BACKGROUND:Interstitial lung abnormalities (ILAs) are common incidental findings in lung cancer screening (LCS). However, challenges remain in identifying clinically relevant ILAs as highlighted in a joint statement by a European multidisciplinary task force led by the European Respiratory Society (ERS). To address these challenges, we analysed ILAs identified in one of Europe's largest LCS studies. METHODS:Of 11 635 LCS individuals, 417 screen-detected ILAs were evaluated using a new visual classification system focused on traction bronchiolectasis: non-fibrotic ILA (no traction bronchiolectasis), fibrotic ILA (traction bronchiolectasis in ≤2 lobes); undiagnosed interstitial lung disease (traction bronchiolectasis in >2 lobes). Observer agreement was compared with Fleischner Society ILA classification using Cohen's Kappa. An age, sex and smoking history-matched control group allowed the examination of associations between baseline ILA/UILD and comorbidities, forced vital capacity (FVC), hospitalisations (Student's t-tests) and mortality (univariable and multivariable Cox proportional hazards models). FINDINGS:Our visual ILA classification showed superior interobserver agreement (K=0.76) versus the Fleischner ILA classification (K=0.64). ILA/UILD subjects had more prevalent comorbidities, increasing (vs controls) approximately 10 years prior to ILA/UILD diagnosis. Compared with controls, mortality rates were 6-fold higher for UILD participants and 3-fold higher for fibrotic and non-fibrotic ILA subtypes. On multivariable Cox regression analysis, ILA/UILD presence (HR=4.90, 95% CI =2.36 to 10.10, p<0.001) showed stronger independent associations with mortality than baseline FVC (HR=0.98, 95% CI =0.96 to 1.00, p=0.04). CONCLUSION:We demonstrate a new reproducible classification of clinically important ILA/UILDs in LCS populations. We highlight that FVC shows limited associations with mortality in ILA/UILD subjects. Increased multiorgan comorbidity in ILA/UILD subjects highlights a need for comprehensive early multisystem evaluation.

Background: The COVID-19 pandemic has required redeployment of staff from their usual place of work. Ongoing clinical pressures from COVID-19 have meant that within our hospitals many clinicians have been redeployed to medical wards and intensive care. Prior to redeployment significant anxiety was identified around the process and expectations. Methodology: An upskilling training programme was conceived and offered to all doctors being redeployed both to medical specialties and intensive care. This covered basic management of COVID-19 and ventilatory support with further drop-in sessions on HFNO and CPAP. Results: From November 2020–February 2021 8 half day upskilling sessions were run, attended by 45 participants of all grades. 6 drop-in sessions on HFNO/CPAP were attended by over 30 participants including nurses, medical students and doctors. Figure 1 demonstrates the feedback from these sessions, indicating that 90% of participants found them useful or extremely useful. Discussion: This was a timely and well received course that highlights the importance of training prior to redeployment. Given the unpredictable nature of pandemic planning there is a need for education that can be adapted to staff needs, these sessions were adapted based upon feedback and the needs of those who attended. The provision of education and training to redeployed staff can help to reduce anxiety about working in a new clinical area.