Welcome to The Royal Devon Research Repository

The Royal Devon Research Repository contains research outputs from staff at the Royal Devon University Healthcare NHS Foundation Trust.

You can browse items by Title, Author, Subject or Community/Collection, or use the search function to find specific topics.

The repository contains details of published, peer-reviewed journal articles, reviews, book chapters, conference abstracts and posters. Full-text of journal articles have been included where publisher's permissions allow.

If you are a member of Royal Devon University Healthcare NHS Foundation Trust and you'd like to submit an item to the repository, please fill in this online form. If you have a list of publications you'd like to submit, please e-mail the repository admin team: rde-tr.ResearchRepository@nhs.net.

For more information or help, please contact The Royal Devon Research Repository admin team:
Email: rde-tr.ResearchRepository@nhs.net
Telephone: Exeter Health Library, 01392 406800

Recent Submissions

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    Response to: Involving Patients Throughout Sensitive Simulation
    (Wiley, 2025-09-24) Hurley, F.; Maye, J. A.; Renal Medicine; Hurley, Florence; Maye, James Anthony
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    Correction: Palliative long-term abdominal drains vs. large volume paracentesis for refractory ascites secondary to cirrhosis: protocol for a definitive randomised controlled trial (REDUCe2 study)
    (Springer Nature, 2025-08-06) Haddadin, Y.; Anagnostopoulou, V.; Bremner, S.; Harder, H.; Starkings, R.; Lambert, D.; Porges, A.; Perry, N.; Wood, W.; Arbon, A.; Gage, H.; Glover, M.; Macken, L.; Johnston, M.; Ganai, B.; Joshi, D.; Hudson, B.; Butler, C.; Richardson, A.; Wright, M.; Prentice, W.; O'Brien, A.; Bedlington, J.; Steer, S.; Gaskin, T.; Verma, S.; The Exeter Liver Centre; Hudson, Ben
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    Challenges in Genomic Variant Interpretation Within Pakistani Populations due to Genomic Healthcare Inequalities
    (Wiley, 2025-07-26) Khalid, Z.; Adams, M.; Muhammad, A.; Tehreen, R.; Azeem, A.; Ahmed, A.; Ubeyratna, N.; Salter, C. G.; Leslie, J. S.; Voutsina, N.; Baple, E. L.; Crosby, A. H.; Firasat, S.; Sarwar, M. T.; Saleha, S.; Gul, A.; Rawlins, L. E.; Wellcome Wolfson Medical Research Centre; Peninsula Clinical Genetics Service; Adams, Matthews; Rawlins, Lettie E
    Accurate classification of genomic variants is crucial to ensure correct diagnosis, genetic counseling, and clinical management of monogenic inherited disorders. Variant interpretation can be hindered in populations that are significantly underrepresented in large reference genomic databases, leading to genomic healthcare inequalities. Despite a relatively high prevalence of inherited autosomal recessive diseases within Pakistan, this population remains significantly underrepresented in reference genomic databases. This genomic data disparity, alongside other population characteristics, including limited access to genomic healthcare, high rates of consanguineous unions, tribal, ethnic, and geographical isolation leading to increased autozygosity, can result in frequent challenges in rare variant interpretation. Here, we describe four Pakistani families with rare monogenic disorders in which whole-exome sequencing identified previously unpublished candidate biallelic variants of uncertain significance (VUS) in four genes: INTS1, PPFIBP1, HSPG2, and ACOX3. Our studies highlight the challenges of rare variant interpretation within the Pakistani community, leading to an increased proportion of variants being classified as VUS. Collectively, our findings highlight the need for increased diversity within genomic research to effectively tackle healthcare inequities faced by underrepresented communities.
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    Risk factors of late intraocular Lens displacement: A multi-national study
    (European Journal of Ophthalmology / SAGE, 2025-07-17) Chipeta, C.; Zhang, J.; Davidson, M.; Sallam, A. B.; Toma, J.; Gallo, B.; Anikina, E.; Ie, A.; Naik, M.; Xue, K.; Sivanesan, O.; Tarafdar, S.; Whitlow, S.; Mitry, D.; Bindra, M. S.; Latasiewicz, M.; Sermeus, L.; Januschowski, K.; Davies, A.; Kawamoto, K.; Bourkiza, R.; Patel, A.; Spiteri-Cornish, K.; Vilkelyte, V.; Ramsden, C.; D'Alterio, F. M.; Sandinha, M. T.; Gotzaridis, S.; Pardhan, S.; Chandra, A.; West of England Eye Unit; Vilkelyte, Virginija; Ramsden, Conor
    PurposeTo examine potential risk factors of late intraocular lens displacement (LIOLD); a rare complication of cataract surgery believed to be due to progressive zonular insufficiency which is often managed with pars plana vitrectomy (PPV) and intraocular lens (IOL) exchange.Setting16 centers across the UK, Germany and GreeceDesignRetrospective case control studyMethodsCases of LIOLD occurring between June 2018 and January 2023 were identified. Demographics, biometry data, previous medical and ocular history were interrogated and multivariate logistic regression was performed.Results434 eyes experiencing LIOLD were identified. 20,321 eyes not experiencing LIOLD during the same period formed the control group. Following multivariate analysis, YAG capsulotomy (OR 17.17, 95% CI 12.44-23.70, p < 0.001), pseudoexfoliation (OR 15.63, 95% CI 10.78-22.64, p < 0.001), complicated cataract surgery (OR 17.60, 95% CI 12.94-23.95, p < 0.001), previous PPV (OR 4.86, 95% CI 3.50-6.75, p < 0.001), younger age at cataract surgery (OR 0.94, 95% CI 0.93-0.95, p < 0.001) and axial myopia (OR 1.16, 95% CI 1.09-1.24, p < 0.001) were identified as risk factors. Female sex was associated with reduced risk (OR 0.64, 95% CI 0.51-0.80, p < 0.001). Patients having cataract surgery under 60 years had an increased risk (40 years OR 2.90, 30 years OR 4.92).ConclusionRisk factors are known to vary by geographical location and our study being the first multinational study provides a significant contribution. Future studies may look at prevention for at-risk individuals and compare outcomes of different IOL fixation techniques.
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    Refractive Outcomes in Keratoconus Patients Following Toric Lens Implantation: A Systematic Review and Single-Group Meta-Analysis
    (MDPI, 2025-08-27) Tan, T. G.; O'Kane, K.; Roberts, H. W.; West of England Eye Unit; Roberts, Harry W
    This systematic review and meta-analysis evaluated refractive outcomes, particularly astigmatic correction, in keratoconus following toric intraocular lens (tIOL) implantation. A systematic search identified eligible studies reporting pre- and postoperative refractive cylinder, spherical equivalent (SE), uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA). Eight studies, comprising 135 eyes, were included. Outcomes were pooled using a random-effects model with restricted maximum likelihood as the estimator for tau(2). Methodological quality was assessed using the MINORS tool for non-comparative studies and the JBI checklist for case series. Postoperative refractive cylinder and SE improved by 2.28 dioptres (95% CI, 1.60-2.96) and 4.17 dioptres (95% CI, 2.32-6.01), respectively. UDVA and CDVA also improved substantially, with pooled gains of 0.87 logMAR (95% CI, 0.71-1.03) and 0.19 logMAR (95% CI, 0.12-0.26), respectively. Most tIOL rotations did not exceed 10 degrees, with only one case requiring realignment surgery. Complications were infrequent and mostly minor. tIOL implantation is effective in reducing astigmatism and improving vision in stable keratoconus patients. However, limitations in vector analysis and methodology heterogeneity underscore the need for standardised reporting to optimise outcomes.
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