The NHS North East London Evidence Repository (NELER) contains research and organisational information generated by people working and volunteering across the North East London Integrated Care System geography
Please see below for the full list of NELER organisations. To engage with us as we develop the repository - including submitting items for adding to the collection - contact us via email: nelrepository@gmail.com
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Recent Submissions
Item Acromioclavicular Fixation Before Coracoclavicular Tunnel Placement and Acromioclavicular Construct Design Improved Reduction and Stability in a Whole-Shoulder Girdle Model: A Pilot Study.(26/05/2025)Background: Reconstruction of the acromioclavicular (AC) ligament after an acute AC dislocation as the first surgical step before coracoclavicular (CC) tunnel placement has been proposed to reduce the risk of postoperative loss of reduction. Additional reconstruction of AC ligamentous complex lesions with different types of bracing constructs has also been described to improve outcomes. Still, the effect of the sequence of surgical steps and the AC bracing construct design on the AC kinematics in a whole-shoulder girdle model has not been reported. Hypothesis: The primary hypothesis was that postoperative AC joint reduction would improve when the AC joint was reconstructed before CC tunnel placement. The secondary hypothesis was that different AC bracing construct designs affect joint kinematics during physiological motion in a whole-shoulder girdle model. Study design: Controlled laboratory study. Methods: Five cadaveric specimens (10 shoulders) were prepared for whole-shoulder mobilization with a robotic manipulator. Joint kinematics was acquired during physiological motions using an optical motion capture system. Recorded parameters were (1) the joint reduction in a resting position, expressed as joint displacements and rotations compared with an intact AC joint, and (2) the joint stability during all tested motions, expressed as joint displacements and rotations. The tested joint conditions were intact AC joint, induced Rockwood type 5 lesion, isolated CC reconstruction, and 4 AC joint bracing construct designs. AC reconstruction was performed before (AC-first technique) and after (CC-first technique) CC tunnel placement in 5 shoulders each. Results: The AC-first surgical step improved the AC joint reduction in anterior-posterior tilt compared with CC-first (median difference, -9.4°; P < .001). The AC-first surgical step also demonstrated an increased superior-inferior joint reduction with hyperreduction (median difference, 1.6 mm; P = .041) compared with CC-first. Dispersion of joint reduction values was reduced with the AC-first step and particularly for anterior-posterior tilt (IQR difference, -4.8°) and lateral-medial displacement (IQR difference, -3.4 mm). The double vertical bracing construct design increased the AC joint stability compared with other constructs and reached a statistical significance in all rotational displacement (P < .001 to P = .041) as well as in lateral-medial displacement (P = .001 to P = .015). Conclusion: The AC-first surgical step sequence improved AC joint alignment in the scapular sagittal plane and increased joint hyperreduction. The double vertical bracing construct design achieved the highest joint stability over other tested designs during passive motion. Clinical relevance: The restoration of the preinjury joint alignment and the optimization of the joint stability may improve outcomes and reduce the risk of construct de-tensioning during the rehabilitation phase.Item Solutions for tackling the global surgery crisis in west Africa.(30/06/2025)The global surgical crisis has become one of the most discussed health topics since the Lancet Commission report published in 2015 because the need is massive, and the consequences are devastating both to countless personal lives and to the economies of low-income and middle-income countries (LMICs). A third of the total global disease burden requires surgical treatment but 5 billion people worldwide (two-thirds of the world's population) do not have access to safe, affordable, and timely surgery. One person dies every 2 seconds from a surgically treatable disease, which is more than the mortality of HIV, tuberculosis, and malaria combined. Nearly half of the world's population would face financial ruin if they accessed surgical care today. 80 million people are driven to financial catastrophe due to the cost of surgery alone or access to surgical care. As a result, countless people suffer and die from a global burden of disease engendered by poverty that can easily be cured. Countries in sub-Saharan Africa fall in the lower third of WHO's Human Development Index because more than two-thirds (up to 69%) of people live on less than £2 a day. The majority (over 90%) of the region's population does not have access to basic surgical and anaesthetic care. Health-care infrastructure in these low-income countries is scarce or non-existent, and there is a shortage of trained health-care providers. Even when those barriers are removed, patients in LMICs face a higher perioperative mortality rate (1% compared with 0·5% in high-income countries).Item Challenges in the diagnosis and management of psoriatic arthritis in people of colour(28/02/2025)PsA is the second commonest inflammatory arthropathy worldwide and appears to affect all people groups. It has been previously suggested that the prevalence of PsA is significantly lower in certain people groups, such as Black Africans. However, this may be due in part to underdiagnosis and misdiagnosis.Item Current practices in HPV-related anogenital neoplasia care in Europe – a survey analysis.(28/07/2025)Background Human papillomavirus (HPV) is causally related to neoplasia in multiple anogenital zones including anal, vulval, vaginal, and cervical areas in women. Care for anogenital neoplasia involves multiple specialist fields. Women with a history of cervical neoplasia are at increased risk of multiple anogenital neoplasias and second cancers occur in the anogenital zones. Results of a survey on current management practices across Europe are presented. Methods A questionnaire was developed by iterative process and circulated amongst specialists in all fields associated with anogenital neoplasia. Data was recorded and analysed using Microsoft Excel/Stata. Results 316/430 (73.5%) respondents collaborated with colleagues to provide care, but only 27.0% were engaged in full multidisciplinary team meetings (MDT). Second cancers were observed both in the same anatomical zone (56.5%) as well as in different anatomical zones (45.3%) by the respondents. The survey identifies significant variability in clinician workload, experience and screening practices. Low utilisation of high-resolution anoscopy (HRA) by specialists (14.9%) indicate lack of standardisation of practices, though some (12.7%) expressed interest in training in HRA. 24.4% did not offer treatment for anogenital neoplasia, while those who treated utilised multiple modes of treatment. Conclusions Recognition of multizonal anogenital neoplasia and the risk of second cancers, and new data on successful treatment of anal neoplasia have led to the assessment of expertise amongst Europe’s specialists. Enhanced HRA training, improved guidelines and robust follow-up protocols are essential to optimising care. A concerted effort is needed to align professional development, workload standards and clinical practices across Europe.Item Doxycycline post-exposure prophylaxis as prevention of STIs – the golden bullet?(25/05/2025)Introduction Doxycycline post-exposure prophylaxis (‘doxyPEP’) is an emerging strategy to prevent bacterial sexually transmitted infections (STIs). Users take 200mg of doxycycline up to 72 hours after condomless sex, and data from randomized controlled trials and real-world implementation have shown doxyPEP to be effective in preventing syphilis, chlamydia, and to a lesser extent gonorrhea, in gay, bisexual, and other men-who-have-sex-with-men (GBMSM) and transgender women. Areas covered: We discuss the potential benefits, risks, and important considerations for doxyPEP implementation, drawing on published literature and our own perspectives. Expert opinion: Is doxyPEP the golden bullet? DoxyPEP provides significant benefits through STI prevention and holistic improvements in sexual health and wellbeing. Concerns over emergent antimicrobial resistance need to be weighed against STI-related morbidity and contextualized within society’s overuse of antibiotics. Inequities in the doxyPEP evidence-base and implementation will undermine its ability to end the syphilis epidemic and reduce chlamydia associated morbidity in cisgender women. Moreover, contexts in which doxyPEP proves effective for gonorrhea prevention initially are unlikely to see a long-lasting impact. Rather than a golden bullet, doxyPEP is a bridge to the next set of STI prevention tools.
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