West Midlands Evidence Repository

WMER is an online repository that is managed by a consortium of West Midlands NHS Library and Knowledge Services. Our aim is to collate, store and make available research and other non-traditional publications by our NHS organisations.

Please see below for the full list of WMER organisations. If you wish to engage with us as we develop the repository, please contact us via email: wmnhskr@gmail.com

Please note deposit of items within WMER does not mean endorsement of the research or any opinions expressed within it by the consortium organisations.

Communities in WMER

Select a community to browse its collections.

Now showing 1 - 10 of 10

Recent Submissions

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Conservatively managed Iatrogenic coronary fistula to the coronary sinus during primary percutaneous intervention
(Elsevier, 2025-12-11) Mahdy, Tarek; Khedr, Mahmoud; Hoey, Edward; Bhatia, Gurbir; Ment, Jerome; Pulikal, George; Cardiology; Radiology; Medical and Dental; Mahdy, Tarek; Khedr, Mahmoud; Hoey, Edward; Bhatia, Gurbir; Ment, Jerome; Pulikal, George
Background: Iatrogenic coronary fistula is a rare complication during percutaneous coronary intervention. Case summary: A 69-year-old woman presented with inferior ST-segment elevation myocardial infarction for which she underwent a primary percutaneous coronary intervention. During the procedure, a communication was noted between the distal right coronary artery and the coronary sinus. The patient was hemodynamically stable. She underwent a computed tomography coronary angiography and echocardiography which confirmed the diagnosis of coronary fistula. She underwent staged procedure for percutaneous coronary intervention, and the fistula flow diminished. The patient remained under follow-up and regular imaging assessment with no concerning signs or symptoms. Discussion: Despite its rarity, iatrogenic coronary fistula during intervention can occur due to intimal balloon inflation, guidewire perforation, and artery-balloon size mismatch. Take-home messages: The appropriate treatment for iatrogenic coronary fistula should be determined on an individual-specific basis. A detailed multimodality imaging assessment is required to determine the fistula route and its hemodynamic effect.
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Learning curve's impact on positive surgical margins in RALRP: a prospective cohort study and meta-analysis
(Elsevier Masson SAS, 2025-12-11) Deb, Abdalla Ali; Naushad, Naufal; Moschonas, Stavros; Serag, Hosam; Abbas, Sami; Zayed, Abdellatif Mohamed; Shaheen, Ashraf M S; Urology; Medical and Dental; Serag, Hosam
Introduction: Robot-assisted laparoscopic radical prostatectomy (RALRP) is becoming increasingly adopted for prostate cancer; however, it is associated with a steep but achievable learning curve. The effect of that curve - particularly on positive surgical margin (PSM) rates, a key oncological outcome - remains underexplored. Objective: To assess the effect of surgical experience on RALRP outcomes through a prospective cohort study and to contextualize findings via a systematic review and meta-analysis of PSM incidence across learning curve stages. Material: We conducted a prospective study of 100 consecutive patients who underwent RALRP at a single center, grouped as cases 1-50 (Group I) and 51-100 (Group II) comparing perioperative, pathological, and functional outcomes. Additionally, a systematic review and meta-analysis in accordance with PRISMA 2020 guidelines was conducted using random effects modelling. Results: Significant improvements in operative time, blood loss, hospital stay, and early functional recovery were noted in Group II. The PSM rate declined from 30 to 14% (P=0.053), approaching thus statistical significance, with no significant difference in biochemical recurrence. The meta-analysis included 22 studies and demonstrated a pooled PSM rate of 28% (95% CI: 24-33%) for surgeons with≤100 cases, decreasing to 22% (95% CI: 17-27%) for 101-200 cases, and to 18% (95% CI: 14-22%) for 401-500 cases. Similar trends were observed in both pT2 and pT3 subgroups. Due to heterogeneity in reporting, other perioperative outcomes could not be meta-analyzed. Conclusion: Surgical experience significantly influences PSM rates in RALRP. These findings highlight the need for structured robotic training and standardized reporting to optimize oncologic outcomes in prostate cancer surgery. Level of evidence: Level III, Retrospective Cohort.
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Healthcare utilization, costs, and cost-effectiveness of patients undergoing laparoscopic and open hemihepatectomy: a secondary analysis of the ORANGE II PLUS randomized controlled, phase 3, superiority trial
(Springer, 2025-12-12) Olij, Bram; Pilz da Cunha, Gabriela; Kimman, Merel; Ratti, Francesca; Abu Hilal, Mohammad; Troisi, Roberto I; Sutcliffe, Robert P; Besselink, Marc G; Aroori, Somaiah; Menon, Krishna V; Edwin, Bjørn; D'Hondt, Mathieu; Lucidi, Valerio; Ulmer, Tom F; Díaz-Nieto, Rafael; Soonawalla, Zahir; White, Steve; Sergeant, Gregory; Coolsen, Mariëlle M E; Kuemmerli, Christoph; Scuderi, Vincenzo; Berrevoet, Frederik; Vanlander, Aude; Marudanayagam, Ravi; Tanis, Pieter J; Dewulf, Maxime J L; Fichtinger, Robert S; Eminton, Zina B; Neumann, Ulf P; Brandts, Lloyd; Pugh, Siân A; Fretland, Åsmund A; Primrose, John N; van Dam, Ronald M; Liver Unit; Medical and Dental; Sutcliffe, Robert P; Marudanayagam, Ravi
Background: Laparoscopic hemihepatectomy (LH) has favorable short-term outcomes compared with open hemihepatectomy (OH), including shorter hospital stay. An in-depth healthcare utilization and cost-effectiveness analysis of the international multicenter ORANGE II PLUS randomized controlled trial comparing LH and OH was performed. Patients and methods: Patients were randomly assigned to LH or OH in 16 European centers from October 2013 to January 2019. Costs were determined as a product of unit costs using patient-level, clinician-reported resource utilization up to 90 days. Item-specific resource use per country was presented. The measure of effect was quality-adjusted life year (QALY). Cost and effect differences were compared between treatment arms using nonparametric bootstrapping, from a Dutch healthcare cost perspective. A cost-effectiveness analysis was performed to establish the incremental cost-effectiveness ratio (ICER), i.e., costs per QALY gained, for LH compared with OH 1 year postoperatively. Results: Among 332 patients randomized to LH (n = 166) and OH (n = 166), intraoperative costs were higher for LH (LH 13,208 € versus OH 9437 €), while postoperative costs were lower for LH (LH 5774 € versus OH 7703 €). Longer operative time and greater instrument use contributed to higher intraoperative costs, while shorter hospital stays contributed to lower postoperative costs. Mean overall costs per patient were higher in LH (LH 18,982 € versus OH 17,141 €). The QALYs gained over 1 year postoperative were mean (standard deviation [SD]) 0.834 (0.218) for LH and mean 0.795 (0.237) for OH. The ICER was 36,677 € per additional QALY gained, and uncertainty analyses showed that LH had a 77% probability of being cost-effective compared with OH at a willingness-to-pay (WTP) threshold of 80,000 €. Conclusions: Although LH was more costly than OH, in a multicenter randomized trial, its clinical advantages translated into more QALYs gained over the first postoperative year and high probability of cost-effectiveness. These findings suggest that, where resources allow, LH may be preferred over OH for selected patients, offering both clinical benefits and acceptable economic value.
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The association of socioeconomic status on kidney transplant access and outcomes: cohort studies of England and Northern Ireland
(Lippincott Williams & Wilkins, 2025-12-12) Corr, Michael; Beck, Jenni; Courtney, Aisling E; Cardwell, Christopher; Bailey, Pippa K; Cockwell, Paul; O'Neill, Ciaran; Maxwell, Alexander P; McKay, Gareth J; Renal Unit; Medical and Dental; Cockwell, Paul
Background: While socioeconomic status (SES) is an established determinant of kidney transplant access and outcomes, less is known about how these disparities vary within universal healthcare systems. This study hypothesized that, despite shared healthcare and organ allocation systems, regional differences would be observed in the magnitude and pattern of the association between SES and transplant access and outcomes between England and Northern Ireland (NI). Methods: We conducted a retrospective cohort study using national transplant registry data from England (n = 42 220) and NI (n = 1615) from 2000 to 2020. SES was measured using national deprivation indices. Outcomes included transplant incidence, preemptive and living donor transplantation, graft survival, and patient survival. Statistical analyses included Poisson regression, Cox proportional hazards models, and concentration indices to assess equity. Results: In England, lower SES was significantly associated with reduced transplant access (incidence rate ratio for most versus least deprived quintile, 0.71; 95% confidence interval [CI], 0.69-0.73), lower rates of preemptive and living donor transplantation, and poorer graft (hazard ratio, 1.41; 95% CI, 1.32-1.50) and patient survival (hazard ratio, 1.49; 95% CI, 1.39-1.59). These disparities persisted across ethnic groups. In contrast, NI showed no significant SES-related differences in transplant access, despite a more deprived population overall. Conclusions: SES remains strongly associated with transplant access in England but not in NI, suggesting that regional models of healthcare delivery may mitigate or exacerbate inequities.These findings suggest a role of system design in promoting equity.
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UK multisociety consensus statement on the emergency management and resuscitation of patients with left-sided Impella support.
(BMJ Pub. Group, 2025-12-18) Akhtar, Waqas; Bowles, Christopher T; Costanzo, Pierluigi; Deakin, Charles D; Elliot, Pauline; Eladawy, Mostafa; Gardner, Roy S; Govier, Matthew; Handslip, Rhodri; Hill, Jonathan; Jain, Ajay; Khan, Sohail Q; Lewis, Ifan; Lim, Hoong Sern; Mariathas, Mark; Mellis, Clare; Monteagudo-Vela, Maria; Naldrett, Ian; Ostermann, Marlies; Perera, Divaka; Pinto, Sofia; Richardson, Carla; Ranasinghe, Aaron; Gil, Fernando Riesgo; Rosenberg, Alex; Schueler, Stephan; Sinclair, Andrew; Swanson, Neil; Wilson, Simon; Webb, Ian; Webb, Stephen; Walker, Christopher; Panoulas, Vasileios; Cardiology; Anaesthetics; Medical and Dental; Khan, Sohail; Richardson, Carla
The use of left-sided Impella microaxial flow pumps has expanded rapidly for the management of cardiogenic shock, left ventricular unloading and as a bridge to heart transplantation. However, standard life support and resuscitation algorithms are not directly applicable to patients receiving this therapy due to fundamental alterations in circulatory physiology. To address this gap, eleven UK Impella centres and eight national professional societies collaborated to develop a unified national consensus statement on the emergency management of patients with left-sided Impella support. Using a systematic review of the literature and a modified Delphi process guided by the European Society of Cardiology framework for grading recommendations, expert representatives achieved agreement on key priorities and structured actions to be undertaken in the first few minutes of resuscitation.The consensus outlines early recognition of circulatory inadequacy (mean arterial pressure <30 mm Hg or end-tidal CO₂ <2 kPa), prompt activation of multidisciplinary responders, reduction of Impella power to P2 before initiating cardiopulmonary resuscitation and structured division of patient-focused and device-focused teams. Device-specific troubleshooting algorithms are presented for suction, malposition, purge-system failure and mechanical malfunction. This multisociety consensus represents the first national standard for emergency management and resuscitation of patients supported by a left-sided Impella device and is intended to inform structured clinical training and improve patient outcomes through rapid, coordinated and physiologically tailored interventions.