Saudi Cultural Missions Theses & Dissertations
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Item Restricted Epidemiological evaluation of oral anticoagulants prescribing and clinical outcomes in atrial fibrillation patients with and without cancer: analysis of primary care data in England(University of Manchester, 2024-05-01) Ajabnoor, Alyaa Mohammedali; Kontopantelis, EvangelosAtrial fibrillation (AF) is a prevalent cardiac arrhythmia imposing a substantial global burden. Given its five-fold increase in stroke risk, prescribing oral anticoagulants (OAC) to intermediate to high-risk AF patients is crucial. However, OAC prescribing rates vary, influenced by factors beyond stroke risk, particularly evident in patients with cancer who face complex clinical conditions affecting stroke and bleeding risks. Yet, the efficacy of risk assessment tools in this population remains unexplored, complicating anticoagulation therapy initiation, often tailored to individual patients. Nevertheless, evidence regarding this matter remains limited. Using the Clinical Practice Research Datalink (CPRD), this thesis presents unique research on Nonvalvular Atrial Fibrillation (NVAF) epidemiology in England. It addresses five key questions: 1) NVAF incidence and OAC prescribing, 2) factors influencing OAC prescription, 3) MB incidence and OAC resumption in NVAF patients, 4) stroke and bleeding risk comparison in NVAF patients with and without cancer, and 5) CHA2-DS2-VASc and HAS-BLED score performance in predicting stroke and bleeding in NVAF patients with and without cancer history. Key findings reveal a temporal increase in NVAF incidence in England until 2015, subsequently plateauing. Disparities in OAC prescription correlate with comorbidities, ethnicity, and socioeconomic status, emphasizing the need for interventions to address inequities in NVAF patient care. Between 2009 and 2019 the incidence of MB in NVAF patients surged tenfold with many experiencing MB despite lacking OAC prescription at the time of bleeding. The decision to resume OAC post-MB appears contingent upon the initial anticoagulant used and does not significantly associate with recurrent MB risk. Examining NVAF patients with different cancer types revealed varying stroke and bleeding risks, with certain cancers exhibiting higher bleeding risks than stroke risks. Notably, certain cancer types, such as haematological and lung cancer, were less likely to receive OAC, highlighting disparities in care. Finally, it was found that CHA2-DS2-VASc score performed similarly in predicting ischemic stroke in NVAF patients, irrespective of cancer history. In contrast, the HAS-BLED score, while well- calibrated, lacked discrimination in predicting major bleeding events in the NVAF population overall and in specific cancer cohorts. Overall, this thesis contributes to the evidence around the pharmacoepidemiology of OACs in the NVAF population in England and highlights socioeconomic disparities in NVAF care. It addresses challenges in managing NVAF cohorts with major bleeding or specific cancers, where current risk assessment scores may inadequately predict clinical outcomes. Further research is necessary to explore health inequalities in OAC prescribing for AF patients in England and understand why certain cancers predispose individuals to bleeding or stroke events.16 0Item Restricted Unravelling Rewilding: The Politics of Landscape Transformation in England(Saudi Digital Library, 2023-11-29) Alammari, Bahja; Swyngedouw, ErikIn the age of the Anthropocene, rewilding has emerged as a set of attractive practices to restore the ecological function of landscapes. This research focuses on its implementation in populated rural landscapes housing culture, as it has been shown to reflect an intricate interplay of ecological restoration, community contestation, and policy dynamics that mandate critical engagement. This research engages with rewilding in England’s rural landscape and decodes its broader implications, reaching beyond ecological boundaries. Through a textual analysis of secondary data sources, including political debates, news articles, and grey literature, this research unpacks configurations that drive the adaptation and expansion of rewilding in England and examines how they shape the landscape and the place of locals within it. The research employs a political ecology framework to examine the changes in discourse, power dynamics, socio-economic shifts, and local engagements that shape the implementation of rewilding in England’s rural landscapes. The research outlines multi-scale configurations critical for understanding how rural landscapes are shaped and reimagined. Through its engagement with the new post-Brexit land management policy (ELMS), this research significantly contributes to examining policy changes that enable rewilding.27 0Item Restricted The Use of Systems Approaches in Public Health in England A Narrative Review(Saudi Digital Library, 2019-11-23) Aljahdali, Aisha; Saddiq, MohammadPublic health field faces many complex, interrelated challenges that require innovative and collective approaches. These approaches should consider the wider influences of systems that affect health outcomes and prioritize the needs of targeted communities. Moreover, they should foster collaboration with a range of stakeholders, such as policymakers, health professionals, researchers and local organizations, to leverage their expertise and resources. This narrative review explored how systems thinking, the whole system approach and systems leadership can help achieve these goals and improve public health practice.3 0Item Restricted Impact of the COVID-19 pandemic on the utilisation and quality of antibiotic use in the primary care settings in England: a population-based, segmented interrupted time series analysis(Saudi Digital Library, 2023) Almutairi, Najla; Kurdi, AmanjBackground: Antimicrobial resistance (AMR) is a public health threaten driven by inappropriate use of antibiotics. During covid-19 there were concerns of increased AMR, but the evidence is limited. this study assessed the impact of Covid-19 on the quantity and quality of antibiotic utilization in primary care in England. Research design and methods: A population-based segmented interrupted time series analysis was conducted to monthly dispensed antibiotics prescriptions using the prescription cost analysis (PCA) of England from March 2019 to March 2023. Antibiotic quantity was measured using the number of antibiotics items dispensed (TID)/1000 inhabitants and Defined Daily Dose (DDD)/1000 inhabitants/day. during and after the first and second lockdown (March 2020, Novembre 2020) stratified to 11 groups based on British National Formulary (BNF) antibiotics classification. While the quality of antibiotics was evaluated using 3 quality indicators: WHO AWaRe classification, and 4C antibiotics, and proportion of broad-spectrum antibiotics. Results: For all antibiotics, there was a non-significant increased TID Before the first lockdown but, non-significant decrease in the level after the first and second lockdown. However, a significant increase in the trend after the second lockdown for all antibiotic classes was observed, with an average increase of .56, and .315 for (DDD). For the quality outcomes, there were no impact of covid 19 on WHO AWaRe antibiotics classes (Access antibiotics increased from 77% in March 2019 to 86% in March2023) and broad-spectrum antibiotics. The proportion of 4C antibiotics decreased significantly after the first lockdown (β3 = -.886, p=.019). Conclusion: The study concludes that, Covid-19 has not significantly impacted the utilization of antibiotics. Also, the quality of the utilization remains unaffected. This study supports further investigation into the impact of remote consultation during Covid-19 and use detailed patient and prescription information. Keywords: Antibiotics, COVID-19, Antimicrobial stewardship, primary healthcare, England9 0