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

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Now showing 1 - 10 of 10

Recent Submissions

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Refractory autoimmune hepatitis in children: considerations for assessment and management
(Xia & He Publishing Inc, 2025-12-27) Valamparampil, Joseph; Brown, Rachel M; McKiernan, Patrick; Pathology; Medical and Dental; Brown, Rachel
Refractory autoimmune hepatitis (AIH) is defined as intolerance of or unresponsiveness to standard immunosuppression and occurs in 10%-20% of children with AIH. Lack of response or slower than expected response to induction of remission with steroids, despite good compliance, might be the first clue to refractory AIH. Refractoriness to treatment is associated with an 11.7 times higher risk for liver transplantation or death due to liver disease. The first and foremost consideration for the management is to assess compliance with treatment. It is then important to re-evaluate the diagnosis, assess alternative aetiologies which can mimic the clinical, serological, and histological features of AIH, and address the presence of extra-hepatic co-morbidities. It is important to consider the specific clinical situations, previous therapy, and prior adverse effects before deciding on the most appropriate treatment regimen in refractory AIH. Consideration also should be given to compliance with previous therapy, need for drug level monitoring, growth potential, available formulations, route of administration of medication, and children's and families' preferences before deciding on the therapy. Treatment should be decided and monitored only in specialized hepatology centers.
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Nutrient-stimulated hormone-based therapies: a new frontier in the prevention and management of MASH-associated hepatocellular carcinoma
(Xia & He Publishing Inc, 2025-10-22) Phillips, Richard; Ma, Yuk Ting; Hanif, Wasim; Shah, Tahir; Sivakumar, Shivan; Oncology; Diabetes; Hepatology; Medical and Dental; Phillips, Richard; Ma, Yuk Ting; Hanif, Wasim; Shah, Tahir; Sivakumar, Shivan
Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most common chronic liver disease in the Western world, driven by obesity, insulin resistance, and systemic inflammation. Its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), can culminate in cirrhosis and hepatocellular carcinoma (HCC). While lifestyle modification remains central to MASLD management, there is growing interest in pharmacological interventions, particularly nutrient-stimulated hormone-based therapies (NuSHs), such as GLP-1 receptor agonists. NuSHs exert metabolic and anti-inflammatory effects primarily via weight loss and improved insulin sensitivity. Emerging clinical data support their efficacy in resolving MASH without worsening fibrosis. However, benefits in cirrhotic patients are less evident, suggesting greater utility in early intervention. Observational studies and clinical trials suggest a reduction in liver-related morbidity with GLP-1 receptor agonist use, though fibrosis regression remains inconsistent. Preclinical models indicate that NuSHs may also reduce MASH-related HCC incidence and tumor burden, likely through systemic metabolic improvements rather than direct antineoplastic action. Observational human data following bariatric surgery reinforce this link, suggesting that weight loss itself plays a key preventive role. Herein, we propose that NuSHs are promising candidates for MASH-related HCC prevention. We provide mechanistic suggestions for how this may occur. Furthermore, incorporating NuSHs into the post-locoregional treatment pathway for HCC may delay the need for systemic anti-cancer therapies, improve immunotherapy synergy and transplant eligibility, and even slow disease progression through reversal of carcinogenic drivers. Future studies are needed to target oncological endpoints and clarify immunometabolic mechanisms to guide the integration of NuSHs into MASLD treatment algorithms.
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Cost-effectiveness of surgery for degenerative cervical myelopathy in the United Kingdom
(Taylor & Francis, 2024-04-26) Goacher, Edward; Yardanov, Stefan; Phillips, Richard; Budu, Alexandru; Dyson, Edward; Ivanov, Marcel; Barton, Gary; Hutton, Mike; Gardner, Adrian; Quraishi, Nasir A; Grahovac, Gordan; Jung, Josephine; Demetriades, Andreas K; Vergara, Pierluigi; Pereira, Erlick; Arzoglou, Vasileios; Francis, Jibin; Trivedi, Rikin; Davies, Benjamin M; Kotter, Mark R N; Hull University Teaching Hospitals NHS Trust; University of Cambridge; Goffin Consultancy; University Hospitals Birmingham NHS Foundation Trust; University College London Hospitals NHS Foundation Trust; Sheffield Teaching Hospitals NHS Foundation Trust; University of East Anglia; Royal Devon and Exeter NHS Foundation Trust; The Royal Orthopaedic Hospital NHS Foundation Trust; Nottingham University Hospitals NHS Trust; King's College Hospital NHS Foundation Trust; King's College London; NHS Lothian; East Suffolk and North Essex NHS Foundation Trust; St George's University Hospitals NHS Foundation Trust; Neurosurgery; Medical and Dental; Budu, Alexandru
Purpose: Degenerative cervical myelopathy (DCM) is the commonest cause of adult spinal cord dysfunction worldwide, for which surgery is the mainstay of treatment. At present, there is limited literature on the costs associated with the surgical management of DCM, and none from the United Kingdom (UK). This study aimed to evaluate the cost-effectiveness of DCM surgery within the National Health Service, UK. Materials and methods: Incidence of DCM was identified from the Hospital Episode Statistics (HES) database for a single year using five ICD-10 diagnostic codes to represent DCM. Health Resource Group (HRG) data was used to estimate the mean incremental surgery (treatment) costs compared to non-surgical care, and the incremental effect (quality adjusted life year (QALY) gain) was based on data from a previous study. A cost per QALY value of <£30,000/QALY (GBP) was considered acceptable and cost-effective, as per the National Institute for Health and Clinical Excellence (NICE) guidance. A sensitivity analysis was undertaken (±5%, ±10% and ±20%) to account for variance in both the cost of admission and QALY gain. Results: The total number of admissions for DCM in 2018 was 4,218. Mean age was 62 years, with 54% of admissions being of working age (18-65 years). The overall estimated cost of admissions for DCM was £38,871,534 for the year. The mean incremental (per patient) cost of surgical management of DCM was estimated to be £9,216 (ranged £2,358 to £9,304), with a QALY gain of 0.64, giving an estimated cost per QALY value of £14,399/QALY. Varying the QALY gain by ±20%, resulted in cost/QALY figures between £12,000 (+20%) and £17,999 (-20%). Conclusions: Surgery is estimated to be a cost-effective treatment of DCM amongst the UK population.
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Epidemiology, presentation, management and outcomes in chronic inflammatory demyelinating polyneuropathy in Birmingham, UK: the impact of ethnicity
(NJ Wiley, 2025-09-29) Rajabally, Zeinab; Spencer, Lydia; Mistry, Niraj; Rajabally, Yusuf A; University Hospitals Birmingham NHS Foundation Trust; Aston University; Haematology; Neurology; Medical and Dental; Spencer, Lydia; Mistry, Niraj; Rajabally, Yusuf
Background: Whether ethnicity impacts on epidemiology, presentation, management, and outcome is unknown in chronic inflammatory demyelinating polyneuropathy (CIDP). Methods: We studied the prevalence/incidence of CIDP in Asian (Indian/Pakistani/Bangladeshi) and white subjects in Birmingham, UK, and associations of ethnicity with demographics/deprivation/phenotype/treatment and outcomes. Results: On 10th July 2025, CIDP prevalence was 6.18 per 100 000 (95% CI: 4.66-8.05). Prevalence was lower in Asian (Indian/Pakistani/Bangladeshi) compared to white subjects (2.64 per 100 000 vs. 10.15 per 100 000; RR: 0.260, 95% CI: 0.111-0.609; p < 0.001). Prevalence in ≥ 50-year-olds was lower in Asian (Indian/Pakistani/Bangladeshi) compared to white subjects (8.00 per 100 000 vs. 46.68 per 100 000; RR: 0.172; 95% CI: 0.061-0.479; p < 0.001) but similar in 18-49-year-olds (2.48 per 100 000 vs. 1.83 per 100 000; RR: 1.355, 95% CI: 0.273-6.712; p = 0.661). Mean incidence of CIDP was 0.54 per 100 000 per year (95% CI: 0.404-0.713). CIDP incidence was lower in Asian (Indian/Pakistani/Bangladeshi) than in white subjects (0.24 per 100 000 per year vs. 0.86 per 100 000 per year, RR: 0.278; 95% CI: 0.118-0.654; p = 0.002). Asian (Indian/Pakistani/Bangladeshi) ethnicity was independently associated with younger age (p = 0.037), greater social deprivation (p = 0.045), and noncompliance to treatment (p = 0.016). No association of Asian (Indian/Pakistani/Bangladeshi) ethnicity was found with CIDP sub-type, diagnostic delay, pretreatment disability, access to high-cost therapies, or posttreatment outcomes. Conclusions: Subjects of Asian (Indian/Pakistani/Bangladeshi) ethnicity in the UK may have a lower risk of CIDP after 50 years of age, but an equivalent risk between 18 and 49 years, compared to white subjects. They may present younger, be more socially deprived, and be more likely noncompliant to treatment, compared to white subjects.
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Water conservation in orthopaedic surgical scrubbing: a comparative analysis of water consumption in standard and modified surgical scrubbing techniques
(Cureus, 2025-12-18) Shahbaz, Aaisha; Dinesh, Yash; Dosanjh, Kamen S; Muzammil, Sohail; Imami, Fahad; Shahbaz, Rohma; Messwi, Mohamed; Bose, Deepa; University Hospitals Birmingham NHS Foundation Trust; University of Birmingham; Doctors Hospital and Medical Center Lahore; Pakistan Air Force Hospitals; Combined Military Hospital Multan; Trauma and Orthopaedics; Anaesthetics; Surgery; Medical and Dental; Shahbaz, Aaisha; Dosanjh, Kamen Singh; Messwi, Mohamed; Bose, Deepa
Background Surgical hand scrubbing plays a vital role in preventing surgical site infections. The current guidelines recommend a scrub that lasts between two and five minutes. This, however, poses a challenge where the traditional continuous flow scrub method consumes around 20 litres of water. With water scarcity quickly becoming a global issue, this highlights the importance of finding more efficient scrubbing techniques. Objective A comparison of the duration of scrubbing and water consumed between the standard continuous flow technique and a modified tap on/off technique, to determine if significant water savings can be achieved without compromising scrub quality. Methods This study was carried out in the trauma and orthopaedic department at Queen Elizabeth Hospital, Birmingham, UK. Thirty-four healthcare professionals participated by performing both standard and modified scrub techniques. To measure the amount of water, a 25-litre container along with a weighing method was used. Stopwatches were used to track the scrub duration and the time the tap was actively running. Results The modified scrubbing technique led to reduced water use, as average staff members used 5.6 ± 1.78 litres (mean ± SD). In the standard technique, the median water use was 16.2 L (interquartile range (IQR) 6.15). The mean saving of 11.34 ± 5.57 litres (mean ± SD) was statistically significant (p < 0.0001). Scrub times were slightly longer with the modified technique, showing a mean increase of 14.96 ± 44.30 seconds (mean ± SD), but this did not reach a statistically significant difference. Conclusion The modified scrubbing method delivers significant water savings without compromising the duration of the process. This makes it a practical and sustainable option, while also supporting the NHS's commitment to the environment.