Keir Lewis - Academia.edu (original) (raw)

Papers by Keir Lewis

NeuroReport, 1997

The carrier rates of a genetic marker for arylsulphatase A pseudodeficiency (ASA-PD) were determi... more The carrier rates of a genetic marker for arylsulphatase A pseudodeficiency (ASA-PD) were determined in three series of patients with vascular dementia (VaD) or Alzheimer&amp;amp;amp;amp;amp;#39;s disease (AD). In the first community-based sample, the 1524 + 95A--&amp;amp;amp;amp;amp;gt;G mutation, which is known to be associated with ASA-PD, was present in 35% of VaD cases and none of the AD cases. In a second sample of cases drawn from a Dementia Register, the mutation rates were 18% (VaD) and 16% (AD). Brain DNA from a post-mortem sample revealed the ASA-PD mutation in 60% of VaD cases and 34% of AD cases. These rates are higher than previous studies of culturally similar populations and suggest that ASA-PD may be a risk factor for dementia.

Tobacco, smoking control and health educ., 2020

The failing lung in COPD, 2019

Introduction Exacerbations of COPD account for approximately 12% of UK hospital admissions. Over ... more Introduction Exacerbations of COPD account for approximately 12% of UK hospital admissions. Over 20% will be complicated by respiratory acidaemia, which has high mortality. Non-Invasive ventilation (NIV) confers a 2–3 fold mortality reduction, but practice is sub-optimal; the intervention is underused, infrastructure is lacking, and complex decisions are made by a wide range of clinicians.1 It is likely that prognostic pessimism contributes to underuse. We aimed to derive and separately validate a simple, bedside, clinical tool to predict in-hospital mortality in exacerbations of COPD complicated by respiratory acidaemia requiring assisted ventilation. Methods Derivation was single-centre and retrospective. Consecutive patients meeting selection criteria were identified and clinical data collected. Multivariable regression identified independent predictors of in-hospital death and a simple model created. For validation, consecutive patients were prospectively recruited from 10 sites and model performance assessed. Results 489 patients were identified in the derivation study and 733 in the validation (in-hospital mortality 25.4 and 20.1% respectively). Key validation descriptors: 70% hospitalised during previous year, Mean (SD) age 70.5 (9.3) years and FEV1 % predicted 37.2 (15.4). 56% were unable to leave the house unassisted (eMRCD 5a or 5b) and 29% prescribed LTOT. 36% had previously required NIV and 9% were receiving home ventilation. Median (IQR) pH at onset of ventilation 7.27 (7.22–7.30), with CO210.2 (2.7) kPa. The final prognostic (NIVO) score comprised: Atrial fibrillation, chest X-ray consolidation, pH <7.25, Glasgow coma scale ≤14 (all 1 point), timing of acidaemia >12 hours from admission time (2 points) and eMRCD (1–4=0, 5a=2, 5b=3) yielding a maximum score of 9 using 6 indices. Stepwise increase in mortality was observed with an area under the receiver operated curve of 0.79 in the validation cohort (0.83 derivation). The NIVO score outperformed pre-identified comparator scores (APACHE II, CAPS, Confalonieri risk chart) in both its derivation and validation studies.Abstract S57 Table 1 NIVO Score Survived Died Total Mortality 0 87 3 90 3.3% 1 70 6 76 7.9% 2 134 7 141 5.0% 3 121 25 146 17.2% 4 95 23 118 19.5% 5 48 39 87 44.8% 6 23 26 49 53.1% 7 7 10 17 58.8% 8 1 7 8 87.5% 9 0 1 1 100% Total 586 147 733 20.1% Risk category (score) Survived Died Total Mortality Low (0 – 2) 291 16 307 5.2% Medium (3–4 ) 216 48 264 18.2% High (5–7 ) 78 75 153 49.0% Very High (8–9 ) 1 8 9 88.9% Discussion Using only simple, readily available indices good prediction of in-hospital mortality is feasible. Potential practical applications include but are not limited to guiding level of care, setting treatment limitations and objectifying both clinician decision making and discussion with patients/family members. Reference Inspiring change 2017

European Medical Journal

The prevalence of respiratory diseases, including asthma and chronic obstructive pulmonary diseas... more The prevalence of respiratory diseases, including asthma and chronic obstructive pulmonary disease, has increased in recent decades, placing a significant burden on healthcare systems and economies around the world. As these diseases are largely incurable, the aim of treatment is to control symptoms and improve quality of life. Aside from stopping smoking and reducing biomass fuel exposure, arguably the most effective strategy in the long-term management of chronic respiratory diseases is the prevention or control of respiratory infections via vaccines and antimicrobial agents. By preventing these infections or reducing exposure to some of the major risk factors, we can reduce further lung damage in these patients, thereby slowing disease progression. This review looks at maintaining long-term respiratory health in patients with asthma and chronic obstructive pulmonary disease, primarily through smoking cessation, reducing exposure to allergens and air pollutants, and infection cont...

ABSTRACTBackgroundA COVID-19 hospital guideline was implemented across all acute hospitals in Wal... more ABSTRACTBackgroundA COVID-19 hospital guideline was implemented across all acute hospitals in Wales in March 2020, and data was collected across the first 3 Waves of the pandemic. We aimed to observe trends in mortality with a focus on ward-based outcomes.MethodsRetrospective case-note review of data for adults admitted to hospital with community acquired COVID-19 between March 2020 and December 2021Results5887 cases were analysed. Overall mortality from COVID-19 fell from 31.5% in Wave 1 to 22.6% in Wave 2 to 18.8% in Wave 3 (p<0.01). Ward mortality for patients on oxygen fell from 34.6% in Wave 1 to 19.5% in Wave 2 (p<0.01) to 14.3% in Wave 3 (p=0.03). For those managed with CPAP/HFNO on wards, the mortality reduced from 58.9% in Wave 1 to 45.6% in Wave 2 (p=0.05) and further to 42.6% in Wave 3 (p=0.03). The mortality for patients managed with CPAP/HFNO on ICU reduced from 43.8% in Wave 1 to 24.7% in Wave 2 (p=0.12) and further to 20.4% in Wave 3 (p=0.03). Patients receiving...

Oxford Handbook of Clinical Diagnosis

Supporting Tobacco Cessation, 2021

Introduction: Supporting tobacco cessation-from health policy to xi health system reorientation a... more Introduction: Supporting tobacco cessation-from health policy to xi health system reorientation and patient care List of abbreviations xvi The challenging changing landscape of the tobacco epidemic 1. Tobacco is still the most important preventable cause of 1 respiratory diseases

Table S1. Patients admitted on weekends and on week days for major acute disorders across England... more Table S1. Patients admitted on weekends and on week days for major acute disorders across England and Wales, compared according to source of admission and social deprivation (DOCX 74 kb)

ObjectiveTo identify and detect metabolomic markers to differentiate cancer related from other pl... more ObjectiveTo identify and detect metabolomic markers to differentiate cancer related from other pleural effusions.Material and methodsUn-targeted flow infusion electrospray mass spectrometry was used on a cohort of 100 samples from benign and malignant pleural effusions (12 primary lung cancers, 14 mesotheliomas, 24 other cancers, 25 congestive cardiac failure, 22 parapneumonic effusion, 3 empyema). Standard metabolomic statistical models for analysis were performed.ResultsFive novel markers were identified using univariate and multivariate receiving operator curve analyses using five discriminant features yielding a diagnostic accuracy of above 0.91 (95% CI: 0.839-0.976) with a sensitivity of 0.97 (95% CI 0.952-0.979) and specificity 0.87 (95% CI 0.852-0.894).ConclusionIndividual biomarkers with the highest accuracy (>0.84) were all raised in cancer and are involved in metabolism of sterol-lipids and acyl carnitines linked to β-oxidation. Our markers performed better than those p...

Health Psychology and Behavioral Medicine, 2021

Objective: Chronic Obstructive Pulmonary Disease (COPD) is a long-term condition that detrimental... more Objective: Chronic Obstructive Pulmonary Disease (COPD) is a long-term condition that detrimentally affects health-related quality of life (HRQoL), with self-management proposed as an effective treatment. Using self-determination theory (SDT), this research explored psychological need satisfaction, frustration, and behavioural regulation to explain indicators of self-management. Design and Main Outcome Measures: Cross-sectional, questionnaire-based methods in people on a pulmonary rehabilitation waiting-list. 72 participants completed SDT, HRQoL, and self-management knowledge questionnaires. Path analyses investigated the ability of SDT concepts to predict selfmanagement knowledge and HRQoL. Results: Chi-square tests found no significant differences (χ 2 (13, N=72) = 16.7, p > 0.05) between the justand over-identified models, and multiple measures suggested an acceptable fit to the data. Relatedness frustration positively predicted controlled regulation and autonomy and relatedness satisfaction positively predicted autonomous regulation. The associations between the other needs and the different regulation types were not statistically significant. Both regulation types strongly predicted HRQoL (35% variance explained) and self-management knowledge (22% variance explained). Conclusion: SDT concepts can predict more self-determined selfmanagement regulation, self-management knowledge, and HRQoL and provide a framework for researchers and healthcare professionals to develop future health interventions for people with COPD. Greater research is needed to understand basic psychological need frustration in health contexts.

European Respiratory Journal, 2020

SSRN Electronic Journal, 2020

Background: The burden of hospital-acquired (nosocomial) COVID-19 remains poorly defined with var... more Background: The burden of hospital-acquired (nosocomial) COVID-19 remains poorly defined with variation in case-definitions used for reporting and little publicly-available information concerning outcomes. Methods: We conducted a retrospective observational study of adult patients with a positive SARS-CoV-2 positive polymerase chain reaction (PCR) hospitalised across Wales between 1st March – 1st July 2020. An electronic survey was used to capture patient outcome following admission until 20th November. The prevalence and outcomes for nosocomial COVID-19 were assessed across of a range of possible case definitions. Findings: The study included 2518 patients from 18 major hospitals sites across Wales and collected outcomes on patients discharged up to 20 th November, representing approximately 60% of patients hospitalised. Inpatient mortality rates for nosocomial COVID-19 ranged from 38% to 42%, and remained consistently higher than patients with community-acquired infection (31% to ...

Sleep and control of breathing, 2021

Oxford Handbook of Clinical Diagnosis, 2009