East Midlands Evidence Repository (EMER)

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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.

 

 

  • The effectiveness of lifestyle interventions in heart failure with preserved ejection fraction: a systematic review and network meta-analysis

    Bilak, Joanna; Brady, Emer; Guarav, Gulsin; McCann, Gerry P; Pepper, Coral; Yeo, Jian (2024-02-28)
    Aims: To perform a network meta-analysis to determine the effectiveness of lifestyle interventions on exercise tolerance and quality of life (QoL) in people with HFpEF. Methods: Ten databases were searched for randomised controlled trials that evaluated a diet and/or exercise intervention in people with HFpEF up until May 2022. The co-primary outcomes were peak oxygen uptake (V̇O2peak) and QoL as assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). We synthesised data using network meta-analysis. Results: Thirteen trials were identified including a total of 869 participants and incorporated six different interventions. Improvements in V̇O2peak compared to controls were seen for all exercise interventions (2.88 [95%CI: 1.36; 4.39]ml/kg/min) for high intensity interval training (HIIT); 2.37 [95%CI: 1.02; 3.71] ml/kg/min for low intensity exercise (LIT) combined with a hypocaloric diet; 2.05 [95%CI: 0.81; 3.29]ml/kg/min for moderate intensity continuous training (MICT); 1.94 [95%CI: 0.59; 3.29] ml/kg/min for LIT; 1.85 [95%CI: 0.27; 3.44]ml/kg/min for MICT combined with resistance training) but not a hypocaloric diet alone (1.26 [95%CI: -0.08; 2.61]ml/kg/min). Only HIIT (-14.45 [95%CI: -24.81; -4.10] points) and LIT (95%CI: -11.05 [-20.55; -1.54] ml/kg/min) significantly improved MLHFQ score. Network meta-analysis indicated HIIT was the most effective intervention for improving both V̇O2peak (mean improvement 2.88 [95%CI: 1.36; 4.39]ml/kg/min, follow up (FU) range 4 weeks- 3 years) and QoL (-14.45 [95%CI: -24.81; -4.10] points, FU range 12-26 weeks) compared to usual care. Conclusions: This network meta-analysis indicates that HIIT is the most effective lifestyle intervention studied to improve exercise capacity and QoL with mean improvements exceeding the minimum clinically meaningful thresholds. HIIT is likely to be an underused management strategy in HFpEF, but further studies are needed to confirm long-term improvements in symptoms and clinical outcomes.
  • A scoping review of artificial intelligence in medical education: BEME Guide No. 84

    Uraiby, Hussein (2024-02-29)
    Background: Artificial Intelligence (AI) is rapidly transforming healthcare, and there is a critical need for a nuanced understanding of how AI is reshaping teaching, learning, and educational practice in medical education. This review aimed to map the literature regarding AI applications in medical education, core areas of findings, potential candidates for formal systematic review and gaps for future research. Methods: This rapid scoping review, conducted over 16 weeks, employed Arksey and O'Malley's framework and adhered to STORIES and BEME guidelines. A systematic and comprehensive search across PubMed/MEDLINE, EMBASE, and MedEdPublish was conducted without date or language restrictions. Publications included in the review spanned undergraduate, graduate, and continuing medical education, encompassing both original studies and perspective pieces. Data were charted by multiple author pairs and synthesized into various thematic maps and charts, ensuring a broad and detailed representation of the current landscape. Results: The review synthesized 278 publications, with a majority (68%) from North American and European regions. The studies covered diverse AI applications in medical education, such as AI for admissions, teaching, assessment, and clinical reasoning. The review highlighted AI's varied roles, from augmenting traditional educational methods to introducing innovative practices, and underscores the urgent need for ethical guidelines in AI's application in medical education. Conclusion: The current literature has been charted. The findings underscore the need for ongoing research to explore uncharted areas and address potential risks associated with AI use in medical education. This work serves as a foundational resource for educators, policymakers, and researchers in navigating AI's evolving role in medical education. A framework to support future high utility reporting is proposed, the FACETS framework.
  • Ibrutinib as first-line therapy for mantle cell lymphoma: a multicenter, real-world UK study

    Walter, Harriet (2024-03-12)
    During the COVID-19 pandemic, ibrutinib with or without rituximab was approved in England for initial treatment of mantle cell lymphoma (MCL) instead of immunochemotherapy. Because limited data are available in this setting, we conducted an observational cohort study evaluating safety and efficacy. Adults receiving ibrutinib with or without rituximab for untreated MCL were evaluated for treatment toxicity, response, and survival, including outcomes in high-risk MCL (TP53 mutation/deletion/p53 overexpression, blastoid/pleomorphic, or Ki67 ≥ 30%). A total of 149 patients from 43 participating centers were enrolled: 74.1% male, median age 75 years, 75.2% Eastern Cooperative Oncology Group status of 0 to 1, 36.2% high-risk, and 8.9% autologous transplant candidates. All patients received ≥1 cycle ibrutinib (median, 8 cycles), 39.0% with rituximab. Grade ≥3 toxicity occurred in 20.3%, and 33.8% required dose reductions/delays. At 15.6-month median follow-up, 41.6% discontinued ibrutinib, 8.1% due to toxicity. Of 104 response-assessed patients, overall (ORR) and complete response (CR) rates were 71.2% and 20.2%, respectively. ORR was 77.3% (low risk) vs 59.0% (high risk) (P = .05) and 78.7% (ibrutinib-rituximab) vs 64.9% (ibrutinib; P = .13). Median progression-free survival (PFS) was 26.0 months (all patients); 13.7 months (high risk) vs not reached (NR) (low risk; hazard ratio [HR], 2.19; P = .004). Median overall survival was NR (all); 14.8 months (high risk) vs NR (low risk; HR, 2.36; P = .005). Median post-ibrutinib survival was 1.4 months, longer in 41.9% patients receiving subsequent treatment (median, 8.6 vs 0.6 months; HR, 0.36; P = .002). Ibrutinib with or without rituximab was effective and well tolerated as first-line treatment of MCL, including older and transplant-ineligible patients. PFS and OS were significantly inferior in one-third of patients with high-risk disease and those unsuitable for post-ibrutinib treatment, highlighting the need for novel approaches in these groups.
  • Hamstring muscle injuries in athletics

    Wheeler, Patrick (2024-04)
    Hamstring muscle injuries (HMI) are a common and recurrent issue in the sport of athletics, particularly in sprinting and jumping disciplines. This review summarizes the latest literature on hamstring muscle injuries in athletics from a clinical perspective. The considerable heterogeneity in injury definitions and reporting methodologies among studies still needs to be addressed for greater clarity. Expert teams have recently developed evidence-based muscle injury classification systems whose application could guide clinical decision-making; however, no system has been adopted universally in clinical practice, yet.The most common risk factor for HMI is a previously sustained injury, particularly early after return-to-sport. Other modifiable (e.g. weakness of thigh muscles, high-speed running exposure) and non-modifiable (e.g. older age) risk factors have limited evidence linking them to injury. Reducing injury may be achieved through exercise-based programs, but their specific components and their practical applicability remain unclear.Post-injury management follows similar recommendations to other soft tissue injuries, with a graded progression through stages of rehabilitation to full return to training and then competition, based on symptoms and clinical signs to guide the individual speed of the recovery journey. Evidence favoring surgical repair is conflicting and limited to specific injury sub-types (e.g. proximal avulsions). Further research is needed on specific rehabilitation components and progression criteria, where more individualized approaches could address the high rates of recurrent HMI. Prognostically, a combination of physical examination and magnetic resonance imaging (MRI) seems superior to imaging alone when predicting 'recovery duration,' particularly at the individual level.

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