Publications by authors named "Pradeesh Sivapalan"

Background: Despite evidence demonstrating that influenza vaccination is associated with reduced risk of cardiovascular events and all-cause mortality in individuals with diabetes mellitus (DM), vaccine uptake remains suboptimal.

Objectives: The purpose of this study was to assess the effectiveness of electronically delivered nudges on influenza vaccine uptake according to the presence of DM status versus other chronic diseases.

Methods: NUDGE-FLU-CHRONIC was a nationwide, randomized, pragmatic implementation trial among younger and middle-aged (18-64 years) Danish citizens with chronic disease during the 2023/2024 influenza season.

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  • The study focuses on the significance of influenza vaccination in patients with acute myocardial infarction (AMI) and evaluates methods to enhance vaccine uptake among this high-risk group.
  • The research consists of three nationwide randomized clinical trials conducted in Denmark that tested the effectiveness of electronically delivered behavioral nudges against usual care in increasing vaccination rates among AMI patients.
  • The primary outcome measured was the rate of influenza vaccinations received, with findings suggesting that these behavioral nudges could potentially improve vaccination uptake in the targeted population.
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  • Despite strong guidelines, flu vaccination rates are low among young and middle-aged people with chronic illnesses, indicating a need for effective strategies to boost these rates.
  • A nationwide clinical trial in Denmark tested whether sending behaviorally informed electronic letters could increase flu vaccination uptake in patients aged 18 to 64 with chronic diseases.
  • Results showed that patients who received any intervention letters had a higher vaccination rate (39.6%) compared to those who received usual care (27.9%), with the most significant impact coming from a follow-up letter sent 10 days later.
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  • A study compared the effects of extra-fine particle inhaled corticosteroids (ICS) to standard particle size ICS on patients with chronic obstructive pulmonary disease (COPD) from 2010 to 2017, focusing on exacerbations needing hospitalization and overall mortality rates.
  • Of the nearly 40,500 patients analyzed, the results showed that extra-fine particle ICS did not significantly lower the risk of hospitalizations or all-cause mortality compared to standard ICS; however, a subgroup of patients using pressurized metered dose inhalers (pMDIs) did report reduced risks.
  • The findings suggest that while extra-fine particle ICS may not generally offer protective benefits, they could be beneficial for specific patients
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  • - The study aimed to examine how the timing of influenza vaccinations (morning vs. later in the day) affects the immune response and overall health outcomes, particularly in a large trial comparing high-dose and standard-dose influenza vaccines.
  • - Researchers analyzed data from 12,477 participants and found that earlier vaccinations were linked to fewer hospitalizations for respiratory issues, regardless of the vaccine dosage, with statistically significant results.
  • - Although both high-dose and standard-dose vaccines showed similar effectiveness regardless of vaccination timing, the findings suggest that getting vaccinated earlier in the day could still be beneficial, warranting further investigation.
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Background: Chronic obstructive pulmonary disease (COPD) and asthma can be treated with inhaled corticosteroids (ICS) delivered by low climate impact inhalers (dry powder inhalers) or high climate impact inhalers (pressurized metered-dose inhalers containing potent greenhouse gasses). ICS delivered with greenhouse gasses is prescribed ubiquitously and frequent despite limited evidence of superior effect. Our aim was to examine the beneficial and harmful events of ICS delivered by low and high climate impact inhalers in patients with asthma and COPD.

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Influenza vaccination reduces the risk of adverse outcomes in patients with cardiovascular disease (CVD). We sought to evaluate whether the presence of CVD modified the relative effectiveness of high-dose (QIV-HD) vs. standard-dose (QIV-SD) quadrivalent influenza vaccine in this prespecified analysis of the DANFLU-1 trial.

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  • Digital letter interventions effectively increased influenza vaccination rates among Danish citizens aged 65 and older during the 2023-2024 flu season through a randomized trial.
  • Participants were divided into groups receiving usual care or various behaviorally informed electronic nudges before vaccination, revealing higher rates of vaccination in the nudge group compared to usual care (76.32% vs. 76.02%).
  • The nudges helped particularly those who were unvaccinated in the previous season, with consistent effects observed across different years, highlighting their scalability and potential for future flu seasons.
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Rationale: Long-acting muscarinic antagonists (LAMAs) reduce the risk of acute exacerbations of chronic obstructive pulmonary disease (AECOPD), usually taken once daily in the morning. However, the circadian activity of autonomic regulation suggests that the highest need for anticholinergic therapy may be in the late night/early morning. This is supported by evidence that AECOPD most often begins in the morning.

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Objective: Pulmonary blastoma is a rare, biphasic, adult-onset lung tumor. In this study, we investigate whether DICER1 pathogenic variants are a feature of pulmonary blastomas through in-depth analysis of the molecular events defining them.

Methods: We performed exome-wide sequencing and DNA methylation profiling of 8 pulmonary blastomas from 6 affected persons.

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Objectives: Endothelial injury may promote declining lung function. We aimed to investigate in well-treated persons living with HIV (PLWH) whether elevated levels of thrombomodulin (TM) and syndecan-1 (SDC1) are associated with excess lung function decline and worsening dyspnea.

Methods: A prospective cohort study comprising patients from the Copenhagen municipality.

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Background: The varied treatment response to inhaled corticosteroids (ICS) in patients with COPD and the associated increased risk of pneumonia necessitate a personalized ICS therapeutic approach. This is informed by blood eosinophil count (BEC), which predicts ICS treatment response. However, BEC appears to change in response to ICS treatment.

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Background: The effect of dual systemic antibiotic therapy against Pseudomonas aeruginosa in patients with pre-existing lung disease is unknown. To assess whether dual systemic antibiotics against P. aeruginosa in outpatients with COPD, non-cystic fibrosis (non-CF) bronchiectasis, or asthma can improve outcomes.

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It is a challenge to keep abreast of all the clinical and scientific advances in the field of respiratory medicine. This article contains an overview of laboratory-based science, clinical trials and qualitative research that were presented during the 2023 European Respiratory Society International Congress within the sessions from the five groups of Assembly 1 (Respiratory Clinical Care and Physiology). Selected presentations are summarised from a wide range of topics: clinical problems, rehabilitation and chronic care, general practice and primary care, electronic/mobile health (e-health/m-health), clinical respiratory physiology, exercise and functional imaging.

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Prior research has raised concerns regarding the use of macrolides and their association with an increased risk of cardiovascular events. We conducted a cohort study, where we explored the cardiovascular risks associated with the treatment of COPD patients using macrolide antibiotics-namely azithromycin, clarithromycin, and roxithromycin-with amoxicillin serving as a reference. The study focused on COPD patients in an outpatient setting and included a thorough 3-year follow-up.

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This review highlights key aspects of treating chronic obstructive pulmonary disease (COPD) exacerbation, focusing on the optimisation of systemic corticosteroid and antibiotic use through personalised treatment using biomarkers. Eosinophil-guided therapy reduces corticosteroid usage which might reduce side effects, while procalcitonin-guided therapy contributes to reduced antibiotic consumption. These approaches, documented through well-conducted randomized controlled trials, suggest the possibility of enhancing COPD exacerbation management, reducing potential side effects, and addressing concerns related to antibiotic resistance.

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Article Synopsis
  • - The study aimed to evaluate the effectiveness of high-dose quadrivalent influenza vaccine (QIV-HD) compared to standard-dose (QIV-SD) based on diabetes status, specifically looking at outcomes like glycated hemoglobin change (∆HbA1c), incident diabetes, and hospitalization rates.
  • - Conducted as a randomized trial among adults aged 65-79, results showed QIV-HD significantly reduced all-cause hospitalizations and was linked to lower risk of hospitalization and death related to pneumonia/influenza among those with diabetes, but did not significantly impact change in HbA1c or incident diabetes risk.
  • - Overall, QIV-HD demonstrated increased relative vaccine effectiveness against various health complications when compared to QIV-S
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Background: In the NUDGE-FLU (Nationwide Utilization of Danish Government Electronic letter system for increasing inFLUenza vaccine uptake) trial, electronic letters incorporating cardiovascular (CV) gain-framing and repeated messaging increased influenza vaccination by approximately 1 percentage point.

Objective: To evaluate the effects of the successful nudging interventions on downstream clinical outcomes.

Design: Prespecified exploratory analysis of a nationwide randomized implementation trial.

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Objectives: Inhaled corticosteroids (ICS) are widely used in patients with chronic obstructive pulmonary disease (COPD). However, ICS are associated with an increased risk of adverse effects.We aimed to determine whether an association between a lower respiratory tract culture with and increasing ICS dosing in patients with COPD exists.

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Background: Yearly influenza vaccination is strongly recommended for older adults and patients with chronic diseases including cardiovascular disease (CVD); however, vaccination rates remain suboptimal, particularly among younger patients. Electronic letters incorporating behavioral nudges are highly scalable public health interventions which can potentially increase vaccination, but further research is needed to determine the most effective strategies and to assess effectiveness across different populations. The purpose of NUDGE-FLU-CHRONIC and NUDGE-FLU-2 are to evaluate the effectiveness of electronic nudges delivered via the Danish governmental electronic letter system in increasing influenza vaccination among patients with chronic diseases and older adults, respectively.

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Chronic Obstructive Pulmonary Disease (COPD) exacerbation is known for its substantial impact on morbidity and mortality among affected patients, creating a significant healthcare burden worldwide. Coagulation abnormalities have emerged as potential contributors to exacerbation pathogenesis, raising concerns about increased thrombotic events during exacerbation. The aim of this study was to explore the differences in thrombelastography (TEG) parameters and coagulation markers in COPD patients during admission with exacerbation and at a follow-up after discharge.

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BACKGROUND: The relative vaccine effectiveness (rVE) of high-dose quadrivalent influenza vaccines (QIV-HD) versus standard-dose quadrivalent influenza vaccines (QIV-SD) against hospitalizations and mortality in the general older population has not been evaluated in an individually randomized trial. Because of the large sample size required, such a trial will need to incorporate innovative, pragmatic elements. METHODS: We conducted a pragmatic, open-label, active-controlled, randomized feasibility trial in Danish citizens aged 65 to 79 years during the 2021–2022 influenza season.

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Objectives: To evaluate the relative effectiveness of high-dose quadrivalent influenza vaccine (QIV-HD) versus standard-dose quadrivalent influenza vaccine (QIV-SD) against recurrent hospitalizations and its potential variation in relation to influenza circulation.

Methods: We did a post-hoc analysis of a pragmatic, open-label, randomized trial of QIV-HD versus QIV-SD performed during the 2021-2022 influenza season among adults aged 65-79 years. Participants were enrolled in October 2021-November, 2021 and followed for outcomes from 14 days postvaccination until 31 May, 2022.

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