Thomas Foundation

Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease caused by inhalation of noxious particles, most commonly cigarette smoking. The consequent changes in airways, lung parenchyma and pulmonary vasculature lead to increased resistive, elastic and threshold loads and impaired capacity of the respiratory muscle pump. COPD is characterized by progressive expiratory flow limitation. During exercise, increases in respiratory rate lead to shortening of expiratory time with consequent gas trapping. The resultant increase in end-expiratory lung volume is referred to as dynamic hyperinflation. Dynamic hyperinflation leads to further load-capacity imbalance with consequent increased neural respiratory drive to maintain ventilatory homeostasis, which is closely related to exertional breathlessness intensity. Neuromechanical dissociation, resulting in uncoupling of increased neural respiratory drive from ventilatory output, develops due to mechanical limitations on tidal volume expansion and reduced force-generating capacity of the diaphragm as dynamic hyperinflation progresses during exercise. This review provides an overview of methods of measuring dynamic hyperinflation in COPD and clinical interventions that aim to alleviate lung hyperinflation and improve exercise tolerance.

Abstract Background National and local standards in acute frailty recommend a seven-day service, with front-door assessment and a dedicated frailty area. Many acute frailty teams struggle to maintain a dedicated space as they are vulnerable to becoming inpatient areas when bed pressures increase. The Acute Older Persons Unit (AOPU) at Guys and St Thomas has faced similar challenges and is based on the Acute Admissions Ward and the Emergency Department. This project assessed whether a dedicated Acute Frailty SDEC (F-SDEC) space increased the number of patients seen and the number of same-day discharges. Methods The AOPU was based in medical SDEC for a trial period of 16 weekends from 23nd February 2025 (F-SDEC). Th F-SDEC space has recliner chairs and consultation rooms but no beds or sluice meaning the referral criteria had to change excluding those who required two to transfer or needed a commode. Data was compared between the 3 weeks prior and for 5 weeks following the implementation of F-SDEC. Results The average number of new patients seen per weekend increased from 8 to 14 during F-SDEC. The number of same day discharges increased from 9/24 (37.5% of patients seen) to 33/62 (53.2% of patients seen). The mean clinical frailty score (CFS) decreased from 6.1 to 3.9. The most common presentation was falls (45.3%) pre-F-SDEC and falls (20.3%) and infection (20.3%) during F-SDEC. Conclusions F-SDEC increased the number of patients seen and the number of same-day discharges. The average CFS decreased due to the space not being suitable for the most frail patients. When advocating for space frailty services need to balance ambulatory requirements with the ability to serve the most frail patients. A dedicated F-SDEC area that accommodates the most frail patients has the potential to increase same day discharges and improve capacity across the system.

Abstract Aim/background Ethnic inequalities in stroke incidence are well-established, but long-term trends and the impact of socioeconomic status (SES) remain understudied. We estimated incidence rates by ethnicity over 30-years, and differences by SES, using the South London Stroke Register (1995–2024). Methods We conducted a population-based study including all residents of a geographically defined area of South London, calculating standardised incidence rates using census-derived denominators and the 2013 European Standard Population. The area-level Index of Multiple Deprivation was the indicator of SES. Poisson regression estimated incidence rate ratios comparing ethnic-minority vs White groups, adjusting for age, sex, and SES, with ethnicity-SES interaction testing and marginal rates derived by subgroup. Results Among 7,726 people with first-ever stroke, overall standardised incidence decreased 34% between 1995–1999 and 2010–2014 (198;[187.8–208] to 131;[122.4–138.9] per 100,000), then increased 13% in 2020–2024. Black-African and Black-Caribbean populations had higher baseline incidence persisting across all periods. Ethnic inequalities narrowed initially but subsequently widened, with incidence twice as high in Black-African (IRR=2.31;[2.03–2.62]) and Black-Caribbean (IRR=2.00;[1.73–2.31]) groups compared to White groups in 2020–2024. Patterns were consistent across stroke subtypes, with the largest inequalities in primary intracerebral haemorrhage. Ethnic differences in incidence attenuated on SES adjustment but remained significant. Within ethnic groups, most deprived Black-African and Black-Caribbean populations showed highest incidence. Conclusion Stroke incidence has risen sharply in the past five years, driven by rising incidence rates in Black-African and Black-Caribbean populations, with reduction in the White population. Achieving equity requires ensuring uptake of cardiovascular risk programmes across all socioeconomic and ethnic groups, with earlier risk management for groups who develop stroke 10-12 years younger than the general population.

Abstract Aim Vitamin B12 deficiency is a recognised risk following oesophagogastric surgery due to multifactorial causes, including reduced gastric acid and intrinsic factor production, and dietary changes. Whilst lifelong intramuscular supplementation is standard post-total gastrectomy, guidance following oesophagectomy and STG is lacking, leading to varied practice. This study aimed to assess the prevalence and timing of B12 deficiency in these patients. Method A retrospective review was undertaken on patients who had an oesophagectomy/STG between January 2020-December 2022, attending the survivorship clinic. Deficiency was defined as holotranscobalamin <25pmol/L, or 25–70pmol/L with elevated methylmalonic acid. B12 levels were collated from pre-operatively to approximately 2 years post-operatively. Results Fifty-five patients (33 oesophagectomy; 22 STG) were included. B12 results were not available for all patients at each timepoint. Prevalence of pre-operative deficiency was 13.0% (7/54). Three patients treated pre-operatively were excluded from post-operative analysis due to ongoing supplementation. Overall prevalence of post-operative deficiency was 26.9% (14/52), with 13.7% (7/51) within 1–12 months and 15.9% (7/44) from 13–27 months. Deficiency was higher post-oesophagectomy (30%) than STG (22.7%). The oesophagectomy subgroup had a higher proportion of older adults (≥65 years: 63.6% vs. 50%) and older mean age (67.7 vs. 64 years). Conclusions B12 deficiency is common post-oesophagectomy/STG, supporting the need for routine monitoring. Findings are limited by sample size and lack of longer-term data. Results suggest residual B12 absorption in most patients after oesophagectomy/STG, negating the need for routine supplementation. Further research is needed to elucidate the longer-term prevalence and evaluate efficacy of oral supplementation.

OP 14: Health Services 3, B302 (FCSH), September 3, 2025, 17:00 - 18:00Cultural mediators (CMs) play a crucial role in facilitating migrants’ access to healthcare services in Turkey. Many CMs are migrants themselves, providing essential support in navigating complex healthcare systems. A three-day training program was designed in May 2019 to enhance their health-related knowledge, with a particular focus on maternal and child health. One of the primary challenges was conveying complex health concepts to individuals from diverse linguistic and cultural backgrounds.To address this, creative drama was employed as a pedagogical technique, fostering curiosity through improvisational scenarios involving both trainers and trainees. A key aspect of this approach was integrating participants’ lived experiences into the learning process, thereby enhancing engagement and retention. The training scenario depicted a migrant woman fleeing conflict, seeking refuge in Turkey, and navigating various healthcare facilities while experiencing multiple health challenges.To evaluate the program’s effectiveness, pre- and post-training surveys?comprising 11 open-ended questions were administered. The results indicated a significant improvement in knowledge, with correct responses increasing by 60%. Initially, only four of the 17 participants correctly identified the legal timeframe for abortion, increasing to ten in the post-test. Similarly, none of the participants?initially answered correctly regarding child vaccination policies in Turkey, whereas ten provided the correct response afterward.Following the training, participants conducted health-related presentations for both their organizations’ staff and the migrant communities they serve. As a result, 10 CMs successfully delivered sessions, reaching 70 migrants and 107 civil society workers. These findings highlight the essential role of CMs in improving healthcare access for migrant populations. Given the increasing migration trends, strengthening CMs’ health knowledge is vital for improving healthcare outcomes. Creative drama emerges as an effective, engaging and innovative pedagogical technique for enhancing learning in healthcare training programs.

Strongyloides hyperinfection can be challenging to diagnose and treat. Although it is typically described in cases of secondary immunodeficiency, it has not previously been reported in a case of inborn error of immunity. Diagnosis via microscopy can be time-consuming and challenging, and serology results may be negative in the setting of hypogammaglobulinemia. Oral ivermectin is an effective treatment for strongyloidiasis and is commonly used in low-endemicity countries. However, its efficacy is limited in cases of malabsorption. Subcutaneous administration of ivermectin is widespread in veterinary medicine, but it is not licensed for use in humans. The use of subcutaneous ivermectin in the treatment of Strongyloides hyperinfection is described in a man with hypogammaglobulinemia secondary to common variable immune deficiency and associated severe malnutrition in the context of chronic Strongyloides-related malabsorption. The diagnostic challenges in low-endemicity settings and therapeutic considerations when oral therapy is unsuccessful are also discussed.

Introduction Childhood obesity remains one of the greatest health challenges faced by the United Kingdom. With shared risk factors, obesity and dental caries are often associated.Aims A quality improvement project (QIP) was conducted at a London dental hospital to: 1) improve recording of children's body mass index (BMI) prior to listing for dental general anaesthetic (DGA); 2) create a referral pathway for children causing weight-based concern; and 3) improve clinician confidence with weight-based conversations.Methods Gold standards were created considering age and medical/behavioural complexities in this two-cycle QIP. The intervention involved smart template creation and teaching by a consultant paediatrician. A childhood obesity pathway was developed to appropriately signpost and refer to weight-based services. A mnemonic (CARES: create, assess, rapport, engage/explore/educate, signpost) was created to support dental professionals with discussions.Results In Cycle 1, BMI was recorded in 12 patients (37.5%) and centile only in seven patients (21.9%) (mean BMI = 20.0 [range: 14.5-50.7]; mean centile = 70th [range: 1-99]). In Cycle 2, BMI was recorded in 20 patients (74.1%) and centile only in one patient (3.7%) (mean BMI = 17.1 [range: 14.6-21.1]; mean centile = 57th [range: 6-95]).Conclusion This QIP demonstrated clinicians were not routinely recording BMI prior to DGA listing. The creation of a smart template, childhood obesity pathway and mnemonic aided clinician engagement in conversations about weight.