pathways: 2WW 37, inpatients 15, angiograms 6, PE service 5, respiratory OPD 17, other MDT 4, OPD 11, GP 3. Only 4/107 patients (3.7%) had high suspicion for lung cancer at outset, -2 confirmed at surgery, 1 received radiotherapy (age 91yrs), 1 declined treatment. No further pathology was detected from surveillance. So far, a total of 246 CTs have been performed with 72 awaited (table 1). Fifteen patients had PET-CT (all low SUV). Fourteen underwent bronchoscopy (normal). Two had CT biopsy (benign), 2 declined biopsy, 2 were smaller at biopsy. One benign lesion was resected (patient choice). Only 28 patients have been discharged from surveillance; 10/28 resolved on 3month CT, 3/28 resolved on 6month CT, 15/28 stable on 12month CT. Fleischner guidance was accurately followed in 67%, most deviance due to delayed timing of 6month CT. Twenty-nine (27%) were discussed without documented nodule size. Conclusion Nodule surveillance has put a significant burden on local Thoracic-Oncology services. No unexpected pathology was encountered during this surveillance period. Until clear clinical and/or radiological identifying factors for high risk patients are understood and rationalised, nodule surveillance will have to continue. There are cost implications not only for Radiology and Respiratory services, but also to patients' emotional and physical well-being. This highlights the continued need for clear surveillance protocols supported by service development. A retrospective study to analyse the outcomes and costs of follow-up of incidental nodules (solitary and multiple) referred to our Department from 2010-2011. Method Consecutive nodule cases were identified by reviewing CT reports of 619 patients discussed at our Lung Cancer MDT from 2010-2011. Only clinically incidental nodules were included. Information was gathered using PACS and hospital records. In our department incidental nodules are seen once in clinic and then largely managed 'remotely' via correspondence. All nodules are managed to Fleischner guidelines.Costs for investigations/procedures/appointments were calculated using local 2012-13 reference costs. Manpower costs for MDTs and correspondence were calculated using a 'bottom-up' costing approach. Results 62 patients were referred with a new incidental nodule (s). Mean age was 66(34-92) with a 1:1 male:female ratio. 56% (35/62) had PS 0-1 and 56%(35/62) were current/ex-smokers. 66%(41/62) had a SPN. Mean size of largest nodule was 9mm. 11%(7/62) were diagnosed with malignancy, 6%(4/62) of pulmonary origin. The 3 non-pulmonary malignancies were renal, breast and metastatic squamous cell. New clinically important diagnoses were made in a further 11%(7/62) including TB/amyloid/ILD, whilst 78%(48/62) were benign.In the malignancy group, 71% (5/7) were current/ex-smokers, 86% (6/7) had a SPN with mean size 7.7mm and there was a higher likelihood of nodules enlarging on follow-up CTs (40% versus 2% at 2nd CT). 75%(3/4) of patients with lung malignancy underwent curative treatment. In the benign group (48), the me...
patients with pathological N2 disease was 806 days, with 30 day survival of 99% and 1 year survival 76%. Conclusions Lung cancer patients with stage IIIA disease make up a very small proportion of the overall lung cancer population. Only a small proportion of these patients receive surgery and there is significant discrepancy between the recorded pre and post operative nodal status. In patients with pathological confirmed N2 disease survival is similar to the 713 days reported in the Albain study. The automated collection of detailed radiotherapy/chemotherapy treatment data in future will allow a more reliable comparison between surgical and non-surgical treatments. Background Three months after radical radiotherapy for lung cancer, 50-60% of patients have radiation pneumonitis (RP) on CT thorax. Our aim was to assess the clinical and dosimetric factors associated with radiologically-defined RP. Our primary endpoint was the development of new infiltrates on CT thorax at 3 months following radiotherapy. Methods 161 patients with lung cancer were referred for radical radiotherapy during 2009-2010. Exclusion criteria were previous thoracic radiotherapy or surgery, palliative radiotherapy, or missing dosimetric or CT data. S108Information on medical history, lung function and date of death were taken retrospectively from electronic notes. Dosimetric parameters V20-Lung (percentage normal lung exposed to more than 20Gy), V5-Lung and Mean Lung Dose were derived from treatment planning dose-volume histograms. Development of RP was defined as an increase in the percentage lung volume occupied by consolidation or ground glass on post-radiotherapy CT. Student's t-test and Fisher's Exact Test were used to define variables which were associated with RP prior to logistic regression analysis. Results 98 cases were included in analysis. 86% had non-small cell lung cancer, 44% had chronic obstructive pulmonary disease (COPD), and 27% smoked. 49/98 (50%) patients developed RP on CT at median 90 days post-radiotherapy.The factors which had a significant positive correlation with RP on univariate analysis were V20-lung, V5-lung and MLD: these were best represented using V20-Lung ≥22%. Current smoking, poor performance status and having COPD had a significant inverse correlation with RP. Use of statins or inhaled Long Acting b2 Agonists, and the presence of moderate-severe radiological emphysema also approached significance: these were included in regression analysis.After logistic regression, the factors which had a significant correlation with RP were V20≥22% (OR 6.45, 95%CI 2.22-18.08), current smoking (OR 0.23, 95%CI 0.07-0.79), and statin use (OR 0.30,.Neither RP nor any other variable was associated with postradiotherapy mortality. Conclusions This study confirms that V20≥22% is associated with the radiological development of RP. In addition, patients who smoked, and those taking statins were significantly less likely to develop RP. A potential role for statins in modifying radiotherapy side effects deserves further attention.
Other relevant checklists e.g. WHO surgical safety checklist were also reviewed. After an iterative design process involving chest physicians, general physicians, trainees and nurses, a checklist was devised, piloted and introduced into practice. Conclusion The Chest drain safety checklist was introduced in August 2011, and has since been adopted by the A&E Department and also neighbouring hospitals. Since its introduction, there have not been any adverse incidents in the Medical Department involving intercostal chest drain insertions. There is more confidence amongst nursing staff as they feel more involved and engaged. Trainees find the structured approach particularly helpful in ensuring key steps are not missed and patient safety ensured, and seek supervision and assistance more readily.
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