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.

Recent Submissions

  • PublicationMetadata only
    3D virtual models versus 2D imaging in preoperative planning for spinal En bloc resections: a comparative cohort study
    (Springer-Verlag, 2026-01-13) Shikanai, Miki; Swaminathan, Aditya; Sumonja Zisakis, Ilijana; Boo, Siu Li; Grainger, Melvin; Haseeb, Huma; Land, Thomas; Shadwell, Jonathan; Shoukry, Hussein; Soon, Wai Cheong; Walters, Sophie; Czyz, Marcin; Neurosurgery; Imaging; Neuroradiology; Cardiac Surgery; Medical and Dental; Boo, Siu Li; Grainger, Melvin; Haseeb, Huma; Land, Thomas; Soon, Wai Cheong; Walters, Sophie; Czyz , Marcin
    No abstract available
  • PublicationMetadata only
    How to diagnose papilloedema
    (BMJ, 2026-01-13) Lowe, Michael C; Berman, Gabriele; Labella Álvarez, Fernando; Shah, Pushkar; Mollan, Susan P; Ophthalmology; Medical and Dental; Berman, Gabriele
    Papilloedema is optic disc swelling due to raised intracranial pressure (ICP). Typically, this occurs bilaterally, and visual function is usually relatively preserved unless the disease is moderately severe or chronic. The implications of a new finding of papilloedema are potentially serious; however, overdiagnosis of papilloedema can lead to iatrogenic harm from unnecessary investigation or treatment. It is important to consider the differential diagnosis for swollen optic disc appearances to ensure patients are investigated appropriately. We describe an approach to the clinical assessment of patients with suspected papilloedema, using history, examination and tools available in the eye clinic including perimetry and optical coherence tomography, as well as the pitfalls that may be encountered using these technologies. We also discuss a strategy for subsequent investigation of patients with probable papilloedema to identify causes of raised ICP, while highlighting potential pitfalls in this process.
  • PublicationMetadata only
    Safety and outcomes of laparoscopic bile duct exploration: a UK-wide multi-centre study (R-ALiCE)
    (Springer, 2026-01-13) Aroori, Somaiah; Andrei, Tanase; Nassar, Ahmad; Katbeth, Tarek Z; MacDonald, Scott; Kilpatrick, Rhona; Healey, Andrew; Zanellato, Artur; Clark-Stewart, Saskia; Paterson-Brown, Simon; Gough, Vivienne; Wong, Chee Siong; McMurray, Laura; Martinez-Isla, Alberto; Navaratne, Lalin; Senra, Fatima; Fehervari, Matyas; Morgan, Richard; Murali, Sreedutt; Abdelkarim, Mostafa; Venkatesan, Gowtham S; Finlay, Ian; Al-Ardah, Mahmoud; Rottenburg, Hannah; Rasheed, Ashraf; Whewell, Harriet; Boyce, Tamsin; Mercer, Stuart; Wilson, Iain; Body, Samantha; Bhatti, Imran; Awan, Altaf; Latif, Javed; Warnaar, Nienke; Suresh, Sreelakshmi; Shahmiri, Anahita; Croxon, Cazz; Robertson, Andrew G N; Driscoll, Peter J; ClydeMarangoni, Danielle Gabriele; Ahmad, Jawad; Fitzpatrick, Suzanne; Silva, Michael; Abbas, Syed Hussain; Ceresa, Carlo; Mourad, Moustafa; Elmaradny, Ahmed; Thomas-Fernandez, Katerina; Maliyil, Jed; Pellen, Michael; Wilkins, Alex; Nazir, Shahani; Spence, Heather; Griffiths, Ewen A; Dada, Oluwasina; Dabhi, Keval; Hoque, Mohammed; Garcea, Giuseppe; Al Saoudi, Tareq; Bahri, Suchita; Roked, Samir; Adam, Streeter; Kuek, Dorothy; Sarsam, Sera; Dhavala, Pooja; Matthew, Cramp; Ashwin, Danda; Gastroenterology; Surgery; Medical and Dental; Griffiths, Ewen A; Dada, Oluwasina
    Background: The optimal management approach for suspected or confirmed bile duct stones (BDS) in patients with symptomatic gallstones remains unclear. This study evaluates outcomes and safety profile of laparoscopic common bile duct exploration and cholecystectomy (LCBDE) from a UK-wide multi-centre study. Methods: The "Retrospective Audit of Laparoscopic Common Bile Duct Exploration (R-ALiCE)", study involved 18 centres across the UK. Adult patients undergoing LCBDE for BDS between 01/01/2015 and 31/12/2019 were included. Patients who underwent LCBDE for non-stone disease and as part of another operation were excluded from the study. Results: 1,689 patients (68.2% female, median age: 59 years) were included. The open conversion rate was 5% (n = 84). Trans-cystic LCBDE (TC-LCBDE) was attempted in 71.5% (n = 1207) (success rate, 77.6%, n = 937). Trans-choledochal-LCBDE (TD-LCBDE) was performed in 41% (694), with 28.5% being direct-to-trans-ductal explorations. The TD-LCBDE success rate was 93.4% (n = 648). The bile leak rate was 4.4% (n = 75) (61, 8.8% in TD-LCBDE vs. 14,1.5% in the TC-LCBDE, Odds Ratio = 6.76; 95% CI 3.75-12.19; P < 0.001). The retained stone rate was 4.4% (n = 74) (4.1% in TC-LCBDE vs. 4.8% in TD-LCBDE; P = 0.53). Postoperative pancreatitis occurred in 0.9% (n = 15) (0.8% for TC-LCBDE vs. 1% for TD-LCBDE; P = 0.65). The bile duct stricture rate was 0 at 90-day follow-up. The 30-day readmission rate was 7.5% (n = 127). The median length of stay was 3 days (range 2-7). Overall morbidity and Clavien-Dindo grade ≥ III complications rate were 18.7% (n = 316) and 8.8% (n = 149), respectively. The 30-day mortality rate was 0.4% (n = 7). Conclusion: LCBDE is a safe and effective approach for managing BDS, with low rates of severe complications, including bile leak, postoperative pancreatitis, and retained stones. The trans-cystic approach is associated with a lower bile leak rate than the trans-ductal approach.
  • PublicationMetadata only
    Retinal perfusion and injury in sepsis and after major surgery
    (Elsevier, 2025-07-22) Courtie, Ella; Mallawaarachchi, Gagana; Kale, Aditya U; Gilani, Ahmed; Capewell, Nicholas; Holding, Donna; Hui, Benjamin T K; Liu, Xiaoxuan; Laws, Elinor; Logan, Ann; Whitehouse, Tony; Denniston, Alastair K; Veenith, Tonny; Blanch, Richard J; Ophthalmology; Resarch and Development; Medical and Dental; Admin and Clerical; Kale, Aditya; Holding, Donna; Denniston, Alastair; Blanch, Richard
    OBJECTIVE: Assess retinal perfusion in sepsis, compared with uncomplicated postoperative care and healthy controls, and assess the effects of reduced perfusion on retinal structure and visual function. DESIGN: We conducted a prospective observational cohort study between March 2018 and December 2022, with follow-up measures collected 3 to 6 months after discharge. SUBJECTS: Twenty-four patients with sepsis were assessed in the intensive care unit (ICU) and 3 to 6 months later, 45 ICU control patients assessed during elective ICU admission after upper gastrointestinal cancer surgery, preoperatively, and 3 to 6 months later, and 15 healthy controls. TESTING: Assessments included retinal layer thickness using OCT, retinal perfusion using OCT angiography, and visual function using Humphrey visual field analysis. Organ dysfunction was assessed by Sequential Organ Failure Assessment (SOFA) scoring. MAIN OUTCOME MEASURES: Superficial vascular plexus (SVP) retinal perfusion, OCT retinal ganglion cell layer (GCL) thickness, and mean deviation (MD) on Humphrey visual field testing were evaluated. RESULTS: Superficial vascular plexus retinal perfusion was 37.4% lower in patients with sepsis compared with ICU control patients ( < 0.001) and 59.7% lower than in healthy controls, which returned to normal by final follow-up. Retinal perfusion correlated with the SOFA score (Pearson = -0.57, < 0.001) and weakly correlated with C-reactive protein ( = -0.337, = 0.01) and mean arterial pressure ( = 0.354, = 0.006). In patients with sepsis and ICU controls, retinal perfusion in the ICU predicted subsequent GCL thickening, with every 1-unit decrease in SVP sum predicting a 1.88 μm increase in GCL thickness at follow-up ( = 0.003), and worsening visual field MD, with every 1-unit decrease in SVP sum predicting a 0.078 decibel lower MD ( = 0.023). CONCLUSIONS: Retinal perfusion was impaired in patients with sepsis compared with both healthy controls and patients after major surgery. It was moderately associated with other measures of organ dysfunction assessed by SOFA. Reduced retinal perfusion in both patients with sepsis and patients after major surgery is strongly associated with subsequent GCL thickening and less strongly associated with decreased visual field MD, suggesting reduced retinal perfusion is associated with retinal damage, with consequent visual dysfunction. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
  • PublicationOpen Access
    Improving the Use of Section 5(2) of the Mental Health Act - Mental Health Liaison Team and UHCW
    (Coventry and Warwickshire Partnership NHS Trust, 2026-01-22) Hasnaoui, Sabrina; Supported by the Quality Improvement Team; Coventry and Warwickshire Partnership NHS Trust; Psychiatry; Medical and Dental; Hasnaoui, Sabrina
    Project Aim: To reduce discrepancies with data on the use of Section 5(2) of the Mental Health Act (MHA) from 42% in April 2024 to 0% by April 2025. Section 5(2) of the Mental Health Act 1983 (MHA) allows for the compulsory detainment of mentally unwell inpatients in hospital for up to 72 hours. Compliance with the MHA Code of Practice should be maintained to ensure the lawful detention of patients. Outside psychiatric hospital settings, healthcare staff may be less familiar with the requirements of the MHA and its application. This project aimed to reduce discrepancies with data on the use of Section 5(2) and improve the accuracy of the information recorded. Tools Used: SPC Chart - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-statistical-process-control.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf ; Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-conventional-process-mapping.pdf. Project Impact: 100% of Section5(2) detentions are now known to both UHCW and the CWPT Mental Health Liaison Team. Members of the safeguarding team have been upskilled through locally arranged MHA teaching sessions and formal Mental Health Administrator training. Collaboration and increased communication between the acute and mental health trust. Increase in accuracy of section 5(2) paperwork from 59% to 85%. All old versions of the 5(2) form removed from throughout the hospital site. All detained patients throughout the hospital now have alert flags added to electronic medical records and are placed on a safer staffing tool to ensure MHA administrative oversight by the Safeguarding Team. Data on all detentions is presented at a bimonthly Mental Health Safeguarding Subgroup with oversight from the Chief Nursing Officer. UHCW run regular quarterly audits on MHA paperwork quality and present this at a newly established MHA governance meeting which a CWPT Consultant Psychiatrist also attends.
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