Imperial College London

ProfessorPallavShah

Faculty of MedicineNational Heart & Lung Institute

Professor of Respiratory Medicine
 
 
 
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Contact

 

+44 (0)20 7351 8021pallav.shah

 
 
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Location

 

Fulham RoadRoyal Brompton Campus

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Summary

 

Publications

Publication Type
Year
to

354 results found

Garner JL, Shah PL, 2022, Endobronchial treatment of severe asthma and severe emphysema with hyperinflation., Curr Opin Pulm Med, Vol: 28, Pages: 52-61

PURPOSE OF REVIEW: The field of interventional pulmonology has ushered in a wave of innovations for individuals with obstructive airways disease in whom established medical therapies have failed. Leading the charge are bronchial thermoplasty for severe refractory asthma and uni-directional valves for severe emphysema with hyperinflation: both have received regulatory approvals in the United Kingdom and United States. With the commissioning of these novel treatments comes new challenges relating to implementation, positioning within therapeutic algorithms, honing of patient selection, and establishing long-term safety and benefits beyond 5 years. RECENT FINDINGS: This review summarises the evidence for their safety and efficacy, predictors of therapeutic response, mechanism(s) of action and emerging data supporting the durability of outcomes out to at least ten years. SUMMARY: It is anticipated the experience of treating increasing numbers of patients, the adoption of international registries, and ongoing research evaluations will serve to optimise these therapies for future generations of patients.

Journal article

Mercer RM, Mishra E, Banka R, Corcoran JP, Daneshvar C, Panchal RK, Saba T, Caswell M, Johnstone S, Menzies D, Ahmer S, Shahidi M, Clive AO, Gautam M, Cox G, Orton C, Lyons J, Maddekar N, De Fonseka D, Prior K, Barnes S, Robinson G, Brown L, Munavvar M, Shah PL, Hallifax RJ, Blyth KG, Hedley E, Maskell NA, Gerry S, Miller RF, Rahman NM, Kemp SVet al., 2021, A randomised controlled trial of intrapleural balloon intercostal chest drains to prevent drain displacement., Eur Respir J

BACKGROUND: Chest drain displacement is a common clinical problem, occurring in 9-42% of cases and results in treatment failure or additional pleural procedures conferring unnecessary risk. A novel chest drain with an integrated intrapleural balloon may reduce the risk of displacement. METHODS: Prospective randomised controlled trial comparing the balloon drain to standard care (12 F chest drain with no balloon) with the primary outcome of objectively-defined unintentional or accidental chest drain displacement. RESULTS: 267 patients were randomised (primary outcome data available in 257, 96.2%). Displacement occurred less frequently using the balloon drain (displacement 5/128, 3.9%; standard care displacement 13/129, 10.1%) but this was not statistically significant (Odds Ratio (OR) for drain displacement 0.36, 95% CI 0.13 to 1.0, χ2 1df=2.87, p=0.09). Adjusted analysis to account for minimisation factors and use of drain sutures demonstrated balloon drains were independently associated with reduced drain fall out rate (adjusted OR 0.27, 95% CI 0.08 to 0.87, p=0.028). Adverse events were higher in the balloon arm than the standard care arm (balloon drain 59/131, 45.0%; standard care 18/132, 13.6%; χ2 1df=31.3, p<0.0001). CONCLUSION: Balloon drains reduce displacement compared with standard drains independent of the use of sutures but are associated with increased adverse events specifically during drain removal. The potential benefits of the novel drain should be weighed against the risks, but may be considered in practices where sutures are not routinely used.

Journal article

Orton CM, Symons HE, Moseley B, Archer J, Watson NA, Philip KEJ, Saccente-Kennedy B, Costello DAE, Browne WJ, Calder JD, Bzdek BR, Hull JH, Reid JP, Shah PLet al., 2021, RESPIRATORY PARTICLE AND DROPLET EMISSION DURING SPEECH AND EXERCISE, Publisher: BMJ PUBLISHING GROUP, Pages: A3-A4, ISSN: 0040-6376

Conference paper

Ravi A, Goorsenberg AWM, Dijkhuis A, Dierdorp BS, Dekker T, van Weeghel M, Sabogal YS, Shah PL, Hacken NHTT, Annema JT, Sterk PJ, Vaz FM, Bonta PI, Lutter Ret al., 2021, Metabolic differences between bronchial epithelium from healthy individuals and patients with asthma and the effect of bronchial thermoplasty, JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, Vol: 148, Pages: 1236-1248, ISSN: 0091-6749

Journal article

Evans RA, McAuley H, Harrison EM, Shikotra A, Singapuri A, Sereno M, Elneima O, Docherty AB, Lone NI, Leavy OC, Daines L, Baillie JK, Brown JS, Chalder T, De Soyza A, Diar Bakerly N, Easom N, Geddes JR, Greening NJ, Hart N, Heaney LG, Heller S, Howard L, Hurst JR, Jacob J, Jenkins RG, Jolley C, Kerr S, Kon OM, Lewis K, Lord JM, McCann GP, Neubauer S, Openshaw PJM, Parekh D, Pfeffer P, Rahman NM, Raman B, Richardson M, Rowland M, Semple MG, Shah AM, Singh SJ, Sheikh A, Thomas D, Toshner M, Chalmers JD, Ho L-P, Horsley A, Marks M, Poinasamy K, Wain LV, Brightling CE, PHOSP-COVID Collaborative Groupet al., 2021, Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study, The Lancet Respiratory Medicine, Vol: 9, Pages: 1275-1287, ISSN: 2213-2600

BACKGROUND: The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. METHODS: The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing. Multivariable logistic regression was done for the primary outcome of patient-perceived recovery, with age, sex, ethnicity, body-mass index, comorbidities, and severity of acute illness as covariates. A post-hoc cluster analysis of outcomes for breathlessness, fatigue, mental health, cognitive impairment, and physical performance was done using the clustering large applications k-medoids approach. The study is registered on the ISRCTN Registry (ISRCTN10980107). FINDINGS: We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5·9 months (IQR 4·9-6·5) after discharge. Participants had a mean age of 58 years (SD 13); 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered, 158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and 124 (19%) of 641 experienced a health-related change in occupation. Factors associated with not recovering were female sex, middle age (40-59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health bur

Journal article

Vijayakumar B, Tonkin J, Devaraj A, Philip KEJ, Orton CM, Desai SR, Shah PLet al., 2021, CT Lung Abnormalities after COVID-19 at 3 Months and 1 Year after Hospital Discharge., Radiology

Background Data on the long-term pulmonary sequelae in COVID-19 are lacking. Purpose To assess symptoms and functional impairment and residual pulmonary abnormalities on serial chest CT in COVID-19 survivors discharged from hospital at up to 1-year follow-up. Materials and Methods Adult patients with COVID-19 discharged between March 2020 and June 2020 were prospectively evaluated at 3 months and 1 year, through systematic assessment of symptoms, functional impairments, and thoracic CT as part of the PHENOTYPE study, an observational cohort study in COVID-19 survivors. Lung function testing was limited to participants with CT abnormalities and/or persistent breathlessness. All statistical analyses were performed using Graphpad PRISM Version 9.0 (86) for Mac, GraphPad Software, (www.graphpad.com); Bonferroni corrected p values are stated. Results Eighty participants (mean age, 59 ±13 years; 53 men) were assessed. Persistent breathlessness 37 (46%) and cough 17 (21%) were reported at outpatient review (median 97 days [IQR 86-121]). CT scans in 73 participants post-discharge (median 105 days [IQR 95-141]) revealed persistent abnormalities in 41/73 participants (56%), with ground-glass opacification (35/73 [48%]) and bands (27/73 [37%]) predominating. Unequivocal signs indicative of established fibrosis (i.e. volume loss +/- traction bronchiectasis) were present in 9/73 (12%) participants. Higher admission serum C-reactive protein (mg/L), fibrinogen (g/dl), urea (mmol/L) and creatinine (micromol/L), longer hospital stay (days), older age (years) and requirement for invasive ventilation were associated with CT abnormalities at 3-month follow-up. 32/41 (78%) of participants with abnormal 3-month follow-up CT underwent repeat imaging at a median of 364 (360-366) days, with 26/32 (81%) showing further radiological improvement (median 18% [IQR 10-40%]). Conclusion CT abnormalities were common at 3 months after COVID-19 but with signs of fibrosis in a minority. More se

Journal article

Vijayakumar B, Shah PL, 2021, Not All Parenchymal Changes on Computed Tomography Are Interstitial Lung Disease, ANNALS OF THE AMERICAN THORACIC SOCIETY, Vol: 18, Pages: 1597-1597, ISSN: 1546-3222

Journal article

Hartman JE, Srikanthan K, Caneja C, ten Hacken NHT, Kerstjens HAM, Shah PL, Slebos D-Jet al., 2021, Bronchoscopic Targeted Lung Denervation in Patients with Severe Asthma: Preliminary Findings, RESPIRATION, ISSN: 0025-7931

Journal article

McCarthy LP, Orton CM, Watson NA, Gregson FKA, Haddrell AE, Browne WJ, Calder JD, Costello D, Reid JP, Shah PL, Bzdek BRet al., 2021, Aerosol and droplet generation from performing with woodwind and brass instruments, AEROSOL SCIENCE AND TECHNOLOGY, Vol: 55, Pages: 1277-1287, ISSN: 0278-6826

Journal article

Born J, Beymer D, Rajan D, Coy A, Mukherjee VV, Manica M, Prasanna P, Ballah D, Guindy M, Shaham D, Shah PL, Karteris E, Robertus JL, Gabrani M, Rosen-Zvi Met al., 2021, On the role of artificial intelligence in medical imaging of COVID-19, PATTERNS, Vol: 2, ISSN: 2666-3899

Journal article

Vijayakumar B, Shah PL, 2021, Is Fibrosis Really Fibrosis?, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 203, Pages: 1440-+, ISSN: 1073-449X

Journal article

van Dijk M, Sue R, Criner GJ, Gompelmann D, Herth FJF, Hogarth DK, Klooster K, Kocks JWH, de Oliveira HG, Shah PL, Valipour A, Slebos D-Jet al., 2021, Expert Statement: Pneumothorax Associated with One-Way Valve Therapy for Emphysema: 2020 Update, RESPIRATION, ISSN: 0025-7931

Journal article

Horby PW, Landray MJ, 2021, Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial, The Lancet, Vol: 397, Pages: 2049-2059, ISSN: 0140-6736

BackgroundMany patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19.MethodsThis randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.FindingsBetween May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of pati

Journal article

Lam S, Shah PL, 2021, Bronchoscopic Diagnosis of Peripheral Lung Lesions, RESPIRATION, Vol: 100, Pages: 764-766, ISSN: 0025-7931

Journal article

Klooster K, Valipour A, Marquette C-H, Boutros J, Mal H, Marceau A, Shah PL, Conway F, Deslee G, Bourdin A, Pison C, Grah C, Hetzel M, Schumann C, Kessler R, Huebner R-H, Skowasch D, Darwiche K, Hammerl P, Stanzel F, Bezzi M, Dutau H, Herth FJF, Slebos D-Jet al., 2021, Endobronchial Coil System versus Standard-of-Care Medical Management in the Treatment of Subjects with Severe Emphysema, RESPIRATION, Vol: 100, Pages: 804-810, ISSN: 0025-7931

Journal article

Chaudhuri R, Rubin A, Sumino K, e Silva JRL, Niven R, Siddiqui S, Klooster K, McEvoy C, Shah PL, Simoff M, Khatri S, Barbers R, Grubb GM, McMullen EA, Olson JL, Laviolette Met al., 2021, Safety and effectiveness of bronchial thermoplasty after 10 years in patients with persistent asthma (BT10+): a follow-up of three randomised controlled trials, LANCET RESPIRATORY MEDICINE, Vol: 9, Pages: 457-466, ISSN: 2213-2600

Journal article

Conway F, Shah PL, Valipour A, Slebos D, Pison C, Schumann C, Bonta P, Kessler R, Gesierich W, Darwiche K, Lamprecht B, Skowasch D, Tonkin Jet al., 2021, Targeted Lung Denervation for Chronic Obstructive Pulmonary Disease: 12-Month Crossover Data from the AIRFLOW-2 Trial, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X

Conference paper

Horby PW, Landray MJ, 2021, Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial, The Lancet, Vol: 397, Pages: 1637-1645, ISSN: 0140-6736

BackgroundIn this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation.MethodsThis randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936).FindingsBetween April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ra

Journal article

Hartman JE, Garner JL, Shah PL, Slebos D-Jet al., 2021, New bronchoscopic treatment modalities for patients with chronic bronchitis, EUROPEAN RESPIRATORY REVIEW, Vol: 30, ISSN: 0905-9180

Journal article

Shah PL, 2021, Springs that don't spring out: Fiducials for stereotactic radiotherapy, RESPIROLOGY, Vol: 26, Pages: 409-410, ISSN: 1323-7799

Journal article

Hartman JE, Klooster K, Augustijn SWS, van Geffen WH, Garner JL, Shah PL, Ten Hacken NHT, Slebos D-Jet al., 2021, Identifying Responders and Exploring Mechanisms of Action of the Endobronchial Coil Treatment for Emphysema, RESPIRATION, Vol: 100, Pages: 443-451, ISSN: 0025-7931

Journal article

Pison C, Shah PL, Slebos D-J, Ninane V, Janssens W, Perez T, Kessler R, Deslee G, Garner JL, Hartman JE, Degano B, Mayr A, Mayse M, Peterson AD, Valipour Aet al., 2021, Safety of denervation following targeted lung denervation therapy for COPD: AIRFLOW-1 3-year outcomes (vol 22, pg 62, 2021), RESPIRATORY RESEARCH, Vol: 22

Journal article

Hartman JE, Criner GJ, Moore WH, van Rikxoort EM, Sciurba FC, Shah PL, Vliegenthart R, Welling JBA, Slebos D-Jet al., 2021, HRCT characteristics of severe emphysema patients: Interobserver variability among expert readers and comparison with quantitative software, EUROPEAN JOURNAL OF RADIOLOGY, Vol: 136, ISSN: 0720-048X

Journal article

Gregson FKA, Watson NA, Orton CM, Haddrell AE, McCarthy LP, Finnie TJR, Gent N, Donaldson GC, Shah PL, Calder JD, Bzdek BR, Costello D, Reid JPet al., 2021, Comparing aerosol concentrations and particle size distributions generated by singing, speaking and breathing, Aerosol Science and Technology, Vol: 55, Pages: 681-691, ISSN: 0278-6826

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted in an unprecedented shutdown in social and economic activity, with the cultural sector particularly severely affected. Restrictions on musical performances have arisen from a perception that there is a significantly higher risk of aerosol production from singing than speaking, based upon high-profile examples of clusters of COVID-19 following choral rehearsals. However, comparing aerosol generation from different types of vocalization, including singing, across a range of volumes is a rapidly evolving area of research. Here, we measured aerosols from singing, speaking and breathing from a large cohort of 25 professional singers in a range of musical genres in a zero-background environment, allowing unequivocal attribution of aerosol production to specific vocalizations. We do not assess the relative volumes at which people speak and sing. However, both showed steep increases in mass concentration with increase in loudness (spanning a factor of 20–30 across the dynamic range measured, p < 0.001). At the quietest volume (50 to 60 dBA), neither singing (p = 0.19) nor speaking (p = 0.20) were significantly different to breathing. At the loudest volume (90 to 100 dBA), a statistically significant difference (p < 0.001) was observed between singing and speaking, but with singing only generating a factor of between 1.5 and 3.4 more aerosol mass. Guidelines for musical performances should be based on the loudness and duration of the vocalization, the number of participants and the environment in which the activity occurs, rather than the type of vocalization. Mitigations such as the use of amplification and increased attention to ventilation should be employed where practicable.

Journal article

RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, Staplin N, Brightling C, Ustianowski A, Elmahi E, Prudon B, Green C, Felton T, Chadwick D, Rege K, Fegan C, Chappell LC, Faust SN, Jaki T, Jeffery K, Montgomery A, Rowan K, Juszczak E, Baillie JK, Haynes R, Landray MJet al., 2021, Dexamethasone in hospitalized patients with Covid-19., New England Journal of Medicine, Vol: 384, Pages: 693-704, ISSN: 0028-4793

BACKGROUND: Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. METHODS: In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the final results of this assessment. RESULTS: A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.92 to 1.55). CONCLUSIONS: In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY Clin

Journal article

Garner J, Biddiscombe MF, Meah S, Lewis A, Buttery SC, Hopkinson NS, Kemp SV, Usmani OS, Shah PL, Verbanck Set al., 2021, Endobronchial valve lung volume reduction and small airways function., American Journal of Respiratory and Critical Care Medicine, Vol: 203, Pages: 1576-1579, ISSN: 1073-449X

Journal article

Horby PW, Roddick A, Spata E, Staplin N, Emberson J, Pessoa-Amorim G, Brightling C, Prudon B, Chadwick D, Ustianowski A, Ashish A, Todd S, Yates B, Buttery R, Scott S, Maseda D, Baillie JK, Buch M, Chappell L, Day J, Faust SN, Jaki T, Jeffery K, Juszczak E, Lim WS, Montgomery A, Mumford A, Rowan K, Thwaites G, Mafham M, Haynes R, Landray MJ, Horby PW, Landray MJ, Baillie JK, Buch M, Chappell L, Day J, Faust SN, Haynes R, Jaki T, Jeffery K, Juszczak E, Lim WS, Mafham M, Montgomery A, Mumford A, Rowan K, Thwaites G, Sandercock P, Darbyshire J, DeMets D, Fowler R, Lalloo D, Roberts I, Wittes J, Horby P, Landray MJ, Haynes R, Fletcher L, Barton J, Basoglu A, Brown R, Brudlo W, Denis E, Howard S, McChlery G, Taylor K, Cui G, Goodenough B, King A, Lay M, Murray D, Stevens W, Wallendszus K, Welsh R, Crichton C, Davies J, Goldacre R, Harper C, Knight F, Latham-Mollart J, Mafham M, Nunn M, Salih H, Welch J, Campbell M, Pessoa-Amorim G, Peto L, Roddick A, Knott C, Wiles J, Bell JL, Emberson J, Juszczak E, Linsell L, Spata E, Staplin N, Bagley G, Cameron S, Chamberlain S, Farrell B, Freeman H, Kennedy A, Whitehouse A, Wilkinson S, Wood C, Reith C, Davies K, Halls H, Holland L, Wilson K, Howie L, Lunn M, Rodgers P, Barnard A, Beety J, Birch C, Brend M, Chambers E, Chappell L, Crawshaw S, Drake C, Duckles-Leech H, Graham J, Harman T, Harper H, Lock S, Lomme K, McMillan N, Nickson I, Ohia U, OKell E, Poustie V, Sam S, Sharratt P, Sheffield J, Slade H, Hoff WV, Walker S, Williamson J, De Soyza A, Dimitri P, Faust SN, Lemoine N, Minton J, Gilmour K, Pearson K, Armah C, Campbell D, Cate H, Priest A, Thomas E, Usher R, Johnson G, Logan M, Pratt S, Price A, Shirley K, Walton E, Williams P, Yelnoorkar F, Hanson J, Membrey H, Gill L, Oliver A, Das S, Murphy S, Sutu M, Collins J, Monaghan H, Unsworth A, Beddows S, Williams KB, Dowling S, Gibbons K, Pine K, Asghar A, Aubrey P, Jewell DB, Donaldson K, Skinner T, Luo J, Mguni N, Muzengi N, Pleass R, Wayman E, Coe A, Hicks J, Hough M, Levettet al., 2021, Azithromycin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial, The Lancet, Vol: 397, Pages: 605-612, ISSN: 0140-6736

BackgroundAzithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.MethodsIn this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospital with COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients were randomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once per day by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatment groups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment and were twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants and local study staff were not masked to the allocated treatment, but all others involved in the trial were masked to the outcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.FindingsBetween April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) were eligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was 65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomly allocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall, 561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days (rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No

Journal article

Vizcaychipi MP, Shovlin CL, McCarthy A, Howard A, Patel S, Godfrey A, Armstrong J, Beveridge I, Brown A, Christie L, Davies G, Davies R, Gupta A, Hayes M, Keays RT, Lockie C, Peters T, Popescu M, Said H, Shah P, Singh S, Sisson Aet al., 2021, IMPROVED COVID-19 SURVIVAL IN ACUTE HOSPITAL SETTINGS FOLLOWING IMPLEMENTATION OF A REAL-TIME CLINICAL DECISION SUPPORT TOOL, Publisher: BMJ PUBLISHING GROUP, Pages: A59-A60, ISSN: 0040-6376

Conference paper

Goorsenberg AWM, D'Hooghe JNS, Srikanthan K, Ten Hacken NHT, Weersink EJM, Roelofs JJTH, Kemp S, Bel EH, Shah PL, Annema JT, Bonta Pet al., 2021, Bronchial Thermoplasty Induced Airway Smooth Muscle Reduction and Clinical Response in Severe Asthma The TASMA Randomized Trial, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 203, Pages: 175-184, ISSN: 1073-449X

Journal article

Singh S, Shah PL, 2021, Safe and efficient practice of bronchoscopic sampling from mechanically ventilated patients: a structured evaluation of the ambu bronchosampler-ascope 4 integrated system, Respiration: international journal of thoracic medicine, Vol: 100, Pages: 27-33, ISSN: 0025-7931

BACKGROUND: Bronchoscopic sampling of bronchoalveolar fluid (BAL) should be safe and effective. Current sampling practice risks loss of sample to the attached negative flow, aerosolisation, or spillage, due to repeated circuit breaks, when replacing sample containers. Such concerns were highlighted during the recent coronavirus pandemic. OBJECTIVES: Evaluation of an alternative integrated sampling solution, with the Ambu Bronchosampler with aScope 4, by an experienced bronchoscopist in ICU. METHODS: An observational study of 20 sequential bronchoscopic diagnostic sampling procedures was performed on mechanically ventilated patients with suspected ventilator-associated pneumonia. Mixed methods assessment was done. The predefined outcome measures were (1) ease of set up, (2) ease of specimen collection, (3) ease of protecting specimen from loss or spillage, and (4) overall workflow. The duration of the procedure and the % volume of sample retrieved were recorded. RESULTS: The mean (±standard deviation [SD]) time for collecting 1 sample was 2.5 ± 0.8 min. The mean (±SD) specimen yield for instilled miniBAL was 54.2 ± 17.9%. Compared with standard sampling, the set-up was much easier in 18 (90%), or easier in 2 (10%) of procedures, reducing the connection steps. It was much more intuitive to use in 14 (70%), more intuitive in 4 (20%), and no more intuitive to use in 2 (10%). The overall set-up and workflow was much easier in 69% of the 13 intraprocedural connections and easier or as easy in the remaining 31% procedures. All procedures where pre connection was established were much easier (7, 100%). The Ambu Bronchosampler remained upright in all procedures with no loss or spillage of sample. Obtaining a sample was much easier in 60%, easier in 10%, no different in 20%, and worse in 10%. The ability to protect a sample from start to finish compared to standard procedures was much easier in 80%, easier in 15%, and no different in 5% of procedur

Journal article

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