Mark Woodhead

Central Manchester University Hospitals NHS Foundation Trust, Manchester, England, United Kingdom

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Publications (42)284.02 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To determine the association between 30-day inpatient mortality and route of admission to hospital, for adults with community acquired pneumonia (CAP).Methods We studied 16 313 adults included in the British Thoracic Society (BTS) national CAP audit dataset. Comparisons were made between adults admitted via emergency departments (ED) with non-ED routes of admission, with regard to 30-day inpatient mortality. Secondary outcome measures were adherence to national CAP guidelines (time to first chest X-ray ≤4 h from admission; time to first antibiotic dose ≤4 h from admission; antibiotic choice; and antibiotic route of administration) by route of admission.Results Of adults hospitalised with CAP, 75.6% were admitted via ED; these adults had a greater prevalence of comorbid illness and higher disease severity in comparison with non-ED admissions. Adjusted 30-day inpatient mortality was similar for ED versus non-ED route of admission (OR 1.10, 95% CI 0.96 to 1.25). Admissions via ED were associated with faster processes of care (time to chest X-ray ≤4 h, adjusted OR 3.39, 95% CI 2.79 to 4.12; time to first antibiotic ≤4 h, adjusted OR 1.62, 95% CI 1.42 to 1.84) and greater use of intravenous antibiotics regardless of disease severity (adjusted OR 1.58, 95% CI 1.43 to 1.74).Conclusions Adults with CAP admitted via EDs have more comorbid illness and greater disease severity compared to those admitted via non-ED routes. Following adjustment for these differences, 30-day inpatient mortality was not associated with route of admission.
    Emergency Medicine Journal 12/2014; · 1.78 Impact Factor
  • Giovanni Sotgiu, Mark Woodhead
    European Respiratory Journal 07/2014; 44(1):5-7. · 7.13 Impact Factor
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    ABSTRACT: Tuberculosis (TB) incidence is rising globally, with drug resistance becoming increasingly problematic. Microbiological confirmation ensures correct anti-tuberculous chemotherapy. We retrospectively analysed all TB cases diagnosed in Central Manchester in 2009 investigating how often we are not achieving microbiological diagnosis, factors influencing this and whether opportunities to obtain microbiological samples are missed. 128/156 (82%) cases had samples sent for microbiology. Factors affecting this included disease site, with ocular disease least likely to be sampled (p < 0.0001), and patient age (with children less likely to be sampled p = 0.002). Ethnicity did not affect sampling (n.s.). Overall, 92/156 (59%) cases were culture positive. Negative culture was related to specimen type (p < 0.0001) and patient age (p = 0.019), with children significantly less likely to have a positive culture. Ethnicity and disease site did not affect culture results. There was a trend towards culture positivity being more common in pulmonary (75%) than non-pulmonary (46%) disease (n.s.). In only 7 (4%), could samples have been sent where they were originally absent (3) or further samples obtained where the cultures proved to be negative (4). Despite an overall culture positive rate of 59%, opportunities to achieve microbiological confirmation are seldom missed. In our centre, which is typical of UK practice, this lack of capacity to increase microbiological confirmation, particularly in an era of increasing importance of extra-pulmonary TB, is concerning. Improvements in sample acquisition and laboratory methods are urgently required.
    Respiratory medicine 10/2013; · 2.33 Impact Factor
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    Waseem Asrar Khan, Mark Woodhead
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    ABSTRACT: This article is a non-systematic review of selected recent publications in community-acquired pneumonia, including a comparison of various guidelines. Risk stratification of patients has recently been advanced by the addition of several useful biomarkers. The issue of single versus dual antibiotic treatment remains controversial and awaits a conclusive randomized controlled trial. However, in the meantime, there is a working consensus that more severe patients should receive dual therapy.
    F1000prime reports. 10/2013; 5:43.
  • Mark Woodhead, Ruth Wiggans
    Expert Review of Respiratory Medicine 02/2013; 7(1):5-7.
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    ABSTRACT: The benefits of β-lactam/macrolide combination therapy over β-lactam therapy alone for the treatment of hospitalised community-acquired pneumonia (CAP) in relation to pneumonia severity are uncertain. We studied 5240 adults hospitalised with CAP from 72 secondary care trusts across England and Wales. The overall 30-day inpatient (IP) death rate was 24.4%. Combination therapy was prescribed in 3239 (61.8%) patients. In a multivariable model, combination therapy was significantly associated with lower 30-day IP death rate in patients with moderate-severity CAP (adjusted OR 0.54, 95% CI 0.41 to 0.72) and high-severity CAP (adjusted OR 0.76, 95% CI 0.60 to 0.96) but not low-severity CAP.
    Thorax 10/2012; · 8.56 Impact Factor
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    Paul A Marsden, Mark Woodhead
    Primary care respiratory journal: journal of the General Practice Airways Group 03/2012; 21(1):11-3. · 2.91 Impact Factor
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    ABSTRACT: Tuberculosis (TB) has increased within the UK and, in response, targets for TB control have been set and interventions recommended. The question was whether these had been implemented and, if so, had they been effective in reducing TB cases. Epidemiological data were obtained from enhanced surveillance and clinics. Primary care trusts or TB clinics with an average of > 100 TB cases per year were identified and provided reflections on the reasons for any change in their local incidence, which was compared to an audit against the national TB plan. Access to data for planning varied (0-22 months). Sputum smear status was usually well recorded within the clinics. All cities had TB networks, a key worker for each case, free treatment and arrangements to treat HIV co-infection. Achievement of targets in the national plan correlated well with change in workload figures for the commissioning organizations (Spearman's rank correlation R = 0.8, P < 0.01) but not with clinic numbers. Four cities had not achieved the target of one nurse per 40 notifications (Birmingham, Bradford, Manchester and Sheffield). Compared to other cities, their loss to follow-up during treatment was usually > 6% (χ2 = 4.2, P < 0.05), there was less TB detected by screening and less outreach. Manchester was most poorly resourced and showed the highest rate of increase of TB. Direct referral from radiology, sputum from primary care and outreach workers were cited as important in TB control. TB control programmes depend on adequate numbers of specialist TB nurses for early detection and case-holding.Please see related article:
    BMC Public Health 11/2011; 11:896. · 2.32 Impact Factor
  • Wei Shen Lim, Mark Woodhead
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    ABSTRACT: The updated British Thoracic Society (BTS) Guidelines for the management of community acquired pneumonia (CAP) in adults was published in October 2009. In conjunction with the Guidelines, the first national BTS audit of adult CAP was conducted. An audit tool was developed as part of the Guidelines. Members of the BTS were invited to participate in the audit capturing data relating to acutely ill adults admitted to hospitals in the U.K. and treated for CAP within the period 1 December 2009 and 31 January 2010. Data entry using the web-based audit tool closed in May 2010. Of 2749 submissions from 64 institutions; 8 were excluded due to inconsistent data. The mean age of patients was 71 years (range 16-105 years). The CURB65 score was 0 to 1 in 40% of patients, 2 in 30% and 3 to 5 in 30%. Five hundred and three (18.3%) patients died in hospital within 30 days, 101 (20.1%) within 1 day of admission. Initial empirical antibiotics were in accordance with local CAP guidelines in 1478 (55.5%) patients and were administered intravenously in 712 (65%), 603 (74%) and 743 (90%) patients with CURB65 scores 0 to 1, 2 and 3 to 5 respectively. Within 4 hours of admission, a chest x-ray was obtained in 83% of patients and the first dose of antibiotics was administered in 58%. The burden of CAP is high. Efforts should be directed at improving adherence to local CAP guidelines and specific processes of care.
    Thorax 06/2011; 66(6):548-9. · 8.56 Impact Factor
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    Nita Sehgal, Mark Woodhead
    Thorax 03/2011; 66(3):187-8. · 8.56 Impact Factor
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    Vandana Gupta, Mark Woodhead
    Primary care respiratory journal: journal of the General Practice Airways Group 12/2010; 19(4):301-3. · 2.91 Impact Factor
  • The International Journal of Tuberculosis and Lung Disease 11/2010; 14(11):1497-8. · 2.76 Impact Factor
  • Santiago Ewig, Mark Woodhead, Antoni Torres
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    ABSTRACT: Four different rules have been suggested and validated for intensive care unit (ICU) admission for community-acquired pneumonia: modified American Thoracic Society (ATS) rule, Infectious Diseases Society of America (IDSA)/ATS rule, España rule, and SMART-COP. Their performance varies, with sensitivity of around 70% and specificity of around 80-90%. Only negative predictive values are consistently high. Critical methodological issues include the appropriate reference for derivation, the populations studied, the variables included, and the time course of pneumonia. Severe community-acquired pneumonia (SCAP) may evolve because of acute respiratory failure or/and severe sepsis/septic shock. Pneumonia-related complications and decompensated comorbidities may be additional or independent reasons for a severe course. All variables included in predictive rules relate to the two principal reasons for SCAP. However, taken as major criteria, they are of little value for clinical assessment. Instead, a limited set of minor criteria reflecting severity seems appropriate. However, predictive rules may not meet principal needs of severity assessment because of failure in sensitivity, ignorance of the potential contribution of complications or decompensated comorbidity to pneumonia severity, and poor sensitivity for the lower extreme in the spectrum of severe pneumonia, i.e., patients at risk of SCAP. We therefore advocate an approach that refers to the evaluation of the need for intensified treatment rather than ICU, based on a set of minor criteria and sensitive to the dynamic nature of pneumonia. Intensified treatment such as monitoring and treatment of acute respiratory failure or/and severe sepsis/septic shock is thought to improve management and possibly outcomes by setting the focus on both patients with severity criteria at admission and those at risk for SCAP.
    European Journal of Intensive Care Medicine 11/2010; 37(2):214-23. · 5.17 Impact Factor
  • Primary Care Respiratory Journal 06/2010; 19(2). · 2.91 Impact Factor
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    ABSTRACT: The identification and management of adults presenting with pneumonia is a major challenge for primary care health professionals. This paper summarises the key recommendations of the British Thoracic Society (BTS) Guidelines for the management of Community Acquired Pneumonia (CAP) in adults. Systematic electronic database searches were conducted in order to identify potentially relevant studies that might inform guideline recommendations. Generic study appraisal checklists and an evidence grading from A+ to D were used to indicate the strength of the evidence upon which recommendations were made. This paper provides definitions, key messages, and recommendations for handling the uncertainty surrounding the clinical diagnosis, assessing severity, management, and follow-up of patients with CAP in the community setting. Diagnosis and decision on hospital referral in primary care is based on clinical judgement and the CRB-65 score. Unlike some other respiratory infections (e.g. acute bronchitis) an antibiotic is always indicated when a clinical diagnosis of pneumonia is made. Timing of initial review will be determined by disease severity. When there is a delay in symptom or radiographic resolution beyond six weeks, the main concern is whether the CAP was a complication of an underlying condition such as lung cancer.
    Primary care respiratory journal: journal of the General Practice Airways Group 02/2010; 19(1):21-7. · 2.91 Impact Factor
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    Thorax 10/2009; 64 Suppl 3:iii1-55. · 8.56 Impact Factor
  • Mark Woodhead
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    ABSTRACT: Community-acquired pneumonia is common throughout the 53 European countries. Despite differences in population structure and habits there are many similarities between countries, including overall frequency and distribution of major causative pathogens. There are, however, also differences between countries, particularly in the frequency of bacterial antibiotic resistance and to a lesser extent how the condition is managed. Having said this there are many gaps in our knowledge with little or no data available from some countries, especially those in the eastern Europe. It is hoped that future years will see these gaps filled through continuing research.
    Seminars in Respiratory and Critical Care Medicine 05/2009; 30(2):136-45. · 2.75 Impact Factor
  • Tania Syed, Mark Woodhead
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    ABSTRACT: Community acquired pneumonia (CAP) is a common cause of hospital admission. The first 24-48 hours are crucial in the correct diagnosis and management of CAP. In this article we highlight the pitfalls in diagnosis and the important management steps. The correct assessment of severity with CURB65 scoring, proper supportive measures and appropriate antibiotics are key to effective treatment of CAP.
    Acute medicine 01/2008; 7(1):3-10.
  • Mark Woodhead, Roger Finch
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    ABSTRACT: For inappropriate antibiotic prescribing to be reduced, education of the public in addition to the medical profession is essential, so that antibiotics are not the expected outcome of every medical consultation. This article summarizes the steps taken by the Specialist Advisory Committee on Antimicrobial Resistance to educate both adults and children. These steps provide a firm foundation for future efforts in what will need to be a continuing campaign.
    Journal of Antimicrobial Chemotherapy 09/2007; 60 Suppl 1:i53-5. · 5.44 Impact Factor
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    Kathryn Armitage, Mark Woodhead
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    ABSTRACT: Community-acquired pneumonia is a major cause of morbidity and mortality, and is the leading cause of death from an infectious disease. International societies have published and revised guidelines aiming to improve the management of adult community-acquired pneumonia, based on the best available evidence. The aim of this review is to compare the current guideline recommendations. Aspects of guidelines differ based on local factors including resources and antimicrobial factors, as well as the differences in interpretation of existing evidence. The lack of robust evidence behind aspects of guideline recommendations as well as the lack of adherence to published guidelines both need to be addressed if the management of community-acquired pneumonia is to be improved.
    Current Opinion in Infectious Diseases 05/2007; 20(2):170-6. · 5.03 Impact Factor

Publication Stats

1k Citations
284.02 Total Impact Points


  • 2013–2014
    • Central Manchester University Hospitals NHS Foundation Trust
      • Department of Anaesthesia (Manchester Royal Infirmary)
      Manchester, England, United Kingdom
  • 2007–2013
    • The University of Manchester
      • Respiratory Medicine Research Group
      Manchester, England, United Kingdom
  • 1986–2012
    • Nottingham University Hospitals NHS Trust
      • Department of Respiratory Medicine
      Nottigham, England, United Kingdom
  • 2005–2011
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
  • 2010
    • The University of Edinburgh
      Edinburgh, Scotland, United Kingdom
  • 1998
    • University of Nottingham
      Nottigham, England, United Kingdom