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1. The optimal second-line therapy for older adults with type 2 diabetes mellitus: protocol for a systematic review and network meta-analysis using individual participant data (IPD)

Author

Wang, Jingya, Nirantharakumar, Krishnarajah, Sainsbury, Christopher, Moore, David J., Sinclair, Alan, Thomas, G. Neil, Hanif, Wasim, Singh, Megha, Tan, Luyuan, Wang, Zhaonan, Simms-Williams, Nikita, Yao, Mi, Gunathilaka, M. Niluka, Singh, Pushpa, Toulis, Konstantinos, Tsapas, Apostolos, Coomar, Dyuti, and Price, Malcolm James

Published
2024
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2. Light painting photography makes particulate matter air pollution visible

Author

Pope, Francis D., Price, Robin, Woolley, Katherine E., Luiu, Carlo, Alam, Mohammed S., Avis, William R., Bartington, Suzanne E., Debebe, Dawit, Getaneh, Zerihun, Greenfield, Sheila M., Howells, Rachel, Khare, Mukesh, Weldetinsae, Abel, Lawson, Chloe, Mishra, Sumit K., Neal, Ben, Newman, Karen, Singh, Ajit, Teklu Wodajo, Bikila, Thomas, G. Neil, and Wilder, Faye

Published
2024
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16. Healthcare provider and patient perspectives on access to and management of atrial fibrillation in the Northern Province, Sri Lanka: a rapid evaluation of barriers and facilitators to care

Author

Sheron, Vethanayagam Antony, Shanmugathas, Shivany, Gooden, Tiffany E., Guruparan, Mahesan, Kumarendran, Balachandran, Lip, Gregory Y. H., Manaseki-Holland, Semira, Nirantharakumar, Krishnarajah, Shribavan, Kaneshamoorthy, Subaschandren, Kumaran, Haniffa, Rashan, Surenthirakumaran, Rajendra, Thomas, G. Neil, Uruthirakumar, Powsiga, Greenfield, Sheila, Lane, Deirdre A., and Beane, Abi

Published
2022
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21. Metabolism

Author

Leong, Wen B., Taheri, Shahrad, Stone, Anna M., Thomas, G. Neil, Phillips, Anna C., Section editor, and Gellman, Marc D., editor

Published
2020
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24. Inequalities in the Management of Diabetic Kidney Disease in UK Primary Care: :A Cross‐Sectional Analysis of A Large Primary Care Database

Author

Phillips, Katherine, Hazlehurst, Jonathan M., Sheppard, Christelle, Bellary, Srikanth, Hanif, Wasim, Karamat, Muhammad Ali, Crowe, Francesca L., Stone, Anna, Thomas, G. Neil, Peracha, Javeria, Fenton, Anthony, Sainsbury, Christopher, Nirantharakumar, Krishnarajah, Dasgupta, Indranil, Phillips, Katherine, Hazlehurst, Jonathan M., Sheppard, Christelle, Bellary, Srikanth, Hanif, Wasim, Karamat, Muhammad Ali, Crowe, Francesca L., Stone, Anna, Thomas, G. Neil, Peracha, Javeria, Fenton, Anthony, Sainsbury, Christopher, Nirantharakumar, Krishnarajah, and Dasgupta, Indranil

Abstract

Aims: To determine differences in the management of diabetic kidney disease (DKD) relevant to patient sex, ethnicity and socio-economic group in UK primary care. Methods: A cross-sectional analysis as of January 1, 2019 was undertaken using the IQVIA Medical Research Data dataset, to determine the proportion of people with DKD managed in accordance with national guidelines, stratified by demographics. Robust Poisson regression models were used to calculate adjusted risk ratios (aRR) adjusting for age, sex, ethnicity and social deprivation. Results: Of the 2.3 million participants, 161,278 had type 1 or 2 diabetes, of which 32,905 had DKD. Of people with DKD, 60% had albumin creatinine ratio (ACR) measured, 64% achieved blood pressure (BP, <140/90 mmHg) target, 58% achieved glycosylated haemoglobin (HbA1c, <58 mmol/mol) target, 68% prescribed renin–angiotensin–aldosterone system (RAAS) inhibitor in the previous year. Compared to men, women were less likely to have creatinine: aRR 0.99 (95% CI 0.98–0.99), ACR: aRR 0.94 (0.92–0.96), BP: aRR 0.98 (0.97–0.99), HbA 1c: aRR 0.99 (0.98–0.99) and serum cholesterol: aRR 0.97 (0.96–0.98) measured; achieve BP: aRR 0.95 (0.94–0.98) or total cholesterol (<5 mmol/L) targets: aRR 0.86 (0.84–0.87); or be prescribed RAAS inhibitors: aRR 0.92 (0.90–0.94) or statins: aRR 0.94 (0.92–0.95). Compared to the least deprived areas, people from the most deprived areas were less likely to have BP measurements: aRR 0.98 (0.96–0.99); achieve BP: aRR 0.91 (0.8–0.95) or HbA 1c: aRR 0.88 (0.85–0.92) targets, or be prescribed RAAS inhibitors: aRR 0.91 (0.87–0.95). Compared to people of white ethnicity; those of black ethnicity were less likely to be prescribed statins aRR 0.91 (0.85–0.97). Conclusions: There are unmet needs and inequalities in the management of DKD in the UK. Addressing these could reduce the increasing human and societal cost of managing DKD.

Published
2024

27. Effectiveness of interventions to reduce household air pollution from solid biomass fuels and improve maternal and child health outcomes in low- and middle-income countries: a systematic review protocol

Author

Woolley, Katherine E., Dickinson-Craig, Emma, Bartington, Suzanne E., Oludotun, Tosin, Kirenga, Bruce, Mariga, Shelton T., Kabera, Telesphore, Coombe, April, Pope, Francis D., Singh, Ajit, Avis, William R., Day, Rosie, Warburton, David, Manaseki-Holland, Semira, Moore, David J., and Thomas, G. Neil

Published
2021
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28. Renin-angiotensin system inhibitors and susceptibility to COVID-19 in patients with hypertension: a propensity score-matched cohort study in primary care

Author

Haroon, Shamil, Subramanian, Anuradhaa, Cooper, Jennifer, Anand, Astha, Gokhale, Krishna, Byne, Nathan, Dhalla, Samir, Acosta-Mena, Dionisio, Taverner, Thomas, Okoth, Kelvin, Wang, Jingya, Chandan, Joht Singh, Sainsbury, Christopher, Zemedikun, Dawit Tefra, Thomas, G. Neil, Parekh, Dhruv, Marshall, Tom, Sapey, Elizabeth, Adderley, Nicola J., and Nirantharakumar, Krishnarajah

Published
2021
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31. Mobile Photoplethysmographic Technology to Detect Atrial Fibrillation

Author

Guo, Yutao, Lip, Gregory Y.H., Lane, Deirdre A., Chen, Yundai, Wang, Liming, Eckstein, Jens, Thomas, G Neil, Tong, Liu, Mei, Feng, Xuejun, Liu, Xiaoming, Li, Zhaoliang, Shan, Xiangming, Shi, Wei, Zhang, Yunli, Xing, Jing, Wen, Fan, Wu, Sitong, Yang, Xiaoqing, Jin, Bo, Yang, Xiaojuan, Bai, Yuting, Jiang, Yangxia, Liu, Yingying, Song, Zhongju, Tan, Li, Yang, Tianzhu, Luan, Chunfeng, Niu, Lili, Zhang, Shuyan, Li, Zulu, Wang, Bing, Xv, Liming, Liu, Yuanzhe, Jin, Yunlong, Xia, Xiaohong, Chen, Fang, Wu, Lina, Zhong, yihong, Sun, shujie, Jia, Jing, Li, Nan, Li, shijun, Li, huixia, Liu, Rong, Li, Fan, Liu, qingfeng, Ge, tianyun, Guan, Yuan, Wen, Xin, Li, Yan, Ren, xiaoping, Chen, ronghua, Chen, Yun, Shi, yulan, Zhao, haili, Shi, yujie, Zhao, quanchun, Wang, weidong, Sun, Lin, Wei, Chan, Esther, Guangliang, Shan, Chen, Yao, Wei, Zong, Dandi, Chen, Xiang, Han, Anding, Xu, Xiaohan, Fan, Ziqiang, Yu, Xiang, Gu, Fulin, Ge, Wang, Hao, Zhang, Hui, Liu, Tong, Liang, Zhaoguang, Xia, Yunlong, Yan, Li, Xing, Yunli, Shi, Haili, Li, Shuyan, Liu, Yanxia, Liu, Fan, and Feng, Mei

Published
2019
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34. Diagnostic accuracy of digital technologies compared with 12-lead ECG in the diagnosis of atrial fibrillation in adults: A protocol for a systematic review.

Author

Sheron, Vethanayagam Antony, Surenthirakumaran, Rajendra, Gooden, Tiffany E., Y. H. Lip, Gregory, Thomas, G. Neil, J. Moore, David, Nirantharakumar, Krishnarajah, Kumarendran, Balachandran, Subaschandran, Kumaran, Kanesamoorthy, Shribavan, Uruthirakumar, Powsiga, and Guruparan, Mahesan

Subjects
ATRIAL fibrillation, DIGITAL technology, RESEARCH protocols, RANDOM effects model, ARRHYTHMIA, DIAGNOSTIC equipment, ADULTS
Abstract

Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in the world. AF increases the risk of stroke 5-fold, though the risk can be reduced with appropriate treatment. Therefore, early diagnosis is imperative but remains a global challenge. In low-and middle-income countries (LMICs), a lack of diagnostic equipment and under-resourced healthcare systems generate further barriers. The rapid development of digital technologies that are capable of diagnosing AF remotely and cost-effectively could prove beneficial for LMICs. However, evidence is lacking on what digital technologies exist and how they compare in regards to diagnostic accuracy. We aim to systematically review the diagnostic accuracy of all digital technologies capable of AF diagnosis. Methods: MEDLINE, Embase and Web of Science will be searched for eligible studies. Free text terms will be combined with corresponding index terms where available and searches will not be limited by language nor time of publication. Cohort or cross-sectional studies comprising adult (≥18 years) participants will be included. Only studies that use a 12-lead ECG as the reference test (comparator) and report outcomes of sensitivity, specificity, the diagnostic odds ratio (DOR) or the positive and negative predictive value (PPV and NPV) will be included (or if they provide sufficient data to calculate these outcomes). Two reviewers will independently assess articles for inclusion, extract data using a piloted tool and assess risk of bias using the QUADAS-2 tool. The feasibility of a meta-analysis will be determined by assessing heterogeneity across the studies, grouped by index device, diagnostic threshold and setting. If a meta-analysis is feasible for any index device, pooled sensitivity and specificity will be calculated using a random effect model and presented in forest plots. Discussion: The findings of our review will provide a comprehensive synthesis of the diagnostic accuracy of available digital technologies capable for diagnosing AF. Thus, this review will aid in the identification of which devices could be further trialed and implemented, particularly in a LMIC setting, to improve the early diagnosis of AF. Trial registration: Systematic review registration: PROSPERO registration number is CRD42021290542. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021290542. [ABSTRACT FROM AUTHOR]

Published
2024
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38. Generalisability of and lessons learned from a mixed-methods study conducted in three low- and middle-income countries to identify care pathways for atrial fibrillation

Author

Gooden, Tiffany E, primary, Wang, Jingya, additional, Carvalho Goulart, Alessandra, additional, Varella, Ana C, additional, Tai, Meihui, additional, Sheron, Vethanayagan Antony, additional, Wang, Hao, additional, Zhang, Hui, additional, Zhong, Jiaoyue, additional, Kumarendran, Balachandran, additional, Nirantharakumar, Krishnarajah, additional, Surenthirakumaran, Rajendra, additional, Bensenor, Isabela M, additional, Guo, Yutao, additional, Lip, Gregory Y H, additional, Thomas, G Neil, additional, and Manaseki-Holland, Semira, additional

Published
2023
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41. Carbon monoxide levels in households using coal-briquette fuelled stoves exceed WHO air quality guidelines in Ulaanbaatar, Mongolia.

Author

Dickinson-Craig, Emma, Bartington, Suzanne E., Watts, Rachel, Mandakhbayar, Oyunbolor, Khurelbaatar, Enkh-Od, Ochir, Chimedsuren, Boldbaatar, Damdindorj, Warburton, David, Thomas, G. Neil, Pope, Francis D., Sereeter, Lodoysamba, Manaseki-Holland, Semira, and Badarch, Jargalsaikhan

Subjects
CARBON monoxide analysis, COOKING equipment, HOME environment, AIR pollution, PARTICULATE matter, CROSS-sectional method, INDOOR air pollution, FOSSIL fuels, PUBLIC health, MEDICAL protocols, RESEARCH funding, ENVIRONMENTAL exposure
Abstract

In 2019, a domestic raw coal ban (RCB) was introduced in Ulaanbaatar, Mongolia. Coal-briquettes have since been promoted in Ger district households, however implications for carbon monoxide (CO) exposure remains uncertain. We obtained 48-hour indoor CO concentrations in 23 Ger district households and compared these to 10 raw-coal households. Information on household characteristics, fuel use behaviour and stove venting practices was collected by survey. Mean 48-hour CO concentrations in coal-briquette households was 6.1 ppm (range 1.5–35.8 ppm) with no signfiicant differences by household, stove or venting factors. Peak time-weighted average CO concentrations exceeded WHO Indoor Air Quality guidelines in 9 (39%) households; with all surpassing the 8-hour guideline (>8.6 ppm); 3(13%) the 24-hour guideline (>6 ppm) and 2(9%) the 1-hour guideline (>30 ppm). Median CO levels were significantly lower in coal-briquette compared to raw coal households (p = 0.049). Indoor CO reduction was associated with RCB implementation although hazardous levels persist in this setting. [ABSTRACT FROM AUTHOR]

Published
2023
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44. Inequalities in the Management of Diabetic Kidney Disease in UK Primary Care: A Cross‐Sectional Analysis of A Large Primary Care Database

Author

Phillips, Katherine, primary, Hazlehurst, Jonathan M., additional, Sheppard, Christelle, additional, Bellary, Srikanth, additional, Hanif, Wasim, additional, Karamat, Muhammad Ali, additional, Crowe, Francesca L., additional, Stone, Anna, additional, Thomas, G. Neil, additional, Peracha, Javeria, additional, Fenton, Anthony, additional, Sainsbury, Christopher, additional, Nirantharakumar, Krishnarajah, additional, and Dasgupta, Indranil, additional

Published
2023
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46. The impact of rate and rhythm control strategies on quality of life for patients with atrial fibrillation:a protocol for a systematic review

Author

Uruthirakumar, Powsiga, Surenthirakumaran, Rajendra, Gooden, Tiffany E., Lip, Gregory Y. H., Thomas, G. Neil, Moore, David J., Nirantharakumar, Krishnarajah, Kumarendran, Balachandran, Subaschandran, Kumaran, Kaneshamoorthy, Shribavan, Sheron, Vethanayagam Antony, and Guruparan, Mahesan

Subjects
Adult, Quality of life, Rate control, Atrial Fibrillation/drug therapy, Atrial fibrillation, Review Literature as Topic, Bias, Meta-Analysis as Topic, Catheter Ablation, Systematic review, Protocol, Humans, Rhythm control, Systematic Reviews as Topic
Abstract

BackgroundAtrial fibrillation (AF) is the most common heart arrhythmia globally and it adversely affects the quality of life (QoL). Available rate and rhythm control strategies equally reduce mortality but may impact QoL differently. A number of systematic reviews have focused on the impact of specific strategies on QoL, though a 2006 review synthesized the evidence on the effect of all strategies on QoL, allowing for a clinically important comparison between the types of strategies. Many trials have been published since the review undertook the search in 2005; therefore, an update is needed. This systematic review aims to provide an update to the 2006 review on the impact of all rate and rhythm control strategies on QoL in people with AF.MethodsThe following four databases and three clinical trial registries will be searched for primary studies: CENTRAL, MEDLINE, Embase, CINAHL, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, and ClinicalTrialsRegister.eu. No language restriction will be applied. The search will be limited to 2004 or later publication year to allow overlap with the search conducted by the 2006 review authors. Any randomized control trial that reports the QoL of adult (≥ 18 years) AF patients following an eligible rate or rhythm control intervention will be eligible for inclusion. Eligible interventions (and comparators) include pacing, atrioventricular node junction and bundle of HIS ablation, pharmacological therapy, radio frequency catheter ablation, cryoablation, pulmonary vein isolation, maze operation, pace maker implantation, and defibrillator implantation. Two reviewers will independently screen for eligible studies, extract the data using a piloted tool, and assess bias by QoL outcome using the RoB 2 tool. The suitability of conducting a meta-analysis will be assessed by the clinical and methodology similarities of included studies. If it is feasible, standardized mean differences will be pooled using a random-effects model and assessed appropriately.DiscussionThe findings from this review will allow for meaningful comparisons between various rate and rhythm control strategies regarding their impact on QoL. This review will be useful for a wide range of stakeholders and will be crucial for optimizing the overall wellbeing of AF patients. BackgroundAtrial fibrillation (AF) is the most common heart arrhythmia globally and it adversely affects the quality of life (QoL). Available rate and rhythm control strategies equally reduce mortality but may impact QoL differently. A number of systematic reviews have focused on the impact of specific strategies on QoL, though a 2006 review synthesized the evidence on the effect of all strategies on QoL, allowing for a clinically important comparison between the types of strategies. Many trials have been published since the review undertook the search in 2005; therefore, an update is needed. This systematic review aims to provide an update to the 2006 review on the impact of all rate and rhythm control strategies on QoL in people with AF.MethodsThe following four databases and three clinical trial registries will be searched for primary studies: CENTRAL, MEDLINE, Embase, CINAHL, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, and ClinicalTrialsRegister.eu. No language restriction will be applied. The search will be limited to 2004 or later publication year to allow overlap with the search conducted by the 2006 review authors. Any randomized control trial that reports the QoL of adult (≥ 18 years) AF patients following an eligible rate or rhythm control intervention will be eligible for inclusion. Eligible interventions (and comparators) include pacing, atrioventricular node junction and bundle of HIS ablation, pharmacological therapy, radio frequency catheter ablation, cryoablation, pulmonary vein isolation, maze operation, pace maker implantation, and defibrillator implantation. Two reviewers will independently screen for eligible studies, extract the data using a piloted tool, and assess bias by QoL outcome using the RoB 2 tool. The suitability of conducting a meta-analysis will be assessed by the clinical and methodology similarities of included studies. If it is feasible, standardized mean differences will be pooled using a random-effects model and assessed appropriately.DiscussionThe findings from this review will allow for meaningful comparisons between various rate and rhythm control strategies regarding their impact on QoL. This review will be useful for a wide range of stakeholders and will be crucial for optimizing the overall wellbeing of AF patients.

Published
2023

49. Metabolism

Author

Leong, Wen B., primary, Taheri, Shahrad, additional, Stone, Anna M., additional, and Thomas, G. Neil, additional

Published
2018
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50. Identifying and understanding the care pathway of patients with atrial fibrillation in Brazil and the impact of the COVID-19 pandemic: A mixed-methods study.

Author

Goulart, Alessandra C., Varella, Ana C., Gooden, Tiffany E., Lip, Gregory Y. H., Jolly, Kate, Thomas, G. Neil, Lotufo, Paulo A., Greenfield, Sheila, Olmos, Rodrigo D., Bensenor, Isabela M., and Manaseki-Holland, Semira

Subjects
COVID-19 pandemic, HEALTH facilities, DISEASE risk factors, ATRIAL fibrillation, DELAYED diagnosis, PATIENT care
Abstract

Background: Atrial fibrillation (AF) is a major risk factor for stroke. To enable improvements to AF diagnosis and follow-up care, understanding current patient pathways and barriers to optimal care are essential. We investigated the patient care pathways and their drivers, and the impact of the COVID-19 pandemic on patient pathways in a middle-income country setting, Brazil. Methods: This mixed-methods study in São Paulo, included adults (≥18y) with AF from 13 primary/secondary healthcare facilities. Surveys using baseline, follow-up (administered ≥two months after baseline) and COVID-19 questionnaires (quantitative), and three focus group discussions (FGDs) were conducted. Minimum sample size for the quantitative component was 236 and we aimed to reach saturation with at least three FGDs for the qualitative component. Descriptive statistics were used for quantitative data and a content analysis was used for qualitative data to identify themes related to AF diagnosis and follow-up care. Results: 267 participants completed the baseline questionnaire: 25% were diagnosed in primary care, 65% in an emergency or inpatient department. At follow-up (n = 259), 31% visited more than one facility for AF care, and 7% had no follow-up. Intervals between international normalised ratio (INR) tests were increased during the pandemic, and the number of healthcare visits and availability of medication were reduced. Seventeen patients participated in three FGDs and revealed that AF diagnosis often occurred following a medical emergency and patients often delay care-seeking due to misconceptions about AF symptoms. Long waiting times, doctor/patient interactions and health system factors, such as doctor availability and the referral system, influence where participants visited for follow-up care. Conclusions: Lack of public awareness and underdeveloped primary healthcare lead to delayed diagnosis, which impacts clinical outcomes and excess patient and healthcare system costs. Health system, care-provider, and pandemic factors disrupt timely and effective continuity of care. [ABSTRACT FROM AUTHOR]

Published
2023
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