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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Recent Submissions
Publication Associations of multimorbidity with mortality, hospital stay, and hospitalization costs in Chinese surgical patients: a retrospective cohort study(BioMed Central, 2025-08-14)Background: Multimorbidity (≥ 2 chronic conditions) is rising in aging populations. China reports over 80 million surgeries annually. This study investigates health burdens of multimorbidity in Chinese surgical patients. It highlights its impact on postoperative outcomes using large-scale data across diverse surgical types, addressing a key gap in existing evidence. Methods: This retrospective cohort study includes adult patients who underwent non-cardiac surgery in 2023 at a major national-level medical center in China. Patients were categorized by having no morbidity, one morbidity, or multimorbidity. Outcomes included in-hospital mortality, hospital stay, and hospitalization costs. Multivariable regression analyses assessed associations, and identified disease combinations with the highest risk and costs. Results: Among 37,084 surgical patients, 17.4% had multimorbidity. Their in-hospital mortality rate was 1.5%, compared to 0.7% with one morbidity and 0.2% with none. Median hospital stays were 8, 7, and 6 days, respectively. Patients with multimorbidity had higher median hospitalization costs ($6,485), compared to $4,975 for one morbidity, and $3,714 for none. Multivariable analysis demonstrated multimorbidity was significantly associated with higher postoperative mortality (P < 0.001), longer hospital stays (P < 0.001), and increased cost (P < 0.001). Hypertension combined with chronic kidney disease and anemia posed the highest mortality risk and costs. Conclusions: Multimorbidity was linked to a 2 to 7-fold increase in mortality, 1-2 extra hospital days, and $1,510-2,771 higher costs compared with patients having one or no morbidities. This large-scale annual study in China underscores the need for enhanced preoperative evaluations and tailored care strategies to improve outcomes and reduce costs for multimorbid surgical patients.Item Association between sleep duration and obesity in patients with type 2 diabetes : a longitudinal study(Wiley, 2025-04-17)Background: Obesity is prevalent in patients with type 2 diabetes (T2D) and negatively impacts diabetes outcomes. While studies in the general population have established a link between sleep duration and obesity, this relationship in T2D remains unclear. Objectives: To assess the association between sleep duration and adiposity in patients with T2D. Methods: This prospective study of adults enrolled in the SLEEP T2D study from 13 UK NHS Trusts. Sleep duration was self-reported using the Pittsburgh Sleep Quality Index (PSQI) and categorized as short (≤ 6 h/ night), long (> 9 h/night) or (normal > 6-9 h/night). Adiposity was assessed using body mass index (BMI) and waist circumference. Results: Among 229 patients (61% male, mean age 61.2 ( ± 11.7) years, 63.7% with BMI ≥ 30 kg/m2). At baseline, sleep duration negatively correlated with BMI (r = -0.27, p < 0.001) and waist circumference (r = -0.25, p = 0.001). After adjusting for potential confounders in different models, short sleep duration was associated with higher BMI (β = -1.01; p = 0.006) and waist circumference (β = -1.91; p = 0.01). Following a median follow-up of 26.5 months, short sleep at baseline was associated with a 5% or more gain in BMI (adjusted OR 10.03; 95% CI 1.55-64.84; p = 0.01). Conclusion: Short sleep duration is associated with higher adiposity measures (BMI and waist circumference) and weight gain in patients with T2D. Addressing sleep duration may reduce the burden of obesity in T2D, and future studies in this area are warranted.Item Transition experiences of UK junior doctors who leave clinical practice to pursue careers in medical education : a qualitative study(BMJ Publishing Group, 2024-12-10)Objectives: The increasing complexity and scale of medical education in the UK demands increasing numbers of medical educators. A small proportion of educators are qualified doctors, but did not reach completion of clinical training (CCT) to become consultants or general practitioners before pursuing a career exclusively in education. This study aimed to (1) explore the experiences of medical educators who left clinical practice as junior doctors and (2) identify the barriers to professional identity formation in this group. Design: In this constructivist qualitative study, semi-structured interviews were conducted with medical educators. Audio data was recorded, transcribed and iteratively interpreted through the lens of reflexive thematic analysis. Setting and participants: Nine UK-based educators were recruited using purposive and snowball sampling. Participants self-identified as medical educators who have experience of the transition from working as junior clinicians to holding positions exclusively in medical education. Participants had not completed clinical training before transitioning into medical education. Results: Three broad themes were identified: (1) push factors away from clinical medicine; (2) pull factors towards medical education; (3) navigating professional identity formation as an educator. Educators reported that medical education offered positives such as improved work-life balance, professional development opportunities and a sense of being more 'upstream' in the world of education. Significant barriers to successful transition were reported, including: a lack of guidance; low respect for medical education by the wider medical profession; and disparity between the educational opportunities afforded to consultant colleagues compared with educators who left medicine before CCT. Conclusions: Educators who leave clinical medicine before CCT perceive themselves as being disadvantaged in their education careers. This study highlights that more could be done to tackle stigmatising perceptions of a medical education career and present medical education as a viable option to junior doctors.Item The otolaryngology consultant workforce in England : a survey update and future repercussions(Wiley, 2024-06-19)Introduction: Effective medical staffing is pivotal for a successful healthcare system, demanding strategic planning to ensure a high-quality service. Although the UK's doctor to population ratio has improved over time, it remains below global averages. The COVID-19 pandemic has exacerbated existing challenges, resulting in an unprecedented NHS waiting list with Ear, Nose, and Throat (ENT) surgeries ranking third highest in waiting times amongst all specialties. Methods: This study utilized a national jotform survey to gather data from ENTUK members, primarily focusing on consultant staffing within ENT departments across the UK. Additional information collected encompassed registration status, part-time roles, gender, vacancies, locum roles, associate specialists, registrars and other junior doctors, and advanced nurse practitioners. When survey responses were inadequate, direct communication was established with departmental consultants or secretaries, followed by Freedom of Information requests as necessary. All data were compiled using Microsoft Excel. Results: Among the 65 responses to the ENTUK survey, 53 individual trusts were identified. These included 41 English acute trusts, with supplementary participation from Scotland, Wales, and Northern Ireland. Data from 749 consultants across 115 English acute trusts were collected in combination with a Freedom of Information request. Conclusion: Despite an increased number of ENT consultants, the persistence of unfilled posts coincides with mounting waiting lists. The pandemic's effects, including early retirements and part-time roles, emphasise the urgency of expanding training positions to counterbalance these shifts. Local and national interventions are essential to fortify and diversify the ENT workforce through a variety of strategies.Publication Efficacy of botulinum toxin in the treatment of chronic anal fissure: a comprehensive systematic review(Wolters Kluwer, 2025-07-13)Acute anal fissure maintains a debilitating state that produces enduring wound damage on the anal mucosa while the internal anal sphincter demonstrates increased muscle tone. This study aims to conduct a comprehensive systematic review to evaluate the efficacy of botulinum toxin (BT) in the treatment of chronic anal fissure, synthesizing current evidence from clinical trials and observational studies to guide evidence-based practice. A review of systematic research investigates the performance and security along with extended outcomes linked to BT therapy for treating chronic anal fissure by analyzing 23 clinical studies. The healing response from BT injections reaches 60%-85% without producing headache side effects commonly experienced with topical glyceryl trinitrate (GTN) medications. Lateral internal sphincterotomy (LIS) produces excellent long-term healing results in 90%-95% of cases, although it leads to fecal incontinence risks at a 5%-15% rate. Expanding BT treatment usually necessitates additional injections or surgical intervention because of its high rate of recurrence over 1-3 years (30%-40%). Combining Botox treatment with GTN administration achieves healing rates between 70% and 80%, but studies provide inconsistent research data. The optimal dosage range for BT treatment is 20-30 units, while Botox performs equally well as Dysport in achieving these results. BT provides patients who do not want surgery the benefit of being a safe, minimally invasive procedure. At the same time, LIS offers a definitive solution for patients who cannot respond to other treatments. Research must establish standardized dose instructions while improving injection methods and developing extended strategies to stop relapses.