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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
Select a community to browse its collections.
Recently Added
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Lamotrigine-induced DRESS syndrome with myelosuppression in a patient with bipolar disorder: case reportLamotrigine-induced DRESS syndrome is a potentially fatal drug reaction with variable clinical presentation and complications requiring early recognition and rapid response.
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Community sentence with mental health treatment requirement (MHTR): an exploration of offenders’ engagement, experience, and outcomesThe Mental Health Treatment Requirement (MHTR) is a sentencing option for offenders where mental health is linked to offending and is delivered by clinical psychologists. An interpretative phenomenological analysis of interviews with 14 MHTR service users explored factors promoting engagement and perceived change. Three superordinate themes were identified: experiences of safety, support, and personal fit facilitating engagement; mechanisms of change through developing tools, insight, and emotional regulation; and shifts in identity, relationships, and lifestyle. Findings highlight the importance of a strong therapeutic alliance, individualized and flexible delivery, and suggest MHTRs can improve mental health, self-worth, and reduce reoffending.
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Effect of deviated nasal septum on eustachian tube dysfunction: a systematic review and meta-analysisObjective: A range of chronic ear complaints may be attributed to Eustachian tube dysfunction. Eustachian tube dysfunction secondary to a deviated nasal septum has been described in several clinical studies, with symptomatic improvement demonstrated following septoplasty. However, uncertainty exists as to the size of the effect and consistency between studies. Methods: Electronic searches were carried out of Pubmed, Embase and the Cochrane Library for adult patients with complaints of nasal obstruction and/or impairment and/or complaints of ear fullness undergoing nasal surgery. Results: Seven studies met the inclusion criteria. Studies evaluated the effect of nasal surgery on Eustachian tube dysfunction using a variety of outcomes, including Eustachian tube function tests, the Eustachian Tube Dysfunction Questionnaire-7, tympanometry and Nasal Obstruction Symptom Evaluation scores. The results demonstrated the positive impact of nasal surgery on various outcomes related to Eustachian tube dysfunction. Conclusion: Nasal surgery has been demonstrated to have promising results as a therapeutic option for patients with Eustachian tube dysfunction and a deviated nasal septum, offering significant symptom relief and improved quality of life. Through the integration of the treatment of nasal symptoms in the management of Eustachian tube dysfunction, clinicians can adopt a comprehensive approach to addressing the underlying pathologies contributing to Eustachian tube dysfunction.
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End-of-life care in a major UK trauma centre.OBJECTIVES: Death occurs within the emergency department (ED) sadly not infrequently. There is limited evidence exploring the demographics of these patients and the experience they have in the ED when they die or are approaching the end of life (EOL). METHODS: A retrospective review of patients aged 18 years and over who died in our major trauma centre was conducted. Data collected included demographics, frailty scores, time of arrival, time of death, time of EOL decision, cause of death in the ED and who wrote do not attempt cardiopulmonary resuscitation (DNACPR) forms. RESULTS: From January to December 2023, 326 patients died in the ED. 76% of patients were aged 65 years or over, with 69% having a clinical frailty score of 5 or more. The average time from arrival to death was 5 hours 56 min, with the average time from EOL decision to death being 1 hour and 53 min. 60% of all patients had a DNACPR, with 75% of those being written by ED clinicians. CONCLUSION: EOL is becoming ever more important in the ED. Further work is needed to see if our local experience matches other EDs.
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Effect of Early Surgical Intervention on Neurological Outcomes in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis.Spinal cord injury (SCI) represents a devastating condition with profound neurological consequences, and the optimal timing of surgical decompression remains controversial. This systematic review and meta-analysis evaluated the impact of early versus late surgical intervention on neurological outcomes and mortality in patients with SCI. A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Scopus, from 2000 to September 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing early surgical decompression (≤24 h) with delayed intervention (>24 h) in adult patients were included. Fourteen studies comprising 2,505 patients (1,115 early intervention, 1,390 delayed intervention) met the inclusion criteria, including three randomized controlled trials (RCTs) and 11 observational studies. The pooled analysis demonstrated a non-significant trend toward improved neurological recovery with early intervention, evidenced by a mean difference (MD) of 3.64 points in the American Spinal Injury Association (ASIA) Motor Score (AMS; 95% CI: -0.05 to 7.33; p = 0.05) and an OR of 1.37 for achieving at least one-grade improvement in ASIA classification (95% CI: 0.90 to 2.10; p = 0.14). Mortality rates showed no significant difference between groups (OR = 1.40, 95% CI: 0.74 to 2.68; p = 0.30). Despite not reaching statistical significance, the consistent directional trend favoring early intervention supports its consideration when medically feasible, as even modest neurological improvements may be clinically meaningful in this devastating condition. These findings suggest that early surgical decompression does not increase mortality risk and may confer neurological benefits, supporting the development of institutional protocols prioritizing expedited intervention while maintaining rigorous perioperative safety standards.
