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Journal articleRazanskaite V, Kallis C, Young B, et al., 2021,
Heterogeneity in outcome assessment for inflammatory bowel disease in routine clinical practice: a mixed-methods study in a sample of English hospitals
, BMJ OPEN, Vol: 11, ISSN: 2044-6055- Author Web Link
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- Citations: 2
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Journal articleButtery S, Philip K, Williams P, et al., 2021,
Patient symptoms and experience following COVID-19: results from a UK-wide survey
, BMJ Open Respiratory Research, Vol: 8, ISSN: 2052-4439Objectives: To investigate the experience of people who continue to be unwell after acute COVID-19, often referred to as ‘long COVID’, both in terms of their symptoms and their interactions with healthcare.Design: We conducted a mixed-methods analysis of responses to a survey accessed through a UK online post-COVID support and information hub between April and December 2020 about people’s experiences after having acute COVID-19.Participants: 3290 respondents, 78% female 92.1% white ethnicity and median age range 45-54 years; 12.7% had been hospitalised. 494(16.5%) completed the survey between 4 and 8 weeks of the onset of their symptoms, 641(21.4%) between 8 and 12 weeks and 1865(62.1%) >12 weeks after.Results: The ongoing symptoms most frequently reported were; breathing problems (92.1%), fatigue (83.3%), muscle weakness or joint stiffness (50.6%), sleep disturbances (46.2%), problems with mental abilities (45.9%) changes in mood, including anxiety and depression (43.1%) and cough (42.3%). Symptoms did not appear to be related to the severity of the acute illness or to the presence of pre-existing medical conditions. Analysis of free text responses revealed three main themes (1) Experience of living with COVID-19 – physical and psychological symptoms that fluctuate unpredictably; (2) Interactions with healthcare that were unsatisfactory; (3) Implications for the future – their own condition, society and the healthcare system, and the need for researchConclusion: Consideration of patient perspective and experiences will assist in the planning of services to address problems persisting in people who remain symptomatic after the acute phase of COVID-19.
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Conference paperKoteci A, Morgan AD, Whittaker HR, et al., 2021,
INCIDENCE AND PREVALENCE OF LEFT-SIDED HEART FAILURE IN PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS: A POPULATION-BASED STUDY
, Publisher: BMJ PUBLISHING GROUP, Pages: A148-A149, ISSN: 0040-6376 -
Journal articleDixon P, Kallis C, Grainger R, et al., 2021,
Care After Presenting with Seizures (CAPS): An analysis of the impact of a seizure referral pathway and nurse support on neurology referral rates for patients admitted with a seizure
, SEIZURE-EUROPEAN JOURNAL OF EPILEPSY, Vol: 92, Pages: 18-23, ISSN: 1059-1311 -
Conference paperKallis C, Morgan A, Maslova E, et al., 2021,
Trends in asthma incidence in children: a UK population-based cohort study
, European-Respiratory-Society (ERS) International Congress, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936- Author Web Link
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- Citations: 1
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Conference paperLenoir A, Whittaker HR, Gayle A, et al., 2021,
Clinical characteristics, mortality rates and causes of death in non-exacerbating COPD patients. A longitudinal cohort analysis of UK primary care data
, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936- Author Web Link
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- Citations: 1
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Journal articleWhittaker H, Kiddle S, Quint J, 2021,
Challenges and pitfalls of using repeat spirometry recordings in routine primary care data to measure FEV1 decline in a COPD population
, Pragmatic and Observational Research, Vol: 2021, Pages: 119-130, ISSN: 1179-7266BackgroundElectronic healthcare records (EHR) are increasingly used for epidemiological studies but are often viewed as lacking quality compared to randomised control trials and prospective cohorts. Studies of patients with chronic obstructive pulmonary disease (COPD) often use rate of forced expiratory volume in 1 second (FEV1) decline as an outcome however, its definition and robustness in EHR has not be investigated. We aimed to investigate how rate of FEV1 decline differs by the criteria used in an EHR database.MethodsClinical Practice Research Datalink and Hospital Episode Statistics were used. Patient populations were defined using 8 sets of criteria around repeated FEV1 measurements. At a minimum, patients had a diagnosis of COPD, were ≥35 years old, were current or ex-smokers, and had data recorded from 2004. FEV1 measurements recorded during follow-up were identified. Thereafter, eight populations were defined based on criteria around: i) the exclusion of patients or individual measurements with potential measurement error; ii) minimum number of FEV1 measurements; iii) minimum time interval between measurements; iv) specific timing of measurements; v) minimum follow-up time; and vi) the use of linked data. For each population, rate of FEV1 decline was estimated using mixed linear regression. ResultsFor 7/8 patient populations, rates of FEV1 decline (age and sex adjusted) were similar and ranged from -18.7ml/year (95%CI -19.2 to -18.2) to -16.5ml/year (95%CI -17.3 to -15.7). Rates of FEV1 decline in populations that excluded patients with potential measurement error ranged from -79.4ml/year (95%CI -80.7 to -78.2) to -46.8ml/year (95%CI -47.6 to -46.0). ConclusionsFEV1 decline remained similar in a COPD population regardless of number of FEV1 measurements, time intervals between measurements, follow-up period, exclusion of specific FEV1 measurements, and linkage to HES. However, exclusion of individuals with questionable data led to selection bias and fast
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Journal articleWild JM, Porter JC, Molyneaux PL, et al., 2021,
Understanding the burden of interstitial lung disease post-COVID-19: the UK Interstitial Lung Disease-Long COVID Study (UKILD-Long COVID)
, BMJ Open Respiratory Research, Vol: 8, Pages: 1-10, ISSN: 2052-4439Introduction The COVID-19 pandemic has led to over 100 million cases worldwide. The UK has had over 4 million cases, 400 000 hospital admissions and 100 000 deaths. Many patients with COVID-19 suffer long-term symptoms, predominantly breathlessness and fatigue whether hospitalised or not. Early data suggest potentially severe long-term consequence of COVID-19 is development of long COVID-19-related interstitial lung disease (LC-ILD).Methods and analysis The UK Interstitial Lung Disease Consortium (UKILD) will undertake longitudinal observational studies of patients with suspected ILD following COVID-19. The primary objective is to determine ILD prevalence at 12 months following infection and whether clinically severe infection correlates with severity of ILD. Secondary objectives will determine the clinical, genetic, epigenetic and biochemical factors that determine the trajectory of recovery or progression of ILD. Data will be obtained through linkage to the Post-Hospitalisation COVID platform study and community studies. Additional substudies will conduct deep phenotyping. The Xenon MRI investigation of Alveolar dysfunction Substudy will conduct longitudinal xenon alveolar gas transfer and proton perfusion MRI. The POST COVID-19 interstitial lung DiseasE substudy will conduct clinically indicated bronchoalveolar lavage with matched whole blood sampling. Assessments include exploratory single cell RNA and lung microbiomics analysis, gene expression and epigenetic assessment.Ethics and dissemination All contributing studies have been granted appropriate ethical approvals. Results from this study will be disseminated through peer-reviewed journals.Conclusion This study will ensure the extent and consequences of LC-ILD are established and enable strategies to mitigate progression of LC-ILD.
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Journal articleBachtiger P, Adamson A, Maclean WA, et al., 2021,
Determinants of shielding behaviour during the COVID-19 pandemic and associations with wellbeing in >7,000 NHS patients: 17-week longitudinal observational study.
, JMIR Public Health and Surveillance, Vol: 7, Pages: 1-14, ISSN: 2369-2960BACKGROUND: The UK National Health Service (NHS) classified 2.2 million people as clinically extremely vulnerable (CEV) during the first wave of the 2020 COVID-19 pandemic, advising them to 'shield' - to not leave home for any reason. OBJECTIVE: The aim of this study was to measure the determinants of shielding behaviour and associations with wellbeing in a large NHS patient population, towards informing future health policy. METHODS: Patients contributing to an ongoing longitudinal participatory epidemiology study (LoC-19, n = 42,924) received weekly email invitations to complete questionnaires (17-week shielding period starting 9th April 2020) within their NHS personal electronic health record. Question items focused on wellbeing. Participants were stratified into four groups by self-reported CEV status (qualifying condition) and adoption of shielding behaviour (baselined at week 1 or 2). Distribution of CEV criteria is reported alongside situational variables and uni- and multivariable logistic regression. Longitudinal trends in physical and mental wellbeing were displayed graphically. Free-text responses reporting variables impacting wellbeing were semi-quantified using natural language processing. In the lead up to a second national lockdown (October 23rd, 2020), a follow-up questionnaire evaluated subjective concern if further shielding were advised. RESULTS: 7,240 participants were included. Among the CEV (2,391), 1,133 (47.3%) assumed shielding behaviour at baseline, compared with 633 (15.0%) in the non-CEV group. Those CEV who shielded were more likely to be Asian (Odds Ratio OR 2.02 [1.49-2.76]), female (OR 1.24 [1.05-1.45]), older (OR per year increase 1.01 [1.00-1.02]) and live in a home with outdoor space (OR 1.34 [1.06-1.70]) or 3-4 other inhabitants (3 = OR 1.49 [1.15-1.94], 4 = OR 1.49 [1.10-2.01]); and be solid organ transplant recipients (2.85 [2.18-3.77]) or have severe chronic lung disease (OR 1.63 [1.30-2.04]). Receipt of a government letter adv
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Journal articlegroves D, karsanji U, evans R, et al., 2021,
Predicting future health risk in COPD: Differential impact of disease specific and multi-morbidity based risk stratification
, International Journal of COPD, Vol: 2021, Pages: 1741-1754, ISSN: 1176-9106Objective: Multi-morbidity contributes to mortality and hospitalisation in COPD but it is uncertain how this interacts with disease severity in risk prediction. We compared contributions of multi-morbidity and disease severity factors in modelling future health risk using UK primary care healthcare data. Method: Health records from 103,955 patients with COPD identified from the Clinical Practice Research Datalink were analysed. We compared Area Under The Curve (AUC) statistics for logistic regression (LR) models incorporating disease indices with models incorporating categorised co-morbidities. We also compared these models with performance of The John Hopkins Adjusted Clinical Groups® System (ACG) risk prediction algorithm. Results: LR models predicting all-cause mortality outperformed models predicting hospitalisation. Mortality was best predicted by disease severity (AUC & 95% CI: 0.816 (0.805 - 0.827)) and prediction was enhanced only marginally by the addition of multi-morbidity indices (AUC & 95% CI: 0.829 (0.818 – 0.839)). The model combining disease severity and multi-morbidity indices was a better predictor of hospitalisation (AUC & 95% CI: 0.679 (0.672 – 0.686)). ACG derived LR models outperformed conventional regression models for hospitalisation (AUC & 95% CI: 0.697 (0.690 – 0.704)) but not for mortality (AUC & 95% CI: 0.816 (0.805 – 0.827)). Conclusion: Stratification of future health risk in COPD can be undertaken using clinical and demographic data recorded in primary care but the impact of disease severity and multi-morbidity varies depending on the choice of health outcome. A more comprehensive risk modelling algorithm such as ACG offers enhanced prediction for hospitalisation by incorporating a wider range of coded diagnoses.
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