Midlands Evidence Repository
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Nutritional Status as a Key Consideration in Dengue Vaccine Outcomes for Adolescents.
Get PDFNo abstract availablehttps://onlinelibrary.wiley.com/doi/10.1002/rmv.7004
The role of alcohol and smoking in delirium risk among older adults. Source
Get PDFNo abstracthttps://onlinelibrary.wiley.com/doi/10.1111/ggi.7008
Hormonal Treatment Effects on Imaging Phenotypes in AI Breast Cancer Detection.
No full textNo Abstracthttps://www.academicradiology.org/article/S1076-6332(25)00514-8/abstrac
Glucose Lowering through Weight management (GLoW): a randomised controlled trial of the clinical and cost effectiveness of a diabetes education and behavioural weight management programme vs a diabetes education programme in adults with a recent diagnosis of type 2 diabetes
Get PDFThis article relates to a research study that included patients or members of the workforce as study participants from GP practices in Nottingham and Nottinghamshire.Aims/hypothesis: UK standard care for type 2 diabetes is structured diabetes education, with no effects on HbA1c, small, short-term effects on weight and low uptake. We evaluated whether remotely delivered tailored diabetes education combined with commercial behavioural weight management is cost-effective compared with current standard care in helping people with type 2 diabetes to lower their blood glucose, lose weight, achieve remission and improve cardiovascular risk factors. Methods: We conducted a pragmatic, randomised, parallel two-group trial. Participants were adults (≥18 years) with overweight or obesity (BMI≥25 kg/m2) and recently diagnosed with type 2 diabetes (≤3 years), recruited from 159 primary care practices in England. We randomised participants to a tailored diabetes education and behavioural weight management programme (DEW; delivered by Weight Watchers) or to current standard care diabetes education (DE; Diabetes Education and Self Management for Ongoing and Newly Diagnosed [DESMOND] programme), using a computer-generated randomisation sequence in a 1:1 allocation stratified by gender and diabetes duration, unknown to those collecting and analysing the data. Participants could not be blinded due to the nature of the interventions. Participants completed assessments at 0, 6 and 12 months. The primary outcome was 12 month change from baseline in HbA1c. We also assessed bodyweight, blood pressure, cholesterol (total, HDL, LDL), glucose-lowering medication, behavioural measures (physical activity, food intake), psychosocial measures (eating behaviour, diabetes-related quality of life, wellbeing) and within-trial and modelled lifetime cost effectiveness. Results: We randomised 577 participants (DEW: 289, DE: 288); 398 (69%) completed 12 month follow-up. We found no evidence for an intervention effect on change in HbA1c from baseline to 12 months (difference: -0.84 [95% CI -2.99, 1.31] mmol/mol, p=0.44) or 6 months (-1.83 [-4.05, 0.40] mmol/mol). We found an intervention effect on weight at 6 (-1.77 [-2.86, -0.67] kg) and 12 months (-1.38 [-2.56, -0.19] kg). Participants in DEW had a higher likelihood of achieving diabetes remission than participants in DE (6 months: RR 2.10 [95% CI 1.03, 4.47]; 12 months: RR 2.53 [1.30, 5.16]). DEW was cost-effective compared with DE in within-trial and lifetime analyses, in the latter generating an incremental cost effectiveness ratio of £2290 per quality-adjusted life year gained. Conclusions/interpretation: A commercial behavioural weight management programme combined with remote dietary counselling after diagnosis of type 2 diabetes did not improve HbA1c up to 12 months post intervention in this trial. The intervention could help people achieve weight loss and be cost-effective compared with current standard National Health Service care
Case of the month from Northampton General Hospital, Northampton, UK: renal accessory spleen
No full texthttps://bjui-journals.onlinelibrary.wiley.com/doi/10.1111/bju.1643
Is geographical variation in emergency epilepsy admissions related to variation in new epilepsy diagnoses among children and young people across England? An observational study using linked datasets.
Get PDFIntroduction Previous studies have reported widespread unexplained geographical variations in emergency paediatric admissions for epilepsy. Objectives Our aim was to investigate the extent to which geographical variation in epilepsy admissions among children and young people (CYP) aged 0–18 years, in England, reflects variation in new epilepsy diagnoses. Design and setting A retrospective secondary analysis of Hospital Episode Statistics data for emergency admissions between April 2018 and March 2019, and Epilepsy12 audit data for new epilepsy diagnoses in England, between July and November 2018. Outcome measures The ratios of observed to expected epilepsy admissions and new diagnoses were calculated for each hospital Trust, based on their catchment population, and adjusted for age, sex and deprivation. Standardised ratios of observed to expected epilepsy admissions were plotted against standardised ratios of observed to expected new diagnoses of epilepsy at Trust level and the Pearson correlation coefficient was calculated. Results There were 9246 emergency admissions for CYP to 134 Trusts with a primary diagnosis of epilepsy in England during the study period. 60 Trusts (44.4%) had either significantly lower or higher than expected standardised admission ratios for a primary diagnosis of epilepsy. There were 960 new diagnoses of epilepsy between July and November 2018 for 74 Trusts. 14 Trusts (18.9%) had either lower or higher standardised diagnosis ratios for a new diagnosis of epilepsy. There was no correlation between standardised emergency epilepsy admissions ratios and standardised new epilepsy diagnoses ratios at Trust level (Pearson r −0.06, p 0.63). Conclusions Widespread unexplained variation in epilepsy admissions cannot be explained by variation in new epilepsy diagnosis. This raises concerns about the equity and accessibility of epilepsy services. Unit-level benchmarking data on new diagnoses and admissions for epilepsy can inform strategies to improve access to care and health outcomes.https://bmjopen.bmj.com/content/15/2/e08263
Worldwide trends in the quality and breadth of clinical investigations of medical devices over the past decade: a scoping review and evidence map.
Get PDFBackground Recent regulatory developments in Europe have enhanced the requirements for clinical investigations of medical devices, partly in response to a perceived need for a higher level of evidence that is publicly available. This scoping review aims to map published clinical investigations of medical devices by device type and clinical specialty and summarise key trial design aspects. Methods We developed a search for EMBASE that identified clinical investigations of medical devices during two discrete 3-month periods at the end of 2012 and of 2022. Core information from observational studies was extracted along with details on study design in interventional studies. We developed an evidence map of published studies across device type and clinical specialty and summarised study design aspects. Results We included 682 studies from 2012 and 1682 studies from 2022. Around a quarter of studies were interventional and the remainder being observational and primary outcomes of effectiveness were more common than efficacy. Key study design aspects were frequently unreported, including sample size justification, registration, randomisation technique and funders. Our evidence map demonstrated that predominantly, investigations were of implants and were in a cardiovascular setting. Clinical investigations were broadly similar between 2012 and 2022, though there was a reduction in the proportion of cardiovascular studies, a move in the share of studies coming out of Europe and North America towards Asia and a general improvement in the quality of study design reported. Conclusions Implanted devices in cardiovascular disease and orthopaedics are the focus of a large proportion of published clinical investigations of medical devices. Reporting of key study design aspects of clinical investigations of medical devices are improving but are still below expected requirements.https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-025-08793-
Symptomatic vitamin A deficiency in a patient on long-term colesevelam.
No full textIntroduction Bile acid sequestrants including colesevelam are increasingly used by gastroenterologists. The risk of fat-soluble vitamin deficiency when sequestrants are used is recognised. Vitamin A deficiency is uncommon in the UK, but delayed diagnosis can cause irreversible blindness. There are no guidelines for the monitoring of fat-soluble vitamin levels. Case discussion We describe a 63-year-old man who had a neuroendocrine tumour, treated with ileal resection and lanreotide and complicated by the development of severe bile acid malabsorption, pancreatic exocrine insufficiency and intermittent episodes of small intestinal bacterial overgrowth. Three and a half years after starting colesevelam, he developed progressive visual symptoms due to severe vitamin A deficiency. After diagnosis and parenteral vitamin A replacement, his visual symptoms improved but have not resolved. Conclusions Clinicians prescribing bile acid sequestrants should be aware that vitamin A deficiency may arise and should consider regular monitoring of serum levels.https://fg.bmj.com/content/early/2025/02/05/flgastro-2024-10291
Psychological detachment from work predicts mental wellbeing of working-age adults: Findings from the 'Wellbeing of the Workforce' (WoW) prospective longitudinal cohort study
Get PDF© 2025 Blake et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.BACKGROUND: There is an urgent need to better understand the factors that predict mental wellbeing in vocationally active adults during globally turbulent times. AIM: To explore the relationship between psychological detachment from work (postulated as a key recovery activity from work) in the first national COVID-19 lockdown with health, wellbeing, and life satisfaction of working age-adults one year later, within the context of a global pandemic. METHODS: Wellbeing of the Workforce (WoW) was a prospective longitudinal cohort study, with two waves of data collection (Time 1, April-June 2020: T1 n = 337; Time 2, March-April 2021: T2 = 169) corresponding with the first and third national COVID-19 lockdowns in the UK. Participants were >18 years, who were employed or self-employed and working in the UK. Descriptive and parametric (t-tests and linear regression) and nonparametric (chi square tests) inferential statistics were employed. RESULTS: Risk for major depression (T1: 20.0% to T2: 29.0%, p = .002), poor general health (T1: 4.7% to T2: 0%, p = .002) and poor life satisfaction (T1: 15.4% to T2: 25.4%, p = .002) worsened over time, moderate-to-severe anxiety remained stable (T1: 26.1% to T2: 30.2%, p = .15). Low psychological detachment from work was more prevalent in the first wave (T1: 21.4% and T2: 16.0%), with a moderate improvement observed from T1 to T2 (t (129) = -7.09, p < .001). No differences were observed with work status (employed/self-employed), except for self-employed workers being more likely to report poor general health at T1 (16.1%, p = .002). Better psychological wellbeing, lower anxiety and higher life satisfaction at T2 were observed in those who reported better psychological detachment from work at T1 (β = .21, p = .01; β = -.43, p < .001; β = .32, p = .003, respectively), and in those who improved in this recovery activity from T1 to T2 (β = .36, p < .001; β = -.27, p < .001; β = .27, p = .008, respectively), controlling for age, gender and ethnicity. CONCLUSION: The ability to psychologically detach from work during the first pandemic lockdown, and improvement in this recovery activity over time, predicted better mental wellbeing and quality of life in vocationally active adults after one year of a global crisis, irrespective of work status. Interventions to encourage workers to psychologically detach from work may help to support employee wellbeing at all times, not only in the extreme circumstances of pandemics and economic uncertainty.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.031267
Peer support for discharge from hospital to community mental healthcare: A cost analysis
Get PDF© Author(s) (or their
employer(s)) 2025. Re-use
permitted under CC BY.
Published by BMJ Group.No abstract availablehttps://gpsych.bmj.com/content/38/1/e10167