Midlands Evidence Repository

Welcome to the Midlands Evidence Repository (MIDER).

MIDER serves as the institutional research repository for 21 NHS Trusts across the Midlands and is managed by a consortium of Midlands NHS Knowledge and Library Services. Its purpose is to enhance the visibility and discoverability of NHS research by capturing, storing, and providing access to research outputs and other non‑traditional publications produced by NHS organisations in the region. Wherever possible, full‑text publications are made available through open‑access, and the repository continues to expand as new collections are added.

Please note that the deposit of items within MIDER does not imply endorsement of the research or the views expressed within it by the consortium organisations. A full list of MIDER partner organisations can be found below.

If you would like to collaborate with us as the repository continues to develop, please contact us at midlandsevidencerepository@gmail.com

Communities in MIDER

Select a community to browse its collections.

Now showing 1 - 24 of 24

Recent Submissions

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Decision making in vascular access: international perspectives on dialysis catheter choice
(Sage Publications, 2026-05-20) Inston, Nicholas; Rifkin, Brian; Rotmans, Joris; Jemcov, Tamara; Renal Unit; Medical and Dental; Inston, Nicholas
Background: Tunneled central venous catheters (TCVCs) remain an important component of hemodialysis vascular access despite recognized complications including infection, thrombosis, and catheter dysfunction. Although multiple catheter designs and technologies are available, there is limited comparative evidence supporting the use of one catheter type over another. Current KDOQI vascular access guidelines acknowledge this lack of evidence and recommend that catheter selection should rely on clinician judgment. This study aimed to explore how clinicians select dialysis catheters in routine practice and identify factors influencing decision-making. Methods: A standardized questionnaire was developed to capture clinician perspectives regarding dialysis catheter use. The survey was distributed internationally using SurveyMonkey via QR codes and web links through professional networks including the Vascular Access Society and the Dialysis Catheter Collaborative. Participation was voluntary and anonymous. The survey was open between January and March 2026. Questions addressed respondent characteristics, practice setting, catheter insertion volume, factors influencing catheter selection, perceived complications limiting catheter lifespan, confidence in current catheter technologies, and priorities for future research. Responses were analyzed descriptively. Results: A total of 111 clinicians from 37 countries responded. Participants included nephrologists/interventional nephrologist (n = 47; 42.3%), vascular surgeons (n = 44; 39.6%), interventional radiologists (n = 15; 13.5%). Catheter performance (63%), availability (42.3%), and ease of insertion (39.6%) were the most frequently cited factors influencing catheter choice. Thrombosis or fibrin sheath formation was considered the complication most often limiting catheter lifespan (52.3%), followed by infection (29.7%). Confidence in current catheter technologies to prevent complications was generally moderate to low. Conclusions: Dialysis catheter selection is primarily influenced by practical considerations rather than strong comparative evidence. These findings highlight a substantial evidence gap and support the need for robust comparative clinical studies to guide catheter choice and improve outcomes for patients requiring TCVC.
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Risk stratification tools for thyroid cancer: a systematic review of models combining ultrasound, cytology, and clinical risk factors
(SAGE Publications, 2026-05-06) Watts, Emma; Sattar, Zakariya; Boelaert, Kristien; Sharma, Neil; Endocrinology; Ear, Nose and Throat; Otolaryngology; Medical and Dental; Watts, Emma; Boelaert, Kristien; Sharma, Neil
Background: The rising incidence of thyroid cancer presents a growing diagnostic and therapeutic challenge. Various risk stratification systems have sought to integrate clinical, ultrasonographic, and, in some cases, cytological features to aid malignancy prognostication. This systematic review aims to critically evaluate risk stratification tools (RSTs) for patients with thyroid nodules, which incorporate multimodal inputs to assess their diagnostic performance and clinical utility in supporting surgical decision-making. Methods: PubMed, Embase, and Cochrane databases were searched from inception to 04/13/2026, identifying studies evaluating multivariable risk prediction models for adult patients undergoing assessment of thyroid nodules. Studies were excluded if the proposed tool failed to incorporate clinical features, ultrasound findings, and cytology results or was not validated with histology. Data extraction encompassed methodology of model development, performance metrics, and approaches to validation. Risk of bias was assessed using the PROBAST+AI tool. Results: Seven studies describing five distinct RSTs met inclusion criteria Thyroid Nodule App (TNAPP), the McGill Thyroid Nodule Score (MTNS), CUT Score, Memorial Sloan Kettering Cancer Centre (MSKCC) nomogram, and Thyroid Prediction Score (TiPS). TiPS demonstrated the highest sensitivity (96.2%) and specificity (97.5%) with area under the curve (AUC) >0.9. The CUT score also showed strong performance (AUC >0.9), particularly in low-to-intermediate risk nodules. TNAPP underperformed (accuracy 50.5%; specificity 27.5%) despite broad clinical inputs. The MTNS and MSKCC, although promising for indeterminate cytology, lacked robust validation. Most models were derived from single-center, retrospective cohorts, limiting generalizability. Conclusions: RSTs integrating multimodal data may improve thyroid nodule risk stratification, particularly in cases of indeterminate cytology. However, methodological limitations and lack of external validation currently restrict clinical utility. Prospective evaluation in diverse populations is required to identify the most effective and generalizable tools. Until then, RSTs should be used as adjuncts to, not replacements for, clinical judgment and shared decision-making in thyroid nodule assessment.
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A large pediatric cohort of colchicine intoxication: prognostic factors and experience with rapid sequence apheresis
(Informa Healthcare, 2026-05-06) Kesici, Selman; Saritas Nakip, Ozlem; Korgal, Nilay; Bayrakci, Benan; PICU; Medical and Dental; Saritas Nakip, Ozlem
INTRODUCTION: Severe colchicine intoxication often leads to multi-organ failure and death. With no specific antidote and ineffective conventional elimination methods, we hypothesized that rapid sequence apheresis could reduce the intravascular colchicine reservoir. This study describes pediatric colchicine poisoning, focusing on dose-related outcomes and the clinical role of rapid sequence apheresis. METHODS: This retrospective observational analysis included children admitted to a tertiary pediatric intensive care unit for colchicine poisoning (2011-2025). Clinical data, ingested dose, organ involvement, and patient characteristics were evaluated. Logistic regression and ROC analyses were used to identify variables associated with disease severity and poor outcomes, including those treated with rapid sequence apheresis. RESULTS: Eighty-four patients were included (median dose: 0.3 mg/kg). Across dose groups (<0.5, 0.5-0.8, and >0.8 mg/kg), higher doses correlated with increased frequency of diarrhea (20.6%, 57.1%, and 57.1%, respectively, = 0.071) and cardiovascular involvement (20.6%, 50%, and 71.4%, respectively; = 0.004). Logistic regression showed that diarrhea significantly increased the likelihood of cardiovascular complications (OR: 3.24, = 0.006). The ROC analysis identified thresholds of >0.39 mg/kg and >24 mg total dose as predictors of cardiovascular toxicity. Seventeen patients (20.2%) underwent rapid sequence apheresis. Despite advanced supportive care, five patients died, including two who ingested <0.5 mg/kg and received rapid sequence apheresis. DISCUSSION: Our findings suggest that higher ingested doses and early gastrointestinal manifestations such as diarrhea may serve as indicators of increased risk for cardiovascular complications in pediatric colchicine intoxication. In addition, clinically significant toxicity may occur at doses lower than traditionally reported thresholds. CONCLUSION: Pediatric colchicine intoxication may lead to significant cardiovascular complications even at relatively lower doses. Early recognition of high-risk clinical indicators, including gastrointestinal symptoms, leukocytosis, and ingested dose, may facilitate clinical risk stratification and early identification of patients at increased risk of adverse outcomes. Rapid sequence apheresis was used in selected severe cases in our cohort; however, its therapeutic role requires further investigation.
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Wolf Creek XVIII Part 6: transforming clinical trial design in cardiac arrest research
(Elsevier, 2025-12-22) Hirsch, Karen G; Bray, Janet; Callaway, Clifton W; Couper, Keith; Drennan, Ian R; Olasveengen, Theresa; Perkins, Gavin D; Elmer, Jonathan; Critical Care; Medical and Dental; Perkins, Gavin D
The 50th Anniversary Wolf Creek XVIII Conference was hosted by the Max Harry Weil Institute for Critical Care Research and Innovation in Ann Arbor, Michigan, USA on June 19-21, 2025. "Transforming Clinical Trial Design in Cardiac Arrest Research" was a topic of focused presentation and discussion. Participants included invited panelists and conference attendees made up of international academic and industry scientists as well as thought leaders in the field of cardiac arrest resuscitation. Panelists identified six key opportunities to transform clinical trial design: (1) Selecting the "right" patient and intervention, (2) Optimizing randomization, (3) Measuring relevant and unbiased outcomes, (4) Designing alternative approaches to "usual" randomize controlled trials (RCTs), (5) Maintaining public trust and engagement, and (6) Changing the approach to knowledge translation from research into clinical practice.
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The effectiveness of pharmacological and non-pharmacological interventions for fatigue in people living with chronic kidney disease: A protocol for a systematic review
(Public Library of Science, 2026-05-05) Young, Hannah Mary Louise; Ancliffe, Lisa; Curtis, Ffion; Efuntoye, Oluwafemi; Graham-Brown, Matthew Pm; Lock, Selina; Parker, Kathrine; Rolfe, Chris; Smith, Ellesha; Udofia, Aniebiot-Abasi; Burton, James O; Booth, Caroline; Yuko, Ishida; March, Daniel Scott; Renal Medicine; Medical and Dental; Efuntoye, Oluwafemi
Chronic kidney disease (CKD) affects approximately 850 million people worldwide and is associated with a substantial and growing symptom burden. Fatigue is one of the most common and debilitating symptoms across all stages of CKD, with prevalence far exceeding that of the general population. It profoundly affects quality of life, daily functioning, and clinical outcomes, underscoring the need to identify and evaluate effective pharmacological and non-pharmacological strategies for its management. This protocol outlines methods for a systematic review to evaluate the efficacy, safety, and perceived effectiveness of interventions for fatigue in people with CKD. We will include randomised controlled trials, non-randomised controlled trials, before-and-after studies, and qualitative evaluations in adults and children with any stage of CKD. Searches will be conducted in MEDLINE, Embase, CINAHL, Web of Science Core Collection, PsycINFO, and ClinicalTrials.gov, alongside grey literature via Google Scholar. No language or publication date restrictions will be applied. Study selection will follow a two-stage screening process, with two reviewers independently assessing titles/abstracts and then full texts using predefined eligibility criteria. Data will be extracted using a standardised form, capturing study characteristics, interventions, and outcomes. Risk of bias will be assessed with the NIH Study Quality Assessment Tools or the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Results will be synthesised narratively, and, where appropriate, pooled using meta-analysis. Certainty of the evidence for the primary outcome will be assessed using the GRADE approach and presented in a Summary of Findings table. This review will provide a comprehensive synthesis of evidence on interventions for fatigue in CKD, highlight gaps to guide future research, and inform the UK Kidney Association Symptom Guidelines.