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Start Over Author "David T, Arnold" Publisher bmj publishing group
2 results on '"David T, Arnold"'

1. Parapneumonic effusions related to Streptococcus pneumoniae: serotype and disease severity trends from 2006 to 2018 in Bristol, UK

Author

Nick Maskell, Shamez Ladhani, Norman K Fry, Robert Challen, Adam Finn, Paul North, Catherine Hyams, David T Arnold, Zahin Amin-Chowdhury, Leon Danon, O Martin Williams, Philip Williams, Robyn Heath, David Hettle, Gabriella Ruffino, and Charli Grimes

Subjects
Medicine, Diseases of the respiratory system, RC705-779
Abstract

Rationale Streptococcus pneumoniae epidemiology is changing in response to vaccination and some data suggest that empyema incidence is increasing. However, differences exist between the UK and US studies. We describe trends in the clinical phenotype of adult pneumococcal pleural infection, including simple parapneumonic effusions (SPE) in the pneumococcal conjugate vaccination (PCV) era.Objectives To determine whether there were differences in pneumococcal disease presentation and severity associated with pleural infection.Methods A retrospective cohort study, all adults ≥16 years admitted to three large UK hospitals, 2006–2018 with pneumococcal disease. 2477 invasive pneumococcal cases were identified: 459 SPE and 100 pleural infection cases. Medical records were reviewed for each clinical episode. Serotype data were obtained from the UK Health Security Agency national reference laboratory.Results Incidence increased over time, including non-PCV-serotype disease. PCV7-serotype disease declined following paediatric PCV7 introduction, but the effect of PCV13 was less apparent as disease caused by the additional six serotypes plateaued with serotypes 1 and 3 causing such parapneumonic effusions from 2011 onwards.Patients with pleural infection had a median survival 468 days (95% CI 340 to 590) vs 286 days (95% CI 274 to 335) in those with SPE. Pleural infection associated with frank pus had lower 90-day mortality than pleural infection without pus (0% vs 29%, p

Published
2023
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2. Patient outcomes after hospitalisation with COVID-19 and implications for follow-up: results from a prospective UK cohort

Author

Jason Viner, Ed Moran, Marie Attwood, Samuel Gunning, Jessica Hatrick, Alice Milne, Shaney L Barratt, Huzaifa Adamali, Anna Bibby, Fergus Hamilton, Alan R. Noel, Sassa Hamilton, David T Arnold, Nick A Maskell, Anna J Morley, James W. Dodd, Karen T Elvers, and Catherine Hyams

Subjects
Pulmonary and Respiratory Medicine, Spirometry, Adult, Male, Pediatrics, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medicine.medical_treatment, Physical examination, Brief Communication, Pulmonary function testing, 03 medical and health sciences, 0302 clinical medicine, Quality of life, respiratory infection, Oxygen therapy, medicine, Blood test, Humans, 030212 general & internal medicine, Prospective Studies, Pandemics, Aged, Rehabilitation, medicine.diagnostic_test, business.industry, SARS-CoV-2, Respiratory infection, COVID-19, Covid19, Middle Aged, United Kingdom, Hospitalization, Cohort, Observational study, Female, viral infection, Chest radiograph, business, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract

BackgroundCOVID-19 causes a wide spectrum of disease. The incidence and severity of sequelae after the acute infection is uncertain. Data measuring the longer-term impact of COVID-19 on symptoms, radiology and pulmonary function are urgently needed to plan follow-up services.MethodsConsecutive patients hospitalised with COVID-19 were prospectively recruited to this observational study with outcomes recorded at 28-days. All were invited to a systematic follow up at 8-12 weeks, including chest radiograph, spirometry, exercise test, bloods, and health-related quality of life (HRQoL) questionnaires.FindingsBetween 30th March and 3rd June 2020, 163 patients with COVID-19 were recruited. Median hospital length of stay was 5 days (IQR 2-8) and 19 patients died. At 8-12 weeks post admission, 134 patients were available for follow up and 110 attended. Most (74%) had persistent symptoms (notably breathlessness and excessive fatigue) with reduced HRQoL.Only patients who required oxygen therapy in hospital had abnormal radiology, clinical examination or spirometry at follow up. Thirteen (12%) patients had an abnormal chest X-ray with improvement in all but 2 from admission. Eleven (10%) had restrictive spirometry. Blood test abnormalities had returned to baseline in the majority (104/110).InterpretationPatients with COVID-19 remain highly symptomatic at 8-12 weeks, however, clinical abnormalities requiring action are infrequent, especially in those without a supplementary oxygen requirement during their acute illness. This has significant implications for physicians assessing patients with persistent symptoms, suggesting that a more holistic approach focussing on rehabilitation and general wellbeing is paramount.FundingSouthmead Hospital Charity

Published
2020
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