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1. Risk prediction and modification in a clinical and database population of people with chronic obstructive pulmonary disease

Author

Rigge, Lucy and Wilkinson, Thomas

Abstract

COPD is a leading cause of hospital admission and healthcare utilisation in the UK. The DOSE score can be used to risk stratify COPD patients based on clinical components routinely measured in Primary Care. Resource is often focussed on patients with high symptom burden, presenting repeatedly to medical professionals. We hypothesised that a database approach could be used to identify lower risk COPD patients by DOSE score and a subgroup at higher risk of clinical deterioration could be further identified using their documented clinical characteristics. We hypothesised that early specialist clinical review of COPD patients would reduce their subsequent symptom burden and future health care utilisation. In a real-world COPD database cohort of 13,608 Primary Care records, we risk stratified patients over four years by DOSE score. We showed clinical characteristics could identify a subgroup at increased risk of poor health outcomes with recent pneumonia and a raised eosinophil count showing the strongest individual associations. Logistic regression modelling determined the combination of characteristics most strongly associated with poor health outcomes. In a feasibility study, 120 patients deemed low risk by DOSE score were identified by Primary Care electronic record search. 76 patients were randomised to an intervention of respiratory specialist review in their Primary Care Practice. The findings suggested that proactive speciality review in a modified form warrants further research with modification of endpoint measures and further development of the recruitment process to avoid recruitment bias. In conclusion, we established the DOSE score can be administrated within a database approach and clinical characteristics can be used to further risk stratify COPD patients within a database. Pro-active specialist review of patients low risk by DOSE score is feasible for further study with some modification.

Published
2018

3. Risk prediction and modification in a clinical and database population of people with chronic obstructive pulmonary disease

Author

Rigge, Lucy. and Rigge, Lucy.

Abstract

COPD is a leading cause of hospital admission and healthcare utilisation in the UK. The DOSE score can be used to risk stratify COPD patients based on clinical components routinely measured in Primary Care. Resource is often focussed on patients with high symptom burden, presenting repeatedly to medical professionals. We hypothesised that a database approach could be used to identify lower risk COPD patients by DOSE score and a subgroup at higher risk of clinical deterioration could be further identified using their documented clinical characteristics. We hypothesised that early specialist clinical review of COPD patients would reduce their subsequent symptom burden and future health care utilisation. In a real-world COPD database cohort of 13,608 Primary Care records, we risk stratified patients over four years by DOSE score. We showed clinical characteristics could identify a subgroup at increased risk of poor health outcomes with recent pneumonia and a raised eosinophil count showing the strongest individual associations. Logistic regression modelling determined the combination of characteristics most strongly associated with poor health outcomes. In a feasibility study, 120 patients deemed low risk by DOSE score were identified by Primary Care electronic record search. 76 patients were randomised to an intervention of respiratory specialist review in their Primary Care Practice. The findings suggested that proactive speciality review in a modified form warrants further research with modification of endpoint measures and further development of the recruitment process to avoid recruitment bias. In conclusion, we established the DOSE score can be administrated within a database approach and clinical characteristics can be used to further risk stratify COPD patients within a database. Pro-active specialist review of patients low risk by DOSE score is feasible for further study with some modification.

Published
2018

4. Seasonality, risk factors and burden of community-acquired pneumonia in COPD patients: a population database study using linked health care records

Author

Williams,Nicholas P, Coombs,Ngaire A, Johnson,Matthew J, Josephs,Lynn K, Rigge,Lucy A, Staples,Karl J, Thomas,Mike, Wilkinson,Tom MA, Williams,Nicholas P, Coombs,Ngaire A, Johnson,Matthew J, Josephs,Lynn K, Rigge,Lucy A, Staples,Karl J, Thomas,Mike, and Wilkinson,Tom MA

Abstract

Nicholas P Williams,1,2 Ngaire A Coombs,3 Matthew J Johnson,4 Lynn K Josephs,3,4 Lucy A Rigge,2,4 Karl J Staples,2 Mike Thomas,1,3,4 Tom MA Wilkinson1,2,4 1Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, 2Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, 3Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, 4NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Southampton, UK Background: Community-acquired pneumonia (CAP) is more common in patients with COPD than in the adult general population, with studies of hospitalized CAP patients consistently reporting COPD as a frequent comorbidity. However, despite an increasing recognition of its importance, large studies evaluating the incidence patterns over time, risk factors and burden of CAP in COPD are currently lacking.Methods: A retrospective observational study using a large UK-based database of linked primary and secondary care records was conducted. Patients with a diagnosis of COPD aged ≥40 years were followed up for 5 years from January 1, 2010. CAP and exacerbation episodes were identified from hospital discharge data and primary care coding records, and rates were calculated per month, adjusting for mortality, and displayed over time. In addition, baseline factors predicting future risk of CAP and hospital admission with CAP were identified.Results: A total of 14,513 COPD patients were identified: 13.4% (n=1,938) had ≥1 CAP episode, of whom 18.8% suffered from recurrent (≥2) CAP. Highest rates of both CAP and exacerbations were seen in winter. A greater proportion of frequent, compared to infrequent, exacerbators experienced recurrent CAP (5.1% versus 2.0%, respectively, P<0.001); 75.6% of CAP episodes were associated with hospital admission compared to 22.1% of exacerbations.

Published
2017

10. Children must be protected from the tobacco industry's marketing tactics

Author

Hopkinson, Nicholas, Wallis, Colin, Higgins, Bernard, Gaduzo, Stephen, Sherrington, Rebecca, Keilty, Sarah, Stern, Myra, Britton, John, Bush, Andrew, Moxham, John, Sylvester, Karl, Griffiths, Valerie, Sutherland, Tim, Crossingham, Iain, Raju, Raghu, Spencer, Charlotte, Safavi, Shahideh, Deegan, Paul, Seymour, John, Hickman, Katherine, Hughes, John, Wieboldt, Jason, Shaheen, Fizah, Peedell, Clive, Mackenzie, Nesta, Nicholl, David, Jolley, Caroline, Crooks, Gillian, Dow, Claire, Deveson, Pete, Bintcliffe, Oliver, Gray, Barry, Kumar, Sanjay, Haney, Sarah, Docherty, Marianne, Thomas, Angela, Chua, Felix, Dwarakanath, Akshay, Summers, Geoffrey, Prowse, Keith, Lytton, Stephen, Ong, Yee Ean, Graves, Jennifer, Banerjee, Tushar, English, Peter, Leonard, Andrew, Brunet, Martin, Chaudhry, Nauman, Ketchell, Robert Ian, Cummings, Natalie, Lebus, Jenny, Sharp, Charles, Meadows, Chris, Harle, Amelie, Stewart, Tara, Parry, Diane, Templeton-Wright, Suzanne, Moore-Gillon, John, Stratford- Martin, James, Saini, Sarvesh, Matusiewicz, Simon, Merritt, Simon, Dowson, Lee, Satkunam, Karnan, Hodgson, Luke, Suh, Eui-Sik, Durrington, Hannah, Browne, Emma, Walters, Nicola, Steier, Joerg, Barry, Simon, Griffiths, Mark, Hart, Nicholas, Nikolic, Marko, Berry, Matthew, Thomas, Ajit, Miller, Joy, McNicholl, Diarmuid, Marsden, Paul, Warwick, Geoffrey, Barr, Laura, Adeboyeku, David, Mohd Noh, Mohd Shahrin, Griffiths, Paul, Davies, Lisa, Quint, Jennifer, Lyall, Rebecca, Shribman, Jonathan, Collins, Andrea, Goldman, Jon, Bloch, Susannah, Gill, Alison, Man, William, Christopher, Anne, Yasso, Razouqi, Rajhan, Ashwin, Shrikrishna, Dinesh, Moore, Caroline, Absalom, Gareth, Booton, Richard, Fowler, Robert William, Mackinlay, Carolyn, Sapey, Elizabeth, Lock, Sara, Walker, Paul, Jha, Akhilesh, Satia, Imran, Bradley, Bethia, Mustfa, Naveed, Haqqee, Raana, Thomas, Matt, Patel, Anant, Redington, Anthony, Pillai, Anilkumar, Keaney, Niall, Fowler, Stephen, Lowe, Lesley, Brennan, Amanda, Morrison, Douglas, Murray, Clare, Hankinson, Jenny, Dutta, P, Maddocks, Matthew, Pengo, Martino, Curtis, Katrina, Rafferty, Gerrard, Hutchinson, John, Whitfield, Ruth, Turner, Steve, Breen, Ronan, Naveed, Shams-un-nisa, Goode, Chris, Esterbrook, Georgina, Ahmed, Liju, Walker, Woolf, Ford, David, Connett, Gary, Davidson, Philip, Elston, Will, Stanton, Andrew, Morgan, David, Myerson, James, Maxwell, David, Harrris, Ann, Parmar, Sonia, Houghton, Catherine, Winter, Robert, Puthucheary, Zudin, Thomson, Fiona, Sturney, Sharon, Harvey, John, Haslam, Patricia L, Patel, Irem, Jennings, David, Range, Simon, Mallia-Milanes, Brendan, Collett, Anne, Tate, Paul, Russell, Richard, Feary, Johanna, O'Driscoll, Ronan, Eaden, James, Round, Jonathan, Sharkey, Emma, Montgomery, Mary, Vaughan, Sophie, Scheele, Kate, Lithgow, Anna, Partridge, Samuel, Chavasse, Richard, Restrick, Louise, Agrawal, Sanjay, Abdallah, Said, Lacy-Colson, Amruta, Adams, Nick, Mitchell, Sally, Haja Mydin, Helmy, Ward, Ann, Denniston, Sarah, Steel, Mark, Ghosh, Dipansu, Connellan, Stephen, Rigge, Lucy, Williams, Ruth, Grove, Alison, Anwar, Sadia, Dobson, Lee, Hosker, Harold, Stableforth, David, Greening, Neil, Howell, Tim, Casswell, Georgina, Davies, Sarah, Tunnicliffe, Georgia, Mitchelmore, Philip, Phitidis, Elpida, Robinson, Louise, Bafadhel, Mona, Robinson, Grace, Boland, Alison, Lipman, Marc, Bourke, Stephen, Kaul, Sundeep, Cowie, Calvin, Forrest, Ian, Starren, Elizabeth, Burke, Hannah, Furness, John, Bhowmik, Angshu, Everett, Caroline, Seaton, Douglas, Holmes, Steve, Doe, Simon, Parker, Samuel, Graham, Annika, Paterson, Ian, Maqsood, Usman, Ohri, Chandra, Iles, Peter, Kemp, Samuel, Iftikhar, Ahsan, Carlin, Chris, Fletcher, Tim, Emerson, Peter, Beasley, Victoria, Ramsay, Michelle, Buttery, Robert, Mungall, Sarah, Crooks, Stephen, Ridyard, John, Ross, David, Guadagno, Alison, Holden, Emma, Coutts, Ian, Cullen, Kathy, O'Connor, Sally, Barker, Jack, Sloper, Katherine, Watson, John, Smith, Peter, Anderson, Paul, Brown, Louise, Nyman, Cyril, Milburn, Heather, Clive, Amelia, Serlin, Matthew, Bolton, Charlotte, Fuld, Jonathan, Powell, Helen, Dayer, Mark, Woolhouse, Ian, Georgiadi, Adamantia, Leonard, Helen, Dodd, James, Campbell, Ian, Ruiz, Gary, Zurek, Andrew, Paton, James Y, Malin, Adam, Wood, Fraser, Hynes, Gareth, Connell, David, Spencer, David, Brown, Sarah, Smith, David, Cooper, David, O'Kane, Cecilia, Hicks, Alex, Creagh-Brown, Ben, Lordan, James, Nickol, Annabel, Primhak, Robert, Fleming, Louise, Powrie, Duncan, Brown, Joanna, Zoumot, Zaid, Elkin, Sarah, Szram, Joanna, Scaffardi, Anthony, Marshall, Robert, Macdonald, Ian, Lightbody, Darren, Farmer, Ray, Wheatley, Iain, Radnan, Paul, Lane, Ian, Booth, Andrew, Tilbrook, Sean, Capstick, Toby, Hewitt, Lee, McHugh, Martin, Nelson, Christopher, Wilson, Patrick, Padmanaban, Vijay, White, John, Davison, John, O'Callaghan, Una, Hodson, Matthew, Edwards, John, Campbell, Colin, Ward, Simon, Wooler, Edwina, Ringrose, Elizabeth, Bridges, Diana, Matthew Hodson, John Edwards, Colin Campbell, Simon Ward, Edwina Wooler, Elizabeth Ringrose, Diana Bridges, Rosalind Backham, Kim Randall, Tracey Mathieson, Long, Alex, Parkes, Marilyn, Clarke, Sarah, Allen, Bev, Connelly, Carol, Forster, Georgia, Hoadley, Jacky, Martin, Katharine, Barnham, Kate, Khan, Katie, Munday, Maureen, Edwards, Catherine, O'Hara, Doreen, Turner, Sally, Pieri-Davies, Sue, Ford, Kate, Daniels, Tracey, Wright, Joanne, Towns, Rebecca, Fern, Karen, Butcher, Jane, Burgin, Karen, Winter, Barbara, Freeman, Debbie, Olive, Sandra, Gray, Linda, Pye, Kathy, Roots, Debbie, Cox, Nicola, Davies, Carol-Anne, Wicker, Jacquelyne, Hilton, Kay, Lloyd, Jananee, MacBean, Vicky, Wood, Marion, Kowal, Julia, Downs, Janis, Ryan, Helen, Guyatt, Fran, Nicoll, Debby, Lyons, Elizabeth, Narasimhan, Divya, Rodman, Anne, Walmsley, Sandy, Newey, Alison, Buxton, Maria, Dewar, Maria, Cooper, Angela, Reilly, Jacqui, Lloyd, Julie, Macmillan, Alison Bennett, Olley, Amy, Voase, Nia, Martin, Sarah, McCarvill, Iona, Christensen, Anne, Agate, Rowan, Heslop, Karen, Timlett, Amber, Hailes, Karen, Davey, Claire, Pawulska, Barbara, Lane, Amber, Ioakim, Shona, Hough, Alexandra, Treharne, Jo, Jones, Helen, Winter-Burke, Alice, Miller, Lauren, Connolly, Bronwen, Bingham, Lyn, Fraser, Una, Bott, Julia, Johnston, Carol, Graham, Alison, Curry, Denise, Sumner, Helen, Costello, Carol Ann, Bartoszewicz, Charlotte, Badman, Ros, Williamson, Kathryn, Taylor, Amy, Purcell, Helen, Barnett, Emma, Molloy, Alanna, Crawfurd, Laura, Collins, Nicola, Monaghan, Valerie, Mir, Misbah, Lord, Victoria, Stocks, Janet, Edwards, Adrian, Greenhalgh, Trish, Lenney, Warren, McKee, Martin, McAuley, Danny, Majeed, Azeem, Cookson, John, Baker, Emma, Janes, Sam, Wedzicha, Wisia, Lomas Dean, David, Harrison, Brian, Davison, Tony, Calverley, Peter, Wilson, Robert, Stockley, Robert, Ayres, Jon, Gibson, John, Simpson, John, Burge, Sherwood, Warner, John, Thomson, Neil, Davies, Peter, Woodcock, Ashley, Woodhead, Mark, Spiro, Stephen, Ormerod, Lawrence, Bothamley, Graham, Partridge, Martyn, Shields, Michael, Montgomery, Hugh, Simonds, Anita, Barnes, Peter, Durham, Stephen, Malone, Sarah, Arabnia, Gilda, Olivier, Sharon, Gardiner, Karen, and Edwards, Sheila

Subjects
Marketing, Tobacco harm reduction, Government, Adolescent, Health professionals, business.industry, MEDLINE, Tobacco Industry, Tobacco Products, General Medicine, Tobacco industry, United Kingdom, Lung disease, Environmental health, Tobacco in Alabama, Product Packaging, Humans, Medicine, Packaging and labeling, Child, business
Abstract

Every day in the UK, hundreds of children aged 11-15 years start smoking for the first time,1 2 and there is compelling evidence that children’s perceptions of cigarettes are influenced by branding.3 4 As health professionals working to prevent and treat lung disease caused by smoking, we welcome the government’s …

11. Children must be protected from the tobacco industry's marketing tactics.

Author

Hopkinson N, Wallis C, Higgins B, Gaduzo S, Sherrington R, Keilty S, Stern M, Britton J, Bush A, Moxham J, Sylvester K, Griffiths V, Sutherland T, Crossingham I, Raju R, Spencer C, Safavi S, Deegan P, Seymour J, Hickman K, Hughes J, Wieboldt J, Shaheen F, Peedell C, Mackenzie N, Nicholl D, Jolley C, Crooks G, Crooks G, Dow C, Deveson P, Bintcliffe O, Gray B, Kumar S, Haney S, Docherty M, Thomas A, Chua F, Dwarakanath A, Summers G, Prowse K, Lytton S, Ong YE, Graves J, Banerjee T, English P, Leonard A, Brunet M, Chaudhry N, Ketchell RI, Cummings N, Lebus J, Sharp C, Meadows C, Harle A, Stewart T, Parry D, Templeton-Wright S, Moore-Gillon J, Stratford- Martin J, Saini S, Matusiewicz S, Merritt S, Dowson L, Satkunam K, Hodgson L, Suh ES, Durrington H, Browne E, Walters N, Steier J, Barry S, Griffiths M, Hart N, Nikolic M, Berry M, Thomas A, Miller J, McNicholl D, Marsden P, Warwick G, Barr L, Adeboyeku D, Mohd Noh MS, Griffiths P, Davies L, Quint J, Lyall R, Shribman J, Collins A, Goldman J, Bloch S, Gill A, Man W, Christopher A, Yasso R, Rajhan A, Shrikrishna D, Moore C, Absalom G, Booton R, Fowler RW, Mackinlay C, Sapey E, Lock S, Walker P, Jha A, Satia I, Bradley B, Mustfa N, Haqqee R, Thomas M, Patel A, Redington A, Pillai A, Keaney N, Fowler S, Lowe L, Brennan A, Morrison D, Murray C, Hankinson J, Dutta P, Maddocks M, Pengo M, Curtis K, Rafferty G, Hutchinson J, Whitfield R, Turner S, Breen R, Naveed SU, Goode C, Esterbrook G, Ahmed L, Walker W, Ford D, Connett G, Davidson P, Elston W, Stanton A, Morgan D, Myerson J, Maxwell D, Harrris A, Parmar S, Houghton C, Winter R, Puthucheary Z, Thomson F, Sturney S, Harvey J, Haslam PL, Patel I, Jennings D, Range S, Mallia-Milanes B, Collett A, Tate P, Russell R, Feary J, O'Driscoll R, Eaden J, Round J, Sharkey E, Montgomery M, Vaughan S, Scheele K, Lithgow A, Partridge S, Chavasse R, Restrick L, Agrawal S, Abdallah S, Lacy-Colson A, Adams N, Mitchell S, Haja Mydin H, Ward A, Denniston S, Steel M, Ghosh D, Connellan S, Rigge L, Williams R, Grove A, Anwar S, Dobson L, Hosker H, Stableforth D, Greening N, Howell T, Casswell G, Davies S, Tunnicliffe G, Mitchelmore P, Phitidis E, Robinson L, Prowse K, Bafadhel M, Robinson G, Boland A, Lipman M, Bourke S, Kaul S, Cowie C, Forrest I, Starren E, Burke H, Furness J, Bhowmik A, Everett C, Seaton D, Holmes S, Doe S, Parker S, Graham A, Paterson I, Maqsood U, Ohri C, Iles P, Kemp S, Iftikhar A, Carlin C, Fletcher T, Emerson P, Beasley V, Ramsay M, Buttery R, Mungall S, Crooks S, Ridyard J, Ross D, Guadagno A, Holden E, Coutts I, Cullen K, O'Connor S, Barker J, Sloper K, Watson J, Smith P, Anderson P, Brown L, Nyman C, Milburn H, Clive A, Serlin M, Bolton C, Fuld J, Powell H, Dayer M, Woolhouse I, Georgiadi A, Leonard H, Dodd J, Campbell I, Ruiz G, Zurek A, Paton JY, Malin A, Wood F, Hynes G, Connell D, Spencer D, Brown S, Smith D, Cooper D, O'Kane C, Hicks A, Creagh-Brown B, Lordan J, Nickol A, Primhak R, Fleming L, Powrie D, Brown J, Zoumot Z, Elkin S, Szram J, Scaffardi A, Marshall R, Macdonald I, Lightbody D, Farmer R, Wheatley I, Radnan P, Lane I, Booth A, Tilbrook S, Capstick T, Hewitt L, McHugh M, Nelson C, Wilson P, Padmanaban V, White J, Davison J, O'Callaghan U, Hodson M, Edwards J, Campbell C, Ward S, Wooler E, Ringrose E, Bridges D, Matthew Hodson, John Edwards, Colin Campbell, Simon Ward, Edwina Wooler, Elizabeth Ringrose, Diana Bridges, Rosalind Backham, Kim Randall, Tracey Mathieson, Long A, Parkes M, Clarke S, Allen B, Connelly C, Forster G, Hoadley J, Martin K, Barnham K, Khan K, Munday M, Edwards C, O'Hara D, Turner S, Pieri-Davies S, Ford K, Daniels T, Wright J, Towns R, Fern K, Butcher J, Burgin K, Winter B, Freeman D, Olive S, Gray L, Pye K, Roots D, Cox N, Davies CA, Wicker J, Hilton K, Lloyd J, MacBean V, Wood M, Kowal J, Downs J, Ryan H, Guyatt F, Nicoll D, Lyons E, Narasimhan D, Rodman A, Walmsley S, Newey A, Buxton M, Dewar M, Cooper A, Reilly J, Lloyd J, Macmillan AB, Roots D, Olley A, Voase N, Martin S, McCarvill I, Christensen A, Agate R, Heslop K, Timlett A, Hailes K, Davey C, Pawulska B, Lane A, Ioakim S, Hough A, Treharne J, Jones H, Winter-Burke A, Miller L, Connolly B, Bingham L, Fraser U, Bott J, Johnston C, Graham A, Curry D, Sumner H, Costello CA, Bartoszewicz C, Badman R, Williamson K, Taylor A, Purcell H, Barnett E, Molloy A, Crawfurd L, Collins N, Monaghan V, Mir M, Lord V, Stocks J, Edwards A, Greenhalgh T, Lenney W, McKee M, McAuley D, Majeed A, Cookson J, Baker E, Janes S, Wedzicha W, Lomas Dean D, Harrison B, Davison T, Calverley P, Wilson R, Stockley R, Ayres J, Gibson J, Simpson J, Burge S, Warner J, Lenney W, Thomson N, Davies P, Woodcock A, Woodhead M, Spiro S, Ormerod L, Bothamley G, Partridge M, Shields M, Montgomery H, Simonds A, Barnes P, Durham S, Malone S, Arabnia G, Olivier S, Gardiner K, and Edwards S

Subjects
Adolescent, Child, Humans, Marketing standards, Product Packaging standards, Tobacco Industry standards, United Kingdom, Marketing legislation & jurisprudence, Product Packaging legislation & jurisprudence, Tobacco Industry legislation & jurisprudence, Tobacco Products
Published
2013
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