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The impact of facial prosthesis on quality of life for people with congenital defects : a systematic review
No full textPurpose: Congenital defects can often cause segregation from society due to aesthetical stigma and subjective opinion by the individual wearing the facial prosthesis, decreasing their overall Quality of Life (QoL). The aim of this systematic review is to collate and subsequently synthesise research reporting the impact of extra-oral facial prostheses on QoL for individuals with a congenital facial defect. Materials and Methods: A systematic review was undertaken following the Joanna Briggs Institute and PRISMA guidelines. The protocol was registered with the International Prospective Register of Systematic Reviews (CRD42023403545), and searches were performed in six databases from inception to June 4th 2025. Results: 1215 records were retrieved after review three articles were retained for inclusion. Four QoL measures were used across the study’s with the majority reporting QoL as a secondary outcome. A total of 22 people were represented across the study’s and were equally divided with 11 males and 11 females with an age range of 16–85. Despite the fact, numerous methodologies and QoL measures were used, statistically significant improvement in QoL was found following the fitting of a facial prostheses. Conclusions: All three studies suggest that a prosthesis influences patient QoL, however due to the small number of studies and the variety of QoL measures used, definitive conclusions regarding the impact of prosthetics on congenital facial deformities cannot be drawn. Future research should use standardized, prosthesis-specific QoL measures for clearer comparisons.https://ij-mp.com/index.php/ijmp/article/view/5
Continuous Glucose Monitoring in People at High Risk of Diabetes and Dysglycaemia: Transforming Early Risk Detection and Personalised Care
Full text linkContinuous glucose monitoring (CGM)-based interventions have been predominantly conducted in people with established diabetes. Recently, there has been an increasing interest in using CGM for clinical and research purposes in people without diabetes. In this review, we describe the current evidence regarding the use of CGM in people at high risk of diabetes. To date, there is no strong evidence to support the global implementation of CGM in individuals who are at risk of developing diabetes. However, there are promising results highlighting the benefits of CGM in specific populations such as people living with obesity, prediabetes, gestational diabetes mellitus, metabolic dysfunction-associated steatotic liver disease, other endocrinopathies, and genetic syndromes. Also, CGM has shown promising potential in people with positive islet autoantibodies and pre-symptomatic type 1 diabetes, those treated with medications that induce hyperglycaemia or diabetes, and individuals receiving solid organ transplantation who are at risk of post-transplant diabetes mellitus. However, larger studies are needed to confirm these preliminary results. CGM-derived data are not currently validated for the diagnosis of diabetes. There is no CGM-derived definition of normoglycaemia in people without diabetes. Looking to the future, CGM metrics, in tandem with physical activity, dietary intake, and clinical parameters, and eventually bioinformatics, may inform personalised risk scores for precision prevention of individuals at risk. We conclude that further research is needed to clarify the indications, drawbacks, and feasibility of CGM use in people at high risk of diabetes to identify those groups who could benefit most from this technology
Investigating the potential association between tattoos and lymphoma: an exploratory systematic review and meta-analysis.
Full text linkBACKGROUND: The tattooed population has risen significantly over the last few decades, leading to increased scrutiny into potential side effects. The recent publication of scientific articles linking tattooing to lymphoma has led to a systematic review being conducted to investigate if an association exists. METHODS: Following the PICO framework, we formed a systematic review comparing tattooed to non-tattooed adults belonging to any region of the world and investigated the likelihood of lymphomagenesis. The protocol was pre-registered on PROSPERO (ID: CRD42024586505). Relevant studies were searched for in PubMed, Web of Science, Embase, Google Scholar, and CENTRAL on 10/09/2024 and updated on 16/07/25. The inclusion criteria consisted of primary studies, including observational studies and case reports which investigated the association between tattoos and non-Hodgkin lymphoma. Exclusion criteria were publications involving subjects under 18 and non-English papers. Data extraction was performed using published numbers from individual papers after requesting raw data. Study quality was assessed using ROBINS-E, and evidence certainty using GRADE. Outcomes assessed were any odds/risk/incidence ratios that associated tattooing with non-Hodgkin lymphoma. FINDINGS: A total of four observational studies, totalling 17,941 participants (2485 cases and 15,456 controls) and three case reports were identified. None of the included studies demonstrated a statistically proven link between lymphomagenesis and tattooing. ROBINS-E showed relatively low bias for our three included studies; however, the certainty of our evidence is low due to the lack of high-quality studies with similar methodologies. The meta-analysis conducted for non-Hodgkin's lymphoma, with subtypes follicular lymphoma and diffuse large B-cell lymphoma, produced odds ratios of 1.01 (95% CI 0.82-1.24), 1.01 (95% CI 0.77-1.33) and 0.89 (95% CI 0.54-1.46), respectively. INTERPRETATION: No significant association was found between tattooing and lymphoma. Due to limitations in the data quality and lack of standardised measurable outcomes, further high-quality research is needed. FUNDING: There was no funding for this study
Trust-wide quality improvement project on improving the competence and confidence of first on-call doctors in Nottinghamshire Healthcare NHS Foundation Trust (NHCFT)
No full textAims: This project emerged in response to surveys conducted in 2022-23, which revealed first on-call doctors at NHCFT, perceived they were required to operate beyond their competency levels. Recognising this could negatively affect both patient safety, and training experience of resident doctors, we sought to improve their confidence and competence through structured support, education, and resource development. The project's aim was to ensure that no first on-call doctor would feel that they were working beyond their competency. Method(s): Cycle-1: The project began with anonymous baseline surveys using Hewson Confidence Tool, grade-specific focus groups which revealed a lack of knowledge in both clinical and practical aspects, increased stress due to untriaged workloads, and feelings of insufficient support from senior staff which contributed to widespread sense of being overwhelmed and impacted confidence and competence. Primary intervention included targeted on-call teaching sessions focussing on areas such as the role of on-call resident doctors, management of common tasks, seclusion reviews, legal frameworks, and escalation pathways. Cycle-2: Observing the positive impact on doctors' self-reported competency and confidence levels in the first PDSA cycle, Cycle 2 began with stakeholder engagement through listening events with first on-call doctors. We held discussions with key leaders, Director of Medical Education, Associate Director of Nursing, Deputy Associate Director of Physical Healthcare, ECG Trainer, Physical Healthcare Nurse, and Ward managers. Subsequently, we designed and delivered a bespoke 'First On-Call Workshop for Resident Doctors', held as two 90-minute sessions in September 2024. The workshops used interactive tools, case-based scenarios, and audio-visual aids on psychiatric medication side effects, managing psychiatric emergencies, risk assessment, escalation pathways, legal procedures e.g., Section 5(2), demonstration videos for ECG and catheterization, along with site orientation videos. Result(s): Cycle-1: Results displayed a 7% increase in confidence and competence. Cycle-2: Outcome measures displayed positive qualitative feedback and an increase in confidence in quantitative feedback by 17% in handling common on-call tasks and clinical scenarios. For sustainability, online resources and tools, i.e., workshop materials, videos, and podcasts, were made accessible and included in Resident Doctors' Survival Guide. Senior medics are now equipped with resources to facilitate these workshops, ensuring the project's longevity. Conclusion(s): This project contributed to enhancing the competence and confidence of first on-call doctors, thereby improving patient safety, and fostering a supportive learning environment within NHCFT. This initiative has underscored the importance of structured educational interventions and collaborative support systems in promoting both trainee and patient well-being.https://www.cambridge.org/core/journals/bjpsych-open/article/trustwide-quality-improvement-project-on-improving-the-competence-and-confidence-of-first-oncall-doctors-in-nottinghamshire-healthcare-nhs-foundation-trust-nhcft/41BE501B1BA11B96A6A0BC0B2476DC6
The user experience of ambulatory assessment and mood monitoring in bipolar disorder : systematic review and meta-synthesis of qualitative studies
Full text link© Laurence Astill Wright, Madiha Majid, Matthew Moore, Goldie Momoh, Renee Patil, Georgina Shajan, Daljit Purewal,
Shireen Patel, Richard Morriss. Originally published in the Journal of Medical Internet Research (https://www.jmir.org),
17.Oct.2025. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://
creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided
the original work, first published in the Journal of Medical Internet Research (ISSN 1438-8871), is properly cited. The
complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and
license information must be includedBackground: Mood monitoring and ambulatory assessment hold promise for supporting self-management and data collection in bipolar disorder (BD), but the effectiveness of these depends crucially on the preferences and perspectives of those who use them. To date, these user experiences have not been systematically synthesized. Objective: This study aimed to explore and synthesize qualitative evidence on the user experience of mood monitoring and ambulatory assessment in BD, with a focus on identifying barriers and facilitators for both individuals with BD and clinicians, as well as the intended purposes of these tools. Methods: We conducted a systematic review and meta-synthesis of qualitative and mixed-methods studies reporting on ambulatory assessment and mood monitoring in BD (PROSPERO CRD42023396473). A total of 8 electronic databases were searched. Studies were appraised using established criteria for qualitative research. First- and second-order constructs were extracted, and a third-order synthesis was developed using the Noblit and Hare meta-ethnographic approach. Results: A total of 20 studies comprising 2365 participants met inclusion criteria. We identified 9 overarching themes: adverse effects, barriers to use, facilitators to use, perceived purpose, sharing with others (positive and negative), clinician concerns, clinician suggestions, and desired features. Users reported both benefits and harms. Some experienced increased insight, behavioral change, and relapse prevention skills, while others reported emotional burden, repetitive content, and worsened mood or anxiety. Preferences varied widely, but a strong, consistent emphasis was placed on personalization, including the ability to control what is tracked, when and how it is shared, and the level of engagement with health care providers. Passive data collection was often seen as less intrusive and more sustainable. Sharing data was sometimes seen as empowering, especially when it enabled communication with trusted individuals or clinicians, but also raised concerns around autonomy, misinterpretation, and privacy. Clinicians echoed many user views but raised additional concerns about liability and interpretability of data. Participants also highlighted the need for onboarding or support to aid comprehension and effective use. Conclusions: This review highlights the complexity and diversity of user experiences with ambulatory assessment and mood monitoring in BD. While many found these tools valuable for fostering insight, self-management, and relapse prevention, others found them burdensome or confronting. User engagement appears closely tied to perceived control, relevance, and personal fit. These findings underscore the need for flexible, user-centered design in future interventions. Customizability should be prioritized—including what is monitored, how feedback is delivered, and whether data is shared externally. Incorporating onboarding and adaptive feedback could help users better understand and apply their data to better self-manage. By aligning interventions more closely with user preferences and lived experience, ambulatory assessment and mood monitoring protocols may achieve greater uptake, engagement, and ultimately, a more effective intervention. Trial Registration: PROSPERO CRD42023396473; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023396473https://www.jmir.org/2025/1/e7152
Anti-synthetase syndrome presenting primarily as interstitial lung disease in a young adult: a diagnostic challenge in acute medicine
No full textAnti-synthetase syndrome (ASyS) is a rare autoimmune connective tissue disorder (CTD) characterized by the presence of autoantibodies targeting tRNA synthetase, most notably the anti-Jo1 antibody. Clinically, it typically manifests with interstitial lung disease (ILD), inflammatory myopathy, arthritis, Raynaud's phenomenon, and the so-called mechanic's hands. Diagnosis can be challenging due to clinical overlap with other pulmonary and rheumatological disorders. We report a case of a young woman in her early 20s who presented at our same day emergency care (SDEC) with a four-week history of exertional dyspnea, low-grade fever, and productive cough, initially managed as a lower respiratory tract infection in the community. Persistent symptoms prompted further evaluation, and CT imaging of the chest, abdomen, and pelvis revealed bilateral ground-glass opacities suggestive of ILD. Five days later, she re-presented with hemoptysis, worsening breathlessness, new-onset myalgia, arthralgia, facial erythema, and hyperkeratosis of the fingertips. Autoimmune screening revealed strongly positive anti-Jo-1 and anti-Ro52 antibodies, confirming the diagnosis of anti-synthetase syndrome. She was treated with intravenous (IV) pulse methylprednisolone, mycophenolate mofetil, and rituximab, with partial clinical improvement and ongoing follow-up for advanced ILD management in a tertiary center. This case highlights how an initial diagnosis of lower respiratory tract infection (LRTI) may mask an underlying autoimmune syndrome (anti-synthetase syndrome), which later manifests as progressive respiratory failure requiring lung transplant. Therefore, as acute medicine physicians, it is imperative to maintain a broad differential diagnosis, particularly in young females newly diagnosed with possible ILD. There may be underlying conditions that require careful examination by acute care physicians, especially in the presence of systemic symptoms, notably rheumatological symptoms. This vigilance is crucial to avoid delayed diagnosis of anti-synthetase syndrome, which necessitates early multidisciplinary involvement to achieve better outcomes.https://www.cureus.com/articles/433951-anti-synthetase-syndrome-presenting-primarily-as-interstitial-lung-disease-in-a-young-adult-a-diagnostic-challenge-in-acute-medicine#!
The "forgotten disease" in a healthy young adult: a case report of lemierre's syndrome
No full textLemierre's syndrome is a rare, life-threatening condition caused by the anaerobic bacterium Fusobacterium necrophorum, typically affecting otherwise healthy individuals. The case report aims to raise awareness of this often-overlooked condition to help prevent associated morbidity and mortality. We present the case of a 22-year-old male who developed sepsis secondary to upper and lower respiratory tract infections. The patient experienced a four-week history of worsening cough and shortness of breath, followed by the onset of fever. His clinical condition rapidly deteriorated, leading to sepsis and type 1 respiratory failure, although invasive ventilation was not required. Computed tomography (CT) scans of the neck and chest revealed thrombosis of the right internal jugular and right pharyngeal veins, along with septic emboli in the lungs. Growth of Fusobacterium necrophorum in blood culturesconfirmed the diagnosis of Lemierre's syndrome. Aggressive treatment with antibiotics and anticoagulants resulted in a full recovery and resolution of thrombosis. Although rare, Lemierre's syndrome remains a potentially fatal condition, and clinicians should maintain a high index of suspicion.https://www.cureus.com/articles/410245-the-forgotten-disease-in-a-healthy-young-adult-a-case-report-of-lemierres-syndrome#!
Clinical and cost-effectiveness of a standardised diagnostic assessment for children and adolescents with emotional difficulties: the STADIA multi-centre RCT
Full text linkCopyright © 2025 Sayal et al. This work was produced by Sayal
et al. under the terms of a commissioning contract issued by
the Secretary of State for Health and Social Care. This is an
Open Access publication distributed under the terms of the
Creative Commons Attribution CC BY 4.0 licence, which permits
unrestricted use, distribution, reproduction and adaptation in
any medium and for any purpose provided that it is properly
attributed. See: https://creativecommons.org/licenses/by/4.0/.
For attribution the title, original author(s), the publication source
– NIHR Journals Library, and the DOI of the publication must
be cited.Background Emotional disorders are common in children and young people and can significantly impair their quality of life. Evidence-based treatments require a timely and appropriate diagnosis. The utility of standardised diagnostic assessment tools may aid the detection of emotional disorders, but there is limited evidence of their clinical value. Objectives To assess the clinical effectiveness and cost effectiveness of a standardised diagnostic assessment for children and young people with emotional difficulties referred to Child and Adolescent Mental Health Services. A nested qualitative process evaluation aimed to identify the barriers and facilitators to using a standardised diagnostic assessment tool in Child and Adolescent Mental Health Services. Design A United Kingdom, multicentre, two-arm, parallel-group randomised controlled trial with a nested qualitative process evaluation. Setting Eight National Health Service Trusts providing multidisciplinary specialist Child and Adolescent Mental Health Services. Participants Children and young people aged 5–17 years with emotional difficulties referred to Child and Adolescent Mental Health Services, excluding emergency/urgent referrals that required an expedited assessment. In the qualitative process evaluation, 15 young people aged 16–17 years, 38 parents/carers and 56 healthcare professionals participated in semistructured interviews. Interventions Participants were randomly assigned (1 : 1) following referral receipt to intervention (the development and well-being assessment) and usual care, or usual care only. Main outcome measures Primary outcome was a clinician-made diagnosis decision about the presence of an emotional disorder within 12 months of randomisation, collected from Child and Adolescent Mental Health Services clinical records. Secondary outcomes collected from clinical records included referral acceptance, time to offer and start treatment/interventions and discharge. Data were also self-reported from participants through online questionnaires at baseline, 6 and 12 months post randomisation, and the cost effectiveness of the intervention was investigated. Results One thousand two hundred and twenty-five (1225) children and young people were randomly assigned (1 : 1) to study groups between 27 August 2019 and 17 October 2021; 615 were assigned to the intervention and 610 were assigned to the control group. Adherence to the intervention (full/partial completion of the development and well-being assessment) was 80% (494/615). At 12 months, 68 (11%) participants in the intervention group received an emotional disorder diagnosis versus 72 (12%) in the control group [adjusted risk ratio 0.94 (95% confidence interval 0.70 to 1.28); p = 0.71]. Child and Adolescent Mental Health Services acceptance of the index referral [intervention 277 (45%) vs. control 262 (43%); risk ratio: 1.06 (95% confidence interval: 0.94 to 1.19)] or any referral by 18 months [intervention 374 (61%) vs. control 352 (58%); risk ratio: 1.06 (95% confidence interval: 0.97 to 1.16)] was similar between groups. There was no evidence of any differences between groups for any other secondary outcomes. The qualitative nested process evaluation identified a number of barriers and facilitators to the use of the development and well-being assessment during the trial, particularly at the assessment and diagnosis stages of the Child and Adolescent Mental Health Services pathway. Limitations It was not possible to mask participants, clinicians or site researchers collecting source data to treatment allocation. Conclusions We found no evidence that completion of the development and well-being assessment aided the detection of emotional disorders in this study. Using the development and well-being assessment in this way cannot be recommended for clinical practice. Future research To determine longer-term service use outcomes and to investigate whether receipt of a clinical diagnosis makes a difference to clinical outcomes and care/intervention receipt. Funding This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 16/96/09.https://www.journalslibrary.nihr.ac.uk/hta/GJKS051
Characteristics and 12-month outcomes of clinically-referred children and young people at risk of body dysmorphic disorder
Full text link© The Author(s) 2025. Open Access This article is licensed under a Creative Commons
Attribution 4.0 International License, which permits use, sharing,
adaptation, distribution and reproduction in any medium or format,
as long as you give appropriate credit to the original author(s) and the
source, provide a link to the Creative Commons licence, and indicate
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article are included in the article’s Creative Commons licence, unless
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use, you will need to obtain permission directly from the copyright
holder. To view a copy of this licence, visit http://creativecommons.o
rg/licenses/by/4.0/.Body Dysmorphic Disorder (BDD) is impairing yet often under-detected in children and young people (CYP). This paper aims to describe the characteristics and 12-month outcomes of clinically referred CYP based on their likelihood of having BDD.https://link.springer.com/article/10.1007/s00127-025-03023-
Accelerated intermittent theta burst transcranial magnetic stimulation of the dorsolateral prefrontal cortex for chronic knee osteoarthritis pain
No full textOBJECTIVE: This study assessed feasibility, safety, and tolerability of accelerated intermittent theta burst stimulation (aiTBS) with effective connectivity-guidance targeting the left dorsolateral prefrontal cortex (lDLPFC) from the right anterior insular (rAI) in chronic knee osteoarthritis pain. METHODS: The BoostCPM clinical trial (ISRCTN15404076) was a randomized, sham-controlled, single-blind, parallel-group pilot study in patients with mild-moderate chronic pain. Participants were assigned 2:1 (active: sham) aiTBS for 4 consecutive days (totaling 36,000 pulses) at a daily dose of 9000 pulses (5 sessions of 1800 pulses). Primary outcomes included safety, tolerability, pain-related and affective outcomes, and quantitative sensory testing. RESULTS: 45 participants received active (n = 33) or sham (n = 12) aiTBS. No serious adverse events were recorded, and protocol adherence (tolerability) was 80.6 % and 100 % for active and sham. Follow-up response rate was 78.1 % and overall acceptance/satisfaction was 89 %. Pain relief was observed immediately after treatment and lasted 16 weeks with clinically meaningful reduction of pain burden, but no differences between groups. CONCLUSIONS: aiTBS with rAI-connected lDLPFC targeting is a safe, well tolerated, feasible, and acceptable intervention in chronic pain patients. However, we found no additional improvements compared to sham. SIGNIFICANCE: Further studies of aiTBS and lDLPFC targeting for pain relief are warranted.https://www.sciencedirect.com/science/article/pii/S138824572500318