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The turner-Warwick lecturer scheme 2021

The Turner-Warwick lecturer scheme is named after the Royal College of Physician’s first female president, Professor Dame Margaret Turner-Warwick, and commemorates her life-time achievements through recognising the exceptional work of Royal College of Physician’s trainees in the UK. The scheme showcases trainees’ contributions to healthcare as well as their ability to communicate and reach across wide-ranging medical training specialties  and levels.  In early 2022, an overall national winner will be announced from the 14 regional winners, which include two from Oxford, Dr Jasmine Gan, NIHR Academic Clinical Fellow and Clinical Lecturer, Dr Rajna Golubic.


Dr Jasmine Gan, NIHR ACF at OUCAGS,  has been selected as the Turner-Warwick Lecturer winner for the Oxford and Thames Valley region with her lecture ‘Poor outcomes in delirium: finds from an observational cohort of over 1,700 unselected acute medicine patients’.


Delirium is characterised by disturbed cognition, awareness and attention and is prevalent in hospitalised patients although data from unselected cohorts are scarce.  Delirium is associated with poor outcomes but it remains uncertain whether it is an independent predictor over and above comorbidity burden, frailty and illness severity.

My lecture will begin by exploring the pathophysiology of delirium and non-pharmacological and pharmacological prevention and treatment. I will then describe the prevalence, incidence and factors associated with delirium in a well-characterised longitudinal (2010-2020) prospective, observational cohort of unselected consecutive admissions to acute medicine.

Among 1,737 patients (age median=75, range 16-101 years, 847 (48.8%) male), delirium occurred in 415 (23.9%, 280 prevalent, 72 incident, and 63 both) with 380/415 (91.5%) cases occurring in patients aged > 65. After adjustment for age and sex, delirium was associated with dementia (OR=3.40, 95% CI 2.47-4.67, p<0.001), preadmission dependency (2.70, 2.06-3.52, p<0.001) and markers of physical frailty (all p<0.001) including falls (2.36, 1.82-3.07), visual/hearing impairment (2.12, 1.54-2.92), urinary incontinence (4.02, 3.05-5.29), and pressure sore risk (3.55, 2.65-4.77) together with illness severity (1.49, 1.14-1.94) and comorbidity burden (1.03, 1.02-1.04). After adjustment for all covariates, delirium remained associated with inpatient stay >7 days (2.49, 1.77-3.51, p<0.001), increased care needs at discharge (2.89, 1.95-4.28, p<0.001) and death <30 days (1.79, 1.19-2.70, p=0.005).

In conclusion, prevalent delirium is over three times more common than incident delirium, emphasizing the importance of developing effective delirium treatments. Identification of delirium should prompt early discharge planning for timely discharge and consideration of advanced care planning.


Dr Gan expresses her gratitude to Professor Sarah Pendlebury, Professor of Medicine and Old Age Neuroscience (Nuffield Department of Clinical Neurosciences, University of Oxford)  and to OUCAGS for opportunities and resources offered. 


Dr Rajna Golubic, NIHR CL at OUCAGS, has been selected as the Turner-Warwick Lecturer winner for the Eastern region with her lecture ‘Novel treatments to improve metabolic health in obesity and type 2 diabetes: the effects of cotadutide’.


Dr Golubic's lecture presented the evolving landscape of the management of metabolic disorders associated with obesity and type 2 diabetes (T2D) using a novel promising drug cotadutide with a similar mechanism of action to naturally occurring hormones glucagon-like peptide 1 and glucagon. Cotadutide is in development for non-alcoholic fatty liver disease and kidney disease, which are metabolic complications of obesity and T2D. There is a major unmet need for therapies which improve metabolic health and achieve disease-modifying weight loss thus increasing the chance of additional improvements in glucose, cardiovascular risk and mortality and slowing or reversing the disease progression.

In collaboration with AstraZeneca, Dr Golubic and colleagues conducted a randomised controlled study on 19 obese volunteers with T2D over 10 visits to determine the mechanism by which cotadutide causes weight loss. They performed comprehensive assessments of energy balance (intake and expenditure) using state-of-the-art methods in our NIHR Cambridge Clinical Research Facility (room calorimetry, energy intake monitors). After 42 days of treatment, an average weight loss was 4.0% in cotadutide group and 1.4% in placebo group (p=0.011, primary outcome). Strikingly, energy intake was 41% lower compared to placebo (p=0.037) while energy expenditure was initially unchanged, but after 6 weeks decreased in cotadutide group (p<0.001). There was a marked improvement in glucose control and lipid profile in cotadutide group. No safety concerns were raised.

This mechanistic study has determined that cotadutide promotes weight loss predominantly through reduction in appetite and energy intake with preservation of energy expenditure in the early phases of treatment.


Dr Golubic would like to acknowledge Dr Mark Evans, reader in diabetic medicine and PI (Institute of Metabolic Science Cambridge); Jane Kennet, study coordinator; NIHR Cambridge Clinical Research Facility team; and AstraZeneca (funder)