Helen E Davies

Cardiff and Vale University Health Board | UHW · Department of Respiratory Medicine

Background Over 30% of adult patients with pleural infection either die and/or require surgery. There is no robust means of predicting at baseline presentation which patients will suffer a poor clinical outcome. A validated risk prediction score would allow early identification of high-risk patients, potentially directing more aggressive treatment...

Importance Malignant pleural effusion (MPE) is challenging to manage. Talc pleurodesis is a common and effective treatment. There are no reliable data, however, regarding the optimal method for talc delivery, leading to differences in practice and recommendations. Objective To test the hypothesis that administration of talc poudrage during thoraco...

Introduction Clinician‐rated performance status (C‐PS) is used routinely to predict whether patients are fit enough to undergo treatment for lung cancer. However, a good proportion of those with seemingly good C‐PS do not go on to receive, let alone complete treatment. The value of C‐PS in accurately predicting this is unclear, as is the merit of e...

Introduction Malignant pleural effusions (MPE) are associated with poor prognosis, with a median survival of 6 months. However, there is a wide variation in survival. Predicting prognosis is important in determining treatment. In heart failure and idiopathic pulmonary disease, breathlessness is associated with poor prognosis. Objective To determin...

A 65‐year‐old man was referred to the respiratory unit for evaluation of a left lower‐zone opacity noted on a chest radiograph. On review, he appeared well and denied any respiratory symptoms. Physical examination was normal. A thoracic computed tomogram (CT) revealed widespread pleural nodularity with fissural and diaphragmatic involvement and pro...

Introduction: The presence of muscle mass depletion is associated with poor outcomes and survival in cancer. Alongside muscle mass, assessment of muscle strength or physical performance is essential for the diagnosis of sarcopenia. Non-small cell lung cancer (NSCLC) is a prevalent form of cancer with high mortality, and Eastern Cooperative Oncolog...

Introduction TIME3, a randomised controlled trial of intrapleural urokinase versus placebo for patients with non-draining malignant pleural effusion (MPE), demonstrated that these patients appear to be a distinct subgroup of patients with a poor prognosis (median survival 58 days). The aim of this study was to identify patient and fluid characteris...

Rationale: Patients with malignant pleural effusion (MPE) experience breathlessness, which is treated by drainage and pleurodesis. Incomplete drainage results in residual dyspnea and pleurodesis failure. Intrapleural fibrinolytics lyse septations within pleural fluid, improving drainage. Objectives: To assess the effects of intrapleural urokinas...

Introduction: Management of symptomatic malignant pleural effusions is becoming more complex due to the range of treatment options, which include therapeutic thoracenteses, thoracoscopic talc pleurodesis, bedside pleurodesis with talc or other sclerosing agents via small-bore chest catheters, indwelling pleural catheters, surgery, or a combination...

Background and objective: Malignant pleural effusion is associated with morbidity and mortality. A randomized controlled trial previously compared clinical outcomes and resource use with indwelling pleural catheter (IPC) and talc pleurodesis in this population. Using unpublished quality of life data, we estimate the cost-effectiveness of IPC compa...

Importance For treatment of malignant pleural effusion, nonsteroidal anti-inflammatory drugs (NSAIDs) are avoided because they may reduce pleurodesis efficacy. Smaller chest tubes may be less painful than larger tubes, but efficacy in pleurodesis has not been proven.Objective To assess the effect of chest tube size and analgesia (NSAIDs vs opiate...

Background Optimal management of pleurodesis for malignant pleural effusion (MPE) has not been defined either in terms of optimal analgesia or chest tube size. Non-steroidal anti-inflammatory drugs (NSAID) are highly effective analgesics, but are avoided in pleurodesis as they may reduce pleurodesis efficacy. Smaller (<14 French) chest tubes may be...

BACKGROUND: Non-small cell lung cancer (NSCLC) frequently presents in advanced stages. A significant proportion of those with reportedly good ECOG performance status (PS) fail to receive planned multidisciplinary team (MDT) treatment, often for functional reasons, but an objective decline in physical performance is not well described. Sarcopenia, o...

Indwelling pleural catheters (IPCs) are increasingly used in clinical practice. They are often accepted as a first-line treatment option for patients with malignant pleural effusion. IPCs are inserted as a day case and afford patients autonomous relief of symptoms in the outpatient setting. They also offer scope for ongoing study, monitoring and tr...

Introduction The management of recurrent malignant pleural effusions (MPE) can be challenging. Various options are available, with the most efficacious and widely used being talc pleurodesis. Talc can either be applied via a chest drain in the form of slurry, or at medical thoracoscopy using poudrage. Current evidence regarding which method is most...

The approach to management of malignant pleural effusions (MPE) has changed over the past few decades. The key goals of MPE management are to relieve patient symptoms using the least invasive means and in the most cost-effective manner. There is now a realization that patient-reported outcome measures should be the primary goal of MPE treatment, an...

Background: Malignant pleural effusion is associated with short life expectancy and significant morbidity. A randomized controlled trial comparing indwelling pleural catheters (IPCs) with talc pleurodesis found that IPCs reduced in-hospital time and the need for additional procedures but were associated with excess adverse events. Methods: Using...

Background The TIME2 Trial[1], a randomised clinical trial comparing indwelling pleural catheter (IPC) with talc pleurodesis for malignant pleural effusion, included a prospective economic analysis. Methods 106 patients at 7 UK medical centres were randomly assigned to IPC or talc pleurodesis following chest drain insertion and followed at biweekly...

Purpose of review: Malignant pleural effusion (MPE) is common. However, regardless of the differences between patients, their underlying cancer type, and pleural fluid characteristics, management options are often limited. These have not advanced significantly over the last 80 years since pleurodesis was first described. Correspondingly, patient-r...

Introduction Drainage of infection pleural fluid is essential in improving patient outcomes. The MIST-2 Trial (NEJM 2011) demonstrated intrapleural tissue plasminogen activator (t-PA) and DNase therapy improves drainage in patients with pleural infection from Day 1 to 7 compared to placebo. However, there is no evidence assessing whether this diffe...

Malignant pleural effusion causes disabling dyspnea in patients with a short life expectancy. Palliation is achieved by fluid drainage, but the most effective first-line method has not been determined. To determine whether indwelling pleural catheters (IPCs) are more effective than chest tube and talc slurry pleurodesis (talc) at relieving dyspnea....

More than 30% of patients with pleural infection either die or require surgery. Drainage of infected fluid is key to successful treatment, but intrapleural fibrinolytic therapy did not improve outcomes in an earlier, large, randomized trial. We conducted a blinded, 2-by-2 factorial trial in which 210 patients with pleural infection were randomly as...

The histological finding of pleural inflammation (pleuritis/fibrosis) is frequently found in pleural biopsies taken at thoracoscopy. This is a nonspecific finding, representing a common endpoint of many pleural conditions. Additional features, such as malignant cells, caseating granulomas and evidence of vasculitis, are required to make an aetiolog...

Pleural disease is common. Traditionally, many patients were subjected to surgery for diagnosis and treatment. Most pleural surgical procedures have not been subjected to high-quality clinical appraisal and their use is based on anecdotal series with selection bias. The evidence (or the lack) of benefits of surgery in common pleural conditions is r...

Pleural infection is common, and has a >30% major morbidity and mortality-particularly when infection is caused by Gram-negative, Staphylococcus aureus or mixed aerobic pathogens. Standard pleural fluid culture is negative in ∼40% of cases. Culturing pleural fluid in blood culture bottles may increase microbial yield, and is cheap and easy to perfo...

#### Summary points Since the 1970s, when computed tomography was introduced into clinical practice, the array of imaging tests that expose patients to radiation has vastly increased. This is a result of improved computed tomography techniques, advances in other techniques such as digital subtraction angiography, and the development of modalities...

Malignant pleural effusion (MPE) is increasing in prevalence and is associated with significant patient morbidity. The evaluation of patients with suspected MPE, and their management can be challenging. This review provides a general overview of the diagnostic strategies available and discusses in detail the palliative therapeutic approaches which...

Weaning is a stressful period for piglets and is associated with gastrointestinal disruption and increased disease susceptibility. This study investigated the influence of probiotics on gut health in young pigs and focused on 1) animal production values, 2) microbiology, 3) gut architecture, mucosal cell distribution and mucus secretion and 4) modu...

A 40-year-old accountant, recently moved into the area, presented with a 3-month history of cough and, over the previous month, dyspnoea on exercise. Initially antibiotics seemed to help, although repeated sputum cultures were negative. Whilst skiing at 3000m, he developed severe dyspnoea, which greatly curtailed his physical activity. On his retur...

A previously fit and well 23-year-old banker was admitted on the acute medical take with an 8-week history of progressive exertional breathlessness, worse over the preceding 3 days. He also reported a brief episode of central pleuritic chest pain on the day of admission.

A 29-year-old lawyer, 16 weeks pregnant, presented with cough, wheeze and dyspnoea on exertion; she had also required antibiotics for repeated chest infections and lost 15kg in weight since her previous pregnancy 2 years previously. At that time she had been diagnosed with asthma when she also had shortness of breath. This had responded well to sal...

A 26-year-old man presented to the dermatologists with a 5-month history of a painless and non-itchy infiltrate in the red areas of a forearm tattoo. In addition, he noticed some small lumps that appeared on the elbow and outer arm above the tattoo. He had noticed some mild arthralgia over the last 3 months. There was no relevant past medical histo...

Based around the curriculum for specialist trainees in respiratory medicine, this book contains 44 well-structured, peer-reviewed cases gathered from the Oxford Hospitals, comprehensively covering the various disorders of the respiratory system.