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Hussain H, McKeever TM, Gonem S. Asthma outcomes, inhaled corticosteroid adherence and socio-economic deprivation in English regions. Clin Exp Allergy 2024. [PMID: 38494591 DOI: 10.1111/cea.14474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Haania Hussain
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sherif Gonem
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Middleton S, Chalitsios CV, Mungale T, Hassanein ZM, Jenkins AR, Bolton CE, McKeever TM. Functional Recovery of Adults Following Acute COVID-19: A Systematic Review and Meta-Analysis. Phys Ther 2024:pzae023. [PMID: 38386981 DOI: 10.1093/ptj/pzae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/29/2023] [Accepted: 02/19/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to investigate the objective, functional recovery of patients more than 3 months after acute COVID-19 infection. METHODS Comprehensive database searches of EMBASE, PubMed/MEDLINE, Cochrane COVID-19 Study Register, CINAHL, and Google Scholar in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were carried out until October 19, 2022. Data were extracted and agreed in duplicate. Data were narratively synthesized, and a series of meta-analyses were performed using the random-effects inverse variance method. RESULTS One-hundred six papers covering 20,063 patients who were either hospitalized or not hospitalized with acute COVID-19 who were followed-up between 3 to 24 months were included. Percentage predicted 6-minute walk distance at 3 months to <5 months was 84.3% (95% CI = 79.2-89.3; n = 21; I2 = 98.3%) and 92.5% (95% CI = 89.8-95.3; n = 9; I2 = 94.5%) at ≥11 months. Cardiopulmonary exercise testing revealed percentage predicted peak oxygen consumption rate ($peak\dot{\mathrm{V}}{\mathrm{o}}_2$) at 3 months to <5 months was 77.3% (95% CI = 71.0-83.7; n = 6; I2 = 92.3%) and 95.4% (95% CI = 87.1-103.6; n = 2; I2 = 77.3%) at ≥11 months. Mean handgrip strength was greatest at ≥11 months at 31.16 kg (95% CI = 19.89-42.43; n = 2; I2 = 98.3%) of all time points. All analyses showed marked heterogeneity. CONCLUSION Patients have reduced physical function more than 3 months after COVID-19 infection. Better physical function in multiple physical domains is found after a longer recovery time. IMPACT Physical function as measured by the 6-minute walk test, hand grip strength, and cardiopulmonary exercise testing is reduced at 3 months after COVID-19 infection and can remain over 11 months of follow-up. This protracted recovery following acute COVID-19 infection supports the need to assess physical function at any clinical follow-up, and further research into rehabilitation programs and intervention for patients who have not recovered.
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Affiliation(s)
- Sophie Middleton
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Dept. of Respiratory Medicine, City Hospital, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Christos V Chalitsios
- Nottingham Centre for Epidemiology and Public Health, Lifespan and population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tanvi Mungale
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Zeinab M Hassanein
- Nottingham Centre for Epidemiology and Public Health, Lifespan and population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alex R Jenkins
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Charlotte E Bolton
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Dept. of Respiratory Medicine, City Hospital, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Tricia M McKeever
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Nottingham Centre for Epidemiology and Public Health, Lifespan and population Health, School of Medicine, University of Nottingham, Nottingham, UK
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Chalitsios CV, Luney MS, Lindsay WA, Sanders RD, McKeever TM, Moppett I. Risk of Mortality Following Surgery in Patients With a Previous Cardiovascular Event. JAMA Surg 2024; 159:140-149. [PMID: 37991772 PMCID: PMC10867684 DOI: 10.1001/jamasurg.2023.5951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/26/2023] [Indexed: 11/23/2023]
Abstract
Importance There is a lack of consensus regarding the interval of time-dependent postoperative mortality risk following acute coronary syndrome or stroke. Objective To determine the magnitude and duration of risk associated with the time interval between a preoperative cardiovascular event and 30-day postoperative mortality. Design, Setting, and Participants This is a longitudinal retrospective population-based cohort study. This study linked data from the Hospital Episode Statistics for National Health Service England, Myocardial Ischaemia National Audit Project and the Office for National Statistics mortality registry. All adults undergoing a National Health Service-funded noncardiac, nonneurologic surgery in England between April 1, 2007, and March 31, 2018, registered in Hospital Episode Statistics Admitted Patient Care were included. Data were analyzed from July 2021 to July 2022. Exposure The time interval between a previous cardiovascular event (acute coronary syndrome or stroke) and surgery. Main Outcomes and Measures The primary outcome was 30-day all-cause mortality. Secondary outcomes were postoperative mortality at 60, 90, and 365 days. Multivariable logistic regression models with restricted cubic splines were used to estimate adjusted odds ratios. Results There were 877 430 patients with and 20 582 717 without a prior cardiovascular event (overall mean [SD] age, 53.4 [19.4] years; 11 577 157 [54%] female). Among patients with a previous cardiovascular event, the time interval associated with increased risk of postoperative mortality was surgery within 11.3 months (95% CI, 10.8-11.7), with subgroup risks of 14.2 months before elective surgery (95% CI, 13.3-15.3) and 7.3 months for emergency surgery (95% CI, 6.8-7.8). Heterogeneity in these timings was noted across many surgical specialties. The time-dependent risk intervals following stroke and myocardial infarction were similar, but the absolute risk was greater following a stroke. Regarding surgical urgency, the risk of 30-day mortality was higher in those with a prior cardiovascular event for emergency surgery (adjusted hazard ratio, 1.35; 95% CI, 1.34-1.37) and an elective procedure (adjusted hazard ratio, 1.83; 95% CI, 1.78-1.89) than those without a prior cardiovascular event. Conclusions and Relevance In this study, surgery within 1 year of an acute coronary syndrome or stroke was associated with increased postoperative mortality before reaching a new baseline, particularly for elective surgery. This information may help clinicians and patients balance deferring the potential benefits of the surgery against the desire to avoid increased mortality from overly expeditious surgery after a recent cardiovascular event.
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Affiliation(s)
- Christos V. Chalitsios
- Academic Unit of Lifespan and Population Health, University of Nottingham, Nottingham, United Kingdom
| | - Matthew S. Luney
- Anaesthesia and Critical Care Section, Academic Unit of Injury, Inflammation and Repair, Queen’s Medical Centre, University of Nottingham, Nottingham, United Kingdom
- Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - William A. Lindsay
- Anaesthesia and Critical Care Section, Academic Unit of Injury, Inflammation and Repair, Queen’s Medical Centre, University of Nottingham, Nottingham, United Kingdom
- Department of Anaesthesia, Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
| | - Robert D. Sanders
- Speciality of Anaesthetics, Central Clinical School, & National Health and Medical Research Council Clinical Trials Centre, University of Sydney
- Department of Anaesthesia & Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Tricia M. McKeever
- Academic Unit of Lifespan and Population Health, University of Nottingham, Nottingham, United Kingdom
| | - Iain Moppett
- Anaesthesia and Critical Care Section, Academic Unit of Injury, Inflammation and Repair, Queen’s Medical Centre, University of Nottingham, Nottingham, United Kingdom
- Department of Anaesthesia, Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
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Lansbury L, Lawrence H, McKeever TM, French N, Aston S, Hill AT, Pick H, Baskaran V, Edwards-Pritchard RC, Bendall L, Ashton D, Butler J, Daniel P, Bewick T, Rodrigo C, Litt D, Eletu S, Sheppard CL, Fry NK, Ladhani S, Trotter C, Lim WS. Pneumococcal serotypes and risk factors in adult community-acquired pneumonia 2018-20; a multicentre UK cohort study. Lancet Reg Health Eur 2024; 37:100812. [PMID: 38170136 PMCID: PMC10758948 DOI: 10.1016/j.lanepe.2023.100812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
Background Higher-valency pneumococcal vaccines are anticipated. We aimed to describe serotype distribution and risk factors for vaccine-serotype community-acquired pneumonia (CAP) in the two years pre-SARS-CoV-2 pandemic. Methods We conducted a prospective cohort study of adults hospitalised with CAP at three UK sites between 2018 and 2020. Pneumococcal serotypes were identified using a 24-valent urinary-antigen assay and blood cultures. Risk factors associated with vaccine-type pneumonia caused by serotypes in the 13-, 15- and 20-valent pneumococcal conjugate vaccines (PCV13, PCV15, PCV20) and 23-valent pneumococcal polysaccharide vaccine (PPV23) were determined from multivariable analysis. Findings Of 1921 adults hospitalised with CAP, 781 (40.7%, 95% confidence intervals (CI) 38.5-42.9%) had pneumococcal pneumonia. A single PCV13-serotype was detected in 242 (31.0%, 95% CI 27.8-34.3%) pneumococcal CAP patients, mostly serotype 3 (171/242, 70.7%, 95% CI 64.5-76.0%). The additional two PCV15-serotypes were detected in 31 patients (4%, 95% CI 2.8-5.6%), and PCV20-non13-serotypes in 192 (24.6%), with serotype 8 most prevalent (123/192, 64.1%, 95% CI 57.1-70.5%). Compared to PCV13-serotype CAP, people with PCV20-non13 CAP were younger (median age 62 versus 72 years, p < 0.001) and less likely to be male (44% versus 61%, p = 0.01). PPV23-non13-serotypes were found in 252 (32.3%, 95% CI 29.1-35.6%) pneumococcal CAP patients. Interpretation Despite mature infant pneumococcal programmes, the burden of PCV13-serotype pneumonia remains high in older adults, mainly due to serotype 3. PCV20-non13-serotype pneumonia is more likely in younger people with fewer pneumococcal risk factors. Funding Unrestricted investigator-initiated research grant from Pfizer, United Kingdom; support from National Institute for Health Research (NIHR) Biomedical Research Centre, Nottingham.
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Affiliation(s)
- Louise Lansbury
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK
| | - Hannah Lawrence
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK
| | - Tricia M. McKeever
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK
| | - Neil French
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Institute of Infection Veterinary & Ecological Science, University of Liverpool, UK
| | - Stephen Aston
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Adam T. Hill
- Centre for Inflammation Research, University of Edinburgh, UK
| | - Harry Pick
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Vadsala Baskaran
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK
| | - Rochelle C. Edwards-Pritchard
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK
| | - Lesley Bendall
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK
| | - Deborah Ashton
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK
| | - Jo Butler
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Priya Daniel
- Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Thomas Bewick
- Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Chamira Rodrigo
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - David Litt
- Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, Colindale, UK
| | - Seyi Eletu
- Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, Colindale, UK
| | - Carmen L. Sheppard
- Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, Colindale, UK
| | - Norman K. Fry
- Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, Colindale, UK
- Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, Colindale, UK
| | - Shamez Ladhani
- Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, Colindale, UK
| | - Caroline Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Wei Shen Lim
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Gonem S, Lemberger J, Baguneid A, Briggs S, McKeever TM, Shaw D. Real-world implementation of the National Early Warning Score-2 in an acute respiratory unit. BMJ Open Respir Res 2024; 11:e002095. [PMID: 38296608 PMCID: PMC10831462 DOI: 10.1136/bmjresp-2023-002095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION The National Early Warning Score-2 (NEWS-2) is used to detect deteriorating patients in hospital settings. We aimed to understand how NEWS-2 functions in the real-life setting of an acute respiratory unit. METHODS Clinical observations data were extracted for adult patients (age ≥18 years), admitted under the care of respiratory medicine services from July to December 2019, who had at least one recorded task relating to clinical deterioration. The timing and nature of urgent out-of-hours medical reviews (escalations) were extracted through manual review of the case notes. RESULTS The data set comprised 765 admission episodes (48.9% women) with a mean (SD) age of 69.3 (14.8). 8971 out of 35 991 out-of-hours observation sets (24.9%) had a NEWS-2 ≥5, and 586 of these (6.5%) led to an escalation. Out of 687 escalations, 101 (14.7%) were associated with observation sets with NEWS-2<5. Rising oxygen requirement and extreme values of individual observations were associated with an increased risk of escalation. 57.6% of escalations resulted in a change in treatment. Inpatient mortality was higher in patients who were escalated at least once, compared with those who were not escalated. CONCLUSIONS Most observation sets with NEWS-2 scores ≥5 did not lead to a medical escalation in an acute respiratory setting out-of-hours, but more than half of escalations resulted in a change in treatment. Rising oxygen requirement is a key indicator of respiratory patient acuity which appears to influence the decision to request urgent out-of-hours medical reviews.
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Affiliation(s)
- Sherif Gonem
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Joseph Lemberger
- Department of Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Abdulla Baguneid
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Steve Briggs
- Digital and Information, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tricia M McKeever
- Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Dominick Shaw
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
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O'Dowd E, Berovic M, Callister M, Chalitsios CV, Chopra D, Das I, Draper A, Garner JL, Gleeson F, Janes S, Kennedy M, Lee R, Mauri F, McKeever TM, McNulty W, Murray J, Nair A, Park J, Rawlinson J, Sagoo GS, Scarsbrook A, Shah P, Sudhir R, Talwar A, Thakrar R, Watkins J, Baldwin DR. Determining the impact of an artificial intelligence tool on the management of pulmonary nodules detected incidentally on CT (DOLCE) study protocol: a prospective, non-interventional multicentre UK study. BMJ Open 2024; 14:e077747. [PMID: 38176863 PMCID: PMC10773382 DOI: 10.1136/bmjopen-2023-077747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/28/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION In a small percentage of patients, pulmonary nodules found on CT scans are early lung cancers. Lung cancer detected at an early stage has a much better prognosis. The British Thoracic Society guideline on managing pulmonary nodules recommends using multivariable malignancy risk prediction models to assist in management. While these guidelines seem to be effective in clinical practice, recent data suggest that artificial intelligence (AI)-based malignant-nodule prediction solutions might outperform existing models. METHODS AND ANALYSIS This study is a prospective, observational multicentre study to assess the clinical utility of an AI-assisted CT-based lung cancer prediction tool (LCP) for managing incidental solid and part solid pulmonary nodule patients vs standard care. Two thousand patients will be recruited from 12 different UK hospitals. The primary outcome is the difference between standard care and LCP-guided care in terms of the rate of benign nodules and patients with cancer discharged straight after the assessment of the baseline CT scan. Secondary outcomes investigate adherence to clinical guidelines, other measures of changes to clinical management, patient outcomes and cost-effectiveness. ETHICS AND DISSEMINATION This study has been reviewed and given a favourable opinion by the South Central-Oxford C Research Ethics Committee in UK (REC reference number: 22/SC/0142).Study results will be available publicly following peer-reviewed publication in open-access journals. A patient and public involvement group workshop is planned before the study results are available to discuss best methods to disseminate the results. Study results will also be fed back to participating organisations to inform training and procurement activities. TRIAL REGISTRATION NUMBER NCT05389774.
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Affiliation(s)
- Emma O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK emma.o'
| | - Marko Berovic
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Indrajeet Das
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Adrian Draper
- Respiratory Medicine, St George's Hospital, London, UK
| | | | - Fergus Gleeson
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sam Janes
- University College London, London, UK
| | | | - Richard Lee
- Royal Marsden Hospital NHS Trust, London, UK
| | | | | | | | - James Murray
- Royal Free London NHS Foundation Trust, London, UK
| | | | - John Park
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Janette Rawlinson
- Consumer Forum, NCRI CSG (lung) Subgroup, BTOG Steering Committee, NHSE CEG, National Cancer Research Institute, London, UK
| | - Gurdeep Singh Sagoo
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
| | | | - Pallav Shah
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Rajini Sudhir
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ambika Talwar
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ricky Thakrar
- University College London Hospitals NHS Foundation Trust, London, UK
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Siraj RA, Bolton CE, McKeever TM. Association between antidepressants with pneumonia and exacerbation in patients with COPD: a self-controlled case series (SCCS). Thorax 2023; 79:50-57. [PMID: 37336642 DOI: 10.1136/thorax-2022-219736] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/26/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To assess whether antidepressant prescriptions are associated with an increased risk of pneumonia and chronic obstructive pulmonary disease (COPD) exacerbation. METHODS A self-controlled case series was performed to investigate the rates of pneumonia and COPD exacerbation during periods of being exposed to antidepressants compared with non-exposed periods. Patients with COPD with pneumonia or COPD exacerbation and at least one prescription of antidepressant were ascertained from The Health Improvement Network in the UK. Incidence rate ratios (IRR) and 95% CI were calculated for both outcomes. RESULTS Of 31 253 patients with COPD with at least one antidepressant prescription, 1969 patients had pneumonia and 18 483 had a COPD exacerbation. The 90-day risk period following antidepressant prescription was associated with a 79% increased risk of pneumonia (age-adjusted IRR 1.79, 95% CI 1.54 to 2.07). These associations then disappeared once antidepressants were discontinued. There was a 16% (age-adjusted IRR 1.16, 95% CI 1.13 to 1.20) increased risk of COPD exacerbation within the 90 days following antidepressant prescription. This risk persisted and slightly increased in the remainder period ((age-adjusted IRR 1.38, 95% CI 1.34 to 1.41), but diminished after patients discounted the treatment. CONCLUSION Antidepressants were associated with an increased risk of both pneumonia and exacerbation in patients with COPD, with the risks diminished on stopping the treatment. These findings suggest a close monitoring of antidepressant prescription side effects and consideration of non-pharmacological interventions.
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Affiliation(s)
- Rayan A Siraj
- Department of Respiratory Care, King Faisal University, Al-Ahasa, Saudi Arabia
- Respiratory Medicine, NIHR Nottingham Biomedical Research Centre Respiratory Theme, University of Nottingham, Nottingham, UK
| | - Charlotte E Bolton
- Respiratory Medicine, NIHR Nottingham Biomedical Research Centre Respiratory Theme, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- NIHR Nottingham Biomedical Research Centre Respiratory Theme, School of Medince, University of Nottingham, Nottingham, UK
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Lawrence H, McKeever TM, Lim WS. Readmission following hospital admission for community-acquired pneumonia in England. Thorax 2023; 78:1254-1261. [PMID: 37524392 DOI: 10.1136/thorax-2022-219925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/28/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Readmission rates following hospital admission with community-acquired pneumonia (CAP) have increased in the UK over the past decade. The aim of this work was to describe the cohort of patients with emergency 30-day readmission following hospitalisation for CAP in England and explore the reasons for this. METHODS A retrospective analysis of cases from the British Thoracic Society national adult CAP audit admitted to hospitals in England with CAP between 1 December 2018 and 31 January 2019 was performed. Cases were linked with corresponding patient level data from Hospital Episode statistics, providing data on the primary diagnosis treated during readmission and mortality. Analyses were performed describing the cohort of patients readmitted within 30 days, reasons for readmission and comparing those readmitted and primarily treated for pneumonia with other diagnoses. RESULTS Of 8136 cases who survived an index admission with CAP, 1304 (15.7%) were readmitted as an emergency within 30 days of discharge. The main problems treated on readmission were pneumonia in 516 (39.6%) patients and other respiratory disorders in 284 (21.8%). Readmission with pneumonia compared with all other diagnoses was associated with significant inpatient mortality (15.9% vs 6.5%; aOR 2.76, 95% CI 1.86 to 4.09, p<0.001). A diagnosis of hospital-acquired infection was more frequent in readmissions treated for pneumonia than other diagnoses (22.1% vs 3.9%, p<0.001). CONCLUSION Pneumonia is the most common condition treated on readmission following hospitalisation with CAP and carries a higher mortality than both the index admission or readmission due to other diagnoses. Strategies to reduce readmissions due to pneumonia are required.
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Affiliation(s)
- Hannah Lawrence
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tricia M McKeever
- Academic Unit of Lifespan and Population Health, University of Nottingham, Nottingham, UK
- Nottingham Biomedical Research Centre, Nottingham, UK
| | - Wei Shen Lim
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Nottingham Biomedical Research Centre, Nottingham, UK
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Chalitsios CV, Fogarty AW, McKeever TM, Shaw DE. Sedative medications: an avoidable cause of asthma and COPD exacerbations? Lancet Respir Med 2023; 11:e31-e32. [PMID: 36804029 DOI: 10.1016/s2213-2600(23)00042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/16/2023] [Accepted: 01/27/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Christos V Chalitsios
- Lifespan and Population Health, Nottingham City Hospital, University of Nottingham, Nottingham NG5 1PB, UK; Nottingham NIHR Respiratory Biomedical Research Centre, Nottingham, UK.
| | - Andrew W Fogarty
- Lifespan and Population Health, Nottingham City Hospital, University of Nottingham, Nottingham NG5 1PB, UK; Nottingham NIHR Respiratory Biomedical Research Centre, Nottingham, UK
| | - Tricia M McKeever
- Lifespan and Population Health, Nottingham City Hospital, University of Nottingham, Nottingham NG5 1PB, UK; Nottingham NIHR Respiratory Biomedical Research Centre, Nottingham, UK
| | - Dominick E Shaw
- Nottingham NIHR Respiratory Biomedical Research Centre, Nottingham, UK
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Lawrence H, McKeever TM, Lim WS. Impact of social deprivation on clinical outcomes of adults hospitalised with community-acquired pneumonia in England: a retrospective cohort study. BMJ Open Respir Res 2022; 9:9/1/e001318. [PMID: 36585037 PMCID: PMC9809293 DOI: 10.1136/bmjresp-2022-001318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/18/2022] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Socioeconomic deprivation has been associated with an increased incidence of infection and poorer clinical outcomes during influenza pandemics and the COVID-19 pandemic. The aim of this study was to determine the relationship between deprivation and adverse clinical outcomes following hospital admission with community-acquired pneumonia (CAP), specifically 30-day all-cause mortality and non-elective hospital readmission. METHODS Data from the British Thoracic Society national CAP audit on patients admitted to hospital with CAP in England between 1 December 2018 and 31 January 2019 were linked to patient-level Hospital Episode Statistics data and Index of Multiple Deprivation (IMD) scores. Multivariable logistic regression models were used to examine the association between deprivation and (a) 30-day mortality and (b) 30-day readmission with p values for trend reported. Age was examined as a potential effect modifier on the effect of IMD quintile on mortality and subsequent subanalysis in those <65 and ≥65 years was performed. RESULTS Of 9165 adults admitted with CAP, 24.7% (n=2263) were in the most deprived quintile. No significant trend between deprivation and mortality was observed (p trend=0.38); however, the association between deprivation and mortality differed by age group. In adults aged<65 years, 30-day mortality was highest in the most deprived and lowest in the least deprived quintiles (4.4% vs 2.5%, aOR 1.83, 95% CI 0.84 to 4.0) with a significant trend across groups (p trend=0.04). Thirty-day readmission was highest in the most deprived quintile (17.1%) with a significant p trend across groups (p trend 0.003). Age-adjusted odds of readmission were highest in the most deprived compared with the least deprived (aOR 1.41, 95% CI 1.16 to 1.73). CONCLUSIONS In adults aged<65 years hospitalised with CAP in England, mortality varied inversely with indices of social deprivation. There was also a significant association between deprivation and 30-day readmission. Strategies are required to decrease health inequalities in pneumonia mortality and hospital readmissions associated with deprivation.
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Affiliation(s)
- Hannah Lawrence
- Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tricia M McKeever
- Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK,Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Wei Shen Lim
- Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK,Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
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11
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Forster S, McKeever TM, Shaw D. Effect of implementing the NEWS2 escalation protocol in a large acute NHS trust: a retrospective cohort analysis of mortality, workload and ability of early warning score to predict death within 24 hours. BMJ Open 2022; 12:e064579. [PMID: 36424101 PMCID: PMC9693871 DOI: 10.1136/bmjopen-2022-064579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To describe the inpatient population, establish patterns in admission and mortality over a 4-year period in different cohorts and assess the prognostic ability and workload implications of introducing the National Early Warning Score 2 (NEWS2) and associated escalation protocol. DESIGN Retrospective cohort analyses of medical and surgical inpatient admissions. SETTING Large teaching hospital with tertiary inpatient care and a major trauma centre employing an electronic observations platform, initially with a local early warning score, followed by NEWS2 introduction in June 2019. PARTICIPANTS 332 682 adult patients were admitted between 1 January 2016 and 31 December 2019. OUTCOME MEASURES Mortality, workload and ability of early warning score to predict death within 24 hours. RESULTS Admissions rose by 19% from 76 055 in 2016 to 90 587 in 2019. Total bed days rose by 10% from 433 382 to 477 485. Mortality fell from 3.7% to 3.1% and was significantly lower in patients discharged from a surgical specialty, 1.0%-1.2% (p<0.001). Total observations recorded increased by 14% from 1 976 872 in 2016 to 2 249 118 in 2019. 65% of observations were attributable to patients under medical specialties, 34% to patients under surgical specialties. Recorded escalations to the registrar were stable from January 2016 to May 2019 but trebled following the introduction of NEWS2 in June 2019. CONCLUSIONS There was an increase in hospital inpatient activity between 2016 and 2019, associated with a reduction in mortality and percentage of observations calculated as reaching threshold NEWS2 score of 7 for escalation to the registrar. The introduction of the NEWS2, with a higher sensitivity and lower specificity, when allied to its escalation protocol, was associated with a significant increase in actual recorded escalations to the registrar. This was more marked in the surgical population and would support refining threshold scores based on admission characteristics when developing the next iteration of NEWS.
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Affiliation(s)
- Sarah Forster
- Respiratory Medicine, University of Nottingham School of Medicine, Nottingham, UK
- Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Dominick Shaw
- Respiratory Medicine, University of Nottingham School of Medicine, Nottingham, UK
- Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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12
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Chalitsios CV, Baskaran V, Harwood RH, Lim WS, McKeever TM. Incidence of cognitive impairment and dementia after hospitalisation for pneumonia: a UK population-based matched cohort study. ERJ Open Res 2022; 9:00328-2022. [DOI: 10.1183/23120541.00328-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
BackgroundSurvivors of common infections may develop cognitive impairment or dementia, however; the risk of these conditions in people hospitalised with pneumonia is not well-established.MethodsA matched cohort study was conducted using Hospital Episode Statistics (HES) data linked to Clinical Practice Research Database (CPRD). Adults with the first ICD-10 code for pneumonia recorded in HES between 1 July 2002 and 30 June 2017 were included and up to four controls without hospitalisation for pneumonia in CPRD were matched by gender, age, and practice. Cognitive impairment and dementia incidence rates were calculated, and survival analysis was performed comparing those hospitalised with pneumonia to the general population.ResultsThe incidence rates of cognitive impairment and dementia were 18 (95%CI 17.3 to 18.7) and 13.2 (95%CI 13 to 13.5) per 1000 person-years among persons previously hospitalised with pneumonia and the matched cohort respectively. People previously hospitalised with pneumonia had 53% higher incidence of cognitive impairment and dementia (aHR 1.53; 95% CI 1.46 to 1.61) than their matched cohort. The highest incidence was observed within 1-year of hospitalisation for pneumonia compared to the general population (aHR=1.89; 95%CI 1.75 to 2.05). Age modified the effect of hospitalisation for pneumonia on cognitive impairment and dementia such that the size of effect was stronger in people between 45 and 60 years old (pinteraction<0.0001).ConclusionCognitive impairment and dementia are more likely to be diagnosed in people who have been hospitalised for pneumonia, especially in the first year after discharge, than in the general population.
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13
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Forster S, McKeever TM, Churpek M, Gonem S, Shaw D. Predicting outcome in acute respiratory admissions using patterns of National Early Warning Scores. Clin Med (Lond) 2022; 22:409-415. [PMID: 38589061 PMCID: PMC9595013 DOI: 10.7861/clinmed.2022-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS Accurately predicting risk of patient deterioration is vital. Altered physiology in chronic disease affects the prognostic ability of vital signs based early warning score systems. We aimed to assess the potential of early warning score patterns to improve outcome prediction in patients with respiratory disease. METHODS Patients admitted under respiratory medicine between April 2015 and March 2017 had their National Early Warning Score 2 (NEWS2) calculated retrospectively from vital sign observations. Prediction models (including temporal patterns) were constructed and assessed for ability to predict death within 24 hours using all observations collected not meeting exclusion criteria. The best performing model was tested on a validation cohort of admissions from April 2017 to March 2019. RESULTS The derivation cohort comprised 7,487 admissions and the validation cohort included 8,739 admissions. Adding the maximum score in the preceding 24 hours to the most recently recorded NEWS2 improved area under the receiver operating characteristic curve for death in 24 hours from 0.888 (95% confidence interval (CI) 0.881-0.895) to 0.902 (95% CI 0.895-0.909) in the overall respiratory population. CONCLUSION Combining the most recently recorded score and the maximum NEWS2 score from the preceding 24 hours demonstrated greater accuracy than using snapshot NEWS2. This simple inclusion of a scoring pattern should be considered in future iterations of early warning scoring systems.
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Affiliation(s)
- Sarah Forster
- Nottingham University Hospitals NHS Trust, Nottingham, UK and University of Nottingham School of Medicine, Nottingham, UK.
| | | | - Matthew Churpek
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, USA
| | - Sherif Gonem
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Dominick Shaw
- Nottingham University Hospitals NHS Trust, Nottingham, UK and University of Nottingham School of Medicine, Nottingham, UK
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14
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Gonem S, Taylor A, Figueredo G, Forster S, Quinlan P, Garibaldi JM, McKeever TM, Shaw D. Dynamic early warning scores for predicting clinical deterioration in patients with respiratory disease. Respir Res 2022; 23:203. [PMID: 35953815 PMCID: PMC9367123 DOI: 10.1186/s12931-022-02130-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background The National Early Warning Score-2 (NEWS-2) is used to detect patient deterioration in UK hospitals but fails to take account of the detailed granularity or temporal trends in clinical observations. We used data-driven methods to develop dynamic early warning scores (DEWS) to address these deficiencies, and tested their accuracy in patients with respiratory disease for predicting (1) death or intensive care unit admission, occurring within 24 h (D/ICU), and (2) clinically significant deterioration requiring urgent intervention, occurring within 4 h (CSD). Methods Clinical observations data were extracted from electronic records for 31,590 respiratory in-patient episodes from April 2015 to December 2020 at a large acute NHS Trust. The timing of D/ICU was extracted for all episodes. 1100 in-patient episodes were annotated manually to record the timing of CSD, defined as a specific event requiring a change in treatment. Time series features were entered into logistic regression models to derive DEWS for each of the clinical outcomes. Area under the receiver operating characteristic curve (AUROC) was the primary measure of model accuracy. Results AUROC (95% confidence interval) for predicting D/ICU was 0.857 (0.852–0.862) for NEWS-2 and 0.906 (0.899–0.914) for DEWS in the validation data. AUROC for predicting CSD was 0.829 (0.817–0.842) for NEWS-2 and 0.877 (0.862–0.892) for DEWS. NEWS-2 ≥ 5 had sensitivity of 88.2% and specificity of 54.2% for predicting CSD, while DEWS ≥ 0.021 had higher sensitivity of 93.6% and approximately the same specificity of 54.3% for the same outcome. Using these cut-offs, 315 out of 347 (90.8%) CSD events were detected by both NEWS-2 and DEWS, at the time of the event or within the previous 4 h; 12 (3.5%) were detected by DEWS but not by NEWS-2, while 4 (1.2%) were detected by NEWS-2 but not by DEWS; 16 (4.6%) were not detected by either scoring system. Conclusion We have developed DEWS that display greater accuracy than NEWS-2 for predicting clinical deterioration events in patients with respiratory disease. Prospective validation studies are required to assess whether DEWS can be used to reduce missed deteriorations and false alarms in real-life clinical settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02130-6.
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Affiliation(s)
- Sherif Gonem
- Department of Respiratory Medicine, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK. .,NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Adam Taylor
- Digital Research Service, University of Nottingham, Nottingham, UK
| | - Grazziela Figueredo
- Digital Research Service, University of Nottingham, Nottingham, UK.,School of Computer Science, University of Nottingham, Nottingham, UK
| | - Sarah Forster
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Philip Quinlan
- Digital Research Service, University of Nottingham, Nottingham, UK
| | | | - Tricia M McKeever
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Dominick Shaw
- Department of Respiratory Medicine, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK.,NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
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15
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Adejumo I, Patel M, McKeever TM, Shaw DE. Does inhaler technology improve adherence and asthma control? A pilot randomized controlled trial. Ann Allergy Asthma Immunol 2022; 128:727-729. [PMID: 35257874 DOI: 10.1016/j.anai.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Ireti Adejumo
- NIHR Nottingham Respiratory Biomedical Research Centre, Department of Respiratory Medicine, University of Nottingham, Nottingham, United Kingdom.
| | - Mitesh Patel
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Tricia M McKeever
- NIHR Nottingham Respiratory Biomedical Research Centre, Department of Respiratory Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Dominick E Shaw
- NIHR Nottingham Respiratory Biomedical Research Centre, Department of Respiratory Medicine, University of Nottingham, Nottingham, United Kingdom
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16
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Chalitsios CV, Shaw DE, McKeever TM. Risk of subtrochanteric and femoral shaft fractures due to bisphosphonate therapy in asthma: a population-based nested case-control study. Osteoporos Int 2022; 33:931-935. [PMID: 34635953 DOI: 10.1007/s00198-021-06197-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022]
Abstract
UNLABELLED Concerns have been raised over the association between bisphosphonates and atypical fractures in subtrochanteric and femoral shaft regions, but the potential risk of these fractures due to bisphosphonate use in asthma has not been examined. INTRODUCTION Bisphosphonates are used as first-line treatment for osteoporosis; however, concerns have been raised over their association with atypical subtrochanteric (ST) and femoral shaft (FS) fractures. The potential risk of atypical ST/FS fractures from bisphosphonate use in asthma has not been examined. METHODS A nested case-control study was conducted using linked data from the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases. Using an asthma cohort, we identified patients with atypical ST/FS fractures and sex, age, and practice-matched controls. Conditional logistic regression was used to determine the association between bisphosphonate exposure and atypical ST/FS fractures. RESULTS From a cohort of 69,074 people with asthma, 67 patients with atypical ST/FS fractures and 260 matched control subjects were identified. Of the case patients, 40.3% had received bisphosphonates as compared with 14.2% of the controls corresponding to an adjusted odds ratio (aOR) of 4.42 (95%CI, 2.98 to 8.53). The duration of use influenced the risk with long-term users to be at a greater risk (> 5 years vs no exposure; aOR = 7.67; 95%CI, 1.75 to 33.91). Drug withdrawal was associated with diminished odds of atypical ST/FS fractures. CONCLUSION Regular review of bisphosphonates should occur in patients with asthma. The risks and benefits of bisphosphonate therapy should be carefully considered in consultation with the patient. To improve AFF prevention, early signs which may warrant imaging, such as prodromal thigh pain, should be discussed.
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Affiliation(s)
- C V Chalitsios
- Division of Respiratory Medicine, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, UK.
- Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, UK.
| | - D E Shaw
- Division of Respiratory Medicine, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, UK
| | - T M McKeever
- Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, UK
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17
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Gupta A, McKeever TM, Hutchinson JP, Bolton CE. Impact of Coexisting Dementia on Inpatient Outcomes for Patients Admitted with a COPD Exacerbation. Int J Chron Obstruct Pulmon Dis 2022; 17:535-544. [PMID: 35300119 PMCID: PMC8921839 DOI: 10.2147/copd.s345751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose People with COPD are at a higher risk of cognitive dysfunction than the general population. However, the additional impact of dementia amongst such patients is not well understood, particularly in those admitted with a COPD exacerbation. We assessed the impact of coexisting dementia on inpatient mortality and length of stay (LOS) in patients admitted to hospital with a COPD exacerbation, using the United States based National Inpatient Sample database. Patients and Methods Patients aged over 40 years and hospitalised with a primary diagnosis of COPD exacerbation from 2011 to 2015 were included. Cases were grouped into patients with and without dementia. Multivariable logistic regression analysis, stratified by age, was used to assess risk of inpatient deaths. Cox regression was carried out to compare death rates and competing risk analysis gave estimates of discharge rates with time to death a competing variable. Results A total of 576,381 patients were included into the analysis, of which 35,372 (6.1%) had co-existent dementia. There were 6413 (1.1%) deaths recorded. The odds of inpatient death were significantly greater in younger patients with dementia (41–64 years) [OR (95% CI) dementia vs without: 1.75 (1.04–2.92), p=0.03]. Cases with dementia also had a higher inpatient mortality rate in the first 4 days [HR (95% CI) dementia vs without: 1.23 (1.08–1.41), p=0.002] and a longer LOS [sub-hazard ratio (95% CI) dementia vs without: 0.93 (0.92–0.94), p<0.001]. Conclusion Dementia as a comorbidity is associated with worse outcomes based on inpatient deaths and LOS in patients admitted with COPD exacerbations.
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Affiliation(s)
- Ayushman Gupta
- NIHR Nottingham BRC Respiratory Theme, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- NIHR Nottingham BRC Respiratory Theme, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - John P Hutchinson
- Respiratory Medicine, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK
| | - Charlotte E Bolton
- NIHR Nottingham BRC Respiratory Theme, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Correspondence: Charlotte E Bolton, B22, NIHR Nottingham BRC respiratory theme, Translational Medical Sciences, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital Campus, Hucknall road, Nottingham, NG5 1PB, UK, Email
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18
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Lansbury L, Lim B, McKeever TM, Lawrence H, Lim WS. Non-invasive pneumococcal pneumonia due to vaccine serotypes: A systematic review and meta-analysis. EClinicalMedicine 2022; 44:101271. [PMID: 35112072 PMCID: PMC8790487 DOI: 10.1016/j.eclinm.2022.101271] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/20/2021] [Accepted: 01/06/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Non-invasive pneumococcal pneumonia causes significant morbidity and mortality in older adults. Understanding pneumococcal sero-epidemiology in adults ≥50 years is necessary to inform vaccination policies and the updating of pneumococcal vaccines. METHODS We conducted a systematic review and random-effects meta-analysis to determine the proportion of community-acquired pneumonia (CAP) in people ≥50 years due to pneumococcus and the proportion caused by pneumococcal vaccine serotypes. We searched MEDLINE, EMBASE and PubMed from 1 January 1990 to 30 March 2021. Heterogeneity was explored by subgroup analysis according to a) patient group (stratified versus age) and depth of testing, b) detection/serotyping method, and c) continent. The protocol is registered with PROSPERO (CRD42020192002). FINDINGS Twenty-eight studies were included (34,216 patients). In the period 1-5 years after introduction of childhood PCV10/13 immunisation, 18% of CAP cases (95% CI 13-24%) were attributable to pneumococcus, with 49% (43-54%) of pneumococcal CAP due to PCV13 serotypes. The estimated proportion of pneumococcal CAP was highest in one study that used 24-valent serotype-specific urinary-antigen detection (ss-UAD)(30% [28-31%]), followed by studies based on diagnostic serology (28% [24-33%]), PCR (26% [15-37%]), ss-UAD14 (17% [13-22%]), and culture alone (14% [10-19%]). A higher estimate was observed in Europe (26% [21-30%] than North America (11% [9-12%](p<0·001). PCV13-serotype estimates were also influenced by serotyping methods. INTERPRETATION Non-invasive pneumococcal CAP and vaccine-type pneumococcal CAP remains a burden in older adults despite widespread introduction of pneumococcal infant immunisation. Studies heavily reliant on ss-UADs restricted to vaccine-type serotypes may overestimate the proportion of potentially vaccine-preventable pneumococcal pneumonia. Sero-epidemiological data from low-income countries are lacking.
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Affiliation(s)
- Louise Lansbury
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK
- Corresponding author at: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, NG5 1PB, United Kingdom.
| | - Benjamin Lim
- Faculty of Biology (School of Medicine), University of Cambridge, Cambridge, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK
| | - Hannah Lawrence
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Wei Shen Lim
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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19
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Chalitsios CV, McKeever TM, Langley TE, Shaw DE. Impact of COVID-19 on corticosteroids and antibiotics prescribing in England: an interrupted time series analysis. J Public Health (Oxf) 2021; 43:517-520. [PMID: 33539527 PMCID: PMC7928821 DOI: 10.1093/pubmed/fdab017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/30/2022] Open
Abstract
Inhaled corticosteroids (ICS), prednisolone and antibiotics all play a crucial role in the management of respiratory diseases. The aim of this study was to analyse whether the declaration of the COVID-19 pandemic affected prescribing rates, as public health measures were implemented to reduce transmission of SARS-CoV-2. Monthly practise-level prescribing data published by NHS Digital were analysed. At the point, the COVID-19 outbreak was declared a pandemic, ICS prescriptions rose significantly. This was followed by a decrease in ICS and prednisolone prescribing in the following months. There was no difference in the antibiotic prescribing trend.
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Affiliation(s)
- Christos V Chalitsios
- Division of Respiratory Medicine, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK.,Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Tessa E Langley
- Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Dominick E Shaw
- Division of Respiratory Medicine, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
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20
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Baskaran V, Lim WS, McKeever TM. Effects of tobacco smoking on recurrent hospitalisation with pneumonia: a population-based cohort study. Thorax 2021; 77:82-85. [PMID: 34145048 DOI: 10.1136/thoraxjnl-2020-216494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/14/2021] [Indexed: 11/04/2022]
Abstract
The incidence of and risk factors for recurrent hospitalisation for pneumonia were investigated using data from Hospital Episode Statistics, linked to a UK primary care database. Within 90 days and 1 year of follow-up, 1733 (3.1%) and 5064 (9.0%), developed recurrent pneumonia respectively. Smoking status at the time of hospitalisation with index pneumonia was associated with the risk of readmission with recurrent pneumonia within a year of discharge: current versus never smokers: adjusted subhazard ratio (sHR) 1.42, 95% CI 1.32 to 1.53, p<0.001, and ex smokers versus never smokers: adjusted sHR 1.24, 95% CI 1.15 to 1.34, p<0.001. Other independent risk factors associated with recurrent pneumonia were age, gender, deprivation and underlying comorbidities.
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Affiliation(s)
- Vadsala Baskaran
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK .,Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.,National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK
| | - Wei Shen Lim
- Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tricia M McKeever
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.,National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK
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21
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Sutherland L, Shaw K, Parrish C, Singleton N, McKeever TM, Stewart I, Shaw D, Martin MJ, Harrison T. A low exhaled nitric oxide level excludes a short-term benefit from inhaled corticosteroids in suspected asthma: A randomized placebo-controlled trial. Respirology 2021; 26:666-672. [PMID: 33939245 DOI: 10.1111/resp.14055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/29/2021] [Accepted: 02/23/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVE Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker that reflects IL-4/IL-13 production and therefore represents T2 allergic inflammation. FeNO has previously been used to guide inhaled corticosteroid (ICS) treatment in asthma. The purpose of this study was to determine if a low FeNO (≤27 ppb) could be used to reliably identify patients with symptoms suggestive of asthma who would not benefit from initiating treatment with an ICS. METHODS A total of 180 steroid-naïve adults with healthcare professional suspected asthma and an FeNO of ≤27 ppb were randomized to receive either 400 mcg of budesonide or placebo daily for 3 months. The primary outcome was the difference in the Asthma Control Questionnaire 7 (ACQ7) between treatment groups and the study was powered to determine equivalence. Secondary outcomes were the difference in FEV1 , Medical Research Council and Leicester Cough Questionnaire scores. RESULTS One hundred and thirty-four patients (68 budesonide and 66 placebo) completed the study and were included in the analysis. The between-group mean difference in ACQ7 from baseline to the end of the study was -0.25 and the 95% CI around this difference was -0.004 to 0.495 confirming equivalence (p < 0.05). Differences in forced expiratory volume over 1 s and other secondary outcomes were also small and clinically unimportant. CONCLUSION The results of this study suggest that steroid-naïve patients with symptoms suggestive of asthma and an FeNO ≤ 27 ppb are unlikely to benefit from initiating treatment with an ICS over 3 months. However, further research is recommended to confirm these findings before withholding ICS treatment.
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Affiliation(s)
- Lissa Sutherland
- School of Life Sciences, NIHR BRC University of Nottingham, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - Karen Shaw
- School of Medicine, NIHR BRC University of Nottingham, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - Clair Parrish
- School of Medicine, NIHR BRC University of Nottingham, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - Nicola Singleton
- School of Medicine, NIHR BRC University of Nottingham, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - Tricia M McKeever
- School of Medicine, NIHR BRC University of Nottingham, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - Iain Stewart
- School of Medicine, NIHR BRC University of Nottingham, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - Dominick Shaw
- School of Medicine, NIHR BRC University of Nottingham, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - Matthew J Martin
- School of Medicine, NIHR BRC University of Nottingham, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - Tim Harrison
- School of Medicine, NIHR BRC University of Nottingham, University of Nottingham, Nottingham City Hospital, Nottingham, UK
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Jones GS, Khakwani A, Pascoe A, Foweraker K, McKeever TM, Hubbard RB, Baldwin DR. Factors associated with survival in small cell lung cancer: an analysis of real-world national audit, chemotherapy and radiotherapy data. Ann Palliat Med 2021; 10:4055-4068. [PMID: 33894719 DOI: 10.21037/apm-20-1824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/08/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The mainstay of treatment for small cell lung cancer (SCLC) involves platinum doublet chemotherapy but the optimal duration, 4 vs. 6 cycles, is not known. Concurrent thoracic radiotherapy followed by prophylactic cranial irradiation (PCI) is recommended for fit individuals with limited stage. However, outside of clinical trials, the efficacy of sequential thoracic radiotherapy and PCI for extensive stage is uncertain. METHODS This retrospective, observational, cohort study used English national lung cancer data to determine the factors associated with survival for all people diagnosed with SCLC. More precisely, for individuals who received chemotherapy, we examined survival by the chemotherapy duration, thoracic radiotherapy dose and the use of PCI. RESULTS In total 6,438 people were diagnosed with SCLC. We identified that male sex (OR 0.7; 95% CI: 0.62-0.80), increasing age (P=0.01) greater comorbidity (P≤0.01), extensive stage (OR 0.21; 95% CI: 0.19-0.25) and worse performance status (PS2 vs. PS0 adjusted OR 0.38 95% CI: 0.31-0.48) were associated with reduced 1-year survival. Receipt of chemotherapy augmented survival. We analysed data for 1,761 people who had received chemotherapy. Thoracic radiotherapy (≥30 Gy for extensive stage and ≥40 Gy for limited stage) and PCI were independently associated with better survival (P≤0.01 for each), but 6 cycles of chemotherapy instead of 4 was not (limited stage adjusted OR 0.97; 95% CI: 0.48-1.97) extensive stage adjusted OR 1.34; 95% CI: 0.81-2.21). CONCLUSIONS Extending chemotherapy beyond 4 cycles to 6 does not augment survival. Appropriately prescribed thoracic radiotherapy and PCI can prolong survival in both limited and extensive stage SCLC.
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Affiliation(s)
- Gavin S Jones
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Aamir Khakwani
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Abigail Pascoe
- Department of Clinical Oncology, Nottingham University Hospitals, Nottingham, UK
| | - Karen Foweraker
- Department of Clinical Oncology, Nottingham University Hospitals, Nottingham, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Richard B Hubbard
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - David R Baldwin
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK; Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
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Baskaran V, Lawrence H, Lansbury LE, Webb K, Safavi S, Zainuddin NI, Huq T, Eggleston C, Ellis J, Thakker C, Charles B, Boyd S, Williams T, Phillips C, Redmore E, Platt S, Hamilton E, Barr A, Venyo L, Wilson P, Bewick T, Daniel P, Dark P, Jeans AR, McCanny J, Edgeworth JD, Llewelyn MJ, Schmid ML, McKeever TM, Beed M, Lim WS. Co-infection in critically ill patients with COVID-19: an observational cohort study from England. J Med Microbiol 2021; 70:001350. [PMID: 33861190 PMCID: PMC8289210 DOI: 10.1099/jmm.0.001350] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/12/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction. During previous viral pandemics, reported co-infection rates and implicated pathogens have varied. In the 1918 influenza pandemic, a large proportion of severe illness and death was complicated by bacterial co-infection, predominantly Streptococcus pneumoniae and Staphylococcus aureus.Gap statement. A better understanding of the incidence of co-infection in patients with COVID-19 infection and the pathogens involved is necessary for effective antimicrobial stewardship.Aim. To describe the incidence and nature of co-infection in critically ill adults with COVID-19 infection in England.Methodology. A retrospective cohort study of adults with COVID-19 admitted to seven intensive care units (ICUs) in England up to 18 May 2020, was performed. Patients with completed ICU stays were included. The proportion and type of organisms were determined at <48 and >48 h following hospital admission, corresponding to community and hospital-acquired co-infections.Results. Of 254 patients studied (median age 59 years (IQR 49-69); 64.6 % male), 139 clinically significant organisms were identified from 83 (32.7 %) patients. Bacterial co-infections/ co-colonisation were identified within 48 h of admission in 14 (5.5 %) patients; the commonest pathogens were Staphylococcus aureus (four patients) and Streptococcus pneumoniae (two patients). The proportion of pathogens detected increased with duration of ICU stay, consisting largely of Gram-negative bacteria, particularly Klebsiella pneumoniae and Escherichia coli. The co-infection/ co-colonisation rate >48 h after admission was 27/1000 person-days (95 % CI 21.3-34.1). Patients with co-infections/ co-colonisation were more likely to die in ICU (crude OR 1.78,95 % CI 1.03-3.08, P=0.04) compared to those without co-infections/ co-colonisation.Conclusion. We found limited evidence for community-acquired bacterial co-infection in hospitalised adults with COVID-19, but a high rate of Gram-negative infection acquired during ICU stay.
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Affiliation(s)
- Vadsala Baskaran
- Department of Respiratory Medicine, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, UK
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK
- NIHR Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham NG7 2UH, UK
| | - Hannah Lawrence
- Department of Respiratory Medicine, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, UK
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK
- NIHR Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham NG7 2UH, UK
| | - Louise E. Lansbury
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK
| | - Karmel Webb
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK
| | - Shahideh Safavi
- NIHR Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham NG7 2UH, UK
- Division of Respiratory Medicine, School of Medicine, University of Nottingham, Queens Medical Centre, Derby Rd, Nottingham NG7 2UH, UK
| | - Nurul I. Zainuddin
- Department of Respiratory Medicine, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, UK
| | - Tausif Huq
- Department of Respiratory Medicine, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, UK
| | - Charlotte Eggleston
- Department of Respiratory Medicine, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, UK
| | - Jayne Ellis
- University College London Hospitals NHS Foundation Trust, 250 Euston Rd, London NW1 2PG, UK
| | - Clare Thakker
- University College London Hospitals NHS Foundation Trust, 250 Euston Rd, London NW1 2PG, UK
| | - Bethan Charles
- Salford Royal NHS Foundation Trust, Stott Ln, Salford M6 8HD, UK
| | - Sara Boyd
- Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, L69 3GE, UK
| | - Tom Williams
- Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Claire Phillips
- Brighton and Sussex University Hospitals NHS trust, Eastern Road, Brighton BN2 1ES, UK
| | - Ethan Redmore
- Brighton and Sussex University Hospitals NHS trust, Eastern Road, Brighton BN2 1ES, UK
| | - Sarah Platt
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Rd, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - Eve Hamilton
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Rd, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - Andrew Barr
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Rd, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - Lucy Venyo
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Rd, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - Peter Wilson
- University College London Hospitals NHS Foundation Trust, 250 Euston Rd, London NW1 2PG, UK
| | - Tom Bewick
- University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK
| | - Priya Daniel
- University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK
| | - Paul Dark
- Salford Royal NHS Foundation Trust, Stott Ln, Salford M6 8HD, UK
- Division of Infection, Immunity and Respiratory Medicine, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, M23 9PT, UK
| | - Adam R. Jeans
- Salford Royal NHS Foundation Trust, Stott Ln, Salford M6 8HD, UK
| | - Jamie McCanny
- Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | | | - Martin J. Llewelyn
- Brighton and Sussex University Hospitals NHS trust, Eastern Road, Brighton BN2 1ES, UK
| | - Matthias L. Schmid
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Rd, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - Tricia M. McKeever
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK
- NIHR Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham NG7 2UH, UK
| | - Martin Beed
- Department of Critical Care, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, UK
- Division of Anaesthesia, School of Medicine, University of Nottingham, Queens Medical Centre, Derby Rd, Nottingham NG7 2UH, UK
| | - Wei Shen Lim
- Department of Respiratory Medicine, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, UK
- NIHR Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham NG7 2UH, UK
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Chalitsios CV, Shaw DE, McKeever TM. Corticosteroids and bone health in people with asthma: A systematic review and meta-analysis. Respir Med 2021; 181:106374. [PMID: 33799052 DOI: 10.1016/j.rmed.2021.106374] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Understanding the potential deleterious effects of corticosteroids on bone health in people with asthma is important when making treatment decisions. There is a need for clearer evidence to better quantify the risk and effect size. METHODS Databases were systematically searched to identify studies reporting on bone mineral density (BMD) measurement and risk of osteoporosis or fracture, comparing people with asthma exposed to inhaled (ICS) or oral (OCS) corticosteroids, with nonexposed people with asthma and healthy controls. Data were narratively synthesized, and a series of meta-analyses were performed using the random-effects inverse variance method. RESULTS This review consists of 28 studies (six randomized control trials and 22 observational). There was no effect of ICS on bone loss both at spine and femoral neck in asthma. People with asthma receiving OCS were at greater risk of osteoporosis than nonexposed people with asthma (pooled HR = 1.76; 95%CI: 1.48 to 2.09; I2=68%). Similarly, higher ICS exposure was associated with higher risk of osteoporosis (OR = 1.63; 95%CI: 1.33 to 1.99) and fracture (pooled OR = 1.19; 95%CI: 1.05 to 1.35; I2=0%) when comparing people with asthma receiving ICS and not. CONCLUSION Patients with asthma exposed to OCS or high ICS doses become more susceptible to bone comorbidities. Striking the right balance between efficacy and safety of steroids in asthma is important to improve patients' quality of life.
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Affiliation(s)
- Christos V Chalitsios
- Division of Respiratory Medicine, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK.
| | - Dominick E Shaw
- Division of Respiratory Medicine, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
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Siraj RA, McKeever TM, Gibson JE, Gordon AL, Bolton CE. Risk of incident dementia and cognitive impairment in patients with chronic obstructive pulmonary disease (COPD): A large UK population-based study. Respir Med 2021; 177:106288. [PMID: 33401149 DOI: 10.1016/j.rmed.2020.106288] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/04/2020] [Accepted: 12/16/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although cognitive impairment and dementia are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), estimates of incidence following a diagnosis of COPD are inconclusive. OBJECTIVE To determine the incidence of cognitive impairment and dementia in people with and without a COPD diagnosis. METHODS A population-based study using UK General Practice (GP) health records from The Health Improvement Network database was conducted. Patients with confirmed COPD diagnosis, ≥40 years old, were matched to up to four subjects without a COPD diagnosis by age, sex and GP practice. Cox proportional hazards models were used to assess the incidence rates of cognitive impairment and dementia. RESULTS Of patients with COPD (n = 62,148), 9% developed cognitive impairment, compared with 7% of subjects without COPD (n = 230,076), p < 0.001. The incidence of cognitive impairment following COPD diagnosis was greater than in subjects without COPD following index date (adjusted Hazard Ratio (aHR), 1.21; 95% CI: 1.16 ─ 1.26, p < 0.001). The coded incidence of either cognitive impairment or dementia was also greater in patients with COPD following adjustment for confounders (aHR: 1.13, 95% CI: 1.09 ─ 1.18, p < 0.001). Coded incident dementia alone was not different between patients with COPD and subjects without COPD (aHR, 0.91, 95% CI: 0.83 ─ 1.01, p = 0.053). CONCLUSION Despite the increased incidence of cognitive impairment in patients with COPD, incidence of dementia was not as frequently recorded in patients with COPD. This raises the concern of undiagnosed dementia and emphasises the need for a systematic assessment in this population.
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Affiliation(s)
- R A Siraj
- NIHR Nottingham Biomedical Research Centre Respiratory Medicine, School of Medicine, University of Nottingham, City Hospital NUH Trust site, Nottingham, UK; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - T M McKeever
- NIHR Nottingham Biomedical Research Centre Respiratory Medicine, School of Medicine, University of Nottingham, City Hospital NUH Trust site, Nottingham, UK; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - J E Gibson
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - A L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK; NIHR Nottingham Biomedical Research Centre, Musculoskeletal Theme, School of Medicine, University of Nottingham, Nottingham, UK
| | - C E Bolton
- NIHR Nottingham Biomedical Research Centre Respiratory Medicine, School of Medicine, University of Nottingham, City Hospital NUH Trust site, Nottingham, UK.
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26
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Chalitsios CV, McKeever TM, Shaw DE. Incidence of osteoporosis and fragility fractures in asthma: a UK population-based matched cohort study. Eur Respir J 2021; 57:13993003.01251-2020. [PMID: 32764111 DOI: 10.1183/13993003.01251-2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/29/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Osteoporosis and fragility fractures are associated with corticosteroids which are the mainstay treatment for asthma; however, these bone comorbidities within asthma need to be better described. METHODS A matched cohort study was conducted using the UK Clinical Practice Research Database (CPRD). Adults with an incident asthma code were identified and matched, with up to four randomly selected people without asthma, by age, sex and practice. Osteoporosis and fragility fracture incidence rates were calculated, and Cox regression was performed comparing hazard rates to the general population. We report the impact of age, sex, glucocorticoids and the risk of specific fractures. RESULTS Patients with asthma had a higher risk of osteoporosis (adjusted hazard ratio (aHR) 1.18, 95% CI 1.13-1.23) and were 12% (aHR 1.12, 95% CI 1.07-1.16) more likely to sustain fragility fractures than the general population. Age modified the effect of asthma on osteoporosis and fragility fractures, such that the effect was stronger in younger people (pinteraction<0.0001). The vertebra (aHR 1.40, 95% CI 1.33-1.48) and forearm/wrist (aHR 1.27, 95% CI 1.22-1.32) were the sites linked with a larger incidence. A dose-response relationship between oral corticosteroids (OCS) and osteoporosis was observed, whereas the risk of fragility fractures increased in those with six or more OCS courses per year. Regular use of inhaled corticosteroids (ICS) increased the risk of both bone conditions. CONCLUSIONS Patients with asthma are more likely to develop osteoporosis or sustain fragility fractures than the general population, with a particular concern in younger people and those more frequently using OCS and ICS.
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Affiliation(s)
- Christos V Chalitsios
- Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Dominick E Shaw
- Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham, UK
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Chalitsios CV, Shaw DE, McKeever TM. Risk of osteoporosis and fragility fractures in asthma due to oral and inhaled corticosteroids: two population-based nested case-control studies. Thorax 2020; 76:21-28. [PMID: 33087546 DOI: 10.1136/thoraxjnl-2020-215664] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Inhaled (ICS) and oral (OCS) corticosteroids are used widely in asthma; however, the risk of osteoporosis and fragility fracture (FF) due to corticosteroids in asthma is not well-established. METHODS We conducted two nested case-control studies using linked data from the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases. Using an asthma cohort, we separately identified patients with osteoporosis or FF and gender-, age- and practice-matched controls. Conditional logistic regression was used to determine the association between ICS and OCS exposure, and the risk of osteoporosis or FF. The prevalence of patients receiving at least one bisphosphonate was also calculated. RESULTS There was a dose-response relationship between both cumulative dose and number of OCS/ICS prescriptions within the previous year, and risk of osteoporosis or FF. After adjusting for confounders, people receiving more OCS prescriptions (≥9 vs 0) had a 4.50 (95% CI 3.21 to 6.11) and 2.16 (95% CI 1.56 to 3.32) increased risk of osteoporosis and FF, respectively. For ICS (≥11 vs 0) the ORs were 1.60 (95% CI 1.22 to 2.10) and 1.31 (95% CI 1.02 to 1.68). The cumulative dose had a similar impact, with those receiving more OCS or ICS being at greater risk. The prevalence of patients taking ≥9 OCS and at least one bisphosphonate prescription was just 50.6% and 48.4% for osteoporosis and FF, respectively. CONCLUSIONS The findings suggest that exposure to OCS or ICS is an independent risk factors for bone health in patients with asthma. Steroid administration at the lowest possible level to maintain asthma control is recommended.
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Affiliation(s)
- Christos V Chalitsios
- School of Medicine, Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Dominick E Shaw
- School of Medicine, Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- School of Medicine, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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Luney MS, Lindsay W, McKeever TM, Moppett IK. Cerebrovascular accident and acute coronary syndrome and perioperative outcomes (CAPO) study protocol: a 10-year database linkage between Hospital Episode Statistics Admitted Patient Care, Myocardial Infarction National Audit Project and Office for National Statistics registries for time-dependent risk analysis of perioperative outcomes in English NHS hospitals. BMJ Open 2020; 10:e037904. [PMID: 33082189 PMCID: PMC7577058 DOI: 10.1136/bmjopen-2020-037904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION An increasing number of people who have a history of acute coronary syndrome or cerebrovascular accident (termed cardiovascular events) are being considered for surgery. Up-to-date evidence of the impact of these prior events is needed to inform person-centred decision making. While perioperative risk for major adverse cardiac events immediately after a cardiovascular event is known to be elevated, the duration of time after the event for which the perioperative risk is increased is not clear. METHODS AND ANALYSIS This is an individual patient-level database linkage study of all patients in England with at least one operation between 2007 and 2017 in the Hospital Episode Statistics Admitted Patient Care database. Data will be linked to mortality data from the Office for National Statistics up to 2018, for 30-day, 90-day and 1-year mortality and to the Myocardial Ischaemia National Audit Project, a UK registry of acute coronary syndromes. The primary outcome will be the association between time from cardiovascular event to index surgery and 30-day all-cause mortality. Additional associations we will report are all unplanned readmissions, prolonged length of stay, 30-day hospital free survival and incidence of new cardiovascular events within one postoperative year. Important subgroups will be surgery specific (invasiveness, urgency and subspecialty), type of acute coronary syndrome (ST or non-ST elevation myocardial infarction) and type of cerebrovascular accident (ischaemic or haemorrhagic stroke). ETHICS AND DISSEMINATION Ethical approval for this observational study has been obtained from East Midlands-Nottingham 1 Research Ethics Committee; REC reference: 18/EM0403. The results of the study will be made available through peer-reviewed publications and via the Health Services Research Centre of the Royal College of Anaesthetists, London.
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Affiliation(s)
- Matthew Stephen Luney
- Anaesthesia and Critical Care Section, Division of Clinical Neuroscience, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - William Lindsay
- Anaesthesia and Critical Care Section, Division of Clinical Neuroscience, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Iain Keith Moppett
- Anaesthesia and Critical Care Section, Division of Clinical Neuroscience, University of Nottingham, Nottingham, Nottinghamshire, UK
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Lawrence H, Lim WS, McKeever TM. Variation in clinical outcomes and process of care measures in community acquired pneumonia: a systematic review. Pneumonia (Nathan) 2020; 12:10. [PMID: 32999854 PMCID: PMC7517805 DOI: 10.1186/s41479-020-00073-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/11/2020] [Indexed: 12/23/2022] Open
Abstract
Background Variation in outcomes of patients with community acquired pneumonia (CAP) has been reported in some, but not all, studies. Although some variation is expected, unwarranted variation in healthcare impacts patient outcomes and equity of care. The aim of this systematic review was to: i) summarise current evidence on regional and inter-hospital variation in the clinical outcomes and process of care measures of patients hospitalised with CAP and ii) assess the strength of this evidence. Methods Databases were systematically searched from inception to February 2018 for relevant studies and data independently extracted by two investigators in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Included studies enrolled adults hospitalised with CAP and reported a measure of variation between two or more units in healthcare outcomes or process of care measures. Outcomes of interest were mortality, length of hospital stay (LOS) and re-admission rates. A structured synthesis of the studies was performed. Results Twenty-two studies were included in the analysis. The median number of units compared across studies was five (IQR 4–15). Evidence for variation in mortality between units was inconsistent; of eleven studies that performed statistical significance testing, five found significant variation. For LOS, of nine relevant studies, all found statistically significant variation. Four studies reported site of admission accounted for 1–24% of the total observed variation in LOS. A shorter LOS was not associated with increased mortality or readmission rates. For readmission, evidence was mixed; of seven studies, 4 found statistically significant variation. There was consistent evidence for variation in the use of intensive care, obtaining blood cultures on admission, receiving antibiotics within 8 h of admission and duration of intravenous antibiotics. Across all outcome measures, only one study accounted for natural variation between units in their analysis. Conclusion There is consistent evidence of moderate quality for significant variation in length of stay and process of care measures but not for in-patient mortality or hospital re-admission. Evidence linking variation in outcomes with variation in process of care measures was limited; where present no difference in mortality was detected despite POC variation. Adjustment for natural variation within studies was lacking; the proportion of observed variation due to chance is not quantified by existing evidence.
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Affiliation(s)
- H Lawrence
- Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, UK.,Division of Epidemiology and Public Health, School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, UK
| | - W S Lim
- Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre/Nottingham Clinical Research Facilities, Nottingham, UK
| | - T M McKeever
- Division of Epidemiology and Public Health, School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre/Nottingham Clinical Research Facilities, Nottingham, UK
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Lawrence H, Pick H, Baskaran V, Daniel P, Rodrigo C, Ashton D, Edwards-Pritchard RC, Sheppard C, Eletu SD, Litt D, Fry NK, Rose S, Trotter C, McKeever TM, Lim WS. Effectiveness of the 23-valent pneumococcal polysaccharide vaccine against vaccine serotype pneumococcal pneumonia in adults: A case-control test-negative design study. PLoS Med 2020; 17:e1003326. [PMID: 33095759 PMCID: PMC7584218 DOI: 10.1371/journal.pmed.1003326] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 08/31/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPV23) is available in the United Kingdom to adults aged 65 years or older and those in defined clinical risk groups. We evaluated the vaccine effectiveness (VE) of PPV23 against vaccine-type pneumococcal pneumonia in a cohort of adults hospitalised with community-acquired pneumonia (CAP). METHODS AND FINDINGS Using a case-control test-negative design, a secondary analysis of data was conducted from a prospective cohort study of adults (aged ≥16 years) with CAP hospitalised at 2 university teaching hospitals in Nottingham, England, from September 2013 to August 2018. The exposure of interest was PPV23 vaccination at any time point prior to the index admission. A case was defined as PPV23 serotype-specific pneumococcal pneumonia and a control as non-PPV23 serotype pneumococcal pneumonia or nonpneumococcal pneumonia. Pneumococcal serotypes were identified from urine samples using a multiplex immunoassay or from positive blood cultures. Multivariable logistic regression was used to derive adjusted odds of case status between vaccinated and unvaccinated individuals; VE estimates were calculated as (1 - odds ratio) × 100%. Of 2,357 patients, there were 717 PPV23 cases (48% vaccinated) and 1,640 controls (54.5% vaccinated). The adjusted VE (aVE) estimate against PPV23 serotype disease was 24% (95% CI 5%-40%, p = 0.02). Estimates were similar in analyses restricted to vaccine-eligible patients (n = 1,768, aVE 23%, 95% CI 1%-40%) and patients aged ≥65 years (n = 1,407, aVE 20%, 95% CI -5% to 40%), but not in patients aged ≥75 years (n = 905, aVE 5%, 95% CI -37% to 35%). The aVE estimate in relation to PPV23/non-13-valent pneumococcal conjugate vaccine (PCV13) serotype pneumonia (n = 417 cases, 43.7% vaccinated) was 29% (95% CI 6%-46%). Key limitations of this study are that, due to high vaccination rates, there was a lack of power to reject the null hypothesis of no vaccine effect, and that the study was not large enough to allow robust subgroup analysis in the older age groups. CONCLUSIONS In the setting of an established national childhood PCV13 vaccination programme, PPV23 vaccination of clinical at-risk patient groups and adults aged ≥65 years provided moderate long-term protection against hospitalisation with PPV23 serotype pneumonia. These findings suggest that PPV23 vaccination may continue to have an important role in adult pneumococcal vaccine policy, including the possibility of revaccination of older adults.
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Affiliation(s)
- Hannah Lawrence
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Harry Pick
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Vadsala Baskaran
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Priya Daniel
- Department of Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Chamira Rodrigo
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Deborah Ashton
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | | | - Carmen Sheppard
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England–National Infection Service, Colindale, London, United Kingdom
| | - Seyi D. Eletu
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England–National Infection Service, Colindale, London, United Kingdom
| | - David Litt
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England–National Infection Service, Colindale, London, United Kingdom
| | - Norman K. Fry
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England–National Infection Service, Colindale, London, United Kingdom
- Immunisation and Countermeasures Division, Public Health England Colindale–National Infection Service, London, United Kingdom
| | - Samuel Rose
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England–National Infection Service, Colindale, London, United Kingdom
| | - Caroline Trotter
- Disease Dynamic Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Tricia M. McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Wei Shen Lim
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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31
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Gupta A, Jayes LR, Holmes S, Sahota O, Canavan M, Elkin SL, Lim K, Murphy AC, Singh S, Towlson EA, Ward H, Scullion J, McKeever TM, Bolton CE. Management of Fracture Risk in Patients with Chronic Obstructive Pulmonary Disease (COPD): Building a UK Consensus Through Healthcare Professional and Patient Engagement. Int J Chron Obstruct Pulmon Dis 2020; 15:1377-1390. [PMID: 32606647 PMCID: PMC7311204 DOI: 10.2147/copd.s233398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 03/23/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction Osteoporosis and bone fractures are common in chronic obstructive pulmonary disease (COPD) and contribute significantly to morbidity and mortality. Current national guidance on COPD management recommends addressing bone health in patients, however, does not detail how. This consensus outlines key elements of a structured approach to managing bone health and fracture risk in patients with COPD. Methods A systematic approach incorporating multifaceted methodologies included detailed patient and healthcare professional (HCP) surveys followed by a roundtable meeting to reach a consensus on what a pathway would look like. Results The surveys revealed that fracture risk was not always assessed despite being recognised as an important aspect of COPD management by HCPs. The majority of the patients also stated they would be receptive to discussing treatment options if found to be at risk of osteoporotic fractures. Limited time and resource allocation were identified as barriers to addressing bone health during consultations. The consensus from the roundtable meeting was that a proactive systematic approach to assessing bone health should be adopted. This should involve using fracture risk assessment tools to identify individuals at risk, investigating secondary causes of osteoporosis if a diagnosis is made and reinforcing non-pharmacological and preventative measures such as smoking cessation, keeping active and pharmacological management of osteoporosis and medicines management of corticosteroid use. Practically, prioritising patients with important additional risk factors, such as previous fragility fractures, older age and long-term oral corticosteroid use for an assessment, was felt required. Conclusion There is a need for integrating fracture risk assessment into the COPD pathway. Developing a systematic and holistic approach to addressing bone health is key to achieving this. In tandem, opportunities to disseminate the information and educational resources are also required.
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Affiliation(s)
- Ayushman Gupta
- NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Leah R Jayes
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Steve Holmes
- General Practitioner, Park Medical Partnership, Shepton Mallet, UK
| | - Opinder Sahota
- Department of Geriatric Medicine, Nottingham University Hospitals Trust, Nottingham, UK
| | - Melissa Canavan
- Department of Respiratory, Respiratory Care Solutions, Leeds, UK
| | - Sarah L Elkin
- Department of Respiratory Medicine, Imperial College Healthcare Trust, London W2 1NY, UK; Airways Section, National Heart and Lung Institute, Imperial College, London, UK
| | - Kelvin Lim
- Eastwood Primary Care Centre, Eastwood, Nottingham, UK
| | - Anna C Murphy
- Department of Pharmacy, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sally Singh
- Department of Respiratory Science, University Hospitals of Leicester NHS Trust, Leicester, UK.,Department of Respiratory Science, University of Leicester, Leicester, UK
| | | | - Helen Ward
- Faculty of Medicine, The Royal Wolverhampton NHS Trust, West Midlands, UK
| | - Jane Scullion
- Department of Respiratory Science, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Charlotte E Bolton
- NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
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32
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Ketelaar ME, Portelli MA, Dijk FN, Shrine N, Faiz A, Vermeulen CJ, Xu CJ, Hankinson J, Bhaker S, Henry AP, Billington CK, Shaw DE, Johnson SR, Benest AV, Pang V, Bates DO, Pogson ZEK, Fogarty A, McKeever TM, Singapuri A, Heaney LG, Mansur AH, Chaudhuri R, Thomson NC, Holloway JW, Lockett GA, Howarth PH, Niven R, Simpson A, Tobin MD, Hall IP, Wain LV, Blakey JD, Brightling CE, Obeidat M, Sin DD, Nickle DC, Bossé Y, Vonk JM, van den Berge M, Koppelman GH, Sayers I, Nawijn MC. Phenotypic and functional translation of IL33 genetics in asthma. J Allergy Clin Immunol 2020; 147:144-157. [PMID: 32442646 DOI: 10.1016/j.jaci.2020.04.051] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 03/22/2020] [Accepted: 04/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Asthma is a complex disease with multiple phenotypes that may differ in disease pathobiology and treatment response. IL33 single nucleotide polymorphisms (SNPs) have been reproducibly associated with asthma. IL33 levels are elevated in sputum and bronchial biopsies of patients with asthma. The functional consequences of IL33 asthma SNPs remain unknown. OBJECTIVE This study sought to determine whether IL33 SNPs associate with asthma-related phenotypes and with IL33 expression in lung or bronchial epithelium. This study investigated the effect of increased IL33 expression on human bronchial epithelial cell (HBEC) function. METHODS Association between IL33 SNPs (Chr9: 5,815,786-6,657,983) and asthma phenotypes (Lifelines/DAG [Dutch Asthma GWAS]/GASP [Genetics of Asthma Severity & Phenotypes] cohorts) and between SNPs and expression (lung tissue, bronchial brushes, HBECs) was done using regression modeling. Lentiviral overexpression was used to study IL33 effects on HBECs. RESULTS We found that 161 SNPs spanning the IL33 region associated with 1 or more asthma phenotypes after correction for multiple testing. We report a main independent signal tagged by rs992969 associating with blood eosinophil levels, asthma, and eosinophilic asthma. A second, independent signal tagged by rs4008366 presented modest association with eosinophilic asthma. Neither signal associated with FEV1, FEV1/forced vital capacity, atopy, and age of asthma onset. The 2 IL33 signals are expression quantitative loci in bronchial brushes and cultured HBECs, but not in lung tissue. IL33 overexpression in vitro resulted in reduced viability and reactive oxygen species-capturing of HBECs, without influencing epithelial cell count, metabolic activity, or barrier function. CONCLUSIONS We identify IL33 as an epithelial susceptibility gene for eosinophilia and asthma, provide mechanistic insight, and implicate targeting of the IL33 pathway specifically in eosinophilic asthma.
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Affiliation(s)
- Maria E Ketelaar
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Division of Respiratory Medicine, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom.
| | - Michael A Portelli
- Division of Respiratory Medicine, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - F Nicole Dijk
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nick Shrine
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom; National Institute for Health Research Leicester Respiratory Biomedical Research Centre, Leicester, United Kingdom
| | - Alen Faiz
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cornelis J Vermeulen
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cheng J Xu
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; CiiM & TWINCORE, Helmholtz-Centre for Infection Research and the Hannover Medical School, Hannover, Germany
| | - Jenny Hankinson
- Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Sangita Bhaker
- Division of Respiratory Medicine, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Amanda P Henry
- Division of Respiratory Medicine, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Charlote K Billington
- Division of Respiratory Medicine, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Dominick E Shaw
- Division of Respiratory Medicine, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Simon R Johnson
- Division of Respiratory Medicine, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Andrew V Benest
- Division of Cancer and Stem Cells, School of Medicine, Biodiscovery Institute, University of Nottingham, Nottingham, and COMPARE University of Birmingham and University of Nottingham, Nottingham, United Kingdom
| | - Vincent Pang
- Division of Cancer and Stem Cells, School of Medicine, Biodiscovery Institute, University of Nottingham, Nottingham, and COMPARE University of Birmingham and University of Nottingham, Nottingham, United Kingdom
| | - David O Bates
- Division of Cancer and Stem Cells, School of Medicine, Biodiscovery Institute, University of Nottingham, Nottingham, and COMPARE University of Birmingham and University of Nottingham, Nottingham, United Kingdom
| | - Z E K Pogson
- Department of Respiratory Medicine, Lincoln County Hospital, Lincoln, United Kingdom; Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Andrew Fogarty
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Amisha Singapuri
- Institute for Lung Health, Department of Respiratory Sciences, Glenfield Hospital, University of Leicester, Leicester, United Kingdom
| | - Liam G Heaney
- Centre for Infection and Immunity, Queen's University of Belfast, Belfast, United Kingdom
| | - Adel H Mansur
- Respiratory Medicine, Birmingham Heartlands Hospital and University of Birmingham, Birmingham, United Kingdom
| | - Rekha Chaudhuri
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Neil C Thomson
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - John W Holloway
- Human Development and Health, Faculty of Medicine and National Institute of Health Biomedical Research Centre, University of Southampton, Southampton, United Kingdom; Clinical and Experimental Sciences, Faculty of Medicine and National Institute of Health Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
| | - Gabrielle A Lockett
- Human Development and Health, Faculty of Medicine and National Institute of Health Biomedical Research Centre, University of Southampton, Southampton, United Kingdom; Clinical and Experimental Sciences, Faculty of Medicine and National Institute of Health Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
| | - Peter H Howarth
- Human Development and Health, Faculty of Medicine and National Institute of Health Biomedical Research Centre, University of Southampton, Southampton, United Kingdom; Clinical and Experimental Sciences, Faculty of Medicine and National Institute of Health Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
| | - Robert Niven
- Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Angela Simpson
- Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Martin D Tobin
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom; National Institute for Health Research Leicester Respiratory Biomedical Research Centre, Leicester, United Kingdom
| | - Ian P Hall
- Division of Respiratory Medicine, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Louise V Wain
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom; National Institute for Health Research Leicester Respiratory Biomedical Research Centre, Leicester, United Kingdom
| | - John D Blakey
- Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Christopher E Brightling
- National Institute for Health Research Leicester Respiratory Biomedical Research Centre, Leicester, United Kingdom; Institute for Lung Health, Department of Respiratory Sciences, Glenfield Hospital, University of Leicester, Leicester, United Kingdom
| | - Ma'en Obeidat
- The Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Don D Sin
- The Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David C Nickle
- Department of Genetics and Pharmacogenomics, Merck Research Laboratories, Boston, Mass
| | - Yohan Bossé
- Department of Molecular Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - Judith M Vonk
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten van den Berge
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Division of Respiratory Medicine, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Gerard H Koppelman
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ian Sayers
- Division of Respiratory Medicine, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Martijn C Nawijn
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Morgan L, McKeever TM, Nightingale J, Deakin DE, Moppett IK. Spinal or general anaesthesia for surgical repair of hip fracture and subsequent risk of mortality and morbidity: a database analysis using propensity score-matching. Anaesthesia 2020; 75:1173-1179. [PMID: 32337715 DOI: 10.1111/anae.15042] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 11/30/2022]
Abstract
Around 76,000 people fracture their hip annually in the UK at a considerable personal, social and financial cost. Despite longstanding debate, the optimal mode of anaesthesia (general or spinal) remains unclear. Our aim was to assess whether there is a significant difference in mortality and morbidity between patients undergoing spinal anaesthesia compared with general anaesthesia during hip fracture surgery. A secondary analysis examined whether a difference exists in mortality for patients with pre-existing cardiovascular disease or chronic obstructive pulmonary disease. This was a clinical database analysis of patients treated for hip fracture in Nottingham, UK between 2004 and 2015. Propensity score-matching was used to generate matched pairs of patients, one of whom underwent each mode of anaesthesia. Data were analysed using conditional logistic regression, with 7164 patients successfully matched. There was no difference in 30- or 90-day mortality in patients who had spinal rather than general anaesthesia (OR [95%CI] 0.97 [0.8-1.15]; p = 0.764 and 0.93 [0.82-1.05]; p = 0.247 respectively). Patients who had a spinal anaesthetic had a lower-risk of blood transfusion (OR [95%CI] 0.84 [0.75-0.94]; p = 0.003) and urinary tract infection (OR [95%CI] 0.72 [0.61-0.84]; p < 0.001), but were more likely to develop a chest infection (OR [95%CI] 1.23 [1.07-1.42]; p = 0.004), deep vein thrombosis (OR [95%CI] 2.18 [1.07-4.45]; p = 0.032) or pulmonary embolism (OR [95%CI] 2.23 [1.16-4.29]; p = 0.016). The mode of anaesthesia for hip fracture surgery resulted in no significant difference in mortality, but there was a significant difference in several measures of postoperative morbidity.
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Affiliation(s)
- L Morgan
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - T M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - J Nightingale
- Department of Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D E Deakin
- Department of Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - I K Moppett
- Anaesthesia and Critical Care, Division of Clinical Neuroscience, University of Nottingham, UK
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34
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Portelli MA, Dijk FN, Ketelaar ME, Shrine N, Hankinson J, Bhaker S, Grotenboer NS, Obeidat M, Henry AP, Billington CK, Shaw D, Johnson SR, Pogson ZE, Fogarty A, McKeever TM, Nickle DC, Bossé Y, van den Berge M, Faiz A, Brouwer S, Vonk JM, de Vos P, Brandsma CA, Vermeulen CJ, Singapuri A, Heaney LG, Mansur AH, Chaudhuri R, Thomson NC, Holloway JW, Lockett GA, Howarth PH, Niven R, Simpson A, Blakey JD, Tobin MD, Postma DS, Hall IP, Wain LV, Nawijn MC, Brightling CE, Koppelman GH, Sayers I. Phenotypic and functional translation of IL1RL1 locus polymorphisms in lung tissue and asthmatic airway epithelium. JCI Insight 2020; 5:132446. [PMID: 32324168 PMCID: PMC7205441 DOI: 10.1172/jci.insight.132446] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 03/12/2020] [Indexed: 12/22/2022] Open
Abstract
The IL1RL1 (ST2) gene locus is robustly associated with asthma; however, the contribution of single nucleotide polymorphisms (SNPs) in this locus to specific asthma subtypes and the functional mechanisms underlying these associations remain to be defined. We tested for association between IL1RL1 region SNPs and characteristics of asthma as defined by clinical and immunological measures and addressed functional effects of these genetic variants in lung tissue and airway epithelium. Utilizing 4 independent cohorts (Lifelines, Dutch Asthma GWAS [DAG], Genetics of Asthma Severity and Phenotypes [GASP], and Manchester Asthma and Allergy Study [MAAS]) and resequencing data, we identified 3 key signals associated with asthma features. Investigations in lung tissue and primary bronchial epithelial cells identified context-dependent relationships between the signals and IL1RL1 mRNA and soluble protein expression. This was also observed for asthma-associated IL1RL1 nonsynonymous coding TIR domain SNPs. Bronchial epithelial cell cultures from asthma patients, exposed to exacerbation-relevant stimulations, revealed modulatory effects for all 4 signals on IL1RL1 mRNA and/or protein expression, suggesting SNP-environment interactions. The IL1RL1 TIR signaling domain haplotype affected IL-33–driven NF-κB signaling, while not interfering with TLR signaling. In summary, we identify that IL1RL1 genetic signals potentially contribute to severe and eosinophilic phenotypes in asthma, as well as provide initial mechanistic insight, including genetic regulation of IL1RL1 isoform expression and receptor signaling.
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Affiliation(s)
- Michael A Portelli
- Division of Respiratory Medicine, NIHR, Nottingham Biomedical Research Centre, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - F Nicole Dijk
- Department of Pediatric Pulmonology and Pediatric Allergology, and
| | - Maria E Ketelaar
- Division of Respiratory Medicine, NIHR, Nottingham Biomedical Research Centre, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom.,Department of Pediatric Pulmonology and Pediatric Allergology, and.,Department of Pathology and Medical Biology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, Netherlands
| | - Nick Shrine
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Jenny Hankinson
- Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Sangita Bhaker
- Division of Respiratory Medicine, NIHR, Nottingham Biomedical Research Centre, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Néomi S Grotenboer
- Department of Pediatric Pulmonology and Pediatric Allergology, and.,Department of Pathology and Medical Biology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, Netherlands
| | - Ma'en Obeidat
- The University of British Columbia Center for Heart Lung Innovation, St. Paul's Hospital Vancouver, Vancouver, British Columbia, Canada
| | - Amanda P Henry
- Division of Respiratory Medicine, NIHR, Nottingham Biomedical Research Centre, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Charlotte K Billington
- Division of Respiratory Medicine, NIHR, Nottingham Biomedical Research Centre, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Dominick Shaw
- Division of Respiratory Medicine, NIHR, Nottingham Biomedical Research Centre, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Simon R Johnson
- Division of Respiratory Medicine, NIHR, Nottingham Biomedical Research Centre, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Zara Ek Pogson
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Andrew Fogarty
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - David C Nickle
- Departments of Genetics and Pharmacogenomics, Merck Research Laboratories, Boston, Massachusetts, USA
| | - Yohan Bossé
- Institut universitaire de cardiologie et de pneumologie de Québec, Department of Molecular Medicine, Laval University, Québec, Canada
| | - Maarten van den Berge
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Department of Pulmonary Diseases, and
| | - Alen Faiz
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Department of Pulmonary Diseases, and
| | - Sharon Brouwer
- Department of Pathology and Medical Biology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, Netherlands
| | - Judith M Vonk
- Department of Epidemiology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, Netherlands
| | - Paul de Vos
- Department of Pathology and Medical Biology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, Netherlands
| | - Corry-Anke Brandsma
- Department of Pathology and Medical Biology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, Netherlands
| | - Cornelis J Vermeulen
- Department of Pathology and Medical Biology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, Netherlands
| | - Amisha Singapuri
- Respiratory sciences, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | - Liam G Heaney
- Centre for Experimental Medicine, Queens University of Belfast, Belfast, United Kingdom
| | - Adel H Mansur
- Department of Respiratory Medicine, Birmingham Heartlands Hospital and University of Birmingham, Birmingham, United Kingdom
| | - Rekha Chaudhuri
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Neil C Thomson
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - John W Holloway
- Department of Human Development and.,Department of Health & Clinical and Experimental Sciences, Faculty of Medicine and NIH Research (NIHR), Southampton Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
| | - Gabrielle A Lockett
- Department of Human Development and.,Department of Health & Clinical and Experimental Sciences, Faculty of Medicine and NIH Research (NIHR), Southampton Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
| | - Peter H Howarth
- Department of Human Development and.,Department of Health & Clinical and Experimental Sciences, Faculty of Medicine and NIH Research (NIHR), Southampton Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
| | - Robert Niven
- Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Angela Simpson
- Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - John D Blakey
- Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Martin D Tobin
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.,NIHR, Leicester Respiratory Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Dirkje S Postma
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Department of Pulmonary Diseases, and
| | - Ian P Hall
- Division of Respiratory Medicine, NIHR, Nottingham Biomedical Research Centre, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Louise V Wain
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.,NIHR, Leicester Respiratory Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Martijn C Nawijn
- Department of Pathology and Medical Biology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, Netherlands
| | - Christopher E Brightling
- Respiratory sciences, University of Leicester, Glenfield Hospital, Leicester, United Kingdom.,NIHR, Leicester Respiratory Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | | | - Ian Sayers
- Division of Respiratory Medicine, NIHR, Nottingham Biomedical Research Centre, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
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Lawrence H, McKeever TM, Lim WS. Admission to hospital in the UK at a weekend does not influence the prognosis of adults with community-acquired pneumonia. Thorax 2020; 75:594-596. [PMID: 32234807 DOI: 10.1136/thoraxjnl-2019-214318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/27/2020] [Accepted: 03/12/2020] [Indexed: 11/04/2022]
Abstract
Outcomes for adults with community-acquired pneumonia (CAP) admitted to hospital at the weekend were compared with those admitted during weekdays using data from the British Thoracic Society national CAP audits. Of 31 400 cases, 40.7% were weekend admissions; these patients were older (mean age 72 vs 71.3 years, p=0.001) and more likely to have high severity CAP (28.9% vs 27.1%, p trend 0.003) but had slightly lower adjusted 30-day inpatient mortality (aOR 0.94 95% CI 0.88 to 1.01) compared with those admitted during weekdays. More patients in the weekend group received antibiotics within 4 hours of admission (70.3% vs 68.7%, aOR 1.07 95% CI 1.01 to 1.12). We did not observe increased mortality for adults admitted at the weekend with CAP.
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Affiliation(s)
- Hannah Lawrence
- Respiratory Medicine, Nottingham City Hospital, Nottingham, UK .,Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Wei Shen Lim
- Respiratory Medicine, Nottingham City Hospital, Nottingham, UK
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Chalitsios CV, Shaw DE, McKeever TM. A retrospective database study of oral corticosteroid and bisphosphonate prescribing patterns in England. NPJ Prim Care Respir Med 2020; 30:5. [PMID: 32054843 PMCID: PMC7018734 DOI: 10.1038/s41533-020-0162-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/16/2020] [Indexed: 11/28/2022] Open
Abstract
Exposure to oral corticosteroids (OCS) is associated with an increased risk of osteoporosis and fragility fractures. Guidelines suggest bisphosphonate (BP) therapy as the first-line treatment of glucocorticoid-induced osteoporosis (GIOP). This population study used publicly available data, including prescription annual cost analysis and monthly practice-level data. Our aim was to examine the prescribing of OCS and BP at practice level and investigate reasons for variation using a mixed-effect negative binomial regression analysis. There was a rise in OCS and BP prescriptions of 55% and 1200% from 1998 to 2018, respectively. Of the 6586 included practices, the median (IQR) of OCS and BP prescriptions were 120.8 (84.8-160.4) and 107.7 (73.8-147.4) per 1000 patients, respectively. Asthma and chronic obstructive pulmonary disease (COPD) were significantly associated with OCS use (p < 0.0001), but only COPD was associated with BP use (p < 0.0001). Higher OCS prescribing rates were associated with higher BP prescribing rates (5th to 1st quintile-IRR = 1.99; 95% CI: 1.88-2.10). Practice list size, deprivation and advanced age were all associated with both drugs (p < 0.0001). In conclusion, although OCS use is positively associated with BP prescription, variation among practices and CCGs exists. The variation in prescribing suggests there is still a need to improve GIOP prevention.
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Affiliation(s)
| | - Dominick E Shaw
- NIHR Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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37
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Pick H, Daniel P, Rodrigo C, Bewick T, Ashton D, Lawrence H, Baskaran V, Edwards-Pritchard RC, Sheppard C, Eletu SD, Rose S, Litt D, Fry NK, Ladhani S, Chand M, Trotter C, McKeever TM, Lim WS. Pneumococcal serotype trends, surveillance and risk factors in UK adult pneumonia, 2013-18. Thorax 2019; 75:38-49. [PMID: 31594801 DOI: 10.1136/thoraxjnl-2019-213725] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/16/2019] [Accepted: 09/14/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Changes over the last 5 years (2013-18) in the serotypes implicated in adult pneumococcal pneumonia and the patient groups associated with vaccine-type disease are largely unknown. METHODS We conducted a population-based prospective cohort study of adults admitted to two large university hospitals with community-acquired pneumonia (CAP) between September 2013 and August 2018. Pneumococcal serotypes were identified using a novel 24-valent urinary monoclonal antibody assay and from blood cultures. Trends in incidence rates were compared against national invasive pneumococcal disease (IPD) data. Persons at risk of vaccine-type pneumonia (pneumococcal conjugate vaccine (PCV)13 and pneumococcal polysaccharide vaccine (PPV)23) were determined from multivariate analyses. FINDINGS Of 2934 adults hospitalised with CAP, 1075 (36.6%) had pneumococcal pneumonia. The annual incidence of pneumococcal pneumonia increased from 32.2 to 48.2 per 100 000 population (2013-18), predominantly due to increases in PCV13non7-serotype and non-vaccine type (NVT)-serotype pneumonia (annual incidence rate ratio 1.12, 95% CI 1.04 to 1.21 and 1.19, 95% CI 1.10 to 1.28, respectively). Incidence trends were broadly similar to IPD data. PCV13non7 (56.9% serotype 3) and PPV23non13 (44.1% serotype 8) serotypes were identified in 349 (32.5%) and 431 (40.1%) patients with pneumococcal pneumonia, respectively. PCV13-serotype pneumonia (dominated by serotype 3) was more likely in patients in the UK pneumococcal vaccination clinical risk group (adjusted OR (aOR) 1.73, 95% CI 1.31 to 2.28) while PPV23-serotype pneumonia was more likely in patients outside the clinical risk group (aOR 1.54, 95% CI 1.13 to 2.10). INTERPRETATION The incidence of pneumococcal CAP is increasing, predominantly due to NVT serotypes and serotype 3. PPV23-serotype pneumonia is more likely in adults outside currently identified clinical risk groups.
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Affiliation(s)
- Harry Pick
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK .,Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Priya Daniel
- Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Chamira Rodrigo
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Thomas Bewick
- Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Deborah Ashton
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Hannah Lawrence
- Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Vadsala Baskaran
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | | | - Carmen Sheppard
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England Colindale, London, UK
| | - Seyi D Eletu
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England Colindale, London, UK
| | - Samuel Rose
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England Colindale, London, UK
| | - David Litt
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England Colindale, London, UK
| | - Norman K Fry
- Immunisation and Countermeasures Division, Public Health England Colindale, London, UK
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, Public Health England Colindale, London, UK
| | - Meera Chand
- Tuberculosis, Acute Respiratory, Gastrointestinal, Emerging/Zoonotic Infections, Travel and Migrant Health Service (TARGET), Public Health England Colindale, London, UK
| | - Caroline Trotter
- Disease Dynamic Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Wei Shen Lim
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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38
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Nilan K, McKeever TM, McNeill A, Raw M, Murray RL. Prevalence of tobacco use in healthcare workers: A systematic review and meta-analysis. PLoS One 2019; 14:e0220168. [PMID: 31344083 PMCID: PMC6657871 DOI: 10.1371/journal.pone.0220168] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/10/2019] [Indexed: 12/25/2022] Open
Abstract
Objectives To estimate tobacco use prevalence in healthcare workers (HCW) by country income level, occupation and sex, and compare the estimates with the prevalence in the general population. Methods We systematically searched five databases; Medline, EMBASE, CINHAL Plus, CAB Abstracts, and LILACS for original studies published between 2000 and March 2016 without language restriction. All primary studies that reported tobacco use in any category of HCW were included. Study extraction and quality assessment were conducted independently by three reviewers, using a standardised data extraction and quality appraisal form. We performed random effect meta-analyses to obtain prevalence estimates by World Bank (WB) country income level, sex, and occupation. Data on prevalence of tobacco use in the general population were obtained from the World Health Organisation (WHO) Global Health Observatory website. The review protocol registration number on PROSPERO is CRD42016041231. Results 229 studies met our inclusion criteria, representing 457,415 HCW and 63 countries: 29 high-income countries (HIC), 21 upper-middle-income countries (UMIC), and 13 lower-middle-and-low-income countries (LMLIC). The overall pooled prevalence of tobacco use in HCW was 21%, 31% in males and 17% in females. Highest estimates were in male doctors in UMIC and LMLIC, 35% and 45%, and female nurses in HIC and UMIC, 21% and 25%. Heterogeneity was high (I2 > 90%). Country level comparison suggest that in HIC male HCW tend to have lower prevalence compared with males in the general population while in females the estimates were similar. Male and female HCW in UMIC and LMLIC tend to have similar or higher prevalence rates relative to their counterparts in the general population. Conclusions HCW continue to use tobacco at high rates. Tackling HCW tobacco use requires urgent action as they are at the front line for tackling tobacco use in their patients.
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Affiliation(s)
- Kapka Nilan
- UK Centre for Tobacco and Alcohol Studies, School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, United Kingdom
- * E-mail: (KN); (RLM)
| | - Tricia M. McKeever
- UK Centre for Tobacco and Alcohol Studies, School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, United Kingdom
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, United Kingdom
| | - Martin Raw
- NYU College of Global Public Health, New York University, New York, New York, United States of America
- NYU Medical School, New York University, New York, New York, United States of America
| | - Rachael L. Murray
- UK Centre for Tobacco and Alcohol Studies, School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, United Kingdom
- * E-mail: (KN); (RLM)
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Baskaran V, Murray RL, Hunter A, Lim WS, McKeever TM. Effect of tobacco smoking on the risk of developing community acquired pneumonia: A systematic review and meta-analysis. PLoS One 2019; 14:e0220204. [PMID: 31318967 PMCID: PMC6638981 DOI: 10.1371/journal.pone.0220204] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/10/2019] [Indexed: 01/19/2023] Open
Abstract
Aim To summarise and quantify the effect of tobacco smoking on the risk of developing community acquired pneumonia (CAP) in adults. Methods We systematically searched MEDLINE, Embase, CINAHL, PsychINFO and Web of Science, from inception to October 2017, to identify case-control and cohort studies and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. The review protocol was registered with the PROSPERO database (CRD42018093943). Study quality was assessed by the Newcastle-Ottawa Scale. Pooled odds ratios (ORs) or hazard ratios (HRs) were estimated using a random-effects model. Results Of 647 studies identified, 27 studies were included (n = 460,592 participants) in the systematic review. Most of the included studies were of moderate quality with a median score of six (IQR 6–7). Meta-analysis showed that current smokers (pooled OR 2.17, 95% CI 1.70–2.76, n = 13 studies; pooled HR 1.52, 95% CI 1.13–2.04, n = 7 studies) and ex-smokers (pooled OR 1.49, 95% CI 1.26–1.75, n = 8 studies; pooled HR 1.18, 95% CI 0.91–1.52, n = 6 studies) were more likely to develop CAP compared to never smokers. Although the association between passive smoking and risk of CAP in adults of all ages was not statistically significant (pooled OR 1.13, 95% CI 0.94–1.36, n = 5 studies), passive smoking in adults aged ≥65 years was associated with a 64% increased risk of CAP (pooled OR 1.64; 95% CI 1.17–2.30, n = 2 studies). Dose-response analyses of data from five studies revealed a significant trend; current smokers who smoked higher amount of tobacco had a higher risk of CAP. Conclusion Tobacco smoke exposure is significantly associated with the development of CAP in current smokers and ex-smokers. Adults aged > 65 years who are passive smokers are also at higher risk of CAP. For current smokers, a significant dose-response relationship is evident.
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Affiliation(s)
- Vadsala Baskaran
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- * E-mail:
| | - Rachael L. Murray
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Abby Hunter
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Wei Shen Lim
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Tricia M. McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
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40
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Khan F, Stewart I, Howard L, McKeever TM, Jones S, Hearson G, Braybrooke R, Edwards C, Jenkins G, Saini G. The Its Not JUST Idiopathic pulmonary fibrosis Study (INJUSTIS): description of the protocol for a multicentre prospective observational cohort study identifying biomarkers of progressive fibrotic lung disease. BMJ Open Respir Res 2019; 6:e000439. [PMID: 31258922 PMCID: PMC6561382 DOI: 10.1136/bmjresp-2019-000439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/26/2019] [Indexed: 01/09/2023] Open
Abstract
Introduction The Its Not JUST Idiopathic pulmonary fibrosis Study (INJUSTIS) is a multicentre, prospective, observational cohort study. The aims of this study are to identify genetic, serum and other biomarkers that may identify specific molecular mechanisms, reflecting disease endotypes that are shared among patients with progressive pulmonary fibrosis regardless of aetiology. Furthermore, it is anticipated that these biomarkers will help predict fibrotic activity that may identify patterns of disease behaviour with greater accuracy than current clinical phenotyping. Methods and analysis 200 participants with the multidisciplinary team confirmed fibrotic lung disease (50 each of rheumatoid-interstitial lung disease (ILD), asbestosis, chronic hypersensitivity pneumonitis and unclassifiable ILD) and 50 idiopathic pulmonary fibrosis participants, recruited as positive controls, will be followed up for 2 years. Participants will have blood samples, lung function tests, quality of life questionnaires and a subgroup will be offered bronchoscopy. Participants will also be given the option of undertaking blinded home handheld spirometry for the first 3 months of the study. The primary end point will be identification of a biomarker that predicts disease progression, defined as 10% relative change in forced vital capacity (FVC) or death at 12 months. Ethics and dissemination The trial has received ethical approval from the National Research Ethics Committee Nottingham (18/EM/0139). All participants must provide written informed consent. The trial will be overseen by the INJUSTIS steering group that will include a patient representative, and an independent chairperson. The results from this study will be submitted for publication in peer-reviewed journals and disseminated at regional and national conferences. Trial registration number NCT03670576.
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Affiliation(s)
- Fasihul Khan
- Respiratory Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, UK
| | - Iain Stewart
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, UK
| | - Lucy Howard
- Respiratory Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, UK
| | - Steve Jones
- Action for Pulmonary Fibrosis, City Wharf, Davidson Road, Lichfield, Staffordshire, UK
| | - Glenn Hearson
- Respiratory Medicine, University Of Nottingham, Nottingham, UK
| | - Rebecca Braybrooke
- Respiratory Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, UK
| | - Colin Edwards
- patientMpower Ltd, The Digital Depot, Thomas Street, Dublin, Ireland
| | - Gisli Jenkins
- Respiratory Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, UK
| | - Gauri Saini
- Respiratory Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, UK
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Abstract
OBJECTIVE To assess the incidence of hip fracture and all major osteoporotic fractures (MOF) in patients with chronic obstructive pulmonary disease (COPD) compared with non-COPD patients and to evaluate the use and performance of fracture risk prediction tools in patients with COPD. To assess the prevalence and incidence of osteoporosis. DESIGN Population-based cohort study. SETTING UK General Practice health records from The Health Improvement Network database. PARTICIPANTS Patients with an incident COPD diagnosis from 2004 to 2015 and non-COPD patients matched by age, sex and general practice were studied. OUTCOMES Incidence of fracture (hip alone and all MOF); accuracy of fracture risk prediction tools in COPD; and prevalence and incidence of coded osteoporosis. METHODS Cox proportional hazards models were used to assess the incidence rates of osteoporosis, hip fracture and MOF (hip, proximal humerus, forearm and clinical vertebral fractures). The discriminatory accuracies (area under the receiver operating characteristic [ROC] curve) of fracture risk prediction tools (FRAX and QFracture) in COPD were assessed. RESULTS Patients with COPD (n=80 874) were at an increased risk of fracture (both hip alone and all MOF) compared with non-COPD patients (n=308 999), but this was largely mediated through oral corticosteroid use, body mass index and smoking. Retrospectively calculated ROC values for MOF in COPD were as follows: FRAX: 71.4% (95% CI 70.6% to 72.2%), QFracture: 61.4% (95% CI 60.5% to 62.3%) and for hip fracture alone, both 76.1% (95% CI 74.9% to 77.2%). Prevalence of coded osteoporosis was greater for patients (5.7%) compared with non-COPD patients (3.9%), p<0.001. The incidence of osteoporosis was increased in patients with COPD (n=73 084) compared with non-COPD patients (n=264 544) (adjusted hazard ratio, 1.13, 95% CI 1.05 to 1.22). CONCLUSION Patients with COPD are at an increased risk of fractures and osteoporosis. Despite this, there is no systematic assessment of fracture risk in clinical practice. Fracture risk tools identify those at high risk of fracture in patients with COPD.
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Affiliation(s)
- Ralph Kwame Akyea
- Nottingham Respiratory Research Unit, NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Division of Epidemiology & Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- Nottingham Respiratory Research Unit, NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Division of Epidemiology & Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jack Gibson
- Division of Epidemiology & Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jane E Scullion
- Institute for Lung Health, University Hospitals of Leicester Glenfield Site, Leicester, UK
| | - Charlotte E Bolton
- Nottingham Respiratory Research Unit, NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
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42
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Pick HJ, Bolton CE, Lim WS, McKeever TM. Patient-reported outcome measures in the recovery of adults hospitalised with community-acquired pneumonia: a systematic review. Eur Respir J 2019; 53:13993003.02165-2018. [PMID: 30635298 DOI: 10.1183/13993003.02165-2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/19/2018] [Indexed: 11/05/2022]
Abstract
Symptomatic and functional recovery are important patient-reported outcome measures (PROMs) in community-acquired pneumonia (CAP) that are increasingly used as trial end-points. This systematic review summarises the literature on PROMs in CAP.Comprehensive searches in accordance with the PRISMA statement were conducted to March 2017. Eligible studies included adults discharged from hospital following confirmed CAP and reporting PROMs.15 studies (n=5644 patients) were included; most were of moderate quality. Studies used a wide range of PROMs and assessment tools. At 4-6 weeks post-discharge, the commonest symptom reported was fatigue (45.0-72.6% of patients, three studies), followed by cough (35.3-69.7%) and dyspnoea (34.2-67.1%); corresponding values from studies restricted by age <65 years (two studies) were lower: fatigue 12.1-25.7%, cough 19.9-31.9% and dyspnoea 16.8-27.5%. Functional impairment 4 weeks post-discharge was reported in 18-51% of patients (two studies), while median time to return to normal activities was between 15 and 28 days (three studies).Substantial morbidity is reported by patients up to 6 weeks post-discharge. There is weak methodological consistency across existing studies. A core set of PROMs for use in future studies is suggested.
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Affiliation(s)
- Harry J Pick
- Dept of Respiratory Medicine, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Charlotte E Bolton
- NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, Nottingham, UK
| | - Wei Shen Lim
- Dept of Respiratory Medicine, Nottingham University Hospital NHS Trust, Nottingham, UK.,NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
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43
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Shrine N, Portelli MA, John C, Soler Artigas M, Bennett N, Hall R, Lewis J, Henry AP, Billington CK, Ahmad A, Packer RJ, Shaw D, Pogson ZEK, Fogarty A, McKeever TM, Singapuri A, Heaney LG, Mansur AH, Chaudhuri R, Thomson NC, Holloway JW, Lockett GA, Howarth PH, Djukanovic R, Hankinson J, Niven R, Simpson A, Chung KF, Sterk PJ, Blakey JD, Adcock IM, Hu S, Guo Y, Obeidat M, Sin DD, van den Berge M, Nickle DC, Bossé Y, Tobin MD, Hall IP, Brightling CE, Wain LV, Sayers I. Moderate-to-severe asthma in individuals of European ancestry: a genome-wide association study. Lancet Respir Med 2019; 7:20-34. [PMID: 30552067 PMCID: PMC6314966 DOI: 10.1016/s2213-2600(18)30389-8] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Few genetic studies that focus on moderate-to-severe asthma exist. We aimed to identity novel genetic variants associated with moderate-to-severe asthma, see whether previously identified genetic variants for all types of asthma contribute to moderate-to-severe asthma, and provide novel mechanistic insights using expression analyses in patients with asthma. METHODS In this genome-wide association study, we used a two-stage case-control design. In stage 1, we genotyped patient-level data from two UK cohorts (the Genetics of Asthma Severity and Phenotypes [GASP] initiative and the Unbiased BIOmarkers in PREDiction of respiratory disease outcomes [U-BIOPRED] project) and used data from the UK Biobank to collect patient-level genomic data for cases and controls of European ancestry in a 1:5 ratio. Cases were defined as having moderate-to-severe asthma if they were taking appropriate medication or had been diagnosed by a doctor. Controls were defined as not having asthma, rhinitis, eczema, allergy, emphysema, or chronic bronchitis as diagnosed by a doctor. For stage 2, an independent cohort of cases and controls (1:5) was selected from the UK Biobank only, with no overlap with stage 1 samples. In stage 1 we undertook a genome-wide association study of moderate-to-severe asthma, and in stage 2 we followed up independent variants that reached the significance threshold of p less than 1 × 10-6 in stage 1. We set genome-wide significance at p less than 5 × 10-8. For novel signals, we investigated their effect on all types of asthma (mild, moderate, and severe). For all signals meeting genome-wide significance, we investigated their effect on gene expression in patients with asthma and controls. FINDINGS We included 5135 cases and 25 675 controls for stage 1, and 5414 cases and 21 471 controls for stage 2. We identified 24 genome-wide significant signals of association with moderate-to-severe asthma, including several signals in innate or adaptive immune-response genes. Three novel signals were identified: rs10905284 in GATA3 (coded allele A, odds ratio [OR] 0·90, 95% CI 0·88-0·93; p=1·76 × 10-10), rs11603634 in the MUC5AC region (coded allele G, OR 1·09, 1·06-1·12; p=2·32 × 10-8), and rs560026225 near KIAA1109 (coded allele GATT, OR 1·12, 1·08-1·16; p=3·06 × 10-9). The MUC5AC signal was not associated with asthma when analyses included mild asthma. The rs11603634 G allele was associated with increased expression of MUC5AC mRNA in bronchial epithelial brush samples via proxy SNP rs11602802; (p=2·50 × 10-5) and MUC5AC mRNA was increased in bronchial epithelial samples from patients with severe asthma (in two independent analyses, p=0·039 and p=0·022). INTERPRETATION We found substantial shared genetic architecture between mild and moderate-to-severe asthma. We also report for the first time genetic variants associated with the risk of developing moderate-to-severe asthma that regulate mucin production. Finally, we identify candidate causal genes in these loci and provide increased insight into this difficult to treat population. FUNDING Asthma UK, AirPROM, U-BIOPRED, UK Medical Research Council, and Rosetrees Trust.
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Affiliation(s)
- Nick Shrine
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Michael A Portelli
- Division of Respiratory Medicine, National Institute for Health Research, Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Catherine John
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Neil Bennett
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Robert Hall
- Division of Respiratory Medicine, National Institute for Health Research, Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Jon Lewis
- Division of Respiratory Medicine, National Institute for Health Research, Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Amanda P Henry
- Division of Respiratory Medicine, National Institute for Health Research, Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Charlotte K Billington
- Division of Respiratory Medicine, National Institute for Health Research, Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Azaz Ahmad
- Division of Respiratory Medicine, National Institute for Health Research, Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Richard J Packer
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Dominick Shaw
- Division of Respiratory Medicine, National Institute for Health Research, Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Zara E K Pogson
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Andrew Fogarty
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Amisha Singapuri
- Institute for Lung Health, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK; Glenfield Hospital, Leicester, UK
| | - Liam G Heaney
- Centre for Infection and Immunity, Queen's University of Belfast, Belfast, UK
| | - Adel H Mansur
- Respiratory Medicine, Birmingham Heartlands Hospital and University of Birmingham, Birmingham, UK
| | - Rekha Chaudhuri
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Neil C Thomson
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - John W Holloway
- Human Development and Health, Clinical and Experimental Sciences, Faculty of Medicine and National Institute of Health Biomedical Research Centre, Southampton, University of Southampton, Southampton, UK
| | - Gabrielle A Lockett
- Human Development and Health, Clinical and Experimental Sciences, Faculty of Medicine and National Institute of Health Biomedical Research Centre, Southampton, University of Southampton, Southampton, UK
| | - Peter H Howarth
- Human Development and Health, Clinical and Experimental Sciences, Faculty of Medicine and National Institute of Health Biomedical Research Centre, Southampton, University of Southampton, Southampton, UK
| | - Ratko Djukanovic
- Human Development and Health, Clinical and Experimental Sciences, Faculty of Medicine and National Institute of Health Biomedical Research Centre, Southampton, University of Southampton, Southampton, UK
| | - Jenny Hankinson
- Division of Infection Immunity and Respiratory Medicine, The University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation Trust, Manchester, UK
| | - Robert Niven
- Division of Infection Immunity and Respiratory Medicine, The University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation Trust, Manchester, UK
| | - Angela Simpson
- Division of Infection Immunity and Respiratory Medicine, The University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation Trust, Manchester, UK
| | - Kian Fan Chung
- The National Heart and Lung Institute, Imperial College, London, UK
| | - Peter J Sterk
- Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - John D Blakey
- Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Ian M Adcock
- The National Heart and Lung Institute, Imperial College, London, UK
| | - Sile Hu
- Data Science Institute, Imperial College, London, UK
| | - Yike Guo
- Data Science Institute, Imperial College, London, UK
| | - Maen Obeidat
- The University of British Columbia Center for Heart Lung Innovation, St Paul's Hospital Vancouver, Vancouver, BC, Canada
| | - Don D Sin
- The University of British Columbia Center for Heart Lung Innovation, St Paul's Hospital Vancouver, Vancouver, BC, Canada; Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Maarten van den Berge
- University of Groningen, University Medical Center Groningen, Department of Pulmonology, Groningen Research Institute for Asthma and COPD Research Institute, Groningen, Netherlands
| | | | - Yohan Bossé
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Molecular Medicine, Laval University, Quebec City, QC, Canada
| | - Martin D Tobin
- Department of Health Sciences, University of Leicester, Leicester, UK; National Institute for Health Research, Leicester Respiratory Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ian P Hall
- Division of Respiratory Medicine, National Institute for Health Research, Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Christopher E Brightling
- Institute for Lung Health, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK; National Institute for Health Research, Leicester Respiratory Biomedical Research Centre, University of Leicester, Leicester, UK; Glenfield Hospital, Leicester, UK
| | - Louise V Wain
- Department of Health Sciences, University of Leicester, Leicester, UK; National Institute for Health Research, Leicester Respiratory Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ian Sayers
- Division of Respiratory Medicine, National Institute for Health Research, Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK.
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Jones GS, McKeever TM, Hubbard RB, Khakwani A, Baldwin DR. Factors influencing treatment selection and 30-day mortality after chemotherapy for people with small-cell lung cancer: An analysis of national audit data. Eur J Cancer 2018; 103:176-183. [PMID: 30261439 DOI: 10.1016/j.ejca.2018.07.133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/04/2018] [Accepted: 07/24/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Thirty-day mortality after treatment for lung cancer is a measure of unsuccessful outcome and where treatment should have been avoided. Guidelines recommend offering chemotherapy to individuals with small-cell lung cancer (SCLC) who have poorer performance status (PS) because of its high initial response rate. However, this comes with an increased risk of toxicity and early death. We quantified real-world 30-day mortality in SCLC after chemotherapy, established the factors associated with this and compared these with the factors that influence receipt of chemotherapy. METHODS We used linked national English data sets to define the factors associated with both receiving chemotherapy and 30-day mortality after chemotherapy. RESULTS We identified 3715 people diagnosed with SCLC, of which 2235 (60.2%) received chemotherapy. There were 174 (7.8%) deaths within 30 days of chemotherapy. The adjusted odds of receiving chemotherapy decreased with older age, worsening PS and increasing comorbidities. Thirty-day mortality was independently associated with poor PS [PS 2 vs PS 0, adjusted odds ratio (OR) 3.75, 95% confidence interval (CI) 1.71-8.25] and stage (extensive vs limited adjusted OR 1.68, 95% CI 1.03-2.74) but in contrast was not associated with increasing age. Both chemotherapy administration and 30-day mortality varied by hospital network. CONCLUSIONS To reduce variation in chemotherapy administration, predictors of 30-day mortality could be used as an adjunct to improve suboptimal patient selection. We have quantified 30-day mortality risk by the two independently associated factors, PS and stage, so that patients and clinicians can make better informed decisions about the potential risk of early death after chemotherapy.
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Affiliation(s)
- Gavin S Jones
- Division of Epidemiology and Public Health, Clinical Sciences Building, Nottingham, NG5 1PB, UK.
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - Richard B Hubbard
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - Aamir Khakwani
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - David R Baldwin
- Division of Epidemiology and Public Health, University of Nottingham, UK; Department of Respiratory Medicine, Nottingham University Hospitals, UK
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Nilan K, McNeill A, Murray RL, McKeever TM, Raw M. A survey of tobacco dependence treatment guidelines content in 61 countries. Addiction 2018; 113:1499-1506. [PMID: 29488266 PMCID: PMC6099485 DOI: 10.1111/add.14204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/18/2017] [Accepted: 02/20/2018] [Indexed: 11/26/2022]
Abstract
AIMS To assess tobacco dependence treatment guidelines content in accordance with Article 14 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and its guidelines, and association between content and country income level. DESIGN Cross-sectional study. SETTING On-line survey from March to July 2016. PARTICIPANTS Contacts in 77 countries, including 68 FCTC Parties, six Signatories and three non-Parties which had indicated having guidelines in previous surveys, or had not been surveyed before. MEASUREMENTS A nine-item questionnaire on guidelines content, key recommendations, writing and dissemination. FINDINGS We received responses from contacts in 63 countries (82%); 61 had guidelines. The majority are for doctors (93%), primary care (92%) and nurses (75%). All recommend brief advice, 82% recording tobacco use in medical notes, 98% nicotine replacement therapy (NRT), 61% quitlines, 31% text messaging and 87% intensive specialist support, and 54% stress the importance of health-care workers not using tobacco. Only 57% have a dissemination strategy, and 62% have not been updated for 5 or more years. Compared with high-income countries, quitlines are less likely to be recommended in upper middle-income countries guidelines [odds ratio (OR) = 0.15, 95% confidence interval (CI) = 0.04-0.61] and intensive specialist support in lower middle-income countries guidelines (OR = 0.01, 95% CI = 0.00-0.20). Guidelines updating is associated positively with country income level (P = 0.027). CONCLUSIONS Although most tobacco dependence treatment guidelines in the 61 countries assessed in 2016 follow the World Health Organization's Framework Convention on Tobacco Control Article 14 recommendations and do not differ significantly by income level, improvements are needed in keeping guidelines up-to-date, applying good writing practices and developing a dissemination strategy.
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Affiliation(s)
- Kapka Nilan
- UK Centre for Tobacco and Alcohol Studies, School of MedicineUniversity of NottinghamNottinghamUK
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol StudiesInstitute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College LondonLondonUK
| | - Rachael L. Murray
- UK Centre for Tobacco and Alcohol Studies, School of MedicineUniversity of NottinghamNottinghamUK
| | - Tricia M. McKeever
- UK Centre for Tobacco and Alcohol Studies, School of MedicineUniversity of NottinghamNottinghamUK
| | - Martin Raw
- New York University College of Global Public Health and NYU Medical SchoolNew YorkNYUSA
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Forster S, Housley G, McKeever TM, Shaw DE. Investigating the discriminative value of Early Warning Scores in patients with respiratory disease using a retrospective cohort analysis of admissions to Nottingham University Hospitals Trust over a 2-year period. BMJ Open 2018; 8:e020269. [PMID: 30061434 PMCID: PMC6067348 DOI: 10.1136/bmjopen-2017-020269] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Early Warning Scores (EWSs) are used to monitor patients for signs of imminent deterioration. Although used in respiratory disease, EWSs have not been well studied in this population, despite the underlying cardiopulmonary pathophysiology often present. We examined the performance of two scoring systems in patients with respiratory disease. DESIGN Retrospective cohort analysis of vital signs observations of all patients admitted to a respiratory unit over a 2-year period. Scores were linked to outcome data to establish the performance of the National EWS (NEWS) compared results to a locally adapted EWS. SETTING Nottingham University Hospitals National Health Service Trust respiratory wards. Data were collected from an integrated electronic observation and task allocation system employing a local EWS, also generating mandatory referrals to clinical staff at set scoring thresholds. OUTCOME MEASURES Projected workload, and sensitivity and specificity of the scores in predicting mortality based on outcome within 24 hours of a score being recorded. RESULTS 8812 individual patient episodes occurred during the study period. Overall, mortality was 5.9%. Applying NEWS retrospectively (vs local EWS) generated an eightfold increase in mandatory escalations, but had higher sensitivity in predicting mortality at the protocol cut points. CONCLUSIONS This study highlights issues surrounding use of scoring systems in patients with respiratory disease. NEWS demonstrated higher sensitivity for predicting death within 24 hours, offset by reduced specificity. The consequent workload generated may compromise the ability of the clinical team to respond to patients needing immediate input. The locally adapted EWS has higher specificity but lower sensitivity. Statistical evaluation suggests this may lead to missed opportunities for intervention, however, this does not account for clinical concern independent of the scores, nor ability to respond to alerts based on workload. Further research into the role of warning scores and the impact of chronic pathophysiology is urgently needed.
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Affiliation(s)
- Sarah Forster
- NIHR Academic Clinical Fellow, University of Nottingham, Nottingham, UK
- Respiratory Research Unit, Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Gemma Housley
- Medical Informatics, East Midlands Academic Health Sciences Network, Nottingham, UK
| | | | - Dominick E Shaw
- Respiratory Research Unit, Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
- Medical Informatics, East Midlands Academic Health Sciences Network, Nottingham, UK
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Abstract
A matched cohort study was conducted to determine the incidence of falls in patients following a diagnosis of COPD using a UK primary care database. 44 400 patients with COPD and 175 545 non-COPD subjects were identified. The incidence rate of fall per 1000 person-years in patients with COPD was higher (44.9; 95% CI 44.1 to 45.8) compared with non-COPD subjects (24.1; 95% CI 23.8 to 24.5) (P<0.0001). Patients with COPD were 55% more likely to have an incident record of fall than non-COPD subjects (adjusted HR, 1.55; 95% CI 1.50 to 1.59). The greater falls risk in patients with COPD needs consideration and modifiable factors addressed.
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Affiliation(s)
- Ali Hakamy
- Nottingham Respiratory Research Unit, NIHR Nottingham BRC, School of Medicine, University of Nottingham, Nottingham, UK.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Charlotte E Bolton
- Nottingham Respiratory Research Unit, NIHR Nottingham BRC, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jack E Gibson
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
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Thomson RJ, Aung N, Sanghvi MM, Paiva JM, Lee AM, Zemrak F, Fung K, Pfeffer PE, Mackay AJ, McKeever TM, Lukaschuk E, Carapella V, Kim YJ, Bolton CE, Piechnik SK, Neubauer S, Petersen SE. Variation in lung function and alterations in cardiac structure and function-Analysis of the UK Biobank cardiovascular magnetic resonance imaging substudy. PLoS One 2018; 13:e0194434. [PMID: 29558496 PMCID: PMC5860758 DOI: 10.1371/journal.pone.0194434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 03/03/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Reduced lung function is common and associated with increased cardiovascular morbidity and mortality, even in asymptomatic individuals without diagnosed respiratory disease. Previous studies have identified relationships between lung function and cardiovascular structure in individuals with pulmonary disease, but the relationships in those free from diagnosed cardiorespiratory disease have not been fully explored. METHODS UK Biobank is a prospective cohort study of community participants in the United Kingdom. Individuals self-reported demographics and co-morbidities, and a subset underwent cardiovascular magnetic resonance (CMR) imaging and spirometry. CMR images were analysed to derive ventricular volumes and mass. The relationships between CMR-derived measures and spirometry and age were modelled with multivariable linear regression, taking account of the effects of possible confounders. RESULTS Data were available for 4,975 individuals, and after exclusion of those with pre-existing cardiorespiratory disease and unacceptable spirometry, 1,406 were included in the analyses. In fully-adjusted multivariable linear models lower FEV1 and FVC were associated with smaller left ventricular end-diastolic (-5.21ml per standard deviation (SD) change in FEV1, -5.69ml per SD change in FVC), end-systolic (-2.34ml, -2.56ml) and stroke volumes (-2.85ml, -3.11ml); right ventricular end-diastolic (-5.62ml, -5.84ml), end-systolic (-2.47ml, -2.46ml) and stroke volumes (-3.13ml, -3.36ml); and with lower left ventricular mass (-2.29g, -2.46g). Changes of comparable magnitude and direction were observed per decade increase in age. CONCLUSIONS This study shows that reduced FEV1 and FVC are associated with smaller ventricular volumes and reduced ventricular mass. The changes seen per standard deviation change in FEV1 and FVC are comparable to one decade of ageing.
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Affiliation(s)
- Ross J. Thomson
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom
| | - Nay Aung
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom
| | - Mihir M. Sanghvi
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom
| | - Jose Miguel Paiva
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom
| | - Aaron M. Lee
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom
| | - Filip Zemrak
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom
| | - Paul E. Pfeffer
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom
- Barts Health NHS Trust, London, United Kingdom
| | | | - Tricia M. McKeever
- Nottingham Respiratory Research Unit, NIHR Nottingham Biomedical Research Centre, School of Medicine, City Hospital NUH Trust Campus, University of Nottingham, Nottingham, United Kingdom
| | - Elena Lukaschuk
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Valentina Carapella
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Young Jin Kim
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Charlotte E. Bolton
- Nottingham Respiratory Research Unit, NIHR Nottingham Biomedical Research Centre, School of Medicine, City Hospital NUH Trust Campus, University of Nottingham, Nottingham, United Kingdom
| | - Stefan K. Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Steffen E. Petersen
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom
- * E-mail:
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Daniel P, Rodrigo C, Bewick T, Sheppard C, Greenwood S, McKeever TM, Trotter C, Lim WS. 13-Valent vaccine serotype pneumococcal community acquired pneumonia in adults in high clinical risk groups. Vaccine 2018; 36:1614-1620. [DOI: 10.1016/j.vaccine.2018.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 01/29/2018] [Accepted: 02/01/2018] [Indexed: 11/24/2022]
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Daniel P, Bewick T, McKeever TM, Roberts M, Ashton D, Smith D, Latip L, Lim WS. Healthcare reconsultation in working-age adults following hospitalisation for community-acquired pneumonia. Clin Med (Lond) 2018; 18:41-46. [PMID: 29436438 PMCID: PMC6330906 DOI: 10.7861/clinmedicine.18-1-41] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Community-acquired pneumonia (CAP) is associated with prolonged symptom persistence during recovery. However, the effect of the residual symptom load on healthcare utilisation is unknown. The aim of this study was to quantify healthcare reconsultation within 28 days of hospital discharge for an index episode of CAP, and explore reasons for these reconsultations. Adults of working age admitted to any of four hospitals in the UK, with a primary diagnosis of CAP, were prospectively studied. Of 108 patients, 71 (65.7%) reconsulted healthcare services within 28 days of discharge; of these, 90.1% consulted their GP. Men were less likely to reconsult than women (adjusted odds ratio [aOR] 0.34, 95% confidence interval 0.13-0.91, p=0.032). Persistence of respiratory symptoms accounted for the majority of these reconsultations. Healthcare utilisation is high in working-age adults after an episode of hospitalised CAP and, in most cases, is due to failure to resolve index symptoms.
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Affiliation(s)
- Priya Daniel
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Thomas Bewick
- Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | | | - Mark Roberts
- Department of Respiratory Medicine, King's Mill Hospital, Mansfield, UK
| | - Deborah Ashton
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Daniel Smith
- Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Lenny Latip
- Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Wei Shen Lim
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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