Publications by authors named "Bhautesh D Jani"

Current evidence suggests the possibility that autistic people may be at more risk of COVID-19 infection, hospitalisation, and mortality than the general population. Previous studies, however, are either limited in scale or do not investigate potential risk factors. Research into risk factors focused on general population samples.

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Key Points: The four-variable kidney failure risk equation (KFRE) does not accurately estimate kidney failure risk in frail individuals. Prognostication of kidney failure is improved in frail individuals with CKD by replacing eGFR creatinine with cystatin C-based eGFR in the KFRE model. Consideration of competing mortality risk is particularly important in those with frailty and higher KFRE risk predictions.

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Background: NICE guidelines recommend GPs use the kidney failure risk equation (KFRE) to identify people with chronic kidney disease (CKD) at higher risk of kidney failure. Albuminuria results are required to calculate KFRE.

Aim: Analyse the implementation of KFRE into clinical practice and investigate if albuminuria testing varied amongst patients with CKD, particularly for underserved groups.

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Background: Studies on avoidable mortality in adults with intellectual disabilities are limited, as are studies on causes of death.

Objectives: We aimed to quantify mortality rates, and causes, and identify factors (i.e.

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Background: Patients with advanced chronic kidney disease requiring initiation of kidney replacement therapy (KRT) are frequently asked to enact complex management plans. Treatment burden has been defined as the effect of healthcare workload and the capacity a person has to manage this workload has on wellbeing. The aim of this review is to examine the experience of healthcare workload and the factors that affect capacity to meet that workload for people transitioning onto KRT for the first time, using a framework synthesis of published literature informed by normalisation process theory (NPT) and theory of patient capacity (TPC).

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Background: Identifying clusters of multiple long-term conditions (MLTCs), also known as multimorbidity, and their associated burden may facilitate the development of effective and cost-effective targeted healthcare strategies. This study aimed to identify clusters of MLTCs and their associations with long-term health-related quality of life (HRQoL) in two UK population-based cohorts.

Methods: Age-stratified clusters of MLTCs were identified at baseline in UK Biobank (n = 502,363, 54.

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Background: Socioeconomic inequality in infant mortality in the UK is rising. This study aims to identify contributory maternal and pregnancy factors that can explain the known association between area deprivation and infant mortality.

Methods: A cohort study was conducted using Clinical Practice Research Datalink (CPRD) primary care data between 2004 and 2019 linked to the Index of Multiple Deprivation (IMD), and infant mortality from the Office for National Statistics death data.

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Introduction: Clinical guidelines recommend the use of the kidney failure risk equation (KFRE) to guide the referral of individuals with chronic kidney disease (CKD) to secondary kidney care services. People living with CKD frequently experience multiple long-term conditions (multimorbidity) and/or frailty. This may impact patients' or carers' perceptions of kidney failure in the context of other health problems and associated risks and emphasises the need for shared decision-making.

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Article Synopsis
  • Prognostic models for chronic kidney disease (CKD) are essential for identifying at-risk patients and enabling precision medicine, but they often fail to consider multimorbidity and frailty.
  • A systematic review found that out of 97 studies on kidney failure models, only a few reported on multimorbidity and none adequately included frailty in their assessments.
  • The lack of studies addressing these factors limits the evidence-based guidance for treating patients with CKD who have multiple health issues, highlighting a critical area for future research.
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  • The study follows the PANORAMIC trial, investigating the long-term effectiveness of molnupiravir for COVID-19 on wellbeing, persistent symptoms, new infections, healthcare use, and time off work at 3 and 6 months post-randomization.
  • Participants included adults over 50 or younger with specific health issues, who were affected by COVID-19 for less than 5 days and were divided into either a molnupiravir treatment group or a standard care group.
  • The trial involved 25,783 participants and aimed to assess various secondary outcomes, including self-reported wellness, symptom severity, health-related quality of life, and overall healthcare usage after the initial
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Article Synopsis
  • - This study seeks to better classify individuals with multiple long-term health conditions (MLTCs) by identifying specific clusters of these conditions across various age groups and their links to negative health outcomes and healthcare utilization.
  • - Researchers employed latent class analysis on data from large cohorts, including over 1.8 million individuals, to determine how different MLTC clusters impact mortality, hospital hospitalizations, and general practitioner usage over ten years.
  • - Findings indicated that certain MLTC clusters, particularly those involving cardiometabolic and pain/mental health issues, showed strong associations with higher risks of mortality and healthcare use, particularly in younger and middle-aged individuals, while data from the UKHLS group did not reveal significant risks.
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Article Synopsis
  • * A total of 42 systematic reviews and 3 additional randomized controlled trials were analyzed, involving nearly 937,000 individuals across 39 LTCs, revealing that exercise improved health-related quality of life (HRQoL) and exercise capacity, though data on mortality and hospitalizations were limited.
  • * The review found methodological quality varied among studies, with a significant number rated as critically low, highlighting the need for more research on multimorbidity and its effects on exercise interventions.
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Frailty, social isolation, and loneliness have individually been associated with adverse health outcomes. This study examines how frailty in combination with loneliness or social isolation is associated with socioeconomic deprivation and with all-cause mortality and hospitalisation rate in a middle-aged and older population. Baseline data from 461,047 UK Biobank participants (aged 37-73) were used to assess frailty (frailty phenotype), social isolation, and loneliness.

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Background: People with chronic kidney disease (CKD) have increased incidence and mortality of most cancer types. We hypothesized that the odds of presenting with advanced cancer may vary according to differences in estimated glomerular filtration rate (eGFR), that this could contribute to increased all-cause mortality and that sex differences may exist.

Methods: Data were from Secure Anonymised Information Linkage Databank, including people with de novo cancer diagnosis (2011-17) and two kidney function tests within 2 years prior to diagnosis to determine baseline eGFR (mL/min/1.

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Background: The cost-effectiveness of molnupiravir, an oral antiviral for early treatment of SARS-CoV-2, has not been established in vaccinated populations.

Aim: To evaluate the cost-effectiveness of molnupiravir relative to usual care alone among mainly vaccinated community-based people at higher risk of severe outcomes from COVID-19 over 6 months.

Design And Setting: An economic evaluation of the PANORAMIC trial in the UK.

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Background: People with severe mental health illness die prematurely, often due to preventable cardiometabolic disease, which can be exacerbated by antipsychotic medicines that are effective for treating mental illness. Literature demonstrates that physical health monitoring, as recommended in guidelines, for people receiving antipsychotics is substandard. Therefore, we aimed to scope the potential of a general practice clinical pharmacist (GPCP)-led multidisciplinary intervention optimising adherence to cardiometabolic monitoring guidelines and delivering polypharmacy reviews.

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Remote exercise tests for patients with pulmonary hypertension (PH) would improve the telemedicine strategies in this disease. The PHRET study assessed the validity and feasibility of four remote exercise tests performed by PH patients at home. Participants undergoing diagnostic assessment for PH were included.

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Background: There has been conflicting evidence on the association between multimorbidity and blood pressure (BP) control. This study aimed to investigate this associations in people with hypertension attending primary care in Canada, and to assess whether individual long-term conditions are associated with BP control.

Methods: This was a cross-sectional study in people with hypertension attending primary care in Toronto between January 1, 2017 and December 31, 2019.

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We investigated prevalence and demographic characteristics of adults living with multimorbidity (≥2 long-term conditions) in three low-income countries of sub-Saharan Africa, using secondary population-level data from four cohorts; Malawi (urban & rural), The Gambia (rural) and Uganda (rural). Information on; measured hypertension, diabetes and obesity was available in all cohorts; measured hypercholesterolaemia and HIV and self-reported asthma was available in two cohorts and clinically diagnosed epilepsy in one cohort. Analyses included calculation of age standardised multimorbidity prevalence and the cross-sectional associations of multimorbidity and demographic/lifestyle factors using regression modelling.

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Background: Components of social connection are associated with mortality, but research examining their independent and combined effects in the same dataset is lacking. This study aimed to examine the independent and combined associations between functional and structural components of social connection and mortality.

Methods: Analysis of 458,146 participants with full data from the UK Biobank cohort linked to mortality registers.

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Background: Evidence from the UK from the early stages of the covid-19 pandemic showed that people with Intellectual Disabilities (ID) had higher rates of covid-19 mortality than people without ID. However, estimates of the magnitude of risk vary widely; different studies used different time periods; and only early stages of the pandemic have been analysed. Existing analyses of risk factors have also been limited.

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Background: In the United Kingdom (UK), cancer screening invitations are based on general practice (GP) registrations. We hypothesize that GP electronic medical records (EMR) can be utilised to calculate a lung cancer risk score with good accuracy/clinical utility.

Methods: The development cohort was Secure Anonymised Information Linkage-SAIL (2.

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Frailty, an age-related decline in physiological reserve, is an increasingly important concept in the management of chronic diseases. The implications of frailty in people with rheumatoid arthritis are not well understood. We undertook a systematic review to assess prevalence of frailty in people with rheumatoid arthritis, and the relationship between frailty and disease activity or clinical outcomes.

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Article Synopsis
  • * Through in-depth interviews with 32 participants, the researchers used Normalization Process Theory and Burden of Treatment Theory to analyze key challenges, including managing life disruptions and navigating healthcare systems amidst poverty.
  • * Findings reveal that poor healthcare resources and limited access to treatment exacerbate the burden, while supportive social networks and access to health education can help alleviate these challenges.
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