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Cost-effectiveness of a group psychological intervention for postnatal depression in British south Asian women : an economic evaluation from the ROSHNI-2 trial
Full text link© 2025 The Author(s). Published by Elsevier Ltd.This is an open access article distributed under the terms of the Creative Commons CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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To request permission for a type of use not listed, please contact Elsevier Global Rights Department.BACKGROUND: Minority ethnic groups often face ethnocultural barriers in accessing mental health treatments. The ROSHNI-2 trial compared culturally adapted cognitive behavioural therapy (Positive Health Programme [PHP]) with treatment as usual for postnatal depression in British south Asian women. We aimed to assess the cost-effectiveness of the PHP intervention. METHODS: The ROSHNI-2 trial was a multicentre, two-arm, assessor-blinded, randomised controlled trial; we conducted an economic evaluation over a 12-month period to assess the cost-effectiveness of PHP plus treatment as usual versus treatment as usual alone from the perspective of the English National Health Service and personal social services. In the trial, British south Asian women aged 16 years or older with a child aged up to 12 months, and meeting DSM-5 criteria for depression, were recruited from northwest England, Yorkshire, the East Midlands, and London. The PHP intervention involved 12 group sessions delivered by two trained bilingual facilitators, held once per week for 2 months and once per fortnight thereafter, each lasting 60-90 min. Questionnaires on depression symptoms, quality of life, and resource use were completed at baseline, 4 months (end of intervention), and 12 months after random assignment. Quality-adjusted life-years (QALYs) were used for the cost-utility analysis, and recovery from depression at 4 months (the primary clinical outcome), assessed using the Hamilton Rating Scale for Depression, informed the cost-effectiveness analysis. After the onset of the COVID-19 pandemic, the intervention was adapted for online delivery for the remaining participants. A stratified analysis compared the cost-effectiveness of online versus in-person delivery. The trial involved researchers with lived experience, and all methods, including health economic measures, were developed in consultation with service users, community members, and faith leaders. This is a preplanned analysis of the ROSHNI-2 trial, registered with ISRCTN (ISRCTN10697380). FINDINGS: From Feb 8, 2017, to March 29, 2020, 732 eligible women were enrolled: 368 participants were randomly assigned to the PHP arm and 364 to the treatment as usual arm. The base-case intention-to-treat analysis showed that PHP significantly increased costs (£712, 95% CI 311 to 1113) and QALYs (0·036, 95% CI 0·006 to 0·067), with an incremental cost-effectiveness ratio of £19 601 (7622 to 83 772). Based on the UK National Institute for Health and Care Excellence (NICE) maximum willingness-to-pay threshold of £30 000 per QALY, the likelihood of PHP being cost-effective was 77% from a health and social care perspective. Cost per remission from depression at the 4-month follow-up was £5509 (2916 to 17 860). In a stratified analysis of 34 participants attending online sessions during the pandemic, incremental QALY effects were 0·125 (0·048 to 0·203), resulting in costs of £202 (-3906 to 10 918) per additional QALY gained. INTERPRETATION: The average cost of PHP for postpartum women was below the lower end of the NICE threshold of £20 000-30 000 per QALY, excluding benefits to the child or potential gains such as reduced lost productivity from early remission. PHP, a culturally adapted group cognitive behavioural therapy-based intervention, might be a cost-effective intervention for postnatal depression in British south Asian women. Online PHP delivery showed promising clinical and cost-effective results for this group but requires a large-scale study. FUNDING: UK National Institute for Health and Care Research.https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(25)00039-2/fulltex
HistoKernel: Whole slide image level Maximum Mean Discrepancy kernels for pan-cancer predictive modelling.
No full textIn computational pathology, labels are typically available only at the whole slide image (WSI) or patient level, necessitating weakly supervised learning methods that aggregate patch-level features or predictions to produce WSI-level scores for clinically significant tasks such as cancer subtype classification or survival analysis. However, existing approaches lack a theoretically grounded framework to capture the holistic distributional differences between the patch sets within WSIs, limiting their ability to accurately and comprehensively model the underlying pathology. To address this limitation, we introduce HistoKernel, a novel WSI-level Maximum Mean Discrepancy (MMD) kernel designed to quantify distributional similarity between WSIs using their local feature representation. HistoKernel enables a wide range of applications, including classification, regression, retrieval, clustering, survival analysis, multimodal data integration, and visualization of large WSI datasets. Additionally, HistoKernel offers a novel perturbation-based method for patch-level explainability. Our analysis over large pan-cancer datasets shows that HistoKernel achieves performance that typically matches or exceeds existing state-of-the-art methods across diverse tasks, including WSI retrieval (n = 9324), drug sensitivity regression (n = 551), point mutation classification (n = 3419), and survival analysis (n = 2291). By pioneering the use of kernel-based methods for a diverse range of WSI-level predictive tasks, HistoKernel opens new avenues for computational pathology research especially in terms of rapid prototyping on large and complex computational pathology datasets. Code and interactive visualization are available at: https://histokernel.dcs.warwick.ac.uk/
The Impact of Primary Renal Diagnosis on Prognosis and the Varying Predictive Power of Albuminuria in the NURTuRE-CKD Study.
No full textINTRODUCTION: The definition of CKD is broad, which neglects the heterogeneity of risk across primary renal diseases. METHODS: The National Unified Renal Translational Research Enterprise (NURTuRE)-CKD is an ongoing UK, prospective multicenter cohort study of 2,996 adults with an eGFR of 15-59 mL/min/1.73 m2 or eGFR ≥60 mL/min/1.73 m2 with a urine albumin-to-creatinine ratio (uACR) >30 mg/mmol. Outcomes and predictive performance of eGFR and uACR were subcategorized by ERA-EDTA primary renal diagnosis (PRD) codes. RESULTS: 2,638 participants were included, with baseline median eGFR of 33.5 mL/min/1.73 m2 and uACR 29.8 mg/mmol. Over a median 49.2 months follow-up, 630 (23.9%) experienced kidney failure (KF), and 352 (13.3%) died before KF, the median eGFR slope was -1.97 mL/min/1.73 m2/year. There were significant differences in risk across the PRD, persisting after adjustment for age, sex, baseline eGFR, and modifiable risk factors (blood pressure, HbA1c, and renin-angiotensin-aldosterone system inhibitors). Diabetic kidney disease (DKD), glomerulonephritis, and familial/hereditary nephropathy were associated with the greatest risk, while tubulointerstitial disease and vasculitis carried a low risk of KF. eGFR had good predictive accuracy across all PRD. However, the addition of uACR showed variable benefit, depending on the PRD. The largest benefit was seen in vasculitis, renal vascular, and DKD groups, but uACR added no predictive value to the familial/hereditary group. CONCLUSION: Significant differences in the risk of kidney-related outcomes occurred across the various primary renal diagnoses persisting after adjustment for age, sex, baseline eGFR, and modifiable risk factors. Albuminuria's discriminatory ability as a biomarker of progression varies by diagnosis. CKD care should, therefore, take a personalized approach that always considers the primary renal diagnosis. INTRODUCTION: The definition of CKD is broad, which neglects the heterogeneity of risk across primary renal diseases. METHODS: The National Unified Renal Translational Research Enterprise (NURTuRE)-CKD is an ongoing UK, prospective multicenter cohort study of 2,996 adults with an eGFR of 15-59 mL/min/1.73 m2 or eGFR ≥60 mL/min/1.73 m2 with a urine albumin-to-creatinine ratio (uACR) >30 mg/mmol. Outcomes and predictive performance of eGFR and uACR were subcategorized by ERA-EDTA primary renal diagnosis (PRD) codes. RESULTS: 2,638 participants were included, with baseline median eGFR of 33.5 mL/min/1.73 m2 and uACR 29.8 mg/mmol. Over a median 49.2 months follow-up, 630 (23.9%) experienced kidney failure (KF), and 352 (13.3%) died before KF, the median eGFR slope was -1.97 mL/min/1.73 m2/year. There were significant differences in risk across the PRD, persisting after adjustment for age, sex, baseline eGFR, and modifiable risk factors (blood pressure, HbA1c, and renin-angiotensin-aldosterone system inhibitors). Diabetic kidney disease (DKD), glomerulonephritis, and familial/hereditary nephropathy were associated with the greatest risk, while tubulointerstitial disease and vasculitis carried a low risk of KF. eGFR had good predictive accuracy across all PRD. However, the addition of uACR showed variable benefit, depending on the PRD. The largest benefit was seen in vasculitis, renal vascular, and DKD groups, but uACR added no predictive value to the familial/hereditary group. CONCLUSION: Significant differences in the risk of kidney-related outcomes occurred across the various primary renal diagnoses persisting after adjustment for age, sex, baseline eGFR, and modifiable risk factors. Albuminuria's discriminatory ability as a biomarker of progression varies by diagnosis. CKD care should, therefore, take a personalized approach that always considers the primary renal diagnosis
The challenge of assessing impaired awareness of hypoglycaemia in diabetes in the era of continuous glucose monitoring: A narrative review of evidence and translation into clinical practice.
No full textLatrogenic hypoglycaemia remains a major barrier in diabetes care. Over time, and with repeated hypoglycaemic episodes, the physiological responses to hypoglycaemia can become blunted, resulting in impaired awareness of hypoglycaemia (IAH). In IAH, the onset of cognitive dysfunction precedes the onset of autonomic symptoms, often preventing appropriate self-treatment, thus increasing the frequency of severe hypoglycaemia (SH). Historically, IAH has been assessed with questionnaires, such as the Gold and Clarke scores, which were developed in the 1990s. A stepwise change in diabetes management in the last few decades has been the deployment of continuous glucose monitoring (CGM). CGM allows people with diabetes to set alarms that can warn them of hypoglycaemia or even impending hypoglycaemia, thus providing a degree of 'technological' awareness. This creates a challenge in assessing awareness status, as people may be alerted to low-sensor glucose events before they experience any symptoms. CGM also allows the introduction of new measures of hypoglycaemia exposure such as time below range, which might complement traditional methods of risk assessment. These changes in the field prompt a need for reassessment of the measures of IAH. This narrative review evaluates the current epidemiology of SH and IAH, explores different measures of IAH, and evaluates the relationship between CGM metrics, IAH and SH. We conclude that a clinical approach involving traditional questionnaires, or newer updated alternatives such as the Hypo A-Q awareness scale, combined with CGM metrics and clinical assessment of human factors is recommended in the absence of a clearly superior measure
Low-Risk Febrile Neutropenia Management: An Audit of Practice in a UK Cancer Center.
No full textBACKGROUND: Febrile neutropenia (FN) is a known complication of chemotherapy. Guidelines from American Society of Clinical Oncology and National Institute for Health and Care Excellence support outpatient management for low-risk FN patients; however, implementation varies across United Kingdom (UK) cancer centers. While some centers have adopted outpatient pathways, others continue to rely on inpatient care, leading to inequities in FN management. Standardized use of risk stratification tools, such as the Multinational Association of Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) scores, is essential for equitable FN management. Globally, oncology nurses play a critical role in optimizing FN care to reduce hospital admissions in low-risk patients. OBJECTIVES: This retrospective study aimed to determine the proportion of FN patients classified as low risk using the MASCC and CISNE scores, evaluate their clinical outcomes, and assess the feasibility of outpatient management. METHODS: A retrospective audit of adult patients with solid tumors admitted with FN was conducted at a UK NHS cancer center over a 6-month period. Data on MASCC/CISNE scores, clinical outcomes, length of stay, and antibiotic use were extracted from electronic records. Statistical analyses, including Mann-Whitney U and Kruskal-Wallis tests, were performed. A cost analysis estimated potential financial savings from outpatient management. RESULTS: Of 18 FN admissions, 11 (61.1%) were classified as low risk by MASCC, and 6 (54.5%) of these were also low risk by CISNE. No adverse events were observed. The median length of stay was shorter for MASCC low-risk patients v high-risk patients (6 v 8 days, P = .043). Estimated cost savings were approximately £30,000 over 6 months. Some UK centers have successfully implemented outpatient FN pathways, but variation in risk stratification and systemic inequities exist. CONCLUSIONS: Oncology nurses are key to standardizing FN risk assessment and advocating for equitable outpatient FN care. Addressing disparities in low-risk FN management may optimize healthcare resources and improve patient experience
Exploring barriers to compassionate acts in individuals with borderline personality disorder : a critical literature review
Full text linkThis 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
properly cited.
© 2025 The Author(s). Personality and Mental Health Published by John Wiley & Sons Ltd.This critical literature review explores the barriers that individuals with borderline personality disorder face when engaging in compassionate acts, including self-compassion, receiving compassion from others and expressing compassion towards others. Borderline personality disorder is characterised by emotional instability, impulsive behaviours and difficulties in maintaining stable relationships. Although compassionate acts are known to enhance recovery and well-being, individuals with borderline personality disorder often struggle with these behaviours. This review identifies several key barriers, including adverse childhood experiences, stigma and systemic discrimination, known as sanism, and internal challenges such as self-judgement, shame and fear of compassion. By synthesising findings from 29 studies, this review highlights the complex interplay between these factors and their impact on the ability of individuals with borderline personality disorder to engage in compassionate behaviours. The findings emphasise the need for personalised, trauma-informed therapeutic interventions and broader societal changes to foster a more compassionate environment for individuals with borderline personality disorder. Future research should focus on longitudinal studies, inclusion of individuals with lived experiences and exploring diverse sources of compassion to enhance understanding and support recovery in this population.https://onlinelibrary.wiley.com/doi/10.1002/pmh.7002
Improving outcomes for people who are homeless and have severe mental illness in Ethiopia, Ghana and Kenya : overview of the HOPE programme
Full text link© The Author(s), 2025. Published by
Cambridge University Press. This is an Open
Access article, distributed under the terms of
the Creative Commons Attribution licence
(http://creativecommons.org/licenses/by/4.0),
which permits unrestricted re-use,
distribution and reproduction, provided the
original article is properly cited.AIM: HOPE (National Institute for Health and Care Research Global Health Research Group on Homelessness and Mental Health in Africa) aims to develop and evaluate interventions that address the unmet needs of people who are homeless and have severe mental illness (SMI) living in three African countries in ways that are rights-based, contextually grounded, scalable and sustainable. METHODS: We will work in the capital city (Addis Ababa) in Ethiopia, a regional city (Tamale) in Ghana, and the capital city (Nairobi) and a rural county (Makueni) in Kenya to understand different approaches to intervention needed across varied settings.We will be guided by the MRC/NIHR framework on complex interventions and implementation frameworks and emphasise co-production. Formative work will include synthesis of global evidence (systematic review, including grey literature, and a Delphi consensus exercise) on interventions and approaches to homelessness and SMI. We will map contexts; conduct focused ethnography to understand lived experiences of homelessness and SMI; carry out a cross-sectional survey of people who are homeless (n = 750 Ghana/Ethiopia; n = 350 Kenya) to estimate prevalence of SMI and identify prioritised needs; and conduct in-depth interviews and focus group discussions with key stakeholders to understand experiences, challenges and opportunities for intervention. This global and local evidence will feed into Theory of Change (ToC) workshops with stakeholders to establish agreement about valued primary outcomes, map pathways to impact and inform selection and implementation of interventions. Intervention packages to address prioritised needs will be co-produced, piloted and optimised for feasibility and acceptability using participatory action research. We will use rights-based approaches and focus on community-based care to ensure sustainability. Realist approaches will be employed to analyse how contextual variation affects mechanisms and outcomes to inform methods for a subsequent evaluation of larger scale implementation. Extensive capacity-strengthening activities will focus on equipping early career researchers and peer researchers. People with lived experience of SMI and policymakers are an integral part of the research team. Community engagement is supported by working closely with multisectoral Community Advisory Groups. CONCLUSIONS: HOPE will develop evidence to support action to respond to the needs and preferences of people experiencing homelessness and SMI in diverse settings in Africa. We are creating a new partnership of researchers, policymakers, community members and people with lived experience of SMI and homelessness to enable African-led solutions. Key outputs will include contextually relevant practice and policy guidance that supports achievement of inclusive development.https://www.cambridge.org/core/journals/epidemiology-and-psychiatric-sciences/article/improving-outcomes-for-people-who-are-homeless-and-have-severe-mental-illness-in-ethiopia-ghana-and-kenya-overview-of-the-hope-programme/2459D68B7C7ACF11CA794F92DC8B662
Methaemoglobinaemia as an Alternative Diagnosis for Shortness of Breath: A Case Report.
Full text linkMethaemoglobinaemia is rarely considered as a differential diagnosis in patients presenting with shortness of breath and cyanosis. It can occur due to either congenital or acquired causes. The effect of medication is an important consideration as an acquired cause of methaemoglobinaemia, and if the diagnosis is missed, it may result in a fatal outcome. This scenario highlights the importance of awareness through thorough history-taking and careful review of investigations. Dapsone (4,4'-diaminodiphenyl sulfone) was identified as the main contributing factor in this case, and the symptoms resolved following its immediate discontinuation, with an improvement in oxygen saturation and a reduction in methaemoglobin levels
The Effect of Previous Transradial Catheterization on Radial Forearm Free Flaps.
No full textRadial forearm free flaps (RFFF) are a versatile option for the reconstruction of a wide variety of soft tissue defects and are particularly common in head and neck surgery. Benefits of RFFF include a relatively short operating time, a long pedicle, and a thinner, more pliable flap. However, in addition to its role in reconstructive surgery, the radial artery may be utilized for a number of other procedures including coronary angiography and percutaneous coronary interventions. Concern has previously been raised that prior catheterization may deleteriously affect the function of the radial artery and in the field of cardiothoracic surgery, individuals are increasingly advising against its use as a graft for coronary artery bypass graft surgery in such circumstances. Despite this, little is known about the effect on RFFF. In this review article, we concisely consider the available evidence of the effect of previous transradial catheterization on the radial artery and discuss the implications for reconstructive surgery. We then summarize the key considerations regarding their use in current practice