A5026183673- Obstructive Sleep Apnea Research
- COVID-19 Clinical Research Studies
- Pleural and Pulmonary Diseases
- SARS-CoV-2 and COVID-19 Research
- Neuroscience of respiration and sleep
- Long-Term Effects of COVID-19
- Respiratory Support and Mechanisms
- Occupational and environmental lung diseases
- Cardiovascular and Diving-Related Complications
- Pneumothorax, Barotrauma, Emphysema
- Ultrasound in Clinical Applications
- Amoebic Infections and Treatments
- Intensive Care Unit Cognitive Disorders
- Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
- Sleep and related disorders
- Trauma Management and Diagnosis
- Cardiovascular Syncope and Autonomic Disorders
- Sleep and Wakefulness Research
- Tracheal and airway disorders
- SARS-CoV-2 detection and testing
- COVID-19 and healthcare impacts
- Antibiotic Use and Resistance
- Nosocomial Infections in ICU
- Respiratory viral infections research
- Management of metastatic bone disease
Musgrove Park Hospital
2015-2025
International Severe Acute Respiratory and Emerging Infection Consortium
2023
St Mary's Hospital
2023
Centre for Inflammation Research
2022
University of Edinburgh
2022
The Queen's Medical Research Institute
2022
Roslin Institute
2022
Somerset NHS Foundation Trust
2011-2021
Public Health England
2021
Taunton & Somerset NHS Foundation Trust
2006-2020
<h3>Importance</h3> Outcomes after exacerbations of chronic obstructive pulmonary disease (COPD) requiring acute noninvasive ventilation (NIV) are poor and there few treatments to prevent hospital readmission death. <h3>Objective</h3> To investigate the effect home NIV plus oxygen on time or death in patients with persistent hypercapnia an COPD exacerbation. <h3>Design, Setting, Participants</h3> A randomized clinical trial (Paco<sub>2</sub>>53 mm Hg) 2 weeks 4 resolution respiratory...
<h3>Importance</h3> For treatment of malignant pleural effusion, nonsteroidal anti-inflammatory drugs (NSAIDs) are avoided because they may reduce pleurodesis efficacy. Smaller chest tubes be less painful than larger tubes, but efficacy in has not been proven. <h3>Objective</h3> To assess the effect tube size and analgesia (NSAIDs vs opiates) on pain clinical related to patients with effusion. <h3>Design, Setting, Participants</h3> A 2×2 factorial phase 3 randomized trial among 320 requiring...
Background High rates of non-adherence to continuous positive airway pressure (CPAP) in obstructive sleep apnoea hamper good clinical outcomes. Current recommendations assumes two behaviours (adherence and non-adherence) days 7–90 follow-up post-CPAP initiation mitigates against non-adherence. Objectives To investigate associations between early CPAP-usage (1) CPAP adherence at month 3 treatment (2) centres’ pathways (the procedures patients undergo that may affect barriers or facilitators...
Heart failure is associated with Cheyne–Stokes breathing, which fragments patients' sleep. Correction of respiratory disturbance may reduce sleep fragmentation and excessive daytime sleepiness. This randomized prospective parallel trial assesses whether nocturnal-assist servoventilation improves sleepiness compared the control. A total 30 subjects (29 male) breathing (mean apnea–hypopnea index 19.8 [SD 2.6] stable symptomatic chronic heart (New York Association Class II–IV) were treated 1...
Overnight tape recordings of breathing movements, airflow, and arterial oxygen saturation from six infants aged 3 weeks to 7 months, who had cyanotic episodes associated with pertussis, were compared 12 age matched healthy controls. In all patients clinically apparent apnoeic the rapid onset progression central cyanosis. When overnight compared, pertussis a greater frequency pauses (particularly those than or equal 12.0 seconds duration) hypoxaemia (oxygen less 80% for 0.5 seconds) pauses....
Previous studies have shown that CPAP has a substantial impact on daytime symptoms and quality of life (QOL). It remains unclear which outcome measures best identify real effects carry independent information.One hundred-two men with moderate-severe obstructive sleep apnea were randomized to either "real" or "sham" for one month. Outcome subjective sleepiness (Epworth Sleepiness Scale [ESS]) QOL includiig SF-36/SF-12 Calgary Sleep Apnea Quality Life Index (SAQLI). The bed partner's rating...
The use of prophylactic radiotherapy to prevent procedure-tract metastases (PTMs) in malignant pleural mesothelioma remains controversial, and clinical practice varies worldwide. We aimed compare with deferred (given only when a PTM developed) suitably powered trial.We did multicentre, open-label, phase 3, randomised controlled trial 22 UK hospitals patients histocytologically proven who had undergone large-bore interventions the 35 days prior recruitment. Eligible were (1:1), using...
Obstructive sleep apnoea syndrome (OSAS) has been associated with cardiovascular disease in epidemiological and observational studies. Continuous positive airway pressure (CPAP) is the treatment of choice for OSAS, but impact this intervention on systemic inflammation involved atherosclerotic process remains unclear.100 men moderate-severe OSAS were randomised to therapeutic (n = 51) or subtherapeutic 49) CPAP 4 weeks investigate effects active inflammatory markers such as highly sensitive C...
Malignant pleural effusion (MPE) is challenging to manage. Talc pleurodesis a common and effective treatment. There are no reliable data, however, regarding the optimal method for talc delivery, leading differences in practice recommendations.To test hypothesis that administration of poudrage during thoracoscopy with local anesthesia more than slurry delivered via chest tube successfully inducing pleurodesis.Open-label, randomized clinical trial conducted at 17 UK hospitals. A total 330...
Background Over 30% of adult patients with pleural infection either die and/or require surgery. There is no robust means predicting at baseline presentation which will suffer a poor clinical outcome. A validated risk prediction score would allow early identification high-risk patients, potentially directing more aggressive treatment thereafter. Objectives To prospectively assess previously described (the RAPID (Renal (urea), Age, fluid Purulence, Infection source, Dietary (albumin)) score)...
Rationale: Patients with malignant pleural effusion experience breathlessness, which is treated by drainage and pleurodesis. Incomplete results in residual dyspnea pleurodesis failure. Intrapleural fibrinolytics lyse septations within fluid, improving drainage.Objectives: To assess the effects of intrapleural urokinase on success patients nondraining effusion.Methods: We conducted a prospective, double-blind, randomized trial. were randomly allocated 1:1 ratio to (100,000 IU, three doses,...
Summary Obstructive sleep apnoea (OSA) is associated with cardiovascular morbidity and may precipitate cardiac dysrhythmias. Uncontrolled reports suggest that continuous positive airway pressure (CPAP) reduce dysrhythmia frequency resting heart rate. We undertook a randomised controlled trial of therapeutic CPAP compared subtherapeutic control which included an exploration changes in Values are expressed as mean (SD). Eighty‐three men [49.5 (9.6) years] moderate–severe OSA [Oxygen...
<i>Background:</i> Obstructive sleep apnoea syndrome (OSAS) has been suggested to be an independent risk factor for non-alcoholic fatty liver disease (NAFLD), possibly via intermittent hypoxia that influences blood pressure, lipid levels and insulin resistance, factors themselves known cause NAFLD. In observational studies, OSAS associated with elevated of enzymes. Continuous positive airway pressure (CPAP) is the treatment OSAS, but effects CPAP on enzymes have not studied in a...
Physicians face considerable challenges in ensuring safe and effective care for patients admitted to hospital with pleural disease. While subspecialty development has driven up standards of care, this been tempered by the resulting loss procedural experience general medical teams tasked managing acute This review aims define a framework though which minimum standard might be implemented. written clinicians from across UK representing all types secondary hospital. Its content formed on basis...
Secondary spontaneous pneumothorax (SSP) is traditionally managed with an intercostal chest tube attached to underwater seal. We investigated whether use of a one-way flutter valve shortened patients’ length stay (LoS). This open-label randomised controlled trial enrolled patients presenting SSP and either seal (standard care: SC) or ambulatory care (AC) valve. The type used depended on at randomisation the patient already had in place: those without pleural vent (PV) was used; situ , Atrium...
The COVID-19 pandemic changed continuous positive airway pressure (CPAP) setup pathways. We evaluated patients commenced on CPAP in 2019 (prepandemic) and 2020 (post-first UK wave). Face-to-face (F2F) numbers, with turned on, decreased from 613 (98.9%) 2019, to 6 (1.1%) 2020. In 2020, setups were F2F without (403 (71.1%)), or remote (158 (27.9%)). Prepandemic median usage at first follow-up was 5.4 (2.7–6.9) hours/night fell by 0.9 (95% CI 0.5 1.2, p<0.0001) found clinically relevant...
Introduction Patients with malignant pleural mesothelioma (MPM) may develop painful ‘procedure tract metastasis’ (PTM) at the site of previous interventions. Prophylactic radiotherapy has been used to minimise this complication; however, three small randomised trials have shown conflicting results regarding its effectiveness. The surgical and large bore procedures in trial (SMART Trial) is a suitably powered, multicentre, controlled trial, designed evaluate efficacy prophylactic within 42...
ABSTRACT Background and objective Chemical pleurodesis is performed for patients with MPE a published success rate of around 80%. It has been postulated that inflammation key in achieving successful pleural symphysis, as evidenced by higher amounts pain or detected inflammatory response. Patients mesothelioma are to have lower due lack normal tissue enabling an Methods The TIME1 trial data set, which were co‐primary outcome measures, was used address number these assumptions. Pain score,...
<i>Introduction:</i> Hospital readmission and mortality following severe exacerbations of COPD requiring acute non-invasive ventilation (NIV) remain high. We hypothesised that HMV HOT, cessation NIV, would be superior to HOT alone. <i>Method:</i> An open labelled parallel randomised controlled trial comparing with alone was performed. The primary outcome 1-year admission free survival. Patients persistent hypercapnia (PaCO<sub>2</sub> >7kPa) 2-4 weeks after resolution respiratory acidosis...