Publications
428 results found
Garner JL, Shaipanich T, Hartman JE, et al., 2020, A prospective safety and feasibility study of metered cryospray for patients with chronic bronchitis in COPD, EUROPEAN RESPIRATORY JOURNAL, Vol: 56, ISSN: 0903-1936
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- Citations: 8
Garner JL, Shah PL, 2020, Lung Volume Reduction in Pulmonary Emphysema, SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 41, Pages: 874-885, ISSN: 1069-3424
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- Citations: 5
Horby P, Mafham M, Linsell L, et al., 2020, Effect of Hydroxychloroquine in Hospitalized Patients with Covid-19, NEW ENGLAND JOURNAL OF MEDICINE, Vol: 383, Pages: 2030-2040, ISSN: 0028-4793
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- Citations: 199
Hartman JE, Shah PL, Sciurba F, et al., 2020, Endobronchial coils for emphysema: Dual mechanism of action on lobar residual volume reduction, RESPIROLOGY, Vol: 25, Pages: 1160-1166, ISSN: 1323-7799
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- Citations: 10
Horby PW, Landray MJ, Mafham M, et al., 2020, Lopinavir-ritonavir in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial, LANCET, Vol: 396, Pages: 1345-1352, ISSN: 0140-6736
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- Citations: 420
Bartlett EC, Kemp S, Ridge CA, et al., 2020, Baseline Results of the West London lung cancer screening pilot study - Impact of mobile scanners and dual risk model utilisation, LUNG CANCER, Vol: 148, Pages: 12-19, ISSN: 0169-5002
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- Citations: 25
Vizcaychipi M, Shovlin C, McCarthy A, et al., 2020, Development and implementation of a COVID-19 near real time traffic light system in an acute hospital setting, Emergency Medicine Journal, Vol: 37, Pages: 630-636, ISSN: 1472-0205
Common causes of death in COVID-19 due to SARS-CoV-2 include thromboembolic disease, cytokine storm and adult respiratory distress syndrome (ARDS). Our aim was to develop a system for early detection of disease pattern in the emergency department (ED) that would enhance opportunities for personalised accelerated care to prevent disease progression. A single Trust’s COVID-19 response control command was established, and a reporting team with bioinformaticians was deployed to develop a real-time traffic light system to support clinical and operational teams. An attempt was made to identify predictive elements for thromboembolism, cytokine storm and ARDS based on physiological measurements and blood tests, and to communicate to clinicians managing the patient, initially via single consultants. The input variables were age, sex, and first recorded blood pressure, respiratory rate, temperature, heart rate, indices of oxygenation and C-reactive protein. Early admissions were used to refine the predictors used in the traffic lights. Of 923 consecutive patients who tested COVID-19 positive, 592 (64%) flagged at risk for thromboembolism, 241/923 (26%) for cytokine storm and 361/923 (39%) for ARDS. Thromboembolism and cytokine storm flags were met in the ED for 342 (37.1%) patients. Of the 318 (34.5%) patients receiving thromboembolism flags, 49 (5.3% of all patients) were for suspected thromboembolism, 103 (11.1%) were high-risk and 166 (18.0%) were medium-risk. Of the 89 (9.6%) who received a cytokine storm flag from the ED, 18 (2.0% of all patients) were for suspected cytokine storm, 13 (1.4%) were high-risk and 58 (6.3%) were medium-risk. Males were more likely to receive a specific traffic light flag. In conclusion, ED predictors were used to identify high proportions of COVID-19 admissions at risk of clinical deterioration due to severity of disease, enabling accelerated care targeted to those more likely to benefit. Larger prospective studies are encouraged.
Born J, Beymer D, Rajan D, et al., 2020, On the Role of Artificial Intelligence in Medical Imaging of COVID-19
<jats:title>Abstract</jats:title><jats:p>The global COVID-19 pandemic has accelerated the development of numerous digital technologies in medicine from telemedicine to remote monitoring. Concurrently, the pandemic has resulted in huge pressures on healthcare systems. Medical imaging (MI) from chest radiographs to computed tomography and ultrasound of the thorax have played an important role in the diagnosis and management of the coronavirus infection.</jats:p><jats:p>We conducted the, to date, largest systematic review of the literature addressing the utility of Artificial Intelligence (AI) in MI for COVID-19 management. Through keyword matching on PubMed and preprint servers, including arXiv, bioRxiv and medRxiv, 463 papers were selected for a meta-analysis, with manual reviews to assess the clinical relevance of AI solutions. Further, we evaluated the maturity of the papers based on five criteria assessing the state of the field: peer-review, patient dataset size and origin, algorithmic complexity, experimental rigor and clinical deployment.</jats:p><jats:p>In 2020, we identified 4977 papers on MI in COVID-19, of which 872 mentioned the term AI. 2039 papers of the 4977 were specific to imaging modalities with a majority of 83.8% focusing on CT, while 10% involved CXR and 6.2% used LUS. Meanwhile, the AI literature predominantly analyzed CXR data (49.7%), with 38.7% using CT and 1.5% LUS. Only a small portion of the papers were judged as mature (2.7 %). 71.9% of AI papers centered on disease detection.</jats:p><jats:p>This review evidences a disparity between clinicians and the AI community, both in the focus on imaging modalities and performed tasks. Therefore, in order to develop clinically relevant AI solutions, rigorously validated on large-scale patient data, we foresee a need for improved collaboration between the two communities ensuring optimal outcomes and allocation of resources. AI may aid clinicians
Orton CM, Garner JL, Shah TA, et al., 2020, Metered Cryospray Modulates Bronchial Epithelial Gene Expression in Patients with Chronic Obstructive Pulmonary Disease, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Shah PL, Orton C, 2020, Epithelial Resurfacing: The Bronchial Skin Peel, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 202, Pages: 641-642, ISSN: 1073-449X
Khalil K, Agbontaen K, McNally D, et al., 2020, Clinical characteristics and 28-day mortality of medical patients admitted with COVID-19 to a central London teaching hospital, JOURNAL OF INFECTION, Vol: 81, Pages: E85-E89, ISSN: 0163-4453
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- Citations: 20
Vizcaychipi MP, Shovlin CL, McCarthy A, et al., 2020, Increase in COVID-19 inpatient survival following detection of Thromboembolic and Cytokine storm risk from the point of admission to hospital by a near real time Traffic-light System (TraCe-Tic), The Brazilian Journal of Infectious Diseases, Vol: 24, Pages: 412-421, ISSN: 1413-8670
IntroductionOur goal was to evaluate if traffic-light driven personalized care for COVID-19 was associated with improved survival in acute hospital settings.MethodsDischarge outcomes were evaluated before and after prospective implementation of a real-time dashboard with feedback to ward-based clinicians. Thromboembolic categories were “medium-risk” (D-dimer >1000 ng/mL or CRP >200 mg/L); “high-risk” (D-dimer >3000 ng/mL or CRP >250 mg/L) or “suspected” (D-dimer >5000 ng/mL). Cytokine storm risk was categorized by ferritin.Results939/1039 COVID-19 positive patients (median age 69 years, 563/939 (60%) male) completed hospital encounters to death or discharge by 21st May 2020. Thromboembolic flag criteria were reached by 568/939 (60.4%), including 238/275 (86.6%) of the patients who died, and 330/664 (49.7%) of the patients who survived to discharge, p < 0.0001. Cytokine storm flag criteria were reached by 212 (22.5%) of admissions, including 80/275 (29.0%) of the patients who died, and 132/664 (19.9%) of the patients who survived, p < 0.0001. The maximum thromboembolic flag discriminated completed encounter mortality (no flag: 37/371 [9.97%] died; medium-risk: 68/239 [28.5%]; high-risk: 105/205 [51.2%]; and suspected thromboembolism: 65/124 [52.4%], p < 0.0001). Flag criteria were reached by 535 consecutive COVID-19 positive patients whose hospital encounter completed before traffic-light introduction: 173/535 (32.3% [95% confidence intervals 28.0, 36.0]) died. For the 200 consecutive admissions after implementation of real-time traffic light flags, 46/200 (23.0% [95% confidence intervals 17.1–28.9]) died, p = 0.013. Adjusted for age and sex, the probability of death was 0.33 (95% confidence intervals 0.30–0.37) before traffic light implementation, 0.22 (0.17–0.27) after implementation, p < 0.001. In subgroup analyses, older patients, males, and patients with hypertension (p ≤ 0.01)
Shah PL, Slebos D-J, 2020, Bronchoscopic interventions for severe emphysema: Where are we now?, RESPIROLOGY, Vol: 25, Pages: 972-980, ISSN: 1323-7799
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- Citations: 13
Garner JL, Shah PL, 2020, Challenges of evaluating lung function as part of cancer care during the COVID-19 pandemic, EUROPEAN RESPIRATORY JOURNAL, Vol: 56, ISSN: 0903-1936
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- Citations: 2
Criner GJ, Eberhardt R, Fernandez-Bussy S, et al., 2020, Interventional Bronchoscopy, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 202, Pages: 29-50, ISSN: 1073-449X
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- Citations: 42
Dransfield MT, Garner JL, Bhatt SP, et al., 2020, Effect of Zephyr Endobronchial Valves on Dyspnea, Activity Levels, and Quality of Life at One Year Results from a Randomized Clinical Trial, ANNALS OF THE AMERICAN THORACIC SOCIETY, Vol: 17, Pages: 829-838, ISSN: 1546-3222
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- Citations: 16
Luo F, Darwiche K, Singh S, et al., 2020, Performing bronchoscopy in times of the COVID-19 pandemic: practice statement from an international expert panel, Respiration: international journal of thoracic medicine, Vol: 99, Pages: 417-422, ISSN: 0025-7931
Lim E, Sousa I, Shah PL, et al., 2020, Lung Volume Reduction Surgery: Reinterpreted With Longitudinal Data Analyses Methodology, ANNALS OF THORACIC SURGERY, Vol: 109, Pages: 1496-+, ISSN: 0003-4975
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- Citations: 9
Rickets W, Lau KKW, Pollit V, et al., 2020, Exploratory cost-effectiveness model of electromagnetic navigation bronchoscopy (ENB) compared with CT-guided biopsy (TTNA) for diagnosis of malignant indeterminate peripheral pulmonary nodules, BMJ OPEN RESPIRATORY RESEARCH, Vol: 7, ISSN: 2052-4439
Slebos D-J, Degano B, Valipour A, et al., 2020, Design for a multicenter, randomized, sham-controlled study to evaluate safety and efficacy after treatment with the Nuvaira (R) lung denervation system in subjects with chronic obstructive pulmonary disease (AIRFLOW-3), BMC Pulmonary Medicine, Vol: 20, Pages: 1-10, ISSN: 1471-2466
BackgroundTargeted lung denervation (TLD) is a bronchoscopically delivered ablation therapy that selectively interrupts pulmonary parasympathetic nerve signaling. The procedure has the potential to alter airway smooth muscle tone and reactivity, decrease mucous secretion, and reduce airway inflammation and reflex airway hyperresponsiveness. Secondary outcome analysis of a previous randomized, sham-controlled trial showed a reduction in moderate-to-severe exacerbations in patients with COPD after TLD treatment. A pivotal trial, AIRFLOW-3 has been designed to evaluate the safety and efficacy of TLD combined with optimal medical therapy to reduce moderate or severe exacerbations throughout 1 year, compared with optimal medical therapy alone.MethodsThe study design is a multicenter, randomized, full sham bronchoscopy controlled, double-blind trial that will enroll 400 patients (1:1 randomization). Key inclusion criteria are FEV1/FVC < 0.7, FEV1 30 to 60% of predicted, post-bronchodilator, ≥ 2 moderate or 1 severe COPD exacerbations in the prior year, and COPD assessment test (CAT) ≥ 10. Primary objective will be the comparison of moderate or severe COPD exacerbations through 12 months of TLD therapy with optimal medical therapy versus optimal medical therapy alone. The sham group will be allowed to cross over at 1 year. Patients will be followed for up to 5 years.DiscussionThe multicenter, randomized, full sham bronchoscopy controlled, double-blind AIRFLOW-3 trial will evaluate the efficacy of TLD to reduce moderate or severe COPD exacerbations beyond optimal medical therapy alone. The target population are patients with COPD, who suffer persistent symptoms and exacerbations despite optimal treatment, defining an unmet medical need requiring novel therapeutic solutions. This trial is registered at clinicaltrials.gov: NCT03639051.
Orton CM, Garner JL, Desai SR, et al., 2020, Aspergillus Cavitation Complicating Endobronchial Lung Volume Reduction Coil Placement, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 201, Pages: E8-E9, ISSN: 1073-449X
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- Citations: 3
Fiorelli A, Pecoraro A, Carlucci A, et al., 2020, Best Evidence Topic: Does the Depth of Sedation Affect Diagnostic Yield of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration?, Clinical Pulmonary Medicine, Vol: 27, Pages: 105-112, ISSN: 1068-0640
The ideal type of sedation during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is still a matter of debate. We evaluated whether depth of sedation could affect the EBUS-TBNA results. We reviewed the literature until February 2020, and 11 studies (7 retrospective; 2 prospective observational; and 2 randomized controlled) provided the most applicable evidence to answer the question. All studies but one found that the depth of sedation did not affect diagnostic yield. Eight papers counted the number of lesions sampled per patient, and all studies but 1 found higher number of lesions biopsied with deep sedation. Seven papers counted the number of needle passes per lesion; 4 studies found higher number of passes with deep sedation; 1 study with conscious sedation; and 2 studies found no difference. Four studies evaluated lesion size, and 2 studies found smaller lesion biopsied with deep sedation. Ten papers evaluated complication rates, and 6 of these also analyzed escalation in level of care. All studies but one found that the depth of sedation was not significantly correlated with complication rates. Three studies evaluated patient satisfaction, showing no difference in relation to the depth of sedation. Only one study evaluated the cost of the procedure and found that deep sedation was associated with higher cost compared with conscious sedation. The depth of sedation did not affect EBUS-TBNA outcomes. Thus, conscious sedation and deep sedation remain 2 available strategies for EBUS-TBNA. The choice of one rather than the other strategy should be made considering several factors including physician's experience, patient's clinical history (ie, anxiety levels, psychotropic drug use, education level), the aim of EBUS-TBNA (ie, staging, diagnosis), and hospital local policy (availability of operating room and anesthesiologist).
Valipour A, Shah PL, Herth FJ, et al., 2020, Two-Year Outcomes for the Double-Blind, Randomized, Sham-Controlled Study of Targeted Lung Denervation in Patients with Moderate to Severe COPD: AIRFLOW-2, INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE, Vol: 15, Pages: 2807-2816, ISSN: 1178-2005
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- Citations: 10
Zhang H, Shen M, Shah PL, et al., 2020, Pathological Airway Segmentation with Cascaded Neural Networks for Bronchoscopic Navigation, IEEE International Conference on Robotics and Automation (ICRA), Publisher: IEEE, Pages: 9974-9980, ISSN: 1050-4729
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- Citations: 3
Criner GJ, Dransfield MT, Sciurba FC, et al., 2020, Serious Pneumothorax Events Following Bronchoscopic Lung Volume Reduction with Endobronchial Valves, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Valipour A, Shah PL, Herth FJ, et al., 2020, A Double-Blind, Randomized, Sham-Controlled Study of Targeted Lung Denervation in Patients with Moderate to Severe COPD: Airflow-2 Two Year Outcomes, Virtual International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Hakami A, Zwartkruis E, Radonic T, et al., 2020, Transbronchial cryobiopsy for diagnosis of pleuroparenchymal fibroelastosis, RESPIRATORY MEDICINE CASE REPORTS, Vol: 31, ISSN: 2213-0071
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- Citations: 1
Garner JL, Kemp S, Srikanthan K, et al., 2020, 5-Year Survival after Endobronchial Coil Implantation: Secondary Analysis of the First Randomised Controlled Trial, RESET, RESPIRATION, Vol: 99, Pages: 154-162, ISSN: 0025-7931
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- Citations: 13
Slebos D-J, Shah PL, Herth FJF, et al., 2019, Safety and Adverse Events after Targeted Lung Denervation for Symptomatic Moderate to Severe Chronic Obstructive Pulmonary Disease (AIRFLOW) A Multicenter Randomized Controlled Clinical Trial, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 200, Pages: 1477-1486, ISSN: 1073-449X
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- Citations: 46
Daniels E, Kadwani O, Molyneaux P, et al., 2019, TEMPORALLY CLOSE PRESENTATION OF PRIMARY LUNG CANCER AND IDIOPATHIC PULMONARY FIBROSIS (IPF): AN ANALYSIS OF INCIDENT IPF CASES FROM 2007-2018, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A122-A122, ISSN: 0040-6376
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