Poster sessionsThorax 2012;67(Suppl 2):A1-A204 A113 may lead to fewer cases of consent being withdrawn from family. A lower threshold for attending donors who might not meet criteria may also yield more organs.Abstract P116 Figure 1 Flow diagram of all lung offers and outcomes

Introduction and Objectives Multi-drug resistant tuberculosis (MDR-TB) is a growing concern 1. Cost of treatment is ten times that of fully sensitive TB. Treatment regimens are complex and prolonged with risk of serious adverse drug reactions (ADRs). Previously no single guidance in the UK has been available to inform clinicians on what baseline testing should be performed and how to monitor for ADRs 2. We would like to introduce the first UK guideline for adverse-effect monitoring in MDR-TB. Methods This document has been written using the best available evidence and, where this is limited, expert consensus. Our multidisciplinary guideline group held regular teleconferences and corresponded by email. When evidence was sparse, expert consensus was sought from the British Thoracic Society TB Special Advisory Group (SAG) and UK MDR-TB Advisory Service. When other specialty input was needed this was sought from experts in that field. Once the guideline was developed it was submitted to the TB SAG for peer review. Results 'MDR-TB: A guideline for treatment monitoring' includes direction on baseline and generic monitoring throughout treatment and individual drug monographs for all drugs currently used to treat MDR-TB in the UK. At the time of writing it is due to be published online, later this month, and will be available on the BTS website (www.brit-thoracic.org.uk). Conclusions We hope that by introducing a guideline to aid ADR monitoring in MDR-TB treatment we can improve morbidity and mortality and reduce treatment costs. By the time of the BTS Winter Meeting we will have nearly six months experience of this guideline being used in practice and will present any feedback received. In due course we plan to audit its use and publish our experiences.

in handling the thoracoscopy equipment and IPC insertion (figure 1). 100% of consultants agreed that the course was mapped to the respiratory curriculum requirements and that the content was appropriate for ST5 trainees. 100% of consultant faculty also agreed that the course structure was adequate; the lectures were delivered at an appropriate level and were happy for the course to be run on a yearly basis. Candidate feedback was positive and indicated that the course would be a useful addition to the training programme. Introduction and Objectives Last year we presented data highlighting the on-going role for Abrams pleural biopsy in areas with high tuberculosis incidence (1). Feedback reiterated ongoing need, but highlighted concerns regarding the attainment of trainee competence at this infrequently performed procedure. We organised and evaluated a half day training course using a well validated porcine-resin model at a regional registrar training day (2). Methods All attendees (18) underwent a practical training session on pleural biopsy using Abrams and Tru-Cut biopsy needles. Feedback forms were completed and perceived success documented, all samples obtained underwent histological assessment by a specialist respiratory Consultant Histopathologist. Results Previous experience was limited (median 0.5 prior biopsies performed, range 0-50). On Likert scales (range 1-5) mean confidence improved (1.86, SD 1.21 to 3.83, SD 0.51; p < 0.0001) and the session was deemed useful (mean score 4.5, SD 0.4) with 13/14 (92.9%) trainees who answered stating the session would change their practice. A mean of 4.56 samples (SD 1.42) were obtained per trainee. Sixty-nine of seventy-six samples (90.8%) were perceived to have been successful by the operator, microscopic evidence of mesothelial lined pleura was obtained in nine samples (11.8%) with connective tissue suggestive of possible pleura obtained in a further 25 (33%) (k = 0.013; poor correlation); real time observation by a training partner suggested a 91.9% success rate (k = 0.584; moderate correlation). There was no increase in accuracy with increased sampling. Despite encouragement only four participants attempted the Tru-Cut method. Conclusions The session was popular and significantly improved trainee confidence. However, histological biopsy success rate and macroscopic correlation was poor. This is most likely related to difficulty in biopsying non-diseased pleura and possibly differences between macroscopic appearances of porcine and human pleura or inexperienced trainees' inability to recognise pleura macroscopically. Experience was low even in a high-incidence region, suggesting simulated pleural biopsy training may be a useful adjunct. Conclusion

time of TB diagnosis. Values at the two time points were compared using Student's paired t-tests. Results Thirty-one participants were followed up between August 2012 and February 2013. Serum 25(OH)D concentrations were significantly higher post-recovery than at diagnosis (mean 29.7 vs. 12 Strain typing of tuberculosis (TB) isolates by 24 loci mycobacterial interspersed repetitive unit-variable number tandem repeats (MIRU-VNTRs) is now a routine laboratory tool for TB control, but its utility in informing contact tracing and public health action has not been well reported in the United Kingdom. Since November 2011 we have routinely held typing meetings and undertaken cluster investigation. Over 18 months, 68 clusters were discussed. Fifty-five (81%) clusters were small (2-5 patients), 7 (10%) were medium (6-14 patients) and 6 (9%) were large (>15 patients, median = 42, IQR = 26-52). Enhanced epidemiological investigation was undertaken in 27/68 (40%) clusters. Typing meetings alone readily identified 20 definite epidemiological links between 46/458 (10%) cases. In 15 cases, 9 definite or probable links were not supported by genotyping, leading to expanded screening in one workplace. 112 extended interviews were done. A further 23 definite links between 77 (17%) cases, 2 probable links between 5 (1%) cases and 24 possible links between 72 (16%) cases were found. Expanded screening as a direct result of strain typing and cluster investigation occurred in 4/6 settings where non-household transmission was identified (a factory, 2 places of worship, a hospital, a hostel and a pub). An additional 124 contacts were identified. 65 attended screening, 21 latent TB cases were treated and 1 active TB case was found. Routine incorporation of strain typing data in contact tracing improves diagnosis of latent and active infection but requires investment in data management systems and human resource for enhanced epidemiological investigation.