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 The effects of rivastigmine on neuropsychiatric symptoms in the early stages of Parkinson's disease : a systematic review(Wiley, 2023-11-17)Background and purpose: Neuropsychiatric symptoms including depression, apathy and psychosis occur frequently in patients with Parkinson's disease. A subgroup of patients develop cognitive impairment, which may increase the risk of falls due to reduced attention. The acetylcholinesterase inhibitor rivastigmine is beneficial in Parkinson's disease dementia, but whether the use of rivastigmine is effective earlier in the disease course is unclear. The aim of this systematic review was to assess the evidence for rivastigmine in the treatment of neuropsychiatric symptoms in Parkinson's disease without dementia. Methods: Embase, Medline, PsychINFO, Cochrane CENTRAL, NGLC, National Institute for Health and Care Excellence Evidence and medRxiv.org were searched for studies with terms relating to population (Parkinson's disease) and intervention (rivastigmine). Of 1922 references identified, 358 were duplications. Following title and abstract review, 1331 articles were excluded. After full-text review, nine articles remained. Results: Outcomes were heterogenous, therefore, the results are presented in narrative form. The articles included six randomized controlled trials, two open-label trials and one case series. Outcome measures included: time to develop psychosis; frequency of rapid eye movement sleep behaviour disorder (RBD) episodes; apathy; gait variability; falls; cognitive ability; Neuropsychiatric Inventory score; and regional spontaneous brain activity. Conclusions: There is evidence that rivastigmine is beneficial for RBD and apathy in Parkinson's disease patients without dementia. There is high level evidence that rivastigmine reduces falls, which may be due to improved attention. The impact of rivastigmine on psychotic symptoms is less clear, but is supported by current theoretical models which involve acetylcholine dysfunction in the generation of visual hallucinations in Parkinson's disease. Keywords: Parkinson disease; acetylcholinesterase; hallucinations; neuropsychiatry; rivastigmine.Publication Xanthomatous hypophysitis relapsing and remitting over two decades(Blackwell Science, 2025-07-14)Inflammation of the pituitary gland can be primary (without another underlying cause) or secondary (associated with a systemic inflammatory condition). Primary hypophysitis is very rare, among which xanthomatous hypophysitis as a histological type is extremely unusual. A woman in her late 50s presented with recurrent pituitary lesions over 20 years. Her general practitioner had diagnosed panhypopituitarism in her 30s; a decade later, she had presented to ophthalmology with visual loss and restricted visual fields, and a pituitary lesion was found. This recurred several times requiring multiple resections. Histopathology showed atypical inflammation in keeping with xanthomatous hypophysitis; this responded well to corticosteroid therapy. Xanthomatous hypophysitis is a rare form of steroid-responsive primary pituitary inflammation, to consider in the differential diagnosis of recurring pituitary lesions.Publication Medical management of tobacco dependency for hospital clinicians(BMJ Publishing Group, 2024-03-26)This Editorial stresses the importance of making every patient contact count in the drive to reduce tobacco dependency.Publication Comparison of efficacy of the combination of topical tazarotene gel and oral fluconazole versus oral fluconazole monotherapy in the treatment of onychomycosis.(Cureus, 2025-01-30)Background: Onychomycosis is a chronic fungal infection of the nails of toes and fingers, with an ongoing search for appropriate and more officious treatment modalities because the currently applied regimens are far from perfect. Objective: The objective of this study was to compare the efficacy of the combination of topical tazarotene 0.1% gel and oral fluconazole with weekly oral fluconazole monotherapy in the treatment of OM. Methodology: This quasi-experimental study was conducted over three months in the outpatient dermatology clinic of a tertiary healthcare facility in Pakistan. A total of 60 patients fulfilling the inclusion criteria were included. A detailed history, dermatological examination, and Onychomycosis Severity Index (OSI) were implemented in each patient to record the severity of their disease and treatment outcome. The patients were randomized into two groups i.e. Group A, where a weekly oral fluconazole tablet of 150mg and daily topical tazarotene 0.1% gel were administered, and Group B in which a weekly oral fluconazole tablet of 150mg alone was administered for three months each. The potassium hydroxide mounts from nail materials were performed at the end of the treatment period in all the patients. Data analysis was carried out using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States). Results: Of the total, 36 (60%) were male with a mean age of 46.47±10.60 years and 24 (40%) were female with a mean age of 46.08±10.16 years. Following the comparison between the two groups, the combination therapy had higher efficacy and better treatment success (70%, n=23) compared to fluconazole monotherapy (56.6%, n=17), in terms of the fall in the degree of OSI, clinical evaluation, and KOH preparation after treatment (p-value <0.001, 0.001, and 0.03, respectively). Conclusions: The efficacy of oral weekly fluconazole combined with daily topical tazarotene 0.1% gel is significantly higher than that of weekly fluconazole monotherapy in the treatment of OM.Publication Cerebellar cavernoma(Elsevier, 2019-07-25)Introduction A cavernoma is a cluster of abnormal blood vessels, usually found in the brain and spinal cord. They're sometimes known as cavernous angiomas, cavernous haemangiomas or cerebral cavernous malformation. A case report of a young male with cavernomas is reported. Methods A 37-year-old man was referred to the ambulatory care unit from the accident and emergency department with a 2-day history of visual disturbance and dizziness. Clinical examinations of all systems were normal including neurologic examination which did not reveal any focal neurological signs. Routine haematology and biochemistry blood tests were all normal. Initially, a computed tomography of the brain was requested which showed no definite acute abnormality, but a small focus of high attenuation present within the left middle cerebellar peduncle may represent a small cavernoma. Further assessment with magnetic resonance imaging was suggested. The patient was then admitted to the acute medical unit for further investigations and workup. Results and discussion An MRI of the brain was performed and revealed multifocal cerebral microhaemorrhages of variable sizes spread randomly throughout the supra- and infra-tentorial compartments of the brain with no predilection for the deep structures (basal ganglia/thalami) to suggest chronic hypertensive encephalopathy. Cavernoma are less common in males at this age, which makes our case more unique. Conclusion A detailed history (personal and family) are key to detect such malformations in young patients, which also helps physicians be aware of its related complexities and further management.