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

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Now showing 1 - 23 of 23

Recent Submissions

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A network-based association of IBD and colorectal cancer using proteomics data
(Wiley, 2026-03) Dhami, Jaiya; Radhakrishnan, Swarnima Kollampallath; Russ, Dominic; Mondal, Sudip; Alzarooni, Abdulrahman; Merodio, Laura Bravo; Duggal, Niharika A; Gupta, Ruchi; Acharjee, Animesh; University of Birmingham; University Hospitals Birmingham NHS Foundation Trust
Background: Colorectal cancer (CRC) is a major cause of morbidity and mortality, with chronic inflammation from inflammatory bowel disease (IBD) representing a well-established risk factor. Clarifying shared molecular mechanisms may facilitate early detection and prevention strategies. Methods: Proteomic data from the UK Biobank were analysed using the Olink proximity extension assay for seven CRC-associated proteins (TFF3, TFF1, AHCY, RETN, LCN2, SELE and CEACAM5) previously identified via machine learning. Expression levels in CRC and IBD cases were compared with controls. Multilayer interaction networks, incorporating protein-protein, protein-metabolite and transcription factor-protein interactions, were generated using OmicsNet. Findings were validated in the Colonomics transcriptomic dataset. Results: All seven proteins were significantly upregulated in CRC; six (excluding CEACAM5) were also elevated in IBD. Network analysis identified AHCY and LCN2 as central hubs linking inflammatory and metabolic pathways. NF-κB and GATA2 emerged as recurrent transcriptional regulators. Colonomics validation confirmed upregulation of AHCY, LCN2 and SELE in CRC tissues. Conclusions: This multi-omics network analysis reveals a shared molecular framework between IBD and CRC, with inflammation as a key driver of colorectal carcinogenesis.
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Isolated urethral injury without penile fracture: a case report
(Springer, 2025-11-04) Ogunfowora, Tolulope T; Abu, Sadiq; Sanni, Quadri Abiodun; Ginepri, Andrea; Bseikri, Khaled; South Warwickshire University NHS Foundation Trust; Urology; Medical and Dental; Ogunfowora, Tolulope; Abu, Sadiq; Sanni, Quadri; Ginepri, Andrea; Bseikri, Khaled
An isolated urethral injury without a penile fracture, particularly one resulting from sexual intercourse, is an infrequent occurrence. Urethral injury without concomitant penile fracture poses a diagnostic dilemma, being an uncommon clinical condition. Early recognition and prompt treatment are essential to prevent complications, which sparked this interest. We report a case of isolated proximal bulbar urethral injury without penile fracture following sexual intercourse in an 18-year-old male who presented with two days of peno-scrotal swelling. An initial diagnosis of bilateral epididymoorchitis was made. During admission, a urethral injury was suspected and subsequently confirmed. A peri-urethral abscess and a right hemiscrotal abscess complicated this injury. He was evaluated using an initial ultrasound testes and subsequently a CT scan of the abdomen and pelvis, and a pelvic MRI due to a diagnostic dilemma. He was treated with antibiotics, underwent urinary diversion via suprapubic cystostomy, flexible cystoscopic-guided urethral catheterisation, and scrotal exploration with drainage of peri-urethral and scrotal abscesses. A subsequent retrograde urethrogram confirmed satisfactory healing. The patient experienced an adequate recovery and healing, and he was followed up for four months without any urinary symptoms. Isolated urethral injuries without an associated penile fracture are uncommon clinical entities. However, when they do occur, they carry a significant risk of complications if not promptly identified. Among the potential sequelae of delayed diagnosis are peri-urethral and scrotal abscesses, which can lead to increased morbidity. These injuries may present atypically, especially following coital trauma, making a high index of clinical suspicion important. Early recognition, supported by appropriate imaging and timely intervention, is key to preventing functional complications. This case highlights the importance of early diagnosis and prompt treatment in optimising patient outcomes and minimising the risk of long-term complications.
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Comparison of pharmacotherapies for obesity with sleeve gastrectomy: a network meta-analysis and systematic review
(Taylor and Francis, 2026-04-12) Omeh, Zachary; Khan, Tahira; Uthman, Olalekan; Barber, Thomas M; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK; Endocrine and Diabetes; Medical and Dental; Barber, Thomas M
INTRODUCTION: Tirzepatide, a glucagon-like peptide-1 receptor agonist (GLP1RA) and glucose-dependent insulinotropic-peptide (GIP), has shown efficacy regarding weight-loss. METHODS: Systematic review and network meta-analysis of randomized controlled trials. MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched between 2014 and 2024 for trials comparing sleeve gastrectomy (SG), Tirzepatide and other pharmacotherapies to control or each other. Eligible studies: adults with obesity and weight loss outcomes ≥24 weeks. Primary outcome: percentage change total body weight. Secondary outcomes included adverse events. Pairwise and network meta-analyses were performed. Interventions ranked by: P-score, mean difference (MD), 95% confidence intervals (CI). RESULTS: Data from 23 trials (14,293 participants) were analyzed. SG (MD 21.1% TWL, 95% CI 14.2% to 28.0%) and Tirzepatide 10 or 15 mg (MD 21.3% TWL, 95% CI 17.3% to 25.2%) demonstrated statistically equivalent weight-loss efficacy (P-score: 0.84) and had the most favorable effectiveness profiles. Semaglutide 2.4 mg (MD 12.7% TWL) and Liraglutide 3.0 mg (MD 5.1% TWL) showed moderate efficacy, whilst Orlistat showed minimal effect (MD 2.7% TWL, 95% CI -4.2% to 9.6%). Network meta-analysis of adverse events demonstrated that Semaglutide 2.4 mg and Orlistat had the most favorable safety profiles amongst pharmacotherapies. CONCLUSIONS: Tirzepatide 10 mg and 15 mg is equivalent to SG regarding weight-loss efficacy. REGISTRATION: This paper was registered with PROSPERO (ID: CRD420251016726). Due to institutional academic requirements and checks, registration was completed after the review began, however the review protocol (supplement material S1) was developed prior to the review, provided by the authors, and thoroughly adhered to by the authors.
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Outcomes following non-operative management for severe liver trauma: a UK multicentre observational study
(BioMed Central, 2026-03-06) Brooks, Adam; Joyce, Danielle; Gouveia, Santiago; Burak, Marta; LaValle, Angelo; Reilly, John-Joe; Adiamah, Alfred; Diacon, Thomas; Blackburn, Lauren; Melia, Georgia; Kitchen, Samuel; Gaski, Iver Anders; Gaarder, Christine; Næss, Paal Aksel; Naumann, David N; Radiology; General Surgery; Gastroenterology; Medical and Dental; Burak, Marta; Diacon , Thomas; Naumann, David N
Background: Patients with severe liver injury may carry a high risk of complications with significant mortality. Non-operative management (NOM) is increasingly common for severe injuries and may be associated with lower morbidity when compared with surgery. Objective: To evaluate the incidence of NOM for severe liver trauma (American Association for the Surgery of Trauma (AAST) Grade IV and V) and compare outcomes for NOM vs operative management. Methods: All patients admitted between 2012-2022 with severe liver trauma to Birmingham and Nottingham Major Trauma Centres (MTCs) were identified from a validated dataset. Outcomes were compared between those managed by surgery vs treated by NOM. Adjusted multivariable logistic regression models were used to determine the odds ratio (OR) and 95% confidence interval (95% CI) for surgical management, survival rates, and development of liver-specific complications (adjusting for age, sex, ISS, AAST grade, polytrauma). Results: There were 190 patients; median age 28 years (IQR 20-41); 134 (71%) were male. Median ISS was 27 (IQR 17-41). Overall mortality was 7% (14/190). 122/190 (64%) patients were managed initially by NOM, with only 8/122 (7%) requiring subsequent surgery. Multivariable logistic regression models showed higher ISS, lower SBP on admission, Grade V injuries and penetrating trauma to be independent predictors for surgical treatment. 34/190(18%) patients had liver-specific complications. There was no difference between NOM and operative management groups for 30-day mortality (p = 0.145), but patients in the NOM group had shorter ICU (p < 0.001) and total lengths of stay (p < 0.001) compared to the operative group. Conclusion: In this modern MTC setting, a high proportion of patients with severe liver trauma were managed by NOM with a low failure rate. Overall mortality rate was low, but liver-specific complications were common. These data support the evolution of traumatic liver injury management in the UK and favour NOM even in severe liver injuries where patient physiology allows. Trial registration: This study was approved by Nottingham University Hospital Clinical Audit Team (ID Reference 22-709C) and University Hospitals Birmingham NHS Foundation Trust Clinical Audit Registration and Management System (ID Reference CARMS 19146). Consent for participation in the study was not obtained as this was a large retrospective audit with anonymised data. Level of evidence: Level III.
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Advanced magnetic resonance imaging techniques for assessing brain metastases response following stereotactic radiosurgery
(Elsevier, 2026-02-12) Patel, Markand; Mei, Nan; Li, Xuanxuan; Jen, Jian Ping; Meade, Sara; Benghiat, Helen; Hartley, Andrew; Wykes, Victoria; Sanghera, Paul; Sawlani, Vijay; Oncology; Neurosurgery; Neurology; Medical and Dental; Meade, Sara; Wykes, Victoria; Sanghera , Paul; Sawlani, Vijay
Objective: Post-stereotactic radiosurgery (SRS) enlargement of brain metastases often creates diagnostic uncertainty that delays appropriate intervention. This study evaluates the combined role of delayed contrast-enhanced magnetic resonance imaging (MRI) (treatment response assessment maps, TRAM) and multiparametric MRI, including diffusion, perfusion, and spectroscopy in distinguishing tumour progression from radiation-induced changes. Methods: A retrospective analysis was performed on 23 patients with 24 enlarging lesions following SRS. All patients underwent advanced MRI, including TRAM, dynamic susceptibility contrast perfusion (relative cerebral blood volume), and MR spectroscopy [MRS] (choline/creatine ratio). The diagnostic performance of each modality was assessed against radiological follow-up at 12 months. Results: Of 22 evaluable lesions, 13 were classified as radiation-related changes and 9 as true progression. TRAM alone (clearance decrease >0%) demonstrated 100% sensitivity but only 38% specificity (accuracy 63%). Perfusion imaging (relative cerebral blood volume ≥2.0) achieved 77% accuracy, while MRS (choline/creatine ≥1.8) yielded 90% accuracy with 88% sensitivity and 92% specificity. Combining TRAM and MRS further improved performance. The best diagnostic accuracy (95%) was achieved through integrated neuroradiologist interpretation of all modalities, with 100% sensitivity and 92% specificity. Conclusions: Advanced MRI incorporating TRAM, diffusion, perfusion, and spectroscopy improves diagnostic accuracy in post-SRS assessment of brain metastases. This multimodal approach enhances lesion characterization and supports timely treatment decisions, including reirradiation, surgery, or surveillance.