Respiratory and Older People's Medicine Respiratory and Older People's Medicine

Overview of Placement

Within Norwich, there is a close collaboration between Respiratory Medicine (Resp Med) and Older peoples’ medicine (OPM). In particular both groups have a strong interest in Chronic Obstructive Pulmonary Disease (COPD), idiopathic pulmonary fibrosis, exercise in lung disease and pneumonia.

Andrew Wilson is currently applicant or co-applicant on grants totalling £8M including studies to evaluate therapeutic interventions in patients with COPD, pulmonary fibrosis and asthma. He is the chief investigator for 4 multi-centre clinical trials or investigational studies. These include:

  • the EME-TIPAC study – a NIHR-EME funded clinical trial of co-trimoxazole therapy in 330 patients with idiopathic pulmonary fibrosis [https://www.uea.ac.uk/eme-tipac],

  • the ARRISA-UK study – a NHR HTA funded complex intervention in primary care involving identification of 9170 patients with at-risk asthma, flagging their electronic medical records and training practice staff how to manage their care,

  • the BET study – a NIHR RfPB funded study of a self-management plan in 220 patients with bronchiectasis and

  • a 12 month modelling study of health related quality of life in 250 patients with idiopathic pulmonary fibrosis.

Yoon Loke is a Convenor of the Cochrane Adverse Effects Methods Group and a clinical pharmacologist specializing in systematic reviews of drug safety. His main interests include the adverse effects of inhaled corticosteroids, as well as prognostic scoring in community-acquired pneumonia.

Helen May along with Martyn Patel and Kelly Waterfield are specialty clinical research network leads for Ageing Research for the Eastern Region giving us support to do multi- centre portfolio studies and support other specialties with their research. Older peoples’ medicine (OPM) have research interests in hypertension, physiology of cardiovascular ageing, syncope, stroke, movement disorders, mental health, physical and mental comorbidities. OPM have ongoing trials in dementia and hip fracture, pharmacological studies in collaboration with UEA (eg liquid alendronate); hip fractures imaging studies of patients with hip fracture, relatives of patients and patients with hip fracture and stroke; postural hypotension in older people and memory impairment and depression in stroke disease. An academic F2 doctor is able to benefit from the research generated by these projects and to participate in aspects of these research projects.

The group currently have three Clinical Academic Chairs, 1 Clinical Research Fellow, 5 Research Nurses and 1 Research Assistant.

The post holder will have access to:

  1. Clinical laboratory facilities: OPM Cardiovascular Laboratory (including Transcranial Doppler, BP monitors, Tilt table, Pulse wave velocity measures); Physiology Research Laboratory (including Spirometry, Impulse oscillometry, Airways resistance, Muscle strength and endurance, Exercise challenge tests); Clinical Respiratory Laboratory (including Body Plethysmography, and cardiopulmonary exercise testing)

  2. Clinical research trials and studies: At present there are 4 multicentre studies hosted by OPM and 6 studies hosted by respiratory. These offer the experiences only available by well-resourced large scale studies including electronic data capture, electronic case record forms and independent specialist monitors. There are an additional 20 studies on going in the two departments providing a wide choice of studies in which an academic F2 can be involved.

  3. Registers: there are currently registers in stroke, TIA, hip fracture and interstitial lung disease. These provide opportunities for data analysis.

  4. Meta-analyses, Audit and Reviewing Journal Articles: Researchers within Resp and OPM have experience undertaking meta-analyses, undertake audit regularly and frequently review articles for peer reviewed journals. This provides a resource for training in these areas.

Examples of work undertaken & outputs

Previous academic foundation doctors have been involved in a wide range of projects including assessment of lung function using novel and experimental techniques including breath condensate, impulse oscillometry, airways resistance measurements; assessment of in patients with COPD and interstitial lung disease using laboratory walking tests and accelerometery, meta-analyses and reviews in the following topics: pneumonia scoring, dysarthria, oral anti-coagulants and antiplatelets, pulmonary rehabilitation, non-lipid lowering effects of statins

  • Turner RM, Kwok CS, Chen-Turner C, Maduakor CA, Singh S, Loke YK.  Thiazolidinediones and associated risk of bladder cancer: a systematic review and meta-analysis. Br J Clin Pharmacol. 2014 Aug;78(2):258-73. doi: 10.1111/bcp.12306.

  • Hayton C, Clark A, Olive S, Browne P, Galey P, Knights E, Staunton L, Jones AP, Coombes E, Wilson AM Barriers to Pulmonary Rehabilitation: characteristics that predict patient attendance and adherence. Respir Med. 2013 107:401-7.

  • Airways resistance in bronchial challenge testing. Baxter MA, Coates D, Wilson AM. J Asthma. 2014 Aug 19:1-6.

  • Jennings BA, Loke YK, Skinner J, Keane M, Chu GS, Turner R, Epurescu D, Barrett A, Willis G Evaluating predictive pharmacogenetic signatures of adverse events in colorectal cancer patients treated with fluoropyrimidines. PLoS One. 2013 Oct 22;8(10):e78053. doi: 10.1371/journal.pone.0078053. eCollection 2013.