, additional, Mitchell, M, additional, Rozman, A, additional, Marc-Malovrh, M, additional, Anevlavis, S, additional, Foudrakis, M, additional, White, P, additional, Bhatnagar, R, additional, and Maskell, N, additional

Published
2023
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7. Molecular profiling in Pleural Biopsies

Author

Sundaralingam, A, primary, Aujayeb, A, additional, Akca, B, additional, Tiedeman, C, additional, George, V, additional, Carling, M, additional, Brown, J, additional, Banka, R, additional, Addala, D, additional, Bedawi, E O, additional, Hallifax, R H, additional, Iqbal, B, additional, Denniston, P, additional, Tsakok, M T, additional, Kanellakis, N, additional, Vafai-Tabrizi, F, additional, Bergmann, M, additional, Funk, G, additional, Benamore, R, additional, Wrightson, J M, additional, and Rahman, N M, additional

Published
2022
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15. P191 The biochemistry of ‘non-specific pleuritis’°

Author

Sundaralingam, A, primary, Addala, D, additional, Bedawi, EO, additional, Hallifax, R, additional, George, V, additional, Banka, R, additional, Ellayeh, MA, additional, Kanellakis, N, additional, Wrightson, J, additional, and Rahman, NM, additional

Published
2021
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19. Critical analysis of the utility of initial pleural aspiration in the diagnosis and management of suspected malignant pleural effusion

Author

Mercer, R.M. Varatharajah, R. Shepherd, G. Lu, Q. Castro-Añón, O. McCracken, D.J. Dudina, A. Addala, D. Tsikrika, S. George, V. Banka, R. Asciak, R. Hassan, M. Hallifax, R. Bedawi, E.O. Shute, J.K. Rahman, N.M.

Abstract

Introduction Current guidelines recommend an initial pleural aspiration in the investigation and management of suspected malignant pleural effusions (MPEs) with the aim of establishing a diagnosis, identifying non-expansile lung (NEL) and, at times, providing a therapeutic procedure. A wealth of research has been published since the guidelines suggesting that results and outcomes from an aspiration may not always provide sufficient information to guide management. It is important to establish the validity of these findings in a 'real world' population. Methods A retrospective analysis was conducted of all patients who underwent pleural fluid (PF) sampling, in a single centre, over 3 years to determine the utility of the initial aspiration. Results A diagnosis of MPE was confirmed in 230/998 (23%) cases, a further 95/998 (9.5%) were presumed to represent MPE. Transudative biochemistry was found in 3% of cases of confirmed MPE. Positive PF cytology was only sufficient to guide management in 45/140 (32%) cases. Evidence of pleural thickening on CT was associated with both negative cytology (χ 2 1df=26.27, p

Published
2020

20. S46 Identification of pleural infection bacterial patterns. The oxford pleural infection metagenomics study

Author

Kanellakis, NI, primary, Wrightson, JM, additional, Gerry, S, additional, Bedawi, EO, additional, Corcoran, JP, additional, Hallifax, R, additional, George, V, additional, Banka, R, additional, Asciak, R, additional, Nezhentsev, A, additional, Economides, GM, additional, Bland, LR, additional, Daly, E, additional, Miller, RF, additional, Dong, T, additional, Maskell, N, additional, Psallidas, I, additional, Crook, D, additional, Hinks, T, additional, and Rahman, NM, additional

Published
2021
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23. Randomised Trial for Ambulatory Management of Primary Spontaneous Pneumothorax

Author

Hallifax, R., primary, McKeown, E., additional, Sivakumar, P., additional, Fairbairn, I., additional, Peter, C., additional, Leitch, A., additional, Knight, M.J., additional, Stanton, A.E., additional, Ijaz, A., additional, Marciniak, S.J., additional, Cameron, J., additional, Amrithraj Bhatta, A., additional, Blyth, K.G., additional, Reddy, R., additional, Harris, M.-C., additional, Maddekar, N., additional, Walker, S.P., additional, West, A., additional, Laskawiec-Szkonter, M., additional, Corcoran, J.P., additional, Gerry, S., additional, Roberts, C., additional, Harvey, J.E., additional, Maskell, N., additional, Miller, R.F., additional, and Rahman, N., additional

Published
2020
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28. Prospective validation of the RAPID clinical risk prediction score in patients with pleural infection: The Pleural Infection Longitudinal Outcome Study (PILOT)

Author

Corcoran, J, Psallidas, I, Gerry, S, Piccolo, F, Koegelenberg, C, Saba, T, Daneshvar, C, Fairbairn, I, Heinink, R, West, A, Stanton, A, Holme, J, Kastelik, J, Steer, H, Downer, N, Haris, M, Baker, E, Everett, C, Pepperell, J, Bewick, T, Yarmus, L, Maldonado, F, Khan, B, Hart-Thomas, A, Hands, G, Warwick, G, Munavvar, M, Guhan, A, Shahidi, M, Pogson, Z, Dowson, L, Ward, N, Saba, J, Read, C, Bhatnagar, R, Hallifax, R, Dobson, M, Shaw, R, Hedley, E, Sabia, A, Robinson, B, Collins, G, Davies, H, Yu, L, Maskell, N, Miller, R, and Rahman, N

Published
2019

34. Predicting outcomes in primary spontaneous pneumothorax using air leak measurements

Author

Hallifax, R, Laskawiec-Szkonter, M, Rahman, N, and Collaborators, Rampp Trial

Abstract

The initial treatment regime for primary spontaneous pneumothorax (PSP) is generic and non-personalised, often involving a long hospital stay waiting for air leak to cease. This prospective study of 81 patients with PSP, who required drain insertion, captured daily digital air leak measurements and assessed failure of medical management against prespecified criteria. Patients with higher air leak at day 1 or 2 had significantly longer hospital stay. If air leak was ≥100 mL/min on day 1, the adjusted OR of treatment failure was 5.2 (95% CI 1.2 to 22.6, p=0.03), demonstrating that early digital air leak measurements could potentially predict future medical treatment failure.

Published
2018

35. Does inflammation predict successful pleurodesis? A post hoc analysis from the time 1 trial

Author

Mercer, R, Macready, J, Jeffries, H, Speck, N, Kanellakis, N, Maskell, N, Pepperell, J, Saba, T, Ali, N, West, A, Miller, R, Asciak, R, Hallifax, R, Corcoran, J, Hassan, M, Psallidas, I, and Rahman, N

Abstract

Malignant pleural effusions are a common complication of advanced malignancy, have a poor prognosis and have a significant impact on quality of life. Treatment strategies include chest drain and pleurodesis, or insertion of an indwelling pleural catheter. Successful pleurodesis is thought to be due to the body’s inflammatory response resulting in pleural symphysis. This post hoc analysis of data from the TIME 1 was conducted to address assess whether there is a correlation between the pleurodesis and a systemic inflammatory response.

Published
2018

36. Is a pleural on-call service beneficial?

Author

Asciak, R, Hallifax, R, Mercer, R, Corcoran, J, Wrightson, J, Hassan, M, Bradley, C, Psallidas, I, and Rahman, N

Abstract

Aim: To audit the pleural on-call service referrals and outcome.

Published
2018

37. Pleural abnormalities predating the development of mesothelioma

Author

Hassan, M, Asciak, R, Hallifax, R, Mercer, R, and Rahman, N

Abstract

Mesothelioma is an aggressive tumour of the pleura that is closely related to asbestos exposure. Asbestos is known to cause benign pleural thickening, effusion and plaques and the majority of patients with these abnormalities do not develop mesothelioma. It has been noted, however, that asbestos-exposed patients who have pleural plaques are at increased risk of mesothelioma. This study aimed to describe the range of pleural abnormalities seen on CT done at some time before the diagnosis of mesothelioma was made.

Published
2018

38. Thoracic ultrasonography as a predictor of pleurodesis success in malignant pleural effusion

Author

Corcoran, J, Hallifax, R, Yousuf, A, Mercer, R, Asciak, R, Hassan, M, Psallidas, I, and Rahman, N

Abstract

Malignant pleural effusion (MPE) is common with 1 new case annually for every 2,000 individuals, imposing a significant burden on patients and healthcare providers as a result. Most patients require definitive treatment, usually drainage and chemical pleurodesis, to relieve symptoms and prevent fluid recurrence. Pleurodesis is reported to have a success rate of around 70%, with no robust means of predicting which patients will suffer failure of the procedure. Thoracic ultrasound (TUS) has been shown to be capable of identifying the presence of pleural adhesions in other clinical scenarios, and could therefore have a role in predicting long-term pleurodesis success or failure in MPE.

Published
2018

39. Medical thoracoscopy: Survey of current practice—How successful are medical thoracoscopists at predicting malignancy?

Author

Hallifax, R, Corcoran, JP, Psallidas, I, and Rahman, N

Subjects
Diagnosis, Differential, Male, Pulmonologists, Attitude of Health Personnel, Predictive Value of Tests, Neoplasms, Surveys and Questionnaires, Thoracoscopy, Humans, Female, Diagnostic Errors, Middle Aged, Aged
Abstract

Use of medical thoracoscopy by respiratory physicians is increasing. This survey of experienced thoracoscopists was conducted to establish current practice of medical thoracoscopy and physicians' opinion of theoretical cases using 20 video clips. Results suggest an increasing trend towards day‐case thoracoscopy but that caution is required when making diagnosis on macroscopic appearance: malignant and benign disease could only be differentiated in 59% of cases, and trapped lung is difficult to predict at thoracoscopy.

Published
2018

40. Understanding pneumothorax: epidemiology, physiology and predicting outcome

Author

Hallifax, R and Rahman, N

Subjects
Epidemiology, Respiratory, Pneumothorax
Abstract

Contrary to traditional teaching, patients with Primary Spontaneous Pneumothorax (PSP) do not have normal lungs. Emphysema-like change (ELC) and inflammation are common. However, the natural history of ELC and its significance in terms of future disease is not known. Current management of pneumothorax is generic and not personalised. This thesis updates the UK epidemiology of pneumothorax, describes the use of two novel methods to examine the lungs, a method of predicting early treatment failure, the association of CT findings and recurrence, and a systematic review of chemical pleurodesis to reduce recurrence. Analysis of fifty years’ data on ~150,000 admissions demonstrated that the incidence of pneumothorax is increasing, and established a method to identify primary from secondary pneumothoraces and their relative risk of recurrence. Reduced ventilation of hyperpolarised Xenon on enhanced-Magnetic Resonance Imaging (MRI) was seen in those PSP patients with greater low attenuation areas on Computed Tomography (CT) and with reduced pulmonary function. A model of lung inhomogeneity found that metrics of lung ventilation distinguished pneumothorax patients from healthy volunteers and Chronic Obstructive Pulmonary Disease (COPD) patients. This may represent subtle or mild disease, not identified on standard testing, which may be exacerbated by smoking. CT scanning found that mild emphysema and cystic airspaces were common in PSP patients. Ex- or current smokers had more (and larger) cysts. Emphysema was more common in smokers and patients with a history of previous pneumothorax: who were at higher risk of recurrence. However, variation in number and size of cysts were seen in both those patients with and without recurrence. As such, no single algorithm to predict recurrence was identified. Airflow measurement early in the patient pathway has the potential to identify those likely to fail treatment, potentially allowing early triage to surgery. The addition of talc or minocycline as an adjunct to surgery provides the lowest recurrence rates, but physician-led talc poudrage may be similarly effective. Those in whom surgery is not suitable, chemical pleurodesis could be offered via chest drain. Data presented in this thesis thus provides insights into the underlying abnormalities in PSP and lays the groundwork for strategies to fundamentally alter the management paradigm.

Published
2018

45. P102 Discordant exudative pleural effusions: demographics and aetiology

Author

Addala, D, primary, Mercer, RM, additional, Lu, Q, additional, Shepherd, G, additional, Castro, O, additional, Varatharajah, R, additional, Thayanandan, A, additional, Hassan, M, additional, Bedawi, E, additional, Mccracken, D, additional, Asciak, R, additional, Tsikrika, M, additional, Hallifax, R, additional, and Rahman, N, additional

Published
2019
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46. S13 The microbiology of pleural infection, an approach based on 16s RRNA gene next generation sequencing

Author

Kanellakis, NI, primary, Bedawi, E, additional, Corcoran, JP, additional, Gerry, S, additional, Hallifax, R, additional, Mercer, R, additional, George, V, additional, Dudina, A, additional, Wrightson, JM, additional, Asciak, R, additional, Miller, R, additional, Dobson, M, additional, Ilott, N, additional, Maskell, NA, additional, Psallidas, I, additional, and Rahman, NM, additional

Published
2019
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50. S129 Does inflammation predict successful pleurodesis? a post hoc analysis from the time 1 trial

Author

Mercer, RM, primary, Macready, J, additional, Jeffries, H, additional, Speck, N, additional, Kanellakis, N, additional, Maskell, N, additional, Pepperell, J, additional, Saba, T, additional, Ali, N, additional, West, A, additional, Miller, RF, additional, Asciak, R, additional, Hallifax, R, additional, Corcoran, JC, additional, Hassan, M, additional, Psallidas, I, additional, and Rahman, NM, additional

Published
2017
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