Breathing SPACE – a practical approach to the breathless patient.

Breathlessness is a common symptom which may have multiple causes in any one individual and causes which may change over time. Breathlessness campaigns encourage people to see their GP if they are unduly breathless. Members of the London Respiratory Network collaborated to develop a tool which would encourage a holistic approach to breathlessness, which was applicable both at the time of diagnosis and during ongoing management. This has led to the development of the aide memoire “Breathing SPACE” which encompasses 5 key themes – Smoking, Pulmonary disease, Anxiety/psychosocial factors, Cardiac disease and Exercise/fitness. A particular concern was to ensure that high value interventions (smoking cessation and exercise interventions) are prioritised across the life-course and throughout the course of disease management. The approach is relevant both to well people and in those with an underling diagnosis or diagnoses. The inclusion of anxiety draws attention to the importance of mental health issues. Parity of esteem requires the physical health problems of people with mental illness to be addressed. The SPACE mnemonic also addresses the problem of underdiagnosis of heart disease in people with lung disease and vice versa, as well as the systematic undertreatment of these conditions where they do co-occur

Attitudes and access to lung volume reduction surgery for COPD: a survey by the British Thoracic Society.

OBJECTIVE: Lung volume reduction surgery for emphysema leads to improved survival in appropriately selected individuals, and it is therefore recommended in national and international guidelines for this group of patients. Despite this, fewer than 100 patients undergo the procedure each year in the UK. Our objective was to establish whether this reflects concerns about morbidity and mortality or difficulties in the referral pathway. DESIGN AND SETTING: We conducted a survey of members of the British Thoracic Society by email to investigate this in the second half of 2013. The survey included questions about access to investigations, the indications for lung volume reduction surgery (LVRS), whether a multidisciplinary meeting discussed eligibility of patients for LVRS and what the morbidity and mortality associated with the procedure was. RESULTS: There were 65 responses, 82% from respiratory physicians. Roughly half of the respondents were either unsure about the risks of death or prolonged (>30 days) hospital stay involved or significantly over-estimated them. In total, 70% did not have a specific multidisciplinary team to discuss the management of patients with advanced chronic obstructive pulmonary disease (COPD). There was no consensus as to which patients with COPD should undergo a CT scan to evaluate them for possible surgery. CONCLUSIONS: Patients with COPD require a systematic and multidisciplinary approach to assessment for LVRS and these survey data suggest that work is needed to deliver this evidence-based therapy in a consistent and comprehensive way across the UK

Use and abuse of statistics in tobacco industry-funded research on standardised packaging

In this commentary we consider the validity of tobacco industry-funded research on the effects of standardised packaging in Australia. As the first country to introduce standardised packs, Australia is closely watched, and Philip Morris International has recently funded two studies into the impact of the measure on smoking prevalence. Both of these papers are flawed in conception as well as design but have nonetheless been widely publicised as cautionary tales against standardised pack legislation. Specifically, we focus on the low statistical significance of the analytical methods used and the assumption that standardised packaging should have an immediate large impact on smoking prevalence

Influenza vaccination for NHS staff: attitudes and uptake.

OBJECTIVES: Annual vaccination against influenza (flu) is recommended for all UK National Health Service (NHS) staff to help reduce the risk of contracting the virus and transmitting it to patients. However, despite flu campaigns and vaccination promotion, uptake remains low. The aim of this study was to investigate staff attitudes to flu vaccination to see how this may influence their decision to be vaccinated. METHODS: An online survey was sent to staff members across 6 NHS trusts, asking if staff had been vaccinated in the preceding flu season (2013-2014); the survey included questions about beliefs and attitudes to the vaccination, scored on a 5-point Likert scale. RESULTS: 3059 NHS staff members responded to the survey (86% in the 26-59 age group, 77% female and 84% hospital based). 68% of respondents reported being vaccinated in the preceding year. Using a stepwise regression model, the survey response retained as a positive predictor of having been vaccinated was people working in healthcare should have the flu vaccination every year (p<0.001), and the responses retained as negative predictors were the flu vaccination will make me unwell (p<0.001) and the flu vaccination was too much trouble for me (p<0.001). Analysis by staff group showed a significant difference in the response to the flu vaccination will make me unwell between groups (p=0.01), with doctors having a greater tendency to disagree with this statement than other staff members. CONCLUSIONS: These results suggest that addressing NHS staff beliefs around the need for vaccination, while ensuring that practical barriers to having the vaccination are removed, may help to increase uptake. An emphasis on alleviating the concerns of particular staff groups regarding adverse effects of the vaccine may also be of benefit in improving uptake, to protect patients as well as staff