Hillingdon Hospitals NHS Foundation Trust

<h3>Introduction</h3> Interstitial Lung Disease (ILD) prevalence is rising, yet ILD often remains misdiagnosed or diagnosed late, particularly due to referral delays (3.8±2.1 years between first spirometry and diagnosis).¹ In primary care, spirometry is the predominant test for assessing respiratory symptoms, but ILD is often overlooked. ArtiQ.Spiro, an AI-based support tool for spirometry interpretation, shows strong potential to assist clinicians in identifying possible ILD. We examine the prevalence of AI-flagged ILD cases in a real-world primary care setting to evaluate AI’s potential to prompt earlier specialist referrals. <h3>Methods</h3> The Hillingdon Confederation runs a central spirometry hub for four GP practices and uses ArtiQ.Spiro to support spirometry execution and interpretation. We applied the AI model to demographic and clinical spirometry data from 2,794 consecutive individuals undergoing spirometry between October 2022 and May 2025. Interpretation followed the ERS/ATS 2021 standard. The AI-predicted ILD cases in primary care were assessed and contextualised based on spirometry patterns. Prediction reliability was supported by prior external validation² demonstrating strong ILD screening performance (AUC=0.9, NPV=92.3%, PPV=60.5%). <h3>Results</h3> The model predicted ILD in 7.8% of cases (n=219; see the table for characteristics). These predictions are associated with higher age compared to the total cohort, and reduced FVC z-scores with normal to elevated FEV1/FVC z-scores (0.41±0.93), as expected in ILD patients when compared to a healthy population. Among the ILD predicted cases, 55.7% exhibited a possible restrictive pattern, 43.4% a normal pattern, and 0.9% a possible mixed disorder. Predicted ILD cases include 24.6% of the patients with obesity and restrictive pattern, indicating the model’s predictions are not driven by obesity-related restriction. While the previously validated PPV suggests some overprediction, high NPV provides confidence that most true ILD cases are being identified. <h3>Conclusions</h3> ArtiQ. Spiro can support ILD diagnosis by flagging at-risk patients across both restrictive and normal spirometry patterns that might otherwise be overlooked. Further work is needed to evaluate how integrating ArtiQ.Spiro into diagnostic pathways could impact secondary care by weighing the benefits of earlier ILD detection against the risks of unnecessary specialist referrals. <h3>References</h3> Topalovic. <i>ERJ</i>, 2022. https://doi.org/10.1183/13993003.congress-2022.1217 Sunjaya. <i>ERJ Open Research</i> 2025. https://doi.org/10.1183/23120541.00116-2025

Bechterew’s disease, or ankylosing spondylitis (AS), is a chronic inflammatory spondyloarthropathy that causes spinal rigidity and increases the risk of unstable fractures, often after low-energy trauma. This systematic review included seven studies encompassing 672 patients with ankylosed spines who sustained spinal fractures. Clinical presentation commonly involves sudden back or neck pain, kyphotic deformity, limited spinal mobility, and neurological deficits, which may be subtle and easily overlooked. Fractures predominantly affect the cervical spine (C5-C7) and thoracolumbar junction (T11-L2), often extending through all three spinal columns, resulting in high instability and risk of spinal cord injury. Accurate imaging is critical; computed tomography delineates bony injuries, while magnetic resonance imaging identifies spinal cord damage, ligamentous disruption, and epidural hematomas. Nonoperative management carries a high risk of secondary displacement and neurological deterioration, whereas early surgical stabilization, typically via posterior or combined anterior-posterior fixation, improves outcomes. Multidisciplinary care involving orthopedic, neurosurgical, and critical care teams is essential for optimizing recovery. Limitations of the current literature include small sample sizes and heterogeneous study designs. Future research should focus on prospective multicenter studies, standardized imaging and management protocols, and long-term functional outcomes to reduce fracture risk and improve care in this high-risk population.

Necrotizing fasciitis (NF) is a rapidly progressive infection with high mortality. When NF complicates orthopedic fractures, early recognition is particularly challenging because swelling, erythema, and pain may be misattributed to trauma or postoperative changes. A systematic review was conducted using PubMed, Embase, Scopus, and Cochrane databases up to June 2025 according to Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines. Eligible studies included human patients with orthopedic fractures complicated by NF in whom radiologic evaluation and clinical outcomes were reported. Risk of bias was assessed using the Joanna Briggs Institute checklist for case reports. Six studies were included, comprising six individual patients with fracture-associated NF. Radiologic evaluation revealed that plain radiographs occasionally demonstrated subcutaneous gas, while CT consistently identified fascial gas, edema, and fluid tracking. MRI was most sensitive for detecting fascial necrosis, particularly in cases under immobilization casts. Clinical outcomes were poor: four patients died, one underwent limb amputation with subsequent death, and one achieved limb salvage with fracture union. Diabetes, ischemia, and virulent pathogens (e.g., Aeromonas hydrophila) were major contributors to adverse prognosis. Reporting of systemic complications, including renal dysfunction, was limited despite their recognized prognostic value. Fracture-associated NF is exceedingly rare but carries devastating outcomes, with mortality in the majority of reported cases. CT and MRI play a critical adjunctive role in diagnosis, but cannot replace urgent surgical exploration. Standardized reporting of systemic complications, especially acute kidney injury, is needed. Multicenter registries are essential to establish more robust diagnostic and prognostic frameworks.

<bold>Introduction:</bold> The Simplified Nutritional Appetite Questionnaire (SNAQ) is a brief appetite screening tool (scores from 4-20 with ≤ 14 indicating poor appetite). We hypothesised that poor appetite is associated with accelerated loss of weight, muscle mass and muscle strength. <bold>Methods:</bold> Participants: Individuals with stable COPD (SNAQ≤ 14; n=35 and 1:1 propensity score matched comparator group with SNAQ ≥15). Study design: Prospective cohort over one year. Measures: Body mass index (BMI), fat free mass (FFM) determined using bioelectrical impedance and a disease specific equation, ultrasound derived rectus femoris cross sectional area (RFCSA), quadriceps maximal voluntary contraction (QMVC). Analysis: Between group comparison of change in BMI, FFM, RFCSA and QMVC over one year. <bold>Results:</bold> Baseline characteristics: 55% male; mean (SD) age 70(9.3) years; BMI 28.8(6.1); FEV1 54.6(18.6) % predicted. Groups were well matched for baseline variables. No significant between group changes in BMI, FFM, RFCSA, QMVC were observed (table 1). <table-wrap><object-id>erj;66/suppl_69/PA5187/TB1</object-id><object-id>T1</object-id><object-id>TB1</object-id><table><colgroup><col></col><col></col><col></col><col></col></colgroup><tbody><tr><td>Variable</td><td>SNAQ ≤14</td><td>SNAQ ≥15</td><td>Between group difference</td></tr><tr><td>ΔBMI (kg/m²)</td><td>-0.26(-0.8 to 0.3)</td><td>-0.37 (-0.9 to 0.2)</td><td>0.1 (-0.7 to 0.9)</td></tr><tr><td>ΔFFM (kg)</td><td>0.50 (-0.26 to 1.2)</td><td>0.31 (-1.0 to 1.6)</td><td>0.17 (-1.3 to 1.6)</td></tr><tr><td>ΔRFCSA (mm²)</td><td>-3.0 (-48.3 to 42.1)</td><td>-45.3 (-76.2 to -14.4)</td><td>42.2 (-11.6 to 96.0)</td></tr><tr><td>ΔQMVC (kg)</td><td>-1.6 (-3.8 to 0.7)</td><td>-1.9 (-5.0 to 1.1)</td><td>0.4 (-3.4 to 4.2)</td></tr></tbody></table><table-wrap-foot><fn> Data presented as 95% (CI) </fn></table-wrap-foot></table-wrap> <bold>Conclusion:</bold> In people with COPD, poor appetite was not associated with accelerated loss in weight, muscle mass or muscle strength over 12 months.

<bold>Introduction:</bold> Prophylactic azithromycin is recommended in treatment guidelines for people with COPD who experience frequent exacerbations. However, implementation in real-world settings is unknown. Assessment for pulmonary rehabilitation (PR) represents an opportunity to identify treatable traits, including frequent exacerbations. <bold>Aim:</bold> To identify eligibility for and appropriate prescription of prophylactic azithromycin in people with COPD attending PR assessment. <bold>Methods:</bold> A retrospective audit of people with COPD assessed for PR at a regional centre between September 2020 - November 2024. Eligibility criteria for prophylactic azithromycin were: 1) three or more exacerbations in the preceding 12 months. Exclusion criteria included current smoking status. Medication history was reviewed to identify current prescriptions of prophylactic azithromycin. <bold>Results:</bold> Of 1564 people with COPD undergoing PR assessments, 248 (16%) were eligible for prophylactic azithromycin (see Figure 1). Of these, only 19 (7.7%) were prescribed prophylactic azithromycin. <bold>Conclusion:</bold> A significant difference exists between eligibility for and real-world prescription of prophylactic azithromycin. Further work is needed to explore the reasons for this implementation gap. Assessment for PR represents an opportunity to identify patients with COPD that may potentially benefit from prophylactic azithromycin. <fig><object-id>erj;66/suppl_69/PA2655/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

Migraine is a leading cause of global disability, and conventional preventive therapies often suffer from poor tolerability and low adherence. Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs: erenumab, fremanezumab, galcanezumab, and eptinezumab) represent a targeted therapeutic advance, but long-term adherence and safety remain under investigation. Following PRISMA guidelines, we systematically searched PubMed, Embase, CENTRAL, Scopus, and Web of Science (2018-2024) for randomized controlled trials, real-world studies, and systematic reviews reporting adherence, tolerability, or discontinuation outcomes in adults with episodic or chronic migraine. Eleven studies (n > 50,000) met the inclusion criteria. Pooled 12-month adherence was approximately 55% (vs. ~35% for oral preventives), while discontinuation due to adverse events ranged from 5.9%-20%, most commonly constipation and injection-site reactions (relative risk, 1.32-1.55); serious adverse events were rare (<5%). Responder rates (≥50% reduction in monthly migraine days) improved from 44% at three months to 64% at 12 months, with network meta-analyses suggesting greater efficacy compared with topiramate and OnabotulinumtoxinA, though direct head-to-head RCTs remain lacking. Overall, anti-CGRP mAbs demonstrate favorable adherence, sustained tolerability, and comparative advantages over conventional therapies, but further research is needed to assess long-term safety beyond 12 months, cost-effectiveness, and use in special populations such as pregnancy.

Heart failure remains a leading global health burden affecting over 64 million individuals worldwide, with limited effective acute management strategies. Carperitide, a recombinant form of human atrial natriuretic peptide, has been primarily used in Japan for acute heart failure treatment, but its clinical efficacy remains controversial. This systematic review and meta-analysis aimed to evaluate the clinical outcomes of carperitide in heart failure patients. A comprehensive literature search was conducted across PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to July 2025, using terms related to carperitide and heart failure. Studies involving adult heart failure patients receiving carperitide that reported cardiovascular mortality, all-cause mortality, or heart failure-related hospitalization were included. Six studies met inclusion criteria, comprising three observational studies, two randomized controlled trials, and one secondary analysis, published between 2008 and 2025. Meta-analysis was performed using RevMan 4.5.1 (The Cochrane Collaboration) with random-effects models. The pooled analysis of four studies examining all-cause mortality demonstrated no significant difference between carperitide and control groups (risk ratio (RR): 1.02, 95% confidence interval (CI): 0.63-1.66), with substantial heterogeneity (I² = 66%). Similarly, hospitalization due to heart failure showed no significant difference (RR: 0.98, 95% CI: 0.85-1.14) with no heterogeneity (I² = 0%). Composite outcomes of hospitalization and death also revealed no significant benefit (RR: 0.98, 95% CI: 0.85-1.14). This meta-analysis provides evidence that carperitide does not significantly improve clinical outcomes in heart failure patients, challenging its widespread use and supporting the need for evidence-based therapeutic alternatives in heart failure management.

Abstract Aim The high volume of trauma calls, leading to resource allocation issues, staff dissatisfaction, and patient safety concerns, prompted this project. The aim was to evaluate trauma call effectiveness, adherence to Major Trauma Network Northwest London Guidelines, patient outcomes, and the impact of interventions on imaging timelines and documentation. Method Trauma calls were reviewed over two audit cycles (1/4/24-10/6/24 and 14/10/24-14/11/24). Interventions between the two periods included educational sessions, the presentation of findings to key stakeholders and relevant departments, and the assigning of an emergency department trauma lead at the start of each shift. In addition, a silver trauma toolkit was introduced for staff to follow. Key metrics included call appropriateness, protocol adherence, documentation rates and patient outcomes. Results In the first cycle, 216 trauma calls (101 adults, 98 silver, 17 paediatric) were recorded, with 58.4% adherence to guidelines. Primary and secondary survey documentation rates were 92.1% and 81.2%, respectively. Average imaging times were 3 hours 10 minutes (general trauma) and 6 hours 29 minutes (silver trauma). Post-intervention, 70 calls (30 adult, 38 silver, 2 paediatric) were logged, with adherence increasing to 71.8% for general trauma and 100% for silver trauma. Primary and secondary survey documentation improved to 96.9% and 90.6%, and imaging times reduced to 2 hours 29 minutes (general) and 3 hours 21 minutes (silver). Conclusions Education, divisional discussion, and assigning a trauma lead reduced inappropriate calls and improved adherence to guidelines and documentation. However, education in a department with high staff turnover or temporary staffing remains a challenge.

Rapid innovations in prostate cancer diagnosis and treatment have led to the adoption of innovative trial designs. The Imperial Prostate 3-PROState Pathway Embedded Comparative Trial (IP3-PROSPECT) aims to explore the feasibility and acceptability of a cohort multiple randomised controlled trial (cmRCT) design within the prostate cancer pathway. Eligible participants were approached at the point of referral for a clinical suspicion of prostate cancer and were invited to join the cohort, agreeing in principle to future randomisations, without knowledge of the details of those interventions. Patients completed patient-reported outcome measure (PROM) questionnaires at baseline and follow-up visits, providing valuable insights into their experiences following prostate cancer diagnosis. IP3-PROSPECT recruited 139 participants from 384 individuals approached across four sites, meeting the primary endpoint with an approach rate of 35.3%. Recruitment outcomes demonstrated the feasibility of recruiting patients to the cmRCT cohort within the prostate cancer pathway, with high completion rates for PROM questionnaires observed throughout the study visits. Participants and health care professionals expressed favourable views towards the design, acknowledging its potential advantages over traditional trial designs. Sufficient interventions that span the prostate pathway so that the potential large number of participants could be involved in answering research questions as well as the need to optimise recruitment strategies were identified. IP3-PROSPECT provides valuable insights into the feasibility and acceptability of implementing a cmRCT design within the prostate cancer pathway. Future research will evaluate the effectiveness of the cmRCT design in generating comparative effectiveness data for prostate cancer interventions.