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
Item Role of pancreatoscopy in the management of suspected and confirmed intraductal papillary mucinous neoplasm of the pancreas(Baishideng Publishing Group Inc., 2026-01-28)Intraductal papillary mucinous neoplasms (IPMN) are pre-malignant tumours of the pancreas with variable malignant potential. Imaging often fails to map the disease extent accurately and guidelines differ on surgical thresholds. Pancreatoscopy, providing direct visualisation of the pancreatic duct and the option of targeted biopsies, may be able to delineate disease boundaries and improve preoperative and intraoperative decision-making. This mini-review appraises the current role, evidence base, and technical application of pancreatoscopy in the management of suspected or confirmed IPMN, with particular focus on its impact on the extent of pancreatic resections. Reported data show detection of additional lesions in about 20%-40% of cases and changes to operative strategy in roughly one third of patients, with low complication rates and high concordance between visual features and histology. Limitations include restricted availability, learning requirements, heterogeneity of technique, absence of a standardised visual classification, and a paucity of prospective outcome data; current international guidelines remain cautious. Pancreatoscopy is a promising adjunct to refine patient selection and the extent of resection in IPMN, particularly for delineating ductal spread and guiding margins. Routine adoption will require robust prospective studies to define diagnostic accuracy, impact on recurrence and survival, and cost-effectiveness.Item The development of a risk threshold to aid risk stratified approach to monitoring for haematological, hepatic and/or renal adverse drug reactions during established cs DMARD treatment for systemic autoimmune rheumatic diseases: a RAND/UCLA Appropriateness Method consensus study(Oxford University Press, 2026-02-04)OBJECTIVE: To explore how appropriate different intervals between monitoring blood tests are considered in relation to the risk of clinically significant adverse drug reactions in adults prescribed conventional synthetic DMARDs (csDMARDs) for ≥1 year for systemic autoimmune rheumatic diseases (SARD). METHODS: A RAND/UCLA Appropriateness Method consensus study was undertaken. Members of the BSR csDMARD guideline working group who manage adults with SARD participated. Experts rated the extent to which intervals between blood tests were appropriate using Likert-type scales with responses from 1 (totally inappropriate) to 9 (totally appropriate) for nine scenarios with 5-year predicted risk of discontinuing treatment due to abnormal monitoring blood tests from 5% to 25%. Median score and the number that voted 1-3 (inappropriate), 4-6 (unsure) and 7-9 (appropriate) were calculated for every interval in each scenario. Scenarios for which agreement could not be reached in the first round were recirculated, enclosing individual round 1 response and the panel median score. Consensus that an interval was appropriate for a scenario was reached where the median panel score was ≥7 and up to six experts rated <7. The results were discussed with patient and public involvement members and experts. RESULTS: Twenty-one of the 27 invitees participated. They comprised 11 consultants/GPs, five specialist nurses, three pharmacists and two rheumatology specialty trainees. Consensus was reached for all scenarios. Six- and three-monthly blood tests were agreed as appropriate when the predicted risk was ≤10% and >10% over 5 years, respectively. CONCLUSION: A threshold to aid risk-stratified monitoring during established csDMARD treatment was agreed for adults with SARD.Item The (Hidden) World of Wide-awake Office Surgery(Wolters Kluwer, 2026-02-01)Item Corneal Neovascularization: Pathogenesis, Current Insights and Future Strategies(MDPI, 2026-01-13)The cornea is an avascular, immune-privileged tissue critical to maintaining transparency, optimal light refraction, and protection from microbial and immunogenic insults. Corneal neovascularization (CoNV) is a pathological sequela of multiple anterior segment diseases and presents a major cause for reduced visual acuity and overall quality of life. Various aetiologies, including infection (e.g., herpes simplex), inflammation (e.g., infective keratitis), hypoxia (e.g., contact lens overuse), degeneration (e.g., chemical burns), and trauma, disrupt the homeostatic avascular microenvironment, triggering an overactive compensatory response. This response is governed by a complex interplay of pro- and anti-angiogenic factors. This review investigates the potential for these mediators to serve as therapeutic targets. Current therapeutic strategies for CoNV encompass topical corticosteroids, anti-VEGF injections, fine-needle diathermy, and laser modalities including argon, photodynamic therapy and Nd:YAG. Emerging therapies involve steroid-sparing immunosuppressants (including cyclosporine and rapamycin), anti-fibrotic agents and advanced drug delivery systems, including ocular nanosystems and viral vectors, to enhance drug bioavailability. Adjunctive therapy to attenuate the protective corneal epithelium prior to target neovascular plexi are further explored. Gene-based approaches, such as Aganirsen (antisense oligonucleotides) and CRISPR/Cas9-mediated VEGF-A editing, have shown promise in preclinical studies for CoNV regression and remission. Given the multifactorial pathophysiology of CoNV, combination therapies targeting multiple molecular pathways may offer improved visual outcomes. Case studies of CoNV highlight the need for multifaceted approaches tailored to patient demographics and underlying ocular diseases. Future research and clinical trials are essential to elucidate optimal therapeutic strategies and explore combination therapies to ensure better management, improved treatment outcomes, and long-term remission of this visually disabling condition.Item A scoping review of outcome reporting in randomized controlled trials of incisional and non-incisional ventral hernia repair(Springer, 2026-01-16)BACKGROUND: Incisional and non-incisional ventral hernias are common and important causes of symptoms, functional restriction, and complications, with significant potential to impact upon quality of life. The goals of hernia repair are to treat, prevent or improve these. However, outcomes of surgery remain relatively poor with significant gaps within the evidence base, which may be due to inconsistent use of outcome measures. The aim of this study was to appraise outcome reporting in the recent literature of randomized controlled trials (RCTs). OBJECTIVES: This scoping review aimed to map and categorize the outcome measures reported in RCTs of incisional and non-incisional ventral hernia repair. ELIGIBILITY CRITERIA: All RCTs assessing any intervention related to incisional, primary, or recurrent ventral hernia repair between2015 and 2025 were included. SOURCE OF EVIDENCE: A literature search was performed of the PubMed, EMBASE (1974 to present), and Cochrane Central Register of Controlled Trials databases in November March 2025. CHARTING METHODS: Data was extracted independently by two reviewers. All outcomes reported by the included studies were identified and recorded. RESULTS: 118 RCTs were included. Their outcomes were mapped into five main broad categories. The commonest outcomes used were short-term operative complications (72.9%), hernia recurrence (59.3%), pain (57.6%), and quality of life (33.9%). Patient-reported outcomes were measured in 78 (66.1%) randomized controlled trials, of which 15 assessment tools were identified; 11 were generic, and 4were hernia-specific. There was considerable heterogeneity in how and when these endpoints were assessed and defined. CONCLUSION: This scoping review found considerable differences in outcome reporting in contemporary RCTs of incisional and non-incisional ventral hernia. These have significant implications for translating evidence into practice, and its synthesis, and support the need for a core outcome set in this field. However, we identified areas such as abdominal wall function which are infrequently reported and require consideration.
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