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Abstract Objectives This study aimed to investigate whether positive serum autoantibodies (AAbs) have any impact on survival and time evolution of radiological findings and pulmonary function indices in patients with interstitial lung disease (ILD). Patients and methods Ninety four patients with regular clinical, functional and high resolution computed tomography (HRCT) imaging follow-up for at least 12 consecutive months and complete testing for a panel of AAbs most commonly associated with ILD were enrolled in this retrospective two-center study. Eligible patients were divided into two groups based on the presence [ILD/AAb(+)] (n = 69) or absence [ILD/AAb(−)] (n = 25) of positive serum AAbs. All-cause mortality and longitudinal indicators of ILD progression such as a sustained decrease from baseline in absolute measurements of forced vital capacity (FVC) of ≥10% or single-breath diffusion capacity (DLCO SB) of ≥15% were the primary study endpoints. DLCO SB < 40% predicted on at least two consecutive measurements and progression of HRCT findings were our secondary endpoints. Kaplan–Meier (K-M) survival analysis and multivariate Cox proportional-hazards (PH) model were used to evaluate the prognostic significance of positive AAbs in the outcome of patients with ILD. Results ILD/AAb(+) patients were predominantly female (71% vs 32%), were significantly younger (54.8 ± 14.6 vs 66.8 ± 10.1 years), and had longer duration of follow-up (78.1 ± 53.1 vs 41.6 ± 26.7 months), compared with ILD/AAb(−) patients (p <.01 for each comparison). Baseline measurements of FVC (% pred.) and DLCO SB (% pred.) did not differ significantly between the two groups. At the end of follow-up, mortality rates and the percentage of patients with a sustained FVC decrease were lower in the ILD/AAb(+) group (p <.05 for each comparison). With the exception of DLCO SB < 40% pred., ILD/AAb(+) patients had a longer median time-to-event for each of the other studied outcomes (p <.01 for each K-M analysis). In addition, Cox PH models adjusted for age, smoking status, baseline pulmonary function tests and morphological pattern of ILD remained statistically significant in favor of the ILD/AAb(+) group (p <.05 for each comparison). Conclusions AAb(+) patients with ILD seem to have a more favorable prognosis regarding all-cause mortality, long-term deterioration in lung function parameters and progression of HRCT findings than their AAb (−) counterparts. Highlights • Long-term, clinically meaningful decrease of FVC or DLCO SB was observed in >50% of patients with ILD. • AAb positivity in patients with ILD is associated with lower mortality rates and prolonged survival. • PFTs and HRCT findings deteriorate less rapidly in ILD/AAb(+) than ILD/AAb(−) patients. [ABSTRACT FROM AUTHOR]

Background and Aims Sweet's syndrome or acute febrile neutrophilic dermatosis is characterized by fever, leukocytosis and tender erythematous plaques, which show infiltration by mature neutrophils on histological examination. Pulmonary involvement is rare in Sweet's syndrome. Method We describe the case of a 17-year-old man with a myelodysplastic syndrome following therapy for Hodgkin's lymphoma who developed Sweet's syndrome and cryptogenic organizing pneumonia. In addition, we conducted a review of the related English literature. Results Literature review yielded six similar reports of biopsy-proven cryptogenic organizing pneumonia associated with Sweet's syndrome. We present the clinical and laboratory characteristics, as well as the response to treatment, of all cases of cryptogenic organizing pneumonia reported in patients with Sweet's syndrome. Conclusions Cryptogenic organizing pneumonia is a rare manifestation of Sweet's syndrome, which may be complicated by respiratory failure. Prompt treatment with corticosteroids usually leads to clinical and radiographic improvement. [ABSTRACT FROM AUTHOR]

Lung abscesses are usually caused by anaerobic or mixed bacterial infection of the lower respiratory tract. Conservative treatment with broad-spectrum antibiotics is established as the therapy of choice for most patients, with 80-95% responding to antimicrobial therapy. Conservative management failure, manifested by sepsis persistence and/or abscess complications, requires drainage with invasive techniques (percutaneous, endoscopic or surgical) or open surgical removal of the affected lung tissue (segmentectomy, lobectomy or rarely pneumonectomy) in patients with good performance status and sufficient respiratory reserve. Although surgical intervention is accompanied by relatively high mortality rates (11%-28%), it remains the most effective method in preventing complications or future relapses. [ABSTRACT FROM AUTHOR]

Acquired diaphragmatic paralysis may compromise lung mechanics and cause dyspnoea and/or lead to respiratory failure in the long term. A 76 year-old female patient presented with progressive worsening of dyspnoea and spirometric indices, and imaging studies revealed elevation of the left hemidiaphragm. Surgical correction was carried out by diaphragmatic plication technique, through a mini-thoracotomy approach. Immediate alleviation (within days) of her symptoms was observed, while improvement of radiological and pulmonary function tests occurred some weeks later. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) has been shown to be associated with increased risk for cardiovascular events. The wide distribution of beta-adrenergic receptors in the respiratory and cardiovascular systems frequently discourages clinicians from using beta-blockers in patients with COPD or inhaled beta2-agonists in those with cardiovascular comorbidities. Evidence in the current literature suggests that inhaled short- and long-acting beta2-agonists can be considered safe in patients without significant cardiac disease or with clinically stable disease (arrhythmia, coronary artery disease or heart failure). In these situations COPD treatment should be initiated or adjusted rationally, provided that worsening of respiratory symptoms is not associated with decompensated heart failure or an acute coronary event. Cardioselective beta-blockers in usual doses should not be withheld from patients with COPD who have mild to severe airway obstruction, in whom their definite therapeutic benefits in the management of myocardial infarction and chronic heart failure outweigh the danger of possible induction of bronchospasm. Further research is necessary on the safety of beta-blockers in very severe stages of COPD (FEV1 <30% pred.) and the use of non-cardioselective beta-blockers in subjects with partially reversible airway obstruction. [ABSTRACT FROM AUTHOR]

A 57 year-old male smoker presented with weight loss and hypertrophic osteoarthropathy. Imaging studies revealed a solid mass (maximum diameter 4.2 cm) located in the left lung and left upper lobectomy was carried out. Histopathology showed low differentiated adenocarcinoma and the patient received adjuvant chemotherapy. Bronchoscopy performed 3 years later to exclude specific infection revealed complete obstruction of the posterior segment of the right upper lobe by a highly vascular, smooth margined mass. At thoracotomy the frozen section was negative for malignancy and histopathological examination revealed a typical carcinoid tumour. The excellent prognosis of this histological type of tumour allowed avoidance of a major surgical procedure and the lesion was resected by bronchotomy with reconstruction of the bronchial gap. Pneumon 2012, 25(4):428-431. [ABSTRACT FROM AUTHOR]

Introduction: Medication review and polypharmacy management, especially in the elderly, are key components of integrated care. Although polypharmacy management is often associated with the primary care setting, hospital clinicians, who are often members of multidisciplinary therapeutic teams, have an opportunity to improve the management of polypharmacy, which has the potential to improve health outcomes in both hospital and primary care. Methods: Mixed-methods (desk reviews, key informant interviews and focus groups) case studies were carried out in Greece and Catalonia, in the framework of the SIMPATHY (Stimulating Innovation Management of Polypharmacy and Adherence in The Elderly) project, in order to describe policies and procedures on the management of polypharmacy and adherence in the elderly and describe implementation strategies. Kotter's Eight Step Process for transforming change and normalization process theory (NPT) were applied both in data collection tools and in the analysis. Progress report: At both sites there was awareness regarding the need for management of polypharmacy in the elderly, although in Greece awareness had not translated to a sense of urgency, a critical early step in Kotter's process. Barriers to implementation in Greece included extreme financial pressure, lack or organizational culture supporting multidisciplinary teams and shared decision making, and lack of guidance from central health authorities. However, despite the lack of national guidelines, hospital pharmacists in state (public) hospitals currently review medication for inpatients and out-patients, and interventions regarding inappropriate polypharmacy and reconciliation of care have been piloted. In Catalonia, implementation of an Institutional network sponsored model has been implemented and it is being evaluated. Polypharmacy was integrated as a specific component of a broader patientcentered service model, driven by a small multidisciplinary team, with a focus on global health outcomes. Facilitators, to implementation included an organizational culture of innovation and shared decision making, advanced training requirements of all hospital pharmacists, and regional health policies focusing on improved care for patients with complex chronic disease. Conclusion and future work: Although Greece is a country with no programme of polypharmacy management identified, there are some policies and clinical activities in place that could support future programmes. National guidance will ultimately be needed to mobilize health professionals and ensure consistency of care. The Catalan experience demonstrates that polypharmacy management can occur in the hospital setting. Future challenges include scaling the current model into other units within the hospital and into primary care. Given the pharmacist training and current medicines management activities in Greece, the hospital may be an appropriate entry point for polypharmacy management activities in that country, later scaling up to the community. As other health systems look to address polypharmacy, hospital should be considered a potential starting point for initiating a programme. Funding: This poster is part of the SIMPATHY project (663082) which has received funding from the European Union's Health Programme (2014-2020). [ABSTRACT FROM AUTHOR]

Introduction: Polypharmacy and medication adherence in the older population are significant public health issues throughout the European Union (EU), and are critical issues in integrated care. SIMPATHY (Stimulating Innovation Management of Polypharmacy and Adherence in The Elderly) is a consortium of 10 organizations representing 8 EU countries with the goal of stimulating innovation around polypharmacy and adherence, ultimately providing the tools for EU policy makers to adopt new programs addressing this issue into existing healthcare systems. Methods: A mixed-methods case study is ongoing in Greece to identify policies on the management of polypharmacy and adherence issues in the elderly. A desk review of the polypharmacy and adherence policies at the government, regional and institutional level has been completed. Legislation, regulations, guidance and other policy documents from the National Organization for Healthcare Services Provision, the Direction of Pharmaceutical Policy of the Greek Ministry of Health, the 1st Regional Healthcare Authority (RHA) of Attica (about 5 million inhabitants), the public body which is responsible for electronic prescription at a national level and the National Organization of Medicines were analyzed. Key informant interviews will be conducted with policymakers and health professionals responsible for developing and implementing strategies. Focus groups consisting of policymakers, clinicians and patients will then be used to validate the research findings. Progress report: The desk review highlighted several surveys illustrating the extent of inappropriate polypharmacy in various settings and geographic areas of Greece, but did not recognize any type of national, regional or local policies, guidelines and legislation regarding polypharmacy and adherence. Currently, most prescribers use disease-specific guidelines (therapeutic protocols), and local initiatives lead by community pharmacists and/or other healthcare professionals address some aspects of, but do not constitute structured, comprehensive programs on polypharmacy management. Health spending in Greece has dropped in each of the years since 2009, driven by a sharp reduction in public spending as part of government-wide efforts to reduce the large budgetary deficit. Implementation of e-prescription at a national level contributed to the rationalization and modernization of medicine prescription and decreased pharmaceutical costs in the country, but did not directly address the issue of polypharmacy and medication adherence. Conclusion and future work: Results from key informant interviews and focus groups are expected to elucidate the possible constraints and barriers to conceptualization and implementation of polypharmacy programs in Greece. The results from this study combined with the other SIMPATHY case studies will provide valuable tools for policymakers, researchers, and clinicians throughout Europe as they move to integrate polypharmacy and adherence activities into existing health care systems. Funding: This poster is part of the SIMPATHY project (663082) which has received funding from the European Union's Health Programme (2014-2020). [ABSTRACT FROM AUTHOR]

We investigated the antibody kinetics after vaccination against COVID-19 in healthcare workers of a Greek tertiary hospital. Eight hundred and three subjects were included, of whom 758 (94.4%) received the BNT162b2 vaccine (Pfizer-BioNTech), eight (1%) mRNA-1273 (Moderna), 14 (1.7%) ChAdOx1 (Oxford-AstraZeneca) and 23 (2.9%) Ad26.COV2.S (Janssen). Before the second dose, at 2, 6 and 9 months after the second dose and at 2 and 6 months after the third dose, anti-spike IgG were quantified by the chemiluminescence microparticle immunoassay method. One hundred subjects were infected before vaccination (group A), 335 were infected after receiving at least one vaccine dose (group B), while 368 had never been infected (group C). Group A presented a greater number of hospitalizations and reinfections compared to group B (p < 0.05). By multivariate analysis, younger age was associated with an increased risk of reinfection (odds ratio: 0.956, p = 0.004). All subjects showed the highest antibody titers at 2 months after the second and third dose. Group A showed higher antibody titers pre-second dose, which remained elevated 6 months post-second dose compared to groups B and C (p < 0.05). Pre-vaccine infection leads to rapid development of high antibody titer and a slower decline. Vaccination is associated with fewer hospitalizations and fewer reinfections. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained. Methods: Change management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework analysis across cases. Results: Polypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland, and Uppsala) and included all care settings. There was agreement, even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation. Conclusion: Within the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives. [ABSTRACT FROM AUTHOR]