Publications by authors named "R D Fletcher"

Aims: The sodium-glucose cotransporter 2 inhibitor canagliflozin reduces the risk of heart failure (HF) hospitalization or cardiovascular death and chronic kidney disease (CKD) progression among patients with type 2 diabetes at high cardiovascular risk or with CKD. Patients with type 2 diabetes commonly have coexisting HF or CKD that require treatment with loop diuretics; however, the prognostic implications of oral loop diuretic intensification are not well characterized.

Methods And Results: In this participant-level pooled analysis of the CREDENCE and CANVAS trials (not including CANVAS-R), 1454/8731 (16.

View Article and Find Full Text PDF

Background: Increasing demands, such as the COVID-19 pandemic, have presented substantial challenges to global healthcare systems, resulting in staff shortages and overcrowded emergency rooms. Health kiosks have emerged as a promising solution to improve overall efficiency and healthcare accessibility. However, although kiosks are commonly used worldwide for access to information and financial services, the health kiosk industry, valued at $800 million, accounts for just 1.

View Article and Find Full Text PDF

Background: Engaging fathers(to-be) can improve maternal, newborn, and child health outcomes. However, father-focused interventions in low-resource settings are under-researched. As part of an integrated early childhood development pilot cluster randomised trial in Nairobi's informal settlements, this study aimed to test the feasibility of a text-only intervention for fathers (SMS4baba) adapted from one developed in Australia (SMS4dads).

View Article and Find Full Text PDF

Background: The health-care sector is responsible for 5·2% of global emissions, however, little data exist regarding the environmental impact of disease management strategies. SGLT2 inhibitors are now widely used to reduce the risk of hospital admission and kidney failure in people with type 2 diabetes and chronic kidney disease. This study aimed to estimate the impact of SGLT2 inhibitors on greenhouse gas emissions using data from the CREDENCE trial.

View Article and Find Full Text PDF

Objective: To evaluate the feasibility and effectiveness of integrating Making Every Contact Count (MECC) using Healthy Conversation Skills (HCS) into an undergraduate medical curriculum and test the performance of an associated assessment.

Methods: Concepts were introduced to second year students through lectures, small group seminars, role-plays and a new Objective Structured Clinical Examination (OSCE).station.

View Article and Find Full Text PDF