دكتوراه
الطب والخدمات الصحية
University of Glasgow
مجال التميز | تميز بحثي ودراسي |
البحوث المنشورة | |
البحث (1): | |
عنوان البحث: | Post Stroke Diabetes Management: A Qualitative Study. |
رابط إلى البحث: | https://mc.manuscriptcentral.com/ageing |
تاريخ النشر: | 31/12/2020 |
موجز عن البحث: | Background: Diabetes is associated with an increased risk of stroke. In many cases, a diagnosis of diabetes may predate a stroke, but it can often diagnose during hospital admission following a stroke. Objective To explore the experiences of stroke survivors as they cope with a new diagnosis of diabetes particularly in relation to developing an effective strategy for managing the disease. Methods: A qualitative grounded theory approach was utilised that used focus group interviews with participants, including clinicians and patients to develop a holistic understanding of primary and secondary care -services and the experiences of those accessing them. Results: Clinicians felt they were not best placed to manage diabetes as a condition. This group felt more emphasis should be placed on self-management and that this would be best managed by lifestyle changes than simply medication. Conversely, stroke survivors with diabetes, felt an additional burden associated with the diagnoses but looked to clinicians to manage their diabetes and felt the clinicians were failing if they were unwilling / unable to do so. Conclusion: The research highlights the tensions between patients and health care professionals. Patients looked toward the health care teams to provide treatment at a time when they had recently undergone a significant life health event where they had both experienced a stoke and received a diagnosis of diabetes. The healthcare teams on the other hand, whilst recognising the importance of a holistic and comprehensive package of treatment were struggling to provide it due to resource limitations Keywords: Stroke, Diabetes, Hypertension |
البحث (2): | |
عنوان البحث: | Novel strategies for secondary stroke prevention – exploring the use of pioglitazone therapy using a mixed method |
رابط إلى البحث: | http://theses.gla.ac.uk/81493/ |
تاريخ النشر: | 26/06/2020 |
موجز عن البحث: | Pioglitazone, an oral thiazolidinedione (TZD), is used in the second- or third-line management of type 2 diabetes mellitus (T2DM). In addition, the Insulin Resistance Intervention after Stroke trial showed that pioglitazone reduced cardiovascular events in people with recent ischaemic stroke or transient ischaemic attacks who were insulin resistant but had no diabetes (relative risk reduction of 24%; 95% confidence interval (CI) 0.62-0.93; P=0.007; absolute risk reduction of 3%) versus placebo. Furthermore, with pioglitazone use, about half as many patients went on to develop diabetes. However, the net benefit of pioglitazone has been questioned because, with its use, the fracture rate increased by about a third (29% relative risk (RR); 2 to 5% absolute risk (AR)), many patients suffered substantial weight gain (55% RR; 6% AR) and there was an increase in peripheral oedema (43% RR; 10% AR). This means doctors are unsure about whether they should use pioglitazone. This is a much-discussed topic in the stroke community. This thesis addresses several areas concerning pioglitazone use after stroke. It aims to better characterise the risk of fracture, explore patient and clinician views regarding pioglitazone use and explore whether other new diabetes treatments could be similarly effective in people with strokes. The fractures, weight gain and peripheral oedema associated with pioglitazone use are important clinical issues. However, fractures are the most concerning. I performed a systematic review and meta-analysis of the fracture risk with TZD drugs following best-practice guidance. A search of the Cochrane Register of Controlled Trials, MEDLINE, EMBASE, the Web of Science and the trial registries (from their inception to Week 36, 2017) was performed. The updated searched was done in Week 10 in 2020. The grey literature was also searched. Published and unpublished studies comparing TZDs with placebo or other antihyperglycaemic drugs were included if they reported data on fracture occurrence. The search identified 860 studies. A total of 78 were included in this study as they satisfied the eligibility criteria. Thirty-four included trials had a high risk of bias, eight had unclear risk and 36 low risk. These studies had an overall high-to-moderate GRADE score of evidence. They included 39,568 participants on TZDs and 25,718 on comparators with 1,917 fracture events. The fracture risk was increased with TZDs (RR 1.35; 95% CI 1.24−1.48; P |
البحث (3): | |
عنوان البحث: | |
رابط إلى البحث: | |
تاريخ النشر: | |
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المؤتمرات العلمية | |
المؤتمر (1): | |
عنوان المؤتمر: | The Scottish Society of Physicians the 59th Annual Meeting, Inverness 2017. |
تاريخ الإنعقاد: | 26/10/2017 |
مكان الإنعقاد: | UK, Inverness |
طبيعة المشاركة: | Oral presentation ورقه علمية |
عنوان المشاركة: | Thiazolidinedion es and risk of bone fractures: a systematic review and meta-analysis of randomised controlled trials |
ملخص المشاركة: | Introduction: Thiazolidinediones (TZDs) drugs are used to treat diabetes. Recent data show they reduce recurrent cardiovascular events in patients with recent ischemic stroke and insulin resistance and that they increase fracture risk. This review aims to summarise all evidence concerning fracture risk with TZDs in adults, with particular emphasis on stroke patients.
Methods: A systematic search of databases was conducted to identify relevant studies (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and Web of Science (from their inception to 28-week, 2016)). Published and unpublished trials comparing TZDs with placebo or other anti-hyperglycaemic agents (AHG) were included. We extracted data on fracture occurrence. Results: From 860 titles, 79 studies were identified in this review as they satisfied the eligibility criteria. Twenty-nine studies had a high risk of bias, 18 unclear risk and 32 low risks. These included 39,568 participants on TZDs and 25,718 on comparators and a total of 1,460 fracture events. Fracture risk was increased with TZDs use (RR 1.31; 95% CI 1.18−1.46; P |
المؤتمر (2): | |
عنوان المؤتمر: | The 5th European Stroke Organisation Conference, Milan, Italy 2019. |
تاريخ الإنعقاد: | 22/05/2019 |
مكان الإنعقاد: | Milan, Italy. |
طبيعة المشاركة: | Poster presentation ورقه علمية |
عنوان المشاركة: | Pioglitazone and risk of bone fracture. A review and meta-analysis of randomised controlled trials |
ملخص المشاركة: | Introduction: The Insulin Resistance Intervention after Stroke (IRIS) study showed that pioglitazone reduced risk of myocardial infarction and stroke in people with insulin resistance by one-fourth (RRR 24%; 95% CI 0.62-0.93; P=0.007). However, the net benefit of pioglitazone has been questioned as fractures rate increased significantly. This review aims to summarise all evidence concerning the risk of bone fracture with pioglitazone therapy, with particular emphasis on people with stroke. Method: A search of the Cochrane Register of Controlled Trials, MEDLINE, EMBASE, Web of Science, and trial registries (from their inception to 36˗week, 2017) was performed. Results: From 860 titles, a total of 27 were included. Comparing pioglitazone versus placebo (13,451 participants; 449 fractures), pioglitazone increased fracture (RR 1.21; 95% CI 1.01−1.45; P=0.04; I 2=32%). Both non-serious (RR 1.25; 95% CI 1.05−1.49; P=0.01; I 2=33%) and serious fracture events (RR 1.35; 95% CI 1.02−1.77; P=0.03; I 2=29%) were increased with pioglitazone use. Fractures risk was mostly increased in the spine (RR 2.08; 95% CI 1.26−3.44; P=0.004; I 2=51%) and lowerextremities (RR 1.86; 95% CI 1.35−2.56; P=0.0002; I 2=0%) with pioglitazone use versus comparators. Conclusion: Pioglitazone increases fracture risk in spine and lower extremities. If we start using pioglitazone post-stroke, we should inform patients of the possible slight increase of fracture risk. Keywords: Pioglitazone, Stroke, Insulin resistance, Diabetes, Fracture. |
المؤتمر (3): | |
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جوائز التكريم | |
الجائزة (1): | |
مسمى الجائزة: | ESO-WSO 2019 young investigator awards |
الجهة المانحة: | The 5th European Stroke Organisation 2019 |
تاريخ الجائزة: | 22/05/2019 |
مجال التكريم: | A travel grants price of €1000 and a free course registration as a young investigator award for my oral presentation (The new antidiabetic therapies for the prevention of stroke risk and mortality. A systematic review and meta-analysis of randomised controlled trials) in the ESO-WSO 2019 Milan, Italy. |
الجائزة (2): | |
مسمى الجائزة: | ESO Stroke Summer School |
الجهة المانحة: | The European Stroke Organisation |
تاريخ الجائزة: | 21/10/2021 |
مجال التكريم: | This award as an ESO Stroke Summer School to attend a full paid course in the ESO Stroke Summer School course, Caen, France, 2021. Oral presentation of diagnosis, risk factors and prognosis of stroke (BP target after stroke (ischemic vs. haemorrhagic, small vessel disease vs. others). |
الجائزة (3): | |
مسمى الجائزة: | Fitzgerald Peel prize winner |
الجهة المانحة: | The Scottish Society of Physicians the 59th Annual Meeting, Inverness 2017 |
تاريخ الجائزة: | 26/10/2017 |
مجال التكريم: | Fitzgerald Peel prize winner award (price of 500£) for my oral presentation (Thiazolidinediones and risk of bone fractures: a systematic review and meta-analysis of randomised controlled trials) in the Scottish Society of Physicians the 59th Annual Meeting, Inverness 2017. The abstract published in the Scottish Medical Journal, vol. 63, 1: pp. 61-70. First Published June 29, 2018. Impact factor 0.849 https://doi.org/10.1177/0036933017744515 |
الجائزة (4): | |
مسمى الجائزة: | Award winner for the best oral presentation |
الجهة المانحة: | U21 Health Sciences Group Doctoral Student Forum. University of Glasgow 2019 |
تاريخ الجائزة: | 09/09/2019 |
مجال التكريم: | Award for my oral presentation (Novel strategies exploring pioglitazone therapy. A mixed method approaches) in the International Doctoral Student Experience and Transferability of Doctoral training the U21 Health Sciences Group Doctoral Student Forum. University of Glasgow 2019. |
الجائزة (5): | |
مسمى الجائزة: | The 3MT runner up winner |
الجهة المانحة: | The 3 Minute Thesis Competition at the University of Glasgow 2020 |
تاريخ الجائزة: | 11/03/2020 |
مجال التكريم: | Award of research grant (price of 100£) for my oral presentation (Surviving second strokes) at the 3 Minute Thesis Competition at the University of Glasgow 2020. |
المرفقات
- https://uksacb.org/wp-content/uploads/1-MSc-Honours-of-the-first-class.pdf
- https://uksacb.org/wp-content/uploads/2-3Thiazolidinediones-and-risk-of-bone-fractures-a-systematic-review-and-meta-analysis-of-randomised-controlled-trial.pdf
- https://uksacb.org/wp-content/uploads/4-5-ESOC-2019-young-investigator-awards-5-ESO-Stroke-Summer-School.pdf
- https://uksacb.org/wp-content/uploads/6-Fitzgerald-Peel-prize.pdf
- https://uksacb.org/wp-content/uploads/7-8-The-U21-Health-Sciences-Group-Doctoral-Student-Forum-3MT.pdf
- https://uksacb.org/wp-content/uploads/9-10-University-of-Glasgow-PhD-Award-2020-10-Hala-Saudi-Arabian-Cultural-Bureau-Excellancy-MSc.PhD-2025-2020.pdf
- https://uksacb.org/wp-content/uploads/11-12-The-9th-Saudi-Student-Conference-in-UK-the-ICC-Birmingham-2016-12th-UK-Stroke-Forum-conference-Liverpool-2017.pdf
- https://uksacb.org/wp-content/uploads/13-14-The-113th-Association-of-Physicians-of-Great-Britain-and-Ireland-Glasgow-2019.pdf
- https://uksacb.org/wp-content/uploads/15-The-5th-European-Stroke-Organisation-Conference.pdf
- https://uksacb.org/wp-content/uploads/16-17-The-PIOSurvey.pdf
- https://uksacb.org/wp-content/uploads/18-19-20-The-6th-European-Stroke-Organisation-Conference-and-World-Stroke-Organization-Vienna-Austria-2020.pdf