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2. Allopurinol and cardiovascular outcomes in patients with ischaemic heart disease: the ALL-HEART RCT and economic evaluation

Author

Mackenzie, Isla S, primary, Hawkey, Christopher J, additional, Ford, Ian, additional, Greenlaw, Nicola, additional, Pigazzani, Filippo, additional, Rogers, Amy, additional, Struthers, Allan D, additional, Begg, Alan G, additional, Wei, Li, additional, Avery, Anthony J, additional, Taggar, Jaspal S, additional, Walker, Andrew, additional, Duce, Suzanne L, additional, Barr, Rebecca J, additional, Dumbleton, Jennifer S, additional, Rooke, Evelien D, additional, Townend, Jonathan N, additional, Ritchie, Lewis D, additional, and MacDonald, Thomas M, additional

Published
2024
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3. Allopurinol versus usual care in UK patients with ischaemic heart disease (ALL-HEART): a multicentre, prospective, randomised, open-label, blinded-endpoint trial

Author

Ahmed, Husnat, Arthur, Peter, Aziz, Jane, Barnes, Lawrence, Boyle, Sarah, Brighton, Tom, Brown, Morris, Caulfield, Mark, Dawson, Jesse, Denvir, Martin, Doney, Alexander SF, Doshi, Sagar, Dryburgh, Moira, Eddleston, Michael, Finlayson, Jim, Fuat, Ahmet, Furnace, Jacqueline, Grieve, JW Kerr, Guthrie, Greg, Ham, Sharon, Isaard, Emma, Jennings, Claudine, Johnson, Richard, Kerr, Claire, Khan, Sohail, Krishnan, Kailash, Long, Susan, Mackintosh, Anne, Macleod, Mary Joan, McCormack, Terry, McEleny, Paul, Morar, Monique, Nadir, Adnan, Newby, David, Petrie, Colin, Preiss, David, Ralston, Stuart, Randall, Marc, Routledge, Helen, Shakir, Saad, Sharma, Raj, Shepherd, Bridget, Sims, Don, Snedden, Gordon, Trevelyan, Jasper, Weir, Christopher, Weir, Robin, Wetherall, Kirsty, Wilson, Robbie, Wilson, Adam, Zutis, Kris, Mackenzie, Isla S, Hawkey, Christopher J, Ford, Ian, Greenlaw, Nicola, Pigazzani, Filippo, Rogers, Amy, Struthers, Allan D, Begg, Alan G, Wei, Li, Avery, Anthony J, Taggar, Jaspal S, Walker, Andrew, Duce, Suzanne L, Barr, Rebecca J, Dumbleton, Jennifer S, Rooke, Evelien D, Townend, Jonathan N, Ritchie, Lewis D, and MacDonald, Thomas M

Published
2022
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4. Screening for atrial fibrillation in primary care

Author

Taggar, Jaspal

Subjects
616.1, WG Cardiocascular system
Abstract

Background: Screening for atrial fibrillation (AF) has been recommended but is yet to be implemented in clinical practice. However, the most effective approaches for screening are not known and it is unclear if screening could feasibly be implemented in primary care. Aims and methods The overall aims were to determine how AF screening might feasibly and effectively be introduced into primary care in the United Kingdom (UK). Objectives were: 1) to determine the range and accuracies of methods for detecting pulse irregularities attributable to AF, 2) to determine the range and accuracies of methods for diagnosing AF using 12-lead electrocardiograms (ECGs) and 3) to investigate the feasibility and opinions of healthcare professionals (HCPs) in primary care about implementing AF screening. Three studies were undertaken: 1) a systematic review and meta-analysis of the diagnostic accuracy of methods for detecting pulse irregularities caused by AF, 2) a systematic review and meta-analysis of the diagnostic accuracy of methods for diagnosing AF using 12-lead ECG and 3) a survey of HCPs in primary care about screening implementation. Results: Study 1: Blood pressure monitors (BPMs) and non-12-lead ECGs had the greatest accuracy for detecting pulse irregularities attributable to AF [BPM: sensitivity 0.98 (95% CI 0.92-1.00), specificity 0.92 (95% CI 0.88-0.95), positive likelihood ratio (PLR) 12.1 (95% C.I 8.2-17.8) and negative likelihood ratio (NLR) 0.02 (95% C.I 0.00-0.09); non-12-lead ECG: sensitivity 0.91 (95% CI 0.86-0.94), specificity 0.95 (95% CI 0.92-0.97), PLR 20.1 (95% C.I 12-33.7), NLR 0.09 (95% C.I 0.06 to 0.14); there were similar findings for smart-phone applications although these studies were small in size. The sensitivity and specificity of pulse palpation were 0.92 (95% CI 0.85-0.96) and 0.82 (95% CI 0.76-0.88), respectively (PLR 5.2 (95% C.I 3.8-7.2), NLR 0.1 (0.05-0.18)]. Study 2: The sensitivity and specificity of automated software were 0.89 (95% CI 0.82-0.93) and 0.99 (95% CI 0.99-0.99), respectively; PLR 96.6 (95% C.I 64.2-145.6); NLR 0.11 (95% C.I 0.07-0.18). ECG interpretation by any HCPs had a similar sensitivity for diagnosing AF as automated software but a lower specificity [sensitivity 0.92 (95% CI 0.81-0.97), specificity 0.93 (95% CI 0.76-0.98), PLR 13.9 (95% C.I 3.5-55.3), NLR 0.09 (95% C.I 0.03-0.22). Sub-group analyses of primary care professionals found greater specificity for General Practitioners (GPs) than nurses [GPs: sensitivity 0.91 (95% C.I 0.68-1.00); specificity 0.96 (95% C.I 0.89-1.00). Nurses: sensitivity 0.88 (95% C.I 0.63-1.00); specificity 0.85 (95% C.I 0.83-0.87)]. Study 3: 39/48 (81%) practices had an ECG machine and diagnosed AF in-house. Fewer non-GP HCPs reported having excellent knowledge about ECG interpretation, diagnosing and treating AF than GPs [Proportion (95% CI): ECG interpretation = GPs: 5.9 (2.8-12.0); healthcare assistants (HCAs): 0; nurses: 2.0 (0.3-13.9); Nurse practitioners (NPs): 11.8 (3.0-36.4). Diagnosing AF = GPs: 26.3 (17.8-37.0); HCAs: 0; nurses: 2.0 (0.3-12.9); NPs: 11.8 (2.7-38.8). Treating AF = GPs: 16.9 (9.9-27.4); HCAs: 0; nurses: 0; NPs: 5.9 (0.8-34.0)]. A greater proportion of non-GP HCPs reported they would benefit from ECG training specifically for AF diagnosis than GPs [proportion (95% CI) GPs: 11.9% (6.8-20.0); HCAs: 37.0% (21.7-55.5); nurses: 44.0% (30.0-59.0); NPs 41.2% (21.9-63.7)]. Barriers included time, workload and capacity to undertake screening activities, although training to diagnose and manage AF was a required facilitator. Conclusions: BPMs and non-12-lead ECG were most accurate for detecting pulse irregularities caused by AF. Automated ECG-interpreting software most accurately excluded AF, although its ability to diagnose this was similar to all other HCP groups. Within primary care, the specificity of AF diagnosis was greater for GPs than nurses. Inner-city general practices were found to have adequate access to resources for AF screening. Non-GP HCPs would like to up-skill in the diagnosis and management of AF and they may have a role in future AF screening. However, organisational barriers, such as lack of time, staff and capacity, should be overcome for AF screening to be feasibly implemented within primary care.

Published
2017

6. The educational value of situational judgement tests (SJTs) when used during undergraduate medical training: A systematic review and narrative synthesis.

Author

Sahota, Gurvinder S., Fisher, Victoria, Patel, Bakula, JuJ, Kiranjit, and Taggar, Jaspal S.

Subjects
PSYCHOLOGY information storage & retrieval systems, JUDGMENT (Psychology), MEDICAL information storage & retrieval systems, SYSTEMATIC reviews, UNDERGRADUATES, EDUCATIONAL tests & measurements, CLINICAL competence, MEDLINE, PROFESSIONALISM, PERSONALITY tests, SCHOOL entrance requirements, MEDICAL education, GREY literature
Abstract

Situational judgement tests (SJTs) are a recognised assessment method for admission into medical school, selection into postgraduate training programs, and postgraduate competency assessment. More recently, however, SJTs have been used during undergraduate medical training (UMT). This systematic review identifies, describes, and appraises the evidence for SJTs in UMT to determine educational associations and outcomes. MEDLINE, EMBASE, ERIC, PsycINFO, SCOPUS, Web of Science, and grey literature were searched for original research studies evaluating SJTs implemented within UMT to 1 November 2022. Studies reporting evaluation outcomes were included. Narrative data syntheses were undertaken. Risk of Bias was appraised using the Quality in Prognosis Studies tool. 24 studies were included. National database-derived SJTs (n = 14) assessed against professionalism, postgraduate attainment, construct of medical degree, medical school admissions scores, personality attributes, and declaration of disability. In-house derived SJTs (n = 10) assessed against professionalism, clinical skills, and personality attributes. Most evidence evaluated and reported inverse SJT associations with professionalism and were moderate risk of bias. SJTs may have utility for developing professional behaviours in medical students. However, further research testing SJT robustness, standard setting methodologies, and prospectively evaluating SJTs against objective outcome measures within the context of UMT is warranted. [ABSTRACT FROM AUTHOR]

Published
2023
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7. Predictors of quit attempts and successful smoking cessation in pregnancy amongst women recruited to a text message, self-help, smoking cessation intervention trial

Author

Taggar, Jaspal, Igoe, Hannah, Naughton, Felix, Leonardi-Bee, Jo, Emery, Joanne, and Coleman, Tim

Subjects
Maternal and Child Health, Family Medicine, Medicine and Health Sciences, Medical Specialties, Women's Health, Obstetrics and Gynecology, Public Health, Social and Behavioral Sciences, Primary Care
Abstract

Smoking in pregnancy causes negative effects for pregnant women, including mortality; and for the foetus, including miscarriage, still birth, and pre-term labour. Children exposed to smoking in-utero, are at increased risk of neonatal death, sudden infant death, poor cognition, and behavioural issues, and are more likely to smoke. Around half of women who smoke attempt to stop when pregnant; however, in the UK 11-20% of pregnant women smoke. Understanding of how to tailor smoking cessation support for pregnant women is an important healthcare priority. Most previous studies have not distinguished between factors influencing women who attempt to quit smoking, and those who become abstinent. This is potentially important as the processes of initiating cessation and maintaining abstinence are likely to have differences. A study by Emery et al found that smoking beliefs predicted trying to quit, but not success in cessation and nicotine dependence was inversely associated with quitting but not with trying to quit. This study will use a 7 times larger dataset (1,400 participants) from MiQuit2 and MiQuit 3 RCTs as an observational cohort and may detect associations not apparent previously. This exploratory analysis of secondary data will investigate variables (demographic; smoking behaviour related and quitting belief related,) which may impact two smoking outcomes – making a quit attempt (self-reported, of at least 24 hours), and abstinence at follow-up in those women who made a quit attempt (self-reported 7-day point prevalence) using logistic regression analyses. Findings from this study may help guide intervention development for encouraging smoking cessation in pregnancy.

Published
2023
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9. Allopurinol versus usual care in UK patients with ischaemic heart disease (ALL-HEART): a multicentre, prospective, randomised, open-label, blinded-endpoint trial

Author

Mackenzie, Isla S, primary, Hawkey, Christopher J, additional, Ford, Ian, additional, Greenlaw, Nicola, additional, Pigazzani, Filippo, additional, Rogers, Amy, additional, Struthers, Allan D, additional, Begg, Alan G, additional, Wei, Li, additional, Avery, Anthony J, additional, Taggar, Jaspal S, additional, Walker, Andrew, additional, Duce, Suzanne L, additional, Barr, Rebecca J, additional, Dumbleton, Jennifer S, additional, Rooke, Evelien D, additional, Townend, Jonathan N, additional, Ritchie, Lewis D, additional, MacDonald, Thomas M, additional, Ahmed, Husnat, additional, Arthur, Peter, additional, Aziz, Jane, additional, Barnes, Lawrence, additional, Boyle, Sarah, additional, Brighton, Tom, additional, Brown, Morris, additional, Caulfield, Mark, additional, Dawson, Jesse, additional, Denvir, Martin, additional, Doney, Alexander SF, additional, Doshi, Sagar, additional, Dryburgh, Moira, additional, Eddleston, Michael, additional, Finlayson, Jim, additional, Fuat, Ahmet, additional, Furnace, Jacqueline, additional, Grieve, JW Kerr, additional, Guthrie, Greg, additional, Ham, Sharon, additional, Isaard, Emma, additional, Jennings, Claudine, additional, Johnson, Richard, additional, Kerr, Claire, additional, Khan, Sohail, additional, Krishnan, Kailash, additional, Long, Susan, additional, Mackintosh, Anne, additional, Macleod, Mary Joan, additional, McCormack, Terry, additional, McEleny, Paul, additional, Morar, Monique, additional, Nadir, Adnan, additional, Newby, David, additional, Petrie, Colin, additional, Preiss, David, additional, Ralston, Stuart, additional, Randall, Marc, additional, Routledge, Helen, additional, Shakir, Saad, additional, Sharma, Raj, additional, Shepherd, Bridget, additional, Sims, Don, additional, Snedden, Gordon, additional, Trevelyan, Jasper, additional, Weir, Christopher, additional, Weir, Robin, additional, Wetherall, Kirsty, additional, Wilson, Robbie, additional, Wilson, Adam, additional, and Zutis, Kris, additional

Published
2022
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26. The impact of the Quality and Outcomes Framework (QOF) on the recording of smoking targets in primary care medical records: cross-sectional analyses from The Health Improvement Network (THIN) database

Author

Taggar Jaspal S, Coleman Tim, Lewis Sarah, and Szatkowski Lisa

Subjects
Smoking, Quality and Outcomes Framework (QOF), Targets, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Smoking is a UK public health threat but GPs can be effective in helping patients to quit; consequently, the Quality and Outcomes Framework (QOF) incentivises the recording of smoking status and delivery of cessation advice in patients’ medical records. This study investigates the association between smoking-related QOF targets and such recording, and the factors which influence these clinical activities. Methods For 2000 to 2008, using medical records in The Health Improvement Network (THIN) database, the annual proportions of i) patients who had a record of smoking status made in the previous 27 months and ii) current smokers recorded as receiving cessation advice in the previous 15 months were calculated. Then, for all patients at selected points before and after the QOF’s implementation, data on gender, age, Townsend score, and smoking-related morbidity were extracted. Multivariate logistic regression was used to investigate individual-level characteristics associated with the recording of smoking status and cessation advice. Results Rapid increases in recording smoking status and advice occurred around the QOF’s introduction in April 2004. Subsequently, compliance to targets has been sustained, although rates of increase have slowed. By 2008 64.5% of patients aged 15+ had smoking status documented in the previous 27 months and 50.5% of current smokers had cessation advice recorded in the last 15 months. Adjusted odds ratios show that, both before and after the introduction of the QOF, those with chronic medical conditions, greater social deprivation and women were more likely to have a recent recording of smoking status or cessation advice. Since the QOF’s introduction, the strongest characteristic associated with recording activities was the presence of co-morbidity. An example of this was patients with COPD, who in 2008, were 15.38 (95% CI 13.70-17.27) times and 11.72 (95% CI 10.41-13.21) times more likely to have a record of smoking status and cessation advice, respectively. Conclusions Rates of recording smoking status and cessation advice plateaued after large increases during the QOF’s introduction; however, recording remains most strongly associated with the presence of chronic disease as specified by the QOF, and suggests that incentivised targets have a direct effect on clinical behaviour.

Published
2012
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28. The GP Academy

Author

Allsopp, Gail M, primary, Sharman, Anjla, additional, and Taggar, Jaspal, additional

Published
2019
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29. Clopidogrel and metoprolol in myocardial infarction

Author

Borja, Javier, Garcia, Olga, Donado, Esther, Izquierdo, Inaki, Karthikeyan, Ganesan, Bhala, Neeraj, Taggar, Jaspal, Chen, Zhengming, Collins, Rory, Peto, Richard, Xie, Jinxiang, Jiang, Lixin, and Liu, Lisheng

Published
2006

31. The management of hypertension in people with dementia

Author

Harrison, Jennifer Kirsty, Van Der Wardt, Veronika, Conroy, Simon Paul, Stott, David J, Dening, Tom, Gordon, Adam Lee, Logan, Pip, Welsh, Tomas, Taggar, Jaspal, Harwood, Rowan, and Gladman, John

Published
2016

34. Recruitment of people with dementia in primary care –experiences from the HIND study

Author

van der Wardt, Veronika, Conroy, Simon, Tomas, W., Logan, Pip, Harrison, Jennifer K., Taggar, Jaspal, and Gladman, John R.F.

Abstract

OBJECTIVES: A purpose of the Hypertension in Dementia feasibility study was to explore recruitment of people with dementia and essential hypertension in primary care practices to prepare a withdrawal study of their antihypertensive medication. METHODS: Primary care practices were invited by phone to support the study, which would entail screening their databases to identify people with diagnoses of both dementia and essential hypertension, and sending out letters to these people asking them to indicate their willingness participate in the feasibility withdrawal study. Practice managers or GPs from practices that declined to support the study were asked to give their reasons. RESULTS: All primary care practices in Nottingham and Nottinghamshire were contacted (n=145). Of those, 12 (8%) practices agreed to support the study. Between them they identified and sent out a total of 249 letters to potential participants. Of these 19 (7%) people responded and only 6 (2%) met the eligibility criteria for withdrawing antihypertensive medication. 80/133 (60%) non responding practices gave reasons for why they did not support the study: the most common responses were that 31 (39%) were ‘too busy’, staff changes or short staffed were cited in 11 (14%) and “too time consuming” was cited in 7 (9%). CONCLUSIONS: Recruitment of a sufficiently large and representative population for a larger trial would not be feasible in primary care practices using these methods, due to the high workload in UK primary care.

Published
2015

35. New horizons: the management of hypertension in people with dementia

Author

Harrison, Jennifer Kirsty, primary, Van Der Wardt, Veronika, additional, Conroy, Simon Paul, additional, Stott, David J., additional, Dening, Tom, additional, Gordon, Adam Lee, additional, Logan, Pip, additional, Welsh, Tomas James, additional, Taggar, Jaspal, additional, Harwood, Rowan, additional, and Gladman, John R. F., additional

Published
2016
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36. Multicentre, prospective, randomised, open-label, blinded end point trial of the efficacy of allopurinol therapy in improving cardiovascular outcomes in patients with ischaemic heart disease: protocol of the ALL-HEART study

Author

Mackenzie, Isla S, primary, Ford, Ian, additional, Walker, Andrew, additional, Hawkey, Chris, additional, Begg, Alan, additional, Avery, Anthony, additional, Taggar, Jaspal, additional, Wei, Li, additional, Struthers, Allan D, additional, and MacDonald, Thomas M, additional

Published
2016
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37. General Practitioners’ views of blood pressure control in people with and without dementia

Author

van der Wardt, Veronika, Conroy, Simon, Taggar, Jaspal, and Gladman, John R.F.

Abstract

Introduction: Since 2012, our group has undertaken a programme of research examining the treatment of hypertension in people with dementia. Hypertension is managed by GPs, who are guided by NICE guidelines, which make no mention of different management in people with dementia. We sought to explore the views of GPs on whether they manage hypertension differently in people with dementia. Method: We chose to try using an on-online survey to seek views, with both open and closed questions. We offered vignettes describing 71 and 83 year old women without cognitive impairment or with dementia, and a free text box – comments provided in this box were analysed thematically. Results: Although 427 GPs responded to the questionnaire, this was only 7% of all GPs eligible. Responding GPs were twice as likely not to offer treatment to the patient aged 71 with dementia and a BP above 140/90 (NICE threshold) compared to one without dementia (23.9% vs 11.7%). A similar finding was found when the vignettes involving 83 year old women with and without dementia (using 160/100, the NICE threshold for this age group) where 7.3% would not offer treatment in the woman with dementia compared to 3.3% in those without dementia. The analysis of free text identified four major themes, which were labelled as ‘complex decisions, ‘blood pressure measurement‘, ‘uncertainties around treatment’ and ‘compliance with guidelines’. Discussion: The low response rate in this survey makes the findings potentially unreliable, and other methods of ascertaining GP views, intentions or practices should be considered. Despite this, the findings from this study, in particular the free text comments indicate that the management of hypertension in people with dementia, is likely to be more complex than current guidelines indicate, and we propose that further research and clarification of best practice would be helpful.

Published
2015

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