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Welcome to the East Midlands Evidence Repository.
The East Midlands Evidence Repository (EMER) is the official institutional research repository for; Derbyshire Community Health Services, Leicester Partnership Trust, NHS Nottingham and Nottinghamshire CCG, Nottinghamshire Healthcare, Sherwood Forest Hospitals, University Hospitals of Derby and Burton and the University Hospitals Of Leicester
EMER is intended to make NHS research more visible and discoverable by capturing, storing and preserving the East Midlands research output and making it available to the research community through open access protocols.
Wherever possible, full-text content is provided for all research publications in the repository. Content grows daily as new collections are added.
Communities in East Midlands Evidence Repository
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Recently Added
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Desmoplakin cardiomyopathy: case reportDesmoplakin (DSP) cardiomyopathy is a distinct form of cardiomyopathy characterized by frequent left ventricular involvement with extensive fibrosis, high arrhythmic risk, and episodes of acute myocardial injury.
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Spontaneous coronary artery dissection: an overviewThe prevalence of spontaneous coronary artery dissection (SCAD) has increased over the last decades in young adults presenting with acute coronary syndrome. Although the diagnostic tools, including intracoronary imaging, have permitted a more accurate diagnosis of SCAD, the prognosis and overall outcomes remain dismal. Furthermore, the disproportionate sex distribution affecting more women and the underdiagnosis in many parts of the world render this pathology a persistent clinical challenge, particularly since the management remains largely supportive with a limited and controversial role for percutaneous or surgical interventions. The purpose of this review is to summarize the available literature on SCAD and to provide insights into the gaps in knowledge and areas requiring further investigation.
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What is the pipeline for future medications for obesity?Obesity is a chronic disease associated with increased risk of obesity-related complications and mortality. Our better understanding of the weight regulation mechanisms and the role of gut-brain axis on appetite has led to the development of safe and effective entero-pancreatic hormone-based treatments for obesity such as glucagon-like peptide-1 (GLP-1) receptor agonists (RA). Semaglutide 2.4 mg once weekly, a subcutaneously administered GLP-1 RA approved for obesity treatment in 2021, results in 15-17% mean weight loss (WL) with evidence of cardioprotection. Oral GLP-1 RA are also under development and early data shows similar WL efficacy to semaglutide 2.4 mg. Looking to the next generation of obesity treatments, combinations of GLP-1 with other entero-pancreatic hormones with complementary actions and/or synergistic potential (such as glucose-dependent insulinotropic polypeptide (GIP), glucagon, and amylin) are under investigation to enhance the WL and cardiometabolic benefits of GLP-1 RA. Tirzepatide, a dual GLP-1/GIP receptor agonist has been approved for glycaemic control in type 2 diabetes as well as for obesity management leading in up to 22.5% WL in phase 3 obesity trials. Other combinations of entero-pancreatic hormones including cagrisema (GLP-1/amylin RA) and the triple agonist retatrutide (GLP-1/GIP/glucagon RA) have also progressed to phase 3 trials as obesity treatments and early data suggests that may lead to even greater WL than tirzepatide. Additionally, agents with different mechanisms of action to entero-pancreatic hormones (e.g. bimagrumab) may improve the body composition during WL and are in early phase clinical trials. We are in a new era for obesity pharmacotherapy where combinations of entero-pancreatic hormones approach the WL achieved with bariatric surgery. In this review, we present the efficacy and safety data for the pipeline of obesity pharmacotherapies with a focus on entero-pancreatic hormone-based treatments and we consider the clinical implications and challenges that the new era in obesity management may bring.
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A retrospective audit of patients with a radiological finding of moderate or severe emphysema. Should we perform spirometry as part of the targeted lung health check?Low dose computer tomography (LDCT) performed in high risk patients in Targeted Lung Health Check programme commonly reports on incidental findings. An audit of patients has found the largest cohort with incidental findings is those with radiological findings of Emphysema. Should we routinely be offering spirometry to this patient group?
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A retrospective audit of patients with a radiological finding of moderate or severe emphysema. Should we perform spirometry as part of the targeted lung health check?Low dose computed tomography (LDCT), screening for lung cancer is being implemented in some European countries. The targeted lung health checks (TLHC) programme is a new and ground-breaking flagship programme of work in England which will contribute to the ambition of the NHS Long Term Plan to improve early diagnosis and survival for those diagnosed with cancer (NHSE, 2022). The Mansfield and Ashfield TLHC commenced in March 2021 and was part of phase one of the NHSE (National Health Service England) pilot programme. Participants invited for the TLHC are those who are, at the date of the first low dose CT scan, aged between 55 and 74 years, 364 days of age, are registered with a GP practice and have ever smoked. Those who are eligible will be assessed to calculate their individual risk of developing lung cancer within the next 5 years using a pre-defined algorithm that automatically calculates both Prostate, Lung, Colorectal and Ovarian (PLCO) (Hocking et al, 2010) risk prediction model and the Liverpool Lung project (LLP) (Cassidy et al, 2008). All identified high risk patients i.e., a risk threshold of ≥1.51% threshold for PLCO and/or ≥2.5 for LLPv2 algorithms, then go on to a face-to-face appointment with trained TLHC nurses to confirm their risk assessment and where it is proven high risk, a low dose computer tomography (LDCT). Incidental findings are detected frequently following a LDCT and have the potential to benefit or harm the participant, and their management adds costs (Morgan et al, 2017). Localised audit of the patients has found the largest cohort of patients with incidental findings within our programme was those with radiological findings of Emphysema. The question is should we routinely be offering spirometry to this patient group either as part of the TLHC programme or making recommendations to primary care to perform one and are there any benefits to the patient?