RSS 1.0
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
Select a community to browse its collections.
Recently Added
-
Improving patient experience and enhancing access to cancer services for people with learning disabilitiesPeople with learning disabilities experience inequities in cancer care including diagnosis and treatment delays, less access to services and therapies, and higher mortality. The Cancer Experience of Care Improvement Collaborative (CIC) brings together healthcare professionals, charities and people with lived experience to improve cancer services in a structured way. This article describes a CIC quality improvement project undertaken at two hospital trusts in England with the aim of reducing diagnosis and treatment delays for people with learning disabilities who have cancer. The authors explore the relevant evidence base and discuss how using data from the National Cancer Patient Experience Survey and CIC quality improvement methodology can drive improvements in cancer services based on what matters to people who use these services.
-
Unrecognised second-trimester pregnancy with fetal demise presenting as acute abdomen and a negative pregnancy testA woman in her early 20s presented with abdominal pain and a heavy period, unaware that she was 18 weeks pregnant. Despite a negative urine pregnancy test, imaging revealed intrauterine fetal demise. This rare case highlights the importance of maintaining clinical suspicion and performing early imaging, as pregnancy tests may yield false-negative results in cases of miscarriage and fetal demise. Human chorionic gonadotropin (hCG) is produced by the placenta, but when a pregnancy fails to develop normally, such as in miscarriage, hCG levels may be lower than expected or decline, leading to negative test results despite advanced gestation.
-
Stress-induced transient diabetic ketoacidosis (DKA) in pregnancy without pre-existing diabetesDiabetic ketoacidosis (DKA) is a rare condition that can result in adverse maternal and foetal outcomes. Recognising atypical presentations such as euglycaemic or starvation ketoacidosis is crucial, as delayed diagnosis can be fatal. We report the case of a pregnant woman under 20 weeks' gestation who presented with vomiting, dehydration, and metabolic acidosis. Laboratory findings revealed significant ketonaemia and acidaemia, with only transient hyperglycaemia lasting less than 24 hours. Her HbA1c was normal, diabetes antibodies were negative, and glucose monitoring remained normal throughout hospitalisation and subsequent follow-up, confirming the absence of underlying latent diabetes. The episode was likely precipitated by infection, dehydration, and starvation. Pregnancy amplifies the metabolic response to stress and starvation, lowering the threshold for ketone production. This case highlights the diagnostic challenge of recognising DKA physiology in non-diabetic pregnant patients.
-
Atypical morphological features in secondary and tertiary hyperparathyroidism mimic malignancy: a detailed clinicopathological study.Patients with secondary or tertiary hyperparathyroidism due to chronic renal failure who fail medical treatment require sub-total or total parathyroidectomy. The histological characteristics of parathyroid glands resected in this setting are not well studied; however, there is awareness that the findings may mimic malignancy. We conducted a detailed clinicopathological study of parathyroid resection specimens from an unselected Royal North Shore Hospital (RNSH) cohort (n=110) and an external consultation cohort (n=44). The most common atypical features observed in the RNSH cohort were fibrous bands (43%) and fibrous capsule (29%), while sheet-like/trabecular architecture (12%), invasive/pseudoinvasive growth pattern (4%) and mitotic activity (9%) were less prevalent. Clinical follow-up data were available for these cases, and none showed recurrence or metastasis. In the external consultation cohort, fibrous bands (84%) and fibrous capsule (66%) were also the most frequently observed features; however, invasive/pseudoinvasive growth pattern (34%) and sheet-like/trabecular architecture (34%) were more commonly seen in this group. One case in this cohort demonstrated unequivocal vascular invasion, fulfilling the diagnostic criteria for parathyroid carcinoma. However, at 5-year follow-up, there was no evidence of recurrence or metastasis. In summary, atypical histological features are common in parathyroid glands resected for secondary or tertiary hyperparathyroidism and should not be misinterpreted as atypical parathyroid tumour or carcinoma. Parathyroid carcinoma is exceedingly rare in this context, and even when strict diagnostic histological criteria are met, the long-term prognosis may be favourable.
-
Is mastoid head bandage really required in patients undergoing middle ear surgery? a randomised control trialBackground: Middle ear surgery is a common procedure addressing various pathologies. Postoperative head bandaging has traditionally been used to provide support and prevent complications. However, its necessity remains controversial, with limited empirical evidence supporting its routine use. Objective: This randomised controlled trial (RCT) evaluated the necessity of head bandaging in middle ear surgery by comparing postoperative complications between a mastoid head bandage and a simple gauze dressing. Methods: Eighty patients scheduled for middle ear surgery were randomly assigned to two groups: the Pressure Bandage group, where a crepe bandage was wrapped around the head, and the No Pressure Bandage group, where a gauze dressing was secured with Mefix tape. All surgeries were performed by a single otolaryngologist using standardised techniques, with the surgeon blinded to the dressing type. Postoperative complications, including hematoma, erythema, skin abrasion and wound infection, were recorded and compared. Results: The mastoid bandage group had a significantly higher incidence of forehead skin abrasions (6/40 vs. 0/40, p = 0.026). No significant differences were observed in hematoma or seroma formation, as neither group developed these complications. Conclusion: Routine mastoid head bandaging does not appear necessary, as it does not reduce postoperative complications and may increase patient discomfort due to skin abrasions. Larger studies with longer follow-ups are recommended to strengthen these findings and guide clinical practice.
