Martin Whyte - Academia.edu (original) (raw)

Papers by Martin Whyte

Aims: Cardiovascular outcome trials with sodium-glucose co-transporter 2 (SGLT2) inhibi... more Aims: Cardiovascular outcome trials with sodium-glucose co-transporter 2 (SGLT2) inhibitors have demonstrated efficacy in reducing risk for hospitalisation for heart failure in high cardiovascular risk groups. However, it is unclear whether these findings translate to the real-world type 2 diabetes population, and to those at lower risk of cardiovascular events. Methods: We used a comprehensive search strategy to identify observational studies that explored the association between SGLT2 inhibitors and heart failure events in people with type 2 diabetes across four databases (PubMed, EMBASE, CINAHL, ISI Web of Science). The identified studies were independently screened by two reviewers using a two-stage screening process. Data were extracted from all eligible studies and those with comparable outcome data were pooled for meta-analysis using random effects models. Results were reported using hazard ratios (HR) with 95% confidence intervals (CI). Results: ...

Obesity Reviews, 2019

The objective of the study is to provide evidence-based guidance on nutritional management and op... more The objective of the study is to provide evidence-based guidance on nutritional management and optimal care for pregnancy after bariatric surgery. A consensus meeting of international and multidisciplinary experts was held to identify relevant research questions in relation to pregnancy after bariatric surgery. A systematic search of available literature was performed, and the ADAPTE protocol for guideline development

PLOS Medicine, 2019

Background Disparities in type 2 diabetes (T2D) care provision and clinical outcomes have been re... more Background Disparities in type 2 diabetes (T2D) care provision and clinical outcomes have been reported in the last 2 decades in the UK. Since then, a number of initiatives have attempted to address this imbalance. The aim was to evaluate contemporary data as to whether disparities exist in glycaemic control, monitoring, and prescribing in people with T2D.

Clinical Medicine

Background The Ottawa subarachnoid haemorrhage (SAH) rule and the Emerald SAH rule are clinical d... more Background The Ottawa subarachnoid haemorrhage (SAH) rule and the Emerald SAH rule are clinical decision tools to aid in the decision for computed tomography (CT) of the head in patients attending an emergency department (ED) with acute non-traumatic headache. The objective of this study was to analyse the performance of these rules in a contemporary UK cohort. Methods We performed a retrospective external validation study. Patients undergoing CT of the head for the evaluation and treatment of non-traumatic headaches over a 6-month period in the ED at two tertiary centres were assessed. Each patient's Ottawa rule and Emerald rule were calculated and compared with their final diagnosis. Results The cohort consisted of 366 patients and there were 16 cases of SAH (based on CT findings or the presence of xanthochromia in cerebrospinal fluid). The Ottawa rule identified 288 patients requiring CT of the head. The sensitivity of the Ottawa rule was 100% (95% confidence interval (CI) 71-100%) and the specificity was 22% (95% CI 18-27%). The Emerald rule identified 267 patients who required CT, and achieved a sensitivity of 81% (95% CI 54-96%) and a specificity of 27% (95% CI 23-32%). Conclusions The Ottawa SAH rule correctly identified all patients with SAH in this contemporary cohort. The Emerald rule did not perform as well in this cohort and is unsuitable for clinical use. The Ottawa rule is a useful tool to aid in the decision for CT of the head in patients presenting with acute non-traumatic headache to the ED.

Advances in Therapy, 2021

Chronic kidney disease (CKD) is a complex disease which affects approximately 13% of the world's ... more Chronic kidney disease (CKD) is a complex disease which affects approximately 13% of the world's population. Over time, CKD can cause renal dysfunction and progression to end-stage kidney disease and cardiovascular disease. Complications associated with CKD may contribute to the acceleration of disease progression and the risk of cardiovascular-related morbidities. Early CKD is asymptomatic, and symptoms only present at later stages when complications of the disease arise, such as a decline in kidney function and the presence of other comorbidities associated with the disease. In advanced stages of the disease, when kidney function is significantly impaired, patients can only be treated with dialysis or a transplant. With limited treatment options available, an increasing prevalence of both the elderly population and comorbidities associated with the disease, the prevalence of CKD is set to rise. This review discusses the current challenges and the unmet patient need in CKD.

Journal of Diabetes Science and Technology, 2021

Blood, 2020

The association of severe coronavirus disease 2019 (COVID-19) with an increased risk of venous th... more The association of severe coronavirus disease 2019 (COVID-19) with an increased risk of venous thromboembolism (VTE) has resulted in specific guidelines for its prevention and management. The VTE risk appears highest in those with critical care admission. The need for postdischarge thromboprophylaxis remains controversial, which is reflected in conflicting expert guideline recommendations. Our local protocol provides thromboprophylaxis to COVID-19 patients during admission only. We report postdischarge VTE data from an ongoing quality improvement program incorporating root-cause analysis of hospital-associated VTE (HA-VTE). Following 1877 hospital discharges associated with COVID-19, 9 episodes of HA-VTE were diagnosed within 42 days, giving a postdischarge rate of 4.8 per 1000 discharges. Over 2019, following 18 159 discharges associated with a medical admission; there were 56 episodes of HA-VTE within 42 days (3.1 per 1000 discharges). The odds ratio for postdischarge HA-VTE assoc...

Surgical Endoscopy, 2019

Background Contemporary 3D platforms have overcome past deficiencies. Available trainee and labor... more Background Contemporary 3D platforms have overcome past deficiencies. Available trainee and laboratory studies suggest stereoscopic imaging improves performance but there is little clinical data or studies assessing specialists. We aimed to determine whether stereoscopic (3D) laparoscopic systems reduce operative time and number of intraoperative errors during specialist-performed laparoscopic cholecystectomy (LC). Methods A parallel arm (1:1) randomised controlled trial comparing 2D and 3D passive-polarised laparoscopic systems in day-case LC using was performed. Eleven consultant surgeons that had each performed > 200 LC (including > 10 3D LC) participated. Cases were video recorded and a four-point difficulty grade applied. The primary outcome was overall operative time. Subtask time and the number of intraoperative consequential errors as identified by two blinded assessors using a hierarchical task analysis and the observational clinical human reliability analysis technique formed secondary endpoints. Results 112 patients were randomised. There was no difference in operative time between 2D and 3D LC (23:14 min (± 10:52) vs. 20:17 (± 9:10), absolute difference − 14.6%, p = 0.148) although 3D surgery was significantly quicker in difficulty grade 3 and 4 cases (30:23 min (± 9:24), vs. 18:02 (± 7:56), p < 0.001). No differences in overall error count was seen (total 47, median 1, range 0-4 vs. 45, 1, 0-3, p = 0.62) although there were significantly fewer 3D gallbladder perforations (15 vs. 6, p = 0.034). Conclusion 3D laparoscopy did not reduce overall operative time or error frequency in laparoscopic cholecystectomies performed by specialist surgeons. 3D reduced Calot's dissection time and operative time in complex cases as well as the incidence of iatrogenic gallbladder perforation (NCT01930344).

World Journal of Gastrointestinal Endoscopy, 2017

In the late 1980s the first laparoscopic cholecystectomies were performed prompting a sudden rise... more In the late 1980s the first laparoscopic cholecystectomies were performed prompting a sudden rise in technological innovations as the benefits and feasibility of minimal access surgery became recognised. Monocular laparoscopes provided only two-dimensional (2D) viewing with reduced depth perception and contributed to an extended learning curve. Attention turned to producing a usable three-dimensional (3D) endoscopic view for surgeons; utilising different technologies for image capture and image projection. These evolving visual systems have been assessed in various research environments with conflicting outcomes of success and usability, and no overall consensus to their benefit. This review article aims to provide an explanation of the different types of technologies, summarise the published literature evaluating 3D vs 2D laparoscopy, to explain the conflicting outcomes, and discuss the current consensus view.

Clinical Endocrinology, 2021

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial ... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Aims: Dipeptidyl peptidase-4 (DPP-4) inhibitors are recommended second or third line therapy in t... more Aims: Dipeptidyl peptidase-4 (DPP-4) inhibitors are recommended second or third line therapy in type 2 diabetes and have become widely prescribed in primary care. We present a description of their current use and prescribing trends in UK primary care. Methods: A cohort of people with type 2 diabetes (N=34,278) was identified from the University of Surrey-Lilly Real World Evidence (RWE) centre database, using routinely collected primary care data. Monthly prescription data was extracted from primary care records on the use of DPP-4 inhibitors in this group. We report prescription numbers over time and the demographics of people prescribed these medications. Results: We found DPP-4 inhibitors were commonly prescribed with 6,306 (18.4%) people with type 2 diabetes initiated on them since January 2008. Prescription rates are continuing to climb with a maximum rate at the end of our study period (March 2015) of 1108 prescriptions per 10,000 people with type 2 diabetes per month. The mean...

Aim The use of glucagon-like peptide-1 (GLP-1) agonists in type 2 diabetes is increasing. We pres... more Aim The use of glucagon-like peptide-1 (GLP-1) agonists in type 2 diabetes is increasing. We present a description of their current use and prescribing trends in UK primary care and compare the characteristics of people prescribed GLP-1 agonists with phase 3 trial populations

Background and aims: Adaptive changes in fatty acid metabolism, liver and muscle fat content and ... more Background and aims: Adaptive changes in fatty acid metabolism, liver and muscle fat content and adipocyte-derived cytokines may potentially explain the beneficial effects of exercise on insulin action. We investigated this in sedentary men before and after 6 weeks of supervised exercise. Materials and methods: Thirteen sedentary overweight male subjects (age 50 ± 304yr, BMI 28.2 ± 0.5) were recruited, seven were randomised to a 6 week exercise programme and six remained sedentary. After completion of the baseline (0 weeks) metabolic study and body composition measurements subjects who were allocated to the exercise group started the exercise programme. Subjects exercised at 60-85% ofV02 max for a minimum of 20 minutes at least 3 times a week for 6 weeks. Insulin sensitivity of fatty acid (NEFA) production rate (Ra), glycerol Ra, glucose Ra and glucose disposal rate (Rd) were measured with stable isotopes of palmitic acid, glycerol and glucose at 0 and 6 weeks with a 2 step hyperins...

Background and aims: Sodium Glucose Co-Transporter 2 inhibitors (SGLT2i) have cardiorenal protect... more Background and aims: Sodium Glucose Co-Transporter 2 inhibitors (SGLT2i) have cardiorenal protective properties and are being increasingly used in type 2 diabetes (T2DM) treatment for glycaemic control. Previous studies have proposed a risk of hyperkalaemia with SGLT2i, potentially by decreased activity of Na+/K+ ATPase on the proximal convoluted tubule basolateral membrane. We performed a systematic review and meta-analysis to assess effects of SGLT2i on serum-potassium and hyperkalaemia-events in T2DM patients. Methods: MEDLINE and Pubmed databases were searched using 'hyperkalaemia' and 'potassium' MeSH terms for publications of SGLT2i in T2DM up to the 31st December 2020. Randomised controlled trials, with potassium or hyperkalaemia assessments as primary/secondary outcomes were included. Study bias was assessed by funnel plots and study quality by the Jadad scoring method. Cochran's Q test and I2 statistic were used to assess statistical heterogeneity. Sensi...

Scenario and medical record of Patient 1 (John Thompson). Scenario and medical record of Patient ... more Scenario and medical record of Patient 1 (John Thompson). Scenario and medical record of Patient 1 (John Thompson) (DOCX 14â kb)

Female Sexual Quality of Life after Bariatric Surgery Background Approximately half of... more Female Sexual Quality of Life after Bariatric Surgery Background Approximately half of all bariatric procedures are performed on women of reproductive age. Studies have examined the impact of surgery on future pregnancies, but less attention has been paid to fertility and sexual function in women after bariatric surgery. Methods Participants were recruited preoperatively from Tier 4 (hospital) obesity services for a prospective cohort study of women of reproductive age (18-45 years) undergoing bariatric surgery. Participants completed a sexual quality of life-female (SQOL-f) questionnaire pre-operatively, then 3, 6 and 12 months post-operatively. SQOL-f can be completed regardless of sexual orientation or relationship status. Total scores are expressed as a percentage; the higher the percentage the better the SQOL. Questionnaire findings were analysed and interpreted in the wider context of health. Results To date, 22 women have baseline and 3 month d...