Antrim Area Hospital

The Trump administration's withdrawal from the World Health Organization (WHO) marked a breakdown in global health cooperation. Framed as a nationalist assertion of sovereignty, the move undermined international solidarity during a global pandemic and reflected a broader retreat from multilateral responsibility. This editorial contends that the decision was not merely administrative but ideological, reducing health to a tool of political posturing and isolationist rhetoric. The impact on low- and middle-income countries reliant on WHO support highlights the real-world consequences of such disengagement. What is at stake is the future of global health security and the integrity of international public health systems.

The collapse of Gaza's health system has rendered traditional models of health planning and humanitarian coordination functionally obsolete. With fewer than half of Gaza's hospitals partially operational and over 90% of health infrastructure damaged or destroyed, the territory is no longer capable of delivering essential services such as dialysis, obstetric care, or oncology treatment. This letter argues that a permanent, internationally managed cross-border health corridor-anchored via the Rafah crossing-offers a feasible and urgent solution to provide structured, rights-based care amid systemic collapse. Drawing on precedents from Syria, the Democratic Republic of Congo, and global humanitarian law, we outline the legal, operational, and political frameworks necessary to establish such a corridor. The corridor model is presented as not only a response to Gaza's immediate crisis but also a replicable framework for other protracted conflict zones where national health systems have irreversibly failed.

The patient-surgeon encounter is a complex relationship characterized by the infliction of pain for the patient's benefit. While surgical interventions are deeply personal, a significant knowledge disparity between patients and surgeons poses challenges in communication. Surgical training emphasizes the cultivation of virtues and practices to prioritize patient interests, but contemporary surgical practice still grapples with ethical quandaries. Addressing these challenges head-on is vital for advancing the field while ensuring patient safety, informed consent, cost-effectiveness, and conflict management. This article aims to contribute to the discourse on surgical ethics by delineating its scope, exploring key ethical issues, and examining strategies employed by surgeons. Additionally, it investigates the impact of surgical ethics on patients, surgeons, and society. Through a bibliometric analysis of the top 50 articles, key themes and influential works are identified. Themes include ethics of surgical innovation, history of surgical ethics, surgical ethics in practice, and ethics education. The analysis also reveals trends in countries of origin, authorship, article types, and journal representation. Findings inform the development of ethical frameworks, guidelines, and ethical competencies in surgical practice, promoting patient-centered care and professionalism. Collaboration among stakeholders is essential to shape the future of surgical ethics.

Abstract Background/Aims NICE guidelines recommend all patients commenced on corticosteroids should have an HBA1C level after initiation of treatment. In May 2023 a giant cell arteritis (GCA) clinic service began which provided seamless transition of care from fast track to follow up for all patients newly diagnosed with GCA. Glucocorticoid (GC)-induced hyperglycaemia is a recognised complication of steroid treatment. A meta-analysis by Liu et al., including 13 studies, has shown that the overall event rate of hyperglycaemia among patients using glucocorticoid related treatments was 32.3%. Our audit reviewed the monitoring of HBA1C levels in newly diagnosed GCA patients prior to, and since this service began. The aim was for 100% of patients reviewed having HBA1C checked between 4 months prior to diagnosis and 4 weeks since initiation. Methods A sample of patients diagnosed with GCA in the trust between January - July 2022 was audited. Comparison was made with May 2023 - April 2024 of patients who were streamlined into a dedicated GCA follow up clinic. HbA1C values were recorded with the date relative to their GCA diagnoses. HbA1c ranges were <42mmol/mol (normal), low risk of GC induced hyperglycaemia, 42-48 mmol/mol (pre diabetic), at risk of GC induced hyperglycaemia, >48mmol/mol (diabetic range). Results In the 2022 cohort, 15/18 (83%) of patients had their HBA1C level checked. 5 were in the normal range, 5 patients pre diabetic range and 5 in the diabetic range, 2 of whom had pre-existing diabetes. Follow up was available in 11/18. 2 patients in the pre diabetic range became diabetic. 1 patient in diabetic range became pre diabetic with steroid taper. There were no other changes across the cohort. In the cohort attending the dedicated GCA clinic 43/44 (98%) had HbA1c checked. 17 patients had normal range, 21 patients pre-diabetic range, and 6 diabetic range (4 of whom had pre-existing diabetes; the other two were referred to GP for follow up). Follow up HbA1c was available in 33/44. 2 patients in the normal range became pre diabetic. 2 in the pre-diabetic range became diabetic and were referred to diabetic services. 7 in the pre-diabetic range normalised to < 42 on steroid reduction. Conclusion The majority (61%) of patients with newly diagnosed GCA in the first year of the GCA clinic had an HbA1c in the diabetic or pre-diabetic range. These patients are at risk of diabetic complications, which may be compounded by comorbidities and other steroid effects. Although there was resolution in some cases on steroid taper, others progressed to diabetes. Having a streamlined service and protocols can ensure GC-induced hyperglycaemia is screened for and managed. Disclosure S.K. Stewart: None. L. Hanna: None. G. Mullan: None. S. Cerruti: None. J. McKnight: None. M. Wray: None.

ObjectivesIdiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease (ILD) and the most common idiopathic interstitial pneumonia. The UK IPF Registry was established in 2013 to collect data pertaining to clinical features, therapeutic approaches and outcomes. From February 2023, the Registry expanded to include any ILD with evidence of fibrosis.DesignThe UK IPF Registry is a national, multicentre observational registry, including both prospective and retrospective data of patients with IPF in secondary or tertiary care. Cases eligible for inclusion were those with a diagnosis of IPF, presenting at participating centres from January 2013.ResultsBetween January 2013 and February 2023, 5052 IPF cases were registered from 64 participating centres. There was a male preponderance (77.8%) with mean±SD age of 74±8.1 years, 66% were ex-smokers and 76% had at least one comorbidity. Over a third (36.7%) experienced symptoms for more than 24 months prior to their first clinic visit. The majority of cases were discussed at a multidisciplinary team (MDT) meeting and the most common radiological patterns at presentation were probable (54.6%) and definite (42.7%) usual interstitial pneumonia. There was a reduction in surgical lung biopsies from 14% in 2013 to 5.5% in 2022. Antifibrotic therapy prescription rose from 36.0% in 2013 to 55.9% in 2023. The use of nintedanib (approved by National Institute of Clinical Excellence in January 2016) rose from 6.7% in 2013 to 31.5% in 2022 and pirfenidone (approved in April 2013) was initially used in around a third of cases before dropping to between 16.8% and 24.9% after nintedanib was approved.ConclusionThese data reflect clinical practice across the UK and it is intended the data will have a role in informing the future of IPF care and providing a model for benchmarking, ultimately increasing knowledge and improving clinical care for this devastating disease.

Introduction and AimsDue to the heterogeneity of presentation, organ involvement, and variable response to treatment assessment can be difficult but should include methods to measure disease activity, burden of disease, and impact using patient reported outcome measures. We aim to correlate Quality of Life measurements to markers of disease activity and severity.Methods83 consecutive patients with sarcoidosis underwent clinical assessment, selected blood tests, pulmonary function testing, plain CXR evaluation andQoL measurement including Kings Sarcoidosis Questionnaire (KSQ) and EQ-5D-5L. Additional data including length of disease, need for treatment, and Drug Burden were integrated. Markers of disease severity, treatment and baseline demographics were correlated against QoL measurements.ResultsThe mean age of the cohort was 58.2 (SD 11.3), 65% were male, with an average disease duration of 7.3 years (SD 6.0), and 52% were on treatment defined as oral prednisolone > 3/12. There were no significant gender differences in terms of EQ-5D-5L or KSQ. There was a trend towards higher QoL with longer disease duration (r 0.173) and lower QoL with raised BMI (r 0.255). Stratifying the cohort by lymphocyte trend and CXR stage are presented in table 1. CXR stage revealed significant differences in FEV1 (p 0.002), FVC (p 0.014) and DLCO (p <0.001). No significant findings for CXR stratification on EQ Visual Assessment of Health [EQ VAS] (p 0.747), Kings Lung (p 0.655), and Kings General (p 0.054) were found. These may have been confounded by cardiac involvement or airway limitation. Treatment with steroids correlated with globally reduced QoL measurements: EQ VAS 60 v 75 (p 0.06), Kings Lung 25 v 19 (p 0.016), and Kings General 43 v 33 (p 0.016). The direction of the relationship is unclear. The strongest correlation was found between number of medications and higher symptom burden defined by the Kings General (r 0.542).ConclusionQoL measures provide additional insights and may help to identify confounders. Corticosteroids have a broad side effect profile. Our data suggests lower QoL in treated groups. A major gap in the management of sarcoidosis is the lack of accessible and objective methods to measure response to intervention. P66 Table 1Demographics and clinical features by lymphocyte trend and CXR stage Lymphocyte Trend CXR Stage ALL N P I R 0 1 2/3 4 N 34 28 17 4 12 18 11 32 83 %Male (n) 56 (19) 71 (20) 76 (13) 100 (4) 75 (7) 61 (11) 64 (7) 59 (19) 65 Age 57.2 (2.2) 57.9 (2.4) 65.3 (2.9) 59.6 (5.3) 59.4 (3.2) 56.5 (2.9) 54.8 (3.5) 62.8 (2.1) 58.2 Duration B 6.9 (1.2) 8.3 (1.2) 6.6 (1.4) 8.2 (1.6) 7.0 (1.5) 4.8 (0.8) 5.4 (1.6) 10.6 (1.3) 7.3 Presentation 50.3 (2.2) 49.6 (2.3) 58.7 (3.3) 51.4 (6.9) 52.4 (3.2) 51.7 (2.9) 49.4 (2.7) 52.2 (2.6) 50.8 BMI 31.5 (0.8) 28.2 (1.2) 28.0 (1.4) 27.6 (1.4) 32.2 (1.7) 29.9 (0.8) 27.5 (1.1) 29.4 (1.1) 29.7 FEV1 B 88 (4) 86 (5) 94 (6) 83 (38) 100 (4) 98 (5) 88 (8) 76 (3) 87 FVC B 93 (4) 95 (3) 98 (7) 96 (21) 99 (3) 103 (4) 97 (8) 84 (3) 93 DLCO B 84 (4) 84 (3) 80 (4) 81 (12) 95 (5) 90 (4) 86 (7) 72 (3) 83 Ratio <0.7 (%) 15 20 50 x 9 15 36 31 18 Meds (mean) 7.8 5.6 7.0 3.3 8.2 4.7 5.3 7.0 6.7 Treatment% (n) 53 (18) 50 (14) 53 (9) 50 (2) 75 (9) 33 (6) 64 (7) 53 (17) 52 EQ VA Health 59 (4) 71 (4) 70 (5) 75 (25) 60 (8) 68 (4) 58 (9) 70 (4) 65 Kings General A 44 (3) 35(3) 33 (5) 27 (7) 43 (4) 41 (4) 44 (5) 33 (3) 39 Kings Lung 23 (2) 20 (2) 20 (3) 15 (9) 22 (3) 22 (2) 23 (3) 21 (2) 22 Key N: Normal, P: Persistent, I: Intermittent, R: Resolved. (Standard Error – unless stated otherwise)A: Significant differences Lymphocyte Trend. B: Significant differences CXR Stage

Introduction and AimsThe role of Gastro-Oesophageal Reflux Disease (GORD) in pulmonary fibrosis is uncertain. There are theoretical concerns regarding the role of micro-aspiration and disease exacerbation, as well as observational studies documenting survival benefit. We aim to assess the impact of PPI therapy in patients with pulmonary fibrosis.Methods223 patients attending the ILD clinic were followed for 3 years. They were stratified by radiological diagnosis; Unclassifiable pulmonary fibrosis (n 66), Probable UIP (n 51), and UIP (n 106). Demographics, pulmonary function tests, dedicated swallow assessments –where available, treatment and use of PPI were recorded. Outcome measures included rate of decline in FVC and death. A subgroup analysis (n 147) assessed the impact of PPI on progression defined by the INBUILD criteria.ResultsThe average age of the cohort was 76.4 (8.8 SD), 63% male (n 141), 21% required O2, mortality during follow up was 36% (n 81). Demographic, baseline data, treatment and outcome for each radiological diagnosis are presented in table 1. 70% of patients received PPI treatment. Of those who underwent dedicated swallow assessment 51% had evidence of dysmotility, reflux or laryngeal penetration. There was similar rates of GORD in those with asymmetric versus uniform pulmonary fibrosis (47% v 55%). There was no significant differences in rate of FVC decline within the cohort as a result of treatment. There appeared to be attenuation of FVC decline by 48ml with treatment in patients with a UIP radiological classification, however this was not replicated in the pUIP group. The relative risk of death was reduced in those on treatment (RR 0.715, p 0.058), estimated benefit calculation suggested NNT 7.71. Review of INBUILD criteria outcomes revealed a 10% increase in progressive symptoms and FVC decline >10% in those on treatment however radiological progression was similar.ConclusionsGORD is prevalent in pulmonary fibrosis. Treatment with PPI appeared to attenuate the rate of decline of FVC in some patients however did not alter progression defined by the INBUILD criteria. There was a suggestion of reduced mortality, further study is required to clarify the impact of PPI treatment. P62 Table 1Clinical Data uPF pUIP UIP ALL n 66 51 106 223 Age 75.0 +/- 8.3 77.8 +/- 7.24 76.6 +/- 8.8 76.4 +/- 8.8 %Male 53% (35) 58% (32) 70% (74) 63% (141) O2 15% (10) 14% (7) 27% (29) 21% (46) PPI 67% (44) 75% (38) 67% (75) 70% (157) AntiF 3% (2) 18% (9) 25% (27) 17% (38) FVC 2.38 2.27 2.38 2.37 Delta FVC 0.087 0.066 0.153 0.114 Delta FVC on PPI (L) 0.079 0.110 0.137 0.114 Delta FVC No PPI (L) 0.101 -0.061 0.185 0.113 Absolute Diff (L) 0.022 -0.171 0.048 -0.001 uPF: Unclassified Pulmonary Fibrosis pUIP: Probable UIP, UIP: Usual Interstitial Pneumonia

<bold>Introduction:</bold> The underlying mechanisms and factors contributing to Long COVID are poorly understood. A wide variety of symptoms have been reported several months after infection by COVID-19, including breathlessness, fatigue, brain fog and many more. <bold>Methods:</bold> During the early phase of the pandemic, we sought to investigate whether a mobile application (TIYGA ecosystem) could be used to capture data about the type, intensity (scale 1-10), and frequency of specific symptoms. We aimed to understand how to record the sequence of occurrence of new symptoms over time. <bold>Results:</bold> Thirteen participants volunteered from a Charity-led Respiratory Support Group. All participants signed a consent form and created anonymised accounts. The symptoms and interventions tracked by the app were individually personalised and chosen by the participants. There was a high burden of symptoms spanning multiple organ systems, the commonest presented in Figure 1A. The app (TIYGA ecosystem) tracked individual patient’s symptoms and provided healthcare professionals (HCPs) with data regarding severity and resolution of symptoms over time (Figure 1B). <fig><object-id>erj;64/suppl_68/PA4367/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig> <bold>Conclusion:</bold> The app (TIYGA ecosystem) allows individualised monitoring on a longitudinal basis giving HCPs a rapid overview of progress and detail about changing specific symptom prevalence. This ecosystem provides a unique digital interface that may enhance communication between patients and HCPs.

End-expiratory occlusion (EEO) and end-inspiratory occlusion (EIO) tests have been successfully used to predict fluid responsiveness in various settings using calibrated pulse contour analysis and echocardiography. The aim of this study was to test if respiratory occlusion tests predicted fluid responsiveness reliably in cardiac surgical patients with protective ventilation. This single-centre, prospective study, included 57 ventilated patients after elective coronary artery bypass grafting who were indicated for fluid expansion. Baseline echocardiographic measurements were obtained and patients with significant cardiac pathology were excluded. Cardiac index (CI), stroke volume and stroke volume variation were recorded using uncalibrated pulse contour analysis at baseline, after performing EEO and EIO tests and after volume expansion (7 mL/kg of succinylated gelatin). Fluid responsiveness was defined as an increase in cardiac index by 15%. Neither EEO, EIO nor their combination predicted fluid responsiveness reliably in our study. After a combined EEO and EIO, a cut-off point for CI change of 16.7% predicted fluid responsiveness with a sensitivity of 61.8%, specificity of 69.6% and ROC AUC of 0.593. In elective cardiac surgical patients with protective ventilation, respiratory occlusion tests failed to predict fluid responsiveness using uncalibrated pulse contour analysis.