Midlands Evidence Repository
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Co-producing a survey on prospective acceptability of neuromodulation for mental health conditions with lived experience experts
No full textAims: Non-invasive brain stimulation ("neuromodulation") techniques, including transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (TES), are used to modulate brain excitability and connectivity. TMS is approved for treating depression in the United Kingdom and preliminary evidence suggests that combining TMS and TES may enhance therapeutic effects. While neuromodulation is generally well-tolerated in research settings, its acceptability among the broader patient population remains unclear due to limited exposure, awareness, and information accessibility. Understanding prospective acceptability, defined as the perceived appropriateness of an intervention before its application, is crucial for improving treatment uptake and addressing concerns about safety and feasibility. We aimed to coproduce a survey with lived experience experts to assess the acceptability of individual and combined neuromodulation techniques among potential service users. Method(s): The study was co-developed with our Neuromodulation Experts-by-experience Advisory patient and public involvement (PPI) group. We underwent three rounds of iterative feedback to refine the survey focus, structure, and questions. A scoping review of existing literature on prospective acceptability of neuromodulation techniques informed the content, alongside the Theoretical Framework of Acceptability. Given the novelty of combined (TMS +TES) neuromodulation, no prior informational materials exist. PPI members advised it was critical to produce accompanying videos and leaflets to briefly illustrate the different neuromodulation techniques. The video scripts and leaflet content were produced in collaboration with three PPI members who tried the neuromodulation techniques, to avoid rehearsed scripts and ensure honest reviews of the techniques. Result(s): The final survey version was adapted to maximise clarity of questions, engagement, and completion rates. The survey incorporated questions on awareness, perceived effectiveness, ethical considerations, and practical burden of different neuromodulation techniques. Online and paper versions of the survey were created to ensure accessibility. We successfully produced three information videos within 90-second target duration featuring PPI members and lead researchers. We developed a supplementary infographic leaflet for enhanced comprehension and accessibility. Conclusion(s): Engaging stakeholders through PPI was instrumental in developing the survey to ensure accessibility and relevance for diverse participants with lived experience of mental health conditions. End-user involvement in the design process improved survey comprehensibility, highlighting the importance of coproduction in developing effective research tools. Findings from this survey will provide insights into the acceptability of novel neuromodulation techniques, ultimately informing future clinical implementation and patient-centred research strategies.https://www.cambridge.org/core/journals/bjpsych-open/article/coproducing-a-survey-on-prospective-acceptability-of-neuromodulation-for-mental-health-conditions-with-lived-experience-experts/0538FF58CE79B334EE077EFADB5F11F
Effectiveness of Beta-Blockers in Reducing Mortality and Recurrence After Myocardial Infarction: A Systematic Review of Contemporary and Foundational Evidence.
Get PDFBeta-blockers have traditionally been a mainstay in the management of patients recovering from myocardial infarction (MI). However, their role in the era of modern cardiac interventions remains a topic of active discussion. This systematic review evaluated evidence from 1983 to 2014, drawn from PubMed, Embase, Scopus, and CENTRAL, on the effectiveness of beta-blockers in reducing mortality and recurrent cardiovascular events in adults following MI. After a comprehensive screening process, four eligible studies (two randomized controlled trials, one post hoc analysis, and one observational study) were included, encompassing a total of 19,078 participants with varied clinical settings and patient profiles. Across these studies, beta-blocker therapy was consistently associated with reductions in all-cause mortality, cardiovascular mortality, and recurrent MI, particularly among individuals with reduced left ventricular function. Some benefit was also observed in those with preserved function, though with less consistency. The magnitude of benefit included a 23-26% reduction in overall mortality and up to a 41% reduction in recurrent MI. Despite differences in study design, patient characteristics, and treatment protocols, the overall findings support the continued use of beta-blockers in post-infarction care. Limitations included heterogeneity in populations, beta-blocker regimens, and study eras, highlighting the need for individualized treatment approaches. Nonetheless, these results align with current guidelines from the American College of Cardiology/American Heart Association and the European Society of Cardiology, reaffirming the relevance of beta-blockers in improving outcomes in this patient population
Accurate Intraoperative Estimation of Tip-Apex Distance in the Cephalomedullary Fixation of Proximal Femoral Fractures
No full textCephalomedullary nailing systems, including the Trochanteric Femoral Nailing-ADVANCED™ (TFNA) (DePuy Synthes, Raynham, Massachusetts, United States), are widely utilised for stabilising proximal femoral fractures. A pivotal aspect of the procedure involves ensuring adequate tip-apex distance (TAD) of the lag screw below 25 mm, a measure that substantially diminishes the cutout rate. We introduce a simple method to accurately estimate the intraoperative TAD in TFNA fixation. This technique relies on the known diameter of the shaft of the screw (the root diameter), just proximal to the threaded section. The new technique is simple, easy, and effective in potentially reducing operative time and improving the accuracy of estimating TAD during cephalomedullary hip fracture stabilisation surgery
Pathobiology and molecular pathways implicated in Osteosarcoma Lung Metastasis: a scoping review
No full textOsteosarcoma (OS) is the most common primary bone malignancy, with lung metastasis being the leading cause of mortality. The metastatic process is driven by complex biological mechanisms, including tumor cell-specific adaptations of growth pathways, immune modulation within the tumor microenvironment, and reactivation of metastatic cells from dormancy. This scoping review captures overlooked and under researched pathways, supporting mainstream therapeutic targets while shedding light on novel ones, reinforcing and revising conclusions drawn in previous literature, and guiding future research. MEDLINE, Embase, and Cochrane CENTRAL were searched with a publication date limit from 2019 onwards using relevant MeSH terms combined with Boolean operators, truncations, and keyword searches. The search culminated in 43 reports, including 30 in vivo, 8 in vitro, and 5 observational studies. This study conforms to the PRISMA-ScR guidelines. Tumor cell adaptations, including epithelial-mesenchymal transition (EMT) and enhanced migratory and proliferative signaling via JAK/STAT and TGF-β pathways, are critical drivers of OS lung metastasis. Manipulated upstream ligand-driven signaling promotes transcriptional changes that increase cell cycle proteins and mesenchymal markers, conferring chemoresistance and advancing OS cells toward a metastatic state. The tumor microenvironment also plays a key role; interactions between OS cell-derived cytokines and tumor-infiltrating immune cells lead to tumor associated macrophages and neutrophils (TAMs/TANs), which help establish a pre-metastatic niche and provoke immune remodeling. However, the impact of TAMs on OS survival remains ambiguous due to their dual pro- and anti-tumor roles. Lung-induced dormancy links tumor intrinsic and immune-driven mechanisms, allowing tumor cells to evade immunity or pause progression. Inflammatory pathways and immune activation can reverse dormancy, promoting further OS dissemination. The reviewed evidence supports targeting intracellular signaling and immune pathways to mitigate OS metastasis. The paucity of longitudinal data on lung dormancy warrants caution, emphasizing integrated approaches and better controlled studies with focus on combinatorial therapies for more conclusive outcomes.https://journals.sagepub.com/doi/10.1177/1533033825135971
Study of treatment modalities and clinical outcomes of screen-detected cancers at a Tertiary Care Unit in the UK
No full textIntroduction Breast cancer is the most common type of cancer in women worldwide, and early detection plays a key role in improving survival and treatment outcomes. National breast screening programs help identify both invasive and non-invasive cancers, such as ductal carcinoma in situ (DCIS). This study aimed to compare the one-year outcomes of screen-detected invasive breast cancer and DCIS in women diagnosed through a regional screening program. Methods A retrospective cohort study was conducted at our tertiary center in the UK. Patients diagnosed with screen-detected breast cancers from January 1, 2023, to December 31, 2024, were followed for one year post-surgery. A total of 216 patients were included: 108 with invasive breast cancer (Group A) and 108 with DCIS (Group B). Data on demographics, tumor characteristics, surgical procedures, postoperative complications, and oncological outcomes were collected using electronic records. Comparative statistical analyses were performed using SPSS version 26 (IBM Corp., Armonk, USA). Chi-square and independent t-tests were used for categorical and continuous variables, and odds ratios (ORs) with 95% confidence intervals were calculated to assess the strength of associations. Statistical significance was set at p < 0.05. Results The mean age was similar between groups (Group A: 57.6 ± 10.8 years; Group B: 58.1 ± 11.5 years). Estrogen and progesterone receptor (ER/PR) positivity was high in both groups (70.4% vs. 75%, p = 0.431). Human epidermal growth factor receptor 2 (HER2) positivity was more frequent in Group A (17.6% vs 11.1%, p = 0.173). Multifocality (24.1% vs 13%, p = 0.038), positive margins (17.6% vs 6.5%, p = 0.015), and nodal involvement (23.1% vs 0%, p < 0.001) were significantly more common in invasive cancers. Postoperative complications (hematoma, wound infection, seroma, flap necrosis) were similar in both groups. However, local recurrence was higher in Group A (9.3% vs 2.8%, p = 0.044), and one-year disease-free survival was lower (85.2% vs 97.2%, p = 0.002). Chemotherapy was given only to patients in Group A (59.3%). Conclusion In our study, we found that screen-detected in situ breast cancer had better short-term outcomes than invasive cancer, with fewer recurrences and higher one-year disease-free survival. Both groups were similar in demographics, but invasive cancer had more multifocality and required more aggressive surgery. Re-excision was more common in the in situ group. The results suggest avoiding overtreatment of DCIS and using risk tools to balance treatment with quality of life. Improving patient education, collaboration, and standardizing surgical decisions is important. The study highlights the need for evidence-based approaches in treatment planning.https://www.cureus.com/articles/364985-study-of-treatment-modalities-and-clinical-outcomes-of-screen-detected-cancers-at-a-tertiary-care-unit-in-the-uk#!
Integrating a unique leg Strengthening Device (S-Press) into physiotherapy rehabilitation practice, a qualitative examination
No full textMuscle deconditioning due to hospitalisation is problematic, causing delayed discharges, more nursing, carer, or social service support following discharge, and possible discharge to a care home rather than the patient’s own home. Muscle deconditioning is associated with increased mortality, infections, depression, and reductions in patient mobility and ability to engage in their activities of daily living. Preserving muscle strength and function should form part of patients’ rehabilitation plans. Progressive resistance training (PRE) offers the most cost-effective way of preserving muscle strength and function; however, it is not routinely carried out in hospitals. A leg strengthening device (the S-Press) has been developed with the aim of improving access to effective PRE for adults. Using a qualitative approach, thematic analysis of interviews with physiotherapists, patients, and relative carers about their experience of using the S-Press provided insight into integrating PRE into patients’ rehabilitation, what promoted or prevented its use, and the outcomes associated with its use. Four overall themes emerged from the data. “Experience of Users” described that the S-Press was accessible, convenient, time efficient, portable, and manoeuvrable, and it provided an objective measure of progress. “Facilitators” included findings around how the S-Press was easy to use, motivational, and comfortable when in use. “Barriers” comprised the inability of some patients to use the S-Press independently and the identification of obstacles that prevented consistent use. “Impact and Benefits” represented the perceptions of increased leg strength and psychological benefits. The S-Press is beneficial for patients’ rehabilitation by offering PRE that is simple and easy to use, acceptable to both patients and professionals, and can be integrated as part of patients’ rehabilitation plans.https://www.scirp.org/journal/paperinformation?paperid=13851
Critical evidence synthesis on rehabilitation following arthroscopic shoulder stabilisation surgery for traumatic anterior instability: consensus recommendations for clinical practice and research - commissioned by the British Elbow & Shoulder Society.
Get PDFArthroscopic shoulder stabilisation surgery (ASSS) is a common procedure for treating anterior shoulder instability. Postoperative rehabilitation remains a crucial, but under-researched, aspect of patient recovery. Despite its importance, no comprehensive rehabilitation guideline based on robust clinical trials has emerged, leaving a gap in evidence-based practice. To address this, the British Elbow & Shoulder Society appointed the Allied Health Professional Clinical Guideline Group to review current practices and establish clinical guidance on rehabilitation. This evidence synthesis aims to provide a critical synthesis and discussion on rehabilitation following ASSS. The intended outcome is to highlight areas of uncertainty and make recommendations for clinical practice and further research. The development of this evidence synthesis followed a rigorous five-stage process: (1) systematic literature review, (2) UK national practice survey, (3) expert consensus (Delphi) study, (4) updated literature search and review and (5) synthesis of the previous four stages. Stages 1–3 have been published previously. This evidence synthesis comprised stages 4 and 5. 10 key domains for postoperative rehabilitation from immediate postsurgery to return to normal function, including sports, were identified. This paper synthesises current knowledge and provides a platform for recommendations in clinical practice and future research. In particular, early shoulder movement was recommended during the ‘immobilisation period’, but confined to shoulder elevation up to 90°, anterior to the scapular plane, with neutral external rotation. Further high-quality primary research is needed to address uncertainties and expand the evidence base, thereby informing and challenging clinical practice.https://bjsm.bmj.com/content/early/2025/10/23/bjsports-2025-10967
Quality improvement project to improve the resident doctors' out-of-hours clinical handover system at Nottinghamshire Healthcare NHS Foundation Trust (NHFT)
No full textAims: An effective and safe clinical handover system is at the heart of safe healthcare delivery, ensuring continuity of care between clinical teams. Handovers are completed face-to-face or verbally and recorded within the NHFT's SharePoint handover system, the standard agreed upon within the Trust. This project aimed to improve the usability, access, and safety of a preexisting SharePoint handover system. Method(s): A pre-implementation survey with 30 responses from the Resident doctors showed that 90% of respondents were aware of the handover system. Still, only 60% carried out face-to-face handovers regularly, while 40% relied on other methods. 35% viewed the SharePoint handover system positively, but 50% found it inefficient, suggesting improvements. Model for Improvement Quality Improvement Methodology was used to design and develop this change project; working alongside key stakeholders (Resident doctors, Medical Education unit, Quality Improvement team and Information Technology (IT) professionals), changes were made using a Plan-Do-Study-Act (PDSA) framework to improve awareness, access, usability and accuracy of the SharePoint handover system. Awareness improved through sessions in the Resident doctors' induction, emails and medical education newsletter. Working in collaboration with the IT team, the SharePoint system was securely moved to a safe server with changes made to the template and dropdown options to improve safety and accuracy. Automatic email reminders were set up to improve handover job completion and recording. A PowerBI dashboard was created to assess system use and the quality of the handover recording to ensure ongoing quality assurance and improvements. Result(s): Six-week baseline data showed that the compliance rate of handovers was 80%, with 20% of handovers indicating neither faceto- face nor verbal communication. Only 20% (42 out of 209) of the jobs were marked complete, against standards of 100%. After implementing change ideas, four-week data showed 100% compliance, indicating that all handovers were completed and recorded. Only 23.03% of the jobs were marked complete on the handover system, indicating an area for further improvement. Conclusion(s): A Trustwide Standard Operating Procedure for Resident Doctor Handover is being developed, and further IT changes are planned to continuously monitor and improve the handover system. In this case, collaborative leadership, perseverance when encountering roadblocks, and a systematic data-driven improvement approach with iterative changes helped establish a safer, more usable, and accessible handover system.https://www.cambridge.org/core/journals/bjpsych-open/article/quality-improvement-project-to-improve-the-resident-doctors-outofhours-clinical-handover-system-at-nottinghamshire-healthcare-nhs-foundation-trust-nhft/F5E1F68DBF1420CC6C9E1EF4C584EEE
Early weight-bearing following modified Lapidus arthrodesis: A retrospective review of 104 cases & postoperative protocol
No full textBackground: Lapidus arthrodesis is indicated for the treatment of first ray dysfunction or hypermobility, hallux valgus (HV) and functional hallux limitus (FHL). Postoperative weightbearing protocols vary amongst surgeons. Purpose: To report radiographic osseous healing and patient-reported outcome measures (PROMS) following a single early weightbearing protocol. Study design: Retrospective review of 104 adults (≥18 years) (104 feet) who underwent open modified Lapidus arthrodesis (without bone graft) by single compression screw and medial locking plate by two surgeons at one centre (between January 2019 to May 2023). Methods: Pre- and postoperative radiographs and electronic records were reviewed for evidence of osseous healing and return to full weightbearing. Secondary measures included deformity reduction and PROMS. Results: At 6-weeks follow-up 98 patients (94 %) were confirmed of osseous healing and returned to full weightbearing. Six patients (6 %) had delayed osseous healing at 6-weeks but showed signs of osseous healing by 3-months follow-up. Postoperative HV and intermetatarsal angle (IMA) showed significant reduction (mean difference: -12 (SD = 8) and -5 (SD = 4) degrees respectively; p < 0.001 for both). Ten patients (10 %) had postoperative complications: hardware irritation 5 (5 %), sesamoiditis 2 (2 %), hypertrophic scar 2 (2 %) and joint stiffness 1 (1 %). Eight patients (8 %) required further surgery (5 required fixation removal due to hardware irritation. Three underwent either; 1st MTPJ open-mobilization, excision of scar or distal metatarsal osteotomy with tibial sesamoid planing). Manchester-Oxford Foot Questionnaire (MOXFQ) showed significant improvement across all domains (mean difference (SD): -51 (SD = 22); walking/standing -49 (SD = 24); pain -52 (SD = 22); and social interaction -51 (SD = 28); (p < 0.001 for all) with clinically significant effect size (Cohen's d: 2.37; 2.01; 2.37; and 1.84 respectively). Patient satisfaction questionnaire (PSQ-10) score was high mean of 91 (SD = 8). 5 patients (5 %) were lost by 6-months follow-up. Conclusion: Early weightbearing achieved consistent osseous healing and high PROMS. Larger controlled studies are required to validate these results.https://www.jfas.org/article/S1067-2516(25)00273-X/abstrac
Sexualities of trans and non-binary people during transition, a narrative synthesis implementing a post-humanist framework
No full textBackground Sexualities are considered a relevant factor to one’s wellbeing. However, research has often fragmented sexualities into discrete elements. Additionally, research within trans and non-binary (TNB) populations has historically been pathologizing. This systematic literature review is grounded in relational ontology, which prioritizes the interactions between elements, over the analysis of isolated identities Aim The aim of this review is to explore how the sexualities of TNB people change during transition and to understand their experiences of these changes. Methods The literature search was conducted using the databases Scopus, Ebsco, CHINAL Plus, Open Dissertations, and Google Scholar, employing search terms related to TNB sexualities and transition experiences. The review synthesized data from qualitative and mixed-methods studies. Despite some studies’ methodological limitations, the narrative synthesis provided a comprehensive examination of the subject. Results The review found that TNB people’s sexualities are fluid and contextually influenced, often undergoing significant changes during transition. These changes are shaped by complex interactions between individual, social, and relational factors. Discussion The findings highlight the need for further research using diverse methodologies and inclusive recruitment strategies to deepen the understanding of TNB sexualities. This research has implications for enhancing sexual health practices and policies to be more inclusive and supportive of TNB individuals, fostering a more comprehensive understanding of their sexual well-being.https://www.tandfonline.com/doi/full/10.1080/26895269.2025.256802