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Journal articleWhittaker H, Rubino A, Mullerova H, et al., 2022,
Frequency and severity of exacerbations of COPD associated with future Risk of exacerbations and mortality: A UK routine health care data study
, The International Journal of Chronic Obstructive Pulmonary Disease, Vol: 17, Pages: 427-437, ISSN: 1176-9106Background: Studies have shown that chronic obstructive pulmonary disease (COPD) exacerbation events are related to future events; however, previous literature typically reports frequent vs infrequent exacerbations per patient-year and no studies have investigated increasing number of severe exacerbations in relation to COPD outcomes.Objective: To investigate the association between baseline frequency and severity of exacerbations and subsequent mortality and exacerbation risk in a COPD cohort.Methods: Clinical Practice Research Datalink (CPRD) Aurum and Hospital Episode Statistics data were used to identify patients registered at general practices in the UK, who had a diagnosis of COPD, were over the age of 40 years, were smokers or ex-smokers and had data recorded from 2004 onwards. Frequency and severity of exacerbations in the baseline year were identified as moderate exacerbations (general practice events) and severe exacerbations (hospitalised events). Patients were categorised as having: none, 1 moderate only, 2 moderate only, 3+ moderate only, 1 severe (and any moderate), 2 severe (and any moderate), and 3+ severe (and any moderate exacerbations). Poisson regression was used to investigate the association between baseline exacerbation frequency/severity and exacerbation events and mortality over follow-up.Results: Overall, 340,515 COPD patients were included. Patients had higher rates of future exacerbations with increasing frequency and severity of baseline exacerbations compared to no baseline exacerbations. Adjusted incidence rate ratios (IRR) for patients with 1, 2, and 3+ moderate exacerbations compared to 0 exacerbations were 1.70 (95% CI 1.66– 1.74), 2.31 (95% CI 2.24– 2.37), and 3.52 (95% CI 3.43– 3.62), respectively. Patients with increased frequency of baseline exacerbations were more likely to die from all-cause, COPD-related, and cardiovascular-related mortality in a graduated fashion.Conclusion: Increasing number and severity o
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Journal articleBednarczyk E, Cook S, Brauer R, et al., 2022,
Stakeholders' views on the use of psychotropic medication in older people: a systematic review.
, Age and Ageing, Vol: 51, ISSN: 0002-0729BACKGROUND: psychotropic medication use has been shown to increase with age and has been associated with increased risk of falls, strokes and mortality. Various guidelines, regulations and tools have been developed to reduce inappropriate prescribing, but this remains high. In order to understand the reasons for this, we aimed to systematically review healthcare professionals', patients' and family caregivers' attitudes towards the use of psychotropic medication in older people. METHODS: a systematic literature search was carried out from inception to September 2020 using PUBMED, EMBASE, PsycINFO and CINAHL and hand-searching of reference lists. Included studies investigated stakeholder views on psychotropic in adults over the age of 65. Findings were thematically synthesised. RESULTS: overall, there was an acceptance of long-term psychotropic medication for older people both living in the community and in residential care. While healthcare professionals were aware of guidelines for the use of benzodiazepines and psychotropic medicines, they identified barriers to following them on individual, team and organisational levels. Alternative non-pharmacological approaches were not always available or accepted by patients. CONCLUSION: psychotropic medicine use in older adults remains a complex issue, which needs to be addressed on a broad level. Attitudes of older people and healthcare professionals encourage long-term use. Meanwhile, various internal and external factors act as barriers to the use of non-drug alternatives in this population. In order to reduce overprescribing of psychotropics, there is a need to increase the acceptability and accessibility of alternative interventions in both care homes and the community.
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Journal articleCookson W, Moffatt M, Rapeport G, et al., 2022,
A pandemic lesson for global lung diseases: exacerbations are preventable.
, American Journal of Respiratory and Critical Care Medicine, Vol: 205, Pages: 1271-1280, ISSN: 1073-449XA dramatic global reduction in the incidence of common seasonal respiratory viral infections has resulted from measures to limit the transmission of SARS2-Cov-19 during the pandemic . This has been accompanied by falls reaching 50% internationally in the incidence of acute exacerbations of pre-existing chronic respiratory diseases that include asthma, Chronic Obstructive Pulmonary Disease (COPD) and Cystic Fibrosis (CF). At the same time, the incidence of acute bacterial pneumonia and sepsis has fallen steeply world-wide. Such findings demonstrate the profound impact of common respiratory viruses on the course of these global illnesses. Reduced transmission of common respiratory bacterial pathogens and their interactions with viruses appear also as central factors. This review summarises pandemic changes in exacerbation rates of asthma, COPD, Cystic Fibrosis (CF) and pneumonia. We draw attention to the substantial body of knowledge about respiratory virus infections in these conditions, and that it has not yet translated into clinical practice. Now the large-scale of benefits that could be gained by managing these pathogens is unmistakable, we suggest the field merits substantial academic and industrial investment. We consider how pandemic-inspired measures for prevention and treatment of common infections should become a cornerstone for managing respiratory diseases. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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Journal articleMacRae C, Whittaker H, Mukherjee M, et al., 2022,
Deriving a standardised recommended respiratory disease codelist repository for future research
, Pragmatic and Observational Research, Vol: 13, ISSN: 1179-7266Background: Electronic health record (EHR) databases provide rich, longitudinal data on interactions with healthcare providers, and can be used to advance research into respiratory conditions. However, since these data are primarily collected to support health care delivery, clinical coding can be inconsistent, resulting in inherent challenges in using these data for research purposes.Methods: We systematically searched existing international literature and UK code repositories to find respiratory disease codelists for asthma from January 2018, and chronic obstructive pulmonary disease 1 and respiratory tract infections from January 2020, based on prior searches. Medline searches using key terms provided article lists. Full-text articles, supplementary files, and reference lists were examined for codelists, and codelists repositories were searched. A reproducible methodology for codelists creation was developed with recommended lists for each disease created based on multidisciplinary expert opinion and previously published literature. Results: Medline searches returned 1,126 asthma articles, 70 COPD articles, and 90 respiratory infection articles, with 3%, 22% and 5% including codelists, respectively. Repository searching returned 12 asthma, 23 COPD, and 64 respiratory infection codelists. We have systematically compiled respiratory disease codelists and from these derived recommended lists for use by researchers to find the most up-to-date and relevant respiratory disease codelists that can be tailored to individual research questions. Conclusions: Few published papers include codelists, and where published diverse codelists were used, even when answering similar research questions. Whilst some advances have been made. greater consistency and transparency across studies using routine data to study respiratory diseases are needed.
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Journal articleAdesanya E, Cook S, Crellin E, et al., 2022,
Alcohol use recording in adults with depression in English primary care: a cross-sectional study
, BMJ Open, Vol: 12, Pages: 1-9, ISSN: 2044-6055Objectives To investigate alcohol use recording in people with newly diagnosed depression in English primary care and individual characteristics associated with the recording of alcohol use.Design A population-based cross-sectional study.Setting Primary care data from English practices contributing to the UK Clinical Practice Research Datalink.Participants We included adults (18+ years) diagnosed with depression between 1 January 2011 and 1 January 2017 without previous antidepressant use and at least 1 year of registration before diagnosis.Primary and secondary outcome measures We described the proportion of individuals with alcohol use and level of alcohol use recorded at four time points (the date of depression diagnosis, 3 months before or after depression diagnosis, 12 months before or after depression diagnosis and any point pre or postdepression diagnosis). We used logistic regression to investigate individual characteristics associated with alcohol use recording in the 3 months before or after depression diagnosis.Results We identified 36 424 adults with depression. 538 (2%) had alcohol use recorded in the 3 months before or after depression diagnosis using formal validated methods such as the Alcohol Use Disorders Identification Test and its abbreviated versions. At each time point, most individuals with alcohol use recorded were low risk drinkers. Alcohol use recording in the 3 months before or after depression diagnosis was associated with male sex (OR=1.38, 95% CI 1.29 to 1.48) and several other individual-level factors.Conclusions Our study shows low levels of alcohol use recording in the 3 months before or after depression diagnosis. Levels of alcohol use recording varied depending on individual characteristics. Incentivised recording of alcohol use will increase completeness, which could improve clinical management and reduce missed opportunities for care in people with depression.
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Journal articleWhittaker H, Gulea C, Koteci A, et al., 2021,
GP consultation rates for post-acute COVID-19 sequelae in cases managed in the community or hospital in the UK: a population-based study
, BMJ: British Medical Journal, Vol: 375, Pages: 1-13, ISSN: 0959-535XObjectiveTo describe GP consultation rates for post-COVID-19 sequelae in non-hospitalised and hospitalised COVID-19 patients, and among non-hospitalised individuals describe how GP consultation rates for post-COVID-19 sequelae change over time, as well as following COVID-19 vaccination. DesignPopulation-based cohort study.Setting1,392 general practices in England contributing to the Clinical Practice Research Datalink Aurum database.Participants456,002 COVID-19 cases diagnosed between 1st August 2020 to 14th February2021 (44.7% male; median age 61 years), either hospitalised within two weeks of diagnosis or not hospitalised and followed-up for a maximum of 9.2 months. A negative control group of individuals without COVID-19 (N=38,511) and patients with influenza before the pandemic (N=21,803) were used to contextualise findings.Main outcome measuresComparison of GP consultation rates for new symptoms, diseases, prescriptions and healthcare utilisation (HCU) in hospitalised and non-hospitalised individuals separately pre and post-COVID-19 infection using Cox regression and negative binomial regression for HCU. This was repeated for the negative control and influenza cohorts. In non-hospitalised individuals, outcomes were additionally described over time following COVID-19 diagnosis and compared pre and post-COVID-19 vaccine in individuals who were symptomatic post-COVID-19, using negative binomial regression. Results Relative to the negative control and influenza cohorts non-hospitalised patients (N=437,943) had significantly higher GP consultation rates for multiple sequelae, the most common being loss of smell/taste (HRadj 5.28 [95%CI 3.89 to 7.17]; p<0.001), venous thromboembolism (VTE) (3.35 [2.87 to 3.90]; p<0.001), lung fibrosis (2.41 [1.37 to 4.25]; p=0.002), and muscle pain (1.89 [1.6 3to 2.20]; p<0.001), as well as HCU post COVID-19 diagnosis compared with 1-year prior. In terms of absolute proportions, the most common outcomes ≥ 4-weeks post-CO
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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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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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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 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
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