Dominic Shaw

Risk factors and outcome differences in hypoglycaemia-related hospital admissions A case-control study in England.

To evaluate risk factors for hospital admissions for hypoglycaemia and compare length of hospitalization, inpatient mortality and hospital readmission between hypoglycaemia‐ and non‐hypoglycaemia‐related admissions.

Sputum proteomics and airway cell transcripts of current and ex-smokers with severe asthma in U-BIOPRED: an exploratory analysis

Severe asthma patients with a significant smoking history have airflow obstruction with reported neutrophilia. We hypothesise that multi-omic analysis will enable the definition of smoking and ex-smoking severe asthma molecular phenotypes. The U-BIOPRED cohort of severe asthma patients, containing current-smokers (CSA), ex-smokers (ESA), nonsmokers and healthy nonsmokers was examined. Blood and sputum cell counts, fractional exhaled nitric oxide and spirometry were obtained. Exploratory proteomic analysis of sputum supernatants and transcriptomic analysis of bronchial brushings, biopsies and sputum cells was performed. Colony-stimulating factor (CSF)2 protein levels were increased in CSA sputum supernatants, with azurocidin 1, neutrophil elastase and CXCL8 upregulated in ESA. Phagocytosis and innate immune pathways were associated with neutrophilic inflammation in ESA. Gene set variation analysis of bronchial epithelial cell transcriptome from CSA showed enrichment of xenobiotic metabolism, oxidative stress and endoplasmic reticulum stress compared to other groups. CXCL5 and matrix metallopeptidase 12 genes were upregulated in ESA and the epithelial protective genes, mucin 2 and cystatin SN, were downregulated. Despite little difference in clinical characteristics, CSA were distinguishable from ESA subjects at the sputum proteomic level, with CSA patients having increased CSF2 expression and ESA patients showing sustained loss of epithelial barrier processes. Inflammatory, oxidative/ER stress and epithelial barrier pathways are differentially activated in current smoking and ex-smoking severe asthma patients http://ow.ly/BVv530j3iP3

Defining and managing risk in asthma

Asthma attacks are a major global source of morbidity and cost. The incidence and impact of asthma attacks have not improved despite widespread adoption of effective universal treatment guidelines. Consequently, there is increasing interest in managing asthma based on specific assessments of both current symptoms and future risk. In this review, we consider ‘risk’ in asthma, and how it might be assessed from the patients history and objective measurements. We also discuss the potential for encouraging shared decision‐making and improving medical consensus through explicit communication of risk and highlight the potential opportunities and challenges in risk assessment to improve asthma management through individualised treatment strategies.

Exploring the Relationship between Location and Behaviour in Out of Hours Hospital Care

‘Out of Hours’ (OoH) hospital care involves a small number of doctors covering a very large number of patients. These doctors are working in stressful environments, performing complex tasks and making difficult task prioritisation decisions, yet little data exists to aid in improving the working practices or to ensure junior doctors are adequately prepared for OoH working. Historically, this has been owing to complex and expensive processes to capture this data; however recent advances in indoor positioning technologies has the potential to automate and improve the capture and availability of data that may help alleviate the burden of OoH care on at a personal and hospital level. This paper describes our work to combine cutting edge indoor positioning technologies from OoH working with and a newly deployed in-ward electronic tasking system. Here we describe data collection via traditional methods, clinical tasking systems, and indoor positioning solutions. We further describe our understanding from such data of the effect of physical layout and current working practices on task completion and time spent in transit, which ultimately may inform improvements to working practice within OoH care. Finally we discuss potential relevance to other work domains.

P194 Early warning scores, too imprecise a tool in patients with respiratory disease?

Introduction Guidance from the National Institute of Health and Care Excellence in 20071 has led to the almost universal use of early warning scores (EWS) derived from vital signs observations in hospitals in the UK to highlight patients at risk of deterioration. Lack of high quality prospective studies limits our understanding of the impact of using such monitoring systems on outcomes and working patterns. No EWS has been validated in respiratory patients despite widespread use. Our aim was to examine the ability of both the locally used EWS and National Early Warning Score (NEWS) to predict patient deterioration and associated burden of escalations generated in a respiratory cohort. Methods Vital signs observations and outcomes for all admissions under the respiratory department at a tertiary referral centre between April 2015 and March 2016 were analysed. Predicted and actual escalation patterns in relation to primary endpoint of mortality were examined comparing NEWS to local EWS. Patients documented as receiving end of life care were removed from analysis. Results Over 12 months there were 165,184 observations sets during 5293 admissions, with a mean of 38 observations per admission (standard deviation 50). Occurrence of primary endpoint of in-hospital death was 6.74%. 13% of observations triggered clinical escalation to a registered nurse or beyond, with mean of 1075 per month. 112 (31%) patients who died did not trigger escalation on their final set of observations, 1 patient was escalated despite scoring below protocol threshold. Applying NEWS criteria retrospectively predicts 6 patients who died would not be escalated, while generating a mean of 12,409 escalations of vital signs observations per month to registered nurse or beyond, 1,621 in patients who went on to die in hospital. Conclusion Our data suggests that neither scoring system provides effective monitoring in patients with respiratory disease, falling short on either sensitivity or specificity for predicting in-hospital death. As more data becomes available, modelling may allow more accurate prediction systems to be developed. Reference Adam S, et al. Acutely ill adults in hospital: recognising and responding to deterioration. In NICE guidelines. Manchester: National Institute for Health and Care Excellence (NICE), 2007. Abstract P194 Figure 1 Percentage of early warning score within last observation set prior to death