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Take a look at a selection of our recent media coverage:
4th December 2024
Our latest Clinical Excellence in Respiratory Care event included a fascinating panel discussion on managing pulmonary hypertension as a multidisciplinary team (MDT). Here, you have exclusive access to the session recording.
Hospital Healthcare Europe and Hospital Pharmacy Europe editor Helena Beer was delighted to be joined by three specialist clinicians for this panel discussion: David Kiely, consultant respiratory physician and professor of pulmonary vascular medicine at Sheffield Teaching Hospitals NHS Foundation Trust, alongside Colm McCabe, respiratory consultant in pulmonary hypertension, and Heba Nashat, consultant cardiologist in pulmonary hypertension – both at the Royal Brompton Hospital in London.
Recorded on 21 November 2024 and shared at the Clinical Excellence event the following week, the panellists discussed diagnostic challenges and the role of imaging technology in pulmonary hypertension, integrating cardiology and pulmonology treatment plans and how to best work together as an MDT for the benefit of the patient. Scroll down to watch now.
Watch more Clinical Excellence event sessions via our new Clinical Excellence Catch-up zone.
You can find brand new interviews and case studies, plus round ups of previous Clinical Excellence event sessions and much more in our Respiratory zone – just look out for the orange Clinical Excellence tag to read a whole host of content that can help to inspire your practice.
We’ve recently started work on 2025 content and there are some brilliant pieces coming through the pipeline so remember to check back regularly so you don’t miss out.
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View the agendas and register for our next Clinical Excellence in Respiratory Care and Clinical Excellence in Cardiovascular Care events now.
Professor Philippe L. Pereira – CIRSE president and director of the Center of Radiology, Minimally Invasive Therapies and Nuclear Medicine at the Academic Hospital of Ruprecht-Karls-University Heidelberg in SLK-Clinics Heilbronn, Germany – talks to Saša Janković about the current challenges and opportunities in interventional radiology in Europe, the drive to inspire holistic and multidisciplinary patient care, and his hopes for the future of the field.
‘Demand is rising for minimally invasive treatments, and we are witnessing incredible growth in interventional radiology, so now is the perfect time for anyone who wants to get involved in the field,’ says interventional radiology (IR) specialist Professor Philippe L. Pereira, reflecting on his experience talking to clinicians and students at the most recent Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Congress held in September.
This year’s CIRSE Congress was a record-breaking event, with nearly 7,000 in-person participants and additional online attendees. For Professor Pereira, who recently began his tenure as CIRSE president, the significant participation of medical students was a promising development.
‘One of our biggest challenges in interventional radiology is awareness among medical students, young clinicians and other medical fields,’ he explains. ‘So, my personal highlight from the Congress was the 480 students from across Europe who registered for the Congress, because getting students involved early will be essential for IR’s continued growth and for meeting patient demand.’
Despite this ‘exponential increase’ of young medical trainees interested in IR, there is still work to be done to consolidate IR’s position in the clinical landscape and secure its future.
Professor Pereira believes the move to make IR a clinical specialty in its own right is ‘long overdue’, and it is still not formally recognised as a subspecialty in several European countries, including Germany where he is based – a lack of recognition that is impacting recruitment.
‘Potential trainees are still required to complete an entire diagnostic radiology training before specialising in IR,’ he explains. ‘So, although we know that many students would like to pursue a career in IR, they don’t want to go through five years of diagnostic training first, which is proving a barrier to growth, particularly given the high demand for IR procedures.’
Professor Pereira therefore advocates for changes in IR training pathways to streamline the requirements and also to provide trainees with clinical experience in managing patient care beyond the procedure itself. ‘The ideal would be a pathway where aspiring interventional radiologists could undergo a shorter diagnostic training period followed by specialised IR training, ensuring more time for hands-on, patient-centred practice,’ he says. ‘A streamlined training model would mean that interventional radiologists are better prepared to deliver comprehensive care.’
Indeed, while IR has traditionally been seen as a procedural element of diagnostic radiology, Professor Pereira champions a more holistic approach and says that ‘interventional radiologists need to be more clinical’ in their management of patient care.
‘I believe interventional radiologists should oversee patient care from initial consultation through follow-up,’ he says. ‘This longitudinal care model could substantially improve patient outcomes because it’s not enough to perform the procedure; we must see the patient before, during and after treatment.’
Professor Pereira sees the increased engagement from young trainees as part of the solution and it has the potential to herald this new wave of patient-centred care. ‘We’re seeing more young interventional radiologists who focus intently on patient outcomes, and they’re driven by technology, image-guided treatments and artificial intelligence (AI), which is a combination that is transforming what’s possible in IR,’ he says.
Technological advancements shaping the future of IR is something Professor Pereira is particularly excited about. AI and 3D imaging are rapidly advancing the precision of minimally invasive treatments, and new techniques for image-guided tumour ablation, are enhancing the effectiveness of treatments for liver, lung and kidney cancers.
‘These technologies are revolutionising the way we approach complex cases,’ he says. ‘My younger colleagues who grew up with this technology are particularly adept at applying it to clinical practice.’
Professor Pereira’s own hospital serves as an example of best practice in interventional radiology. Operating with a highly integrated and multidisciplinary team, the hospital was the first in Germany to be awarded IASIOS accreditation. This is an international certification recognising clinical excellence in interventional oncology – the field of IR focusing on minimally invasive, image-guided cancer treatments.
‘This certification doesn’t just assess our ability to perform procedures, it examines our patient pathways, ensuring we work seamlessly with surgeons, oncologists, and other specialists,’ Professor Pereira explains. ‘This coordinated care is essential for addressing complex conditions that require input from multiple experts because when we collaborate, patients benefit and outcomes improve.’
This approach highlights the importance of multidisciplinary collaboration and open communication in addressing complex conditions, such as oncology cases, which often require a combination of surgical, radiological and medical treatments. Professor Pereira believes that broader adoption of multidisciplinary models across Europe could help alleviate unmet patient needs, particularly in oncology.
‘For example, IR treatments for tumours – such as ablation or intra-arterial targeted therapies – allow patients to leave the hospital in days rather than weeks, often resuming normal activities within days,’ he says. ‘One of my recent patients with a liver tumour was discharged two days after treatment and was ready to return to work the following week.’
By reducing hospital stays and facilitating quicker recovery, IR not only benefits patients but also the finances of healthcare systems. Professor Pereira adds: ‘IR is less invasive, reduces complications, and has shown immense value in healthcare cost savings.’
While Professor Pereira is optimistic about the future of IR across Europe, he says there is still more to be done in order for the field to expand and meet patient demand.
‘It’s essential we build more support for IR at both institutional and governmental levels across Europe. We need greater recognition of IR’s value, not just within healthcare but from society as a whole,’ he says. ‘When we treat a tumour with a minimally invasive approach, the patient goes home sooner, returns to work faster, and the cost to the system is lower – and this is the future of healthcare.’
Further increasing awareness and support of the specialty within the multidisciplinary team is also key, and it’s here that Professor Pereira highlights another potential barrier. He notes that in some areas there is ‘competition’ between IR and surgical disciplines, particularly in cases that could be managed by either specialty.
‘If surgeons and interventional radiologists work together, we can offer more comprehensive care, as each specialty brings different strengths to the table,’ he says. ‘Although I am optimistic that collaboration will improve as newer generations of clinicians embrace multidisciplinary practices.’
With these advancements and collaborations in place, Professor Pereira believes IR could play a central role in European healthcare within the next decade. He says: ‘We’re showing that minimally invasive treatment isn’t just an alternative; it’s often the best option, and by working together across disciplines we can provide patients with a level of care that genuinely improves their lives.’
3rd December 2024
The monoclonal antibody benralizumab, which is currently used in the treatment of severe asthma, could help to treat exacerbations in asthma and COPD, according to a new UK trial.
Benralizumab was found to be more effective than a dose of steroids when patients had gone to urgent care clinics or emergency departments with acute symptoms and high eosinophil counts. This reduced the need for further treatment and hospitalisations.
Researchers at King’s College London said the findings could be ‘game-changing’ in an area of medicine that had not changed in 50 years.
In the trial, patients having an asthma or COPD attack were randomly assigned into three groups. The first was treated with a benralizumab injection and placebo tablets, the second received the standard of care of prednisolone 30mg daily for five days plus a placebo injection, and the third received both a benralizumab injection and the standard of care prednisolone.
After 28 days cough, wheeze, breathlessness and sputum were found to be better in patients who had received benralizumab and after 90 days, there were four times fewer people in the benralizumab group that failed treatment compared with those who only received prednisolone.
Writing in The Lancet Respiratory Medicine, the researchers also noted that treatment with benralizumab ‘took longer to fail’, meaning fewer visits to a GP or hospital. There was also an improvement in the quality of life for people with asthma and COPD.
Almost three quarters (74%) of patients who received standard of care prednisolone needed further treatment within 90 days, highlighting the poor outcomes currently seen with short-course steroids when treating eosinophilic exacerbations, they concluded.
The safety profile of benralizumab injections was similar to previous studies and the researchers said it could potentially be given in a GP practice or emergency department.
Eosinophilic exacerbations make up to 30% of COPD flare-ups and almost 50% of asthma attacks, with two million exacerbations of this type in the UK per year.
Study leader Professor Mona Bafadhel, director of the King’s Centre for Lung Health, said: ‘Benralizumab is a safe and effective drug already used to manage severe asthma.
‘We’ve used the drug in a different way – at the point of an exacerbation – to show that it’s more effective than steroid tablets, which is the only treatment currently available.’
She added that the big advancement in this study was discovering that targeted therapy works in asthma and COPD attacks.
‘Instead of giving everyone the same treatment, we found targeting the highest risk patients with very targeted treatment, with the right level of inflammation was much better than guessing what treatment they needed,’ she said.
Dr Samantha Walker, director of research and innovation, at the charity Asthma + Lung UK, said: ‘It’s great news for people with lung conditions that a potential alternative to giving steroid tablets has been found to treat asthma attacks and COPD exacerbations.
‘But it’s appalling that this is the first new treatment for those suffering from asthma and COPD attacks in 50 years, indicating how desperately underfunded lung health research is.’
The publication of this research comes as the long-awaited NICE/BTS/SIGN joint guidelines on management of asthma were launched.
In November, a report revealed that a digital asthma tool could reduce emergency appointments and save NHS £25m annually.
A version of this article was originally published by our sister publication Pulse.
2nd December 2024
Adults who have irregular sleep patterns are 26% more likely to have a major cardiovascular event than those with a regular sleep-wake cycle, a new study shows.
Going to bed and waking up at different times was found to be detrimental to cardiac health and ‘strongly associated’ with an increased risk of myocardial infarction and stroke, even for people who got the recommended nightly hours of sleep, researchers found.
The study is one of the first to look at the patterns and habits of sleep rather than the length of time a person is asleep.
Published in the Journal of Epidemiology & Community Health, the findings highlight the importance of consistent sleep schedules as well as adequate sleep duration to reduce cardiovascular risks.
The researchers designed an observational study involving 72,269 people from the UK Biobank aged between 40 and 79 with no history of cardiovascular disease.
Each participant wore an activity tracker for seven days to monitor their sleep patterns, giving a Sleep Regularity Index (SRI) score. Participants with an SRI score of 87 were considered to have a regular sleep pattern, while those with an SRI score of less than 72 were categorised as irregular sleepers. People with SRI scores between this range were recorded as moderately irregular sleepers.
Cardiovascular health, including myocardial infarction, heart failure and stroke, was tracked over the next eight years using hospital records and death registries. Variables such as age, levels of physical activity, and general physical and mental health were accounted for.
Irregular sleepers were 26% more likely to have a major adverse cardiovascular event (MACE) compared to regular sleepers. Moderately irregular sleeping patterns led to an 8% increased risk of MACE.
As SRI scores increased to reflect more regular sleep patterns, the risk of MACE decreased, showing an almost linear relationship. This suggests that greater improvements in sleep regularity may lead to significant cardiovascular benefits.
The recommended amount of nightly sleep is between seven and nine hours for adults aged 18-64 and between seven and eight hours for adults over 65. Regular sleepers were more likely to meet this recommended quota than irregular sleepers (61% vs 48%, respectively).
For moderately irregular sleepers, meeting sleep duration recommendations could largely offset the elevated risk of cardiovascular events, the researchers found. For irregular sleepers, getting the recommended amount of sleep did not fully mitigate against the increased risk of MACE caused by the effects of changing sleep patterns.
The researchers suggested that although this is an observational study and further research is needed, sleep regularity could be a good predictor of future cardiovascular events.
The researchers commented: ‘Our results suggest that sleep regularity may be more relevant than sufficient sleep duration in modulating MACE risk.
‘Findings from this study suggest that more attention needs to be paid to sleep regularity in public health guidelines and clinical practice due to its potential role in cardiovascular health.’
A version of this article was originally published by our sister publication Nursing in Practice.
Staying abreast of developments in artificial intelligence and machine learning is becoming increasingly important for the delivery of timely, efficient and cutting-edge healthcare, but that can be a challenge. Data science academic Dr Russell Hunter PhD looks at the top trends that healthcare professionals and their organisations need to know about as they navigate this rapidly evolving landscape.
There has long been a widespread interest in how artificial intelligence (AI) and machine learning (ML) could transform the healthcare sector. For example, common searches on Google include questions such as ‘How is machine learning used in healthcare?’ and ‘Does the NHS use machine learning?’.
The interest was taken up a notch recently when the Government committed to a digital-first NHS following critical concerns raised in the Darzi report. Yet, although AI and ML are reshaping everyday practices within healthcare, questions – and perhaps scepticism – remain. And it can be hard for healthcare leaders to address concerns when they are not experts and AI is evolving so fast.
So, what do leaders need to know in terms of emerging trends in AI and ML, and how can those who are suspicious of AI be convinced that it can be a help rather than something to be worried about?
Explainable AI, also known as XAI, aims to make AI decisions understandable to humans, enhancing trust and regulatory compliance.
When a model is built to solve a particular problem, persuading stakeholders to come on board can often be difficult. In fact, many would prefer a model that is more easily understood, even if it is less optimal. Something that can be visualised is preferable to jumping on board with a mysterious model that works for unknown reasons. This is especially important when it comes to healthcare or finance.
In healthcare, XAI provides explanations for diagnostic decisions or treatment recommendations made by AI systems. These explanations are crucial for doctors and patients to trust and act on AI-driven insights, ultimately improving patient outcomes. AI models used for predicting patient risks, such as the likelihood of developing a certain disease, need to be clear and understandable to ensure that healthcare providers can grasp the underlying factors behind the risk assessment.
Autonomous systems are transforming healthcare by accelerating the speed and precision of decision-making, driving greater efficiency and enhancing customer experiences. In the business world, ML technologies can increase companies’ ability to quickly analyse vast amounts of data while uncovering patterns and making informed decisions.
Just as automating manual processes can help make sense of business data, advanced systems can be applied to healthcare. Sophisticated multimodal AI can analyse genetic data and patient histories to recommend personalised treatment plans. This leads to more effective and individualised healthcare.
Similarly, by leveraging data from electronic health records, these systems can predict patient outcomes or complications, which allows for proactive intervention.
Agenetic AI is a new class of AI designed to act with autonomy. It proactively sets its own goals and takes autonomous steps to achieve them, making decisions and taking action without direct human intervention. This makes it a significant advancement beyond classical reactive AI.
These proactive systems can enhance patient care and have the potential to alleviate the burden on healthcare professionals by automating routine monitoring and treatment adjustments.
In the realm of personalised healthcare, agentic AI can revolutionise patient care by continuously monitoring patient health metrics and autonomously administering medication as needed. For example, an agentic AI system could monitor the blood sugar levels of a patient with diabetes in real-time and administer insulin precisely when required, thus maintaining optimal glucose levels and reducing the risk of complications.
Agentic AI can also help with personalised treatment plans for chronic diseases by analysing vast amounts of patient data to predict disease progression and suggest tailored treatment plans. For instance, in oncology, agentic AI can process data from medical records, genetic profiles and treatment responses to recommend personalised chemotherapy protocols, potentially improving outcomes and minimising side effects.
Another cutting-edge development is Edge AI, which brings an immediate processing capability crucial for applications in healthcare monitoring where time-sensitive tasks require prompt responses. This is achieved by processing data locally on the device, reducing latency, enabling real-time decision-making and minimising the amount of data that needs to be transmitted to central servers.
Processing sensitive information locally also enhances privacy and security, reducing the risk of data breaches during transmission, which is particularly important with healthcare data.
However, there are challenges. There are hardware limitations and integration complexity, and there is a need for efficient management and maintenance of numerous edge devices. These could curtail the full effectiveness of edge AI.
While there are concerns that AI will replace humans in the workplace, the latest AI developments can augment rather than undermine human contributions. For example, AI can assist doctors by analysing medical images and patient data to identify patterns that the human eye might miss. This allows doctors to make more accurate diagnoses and develop personalised treatment plans, thereby improving patient outcomes and operational efficiency.
The collaboration between humans and AI combines the strengths of both, allowing AI to handle repetitive, data-intensive tasks while people focus on strategic, creative and interpersonal activities that require emotional intelligence and critical thinking. This applies to healthcare as much as any other sector.
Rather than eliminating jobs, AI reshapes them. As technology advances, new roles will be created where the job is managing, programming and collaborating with AI systems. It is crucial to keep an eye on developments to ensure healthcare organisations are fully equipped to gain an edge by leveraging AI and ML.
Dr Russell Hunter has a PhD in Computational Neuroscience and works at the University of Cambridge. He leads the course Leveraging Big Data for Business Intelligence at Cambridge Advance Online.
A version of this article was originally published by our sister publication Healthcare Leader.
29th November 2024
In September, the Royal College of Paediatrics and Child Health published its updated position statement on air pollution in the UK. Dr Emily Parker, RCPCH Clinical Fellow and one of the position statement’s authors, explains the importance of this document and its relevance to healthcare professionals.
I became interested in air pollution during a year working as a Sustainability Fellow at Newcastle Hospitals NHS Foundation Trust. I was working on a project to reduce the carbon footprint of paediatric asthma care by making changes to inhaler prescribing and recycling practices.
I started to realise that it made sense to focus further upstream and try to tackle the environmental causes of childhood asthma itself. This got me thinking about air pollution and how improving air quality can have a positive impact on both health and climate change.
When I think back to what I learnt about air pollution in medical school, it’s curious that it took me so long to make this link. I did my undergraduate training in Newcastle Upon Tyne in the northeast of England, which has a strong industrial heritage, so I learnt about how inhaled pollutants from the mining and ship building industries impacted both workers and their families.
However, I got the impression that air pollution’s impact on health was a thing of the past in the UK, and current issues were located further afield, such as the use of solid fuels for cooking in some parts of the world. We didn’t learn about how ambient air pollution at current levels is impacting people’s health.
The RCPCH’s recently published position statement counters this narrative and highlights the significant child health impacts of air pollution, including in the UK.
Air pollution exposure at every stage of the human lifecycle – from gestation right through to adulthood – adversely impacts health. Children are particularly vulnerable to air pollution exposure because they breathe more air than adults in proportion to their body weight, so they take in more pollutants, and the health impacts are amplified due to their smaller bodies and developing organs. In fact, air pollution is the second leading risk factor for death in children under five, both in UK and globally.1
Fine particulate matter and nitrogen dioxide (NO2) are responsible for a significant proportion of air pollution’s health impacts. The term ‘particulate matter’ refers to very small solid or liquid particles, which are present in the air – or ‘everything in the air that is not a gas’.2 The term ‘fine particulate matter’ or PM2.5 refers to particles that are less than 2.5 micrometres in diameter (less than 1/20th of the width of a human hair), so small that they can cross from the lungs into the bloodstream, and even cross the placenta. NO2 is one of a group of gases known as oxides of nitrogen (NOX). These gases are highly reactive and can irritate the airways.
The air pollution-related health risks in children are far-reaching and span multiple organ systems. The impact on the respiratory system is perhaps best known and most relatable. Between 2017 and 2019, an estimated 7% of paediatric asthma admissions in London were linked to spikes in air pollution, and reductions in air pollution concentration correlated with reduced hospital admissions.3
The cases of Ella Adoo Kissi-Debrah, who died of severe asthma aged nine, and Awaab Ishak, who died aged two due to exposure to black mould in his home, highlight the severity of this problem. These cases also draw attention to the health and racial inequalities that are exacerbated by unequal exposure to air pollution. As the RCPCH position statement points out, already deprived populations, despite contributing less to air pollution, experience greater health impacts from air pollution exposure.
Air pollution also impacts other parts of the body such as the cardiovascular system, metabolic system and brain. There is emerging evidence that air pollution is also contributing to diabetes, obesity, and mental illness. We know that it adversely impacts cardiovascular health in adulthood, leading to high blood pressure, heart attacks and strokes. It appears that the disease processes start in childhood.
The RCPCH feels strongly that air pollution is an avoidable cause of morbidity and mortality, therefore governments, local authorities, and key anchor institutions should act to protect the most vulnerable, who have the least power and resources to control their environments.
Furthermore, measures to improve air quality often have additional health and environmental co-benefits. The solutions must come from all sectors of society, so our policy recommendations are aimed at schools, transport, housing, the NHS, and the Department for Environment, Food and Rural Affairs.
Healthcare professionals can play a role here too – both in advising their patients on the impact of air pollution and how best to avoid exposure, and in advocating for systemic change. At the RCPCH, we’re working with over 100 members of our Clean Air Network to amplify our policy recommendations both locally and nationally, including the need for the NHS to mandate the implementation of the Clean Air Hospital Framework across all NHS organisations.
Healthcare professionals are consistently among the most trusted professional groups in society,4 so their support can help to reframe divisive or overlooked political issues and lead to tangible policy change.
References
28th November 2024
Long-awaited joint UK guidelines for chronic asthma have been finalised, overhauling diagnosis and treatment recommendations in an effort to better manage the condition in primary care and reduce pressure on hospitals.
The final chronic asthma guidance from the National Institute for Health and Care Excellence (NICE), British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN) is designed to support clinicians in making accurate diagnoses, promoting good practice, and providing effective, personalised treatment to control and prevent acute asthma attacks.
This is the first time the organisations have collaborated to produce joint UK-wide guidance on the diagnosis and management of chronic asthma for adults, young people and children.
Alongside its publication, NICE, BTS and SIGN have also developed a new joint asthma pathway. This digital resource collates tools and information for in a central hub, providing ‘a seamless user journey across the newly published guideline and existing asthma guidance‘.
In June, draft guidance revealed significant changes to the current treatment approaches. This included replacing the sole use of short-acting beta agonist (SABA) when asthma is first diagnosed with a low-dose combination of inhaled corticosteroids (ICS) and formoterol, which the final guidance has now reinforced.
Indeed NICE emphasised that healthcare professionals should ‘always prescribe maintenance or combination treatments’ rather than the ‘familiar blue “reliever-only” inhaler, when asthma is first diagnosed’.
This is based on evidence which ‘showed that using the combined ICS and formoterol inhalers when required led to people suffering fewer severe asthma attacks’.
The final chronic asthma guidance has also confirmed changes to recommendations on testing for asthma, with a new recommendation to use peak expiratory flow (PEF) variability as a method for diagnosis, which has been added following consultation.
It advised healthcare professionals to use a stepwise series of tests including eosinophil count, FeNO, spirometry and bronchial challenge in patients where the condition is suspected on clinical grounds.
However, NICE warned that these tests – recommended for both children and adults – are ‘not routinely carried out in current practice’, with ‘only a minority of GP practices’ having onsite access to FeNO tests, while bronchial challenge testing is not available at all in primary care.
As such, NICE recognised that there will be a ‘capacity problem’ and that implementing the recommended diagnostic pathway into clinical practice would ‘require significant investment’.
Another addition to the joint guidance following consultation was a recommendation to consider providing an additional metered SABA inhaler plus spacer for emergency use for children under 12 years who may be unable to activate a dry powder inhaler during an acute asthma attack.
NICE’s chief medical officer Professor Jonathan Benger said the new guidance aims to ‘ease pressure’ on the NHS by ‘reducing hospital admissions due to asthma and lowering the use of less effective monitoring tests’.
He continued: ‘Having one clear set of national asthma guidelines is vital to ensure people receive consistent and effective asthma care across the health service, so people across the UK receive the right diagnosis and treatment for them.’
BTS chair Dr Paul Walker said the changes to recommendations for testing ‘will simplify diagnostic processes and help with current diagnostic delays for adults, children and young people’.
‘The treatment changes represent a true pivot in the principles of asthma care and will contribute to improved outcomes,’ he added.
Dr Andy Whittamore, GP and Asthma and Lung UK clinical lead, said the new guidelines ‘have the potential to make a real difference’ to the 7.2 million people in the UK living with asthma.
He said the recommendation to ‘move away from over-reliance’ on SABA inhalers, which is a ‘key driver of poor asthma control’, is ‘particularly welcome’.
Dr Whittamore also highlighted that the changes to diagnostic recommendations will ‘need to be accompanied by good clinician education to ensure they can confidently and reliably work within the new diagnostic pathway’.
On resourcing for testing, he added: ‘It is very positive that the guidelines acknowledge the difficulties in diagnosing asthma correctly and identify poor access to FeNO and spirometry testing as a barrier that can block safe, good quality care.
‘Funding must be made available to support healthcare professionals to deliver these tests and make them available for every person with suspected asthma.’
Chair of the Primary Care Respiratory Society Dr Katherine Hickman, who is also a GP in Bradford, said the new guidelines ‘introduce a systematic and evidence-based approach to diagnosis’ and she is ‘confident these recommendations will help ensure more accurate assessments and better patient care’.
She continued: ‘One of the most promising advancements is the move towards anti-inflammatory reliever therapy (AIR) and maintenance and reliever therapy (MART).
‘This innovative approach marks a significant shift in asthma treatment, offering new hope to patients and healthcare providers alike. It has the potential to transform how we manage asthma by reducing the burden on primary and secondary care, saving lives, and restoring control to patients over their condition.
‘The guidelines give me real hope for the future of asthma care. They represent a critical step in not only improving patient outcomes but also reshaping how asthma is managed at every level of the healthcare system.’
However, Dr Hickman advised GPs that no patient should be switched to a new inhaler without an ‘informed discussion’.
Professor Azeem Majeed, a GP and professor of primary care and public health at Imperial College London, said the recommendation to replace SABA inhalers alone with combination inhalers ‘reflects evidence that this approach can improve overall asthma control’.
He also said the new recommendations on testing will ‘help reduce misdiagnosis and ensure that treatment is appropriate’, but he warned that implementing the joint guideline will ‘require significant investment to ensure widespread access’ to diagnostic methods such as FeNo and spirometry.
Professor Majeed continued: ‘Another concern is ensuring that all patients, regardless of where they live, have equitable access to the recommended tests. Currently, geographic disparities exist in diagnostic capabilities, which could lead to unequal implementation and outcomes between areas.
‘Overcoming capacity and implementation challenges will require investment in diagnostic infrastructure; workforce expansion and training; and collaboration across primary and specialist care.’
Earlier this month, a report from UCLPartners revealed that an app to assist with asthma self-management could save the NHS up to £25m in a year if it were used by 100,000 patients for three months.
In February 2024, the BTS and Primary Care Respiratory Society published a position statement on integrated respiratory care models and the importance of putting patients at their centre.
A version of this article was originally published by our sister publication Pulse.
27th November 2024
Personalised treatment innovations in the field of rheumatology are transforming patient care and outcomes, driven by significant advances in understanding the origins of rheumatological diseases. Professor Xenofon Baraliakos, president-elect of EULAR, speaks to Helen Quinn about the biggest challenges and opportunities in the field and where he sees rheumatology advancing to next.
Scientific advancements in rheumatology are shifting treatment from a one-size-fits-all approach towards more patient-centred care. Inflammation can show up differently across individuals, arising from a variety of causes. Targeted therapies now offer more effective and individualised options for patients, marking the beginning of a new era in rheumatologic care.
Within this exciting landscape of research innovation and clinical advancement, Professor Xenofon Baraliakos will take over the European Alliance of Associations for Rheumatology (EULAR) presidency in June 2025, having recently been voted as the Alliance’s president-elect.
Professor Baraliakos is a world-leading expert in rheumatology and is currently seeing out his term as president of the Assessment of Spondyloarthritis International Society alongside his roles as medical director at Rheumazentrum Ruhrgebiet in Herne, Germany, and full professor of internal medicine and rheumatology at Ruhr-University Bochum, Germany.
‘We are at a pretty advanced stage when it comes to now being able to have the right techniques to understand where diseases come from,’ Professor Baraliakos explains. ‘In the last 20 to 25 years, we have seen a huge development with biologics, which was a revolution.’
Indeed, biologics have transformed the treatment of inflammation, offering a safer and more effective options compared to traditional medications such as prednisone and cortisone, which reduce inflammation but can have unwanted side effects.
The rise of personalised therapies means there has been a step away from broad treatment options like TNF blockers, IL-6 blockers and IL-17 blockers, which treat everything rather than specific cytokines. Alongside this, advancements have also been made in tissue and blood analysis, allowing researchers to gain further insights into the causes of inflammation and select treatments based on an individual’s needs.
‘We understand better why one [patient] is getting a response and one is not and what this means. We understand better how diseases occur and how they develop over time. Now that means we also have a big unmet need: to translate that basic science back to clinical outcomes,’ Professor Baraliakos says. ‘Before, we just didn’t know where the disease came from. I think now we are in a very good position in terms of developing the field further – even faster.’
It is hoped that this additional knowledge will lead to fewer treatment failures for patients, as clinicians can identify the most effective treatment for each individual. In addition, Professor Baraliakos explains that by borrowing treatments from fields such as oncology and haematology and developing them further for their own needs in rheumatology, certain treatments may even be able to give the hope of a cure.
‘We are now also in the position to speak about possibilities to cure rheumatological diseases,’ he says. ‘This of course may take time, but curing is now, I believe, in reach, as compared to not being an option 10 years ago.’
Professor Baraliakos has contributed extensively to imaging research in rheumatology, and he says the first 10 years of this century saw the MRI and ultrasound becoming standard tools for diagnosing rheumatic diseases. But the biggest changes have come through recent improvements in image quality, with clinicians now able to get much greater detail of information from the images, allowing them to read and understand the progression of the disease more accurately.
‘We’ve learned how to interpret the images better in the clinical context. Something showing as ‘positive’ on imaging does not always mean the presence of a disease. We’ve learned to make that differentiation: that signal of inflammation may not be rheumatological, the inflammation may be something else. [It’s a] distinction between pathology and a coincidental finding,’ he explains.
In addition to advancements in imaging and the understanding of pathology, Professor Baraliakos emphasises the critical role of artificial intelligence (AI) in driving the future of rheumatology. Screening for diseases using AI is enabling early and accurate diagnosis, reducing the risk of misdiagnosis and unnecessary treatment while also ensuring patients are directed to the right clinician without losing time.
‘AI will change everything,’ he says. ‘It will make us aware of things we’re not really seeing that much. AI will be much more sensitive to [pathological] change, so the sensitivity of image interpretation will be improved beyond the human eye and human understanding.’
Coupled with AI’s ability to identify images with greater speed and accuracy, Professor Baraliakos believes these advancements will play an essential role in enhancing patient-centred treatment models. ‘I would see AI as a tool and not as a threat,’ he says.
Professor Baraliakos hopes to use his platform as the future president of EULAR to expand the Alliance’s global outreach and education initiatives, leveraging recent scientific advancements and enhancing interdisciplinary collaboration to ensure optimal treatment for all patients no matter where they live.
‘I think EULAR is on a very good track,’ he says. ‘We are already the number one global rheumatology organisation worldwide. But of course, we need to develop and go with the science of the times. We need to invest in improving the patients’ situation because there are big differences between countries and continents.’
To this end, Professor Baraliakos hopes to extend the EULAR’s reach ‘to provide research, but also educational activities that are for everyone,’ whether they are based in Europe or further afield.
One of his first tasks as president will be to oversee the Alliance’s annual Congress and he is keen to make it ‘the place to be’ in the rheumatology calendar and ‘where you really see the most recent rheumatological status, what is moving the field, and where the field will be moving towards’.
While the focuses of next year’s Congress remain safely under wraps for the time being, Professor Baraliakos is resolute that it will cover the most recent research and innovations in the field at a time of such exciting progress. He believes that being flexible in the structure and forward-looking in the content is the key to achieving this goal.
‘We are trying new formats to attract people and implement their ideas where possible. Content wise, we’re concentrating on what’s hot and what’s important. I think that makes it attractive for everyone, and also really exciting, but suited to the times we’re living in,’ he says.
Reflecting on his work and plans for the future, Professor Baraliakos says that at the heart of his ambitions is a strong desire to understand rheumatological diseases even better and to champion translational research and bring it back to the patient.
‘The most rewarding part of my work is to really see ideas coming into life,’ he says. ‘I feel the responsibility, but I’m also looking forward to really applying my plans to reach the goal, to improve patients’ lives and improve outreach overall.’
26th November 2024
A study aimed at quantifying excess antibiotic use in an acute UK hospital found that nearly a quarter of antibiotic days of therapy (DOTs) were unnecessary.
The most significant opportunity to reduce antibiotic use came in optimising the pre-72 hours antibiotic review. Other important opportunities to reduce use included avoiding inappropriate initiation of antibiotics and ensuring course lengths were appropriate for each patient.
Patients discharged from a district general hospital in south-west England in August 2020 who had received antibiotics were monitored using an audit tool to evaluate and measure the use of antibiotics. Two infection specialists then determined the appropriateness of antibiotic use and calculated the DOTs.
Of the 647 patients discharged during the study, 184 were reviewed for antibiotic use. In total, 1,658 DOTs were administered across all patients in the study. Nearly a quarter of the DOTs (24%, n=403) were excess days when antibiotic use was unnecessary.
Half of the patients reviewed (n=92) were prescribed antibiotics for longer than was clinically necessary, contributing to the excess DOTs.
Nearly half of the excess DOTs (45.7%) occurred before the 72-hour review and over a quarter (27.8%) at initiation of therapy, where antibiotics were taken for too long or unsuitable medications were chosen. Inappropriately long courses of antibiotics contributed 26.6% of DOTs.
The findings suggest that addressing antibiotic use at the three time points of initiation, review and duration could significantly reduce unnecessary use, leading to improved patient outcomes and a reduction in antibiotic resistance.
The researchers hope the findings may provide a target for reducing excess antimicrobial therapy in line with the national antimicrobial resistance (AMR) strategy and improve future prescribing habits.
Reference
Owens, R et al. Assessment of the appropriateness of antibiotic prescribing in an acute UK hospital using a national audit tool: a single centre retrospective survey. European Journal of Hospital Pharmacy 2024; Oct 25: DOI: 10.1136/ejhpharm2022-003569.
25th November 2024
A second interim analysis of the KEYNOTE-671 trial has shown that adding perioperative pembrolizumab to neoadjuvant chemotherapy for early-stage non-small-cell lung cancer (NSCLC) is effective and safe. This combination of medication showed significant overall survival benefit for patients who lived longer without cancer progression, recurrence or death and increased health-related quality of life.
This follows the results of the first interim analysis which found that adding perioperative pembrolizumab to neoadjuvant chemotherapy significantly improved event-free survival in participants with early-stage NSCLC but did not improve overall survival.
The global phase 3 trial was undertaken at 189 medical centres between May 2018 and Dec 2021 and involved 797 participants. All participants were 18 or older and had resectable stage II, IIIA, or IIIB (N2) NSCLC.
Patients were randomly assigned to one of two medication groups, with 397 undertaking treatment with pembrolizumab: four cycles of neoadjuvant pembrolizumab (200 mg administered intravenously every three weeks) plus cisplatin-based chemotherapy followed by surgery and 13 cycles of adjuvant pembrolizumab (200 mg administered intravenously every three weeks).
The control group had four cycles of neoadjuvant placebo (administered intravenously every three weeks) plus cisplatin-based chemotherapy followed by surgery and 13 cycles of adjuvant placebo (administered intravenously every three weeks).
Groups were stratified based on disease stage, levels of the PD-L1 protein in cancer cells, lung cancer types and geographical regions. Researchers compared rates of overall survival and event-free survival between the two groups.
At 36 months, overall survival rates were 71% (95% CI 66–76) in the pembrolizumab group and 64% (95% CI 58–69) in the placebo group. Median event-free survival was 47.2 months in the pembrolizumab group and 18.3 months in the placebo group.
Serious side effects (grade 3–5) were more common in the pembrolizumab group (45%) compared to the placebo group (38%). Treatment-related adverse events led to death in four (1%) participants in the pembrolizumab group and three (1%) participants in the placebo group.
The authors concluded that the use of neoadjuvant pembrolizumab plus chemotherapy followed by adjuvant pembrolizumab was beneficial in patients with resectable, early-stage NSCLC due to significant overall survival benefits and the manageable safety profile, supporting its use in this patient group.
Reference
Spicer, J et al. Neoadjuvant pembrolizumab plus chemotherapy followed by adjuvant pembrolizumab compared with neoadjuvant chemotherapy alone in patients with early-stage non-small-cell lung cancer (KEYNOTE-671): a randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet 2024; Sept. 28: DOI: 10.1016/S0140-6736(24)01756-2.
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