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.

 

 

  • Understanding how and why users might use NHS repositories: A mixed methods study

    Rawson, Beth
    Background There is little evidence on the use or potential use of NHS repositories within the UK. Methods A mixed methods (quantitative/qualitative) study of two repositories: amber - the home of ambulance service research, and EMER (East Midlands Evidence Repository). A structured online questionnaire was distributed via the repository home page, promoted via social media, email networks, and lists. Next, three research leaders were interviewed in-person online (see Appendix 1). Transcripts of the recorded interviews were summarised using ChatGPT 3.5. Results From the 148 questionnaire responses, 38% of respondents had used an NHS repository. Librarian activities were key to encouraging repository use (that is, searching and depositing materials). ResearchGate was the most widely used alternative. Perceived benefits of using repositories included open access to materials, and knowledge sharing with colleagues. Users generally did not know the deposit process, and over 50% of respondents were unaware of Green Open Access. Discussion Building greater awareness, and institutional support is key to increasing repository usage. Marketing activities and educating researchers about the benefits of engaging with the repository are fundamental. Conclusion NHS librarians need to market NHS repositories using principles of knowledge management and ensure that the grey literature of research and evaluation reports in repositories is better used.
  • Development and external validation of the ‘Global Surgical-Site Infection’ (GloSSI) predictive model in adult patients undergoing gastrointestinal surgery

    Currow, C; Mykoniatis, I (2024-06)
    Background Identification of patients at high risk of surgical-site infections may allow surgeons to minimize associated morbidity. However, there are significant concerns regarding the methodological quality and transportability of models previously developed. The aim of this study was to develop a novel score to predict 30-day surgical-site infection risk after gastrointestinal surgery across a global context and externally validate against existing models. Methods This was a secondary analysis of two prospective international cohort studies: GlobalSurg-1 (July–November 2014) and GlobalSurg-2 (January–July 2016). Consecutive adults undergoing gastrointestinal surgery were eligible. Model development was performed using GlobalSurg-2 data, with novel and previous scores externally validated using GlobalSurg-1 data. The primary outcome was 30-day surgical-site infections, with two predictive techniques explored: penalized regression (least absolute shrinkage and selection operator (‘LASSO’)) and machine learning (extreme gradient boosting (‘XGBoost’)). Final model selection was based on prognostic accuracy and clinical utility. Results There were 14 019 patients (surgical-site infections = 12.3%) for derivation and 8464 patients (surgical-site infections = 11.4%) for external validation. The LASSO model was selected due to similar discrimination to extreme gradient boosting (AUC 0.738 (95% c.i. 0.725 to 0.750) versus 0.737 (95% c.i. 0.709 to 0.765)), but greater explainability. The final score included six variables: country income, ASA grade, diabetes, and operative contamination, approach, and duration. Model performance remained good on external validation (AUC 0.730 (95% c.i. 0.715 to 0.744); calibration intercept −0.098 and slope 1.008) and demonstrated superior performance to the external validation of all previous models. Conclusion The ‘Global Surgical-Site Infection’ score allows accurate prediction of the risk of surgical-site infections with six simple variables that are routinely available at the time of surgery across global settings. This can inform the use of intraoperative and postoperative interventions to modify the risk of surgical-site infections and minimize associated harm.
  • The role of day-case thoracoscopy at a district general hospital: A real world observational study

    Reed, Darren (2024-09)
    Objective To assess the feasibility and safety of talc pleurodesis performed as part of day-case medical thoracoscopy. Methods A Richard Wolf® 5 mm mini thoracoscope through a 5.5 mm port was used with eligible cases having talc poudrage followed by insertion of indwelling pleural catheter (IPC). District nurses drain the IPC daily for the first 5 days. Once the drain output is <150 mL, the frequency is progressively reduced to once weekly. The drain is removed after two consecutive dry taps 1 week apart. Results Overall, 51 patients underwent day-case thoracoscopy. Median time to removal of IPC for our day-case protocol was 14 days. There were seven deaths within 70 days among 41 patients with malignant pleural effusion in the day-case cohort, compared to eight deaths in the 33 conventional thoracoscopy controls. Overall, the day-case cohort observed a statistically significant reduction in all-cause mortality at 180 days compared to the conventional cohort (log rank p = 0.024). The average cost per patient of the day-case and inpatient cohort was £1,328.0 ± 106.0 and £1,835.0 ± 295.0 (p = 0.961). Conclusion This study suggests that thoracoscopy and talc poudrage can be performed safely as a day-case procedure. Further data are needed to ascertain long-term outcomes.
  • Sigmoid Diverticulitis in a tight spot: an atypical presentation within a ventral hernia

    Amaefule-Orie, Grace (2023-12)
    Ventral hernia and acute diverticulitis may present with similar symptoms posing difficulty in clinical diagnosis. Rarely, complicated sigmoid diverticulitis is found within an irreducible ventral hernia sac in the emergency setting. Intraoperative decision on the appropriate surgical option depends on the surgeon’s experience and the patient’s clinical state. We present a case of a middle-aged female who came in with infraumbilical hernia containing necrotic sigmoid diverticulitis. Her surgical history was cesarean section and total abdominal hysterectomy with a re-look laparotomy. She had an emergency exploration of the hernia through a midline incision, excision of the necrotic diverticulum, and the formation of loop colostomy at the site of the hernia. Post-operative recovery was uneventful and she has been scheduled for an elective sigmoid colectomy and reversal of the stoma. This study highlights that complicated sigmoid diverticulitis can rarely present as an irreducible ventral hernia and that less is often more in safely getting patients out of trouble in an emergency.
  • Research strategies for trainee and qualified advanced clinical practitioners that enhance evidence-based practice

    Alsararatee, Hasan Hazim (2024-07-18)
    Advanced clinical practitioners (ACPs) are integral to modern healthcare, providing high-quality, evidence-based care to patients. While ACPs show some development in clinical practice, leadership, and education, challenges persist in the research pillar. Trainee and qualified ACPs often have difficulties initiating their research journey and may feel uncertain about where to start. Existing studies have explored and emphasised the importance of ACPs developing and maintaining their research skills, yet there remains a gap in understanding how they can effectively demonstrate their research capabilities. Therefore, this article aims to help trainees and qualified ACPs on how to evidence their research pillar capabilities.

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