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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    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, 2025-06-04) 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
    BACKGROUND: Ascites remains the most common complication of cirrhosis and a frequent reason for hospitalisation in advanced chronic liver disease (ACLD). Ascites is associated with significant symptom burden, caregiver workload and poor health-related quality of life (HRQoL). Once refractory to treatment, median survival is poor. Many with refractory ascites (RA) will neither receive a transjugular intrahepatic portosystemic shunt (TIPS) nor a liver transplant. Palliative care remains underutilised and evidence-based interventions focused on improving HRQoL are clearly needed. The standard of care for RA is repeated hospital ascites drainage with large volume paracentesis (LVP). Our earlier feasibility randomised controlled trial (RCT) (REDUCe) showed acceptability of palliative tunnelled long-term abdominal drains (LTADs), as well as preliminary evidence of safety and efficacy. The current REDUCe2 trial is a definitive national study designed to assess the impact of palliative LTADs on HRQoL in patients with RA due to ACLD. METHODS/DESIGN: The REDUCe2 study is a pragmatic, multicentre, open-label, mixed-methods, superiority RCT being conducted in England, Scotland and Wales. Patients with RA secondary to ACLD who are ineligible for a liver transplant or TIPS will be randomised 1:1 to receive a LTAD or continue the current standard of care (LVP). Fortnightly home research visits will be conducted for 12 weeks in both arms. The primary outcome will be liver specific HRQoL assessed at 12 weeks using the Short Form Liver Disease Quality of Life questionnaire (SFLDQoL). Secondary outcomes include assessment of symptom burden (Ascites Questionnaire), health utilities (EQ-5D-5L tool), caregiver workload (Caregiver Roles and Responsibilities Scale-CRRS questionnaire), safety (including infection, acute kidney injury and other clinical outcomes), health resource utilisation and acceptability of the intervention by patients, caregivers and healthcare professionals. We aim to recruit a total of 310 patients (155 in each arm). DISCUSSION: Effective palliative care provision remains an unmet need in ACLD. The REDUCe2 study, the largest palliative interventional trial in the UK, aims to address this inequity for this vulnerable and underserved cohort. It has the potential to generate high quality evidence to optimise and enhance palliative care in RA. TRIAL REGISTRATION: ISRCTN26993825, date registered: 15/08/2022.
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    Urethral Leiomyoma in Pregnancy: A Rare Case of Symptomatic Pelvic Mass With Successful Surgical Management
    (Springer Nature, 2025-06-25) Latoui, R. B.; Sulemana, A. S.; Chaudhry, M.; Abbas, U.; Khan, M. A.; Renal Medicine; Sulemana, Abdul Samed
    Leiomyomas, benign tumors derived from smooth muscle, are typically found in the uterus. Urethral involvement is an exceptionally rare occurrence, particularly in the context of a pre-fashioned thigh flap. Our case, therefore, presents a unique and intriguing instance, with only a few similar cases reported. We present a case of a 27-year-old primigravida at 11 weeks gestation with a protruding anterior vaginal mass, pelvic heaviness, and recurrent urinary complaints. A well-circumscribed vascular mass came out through the vulval orifice on physical examination. Transvaginal ultrasonography and pelvic magnetic resonance imaging revealed a 6×4 cm-sized mass that originated from the anterior vaginal wall, and it did not invade the adjacent structures. The surgical resection through anterior vaginal route with the use of spinal anesthesia. Histopathological examination revealed urethral leiomyoma, and the diagnosis was supported by positive immunoreactivity for the smooth muscle markers. The recovery following surgery was uneventful, and the pregnancy was carried to term with a successful normal delivery, instilling hope and optimism in similar cases. Our case underscores the crucial role of obstetricians and gynecologists in considering urethral leiomyoma in the differential diagnosis of anterior vaginal wall masses, even in pregnancy. This emphasis on early multimodal treatment can significantly impact the outcome; good results can be achieved, and pregnancy outcomes can be improved with curative therapy.
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    Calculating genetic risk scores directly from summary statistics with an application to type 1 diabetes
    (Oxford University Press, 2025-07-02) Squires, S.; Weedon, M. N.; Oram, R. A.; The Academic Renal Unit; Oram, Richard A
    MOTIVATION: Genetic risk scores (GRS) summarise genetic data into a single number and allow for discrimination between cases and controls. Many applications of GRSs would benefit from comparisons with multiple datasets to assess quality of the GRS across different groups. However, genetic data is often unavailable. If summary statistics of the genetic data could be used to calculate GRSs more comparisons could be made, potentially leading to improved research. RESULTS: We present a methodology that utilises only summary statistics of genetic data to calculate GRSs with an example of a type 1 diabetes (T1D) GRS. An example on European populations of the mean T1D GRS for those calculated from genetic data and from summary statistics (our method) was 10.31 (10.12-10.48) and 10.38 (10.24-10.53), respectively. An example of a case-control set for T1D has an area under the receiver operating characteristic curve of 0.917 (0.903-0.93) for those calculated from genetic data and 0.914 (0.898-0.929) for those calculated from summary statistics. AVAILABILITY: The code is available at https://github.com/stevensquires/simulating_genetic_risk_scores.
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    Coming to a hard stop? Effect of tapered tocilizumab after weekly tocilizumab cessation for giant cell arteritis: a multicentre evaluation
    (Oxford University Press, 2025-08-26) Quick, V.; Sah, S.; Dubey, S.; Mercer, L.; Nair, J. R.; Coath, F. L.; Kurshid, M.; Abusalameh, M.; Ahmed, S.; Alkoky, H.; Bukhari, M.; Carter, S.; Davidson, B.; Doddamani, P.; Ducker, G.; Griffiths, B.; Gullick, N.; Heaney, J.; Holloway, A.; Htut, E. E. P.; Hughes, M.; Irvine, H.; Kinder, A.; Lim, J.; Ludwig, D. R.; Malik, M.; Mulhearn, B.; Patel, R.; Robson, J.; Saha, P.; Tansley, S.; Mackie, S. L.; Rheumatology Department; Abusalameh, Mahdi
    OBJECTIVES: In England, there is a hard stop" to weekly tocilizumab (qwTCZ) therapy for GCA; this is currently 12 months but was extended during the COVID-19 pandemic subject to certain criteria for GCA relapse risk. Taking advantage of variation in practice, we aimed to compare outcomes of GCA patients who tapered TCZ vs those who stopped abruptly (non-taper patients). METHODS: Secondary analysis of an English multicentre service evaluation of relapse after stopping qwTCZ for GCA. Time to relapse was compared between taper and non-taper patients. We examined outcomes according to whether they had been "adequate responders" during qwTCZ therapy, defined as those in remission and on ≤ 5mg prednisolone at qwTCZ cessation, without relapse whilst taking qwTCZ. RESULTS: We analysed 336 patients from 40 centres. Time to relapse after qwTCZ cessation was significantly longer in adequate responders than non-adequate responders (p = 0.0004).17.0% (57/336) patients tapered to fortnightly TCZ after qwTCZ cessation, for a median of 6 (IQR 2-13) months. For adequate responders, time to relapse whilst taking tapered-dose TCZ was significantly longer compared with those in the non-taper group (p = 0.0231) based on a relatively small number of flares. There was no difference between the taper and non-tapered groups after tapered TCZ was stopped (p = 0.8346). In contrast, time to relapse for non-adequate responders was similar in taper-patients compared with non-taper patients (p= 0.4892). CONCLUSION: Tapering TCZ after qwTCZ cessation delayed relapse only during the tapering period, but only in adequate responders to qwTCZ. No lasting benefit was seen after tapering ended."
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