Julia L Newton’s research while affiliated with Newcastle University and other places

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Publications (515)


Figure 1 Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow diagram template for systematic reviews. POCT, point-of-care testing. Source: Page et al. 16 This work is licensed under CC BY 4.0. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/.
Can we trust published evidence on point-of-care tests for cholesterol? A rapid review
  • Literature Review
  • Full-text available

March 2025

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35 Reads

Chikomborero Cynthia Mutepfa

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Objectives There is a need to better inform clinicians and decision-makers in primary or community care settings on selecting the appropriate point-of-care tests (POCTs) for screening purposes (as a part of the NHS Health Check Programme). Here we provide an overview of the published analytic validity and diagnostic accuracy studies on POCTs for measuring blood lipids that are available on the UK market to determine whether they meet the accuracy specifications based on the 1995 US National Cholesterol Education Program (NCEP) recommendations. Design Rapid review of analytical validity and diagnostic accuracy studies. Data sources On 12 May 2023, Medline and Embase were searched. Google Scholar was manually scrutinised to identify additional studies. Key article reference lists were also hand-searched. Eligibility criteria We included analytical validity and diagnostic accuracy studies that compared POCT to laboratory testing (or another POCT) performance for measuring at least total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C). Data extraction and synthesis Identified studies were independently reviewed by two researchers using standardised methods of screening. Where necessary, conflicts were resolved by a third reviewer. Title and abstract as well as full texts were screened using prespecified inclusion and exclusion criteria. The quality of identified studies was assessed using QUADAS-2 for diagnostic accuracy studies and a modified quality appraisal tool for studies of diagnostic reliability (QAREL) for analytical validity studies. We assessed the quality of analytical and diagnostic accuracy studies and compared the accuracy of the POCTs for TC, triglyceride (TG), HDL-C and low-density lipoprotein cholesterol (LDL-C) against NCEP standards for mean per cent bias, coefficient of variation or total error. We narratively synthesised analytical and clinical validity evidence from retrieved studies. Results This study examined analytical and diagnostic accuracy evidence for the selected POCTs. Through the review of 22 studies, 6 POCTs were identified. All retrieved studies were analytical validity assessments, while five of them also reported diagnostic accuracy information. The majority of evidence focused on Cholestech LDX, CardioChek PA and Accutrend Plus. Evidence of between and within-study heterogeneity was found. Precision measures often showed systematic differences between the POCT and reference standards. Most devices, except for Elemark, met at least one NCEP standard for either TC, TG, HDL-C, or LDL-C. Conclusions We found that evidence for two of the devices mostly met the requirements of the NCEP standard of evidence for bias and precision and could be recommended to general practitioners to use in the NHS Health Check programme. These were the Cholestech LDX and the Cobas b101 system.

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Illustrative example of beat‐to‐beat monitoring during the active stand test with selected postural blood pressure features: early phase, stabilization point and late phase for the clustering model. Features are derived from the magnitude of shift from baseline (Δ% SBP). The period for baseline calculation was taken during the supine phase, shaded in blue. Active stand phase duration was from 0 to 120 s. Abbreviation: SBP, systolic blood pressure.
Visualization of clusters generated by k‐means++ clustering (k = 3). Assignment of participants to clusters: iOHYPO (initial deficit), OHYPO (sustained deficit) and OHYPER (persistent rise), with respective sizes (n).
Trend analysis of postural blood pressure profiles in the clusters: OHYPER (persistent rise), iOHYPO (initial deficit), OHYPO (sustained deficit) and NOR (normal orthostatic response) group, with associated trend lines. Distribution of features in early phase, stabilization point and late phase, with mean magnitude of shift from baseline (Δ% SBP). Reciprocal NOR mean values for each feature are included along the red dashed line. Abbreviation: SBP, systolic blood pressure.
Odds ratios (depicted as points) and 95% confidence intervals (CI; represented by whiskers) for clinical assessments in clusters iOHYPO (initial deficit; a), OHYPO (sustained deficit; b) and OHYPER (persistent rise; b), relative to the normal orthostatic response (NOR) reference group, across three logistic regression models: unadjusted, age and sex adjusted, and fully adjusted. Red dashed line represents odds below one indicating lower likelihood and above one indicating higher likelihood of the evaluated clinical variable in each cluster (a–c). Models where horizontal whiskers do not intersect with the red dashed line indicate statistical significance (P < 0.05).
Artificial intelligence driven clustering of blood pressure profiles reveals frailty in orthostatic hypertension

November 2024

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47 Reads

Gravity, an invisible but constant force , challenges the regulation of blood pressure when transitioning between postures. As physiological reserve diminishes with age, individuals grow more susceptible to such stressors over time, risking inadequate haemodynamic control observed in orthostatic hypotension. This prevalent condition is characterized by drops in blood pressure upon standing; however, the contrary phenomenon of blood pressure rises has recently piqued interest. Expanding on the currently undefined orthostatic hypertension, our study uses continuous non‐invasive cardiovascular data to explore the full spectrum of blood pressure profiles and their associated frailty outcomes in community‐dwelling older adults. Given the richness of non‐invasive beat‐to‐beat data, artificial intelligence (AI) offers a solution to detect the subtle patterns within it. Applying machine learning to an existing dataset of community‐based adults undergoing postural assessment, we identified three distinct clusters (iOHYPO, OHYPO and OHYPER) akin to initial and classic orthostatic hypotension and orthostatic hypertension, respectively. Notably, individuals in our OHYPER cluster exhibited indicators of frailty and sarcopenia, including slower gait speed and impaired balance. In contrast, the iOHYPO cluster, despite transient drops in blood pressure, reported fewer fallers and superior cognitive performance. Surprisingly, those with sustained blood pressure deficits outperformed those with sustained rises, showing greater independence and higher Fried frailty scores. Working towards more refined definitions, our research indicates that AI approaches can yield meaningful blood pressure morphologies from beat‐to‐beat data. Furthermore, our findings support orthostatic hypertension as a distinct clinical entity, with frailty implications suggesting that it is worthy of further investigation.




Characteristics of Interviewees (n = 15).
Lipid Management in Primary Care for Socioeconomically Disadvantaged Populations in Northern England: A Qualitative Study

October 2024

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9 Reads

Introduction People in low socioeconomic circumstances are more susceptible to dyslipidemia and cardiovascular disease than those living in more affluent populations. Limited healthcare access and low preventive care uptake widen health inequalities. Understanding how primary care can better serve socioeconomically disadvantaged communities is urgently needed. Aim To explore lipid management delivery in socioeconomically disadvantaged areas and identify barriers and enablers for lipid optimization for socioeconomically disadvantaged populations. Method Individual semi-structured remote interviews with clinicians, purposively recruited from primary care practices serving extremely socioeconomically disadvantaged communities in Northern England, UK, who were involved in the delivery and organization of lipid management. Interviews were recorded, transcribed, and analyzed thematically following framework analysis. Results Fifteen interviews were undertaken. Five themes emerged: complex and multimorbid patients with competing priorities, limited access and follow-up to supporting services, being flexible and working beyond guidelines, high workload with inadequate staff support, and the need for care integrity and sustainable support. Conclusion The findings of this study have been fed back to the delivery of the national program to improve cardiovascular health. Socioeconomically disadvantaged communities have complex health needs posing risks of multimorbidity but living with low health literacy, competing demands upon time, and financial constraints. Clinicians are willing to adapt services but a lack of guidance for care and funded services remains a significant barrier to targeted service delivery. Research is needed to inform the effectiveness and acceptability of interventions for lipid management tailored for those experiencing low socioeconomic disadvantage.






Colonoscopic cancer detection rate: a new performance measure – is it FIT for purpose?

December 2023

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30 Reads

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3 Citations

Frontline Gastroenterology

Introduction Gastrointestinal symptoms correlate poorly with cancer diagnosis. A faecal immunochemical test (FIT) result of ≥10 µg has high sensitivity and negative predictive value for colorectal cancer (CRC) detection. An FIT-based diagnostic pathway may lead to more effective resource utilisation. We aimed to use National Endoscopy Database (NED) data to create a new colonoscopy performance measure, cancer detection rate (CDR) to assess the appropriate identification of target populations for colonoscopy; then to use CDR to assess the impact of implementing an FIT-based referral pathway locally. Methods NED data were analysed to compare local diagnostic colonoscopic CDR in 2019 (prepathway revision) and 2021 (postpathway revision), benchmarked against overall national CDR for the same time frames. Results 1, 123, 624 NED diagnostic colonoscopies were analysed. Locally, there was a significant increase in CDR between 2019 and 2021, from 3.01% (2.45%–3.47%) to 4.32% (3.69%–4.95%), p=0.003. The CDR increase was due to both a 10% increase in the number of CRCs detected and a 25% reduction in the number of diagnostic colonoscopies performed. Nationally, there was a smaller, but significant, increase in CDR from 2.02% (1.99%–2.07%) to 2.33% (2.29%–2.37%), p<0.001. The rate of increase in CDR% between 2019 and 2021 was significantly different locally compared with nationally. Conclusion Our study indicates that the introduction of a robustly vetted FIT-based algorithm to determine whether diagnostic colonoscopy is required, is effective in increasing the colonoscopic CDR. Moreover, CDR appears to be a meaningful performance metric that can be automatically calculated through NED, enabling monitoring of the quality of referral and vetting pathways.


Citations (67)


... A recent single-centre study with a pre/post-study design in 175 hospitalised patients with peripheral arterial disease in the United States demonstrated that the addition of a pharmacist-led lipid consult and protocol was significantly associated with more patients being discharged on high-intensity statin (70.4% vs 38.3%; p < 0.001) or an increased statin intensity (35.8% vs 20.2%; p = 0.020) [28]. Also, another single-centre study of 216 vascular and diabetic foot patients in an area of high social deprivation in the United Kingdom demonstrated that a pharmacist-led lipid clinic significantly improved the utilization of high-intensity statins (76% vs 39%; p < 0.001) and other therapies, with more patients attaining lipid goals [29]. ...

Reference:

Learnings from Implementation Strategies to Improve Lipid Management
Lipid-lowering optimisation for secondary prevention vascular and diabetic foot patients in a pharmacist-led clinic
  • Citing Article
  • March 2024

Journal of Clinical Lipidology

... 15 This change increased CCDR and reduced the total number of procedures. 9 Our pathway differs in that FIT is advised but not mandated to the same extent. Despite the demonstrated efficiency gains, our total proportion of patients undergoing any investigation did not change, nor did CDR. ...

Colonoscopic cancer detection rate: a new performance measure – is it FIT for purpose?
  • Citing Article
  • December 2023

Frontline Gastroenterology

... The relationship between OH and age is complex. While some studies indicate that older age is a significant predictor of OH, others suggest that lifestyle factors such as physical inactivity, poor diet, and comorbid conditions, including hypertension and diabetes, may play a more crucial role [14]. In older adults, the cumulative impact of these conditions may exacerbate the severity of OH and its associated complications. ...

Prospective association of occupational and leisure-time physical activity with orthostatic blood pressure changes in older adults

... Current therapies for hyperlipidemia include ezetimibe, bile acid sequestrants, niacin, statins, and fibrates. Treatment with statins/ezetimibe/or PCSK9 plays a considerable impact on patients on the verge of CVD and lipid level management (14)(15)(16). Whereas few studies reported that statin, fenofibrate, or nicotinamide therapy had no benefit except PCSK9 inhibitors in reducing death rate or need for intubation in COVID-19 patients and drop in the use of antihyperlipidemic drugs in the end phase of COVID-19 pandemic (17,18). ...

Optimizing lipid management-impact of the COVID 19 pandemic upon cardiovascular risk in England
  • Citing Article
  • May 2023

British Medical Bulletin

... It is small, portable, requires a small sample volume (1.2 µL), and is user-friendly. Imprecision (CV) has been reported as ranging from 3 to 13% over a wide range of creatinine concentrations [24][25][26][27][28][29][30][31]. However, it tends to be less accurate with older ages and greater creatinine concentrations. ...

Patient Self-Testing of Kidney Function at Home, a Prospective Clinical Feasibility Study in Kidney Transplant Recipients

Kidney International Reports

... However, as a major metabolite of curcumin in vivo, it exhibits similar pharmacological activities to curcumin and has better bioavailability and stability than curcumin [26]. Clinical studies have shown that supplementation with curcumin can significantly reduce levels of ALT, AST, FBI, TC, and TG in patients with MAFLD [27]. Curcumin also significantly reduced the ratio of Firmicutes to Bacteroidetes in NASFL patients and significantly increased the abundance of Bacteroidetes, and effectively alleviated MASH [28]. ...

Meta-Analysis of Exploring the Effect of Curcumin Supplementation with or without Other Advice on Biochemical and Anthropometric Parameters in Patients with Metabolic-Associated Fatty Liver Disease (MAFLD)

... The potential mechanisms involved in HRA include respiratory patterns and various physiological reflexes, such as the baroreflex regulating the cardiovascular system [21,22]. A significant reduction in HRA features has been observed in subjects with attention-deficit/hyperactivity disorder, heart failure, vasovagal syndrome, gastric cancer, or a history of diabetes [23][24][25][26], but the influence of MDD on HRA features in adolescents has only been examined in one study [27]. Additionally, a compensatory phenomenon has been demonstrated in HRA analysis, that in healthy subjects, the contributions of heart rate decelerations are greater than those of accelerations for short-term HRV, whereas the contributions of accelerations are greater than those of decelerations for long-term HRV [28,29]. ...

An assessment of heart rate and blood pressure asymmetry in the diagnosis of vasovagal syncope in females

... 24 Moreover, this study reported patients' misconceptions and myths about statin side effects, influencing adherence rates in deprived areas. While statin prescribing rates are comparable between affluent and deprived areas, 25 higher use is detected in deprived areas contributing to total cholesterol reduction. Efforts to increase statin use should focus on tailored interventions 9 that include effective communication, patient education, and information provision dispelling myths about medication side effects. ...

Cardiovascular-related conditions and risk factors in primary care for deprived communities before and during the COVID-19 pandemic: an observational study in Northern England

... Even though the reference values for circulating irisin remained undefined, the data reported by different studies suggest that the secretion of irisin is associated with health conditions and increased longevity. During our research, a total of 14 articles [17][18][19][20][21][22][23][24][25][26][27][28][29]51] ( Table 1) were found reporting data on irisin in healthy older adults, among which two of those [25,29] conducted were in healthy centenarian older adults. ...

Effects of Sitting Callisthenic Balance and Resistance Exercise Programs on Cognitive Function in Older Participants