Introduction and objectivesRandomised controlled trials of vitamin D to prevent acute respiratory infection have yielded mixed results. We conducted an individual patient data (IPD) meta-analysis to identify factors that may explain this heterogeneity.MethodsWe performed an IPD meta-analysis of 25 trials of vitamin D supplementation with incidence of acute respiratory infection as a pre-specified outcome (total 11,321 participants, aged 0 to 95 years). We used one-step logistic regression with random effects adjusting for age, sex, study duration and clustering by study. Pre-specified sub-group analyses were done to determine whether effects of vitamin D on risk of acute respiratory infection varied according to baseline 25-hydroxyvitamin D (25[OH]D) concentration or dosing regimen.ResultsIPD were obtained for 10,933/11,321 (96.6%) participants. Vitamin D supplementation reduced risk of acute respiratory infection among all participants (adjusted Odds Ratio [aOR] 0.88, 95% CI: 0.81 to 0.96, P = 0.003; P for heterogeneity < 0.001). Sub-group analysis revealed a strong protective effect among individuals with baseline 25(OH) D < 25 nmol/L (aOR 0.62, 95% CI: 0.45 to 0.83, P = 0.002), not seen among those with higher levels (aOR 0.91, 95% CI: 0.78 to 1.05; Pinteraction = 0.01). A protective effect was also seen in individuals receiving daily or weekly vitamin D without additional bolus doses (aOR 0.81, 95% CI: 0.72 to 0.91, P < 0.001), but not in those receiving one or more bolus doses (aOR 0.97, 95% CI: 0.86 to 1.10, Pinteraction = 0.05). Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event (aOR 0.98, 95% CI: 0.80 to 1.20, P = 0.83). The body of evidence contributing to these analyses was assessed as being of high quality.ConclusionsVitamin D supplementation was safe, and it protected against acute respiratory infection overall. Very deficient individuals and those not receiving bolus doses experienced the most benefit.
Methods Secondary analysis of the Edinburgh pneumonia database, a prospective observational study of CAP (2005)(2006)(2007)(2008)(2009)(2010). All discharged patients were included. Follow-up data were obtained from a database linked to national morbidity and mortality registers. Outcomes were assessed using cox proportional hazards regression adjusting for confounding variables (age, gender, previous cardiovascular events, ACE-inhibitor/anti-platelet use, smoking status and severity of pneumonia). Results Data from 1631 patients with complete follow-up were analysed. Readmissions occurred in 728 patients (44.6%) with 157 readmissions within 30 days of discharge. 133 patients had a further hospitalisation with CAP. The 1 year mortality rate was 12.8%. 523 patients were current statin users. There were significant differences between statin and non-statin users. Statin users were older, suffering more cardiovascular disease, stroke, diabetes, renal disease, COPD and a greater severity of pneumonia. 1 year mortality rates were similar in statin and non-statin users. After adjusting for baseline differences, statins were associated with a non-significant trend towards lower 1 year mortality HR 0.78(0.55-1.1). When adjusted for the propensity score, the difference in mortality became statistically significant HR 0.70 (0.50-0.98).In the fully adjusted analysis, statins were not significantly associated with readmissions HR 0.85(0.70-1.03) but were associated with a significantly lower risk of recurrent pneumonia HR 0.60 (0.37-0.96). There was no association with reduced cardiovascular hospitalisations HR 0.94(0.65-1.34). There were no beneficial effects seen with either antiplatelet or ACE-inhibitor use following CAP. Conclusion Statins are associated with reduced 1 year mortality and a significantly lower rate of recurrent pneumonia. This is the first study to show that statins may improve long term outcomes in CAP, and that the associated morbidity and mortality can be modified. Introduction and Objectives Meta-analysis of clinical trials of vitamin D supplementation for the prevention of acute respiratory infection (ARI) shows a protective effect in the general population, but there is controversy regarding the optimal dosing regimen. Low-dose vitamin D supplementation is already recommended in older adults for prevention of fractures and falls, but clinical trials investigating whether higher doses could provide additional protection against ARI are lacking. Methods We conducted a double-blind cluster-randomised placebo-controlled trial of high-vs. low-dose vitamin D supplementation in residents and staff of sheltered accommodation schemes in London, UK. 108 schemes were allocated to receive the intervention (vitamin D 3 2.4 mg 2-monthly + 10 µg daily for residents; 3 mg 2-monthly for staff) or control (vitamin D 3 10 µg daily for residents, nil for staff) over the course of one year. The primary endpoint of the trial was time from first dose of study S123 INCREASED RISK OF UPPER RESPIRATORY INFECTION WITH ADDITI...
Methods Patients completing PR were recruited to once weekly LTE held in accessible venues by 2 exercise instructors (Loughborough trained for exercising patients with chronic respiratory disease). Baseline demographics and disease severity were collected and outcomes: 6 minute walk test (6MWT), Hospital Anxiety & Depression (HAD) score, COPD Assessment Test (CAT), Chronic Respiratory Questionnaire (CRQ) and patient satisfaction measured at baseline, 6 and 12 months. Patients who accepted referral for LTE but never attended or dropped-out were recalled for outcomes at 12 months. Hospital admissions were audited for 12 months after PR-completion. Results Between June-2010 and January-2012 75 patients mean(SD) age 69.3(9.7)yrs, FEV 1 1.26(0.54)L, MRC 3.16(0.81) 63% female, 19.2% current smokers and 3 on LTOT accepted referral to LTE. 35% (26/75) never attended and 27%(20/75) dropped out after starting; 39% (29/75) continued to exercise for at least 6 months and 25% (19/75) exercised to 1 yr. For patients who exercised for 12 months there was no significant decline in exercise capacity (6MWT), a significant improvement in CAT over 6/12 (p=0.002) maintained to 12/12 (p=0.02) and no increase in anxiety levels, which remained below clinical relevance for the 12 months post PR. In comparison, patients who did not continue LTE had a significant (p=0.001) decline in 6MWT, no change in CAT score and a significant(p=0.04) increase in anxiety to a clinically important range (table 1). Self reported hospital admissions in the year following PR were higher for patients who did not exercise (mean 0.61 (SD 1.47)) compared to those who did, 0.16 (0.50). Conclusions This pilot demonstrates that community-based LTE with trained instructors is safe and realistic for breathless patients after completing PR and, for the first time, demonstrates significant prolongation of functional and emotional benefits. This offers acheaper, more durable alternative to repeating PR.
A365patients were conducted by cancer treating physicians in Germany/France/Spain/ Italy (EU4) and the UK; Data collection period was Jan-Dec 2013. Physicians were recruited from a geographically representative sample in each country. Approximately 10-25 eligible patients on usual care anti-cancer regimen were identified by each physician within the four-quarterly study observation-window. Physicians abstracted data on patient demographics, disease status, treatment patterns and biomarker status .The analysis focused on patients that were either tested (T) or not-tested (NT) for EGFRm in UK & EU4. Results: Approximately 4800 mNSCLC patient-charts (UK~630/4EU~4170) were collected in 2013. 62%/62% were tested for EGFRm in the UK/4EU respectively.
Aim This multicentre observational study was conducted to confirm the observed retrospective findings prospectively in UK clinical practice. Methods Retrospective data were collected in the 12 months prior to and prospective data for up to 12 months following omalizumab initiation. The primary endpoint was the change in mean daily OCS dosage (reported previously). Secondary endpoints included changes in mean exacerbation frequency (defined as requiring hospital admission or Accident and Emergency (A&E) attendance and/or a course of OCS (dosage increase of at least 10 mg/day for at least 3 days)), healthcare utilisation and missed days in education or at work. Results 235 patients were enrolled in the study at end December 2013 in 22 UK centres. Data for interim analysis were examined from patients with 12 months of assessment at database lock (n = 85, females, 54%, mean (±SD) age 44 yr (±13.2), mean (±SD) duration of asthma 26 yr (±14.0)). At the 16 weeks assessment 74/85 (87%) patients were classified as responders to omalizumab treatment. Comparing the 12 month periods prior to and following initiation of omalizumab, mean total exacerbations decreased by 51% from (mean, ±SD) 4.25 ± 2.73 to 2.07 ± 2.01 (mean difference 2.18, p < 0.001), while mean exacerbations involving hospital visits decreased by 61% from 1.52 ± 2.00 to 0.59 ± 1.25 (difference 0.93, p < 0.001). A&E attendances were reduced from 54 to 19 (p < 0.01) and inpatient hospitalisations from 85 to 36 (p < 0.001). The percentage of average days absent from work or education due to sickness was more than halved in the 12 months pre and post omalizumab initiation reducing from 19.6% to 7.72% (n = 27, p < 0.05). Conclusions The data prospectively confirms that omalizumab is associated with significant reduction in exacerbations, healthcare utilisation and societal burden in severe allergic asthma patients as was reported in the retrospective study. S94A Background A previous retrospective study of UK clinical practice demonstrated that omalizumab reduced OCS burden. Aim This multi-centre observational study was conducted to confirm the observed retrospective findings prospectively. Methods Retrospective data were collected in the 12 months prior to omalizumab, while prospective data were collected at 16 weeks, 8 and 12 months following initiation. The primary endpoint was the change in mean daily OCS dose in the 12 months pre and post omalizumab initiation. Secondary endpoints included changes in ACT and AQLQ scores in the 12 months pre and post omalizumab initiation. Results 235 patients were enrolled by the end December 2013 in 22 UK centres. Data for interim analysis were examined from patients who had 12 months assessment at database lock (n = 85, 54% females, mean (±SD) age 44 yr (±13.2), mean (±SD) duration of asthma 26 yr (±14.0)). At the 16 weeks assessment 74/85 (87%) patients were classified as responders to omalizumab treatment. At 12 months, mean daily OCS dose decreased by 25% (n = 85, p < 0.001) from 10.77 mg/day (±7.87) to 8.08 mg/day (±8....
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