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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Sites of skin inflammation recurrence in patients with SLE: an analysis of clinical trial data
(BMJ Publishing Group, 2026-02-15) Peterknecht, Elizabeth; Branco, Marco; Reynolds, John; Sandwell and West Birmingham NHS Trust; University of Birmingham; Rheumatology; Medical and Dental; Branco, Marco; Reynolds, John A
No abstract available.
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Incretin-based dual and triple agonists in overweight or obese individuals: a systematic review and meta-analysis
(Lippincott, Williams and Wilkins, 2026-02-19) Chan, Zhi Hong; Omar, Abdousamad Said; Gill, Kieran; Volucke, Gabriele; Azhar, Muhammad Muneeb; Haleem, Syed Mohammad; Sia, Jian En; Rahman, Obaid Ur; Ahmad, Moaz; Shahid, Nuraan; Gardezi, Syed Anjum; Joseph, Kevin Vinod; Behary Paray, Nitish; Zulfiqar, Eeshal; Sandwell and West Birmingham NHS Trust; Musgrove Park Hospital; Aneurin Bevan University Health Board; Newcastle University; et al.; Cardiology; Medical and Dental; Rahman, Obaid U
Incretin-based dual and triple agonists have emerged as effective options for obesity management, offering enhanced weight loss through multi-receptor agonism. However, data on their efficacy and safety remain limited. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of these emerging agents. A comprehensive literature search was conducted using PubMed, the Cochrane Library, and Google Scholar from inception to June 2025 to identify randomized controlled trials evaluating tirzepatide, retatrutide, or mazdutide in obese adults. Clinical outcomes were assessed using the random-effects model and pooled as mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CIs). A total of 10 randomized controlled trials, including 3236 participants, were analyzed. Incretin polyagonists significantly reduced body weight compared to placebo (MD -11.47; 95% CI: -14.00 to -8.95). Significant reductions were also observed in waist circumference (MD -9.40; 95% CI: -11.91 to -6.89), glycated hemoglobin (MD -0.96; 95% CI: -1.16 to -0.75), and fasting plasma glucose (MD -26.89 mg/dL; 95% CI: -33.48 to -20.30). However, the use of dual and triple agonists was associated with a higher risk of any adverse events (AEs) (RR 1.13; 95% CI: 1.08-1.19), including gastrointestinal AEs (nausea, vomiting, diarrhea, constipation), AEs leading to withdrawal (RR 1.96; 95% CI: 1.17-3.30), and hypoglycemic episodes (RR 3.08; 95% CI: 1.61-5.89). No significant difference was found in serious AEs (RR 0.87; 95% CI: 0.65-1.14). In conclusion, incretin-based polyagonists were associated with significant weight reduction and improved metabolic outcomes compared to placebo.
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The hidden costs of the intercollegiate membership of the Royal College of surgeons examinations: can trainees afford it?
(Elsevier Ltd, 2024-02-17) Sheng, Ziyan; Laloo, Ryan; Lewis, Sophie; Giwa, Lola; Burke, Josh; Brennan, Peter A; Ellis, Ricky; Sheng, Ziyan
BACKGROUND: The Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination is a mandatory requirement for higher specialty surgical training in the UK. However, there is a significant economic impact on trainees which raises the question of whether the costs of this exam hinder surgical career progression. This study explores the burden of these exams on trainees. METHODS: A 37-point questionnaire was distributed to all trainees who were preparing for or have sat MRCS examinations. Univariate analyses included the cost of the preparatory resources, extra hours worked to pay for these and the examinations, and the number of annual leave (AL) days taken to prepare. Pearson correlation coefficients were used to identify possible correlation between monetary expenditure and success rate. RESULTS: On average, trainees (n = 145) spent £332.54, worked 31.2 h in addition to their rostered hours, and used 5.8 AL days to prepare for MRCS Part A. For MRCS Part B/ENT, trainees spent on average £682.92, worked 41.7 extra hours, and used 5 AL days. Overall, the average trainee spent 5-9% of their salary and one-fifth of their AL allowance to prepare for the exams. There was a positive correlation between number of attempts and monetary expenditure on Part A preparation (r(109)=0.536, p < 0.001). CONCLUSIONS: There is a considerable financial and social toll of the MRCS examination on trainees. Reducing this is crucial to tackle workforce challenges that include trainee retention and burnout. Further studies exploring study habits can help reform study budget policies to ease this pressure on trainees.
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Tuberculosis or vasculitis? Granulomatous inflammation of the pancreatic tail as an atypical presentation of granulomatosis with polyangiitis
(BMJ Publishing Group, 2026-02-18) Whallett, Matthew; Ayaz, Aimen; Hagan, Guy; Sagar, Vandana; Sandwell and West Birmingham NHS Trust; Gastroenterology; Respiratory Medicine; Medical and Dental; Whallett, Matthew; Hagan, Guy; Ayaz, Aimen; Sagar, Vandana
Granulomatosis with polyangiitis (GPA), a subtype of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), is a systemic inflammatory disease that typically affects the respiratory tract and kidneys. However, atypical pancreatic manifestations have been reported, which may present clinically as acute pancreatitis or exocrine insufficiency, and radiologically as pancreatic enlargement or pseudotumour.A female in her 40s presented with nasal crusting and epistaxis. She subsequently developed fever, weight loss, haemoptysis, bilateral pulmonary nodules and a pancreatic tail mass. Pancreatic biopsy revealed caseating granulomatous inflammation, and antitubercular therapy was commenced.On developing haematuria and proteinuria, proteinase 3-ANCA testing and renal biopsy confirmed AAV. Treatment with rituximab and high-dose corticosteroids led to clinical improvement and radiological regression of both pulmonary and pancreatic lesions, consistent with systemic GPA involvement.This case highlights the importance of considering systemic inflammatory disease, alongside infective and malignant aetiologies, when evaluating pancreatic masses or focal pancreatitis with constitutional symptoms and multiorgan involvement.
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Switching from Intravitreal Ranibizumab (Lucentis) to Biosimilar Ranibizumab (Ongavia) injections: insights from a tertiary care eye centre
(Cureus Inc., 2026-01-19) Sourla, Evdokia; Zaheer, Naima; Chavan, Randhir; Sandwell and West Birmingham NHS Trust; Ophthalmology; Medical and Dental; Sourla, Evdokia; Zaheer, Naima; Randhir, Chavan
Background: Ranibizumab has been widely used to treat retinal conditions such as wet age-related macular degeneration, diabetic macular oedema, and macular oedema secondary to retinal vein occlusions. In 2022, the Medicines and Healthcare products Regulatory Agency (MHRA) approved Ongavia, the first biosimilar of ranibizumab. Ongavia offers comparable efficacy and safety, with a similar side effect profile to the original medication, while being more cost-effective. Method: The study was conducted in the medical retina department of a tertiary care eye hospital. Data were collected from patients undergoing treatment with intravitreal ranibizumab (Lucentis) who were switched to the ranibizumab biosimilar, Ongavia, between November 2023 and February 2024. This study included two components. The first was a cross-sectional observational survey, in which patients being switched to Ongavia completed a satisfaction questionnaire regarding the information leaflet received and the discussions held about the switch. The second component was a retrospective review to assess the effectiveness and safety of ranibizumab biosimilar Ongavia in patients with wet AMD. After two Ongavia injections, the treatment interval for the next injection was reviewed and compared with the treatment interval with ranibizumab. Similarly, OCT scans before and after the switch were reviewed and compared. Any adverse effects documented in the clinical notes were recorded. Results: Out of 121 eyes, 92 eyes (76%) were switched to biosimilar ranibizumab (Ongavia) injections, while 18 eyes (15%) continued receiving ranibizumab injections. Patient satisfaction with the information process was 100%. Eighty-seven eyes of patients with wet AMD received more than two Ongavia injections as per the treat-and-extend protocol. Out of these 87 eyes, in 64 eyes (73.5%), injection intervals were either maintained or extended. The treatment interval was reduced in seven eyes (8%), and nine eyes (10.3%) were switched to a different anti-VEGF medication. No safety concerns were identified with biosimilar ranibizumab. Conclusions: Patient satisfaction with the information process was high, likely due to active involvement in treatment decision-making. The results indicate that the clinical effectiveness of ranibizumab biosimilar Ongavia is comparable to ranibizumab and that it has a similar safety profile. Ongavia could serve as a cost-effective alternative, reducing healthcare system costs while maintaining high standards of patient care.