Search

Data sharing: Fully anonymised data will be provided upon reasonable request to the corresponding author. Copyright © 2022 The Author(s). Background: There are few evidence-based interventions for long COVID; however, holistic approaches supporting recovery are advocated. We assessed whether an online breathing and wellbeing programme improves health related quality-of-life (HRQoL) in people with persisting breathlessness following COVID-19. Methods: We conducted a parallel-group, single-blind, randomised controlled trial in patients who had been referred from one of 51 UK-based collaborating long COVID clinics. Eligible participants were aged 18 years or older; were recovering from COVID-19 with ongoing breathlessness, with or without anxiety, at least 4 weeks after symptom onset; had internet access with an appropriate device; and were deemed clinically suitable for participation by one of the collaborating COVID-19 clinics. Following clinical assessment, potential participants were given a unique online portal code. Participants were randomly assigned (1:1) to either immediate participation in the English National Opera (ENO) Breathe programme or to usual care. Randomisation was done by the research team using computer-generated block randomisation lists, with block size 10. The researcher responsible for randomisation was masked to responses. Participants in the ENO Breathe group participated in a 6-week online breathing and wellbeing programme, developed for people with long COVID experiencing breathlessness, focusing on breathing retraining using singing techniques. Those in the deferred group received usual care until they exited the trial. The primary outcome, assessed in the intention-to-treat population, was change in HRQoL, assessed using the RAND 36-item short form survey instrument mental health composite (MHC) and physical health composite (PHC) scores. Secondary outcome measures were the chronic obstructive pulmonary disease assessment test score, visual analogue scales (VAS) for breathlessness, and scores on the dyspnoea-12, the generalised anxiety disorder 7-item scale, and the short form-6D. A thematic analysis exploring participant experience was also conducted using qualitative data from focus groups, survey responses, and email correspondence. This trial is registered with ClinicalTrials.gov, NCT04830033. Findings: Between April 22 and May 25, 2021, 158 participants were recruited and randomly assigned. Of these, eight (5%) individuals were excluded and 150 participants were allocated to a treatment group (74 in the ENO Breathe group and 76 in the usual care group). Compared with usual care, ENO Breathe was associated with an improvement in MHC score (regression coefficient 2·42 [95% CI 0·03 to 4·80]; p=0·047), but not PHC score (0·60 [–1·33 to 2·52]; p=0·54). VAS for breathlessness (running) favoured ENO Breathe participation (−10·48 [–17·23 to –3·73]; p=0·0026). No other statistically significant between-group differences in secondary outcomes were observed. One minor self-limiting adverse event was reported by a participant in the ENO Breathe group who felt dizzy using a computer for extended periods. Thematic analysis of ENO Breathe participant experience identified three key themes: (1) improvements in symptoms; (2) feeling that the programme was complementary to standard care; and (3) the particular suitability of singing and music to address their needs. Interpretation: Our findings suggest that an online breathing and wellbeing programme can improve the mental component of HRQoL and elements of breathlessness in people with persisting symptoms after COVID-19. Mind–body and music-based approaches, including practical, enjoyable, symptom-management techniques might have a role supporting recovery. Imperial College London

BackgroundThe symptoms, radiography, biochemistry and healthcare utilisation of patients with COVID-19 following discharge from hospital have not been well described.MethodsRetrospective analysis of 401 adult patients attending a clinic following an index hospital admission or emergency department attendance with COVID-19. Regression models were used to assess the association between characteristics and persistent abnormal chest radiographs or breathlessness.Results75.1% of patients were symptomatic at a median of 53 days post discharge and 72 days after symptom onset and chest radiographs were abnormal in 47.4%. Symptoms and radiographic abnormalities were similar in PCR-positive and PCR-negative patients. Severity of COVID-19 was significantly associated with persistent radiographic abnormalities and breathlessness. 18.5% of patients had unscheduled healthcare visits in the 30 days post discharge.ConclusionsPatients with COVID-19 experience persistent symptoms and abnormal blood biomarkers with a gradual resolution of radiological abnormalities over time. These findings can inform patients and clinicians about expected recovery times and plan services for follow-up of patients with COVID-19.

Background Patients discharged from hospital following treatment for COVID-19 infection, experience ongoing breathlessness during recovery 1 One minute sit-to-stand test (1MSTS) has been recommended to identify desaturation in these patients during acute and post-acute phase 2 We aimed to assess the feasibility of 1MSTS to monitor recovery in COVID-19 patients following hospital discharge Methods All patients admitted to our hospital, with COVID-19 were offered clinic review approximately 6-8 weeks post discharge This clinical assessment included 1MSTS, bloods and imaging If ongoing clinical concern, a second review was offered at 3 months We reviewed the 1MSTS in terms of (a) ability to complete test (b) oxygen desaturation >3%2 (c) longitudinal improvement in 1MSTS repetitions Fisher's exact and Mann-Whitney tests were used to compare variables Results 366/413(88%) COVID-19 patients reviewed at initial follow-up clinic completed a 1MSTS and 141 repeated 1MSTS at 3 months Those who were unable to complete a 1MSTS at initial clinic were older, frailer and had longer hospital admissions with COVID-19 (table 1) 77/366 (21%) patients had desaturation of >3% on 1MSTS at initial follow-up, which was associated with severe disease during admission (p=0 051) and persisting radiographic abnormalities (p=0 0018) No association between desaturation and symptom burden was noted Clinicians found 1MSTS with no desaturation to be helpful in the discharge process if other investigations were normal Desaturation during initial clinic was not predictive of abnormal cardiac and respiratory investigations at 3 month followup (p=0 317) An improvement in number of repetitions/minute between clinic visits did not correlate with an improvement in VAS breathlessness (p=0 099), MRC score (p=0 267) or imaging (p=0 448) Conclusion The majority of patients recovering from COVID-19 can perform 1MSTS at follow-up clinic Those unable were generally more frail, older and with co-morbidities 1MSTS helped with discharge decisions at 6-8 weeks However, the wider utility of the 1MSTS results is limited in COVID-19 follow-up Serial measurements were not helpful in predicting symptomatic or radiological improvement

Tuberculosis (TB) is an important cause of childhood death and morbidity worldwide. The diagnosis in the pediatric population remains challenging due to the paucibacillary nature of the disease. Intrathoracic lymphadenopathy is one of the most common manifestations of primary disease but is often difficult to sample. A retrospective case review was performed of children (younger than 16 years) suspected with intrathoracic TB lymphadenopathy who underwent an endobronchial ultrasound (EBUS)-transbronchial needle aspiration (TBNA) between January 2010 and 2020 in a London TB center. Ten children between 11 years 4 months and 15 years 9 months, with weights ranging from 48 to 95 kg, underwent EBUS-TBNA. All procedures were performed under conscious sedation with no reported complications. Six of 10 cases showed granulomas on rapid onsite histologic evaluation. Nine of 10 cases were confirmed to have Mycobacterium tuberculosis. Seven of 10 cases were culture positive with a mean turn-around time of 13.7 days; of these, 4 of 7 were smear positive. Six of 7 culture positive cases were also TB polymerase chain reaction (PCR) positive. TB PCR identified 2 further cases where microscopy and culture remained negative. One case had multidrug-resistant TB identified on TB PCR allowing early initiation of correct drug therapy. In our cohort, we show EBUS-TBNA is a safe and effective way of investigating intrathoracic TB lymphadenitis in children and a high diagnostic rate can be achieved. In high-resource settings, we should approach childhood TB with a standardized diagnostic approach and utilize EBUS-TBNA as a diagnostic modality. Samples should be sent for culture but also for molecular assays to timely identify TB and drug-resistant disease.

Introduction Management of malignant pleural disease has advanced over the past decade with the role of a pleural specialist service becoming increasingly essential in efforts to optimise patient care. The use of indwelling pleural catheters (IPC) has changed the arena in which malignant pleural effusions (MPE) can be managed, allowing more patient autonomy and less use of hospital resources. The LENT scoring system, validated in 2014, is often used to guide decision making in patients with MPE. Current ATS recommendations suggest IPCs are not suitable in individuals with a ‘very short survival’ prognosis however this determination is variable and is an example of where the LENT scoring system may be involved. Methods Retrospective analysis was carried out on patients who underwent IPC insertion at our institution between 2016 and 2019. All patients were seen in the specialist pleural service and underwent subsequent intervention. Data collected included primary cancer diagnosis, date of first pleural aspiration, LENT score, observed complications, IPC removal date if applicable and date of death to calculate survival time. Results 58 patients underwent successful IPC insertion of which 5 were for non-malignant disease (2/5 refractory heart failure, 3/5 advanced liver cirrhosis). The remaining 53 patients all had a confirmed pathological diagnosis of malignant pleural effusion. At the time of submission, 8 patients remained alive and were excluded from analysis leaving a remaining 45 cases. Using LENT assessment 13/45 classed as high risk, 31/45 as moderate and 1/45 as low. The observed average survival time in high risk patients was 122 days and median 93 days. This was notably higher than the anticipated 44 days predicted median survival time noted in the literature. Conclusion Our data suggests that high risk patients according to LENT assessment were more likely to live longer following IPC intervention and aftercare. This suggests that use of prognostic assessment tools may be ineffective in this sub-group and should be employed with caution. The improved patient outcomes reinforce the benefit of a dynamic responsive pleural service. They may also reflect upon the increased recognition of tumour heterogeneity alongside the recent advent of novel molecular based therapies.

Intro: Guidelines advise screening patients for latent TB infection (LTBI) prior to initiation of biologic therapy. We examined the impact of interferon gamma release assay (IGRA) availability on rates of adequate screening and treatment for LTBI prior to biologic therapy in a low TB incidence setting. Method: We analysed clinic letters, laboratory and pharmacy data to assess LTBI screening for patients starting biologics at a UK district general hospital between 2009-14. We used logistic regression to identify predictors of LTBI treatment. Results: 450 patients initiated biologics 2009-14: 116 before, and 334 after, IGRA availability (Jan 2010). 100/334 (30%) were IGRA tested. Adequate screening, defined as any immunological test and clinical review, increased with IGRA availability but remained low (105/334 vs 14/116; p Conclusion: LTBI screening in patients starting biologics improved after IGRA availability, but 69% were inadequately screened. Historically a negative IGRA has not influenced the decision to treat, but improved data on the negative predictive value of IGRAs may reduce treatment rates. In our limited sample, this did not adversely affect outcomes.