RSS 1.0University Hospitals Coventry and Warwickshire NHS Trust
The Trust’s mission statement is Care, Achieve and Innovate, as research into new treatments and interventions means that our patients benefit from the latest evidence-based practice. We work in partnership with Universities, industry and other partners to develop research within the Trust.
Sub-communities within this community
-
Research & Development Team
For publications by members of the R&D Team
Recent Submissions
-
Gender, race and ethnicity biases experienced by hospital physicians: an umbrella review to explore emerging biases in the evidence base.Objectives: To examine the authorship and content of systematic reviews (SRs) of biases experienced by medical professionals through a gender lens. Design: Review of SRs. Data sources: We searched PubMed, Embase, PsycINFO and CINAHL from inception. Searches were conducted in May 2022 and updated in October 2023. Eligibility criteria: Reviews of studies reporting biases experienced by hospital physicians at any stage of their careers and in any country. Reviews were included if they used systematic methods to search the literature and synthesise the data. Non-English language publications were excluded. Data extraction and synthesis: The main theme of each eligible review was identified through qualitative thematic analysis. We used NamSor to determine the first/last authors' gender and computed the proportion of female authors for each review theme. Results: 56 articles were included in the review. These covered 12 themes related to gender, race and ethnicity bias experienced by physicians at any stage of their careers. The overall proportion of female authors was 70% for first authors and 51% for last authors. However, the gender of authors by theme varied widely. Female authors dominated reviews of research on discrimination and motherhood, while male authors dominated reviews on burnout, mental health and earnings. Only six reviews were identified that included race and ethnicity; 9 out of the 12 first and last authors were female. Conclusions: Understanding the potential for a gendered evidence base on biases experienced by hospital physicians is important. Our findings highlight apparent differences in the issues being prioritised internationally by male and female authors, and a lack of evidence on interventions to tackle biases. Going forward, a more collaborative and comprehensive framework is required to develop an evidence base that is fit for purpose. By providing a point of reference, the present study can help this future development.
-
Knee-Related Patient-Reported Outcome Measures for Young Adults: A Scoping Meta-Review.Background: There is a lack of patient-reported outcome measures (PROMs) research on young adults and knee disorders. This scoping meta-review examined a young adult population and aimed to (1) provide an overview of knee-related PROMs research and (2) evaluate the measurement properties of the five most evaluated knee-related PROMs relevant for individual care and group-level analysis. Methods: A systematic search of the PubMed and COSMIN databases was conducted on 18 September 2023 and updated on 25 November 2024 to identify systematic reviews of knee-related PROMs in young adults. Data relevant to individual care and group-level analysis of the five most evaluated PROMs were extracted based on the PROM-cycle and analysed guided by COSMIN recommendations. Results: Fifteen systematic reviews were included, evaluating 80 knee-related PROMs. Ten of the 15 systematic reviews did not use a tool to synthesise multiple studies or a PROM evaluation tool. Knee Injury and Osteoarthritis Outcome Score (KOOS) had the strongest evidence to be an appropriate PROM for individual care and the Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS) for group-level analysis in a young adult population. However, none of the five PROMs demonstrated sufficient high-quality evidence across all identified measurement properties. Conclusion: The scoping meta-review highlights that systemic reviews of measurement properties were reported inconsistently, making it challenging to detangle the extracted data. Therefore, advances in PROMs-specific methods and reporting recommendations should enhance the quality of PROM evidence, allowing readers to appraise relevant evidence and select the most appropriate PROMs for their intended purpose.
-
The Development and Optimisation of a Urinary Volatile Organic Compound Analytical Platform Using Gas Sensor Arrays for the Detection of Colorectal CancerThe profile of Volatile Organic Compounds (VOCs) may help prioritise at-risk groups for early cancer detection. Urine sampling has been shown to provide good disease accuracy whilst being patient acceptable compared to faecal analysis. Thus, in this study, urine samples were examined using an electronic nose with metal oxide gas sensors and a solid-phase microextraction sampling system. A calibration dataset (derived from a previous study) with CRC-positive patients and healthy controls was used to train a radial basis function neural network. However, a blinded analysis failed to detect CRC accurately, necessitating an enhanced data-processing strategy. This new approach categorised samples by significant bowel diseases, including CRC and high-risk polyps. Retraining the neural network showed an area under the ROC curve of 0.88 for distinguishing CRC versus nonsignificant bowel disease (without CRC, polyps or inflammation). These findings suggest that, with appropriate training sets, urine VOC analysis could be a rapid, low-cost method for early detection of precancerous colorectal polyps and CRC.
-
Airway management in patients with suspected or confirmed cervical spine injury. AnaesthesiaProviding an accurate estimated time for patient handover in the emergency department (ED) can be difficult from the scene. The time taken to offload a patient from a conveying ambulance and transfer into the resuscitation room is often not considered within the estimated time of arrival (ETA). The aim of this study was to assess offload times for pre-alerted patients conveyed by a UK Helicopter Emergency Medical Service (HEMS) by air and road ambulance.
-
The offload study: A prospective observational study of the time to offload a patient from an ambulance or helicopter into an emergency department or percutaneous coronary intervention centreProviding an accurate estimated time for patient handover in the emergency department (ED) can be difficult from the scene. The time taken to offload a patient from a conveying ambulance and transfer into the resuscitation room is often not considered within the estimated time of arrival (ETA). The aim of this study was to assess offload times for pre-alerted patients conveyed by a UK Helicopter Emergency Medical Service (HEMS) by air and road ambulance.
-
Leadership training in emergency medicine: A national surveyEmergency medicine (EM) is a uniquely stressful environment in which leadership training could improve individual and team performance, patient outcomes, well-being, and EM career intentions. The primary aim was to evaluate EM-specific leadership training (EMLeaders) compared to no leadership training. A secondary comparison was with other forms of leadership training.
-
Prehospital critical care beyond advanced life support for out-of-hospital cardiac arrest: A systematic review.To assess the clinical outcomes of patients with out-of-hospital cardiac arrest attended by prehospital critical care teams compared to non-critical care teams.
-
Extrication following a motor vehicle collision: a consensus statement on behalf of The Faculty of Pre-hospital CareRoad traffic injury is the leading cause of death among young people globally, with motor vehicle collisions often resulting in severe injuries and entrapment. Traditional extrication techniques focus on limiting movement to prevent spinal cord injuries, but recent findings from the EXIT project challenge this approach. This paper presents updated recommendations from the Faculty of Pre-Hospital Care (FPHC) that reflect the latest evidence on extrication practices.
-
Biomarker-guided antibiotic stewardship in suspected ventilator-associated pneumonia (VAPrapid2): a randomised controlled trial and process evaluationBackground: Ventilator-associated pneumonia is the most common intensive care unit (ICU)-acquired infection, yet accurate diagnosis remains difficult, leading to overuse of antibiotics. Low concentrations of IL-1β and IL-8 in bronchoalveolar lavage fluid have been validated as effective markers for exclusion of ventilator-associated pneumonia. The VAPrapid2 trial aimed to determine whether measurement of bronchoalveolar lavage fluid IL-1β and IL-8 could effectively and safely improve antibiotic stewardship in patients with clinically suspected ventilator-associated pneumonia. Methods: VAPrapid2 was a multicentre, randomised controlled trial in patients admitted to 24 ICUs from 17 National Health Service hospital trusts across England, Scotland, and Northern Ireland. Patients were screened for eligibility and included if they were 18 years or older, intubated and mechanically ventilated for at least 48 h, and had suspected ventilator-associated pneumonia. Patients were randomly assigned (1:1) to biomarker-guided recommendation on antibiotics (intervention group) or routine use of antibiotics (control group) using a web-based randomisation service hosted by Newcastle Clinical Trials Unit. Patients were randomised using randomly permuted blocks of size four and six and stratified by site, with allocation concealment. Clinicians were masked to patient assignment for an initial period until biomarker results were reported. Bronchoalveolar lavage was done in all patients, with concentrations of IL-1β and IL-8 rapidly determined in bronchoalveolar lavage fluid from patients randomised to the biomarker-based antibiotic recommendation group. If concentrations were below a previously validated cutoff, clinicians were advised that ventilator-associated pneumonia was unlikely and to consider discontinuing antibiotics. Patients in the routine use of antibiotics group received antibiotics according to usual practice at sites. Microbiology was done on bronchoalveolar lavage fluid from all patients and ventilator-associated pneumonia was confirmed by at least 104 colony forming units per mL of bronchoalveolar lavage fluid. The primary outcome was the distribution of antibiotic-free days in the 7 days following bronchoalveolar lavage. Data were analysed on an intention-to-treat basis, with an additional per-protocol analysis that excluded patients randomly assigned to the intervention group who defaulted to routine use of antibiotics because of failure to return an adequate biomarker result. An embedded process evaluation assessed factors influencing trial adoption, recruitment, and decision making. This study is registered with ISRCTN, ISRCTN65937227, and ClinicalTrials.gov, NCT01972425. Findings: Between Nov 6, 2013, and Sept 13, 2016, 360 patients were screened for inclusion in the study. 146 patients were ineligible, leaving 214 who were recruited to the study. Four patients were excluded before randomisation, meaning that 210 patients were randomly assigned to biomarker-guided recommendation on antibiotics (n=104) or routine use of antibiotics (n=106). One patient in the biomarker-guided recommendation group was withdrawn by the clinical team before bronchoscopy and so was excluded from the intention-to-treat analysis. We found no significant difference in the primary outcome of the distribution of antibiotic-free days in the 7 days following bronchoalveolar lavage in the intention-to-treat analysis (p=0·58). Bronchoalveolar lavage was associated with a small and transient increase in oxygen requirements. Established prescribing practices, reluctance for bronchoalveolar lavage, and dependence on a chain of trial-related procedures emerged as factors that impaired trial processes. Interpretation: Antibiotic use remains high in patients with suspected ventilator-associated pneumonia. Antibiotic stewardship was not improved by a rapid, highly sensitive rule-out test. Prescribing culture, rather than poor test performance, might explain this absence of effect.
-
Maternal and neonatal outcomes following resuscitative hysterotomy for out of hospital cardiac arrest : a systematic reviewThe review was registered with PROSPERO (CRD42023445064). Studies included pregnant women with out of hospital cardiac arrest and resuscitative hysterotomy performed (in any setting) during cardiac arrest. We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL), from inception to 25th May 2024, restricted to humans. We included randomised controlled trials, observational studies, cases series or case reports. Two reviewers independently assessed study eligibility, extracted study data, and assessed risk of bias using validated tools. Data are summarised in a narrative synthesis.
-
Risk factors associated with COVID-19 severity among patients on maintenance haemodialysis: a retrospective multicentre cross-sectional study in the UKObjectives: To assess the applicability of risk factors for severe COVID-19 defined in the general population for patients on haemodialysis. Setting: A retrospective cross-sectional study performed across thirty four haemodialysis units in midlands of the UK. Participants: All 274 patients on maintenance haemodialysis who tested positive for SARS-CoV-2 on PCR testing between March and August 2020, in participating haemodialysis centres. Exposure: The utility of obesity, diabetes status, ethnicity, Charlson Comorbidity Index (CCI) and socioeconomic deprivation scores were investigated as risk factors for severe COVID-19. Main outcomes and measures: Severe COVID-19, defined as requiring supplemental oxygen or respiratory support, or a C reactive protein of ≥75 mg/dL (RECOVERY trial definitions), and its association with obesity, diabetes status, ethnicity, CCI, and socioeconomic deprivation. Results: 63.5% (174/274 patients) developed severe disease. Socioeconomic deprivation associated with severity, being most pronounced between the most and least deprived quartiles (OR 2.81, 95% CI 1.22 to 6.47, p=0.015), after adjusting for age, sex and ethnicity. There was no association between obesity, diabetes status, ethnicity or CCI with COVID-19 severity. We found no evidence of temporal evolution of cases (p=0.209) or clustering that would impact our findings. Conclusion: The incidence of severe COVID-19 is high among patients on haemodialysis; this cohort should be considered high risk. There was strong evidence of an association between socioeconomic deprivation and COVID-19 severity. Other risk factors that apply to the general population may not apply to this cohort.
-
Rapid exome sequencing: revolutionises the management of acutely unwell neonatesDiagnosing acutely unwell infants with a potential genetic diagnosis can be challenging for healthcare professionals. Evidence suggests that up to 13% of critically unwell infants on the neonatal intensive care unit (NICU) have an underlying molecular diagnosis and when identified directly affects treatment decisions in 83%. On 1st October 2019, the National Health Service England (NHSE) launched a nationally commissioned service so that rapid whole-exome sequencing can be offered to critically unwell babies and children with a likely monogenic disorder who are admitted to NICU and paediatric intensive care unit (PICU). We present 7 cases from two neonatal units in the West Midlands (UK), where rapid exome sequencing has revealed a genetic diagnosis. Early genetic diagnosis in this cohort has influenced management in all (100%) cases, and in 57% (4 in 7 cases), it has helped in the decision to reorientate care. In some cases, early diagnosis has reduced the need for invasive and unnecessary investigations and avoided the need for post-mortem investigations. The genetic diagnosis has helped in counselling the families regarding the recurrence risk for future pregnancies. In some cases, this has provided parents with the reassurance of a low recurrence. In others, it has resulted in the offer of prenatal diagnosis or assisted conception technologies. What is Known: • Rapid whole-exome sequencing was commissioned in the UK in October 2019. • It is available for critically unwell babies with a likely monogenic aetiology. What is New: • It helps management planning for rare genetic disorders and future pregnancies counselling. • It can reduce the need for invasive investigations and overall intensive care costs.
-
The National Joint Registry Data Quality Audit of elbow arthroplastyAims: The aim of this audit was to assess and improve the completeness and accuracy of the National Joint Registry (NJR) dataset for arthroplasty of the elbow. Methods: It was performed in two phases. In Phase 1, the completeness was assessed by comparing the NJR elbow dataset with the NHS England Hospital Episode Statistics (HES) data between April 2012 and April 2020. In order to assess the accuracy of the data, the components of each arthroplasty recorded in the NJR were compared to the type of arthroplasty which was recorded. In Phase 2, a national collaborative audit was undertaken to evaluate the reasons for unmatched data, add missing arthroplasties, and evaluate the reasons for the recording of inaccurate arthroplasties and correct them. Results: Phase 1 identified 5,539 arthroplasties in HES which did not match an arthroplasty on the NJR, and 448 inaccurate arthroplasties from 254 hospitals. Most mismatched procedures (3,960 procedures; 71%) were radial head arthroplasties (RHAs). In Phase 2, 142 NHS hospitals with 3,640 (66%) mismatched and 314 (69%) inaccurate arthroplasties volunteered to assess their records. A large proportion of the unmatched data (3,000 arthroplasties; 82%) were confirmed as being missing from the NJR. The overall rate of completeness of the NJR elbow dataset improved from 63% to 83% following phase 2, and the completeness of total elbow arthroplasty data improved to 93%. Missing RHAs had the biggest impact on the overall completeness, but through the audit the number of RHAs in the NJR nearly doubled and completeness increased from 35% to 70%. The accuracy of data was 94% and improved to 98% after correcting 212 of the 448 inaccurately recorded arthroplasties. Conclusion: The rate of completeness of the NJR total elbow arthroplasty dataset is currently 93% and the accuracy is 98%. This audit identified challenges of data capture with regard to RHAs. Collaboration with a trauma and orthopaedic trainees through the British Orthopaedic Trainee Association improved the completeness and accuracy of the NJR elbow dataset, which will improve the validity of the reports and of the associated research.
-
The diagnostic accuracy of colon capsule endoscopy in Inflammatory bowel disease - a systematic review and meta-analysisColon capsule endoscopy (CCE) has regained popularity for lower gastrointestinal investigations since the COVID-19 pandemic. While there have been systematic reviews and meta-analyses on colonic polyp detection using CCE, there is a lack of comprehensive evidence concerning colonic inflammation. Therefore, this systematic review and meta-analysis aimed to assess the diagnostic accuracy of CCE for colonic inflammation, predominantly ulcerative colitis (UC) and Crohn's disease (CD). Methods: We systematically searched electronic databases (EMBASE, MEDLINE, PubMed Central, and Cochrane Library) for studies comparing the diagnostic accuracy between CCE and optical endoscopy as the standard reference. A bivariate random effect model was used for the meta-analysis. Results: From 3797 publications, 23 studies involving 1353 patients were included. Nine studies focused on UC, and ten focused on CD. For UC, CCE showed a pooled sensitivity of 92% (95% CI, 88-95%), a specificity of 71% (95% CI, 35-92%), and an AUC of 0.93 (95% CI, 0.89-0.97). For CD, the pooled sensitivity was 92% (95% CI, 89-95%), and the specificity was 88% (95% CI, 84-92%), with an AUC of 0.87 (95% CI, 0.76-0.98). Overall, for inflammatory bowel disease, the pooled sensitivity, specificity, and AUC were 90% (95% CI, 85-93%), 76% (95% CI, 56-90%), and 0.92 (95% CI, 0.94-0.97), respectively. Conclusions: Despite the challenges around standardised disease scoring and the lack of histological confirmation, CCE performs well in diagnosing inflammatory bowel disease. It demonstrates high sensitivity in both UC and Crohn's terminal ileitis and colitis and high specificity in Crohn's disease. Further studies are needed to evaluate the diagnostic accuracy of other colonic inflammatory conditions.
-
Assessing the landscape and charting paths : UK neurology trainees' opinions on neuroinflammation subspecialtyTherapeutics of neuroinflammatory disorders including multiple sclerosis is one of the fastest growing areas in neurology. However, pressures on higher specialty training in neurology together with an expanding curriculum have led to challenges in adequately preparing trainees for a subspecialist career. In this study we set out to understand current perceptions and barriers to training in neuroinflammatory disorders among neurology trainees in the UK. A structured questionnaire was used to assess trainees' perspectives on training opportunities and career aspirations. Findings reveal significant gaps in training, including insufficient training opportunities, lack of mentorship, and concerns about managing complex treatment regimes. We used these findings to develop structured action points with aim of improving training and retention in this subspecialty. These include early exposure to subspecialty experiences, enhanced mentorship, and equal access to training opportunities regardless of geographical location. Our findings underscore the need for further curriculum development in neurology training, potentially combining early support with dedicated fellowships later in training, in order to ensure sustainability of neuroinflammation as a subspecialty and to meet the growing demand for expertise in MS and related conditions.
-
Intra-operative Pectoral Nerve Block under direct vision – does it save theatre time for breast surgery?From the European Society of Surgical Oncology (ESSO) 40 Virtual Congress 2020.
-
Benjamin Franklin: created a stronger constitution from improved catheter designEposter abstract P7-8 from the British Association of Urological Surgeons BAUS 2021 virtual meeting.