Midlands Evidence Repository
Not a member yet
9653 research outputs found
Sort by
Implementation of dementia communication skills training in acute hospitals : a longitudinal, mixed-methods case study evaluation [In Press]
No full textPurpose People with dementia occupy c.25% of acute hospital beds. Being in hospital can lead to distress in people with dementia, exacerbated by the difficult acute hospital environment and lack of staff preparedness to meet their often-complex needs. Acute hospital staff identify supporting distressed patients with dementia as a practice challenge. Communication skills training can improve interaction quality and staff confidence, however little communication research to date has been conducted in acute hospitals. This study aimed to implement a communication skills training programme for preventing and responding to distress in patients with dementia in acute hospitals, and to assess its impact. Methods A longitudinal, mixed-methods, multiple case study design was employed in six wards across three English acute hospitals. The Kirkpatrick training evaluation framework (reaction to training, impact on knowledge and confidence, behaviours and outcomes for patients and staff) underpinned the study, with qualitative observational and interview, and quantitative survey and outcomes data collected immediately pre, post and 1-3 months post training. The [redacted] communication skills training programme included three communication trainables identified in an earlier conversation analysis study phase. It was delivered over two half-days, by local clinical educators, upskilled via a train-the-trainer programme. Findings A total of 145 staff attended at least one half-day of training. Delivery was feasible, however practical challenges with training organisation and freeing up staff to attend occurred. Staff who found it engaging and relevant to their role, valued its interactive content and the opportunity for reflection and implementation of skills between sessions. A statistically significant increase was found pre- to immediate post-training on staff communication knowledge (CI 0.01-1.2) and confidence in caring for people with dementia (CI 4.9-7.3). Staff reported a range of areas of learning aligned to the trainables. Over 90% of staff said they planned to implement the training in practice and many provided concrete examples of application. Challenges in applying the specific communication principals taught to wider practice situations were identified by some staff. Impact on observed patient agitation levels and staff communication practices were challenging to evidence objectively in the context of the acute hospital environment. Conclusion/original contribution It is feasible, although challenging, to deliver empirically based communication skills training to support acute hospital staff to better care for patients with dementia who may become distressed. It can lead to perceived increases in knowledge and confidence to support distress in this population. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY 4.0 International license.https://www.medrxiv.org/content/10.1101/2025.07.02.25330714v
Social deprivation and psychiatric inpatient numbers amongst people with intellectual disabilities and/or autism in England: a preliminary analysis and policy critique
Get PDFHealth and social care policy in England is committed to reducing psychiatric inpatient numbers for people with intellectual disabilities (ID) and/or autism but is making mixed progress. This study, a preliminary study, aims to explore the extent to which inpatient numbers are influenced by social deprivation. It is hypothesised that higher regional social deprivation will predict higher inpatient numbers amongst people with ID and/or autism.Data on social deprivation per English Local Authority (n = 317) are publicly available via the Indices of Multiple Deprivation, whilst data on ID and/or autism inpatient numbers per NHS Integrated Care Board (n = 42) are publicly available via NHS Digital. These data sets were curated and combined to test for associations between regional deprivation and ID and/or autism inpatient numbers per million of the general population, as well as regional deprivation and proportional makeup of inpatients with ID (with or without autism) compared to those with autism-only.Higher regional deprivation was positively correlated with a higher number of inpatients with ID and/or autism, with weak but statistically significant associations (R² = 0.104, p = 0.037). Higher regional deprivation was positively correlated with the proportion of inpatients with ID (with or without autism) (R² = 0.106; p = 0.037) and negatively correlated with the proportion of inpatients with autism-only (R² = 0.129, p = 0.019), again with weak but statistically significant associations.This study supports the hypothesis that, in England, higher regional social deprivation is associated with higher numbers of inpatients with ID and/or autism. However, it is suggested that a range of factors may be confounding the statistical evidence and obscuring stronger links between social deprivation and ID and/or autism inpatient numbers. Implications for ID and autism policy are discussed.https://www.emerald.com/tldr/article-abstract/doi/10.1108/TLDR-03-2025-0005/1276418/Social-deprivation-and-psychiatric-inpatient?redirectedFrom=fulltex
An Investigation of the effects of α- and β-Frequency neural entrainment using tACS on phase-aligned TMS-Evoked corticospinal excitability
Get PDFThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properlycited.© 2025 The Author(s). Brain and Behavior published by Wiley Periodicals LLC.PURPOSE: Deep brain stimulation (DBS) is an effective treatment for many brain disorders (e.g., Parkinson's disease), has a favorable adverse effect profile, and can be particularly effective for individuals with treatment-resistant symptoms. DBS is, however, inaccessible for most individuals, is extremely expensive, and is not considered suitable for children and adolescents. For these reasons, noninvasive alternatives to DBS, such as transcranial magnetic stimulation (TMS), are increasingly being sought to treat brain health conditions. Unfortunately, current TMS approaches exhibit large intra- and inter-subject variability in their efficacy, which limits their use clinically. One likely reason for this is that TMS is invariably delivered without reference to ongoing brain activity (i.e., open loop). METHODS: We propose that the efficacy of stimulation might be improved, and the variability of its effects reduced, if stimulation could be synchronized with ongoing brain activity. To investigate this, we used transcranial alternating current stimulation (tACS) to induce entrainment of brain activity at two frequencies (α = 10 Hz and β = 20 Hz), and we delivered single-pulse TMS that was temporally aligned with the phase of each tACS oscillation. To investigate the effects of tACS-phase-aligned TMS, we measured motor-evoked potentials (MEPs). FINDINGS: Our findings confirm that for α- and β-tACS, both corticospinal excitability and inter-trial variability varied as a function of tACS phase. Importantly, however, the tACS phase angle that produced maximum TMS-evoked excitability was different for α- and β-tACS, coinciding with the negative peak (trough) for α-tACS and the positive peak (peak) for β-tACS. CONCLUSION: These findings confirm that aligning noninvasive brain stimulation to ongoing brain activity may increase the efficacy of TMS and reduce the variability of its effects. However, our results illustrate that the optimal phase of the tACS cycle at which to deliver TMS may vary for different tACS frequencies.https://onlinelibrary.wiley.com/doi/10.1002/brb3.7087
Semaglutide-associated drug-induced liver injury: a case report and review of the literature
Get PDFSemaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA) used to manage type 2 diabetes and, since 2021, for weight loss in individuals with obesity or weight-related comorbidities. It works by enhancing insulin secretion, delaying gastric emptying and reducing appetite. Common side effects include hypoglycaemia, gastrointestinal disturbances, nausea, weight loss and cholelithiasis. While some studies have noted an association with acute kidney injury, reports of liver injury are rare. We present a rare case of drug-induced liver injury in a middle-aged female, associated with transient liver failure after semaglutide use. She presented one month after starting the medication with rapidly worsening liver function tests. Investigations, including a non-invasive liver screen, viral studies, ultrasound and CT imaging, revealed no clear cause. A liver biopsy supported the diagnosis of drug-induced liver injury. The patient improved with supportive treatment and withdrawal of semaglutide. This case underscores the importance of clinician awareness given its increasing, and often unregulated, use for weight loss.https://academic.oup.com/omcr/article/2025/9/omaf177/826694
Variation in missed opportunities for secondary fracture prevention.
No full textIntroduction Despite clear national guidelines and government support for Fracture Liaison Services, the osteoporosis treatment gap remains significant. The Fracture Liaison Service Database (FLS-DB), a national audit run by the Royal College of Physicians (RCP), has recently expanded its reporting to highlight this issue. Method Previously the FLS-DB benchmarked data from those trusts submitting data to the audit. From January 2025, an extra column has been added to show ‘Missed Opportunities’ that includes data from sites not participating in the FLS-DB. Using local hip fracture data for 2022 from the National Hip Fracture Database (NHFD) figures, the predicted local FLS caseload was determined by multiplying the number of hip fractures by 5. Expecting 80% of the predicted caseload to be identified, at least 50% of those to be recommended treatment (accounting for mortality, severe comorbidities etc.) and 80% of those initiating and staying on treatment up to 12 months gives the expected on treatment population. This was compared with the data from the FLS-DB and NHFD KPI set to generate the number with a missed opportunity. Results 77 FLS are participating with the FLS-DB with 82 NHFD sites not covered by an FLS. While 80,767 records were submitted in 2022, the missed opportunity count was estimated to be 56,550 patients (48,214 in England and 6180 in Wales) per annum. When the missed opportunity estimate was analysed in 36 ICSs, there was an over 100-fold difference in the estimate. Conclusions Despite clear guidelines and prioritisation of FLSs, over 50,000 patients are not on osteoporosis treatment when they should be. By making this data visible at the local hospital and ICS/Health board level, care providers can better judge the level of resources required for FLS locally, and the data provides support for ICSs in FLS implementation.https://academic.oup.com/ageing/article-abstract/54/Supplement_2/afaf133.031/8185910?login=true#no-access-messag
PRNP E146G mutation inherited prion disease: distinctive clinical, pathological and fluid biomarker features
No full textInherited prion diseases (IPDs) are phenotypically diverse neurodegenerative conditions caused by mutations in the prion protein gene (PRNP). We describe IPD due to a novel PRNP E146G mutation in a 50-year-old man presenting with slowly progressive dysarthria, prominent myoclonus especially in the lower limbs, and less prominent gait ataxia, pyramidal and extrapyramidal signs. Cognitive impairment was not overt at disease onset. MRI revealed cerebellar atrophy and white matter hyperintensities. His 46-year-old sister carries the mutation and has subtle gait ataxia and dysarthria. Both patients exhibit a distinctive fluid biomarker profile: in CSF S100B is > twofold upper limit of normal, total tau is moderately elevated, and neurofilament light chain, 14-3-3 and RT-QuIC are negative; in plasma there is marked elevation of GFAP but repeatedly normal neurofilament light chain. The proband's father died aged 55 following an 8-year dementing illness with similar presentation. Post-mortem revealed cerebellar cortical atrophy and profuse large PrP amyloid plaques across cerebral and cerebellar grey matter. Immunoblotting identified low molecular weight protease-resistant PrP fragments. E146G mutation IPD broadly fits into the historical Gerstmann-Sträussler-Scheinker disease spectrum but, based on deep clinical phenotyping of this initial pedigree, we highlight some distinctive features, which may aid in identification of this disease.https://link.springer.com/article/10.1007/s00415-025-13022-
Redefining urogynaecology services: the impact of nurse-physiotherapist triage clinics on reducing delays and improving patient care
No full textIntroduction and Hypothesis This project aimed to evaluate the impact of a nurse-physiotherapist triage clinic (NPTC) on service delivery within a urogynaecology department. The NPTC model was designed to be the first point of contact for urogynaecology referrals to supplement a consultant-led model and was run by specialist nurses and pelvic floor physiotherapists. The project period spanned one year before and one year after the NPTC’s introduction. Methods This was a service evaluation project registered with the local clinical governance team (reference number GYNAE374). A retrospective review of 200 case notes compared patients referred before the NPTC’s establishment, pre-NPTC or group 1 (100 new patients), with those referred afterwards, post-NPTC or group 2 (100 new patients), with ensured comparability of primary reasons for referral between both groups. The patient selection for group 1 was conducted using statistical software R version 4.4.2 (R Foundation for Statistical Computing, Vienna, Austria). Results The process measure for the project was to determine whether implementation of the NPTC reduced time intervals between general practitioner (GP) referral to first appointment and from the first visit to treatment completion. In both analyses, the NPTC showed significant reduction in the time intervals. The time interval between GP referral and first appointment was significantly reduced in group 2, with a p value of < 0.001. Similarly, the time interval from the first visit to treatment completion was shorter for group 2, with a p value of < 0.001, demonstrating the NPTC’s efficiency in accelerating the care process and reducing treatment timelines. The balance measure was to investigate patient satisfaction, using feedback forms, which was overwhelmingly positive; 95% of respondents rated the clinic’s service as ‘excellent’, and 5% rated it as ‘good’. Conclusions The NPTC model provides an effective, resource-efficient solution to urogynaecological service delivery, demonstrating its potential as a benchmark for modern urogynaecological practice. This was a successful quality improvement journey that can lead the way for adaptation of the same approach by different units.https://link.springer.com/article/10.1007/s00192-025-06259-
Use of End-of-Life care pathways in hospitalized stroke patients: a retrospective study of the AMBER care and dying adults in the last days of life approaches
No full textBackground: Stroke-related deaths often follow rapid deterioration, making end-of-life (EOL) care decisions particularly challenging in acute settings. Although national guidelines support structured approaches to end-of-life care, there is limited evidence of how these pathways are applied in routine stroke practice. Objective: To evaluate the use of structured end-of-life care pathways, including the AMBER Care Bundle and Dying Adults in the Last Days of Life (DALDL), in stroke patients who died during admission at a general hospital stroke center. Methods: This retrospective, single-center cohort study included 123 patients with confirmed stroke (73.2% ischemic, 26.8% hemorrhagic) who died in hospital during 2023. Clinical characteristics, the timing of care pathway decisions, palliative care involvement, withdrawing of medical procedures, and outcomes were analyzed. Descriptive statistics, Mann–Whitney U tests, Spearman correlations, chi-square tests, and a multivariate regression model were performed. Results: Of 123 patients, 101 (82.1%) entered the DALDL pathway a median of 14.8 days after admission, with a subsequent median survival of 2.9 days. Anticipatory medications were prescribed in 100% of DALDL patients versus 0% of non-DALDL. Do Not Attempt Cardiopulmonary Resuscitation orders were documented in 99%, and 67.3% received specialist palliative care input. Nasogastric tube insertion correlated with a higher National Institutes of Health Stroke Scale (NIHSS) and higher rate of infections. Conclusions: Most patients had access to structured EOL care, but variability in timing and interventions highlights the need for earlier palliative engagement and consistent implementation of pathways to improve the quality of EOL care in stroke patients. We detected areas that could be improved, such as access to a palliative care team and the anticipatory medication use in dying stroke patients.https://www.mdpi.com/2227-9032/13/16/197
Epidemiological and clinical landscape of nasopharyngeal carcinoma over two decades (2000-2021): a retrospective analysis of 10419 cases.
No full textTailored performance of additively manufactured titanium TPMS bone scaffold
Get PDFTriply periodic minimal surfaces (TPMS), exemplified by the Schwarz geometry, provide an optimal platform for bone scaffolds due to their high surface-to-volume ratio, continuous porosity, and bone-analogous mechanical response. Here, titanium TPMS scaffolds were additively manufactured via laser powder bed fusion (L-PBF) with precise control over geometric parameters. A data-driven surrogate model, informed by experimental and numerical analyses, was developed to map the relationship between design variables and mechanical performance. The model enabled the design of scaffolds with tailored stiffness matching that of native bone, while revealing the dominant roles of wall thickness and cell size. Porosity varied from 47 % to 68 %, governed inversely by wall thickness, while elastic modulus scaled from 6 to 24 GPa, driven primarily by wall thickness and secondarily by cell size. Yield and ultimate strengths exhibited strong positive correlations with wall thickness, spanning 240–655 MPa and 320–784 MPa, respectively. This study provides a predictive framework for engineering 3D printed titanium scaffolds with targeted mechanical properties, offering a basis for next-generation load-bearing orthopaedic implants