British Thoracic Society

Seeking mastery across Key Stages Three, Four, and Five, this paper looks at the creative use of music as an educational tool for statistics teaching. Challenges with student engagement, conceptual grasp, and the perception of statistics as abstract and difficult often beset conventional statistical education. This method aims to improve cognitive processing, broaden conceptual understanding, and promote a more pleasurable and accessible learning environment by including musical components—such as rhythm, melody, harmony, and structure—into the curriculum. Based on ideas of mastery learning, cognitive psychology, and multiple intelligences, this article offers practical techniques for including music to teach main statistical ideas from basic data processing in KS3 to inferential statistics in KS5. It claims that a music-enriched strategy can revolutionize mathematics teaching, encouraging not just rote memorization but actual conceptual understanding, critical thinking, and a good attitude toward quantitative reasoning—thus embodying a genuine next-generation approach to mathematics instruction.

ABSTRACTBackgroundAlopecia areata (AA) is a common non‐scarring alopecia. Data continue to emerge on associations with autoimmune and other conditions. Janus kinase inhibitors (JAKi) are increasingly used to treat AA.ObjectivesThe aim was to assess variation in laboratory testing in patients with AA among hair experts internationally and to compare subspecialized clinical practice to current guidelines.MethodsThirty hair experts from 14 countries and six continents contributed to develop a 24‐item survey collecting demographic information on respondents; methods of severity assessment; and laboratory testing practices in AA for mimics, contributory factors, associations, and workup for systemic therapy. The survey was distributed to a global network of expert hair specialists.ResultsOf 214 respondents, 79.9% (171/214) had special interest/expertise in hair loss disorders, and 35.5% (n = 76) were based in Europe. Most cared for both adults and children (87.9%, n = 188). For clinical assessment, almost two‐thirds (63.6%, n = 136) used the Severity of Alopecia Tool and 38% (n = 84) used the Dermatology Life Quality Index. Only 24.3% (n = 52) typically tested for alternative infectious or inflammatory diagnoses, 39.7% (n = 85) typically tested for contributory conditions such as nutritional deficiencies, and 50.9% (n = 109) typically tested for co‐existent autoimmune illnesses. Thyroid function testing was routinely performed in 73.4% (n = 157) and complete blood count (CBC) was checked in 65.9% (n = 141). Compared to conventional systemic therapy, experts were more likely to check lipid levels, creatine kinase, coagulation profiles, thrombophilia screens, tuberculosis blood testing, hepatitis B and C serology before prescribing JAKi.ConclusionsReal world practice of laboratory testing for AA by hair experts, who may see more severe or complex alopecia, is variable. Most experts routinely perform thyroid function and CBC testing. We discuss evidence for indications for testing for AA mimics, contributory factors, associated autoimmune conditions, and before systemic therapy. Further research is required to characterise the role of laboratory testing in AA.

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.

<bold>Introduction:</bold> Sarcoidosis is a multi-system granulomatous disease, with significant heterogeneity in many aspects of the disease. We reviewed 10y database from the British Thoracic Society UK ILD Registry and present salient findings on demographics, management and clinical symptoms. <bold>Methods:</bold> Participating centres entered data onto a central electronic database between 1 January 2013 and 19 February 2023. Informed consent was obtained by all participants. A cross-sectional descriptive analysis was undertaken. <bold>Results:</bold> Data were available from 937 unique cases from 50 centres. There was a male preponderance (60%); mean age 52.7y (± 26.9). The cohort was predominantly white (65%). Black patients formed 7% of the cohort compared to 3% of the national population of the UK. Systemic hypertension affected 21% of patients, and diabetes 16%, while almost two thirds had no reported comorbidities. Over 10 years, the proportion of cases where at least one biopsy was obtained remained largely consistent (93%); and during that time the use of endobronchial ultrasound (EBUS) rose from 38% to 64%. Less than half of patients experienced breathlessness and cough (45% and 41%) and 26% experienced fatigue, which can impact daily activities. At presentation 46% of patients were prescribed systemic corticosteroids; 42% were not treated, 1 in 4 patients was referred or signposted to other support (such as patient support groups or mental health support) and 2% were in clinical trials. <bold>Conclusion:</bold> These data provide a snapshot of clinical practice across ILD centres in the UK over the last decade which could be used as a basis for further work in improving the management of patients with sarcoidosis.

Since early 2020, COVID‐19 has dominated headlines, claimed millions of lives, crippled global economies, overwhelmed health services, attracted multi‐disciplinary scientific attention and transformed our daily lives. Unsurprisingly, the Lifestyle Medicine field has not been immune to the pandemic's wide‐reaching influence. Although COVID‐19 highlighted the necessity of maintaining healthy behaviours, the associated lockdowns and social distancing measures challenged our ability to do so. Attempts to mitigate the spread of COVID‐19 may, therefore, have exacerbated the obesity pandemic and other diseases associated with unhealthy lifestyle habits. One hopes this devastating virus provides the impetus for policymakers, clinicians and patients to collaborate in tackling the diseases of modern life. This commentary explores how lifestyle‐correlated conditions (which are closely intertwined with socioeconomic factors) rendered much of the UK population vulnerable to COVID‐19 infection, morbidity and mortality. Subsequently, we consider the impact of lockdown measures on the accessibility of healthy living, focussing on eating behaviours, physical activity, relationships, sleep and substance abuse, as well as the social demographics particularly affected. Approaching the aftermath of this vicious cycle with optimism, we discuss why the post‐Covid era presents a unique opportunity for Lifestyle Medicine, as an evidence‐based approach to supporting patients to adopt and sustain healthy behaviours.

We conducted a 14-year mark–recapture study of a population of Drymarchon couperi (Eastern Indigo Snake) inhabiting an unusual geologic region (Altamaha Grit) embedded within the Vidalia Uplands Physiographic Province of southeastern Georgia. Here, we documented regular cool-season use of refuges (ground holes, crevices) associated with aboveground sandstone outcrops. Several discrete rock outcrop sites were used throughout our study period, with individual snakes often returning to the same rock dens in successive years. We describe these habitats and discuss the significance of this discovery.

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive and terminal interstitial lung disease (ILD) with a median survival of 3–5 years. The British Thoracic Society (BTS) established the UK IPF Registry in 2013 as a platform to collect data on clinical characteristics, treatments and outcomes for this cohort in the UK.Between 1 January 2013 and 31 October 2019, 2474 cases were registered. Most patients were male (79%) with a mean±sd age of 74±8.3 years and 66% were ex-smokers. Over time we observed an increase in the number of patients aged over 70 years. However, we have not seen a trend towards earlier presentation as symptoms of breathless and/or cough were present for >12 months in 63% of the cohort. At presentation, mean±sd % predicted forced vital capacity (FVC) was 78.2±18.3%, median 76.2% (interquartile range (IQR) 22.4%) and transfer factor of the lung for carbon monoxide (TLCO) 48.4±16.0, median 47.5 (IQR 20.1). Most cases were discussed at an ILD multidisciplinary meeting, with an increase over this time in the number of cases reported as having possible usual interstitial pneumonia (UIP) pattern on high-resolution computed tomography (HRCT) thorax. We noted a reduction in the number of patients undergoing surgical lung biopsy or bronchoalveolar lavage. Although more patients were prescribed anti-fibrotic therapies from 2013 to 2019, 43% were ineligible for treatment based upon National Institute for Health and Care Excellence (NICE) prescribing criteria. Hypertension, ischaemic heart disease, diabetes mellitus and gastro-oesophageal reflux were the most common comorbidities.In conclusion, we have presented baseline demographics as well as diagnostic and treatment strategies from the largest single-country IPF registry, reflecting changes in UK practices over this period.

Introduction: Antifibrotic drugs for patients with IPF in England and Wales are only available to those whose FVC is between 50 and 80% predicted. The prescribing guidance does not state which reference values should be used. Aim: Establish the eligibility for antifibrotic therapy of patients registered on the BTS UK IPF Registry for various reference equations. Methods: BTS UK IPF registry cases with full lung function between 1st January 2013 and 31st December 2019 were included. Five equations were used to calculate % predicted FVC. Variables used included gender, height and age. The number (%) of values that met eligibility criteria were calculated. Results: The majority of the 1784 cases were male (79%). Mean age was 74±8.3 years and 66% were ex-smokers.The majority of UK centres use European Coal and Steel Community (ECSC) reference tables but using these only 57% of patients are eligible for anti-fibrotic therapy. Switching to the newer Global Lung Function Initiative (GLI) standards increases the ‘eligible’ proportion to 64% of patients (Table 1). Of the 767 patients ‘ineligible’ using ECSC tables 536 (70%) would be ‘eligible’ under at least one other calculation. Conclusions: Access to antifibrotic therapy for people with IPF in England and Wales may depend on the choice of reference equation used. This may lead to variation in access to care.

The Royal College of Anaesthetists 6th National Audit Project examined Grade 3-5 perioperative anaphylaxis for 1year in the UK. To describe the causes and investigation of anaphylaxis in the NAP6cohort, in relation to published guidance and previous baseline survey results. We used a secure registry to gather details of Grade 3-5 perioperative anaphylaxis. Anonymous reports were aggregated for analysis and reviewed in detail. Panelconsensus diagnosis, reaction grade, review of investigations and clinic assessment are reported and compared to the prior NAP6 baseline clinic survey. A total of 266 cases met inclusion criteria between November 2015 and 2016, detailing reactions and investigations. One hundred and ninety-two of 266 (72%) had anaphylaxis with a trigger identified, of which 140/192 (75%) met NAP6 criteria for IgE-mediated allergic anaphylaxis, 13% lacking evidence of positive IgE tests were labelled "non-allergic anaphylaxis". 3% were non-IgE-mediated anaphylaxis. Adherence to guidance was similar to the baseline survey for waiting time for clinic assessment. However, lack of testing for chlorhexidine and latex, non-harmonized testing practices and poor coverage of all possible culprits was confirmed. Challenge testing may be underused and many have unacceptably delayed assessments, even in urgent cases. Communication or information provision for patients was insufficient, especially for avoidance advice and communication of test results. Insufficient detail regarding skin test methods was available to draw conclusions regarding techniques. Current clinical assessment in the UK is effective but harmonization of approach to testing, access to services and MHRA reporting is needed. Expert anaesthetist involvement should increase to optimize diagnostic yield and advice for future anaesthesia. Dynamic tryptase evaluation improves detection of tryptase release where peak tryptase is <14μg/L and should be adopted. Standardized clinic reports containing appropriate details of tests, conclusions, avoidance, cross-reactivity and suitable alternatives are required to ensure effective, safe future management options.