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BackgroundLung cancer screening programs provide an opportunity to support smokers to quit, but the most appropriate model for delivery remains to be determined. Immediate face to face smoking cessation support for people undergoing screening can increase quit rates, but it is not known whether remote delivery of immediate smoking cessation counselling and pharmacotherapy in this context is also effective.Materials and MethodsIn a single-blind randomised controlled trial, smokers aged 55-75 years attending a Targeted Lung Health Check (TLHC) were allocated by day of attendance to receive either immediate telephone smoking cessation support (TSI) (starting immediately and lasting for 6 weeks) with appropriate pharmacotherapy, or usual care (very brief advice to quit and signposting to smoking cessation services) (UC). The primary outcome was self-reported 7-day point prevalence smoking abstinence at three months. Differences between groups were assessed using logistic regression.Results315 current smokers taking part in the screening programme, mean (SD) age 63(5.4) years, 48% female, were randomised to telephone smoking cessation (n=152) or usual care (n=163). The two groups were well-matched at baseline. Self-reported quit rates were higher in the intervention arm, 21.1% vs 8.9% (odds ratio [OR]: 2.83, 95% CI 1.44-5.61, p=0.002). Controlling for participant demographics, baseline smoking characteristics or the discovery of abnormalities on low dose CT scanning did not modify the effect of the intervention.ConclusionImmediate provision of an intensive telephone-based smoking cessation intervention, delivered within a targeted lung screening context, is associated with increased smoking abstinence at three months.Trial registrationThis study is registered online: ISRCTN12455871.Take home messageProviding immediate, telephone smoking cessation support with pharmacotherapy to smokers enrolled in a TLHC program increases quit rates in this population by almost a third.

Lung cancer screening programs provide an opportunity to support people who smoke to quit, but the most appropriate model for delivery remains to be determined. Immediate face-to-face smoking cessation support for people undergoing screening can increase quit rates, but it is not known whether remote delivery of immediate smoking cessation counselling and pharmacotherapy in this context also is effective.Does an immediate telephone smoking cessation intervention increase quit rates compared with usual care among a population enrolled in a targeted lung health check (TLHC)?In a single-masked randomized controlled trial, people 55 to 75 years of age who smoke and attended a TLHC were allocated by day of attendance to receive either immediate telephone smoking cessation intervention (TSI) support (starting immediately and lasting for 6 weeks) with appropriate pharmacotherapy or usual care (UC; very brief advice to quit and signposting to smoking cessation services). The primary outcome was self-reported 7-day point prevalence smoking abstinence at 3 months. Differences between groups were assessed using logistic regression.Three hundred fifteen people taking part in the screening program who reported current smoking with a mean ± SD age of 63 ± 5.4 years, 48% of whom were women, were randomized to TSI (n = 152) or UC (n = 163). The two groups were well matched at baseline. Self-reported quit rates were higher in the intervention arm, 21.1% vs 8.9% (OR, 2.83; 95% CI, 1.44-5.61; P = .002). Controlling for participant demographics, neither baseline smoking characteristics nor the discovery of abnormalities on low-dose CT imaging modified the effect of the intervention.Immediate provision of an intensive telephone-based smoking cessation intervention, delivered within a targeted lung screening context, is associated with increased smoking abstinence at 3 months.IRSCTN registry; No.: ISRCTN12455871; URL: www.IRSCN.com.

Objectives The West London lung screening pilot aimed to identify early-stage lung cancer by targeting low-dose CT (LDCT) to high risk participants. Successful implementation of screening requires maximising participant uptake and identifying those at highest risk. As well as reporting pre-specified baseline screening metrics, additional objectives were to 1) compare participant uptake between a mobile and hospital-based CT scanner and 2) evaluate the impact on cancer detection using two lung cancer risk models. Methods From primary care records, ever-smokers aged 60–75 were invited to a lung health check at a hospital or mobile site. Participants with PLCOM2012 6-yr risk ≥1.51 % and/or LLPv2 5-yr risk ≥2.0 % were offered a LDCT. Lung cancer detection rate, stage, and recall rates are reported. Participant uptake was compared at both sites (chi-squared test). LDCT eligibility and cancer detection rate were compared between those recruited under each risk model. Results Of 8366 potential participants invited, 1047/5135 (20.4 %) invitees responded to an invitation to the hospital site, and 702/3231 (21.7 %) to the mobile site (p = 0.14). The median distance travelled to the hospital site was less than to the mobile site (3.3 km vs 6.4 km, p Conclusion Targeted screening is effective in detecting early-stage lung cancer. Similar levels of participant uptake at a mobile and fixed site scanner were demonstrated, indicating that uptake was driven by factors in addition to scanner location. The LLPv2 model was more permissive; recruitment with PLCOM2012 alone would have missed several cancers.

ObjectivesLung cancer screening programmes offer an opportunity to address tobacco dependence in current smokers. The effectiveness of different approaches to smoking cessation in this context has not yet been established. We investigated if immediate smoking cessation support, including pharmacotherapy, offered as part of a lung cancer screening programme, increases quit rates compared to usual care (Very Brief Advice to quit and signposting to smoking cessation services).Materials and methodsWe conducted a single-blind randomised controlled trial of current smokers aged 55–75 years attending a Targeted Lung Health Check. On randomly allocated days smokers received either (1) immediate support from a trained smoking cessation counsellor with appropriate pharmacotherapy or (2) usual care. The primary outcome was self-reported quit rate at 3 months. We performed thematic analysis of participant interview responses.ResultsOf 412 people attending between January and March 2020, 115 (27.9%) were current smokers; 46% female, mean (SD) 62.4 (5.3) years. Follow-up data were available for 84 smokers. At 3 months, quit rates in the intervention group were higher 14/48 (29.2%) vs 4/36 (11%) (χ23.98, p=0.04). Participant interviews revealed four smoking-cessation related themes: (1) stress and anxiety, (2) impact of the COVID-19 pandemic, (3) CT scans influencing desire to quit and (4) individual beliefs about stopping smoking.ConclusionThe provision of immediate smoking cessation support is associated with a substantial increase in quit rates at 3 months. Further research is needed to investigate longer-term outcomes and to refine future service delivery.Trial registration numberISRCTN12455871.

Regional lung cancer screening (LCS) is underway in England, involving a “lung health check” (LHC) and low-dose CT scan for those at high risk of cancer. Incidental findings from LHCs or CTs are usually referred to primary care. We describe the proportion of participants referred from the West London LCS pilot to primary care, the indications for referral, the number of general practitioner (GP) attendances and consequent changes to patient management, and provide an estimated cost-burden analysis for primary care. A small proportion (163/1542, 10.6%) of LHC attendees were referred to primary care, primarily for suspected undiagnosed chronic obstructive pulmonary disease (55/163, 33.7%) or for QRISK® (63/163, 38.7%) assessment. Ninety one of 159 (57.2%) participants consenting to follow-up attended GP appointments; costs incurred by primary care were estimated at £5.69/LHC participant. Patient management changes occurred in only 36/159 (22.6%) referred participants. LHCs result in a small increase to primary care workload provided a strict referral protocol is adhered to. Changes to patient management arising from incidental findings referrals are infrequent.

Background: Targeted lung health checks (TLHC) including a CT thorax have the potential to detect lung cancers at an earlier stage. Prompting smoking cessation attempts can be an additional benefit. Methods: People aged 60-75 years who had smoked beyond the age of 40 were invited to attend for a TLHC. Smokers received brief quit advice and were signposted to stop smoking services. A follow up telephone call was made a mean(SD) 8.1(2.6) months later to ask about ongoing smoking. Results: 351(31%) of 1145 people attending self-reported as current smokers. 34(9.6%) were referred to a smoking cessation service, 102(29.1%) took information about services and 177(50.4%) did not wish to quit. For 37(10.5%) data were missing. 275 were successfully contacted for follow up. Of these 237(86%) said that they were still smoking and 38(14%) reported that they had quit. 50(18%) patients had made unsuccessful quit attempts. Quit attempts had involved a variety of nicotine replacement therapies (NRTs) and Varenicline. Participants were generally aware of the health risks of smoking; the discovery of abnormalities on CT was reported as an additional prompt to try to quit. Those who had not quit cited reasons including; enjoyment; being social /occasional /not heavy smokers; frustration at previous failed quit attempts. Others were procrastinating; thought it was too late to quit; preferred to use alternative therapies; or to self-attempt to quit. Additionally, others described smoking as a remedy for underlying mental health problems. Conclusion: Our preliminary data suggest that meaningful numbers of participants do attempt and succeed in quitting following CT screening for lung cancer.

Background Pilot lung cancer screening programmes in England have utilised a lung health check (LHC) model, comprising a nurse-led respiratory consultation, spirometry and a lung cancer risk calculation. We report the short-term outcomes of recommendations made to primary care for management of non-cancer incidental findings in a screening pilot. Methods 1542 participants from 17 general practice (GP) surgeries attended for a LHC between August 2018 and April 2019. Lung nodules, significant incidental lung findings on computed tomography (CT), unexplained respiratory symptoms, and suspected non-lung malignancies were managed within the screening programme. Participants with: i) ‘red-flag’ symptoms without lung cancer, ii) unexplained obstructive spirometry and respiratory symptoms, iii) significant coronary artery calcification (CAC) on CT, who were not known to have previously undergone cardiovascular risk stratification, and iv) significant, but non-urgent, non-lung incidental findings on CT, were referred to primary care. GP records were evaluated to establish outcomes. Results 165 primary care recommendations were made in 157/1542 (10.2%) individuals. Results below are from 16 GP practices and will be updated at the time of presentation. 49/1542 (3.2%) were referred to their GP for suspected undiagnosed chronic obstructive pulmonary disease (COPD), of whom 19/49 (38.8%) had a community-based respiratory review. 12/49 (24.5%) were newly diagnosed with COPD, and 5/49 (10.2%) commenced inhaler therapy. Of 52/1145 (4.5%) scanned participants with heavy CAC but without known ischaemic heart disease, 26/52 (50.0%) had a QRISK2 score (all >10%). Lipid-lowering therapy was commenced in 21/52 (40.4%). Echocardiography was recommended for 22/1542 (1.4%) participants with suspected cardiac disease, largely aortic valve calcification. 7/22 (31.8%) underwent echocardiography. Only 1/22 (4.5%) was deemed to require intervention for significant aortic stenosis. 7/1542 (0.5%) recommendations were made for other non-urgent/non-cardiothoracic incidental findings; none required further intervention. Conclusions A minority of participants required primary care management for incidental findings based on the West London lung screening study protocol. Although not all recommendations were implemented, incidental findings infrequently led to changes to patient management overall. Changes to patient management most commonly occurred as a result of recommendations for assessment for COPD and cardiovascular risk.

UNSCR 1325 was a watershed moment for women, peace and security. This article analyses and critiques the Resolution itself. The current implementation of the Resolution is identified, including failures to include women in all aspects of peace and conflict processes. Key opportunities to achieve transformative change are covered: meaningful engagement with civil society, experts and governments; a co- ordinated strategy to unite men and men's groups as male champions of change; and states having high-impact well-resourced national action plans that are a meta-policy requiring a complete gender re-think. The article concludes that the most important requirement is that there is a true commitment to gender equality in order to move from aspiration to action; the time to act is now. Resolucija VS OZN 1325 pomeni prelomnico za ženske, mir in varnost. Članek vključuje analizo in oceno resolucije. Analiza obsega uresničevanje resolucije, vključno z napakami o nevključevanju žensk na vseh ravneh mirovnih in konfliktnih procesov. Obravnavane so ključne priložnosti za doseganje sprememb: resno sodelovanje s civilno družbo, strokovnjaki in vladami, usklajena strategija združevanja moških skupin in posameznikov kot moških pobudnikov sprememb ter sprejemanje dobro financiranih in vplivnih nacionalnih akcijskih načrtov v različnih državah kot neke vrste meta politike, za katero je nujno popolno prevrednotenje vlog spolov. Iz sklepov članka izhaja, da je najpomembnejša resnična predanost enakosti spolov, s katero se bo mogoče premakniti od prizadevanj k dejanjem. Zdaj je pravi čas za ukrepanje.

The solid state structure of the triphenylphosphine oxide (TPPO) adduct of tri-3-thienyltin bromide has been investigated by both single crystal X-ray analysis and Mossbauer spectroscopy. The crystal structure consists of discrete molecules and there is no evidence of any intermolecular tin-sulphur interactions. Each tin atom is found to be in a five-coordinate trigonal bipyramidal environment in which the three thienyl groups occupy equatorial positions. The metal atom is displaced by 0.182 A out of the equatorial plane and towards the axial bromine. Two of the thienyl ligands exhibit rotational disorder and the lack of disorder in the remaining heteroaryl ligand is attributed to the close proximity of this group to a phenyl ligand. The Mossbauer parameters are also in accord with five-coordination for tin and are indicative of the aryl groups being equatorial.

A series of 3-furyltin halides of the types SnRnX4–n(R = 3-furyl; n= 2 or 3; X = Cl or Br) have been prepared and characterised by chemical and spectroscopic techniques. Mossbauer data for triphenyl-phosphine oxide adducts of the tris(3-furyl)tin halides are consistent with five-co-ordinate trigonal-bipyramidal structures bearing equatorial heteroaryl groups. The bis(3-furyl)tin dihalides have been characterised by complex formation with 2,2′-bipyridyl and Mossbauer studies suggest a six-co-ordinate cis-octahedral environment for tin. The 3-furyltin halides have been found to be considerably more stable than their 2-furyl and 2-thienyl analogues. Continued attempts to characterise these less stable compounds by complex formation have met with some success. 119Sn N.m.r. data are presented for the above series of heteroaryltin compounds and also for a range of tetrakis-(heteroaryl)tin systems. The 119Sn n.m.r. and Mossbauer data are discussed in terms of the possible electronic effects of the heteroaryl groups.

The preparation of a range of (3-thienyl)tin halides, (3-C4H3S)nSnX4-n (n  2 or 3; X  Cl, Br or I), and some complexes with donor ligands, is described. Mossbauer spectroscopy indicates that the halides have unassociated, tetrahedral, structures. The related 2-thienyl- (and 2-furyl-) tin halides have also been prepared and characterised by Mossbauer spectroscopy, but are much less stable.