Imperial College London

Professor Martyn Partridge National Heart and Lung Institute

Faculty of MedicineNational Heart & Lung Institute

Professor of Respiratory Medicine and Patient Centred Care
 
 
 
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Contact

 

+44 (0)20 7351 8174m.partridge

 
 
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Location

 

Guy Scadding BuildingRoyal Brompton Campus

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Summary

 

Publications

Publication Type
Year
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184 results found

Effing TW, Vercoulen JH, Bourbeau J, Trappenburg J, Lenferink A, Cafarella P, Coultas D, Meek P, van der Valk P, Bischoff EWMA, Bucknall C, Dewan NA, Early F, Fan V, Frith P, Janssen DJA, Mitchell K, Morgan M, Nici L, Patel I, Walters H, Rice KL, Singh S, Zuwallack R, Benzo R, Goldstein R, Partridge MR, van der Palen J, Effing TW, Vercoulen JH, Bourbeau J, Trappenburg J, Lenferink A, Cafarella P, Coultas D, Meek P, van der Valk P, Bischoff EWMA, Bucknall C, Dewan NA, Early F, Fan V, Frith P, Janssen DJA, Mitchell K, Morgan M, Nici L, Patel I, Walters H, Rice KL, Singh S, Zuwallack R, Benzo R, Goldstein R, Partridge MR, van der Palen J, Effing TW, Vercoulen JH, Bourbeau J, Trappenburg J, Lenferink A, Cafarella P, Coultas D, Meek P, Van Der Valk P, Bischoff EWMA, Bucknall C, Dewan NA, Early F, Fan V, Frith P, Janssen DJA, Mitchell K, Morgan M, Nici L, Patel I, Walters H, Rice KL, Singh S, Zuwallack R, Benzo R, Goldstein R, Partridge MR, Van Der Palen J, Effing TW, Vercoulen JH, Bourbeau J, Trappenburg J, Lenferink A, Cafarella P, Coultas D, Meek P, van der Valk P, Bischoff EW, Bucknall C, Dewan NA, Early F, Fan V, Frith P, Janssen DJ, Mitchell K, Morgan M, Nici L, Patel I, Walters H, Rice KL, Singh S, Zuwallack R, Benzo R, Goldstein R, Partridge MR, van der Palen J, Effing TW, Vercoulen JH, Bourbeau J, Trappenburg J, Lenferink A, Cafarella P, Coultas D, Meek P, van der Valk P, Bischoff EWMA, Bucknall C, Dewan NA, Early F, Fan V, Frith P, Janssen DJA, Mitchell K, Morgan M, Nici L, Patel I, Walters H, Rice KL, Singh S, Zuwallack R, Benzo R, Goldstein R, Partridge MR, van der Palen J, Effing TW, Vercoulen JH, Bourbeau J, Trappenburg J, Lenferink A, Cafarella P, Coultas D, Meek P, van der Valk P, Bischoff EW, Bucknall C, Dewan NA, Early F, Fan V, Frith P, Janssen DJ, Mitchell K, Morgan M, Nici L, Patel I, Walters H, Rice KL, Singh S, Zuwallack R, Benzo R, Goldstein R, Partridge MR, van der Palen Jet al., 2016, Definition of a COPD self-management intervention: International Expert Group consensus, EUROPEAN RESPIRATORY JOURNAL, Vol: 48, Pages: 46-54, ISSN: 0903-1936

There is an urgent need for consensus on what defines a chronic obstructive pulmonary disease (COPD) self-management intervention. We aimed to obtain consensus regarding the conceptual definition of a COPD self-management intervention by engaging an international panel of COPD self-management experts using Delphi technique features and an additional group meeting.In each consensus round the experts were asked to provide feedback on the proposed definition and to score their level of agreement (1=totally disagree; 5=totally agree). The information provided was used to modify the definition for the next consensus round. Thematic analysis was used for free text responses and descriptive statistics were used for agreement scores.In total, 28 experts participated. The consensus round response rate varied randomly over the five rounds (ranging from 48% (n=13) to 85% (n=23)), and mean definition agreement scores increased from 3.8 (round 1) to 4.8 (round 5) with an increasing percentage of experts allocating the highest score of 5 (round 1: 14% (n=3); round 5: 83% (n=19)).In this study we reached consensus regarding a conceptual definition of what should be a COPD self-management intervention, clarifying the requisites for such an intervention. Operationalisation of this conceptual definition in the near future will be an essential next step.

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Roberts NJ, Patel IS, Partridge MR, Roberts NJ, Patel IS, Partridge MR, Roberts NJ, Patel IS, Partridge MR, Roberts NJ, Patel IS, Partridge MRet al., 2016, The diagnosis of COPD in primary care; gender differences and the role of spirometry, RESPIRATORY MEDICINE, Vol: 111, Pages: 60-63, ISSN: 0954-6111

BACKGROUND: Females with exacerbations of Chronic Obstructive Pulmonary Disease now account for one half of all hospital admissions for that condition and rates have been increasing over the last few decades. Differences in presentations of disease between genders have been shown in several conditions and this study explores whether there are inter gender biases in probable diagnoses in those suspected to have COPD. METHODS: 445 individuals with a provisional diagnosis by their General Practitioner of "suspected COPD" or "definite COPD" were referred to a community Respiratory Assessment unit (CRAU) for tests including spirometry. Gender, demographics, respiratory symptoms and respiratory medical history were recorded. The provisional diagnoses were compared with the final diagnosis made after spirometry and respiratory specialist nurse review and the provisional diagnosis was either confirmed as correct or refuted as unlikely. RESULTS: Significantly more men (87.5%) had their diagnosis of "definite COPD" confirmed compared to 73.9% of women (p = 0.021). When the GP suggested a provisional diagnosis of "suspected COPD" (n = 265) at referral, this was confirmed in 60.9% of men and only 43.2% of women (p = 0.004). There was a different symptom pattern between genders with women being more likely to report allergies, symptoms starting earlier in life, and being less likely than men to report breathlessness as the main symptom. CONCLUSIONS: These results may suggest a difference between genders in some of the clinical features of COPD and a difference in likelihood of a GPs provisional diagnosis of COPD being correct. The study reiterates the absolute importance of spirometry in the diagnosis of COPD.

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Drakatos P, Ghiassi R, Jarrold I, Harris J, Abidi A, Douiri A, Hart N, Kosky C, Williams AJ, Partridge MR, Steier J, Drakatos P, Ghiassi R, Jarrold I, Harris J, Abidi A, Douiri A, Hart N, Kosky C, Williams AJ, Partridge MR, Steier J, Drakatos P, Ghiassi R, Jarrold I, Harris J, Abidi A, Douiri A, Hart N, Kosky C, Williams AJ, Partridge MR, Steier Jet al., 2015, The use of an online pictorial Epworth Sleepiness Scale in the assessment of age and gender specific differences in excessive daytime sleepiness, JOURNAL OF THORACIC DISEASE, Vol: 7, Pages: 897-902, ISSN: 2072-1439

BACKGROUND: Excessive daytime sleepiness (EDS) is a non-specific but highly prevalent cardinal symptom of sleep disorders. We hypothesized that with modern media and an online pictorial Epworth Sleepiness Scale (ESS) age and gender specific differences of EDS could be identified on a large scale. This could be helpful in the screening of patients with sleep disorders. PATIENTS AND METHODS: In 8,098 subjects, age and gender were recorded in addition to an online pictorial ESS (range 0-24 points). The cut-off for EDS (ESS >10 points) was chosen in line with the traditional ESS. RESULTS: The prevalence of EDS was slightly higher in male subjects (45% vs. 43%, P=0.033). When age was considered, female subjects tended to be sleepier in their 3(rd) and 4(th) lifetime decade (P=0.01 and P=0.003, respectively), whilst male subjects scored significantly higher in their 7(th) decade (P<0.0001); there was a trend to more daytime symptoms with higher age (P for trend <0.001). CONCLUSIONS: The online pictorial ESS identifies gender differences in EDS and reveals increased levels of sleepiness associated with higher age. The use of modern media facilitates reaching out to the general population to raise awareness of conditions associated with EDS such as sleep apnoea.

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Partridge MR, Partridge MR, Partridge MR, Partridge MRet al., 2015, Television Advertising of Medicines Unexpected Consequences?, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 192, Pages: 2-3, ISSN: 1073-449X

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Chung KF, Partridge M, Tetley TD, Chung KF, Partridge M, Tetley TD, Chung KFA, Partridge M, Tetley TD, Chung KF, Partridge M, Tetley TD, Chung KF, Partridge M, Tetley TDet al., 2014, Abraham ("Abe") Guz: a life devoted to breathing and breathlessness, EUROPEAN RESPIRATORY JOURNAL, Vol: 44, Pages: 1423-1425, ISSN: 0903-1936

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Partridge MR, Partridge MR, Partridge MR, 2014, Enhancing the diagnosis and management of COPD in Primary care., Multidiscip Respir Med, Vol: 9, Pages: 62-62, ISSN: 1828-695X

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Partridge MR, Partridge MR, Partridge MR, Partridge MRet al., 2014, Medicine: a rethink? Are entrants to the profession and the way it is organised fit for purpose?, CLINICAL MEDICINE, Vol: 14, Pages: 225-228, ISSN: 1470-2118

The health burden in most countries has changed. Although acute care is needed for trauma, acute illness and exacerbations of chronic disease, most of the burden is now long term. These patients need different approaches, with more emphasis upon supporting self-management, enhancing lifestyle changes, aiding compliance by shared decision-making and providing more convenient follow-up that appreciates the likelihood of multimorbidity. Integrated care will increasingly be offered from within the community. The current hospital- and doctor-centric focus needs to change to one where specialists work in the community as much as in hospitals and share this different type of care with others. For potential future doctors, the scientific basis of medicine will still underpin their unique role in diagnosis and prescribing, but they will need to understand these other changes and to be selected according to attributes compatible with their future role, and then be trained and assessed accordingly.

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Reddel HK, Jenkins CR, Partridge MR, Reddel HK, Jenkins CR, Partridge MR, Reddel HK, Jenkins CR, Partridge MR, Reddel HK, Jenkins CR, Partridge MRet al., 2014, Self-management support and other alternatives to reduce the burden of asthma and chronic obstructive pulmonary disease, INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE, Vol: 18, Pages: 1396-1406, ISSN: 1027-3719

While pharmacotherapy is important in the management of asthma and chronic obstructive pulmonary disease, it is also important to consider additional interventions that can further reduce the burden of ill health for patients, their families and the health care system. In this review, the evidence in favour of self-management support that leads to successful self-care by the patient is reviewed, and the key components of successful strategies are outlined; areas where more research is needed are identified. In addition to self-management support, other methods of delivering care, such as telemonitoring, admission avoidance, assisted discharge schemes and use of lay educators, are reviewed.

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Burgel P-R, Paillasseur J-L, Partridge M, Miravitlles M, Cazzola M, Vogelmeier C, Leynaud D, Ostinelli J, Kessler Ret al., 2013, Impact of age-related comorbidities on the risk of COPD exacerbations in subjects with severe airflow limitation: A pan-European study, EUROPEAN RESPIRATORY JOURNAL, Vol: 42, ISSN: 0903-1936

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Partridge MR, Partridge MR, Partridge MR, 2013, Redefining Medicine, Transforming Healthcare: The Lee Kong Chian School of Medicine, ANNALS ACADEMY OF MEDICINE SINGAPORE, Vol: 42, Pages: 165-167, ISSN: 0304-4602

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Effing TW, Bourbeau J, Vercoulen J, Apter AJ, Coultas D, Meek P, van der Valk P, Partridge MR, van der Palen J, Effing TW, Bourbeau J, Vercoulen J, Apter AJ, Coultas D, Meek P, Valk PV, Partridge MR, Palen JV, Effing TW, Bourbeau J, Vercoulen J, Apter AJ, Coultas D, Meek P, Valk P, Partridge MR, Palen J, Effing TW, Bourbeau J, Vercoulen J, Apter AJ, Coultas D, Meek P, Valk PVD, Partridge MR, Palen JVDet al., 2012, Self-management programmes for COPD: Moving forward, CHRONIC RESPIRATORY DISEASE, Vol: 9, Pages: 27-35, ISSN: 1479-9723

Self-management is of increasing importance in chronic obstructive pulmonary disease (COPD) management. However, there is confusion over what processes are involved, how the value of self-management should be determined, and about the research priorities. To gain more insight into and agreement about the content of programmes, outcomes, and future directions of COPD self-management, a group of interested researchers and physicians, all of whom had previously published on this subject and who had previously collaborated on other projects, convened a workshop. This article summarises their initial findings. Self-management programmes aim at structural behaviour change to sustain treatment effects after programmes have been completed. The programmes should include techniques aimed at behavioural change, be tailored individually, take the patient's perspective into account, and may vary with the course of the patient's disease and co-morbidities. Assessment should include process variables. This report is a step towards greater conformity in the field of self-management. To enhance clarity regarding effectiveness, future studies should clearly describe their intervention, be properly designed and powered, and include outcomes that focus more on the acquisition and practice of new skills. In this way more evidence and a better comprehension on self-management programmes will be obtained, and more specific formulation of guidelines on self-management made possible.

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O'Byrne L, Roberts NJ, Partridge MR, O'Byrne L, Roberts NJ, Partridge MR, O'Byrne L, Roberts NJ, Partridge MR, O'Byrne L, Roberts N, Partridge Met al., 2012, Preclinic telephone consultations: an observational cohort study, CLINICAL MEDICINE, Vol: 12, Pages: 140-145, ISSN: 1470-2118

Patients referred to secondary care for specialist respiratory review frequently undergo multiple hospital attendances for investigations and consultations. This study evaluated the potential of a preclinic telephone consultation and subsequent coordination of tests and face-to-face consultations to reduce hospital visits. Total hospital attendances were recorded for three cohorts (participants, non-participants and comparators) for 6 months from first specialist contact. Patients completed the medical interview satisfaction scale-21 (MISS-21). The study showed that a preclinic telephone consultation can significantly reduce hospital visits over a fixed period without reducing patient satisfaction. In total, 20.8% of the participant group had three or more hospital attendances compared with 42.9% of the non-participant group (p = 0.001) and 44.7% of the comparator group (p = 0.002). Participants had fewer follow up visits and lower rates of non-attendance/late rearrangement of appointments. This service reduces unnecessary hospital visits, seems to improve patient compliance and may save costs associated with non-attendance and follow up consultations.

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Roberts NJ, Boyd KA, Briggs AH, Caress AL, Partridge MR, Roberts NJ, Boyd KA, Briggs AH, Caress AL, Partridge MR, Roberts NJ, Boyd KA, Briggs AH, Caress AL, Partridge MR, Roberts NJ, Boyd KA, Briggs AH, Caress AL, Partridge MRet al., 2012, Nurse led versus lay educators support for those with asthma in primary care: a costing study, BMC PULMONARY MEDICINE, Vol: 12, ISSN: 1471-2466

BACKGROUND: Regular review and support for asthma self-management is promoted in guidelines. A randomised controlled trial suggested that unscheduled health care usage was similar when patients were offered self management support by a lay-trainer or practice nurses. METHODS: Following the RCT, a costing study was undertaken using the trial data to account for the cost of delivery of the service under both strategies and the resulting impact on unscheduled healthcare (measure of effectiveness) in this trial. RESULTS: One year data (n = 418) showed that 29% (61/205) of the nurse group required unscheduled healthcare (177 events) compared with 30.5% (65/213) for lay-trainers (178 events).The training costs for the lay-trainers were greater than nurses (£36 versus £18 respectively per patient, p<0.001), however, the consultation cost for lay-trainers were lower than nurses (£6 per patient versus £24, p<0.001). If the cost of unscheduled healthcare are accounted for then the costs of nurses is £161, and £135 for lay-trainers (mean difference £25, [95% CI = -£97, £149, p = 0.681]). The total costs (delivery and unscheduled healthcare) were £202 per patient for nurses versus £178 for lay-trainers, (mean difference £24, [95%CI = -£100, £147, p = 0.707]). CONCLUSIONS: There were no significant differences in the cost of training and healthcare delivery between nurse and lay trainers, and no significant difference in the cost of unscheduled health care use.

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Roberts NJ, Younis I, Kidd L, Partridge MR, Roberts NJ, Younis I, Kidd L, Partridge MR, Roberts NJ, Younis I, Kidd L, Partridge MRet al., 2012, Barriers to the implementation of self management support in long term lung conditions., London J Prim Care (Abingdon), Vol: 5, Pages: 35-47, ISSN: 1757-1472

Background Self-management improves outcomes in asthma and COPD and is strongly recommended in national and international guidelines; however implementation of the guidelines such as use of written action plans in practice is often poor. Setting A questionnaire survey was undertaken to identify the healthcare professional barriers to implementation of self-management for asthma and COPD in West London. Question Why is self-management education not being undertaken in respiratory conditions? Methods A questionnaire was designed to elicit healthcare professionals' views about barriers to implementation of self-management in asthma and COPD. Results Response rates were 33% (58/175). Results showed strong support for guideline recommendations, however implementation was patchy. Seventy six percent of respondents discussed asthma self-management with patients; however only 47.8% of patients received a written action plan. For COPD patients, 55.1% discussed self-management, with 41% receiving a written action plan. In COPD, there was greater GP involvement and less delegation of self-management. Barriers to implementation included patient factors (compliance, literacy and patient understanding), time constraints and insufficient resources. Those who believed they had witnessed improved health outcomes with self-management (53%, 31/58) were more likely to give written action plans (78%, 24/31, 'nearly always/sometimes' gave written action plans), Nearly a third of healthcare professionals reported lacking confidence in constructing written action plans (33% 19/58; GPs 43%, nurses 43%). Conclusion Despite overwhelming evidence self-management support is still not being implemented into routine clinical practice, identified barriers included time constraints, lack of training, lack of belief in patients ability to self-manage and lack of confidence completing self-management plans. Practice implications These issues need to be addressed if self-management support is to be de

JOURNAL ARTICLE

Starren ES, Roberts NJ, Tahir M, O'Byrne L, Haffenden R, Patel IS, Partridge MR, Starren ES, Roberts NJ, Tahir M, O'Byrne L, Haffenden R, Patel IS, Partridge MR, Starren ES, Roberts NJ, Tahir M, O'Byrne L, Haffenden R, Patel IS, Partridge MR, Starren ES, Roberts NJ, Tahir M, O'Byrne L, Haffenden R, Patel IS, Partridge MRet al., 2012, A centralised respiratory diagnostic service for primary care: a 4-year audit, PRIMARY CARE RESPIRATORY JOURNAL, Vol: 21, Pages: 180-186, ISSN: 1471-4418

BACKGROUND: The literature shows that delayed or erroneous diagnosis of respiratory conditions may be common in primary care due to underuse of spirometry or poor spirometric technique. The Community Respiratory Assessment Unit (CRAU) was established to optimise diagnosis and treatment of respiratory disease by providing focused history-taking, quality-assured spirometry, and evidence-based guideline-derived management advice. AIMS: To review the service provided by the CRAU to primary care health professionals. METHODS: Data from 1,156 consecutive GP referrals over 4 years were analysed. RESULTS: From the 1,156 referrals, 666 were referred for one of five common reasons: suspected asthma, confirmed asthma, suspected chronic obstructive pulmonary disease (COPD), confirmed COPD, or unexplained breathlessness. COPD was the most prevalent referral indication (445/666, 66.8%), but one-third of suggested diagnoses of COPD by the GP were found to be incorrect (161/445, 36%) with inappropriate prescribing of inhaled therapies resulting from this misdiagnosis. Restrictive pulmonary defects (56/666, 8% of referrals) were overlooked and often mistaken for obstructive conditions. The potential for obesity to cause breathlessness may not be fully appreciated. CONCLUSIONS: Misdiagnosis has significant financial, ethical, and safety implications. This risk may be minimised by better support for primary care physicians such as diagnostic centres (CRAU) or alternative peripatetic practice-based services operating to quality-controlled standards.

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Ahmedzai S, Balfour-Lynn IM, Bewick T, Buchdahl R, Coker RK, Cummin AR, Gradwell DP, Howard L, Innes JA, Johnson AOC, Lim E, Lim WS, McKinlay KP, Partridge MR, Popplestone M, Pozniak A, Robson A, Shovlin CL, Shrikrishna D, Simonds A, Tait P, Thomas M, Ahmedzai S, Balfour-Lynn IM, Bewick T, Buchdahl R, Coker RK, Cummin AR, Gradwell DP, Howard L, Innes JA, Johnson AO, Lim E, Lim WS, McKinlay KP, Partridge MR, Popplestone M, Pozniak A, Robson A, Shovlin CL, Shrikrishna D, Simonds A, Tait P, Thomas M, British Thoracic Society Standards of Care Committee, Ahmedzai S, Balfour-Lynn IM, Bewick T, Buchdahl R, Coker RK, Cummin AR, Gradwell DP, Howard L, Innes JA, Johnson AOC, Lim E, Lim WS, McKinlay KP, Partridge MR, Popplestone M, Pozniak A, Robson A, Shovlin CL, Shrikrishna D, Simonds A, Tait P, Thomas M, British Thoracic Society Standards of Care Committee, Ahmedzai S, Balfour-Lynn IM, Bewick T, Buchdahl R, Coker RK, Cummin AR, Gradwell DP, Howard L, Innes JA, Johnson AOC, Lim E, Lim WS, McKinlay KP, Partridge MR, Popplestone M, Pozniak A, Robson A, Shovlin CL, Shrikrishna D, Simonds A, Tait P, Thomas Met al., 2011, Managing passengers with stable respiratory disease planning air travel: British Thoracic Society recommendations, THORAX, Vol: 66, Pages: 1-30, ISSN: 0040-6376

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Calderon-Larranaga A, Carney L, Soljak M, Bottle A, Partridge M, Bell D, Abi-Aad G, Aylin P, Majeed A, Calderón-Larrañaga A, Carney L, Soljak M, Bottle A, Partridge M, Bell D, Abi-Aad G, Aylin P, Majeed A, Calderón-Larrañaga A, Carney L, Soljak M, Bottle A, Partridge M, Bell D, Abi-Aad G, Aylin P, Majeed A, Calderón-Larrañaga A, Carney L, Soljak M, Bottle A, Partridge M, Bell D, Abi-Aad G, Aylin P, Majeed A, Calderon-Larranaga A, Carney L, Soljak M, Bottle A, Partridge M, Bell D, Abi-Aad G, Aylin P, Majeed A, Calderón-Larrañaga A, Carney L, Soljak M, Bottle A, Partridge M, Bell D, Abi-Aad G, Aylin P, Majeed Aet al., 2011, Association of population and primary healthcare factors with hospital admission rates for chronic obstructive pulmonary disease in England: national cross-sectional study, THORAX, Vol: 66, Pages: 191-196, ISSN: 0040-6376

BACKGROUND: Hospital admission rates for chronic obstructive pulmonary disease (COPD) are known to be strongly associated with population factors. Primary care services may also affect admission rates, but there is little direct supporting evidence. OBJECTIVES: To determine associations between population characteristics, diagnosed and undiagnosed COPD prevalence, primary healthcare factors, and COPD admission rates primary care trust (PCT) and general practice levels in England. DESIGN, SETTING, AND PARTICIPANTS: National cross-sectional study (53,676,051 patients in 8,064 practices in 152 English PCTs), combining data on hospital admissions, populations, primary healthcare staffing, clinical practice quality and access, and prevalence. Main outcome measures Directly and indirectly standardised hospital admission rates for COPD, for PCT and practice populations. RESULTS: Mean annual COPD admission rates per 100,000 population varied from 124.7 to 646.5 for PCTs and 0.0 to 2175.2 for practices. Admissions were strongly associated with population deprivation at both levels. In a practice-level multivariate Poisson regression, registered and undiagnosed COPD prevalence, smoking prevalence and deprivation were risk factors for admission (p < 0.001), while healthcare factors- influenza immunisation, patient-reported access to consultations within two days, and primary care staffing, were protective (p < 0.05). CONCLUSION: Associations of COPD admission rates with deprivation, primary healthcare access and supply highlight the need for adequate services in deprived areas. An association between admission rates and undiagnosed COPD prevalence suggests that case-finding strategies should be evaluated. Of the COPD clinical quality indicators, only influenza immunisation was associated with reduced admission rates. Patients' experience of access to primary care may also be clinically important.

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Ghiassi R, Murphy K, Cummin AR, Partridge MR, Ghiassi R, Murphy K, Cummin AR, Partridge MR, Ghiassi R, Murphy K, Cummin AR, Partridge MR, Ghiassi R, Murphy K, Cummin AR, Partridge MRet al., 2011, Developing a pictorial Epworth Sleepiness Scale, THORAX, Vol: 66, Pages: 97-100, ISSN: 0040-6376

OBJECTIVE: The Epworth Sleepiness Scale (ESS) was designed to be self-completed by the patient. However, it may not be understood by all, and unrecognised problems with literacy can impair the process. The ESS has been translated into a pictorial version for use in those with normal or diminished literacy skills. METHODS: An evaluation of the patients' ability to self-complete the ESS was undertaken in sleep and non-sleep respiratory clinics. Errors or problems encountered were recorded on a standard questionnaire. With the aid of a medical artist, pictorial representations of the eight ESS questions were developed and the new pictorial ESS was offered to patients alongside the traditional ESS. The two scales were compared for agreement with a kappa statistic, and patients were asked to record a preference for either the written or the pictorial scale. RESULTS: Evaluation of the traditional ESS showed that 33.8% (27/80) of ESS-naive patients made errors and 22.5% (18/80) needed help completing the questionnaire. The translated pictorial ESS showed good agreement with the traditional ESS on most questions; median kappa score 0.63, IQR 0.04. Fifty-five per cent reported a preference for the pictorial scale compared with the standard written ESS. Despite the fact that errors were frequently made on the traditional ESS, 96.8% of participants in the second study reported both scales to be easy to complete. More people (75.6%) reported the pictorial ESS to be very easy, in comparison with (64.6%) the worded ESS questionnaire. CONCLUSION: Errors are common when patients self-complete the traditional written ESS. Pictures with words have been shown to enhance the understanding and translation of medical information, and a pictorial translation of the ESS produces scores comparable with the traditional ESS and may be a suitable alternative for those with normal or diminished literacy.

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Ghiassi R, Partridge MR, Ghiassi R, Partridge MR, Ghiassi R, Partridge MR, Ghiassi R, Partridge MRet al., 2011, Health literacy and sleep apnoea, THORAX, Vol: 66, Pages: 180-180, ISSN: 0040-6376

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Kessler R, Partridge MR, Miravitlles M, Cazzola M, Vogelmeier C, Leynaud D, Ostinelli J, Kessler R, Partridge MR, Miravitlles M, Cazzola M, Vogelmeier C, Leynaud D, Ostinelli J, Kessler R, Partridge MR, Miravitlles M, Cazzola M, Vogelmeier C, Leynaud D, Ostinelli J, Kessler R, Partridge MR, Miravitlles M, Cazzola M, Vogelmeier C, Leynaud D, Ostinelli Jet al., 2011, Symptom variability in patients with severe COPD: a pan-European cross-sectional study, EUROPEAN RESPIRATORY JOURNAL, Vol: 37, Pages: 264-272, ISSN: 0903-1936

In between exacerbations, chronic obstructive pulmonary disease (COPD) is usually regarded as a stable condition, but there is increasing recognition of variability in this state. This cross-sectional study assessed patients' perception of symptom variability. Participants were outpatients > 45 yrs old with COPD, current or ex-smokers, forced expiratory volume in 1 s (FEV₁) <50% predicted, FEV₁/forced vital capacity < 0.7 and no exacerbation leading to therapeutic intervention in the previous 3 months. Patients' perceptions of COPD symptoms and their impact on daily life activities were recorded. Alterations in therapy use in response to COPD worsening were also recorded. COPD symptoms were experienced by 2,258 (92.5%) out of 2,441 patients during the 7 days before interview. Breathlessness was the most common symptom (72.5%). Daily and/or weekly symptom variability was reported by 62.7% of symptomatic patients; the morning was the worst time of day. Factors associated with perception of variability of breathlessness included younger age, symptom severity and recruitment to the study by general practitioners. The perception of variability was significantly different between European countries or regions. Patient-perceived COPD symptoms vary over the day and the week, and impact on daily activities; morning being the worst time of day. The majority of patients appear not to adjust treatment when symptoms worsen.

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Partridge MR, Dal Negro RW, Olivieri D, Partridge MR, Dal Negro RW, Olivieri D, Partridge MR, Dal Negro RW, Olivieri D, R Partridge M, Dal Negro RW, Olivieri Det al., 2011, Understanding patients with asthma and COPD: insights from a European study, PRIMARY CARE RESPIRATORY JOURNAL, Vol: 20, Pages: 315-323, ISSN: 1471-4418

AIMS: To understand the needs of people with asthma and COPD, and to identify opportunities for improved care. METHODS: Quantitative questionnaire-based survey performed in five European countries on patients with asthma and COPD. Questionnaires were administered to patients using Computer Assisted Web Interview methodology. RESULTS: 1022 patients with asthma (UK [n=190]; Germany [n=214]; France [n=200]; Italy [n=222]; Spain [n=196]) and 719 patients with COPD (UK [n=153]; Germany [n=147]; France [n=145]; Italy [n=140]; Spain [n=134]) were enrolled in the study. 32% of those with asthma and 67% of those with COPD considered that their condition had a significant effect on their quality of life, and stigma and emotional distress was common. Many expressed concern regarding potential medication side effects or that medicines might lose their effect with time. Major discrepancies between expectations and patient satisfaction with the doctor-patient relationship were observed, including a need to be consulted in the choice of inhalers. Consultations were infrequent, and 75% of respondents sought additional information beyond that received during consultations - commonly from the internet. CONCLUSIONS: Patient satisfaction was high but information needs were not addressed and the emotional burden of disease is underappreciated.

JOURNAL ARTICLE

Roberts NJ, Partridge MR, Roberts NJ, Partridge MR, Roberts NJ, Partridge MR, Roberts NJ, Partridge MRet al., 2011, Evaluation of a paper and electronic pictorial COPD action plan, CHRONIC RESPIRATORY DISEASE, Vol: 8, Pages: 31-40, ISSN: 1479-9723

Personalised written action plans are increasingly regarded as an important component of chronic obstructive pulmonary disease (COPD) self-management support and yet they may not be understood by those with limited literacy skills. This study was designed to produce a comprehensible pictorial COPD action plan for use by patients and health care professionals. With advice from a group of doctors and nurses a 'standard' written COPD action plan was translated by a medical artist into a series of pictorial images. These were assessed using the techniques of guessability and translucency in 21 adults attending a COPD clinic in a London hospital. Guessability and translucency scores show that pictograms were reasonably well understood, with only 3 pictograms showing low score in both guessability and translucency questionnaires. These included images depicting increased sputum production, swollen ankles, and use of extra doses of reliever medication. However, after brief spoken reinforcement about self-management, most patients could use the pictorial plan to suggest appropriate self-management behaviour such as when to access medical care. We have developed a pictorial COPD action plan. Pictorial methods represent an effective method of reinforcing the spoken word for all ranges of literacy.

JOURNAL ARTICLE

Roberts NJ, Smith SF, Partridge MR, Roberts NJ, Smith SF, Partridge MR, Roberts NJ, Smith SF, Partridge MR, Roberts NJ, Smith SF, Partridge MR, Roberts NJ, Smith SF, Partridge MRet al., 2011, Why is spirometry underused in the diagnosis of the breathless patient: a qualitative study, BMC PULMONARY MEDICINE, Vol: 11, ISSN: 1471-2466

BACKGROUND: Use of spirometry is essential for the accurate diagnosis of respiratory disease but it is underused in both primary and specialist care. In the current study, we have explored the reasons for this underuse. METHODS: Five separate focus groups were undertaken with final year medical undergraduates, junior hospital doctors, general practitioners (GPs) and specialist trainees in respiratory medicine. The participants were not told prior to the session that we were specifically interested in their views about spirometry but discussion was moderated to elicit their approaches to the diagnosis of a breathless patient, their use of investigations and their learning preferences. RESULTS: Undergraduates and junior doctors rarely had a systematic approach towards the breathless patient and tended, unless prompted, to focus on the emergency room situation rather than on patients with longer term causes of breathlessness. Whilst their theoretical knowledge embraced the possibility of a non-respiratory cause for breathlessness, neither undergraduates nor junior doctors spontaneously mentioned the use of spirometry in the diagnosis of respiratory disease. When prompted they cited lack of familiarity with the use and location of equipment, and lack of encouragement to use it as being major barriers to utilization. In contrast, GPs and specialist respiratory trainees were enthusiastic about its use and perceived spirometry as a core element of the diagnostic workup. CONCLUSIONS: More explicit training is needed regarding the role of spirometry in the diagnosis and management of those with lung disease and this necessitates both practical experience and training in interpretation of the data. However, formal teaching is likely to be undermined in practice, if the concept is not strongly promoted by the senior staff who act as role models and trainers.

JOURNAL ARTICLE

Rooney LK, Bhopal R, Halani L, Levy ML, Partridge MR, Netuveli G, Car J, Griffiths C, Atkinson J, Lindsay G, Sheikh A, Rooney LK, Bhopal R, Halani L, Levy ML, Partridge MR, Netuveli G, Car J, Griffiths C, Atkinson J, Lindsay G, Sheikh A, Rooney LK, Bhopal R, Halani L, Levy ML, Partridge MR, Netuveli G, Car J, Griffiths C, Atkinson J, Lindsay G, Sheikh A, Rooney LK, Bhopal R, Halani L, Levy ML, Partridge MR, Netuveli G, Car J, Griffiths C, Atkinson J, Lindsay G, Sheikh Aet al., 2011, Promoting recruitment of minority ethnic groups into research: qualitative study exploring the views of South Asian people with asthma, JOURNAL OF PUBLIC HEALTH, Vol: 33, Pages: 604-615, ISSN: 1741-3842

BACKGROUND: We sought to understand the barriers and facilitators to participation in research from the perspectives of South Asian people with asthma. METHODS: Eight focus groups were conducted in the preferred language of participants. Sampling was purposeful to ensure inclusion of males and females from differing ethnic, linguistic and religious backgrounds. RESULTS: The forming of trusting relationships was described as pivotal to the successful recruitment of minority ethnic groups into research; personalized approaches were likely to be better received than more impersonal written approaches. Notable barriers to participation included: the stigma of being labelled with asthma; concerns surrounding participation in pharmaceutical trials; major time or travel commitments and a failure to show respect by not making information available in minority ethnic languages. Flexibility, in terms of timing, location and respecting of cultural and religious sensitivities around gender segregation, together with the offer of incentives, were highlighted as key factors to promote participation. CONCLUSIONS: The barriers to recruitment are largely surmountable, but these will necessitate the use of resource intensive and more personalized approaches than are commonly employed for the White European origin population. Our proposed model to enhance recruitment is likely to have transferability beyond the field of asthma.

JOURNAL ARTICLE

Smith SM, Bell D, Hopkinson NS, Valentine J, Shaw EL, Partridge MR, Elkin SL, Smith SM, Bell D, Hopkinson NS, Valentine J, Shaw EL, Partridge MR, Elkini SL, Smith SM, Bell D, Hopkinson NS, Valentine J, Shaw EL, Partridge MR, Elkin SL, Smith SM, Bell D, Hopkinson NS, Valentine J, Shaw EL, Partridge MR, Elkini SL, Smith S, Bell D, Hopkinson N, Valentine J, Shaw E, Partridge M, Elkin Set al., 2011, A review of discharge planning for people with chronic obstructive pulmonary disease at high risk for readmission, CLINICAL MEDICINE, Vol: 11, Pages: 510-511, ISSN: 1470-2118

JOURNAL ARTICLE

Stirland L, Halani L, Raj B, Netuveli G, Partridge M, Car J, Griffiths C, Levy M, Sheikh A, Stirland L, Halani L, Raj B, Netuveli G, Partridge M, Car J, Griffiths C, Levy ML, Sheikh A, Stirland L, Halani L, Raj B, Netuveli G, Partridge M, Car J, Griffiths C, Levy ML, Sheikh A, Stirland L, Halani L, Raj B, Netuveli G, Partridge M, Car J, Griffiths C, Levy M, Sheikh Aet al., 2011, Recruitment of South Asians into asthma research: qualitative study of UK and US researchers, PRIMARY CARE RESPIRATORY JOURNAL, Vol: 20, Pages: 282-290, ISSN: 1471-4418

BACKGROUND: There is increasing international concern about the persistent under-representation of ethnic minority patients in research. AIMS: We aimed to explore strategies being employed by US and UK researchers when attempting to recruit minority ethnic participants into research with a view to increasing participation by South Asians in UK asthma research. METHODS: Qualitative interviews with 36 asthma-interested researchers. RESULTS: Key themes were: the need to build long-term trusting relationships; ensuring that the procedures and practices used were respectful; paying attention to logistic considerations with respect to funding, the location of the research and taking proactive steps to overcome language-related barriers; and the importance of effective dissemination of results to, amongst others, the minority ethnic groups under study. The use of financial incentives or "co-payments" was reported as being a successfully-employed strategy in the US context, which could be considered for use in the UK. CONCLUSIONS: There is a need for funders and researchers to take proactive steps to develop longer-term relationships built on trust and respect with the populations they wish to study. Attention to the location of research, language considerations, financial reimbursement and appropriate dissemination of results are all likely to translate into improved recruitment of these "hard-to-reach" populations.

JOURNAL ARTICLE

Bousquet J, Mantzouranis E, Cruz AA, Ait-Khaled N, Baena-Cagnani CE, Bleecker ER, Brightling CE, Burney P, Bush A, Busse WW, Casale TB, Chan-Yeung M, Chen R, Chowdhury B, Chung KF, Dahl R, Drazen JM, Fabbri LM, Holgate ST, Kauffmann F, Haahtela T, Khaltaev N, Kiley JP, Masjedi MR, Mohammad Y, O'Byrne P, Partridge MR, Rabe KF, Togias A, van Weel C, Wenzel S, Zhong N, Zuberbier T, Bousquet J, Mantzouranis E, Cruz AA, Aït-Khaled N, Baena-Cagnani CE, Bleecker ER, Brightling CE, Burney P, Bush A, Busse WW, Casale TB, Chan-Yeung M, Chen R, Chowdhury B, Chung KF, Dahl R, Drazen JM, Fabbri LM, Holgate ST, Kauffmann F, Haahtela T, Khaltaev N, Kiley JP, Masjedi MR, Mohammad Y, O'Byrne P, Partridge MR, Rabe KF, Togias A, van Weel C, Wenzel S, Zhong N, Zuberbier T, Bousquet J, Mantzouranis E, Cruz AA, Aït-Khaled N, Baena-Cagnani CE, Bleecker ER, Brightling CE, Burney P, Bush A, Busse WW, Casale TB, Chan-Yeung M, Chen R, Chowdhury B, Chung KF, Dahl R, Drazen JM, Fabbri LM, Holgate ST, Kauffmann F, Haahtela T, Khaltaev N, Kiley JP, Masjedi MR, Mohammad Y, O'Byrne P, Partridge MR, Rabe KF, Togias A, Van Weel C, Wenzel S, Zhong N, Zuberbier T, Bousquet J, Mantzouranis E, Cruz AA, Aït-Khaled N, Baena-Cagnani CE, Bleecker ER, Brightling CE, Burney P, Bush A, Busse WW, Casale TB, Chan-Yeung M, Chen R, Chowdhury B, Chung KF, Dahl R, Drazen JM, Fabbri LM, Holgate ST, Kauffmann F, Haahtela T, Khaltaev N, Kiley JP, Masjedi MR, Masjedi MR, Mohammad Y, O'Byrne P, Partridge MR, Rabe KF, Togias A, van Weel C, Wenzel S, Zhong N, Zuberbier T, Bousquet J, Mantzouranis E, Cruz AA, Aït-Khaled N, Baena-Cagnani CE, Bleecker ER, Brightling CE, Burney P, Bush A, Busse WW, Casale TB, Chan-Yeung M, Chen R, Chowdhury B, Chung KF, Dahl R, Drazen JM, Fabbri LM, Holgate ST, Kauffmann F, Haahtela T, Khaltaev N, Kiley JP, Masjedi MR, Mohammad Y, O'Byrne P, Partridge MR, Rabe KF, Togias A, van Weel C, Wenzel S, Zhong N, Zuberbier Tet al., 2010, Uniform definition of asthma severity, control, and exacerbations: Document presented for the World Health Organization Consultation on Severe Asthma, JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, Vol: 126, Pages: 926-938, ISSN: 0091-6749

Asthma is a global health problem affecting around 300 million individuals of all ages, ethnic groups and countries. It is estimated that around 250,000 people die prematurely each year as a result of asthma. Concepts of asthma severity and control are important in evaluating patients and their response to treatment, as well as for public health, registries, and research (clinical trials, epidemiologic, genetic, and mechanistic studies), but the terminology applied is not standardized, and terms are often used interchangeably. A common international approach is favored to define severe asthma, uncontrolled asthma, and when the 2 coincide, although adaptation may be required in accordance with local conditions. A World Health Organization meeting was convened April 5-6, 2009, to propose a uniform definition of severe asthma. An article was written by a group of experts and reviewed by the Global Alliance against Chronic Respiratory Diseases review group. Severe asthma is defined by the level of current clinical control and risks as "Uncontrolled asthma which can result in risk of frequent severe exacerbations (or death) and/or adverse reactions to medications and/or chronic morbidity (including impaired lung function or reduced lung growth in children)." Severe asthma includes 3 groups, each carrying different public health messages and challenges: (1) untreated severe asthma, (2) difficult-to-treat severe asthma, and (3) treatment-resistant severe asthma. The last group includes asthma for which control is not achieved despite the highest level of recommended treatment and asthma for which control can be maintained only with the highest level of recommended treatment.

JOURNAL ARTICLE

Ghiassi R, O'Byrne L, Cummin AR, Partridge MR, Ghiassi R, O'Byrne L, Cummin AR, Partridge MRet al., 2010, WHAT MIGHT PATIENTS MEAN BY "SLEEPINESS"?, Publisher: B M J PUBLISHING GROUP, Pages: A165-A165, ISSN: 0040-6376

CONFERENCE PAPER

O'Byrne L, Darlow C, Roberts N, Wilson G, Partridge MR, O'Byrne L, Darlow C, Roberts N, Wilson G, Partridge MR, O'Byrne L, Darlow C, Roberts N, Wilson G, Partridge MR, O'Byrne L, Darlow C, Roberts N, Wilson G, Partridge MRet al., 2010, Smoothing the passage of patients from primary care to specialist respiratory opinion, PRIMARY CARE RESPIRATORY JOURNAL, Vol: 19, Pages: 248-253, ISSN: 1471-4418

AIMS: To assess whether information in general practitioner (GP) referral letters provides a basis for selection of diagnostic tests in patients referred for specialist respiratory advice. METHODS: We undertook a prospective study within a respiratory outpatients department to compare the diagnostic tests planned at three stages of the referral/specialist consultation process: i) using the GP referral letter alone; ii) using the referral letter and patient history; iii) using the referral letter, patient history, and clinical examination. RESULTS: Analysis of the content of GP referral letters revealed wide variations in referral information. A high proportion of tests selected using the referral letter alone were altered after specialist history-taking and examination. Far fewer changes were recorded between history-taking and examination. CONCLUSIONS: Neither literature review nor our study support a system which bases diagnostic test selection on GP referral letters alone. However, our findings suggest that approaches which include specialist history-taking in advance of face-to-face consultation merit further investigation.

JOURNAL ARTICLE

Partridge MR, Miravitlles M, Stahl E, Karlsson N, Svensson K, Welte T, Partridge MR, Miravitlles M, Ståhl E, Karlsson N, Svensson K, Welte T, Partridge MR, Miravitlles M, Ståhl E, Karlsson N, Svensson K, Welte T, Partridge MR, Miravitlles M, Stahl E, Karlsson N, Svensson K, Welte Tet al., 2010, Development and validation of the Capacity of Daily Living during the Morning questionnaire and the Global Chest Symptoms Questionnaire in COPD, EUROPEAN RESPIRATORY JOURNAL, Vol: 36, Pages: 96-104, ISSN: 0903-1936

This report concerns the development and validation of two patient-reported outcomes questionnaires developed to assess chronic obstructive pulmonary disease (COPD) patients' ability to perform morning activities and to evaluate their morning symptoms. Based on interviews with COPD patients, the Capacity of Daily Living during the Morning (CDLM) questionnaire and the Global Chest Symptoms Questionnaire (GCSQ) were developed, linguistically validated and incorporated into two multicentre, randomised trials involving a total of 1,100 COPD patients; those trials were registered at ClinicalTrials.gov (NCT00496470 and NCT00542880). Data from these trials were used to determine the reliability, validity and responsiveness of the questionnaires and to derive estimates of minimal important differences (MIDs). Both questionnaires displayed good-to-high reliability (Cronbach's alpha 0.75-0.93). Analysis of convergent validity showed that CDLM and GCSQ scores correlated significantly (p<0.001) with symptoms, health-related quality of life (HRQoL) and use of rescue medication. In both trials, CDLM and GCSQ scores discriminated between patients with different levels of HRQoL, as assessed by the St George's Respiratory Questionnaire for COPD patients (SGRQ-C), but not with disease severity, as assessed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. A significant improvement in CDLM and GCSQ scores occurred in response to treatment. Estimations of MID scores, corresponding to an SGRQ-C MID of 4, were 0.20 for the CDLM questionnaire and 0.15 for the GCSQ. Both the CDLM questionnaire and the GCSQ are easy-to-use, reliable, responsive, self-administered questionnaires that report on patients' symptoms and ability to perform morning activities.

JOURNAL ARTICLE

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