A Phase II, Randomised, Double-blind, Placebo-controlled, Parallel group,Multicentre Study Investigating the Efficacy and Safety of Sepranolone (UC1010) in Patients with PMDD

This study is recruiting participants with severe premenstrual symptoms that may fit the diagnosis of premenstrual dysphoric disorder (PMDD). The aim of this study is to investigate the effect of Sepranolone given during three consecutive menstrual cycles (during the luteal phase only) on premenstrual symptoms and evaluate the safety of this potential new medication for PMDD.

The effect on symptoms will be evaluated using a questionnaire; you will be asked to report your symptoms using an electronic patient diary. There are 3 treatment groups; two groups with different doses of Sepranolone and a placebo (dummy medication without any active ingredients) group. You will not know which treatment group you have been assigned to; however you will have a 2:1 chance of receiving Sepranolone.

A multi-centre randomised controlled trial of the efficacy and mechanism of action of gabapentin for the management of chronic pelvic pain in women.

In this study we will use a drug called gabapentin. Gabapentin is a commonly used drug for other chronic or long term pain conditions but there is no proof that it helps women with chronic pelvic pain. We carried out a small study comparing gabapentin against placebo (an identical dummy capsule) and this showed that it might help with this pain but we need more evidence, therefore we are asking you to take part in this larger study to try and prove whether it works. We will give half the women in our study gabapentin and half a placebo for sixteen weeks. You will not know whether you are taking gabapentin or placebo until the end of the study. We will ask you to tell us how your pain is at the beginning of the study before you take any capsules and again for the last 4 weeks of taking them. We hope that this will tell us whether gabapentin is helpful for women with CPP.

FUTURE Study - Female Urgency, Trial of Urodynamics as Routine Evaluation

The FUTURE study aims to assess whether routinely performing urodynamic studies, over and above comprehensive clinical assessment in women with refractory over active bladders, improves the outcomes of treatment. We also want to assess whether doing the UDS test on everybody makes the best use of the NHS resources i.e. whether it is cost-effective.

Ectopic Pregnancy DIagnosis sTudy:

Developing metabolomics profile analysis in biofluids to detect an ectopic pregnancy in symptomatic women in early pregnancy

Approximately 1 in 3 of all women who are pregnant, will visit the gynaecological emergency department in early pregnancy because of bleeding and/or abdominal pain. One woman in thirty with these symptoms will have, a pregnancy that grows outside of the womb (an ectopic pregnancy).

An ectopic pregnancy can be in the fallopian tube, ovaries or anywhere in the pelvis. Even with all modern technologies, it is still difficult to diagnose an ectopic pregnancy, with more than half not diagnosed when women first seek medical help. Because of this, we need to improve the way we diagnose an ectopic pregnancy by developing better tests in order to reduce the health risks and stress to women. We are looking for 625 women who are in the beginning of their pregnancy (less than 10 weeks from their last period) and visit the Liverpool Women’s Hospital emergency department because of bleeding and/or abdominal pain. We are trying to develop an easy and quick test that can accurately identify women with ectopic pregnancies

The TOPSY Trial: A study comparing self-management with clinic based follow up for women using a vaginal pessary for prolapse

Pelvic organ prolapse is a common condition that often leads to women having symptoms that interrupt their day to day life. One treatment that some women receive for pelvic organ prolapse is a vaginal pessary.  However, it is not clear how to support women once their pessary is in place. One option is that women attend an appointment approximately every four to six months to have their pessary changed: this is called standard pessary care. Another option is that women are taught how to remove and re-insert their pessary at home: this is called pessary self-management. 

At the moment there is no evidence to tell us which of these is better for women. Therefore this study aims to compare standard pessary care with pessary self-management to find out which is better at improving women’s quality of life when they are using a vaginal pessary for treatment of pelvic organ prolapse.

A randomised placebo-controlled trial of mifepristone and misoprostol versus misoprostol alone in the medical management of missed miscarriage

The purpose of this study is to test which is the best drug treatment for the medical management of missed miscarriage. In this study, we will test if taking an extra tablet (called mifepristone) in addition to the standard treatment (a drug called misoprostol) is more effective for treating missed miscarriage.

MifeMiso is a randomised, double-blind, placebo-controlled trial:

Randomised: The women who take part will be given either the treatment drug (mifepristone) or a placebo – a dummy drug that has no active ingredients. A computer makes the selection so it’s completely random.

Double-blind: The women in the study won’t be told whether they are taking the active medicine or the placebo – and neither will their doctors. So both are blinded to this information.

Placebo-controlled: Half the women in the study will have the active medicine and half (the controls) will have the placebo. The medicine that they receive will look exactly the same to them and their doctors, but a completely separate group will keep a record of which women have mifepristone and which have the placebo.

It is important to note that all women will receive misoprostol two days later, which is currently the recommended treatment for the medical management of miscarriage.

The Pipelle for Pregnancy for polycystic ovarian syndrome (PIP-PCOS) study

Endometrial pipelle sampling (also known as endometrial biopsy, injury or scratching) is a new procedure now being trialed in couples with subfertility related to polycystic ovarian syndrome. The procedure involves inserting a thin plastic sampler (pipelle) through the cervix and into the womb where a sample from the endometrium is then obtained by rotation. The sample is then discarded. It is thought that the action of taking the sample results in a small disturbance to the lining of the womb which might result in an increased chance of pregnancy.

Some preliminary research has found that pipelle sampling in women who have undergone many unsuccessful IVF cycles increases their chance of pregnancy in the next IVF cycle. However, it is not known whether pipelle sampling is also helpful

Couples who agree to take part in the PIP-PCOS study will be randomly allocated to either pipelle sampling or no sampling.

 The role of the identified regulators of cell fate (RCF) and metastasis-inducing-proteins (MIP) in endometrial stem/progenitor cells (SPC) in endometriosis

The inner lining of the womb (endometrium) may play an important part in recurrent pregnancy loss. Recurrent pregnancy loss affects one percent to three percent of women. Recurrent implantation failures may present as infertility. It is possible that an abnormality of special cells in the endometrium called stem cells can cause recurrent pregnancy loss or recurrent implantation failures. If so, the information from this gynaecology study of endometrium stem cells will help us to develop new techniques to diagnose and treat this distressing condition.

This is a study for women who suffer from heavy menstrual periods; for which the main treatment is a device called the Mirena coil. Recently, a new drug called ulipristal has been found to quickly reduce bleeding in women with large, non-cancerous growths in the womb, known as fibroids. It is not known whether this drug is effective in reducing the impact of heavy menstrual bleeding in women who do not have fibroids, or have small, insignificant fibroids. It is also unclear how ulipristal stops menstrual bleeding and its effect on the womb lining. Both ulipristal tablets and the hormone releasing coil are safe, effective treatments, each with advantages and disadvantages, but doctors do not know which women will benefit from either treatment. Since the way the treatments work and are used are different, it is important to compare them against each other.

Traditionally, embryos are put back into the uterus within a few days of being created. Recent research has suggested that delaying embryo replacement until the hormonal effects of the IVF treatment have worn off may lead to higher pregnancy rates and fewer complications. This is achieved by freezing the created embryos and transferring them within 3 months.

The aim of this trial is to find out which method of embryo transfer is more likely to increase the chances of having a healthy baby. The trial compares fresh embryo transfer with thawed frozen embryo transfer in a large number of couples undergoing IVF treatment across multiple clinics in the U.K.

The main purpose of this clinical research trial is to learn about the effect and safety of different doses of FE 999302 when given together with REKOVELLE. FE999302 is the experimental drug and REKOVELLE is the standard IVF teatment. FE 999302 is thought to increase the quality of the eggs retrieved and thereby increase the chance of achieving pregnancy compared to standard treatment. The results of this trial will be used to select the optimal dose(s) for further clinical development of FE 999302.

Determining the Optimal Embryo Implantation Site

The placement of an embryo is one of the most important steps in your IVF treatment. Embryo implantation is a complicated process that is not fully understood. We know from experience that where the embryo is placed in the uterus does not always mean is where it stays. This study will be looking at which area of the uterus the pregnancy has implanted that has led to your pregnancy. Using this information may help us better place an embryo in the first instance.

 3D / 4D Ultrasound Guided Embryo Transfer vs. Clinical Touch: a randomised controlled trial

This study is looking at the process of replacing an embryo under trans-vaginal ultrasound guidance with the addition of 3D and 4D visualisation of the uterus during the procedure as opposed to routine clinical touch. The aim is to determine whether this procedure improves the pregnancy and live birth rates compared with our standard practice.

Simple Hysterectomy And Pelvic node dissection in Early cervix cancer

The usual treatment for early stage cancer of the cervix is with a type of extensive surgery called a radical hysterectomy, in which the uterus and surrounding tissues are removed along with pelvic nodes. Radical hysterectomy is highly effective and will cure over 90% of women with early stage cervical cancer. However, it also causes a number of side-effects, both soon after the surgery, and in the long-term. It has been proposed that performing a less extensive surgical procedure, called a simple hysterectomy, in which less of the tissue surrounding the uterus is removed along with pelvic nodes, will have the same benefits in preventing cancer of the cervix from returning. It is also proposed that the simple hysterectomy will have fewer side-effects after surgery and fewer long-term side-effects.

Refining Ovarian Cancer Test Accuracy Scores:

A test accuracy study to validate new risk scores in women with symptoms of suspected ovarian cancer

We know that lots of women have symptoms such as bloating and tummy discomfort. It is also very common to have cysts (balloon like swellings) on women’s ovaries picked up by ultrasound. In addition, some women have higher levels of a blood test called CA125; this blood test is abnormal in lots of conditions - women with periods, fibroids, appendicitis etc. A very small number of women with ovarian cysts or abnormal CA125 will go on to be diagnosed with ovarian cancer.

The purpose of this study is to identify better tests for women with ovarian cysts or abnormal blood tests so we can pick up ovarian cancer earlier. This will also reduce unnecessary tests, hospital visits and distress in women who don’t have cancer.

The Impact of Multiparametric MRI on the Staging and Management of Patients with Suspected or Confirmed Ovarian Cancer

When patients have suspected or confirmed ovarian cancer the best treatment is often surgical removal of all or most of the disease. Currently, a simple test called a CT scan (or Cat Scan) is used to identify where the disease is located and if surgery would be a suitable treatment option.

However, CT scans cannot always tell if the disease is benign (not cancer) or malignant (cancer) nor can it always tell us how far the cancer has spread or reliably show us when it would be best to operate. Because doctors want to offer patients the chance of surgery when possible, women are given the benefit of any doubt if there is any uncertainty on the CT scan as to whether surgery will be successful. This means that 15–40% of patients are found to have inoperable disease at the time of surgery, gaining little benefit from surgery and delaying the start of their chemotherapy. Additionally, in up to 30% of cases, suspected ovarian cancer turns out not to be cancer at all, and these women could have undergone less complex surgery or even avoided surgery and associated emotional distress if the CT scan was more accurate.

It is possible that a different type of scan, called magnetic resonance imaging scan (MRI), may be more accurate than CT, especially a newer version “multi-parametric” MRI (mpMRI). From an mpMRI scan, doctors are able to see additional features, such as the movement of water molecules. This may enable them to better recognise healthy tissue from cancer. Our study aims to determine whether women would benefit from having a pre-operative mpMRI compared to CT scan

A Comparison of the Clinical and Histological appearances after treatment of Ovarian Cancer with Plasmajet

The aim of this study is to assess the clinical appearances of tissue following treatment with Plasmajet, and to compare this with the histological assessment of the same tissue which has not been treated.

Within the study we will use Plasmajet on a small area of tumour that has already been removed as part of the operation. This area will be treated with Plasmajet until no visible disease is present to the naked eye. This Plasmajet treated section would then be sent to the histopathology laboratory along with all other removed specimens, and we will ask the Pathologists to assess that area for the presence or absence of any tumour cells, and the presence or absence of damage to any underlying structure, e.g. bowel surface.

SuPPoRT: Stitch, Pessary or Progesterone; a randomised trial

The purpose of this study is to assess which treatment is best for the mother's and the baby’s health. In order to find out which treatment is best, we need to make comparisons between them when the choice of treatment for each participant is randomly allocated (which we will do using a computer program). Neither the participants nor their doctor will be able to choose the form of treatment. We hope that 510 women will agree to participate, of whom 170 will be treated with a stitch, 170 with progesterone and 170 with the pessary. The results will then be compared to see if one treatment is better than the others.

Cerclage Suture Type for an Insufficient Cervix and its effect on Health Outcomes

There are two types of threads commonly used for cervical stitches. One thread is made of a single strand; the other is made of strands woven together. Woven threads are sometimes thought to be stronger and easier to remove before birth. However, they might encourage infection, which can trigger an early start to labour.

In contrast, a single strand thread is considered by some to be less likely to cause infection. However, others think this thread can cut the cervix and be harder to remove.

At the moment there is no evidence as to which is the best type of thread to offer to women who are having a stitch to prevent their baby being born too soon. This is why we are doing C-STICH. Your doctor is happy to use either type of thread.

Collection and storage of tissue from gynaecological surgery (hysterectomy)

The Research Tissue Bank collects and stores tissue taken at surgery for research. By doing this the research tissue bank is able to build up a valuable collection that will be used by research groups investigating complications of the female reproductive system. It is hoped that the resulting knowledge will help other women in the future.

An open randomised trial of the Arabin pessary to prevent preterm birth in twin pregnancy, with health economics and acceptability – STOPPIT-2

The study aims to determine whether the Arabin cervical pessary prevents preterm birth in women with a twin pregnancy and a short cervix. Women with a twin pregnancy are at risk of having a baby preterm (before their due date). Women with a short cervix are at extra risk of a preterm birth. Babies born prematurely have increased risk of health problems and are more likely to require admission to the neonatal unit.

The Arabin cervical pessary is placed in the vagina and fits over the cervix. The pessary is made of silicone which is soft and flexible. Fitting the pessary involves minor discomfort only. The pessary is then left in place until 36 weeks of pregnancy but if the woman goes into labour it will be removed. Recent studies indicate the pessary may prevent preterm birth in twins. We want to find out if this is correct.

Induction of labour for predicted macrosomia ‘The Big Baby Trial’

The aim of this study is to find out the best way to care for women with babies who appear to be bigger than expected for their dates. Identifying if labour should be started a little earlier for these women is an important unanswered question. The results of this study will provide evidence about the best way to care for women with bigger babies.

In some pregnancies in order to diagnose certain genetic and chromosomal problems an amniocentesis (a sample taken from the fluid surrounding the baby) or chorionic villus sampling (CVS) (a sample taken from the placenta) is needed. Research has shown that it may be possible to use a simple blood test taken from the mother early in pregnancy to gather information about the health of the baby and predict certain complications of pregnancy. One of the key advantages of the new blood tests will be the ability to make a diagnosis without the need for amniocentesis or CVS which means future testing could be much simpler and much safer for both mother and baby.

Before we can offer the new tests routinely it is important to ensure they work well and are accurate. To do this we need the help of parents with both normal and complicated pregnancies to collect a bank of samples that will allow us to compare these new tests with those in current use.

If you are attending the Fetal Centre or FMU for amniocentesis or chorionic villus sampling and would like to take part in this study, contact the Research Midwives on 0151-702-4355.

Neurodevelopment After Prenatal Exposure to Seizures (NAPES) Study

We are doing this study to find out more about the health and development of children born to women who have epilepsy. Every year thousands of women with epilepsy around the world become pregnant; in fact 1 out of 250 pregnancies is to a women with epilepsy.

This study aims to help understand whether having seizures during pregnancy is linked to poorer child development in their first year of life. Currently there is no clear information as to whether short seizures have an effect on the developing baby. Without having this information it makes it harder for women and their doctors to make decisions about treatment during pregnancy when a women is having seizures. It is expected that when this study has finished the information collected will help doctors and women with these decisions.

Some women may feel frightened about giving birth. However, little is known about what these fears are about or how they affect women in pregnancy. We are interested in understanding more about women's childbirth fears, so that we can improve ways of identifying and supporting women with fear of childbirth during pregnancy.  We are currently running a study with women who are pregnant and who have reported feelings of fear about giving birth to their midwife. You may be asked if you would like to hear more about taking part in this study, or you can contact the researcher about the study yourself if you think it is relevant to you after seeing this information.  For further information please contact Katie Balling on 07776 491 292 / kballing@liverpool.ac.uk or Kayleigh Sheen Kayleigh.sheen@liverpool.ac.uk.

The aim of this study, by Liverpool University is looking at whether your relationship with your baby influences your engagement with health related behaviours during pregnancy. You must be in your third trimester (28-36 weeks) to participate in this study and before you decide whether to take part, it is important for you to understand what it will involve.

Important things you need to know:

• You will be asked to complete a set of questionnaires that will be related to your mood, your relationship with your baby and your lifestyle.  This should take around 30-40 minutes to complete.
• Your answers on the questionnaires will be kept confidential and will not be shared with health professionals involved in your care.  However, if you disclose information that indicates a potential risk to yourself or others the researcher will be required to inform your midwife, which will be done with your consent where possible.
• Taking part in this study is voluntary - you can stop taking part at any time without having to give any reason.
• The questionnaires will be anonymised so that you cannot be identified when the data is being analysed.  The data will be stored securely in accordance with Data Management policies at the University of Liverpool.
• This is a research study and you will not personally benefit from taking part in the study.
• This study has been granted ethical approval by the NHS Research Ethics Committee.

For more information please contact Elizabeth Bickford-Smith: e.bickford-smith@liverpool.ac.uk  or  0151 794 5102.

Outcome after Selective Early Treatment for Closure of Patent Ductus ARteriosus in Preterm Babies

PDA is a condition that is caused by a blood vessel called the Ductus Arteriosus staying open after a baby’s birth (patent here means open). During pregnancy, the Ductus Arteriosus allows blood from the baby’s heart to flow to the mother’s placenta to get oxygen, bypassing the baby’s lungs. Soon after birth the ductus should close to allow blood to flow to the baby’s own lungs to get oxygen. However in very premature babies the ductus often takes a long time to close on its own and this can lead to a variety of complications. Doctors are unsure if early treatment should be offered to very premature babies to close the PDA and reduce the risks of complications, or whether it would be better to wait and see (the conservative approach) if the ductus will close on its own.

The aim of this study is to find out whether or not a large Patent Ductus Arteriosus (PDA) in very premature babies should be treated with ibuprofen within 72 hours of birth. Ibuprofen is a NSAID (non-steroidal anti-inflammatory drug) that is commonly used for pain relief in adults.

Improving early decisions in neonatal encephalopathy

Neonatal encephalopathy or hypoxic ischaemic encephalopathy (HIE) is a condition that happens when there is lack of oxygen and blood flow to the baby’s brain around the time of birth. How well the baby will be, depends on how much suffering the lack of oxygen caused to the baby’s brain. If it was only minimal, babies may not have any long-term problems. If the lack of oxygen caused severe brain injury, some babies may not survive or may have long term development problems.

Brain injury can be reduced in some babies if appropriate treatment (for example cooling therapy) is started soon after birth, and stress is prevented. However, we do not have any accurate tools to measure the degree of brain injury at such an early time. We also don’t have any device to measure stress in real-time. This study will find out if analysing small changes in heartbeat can help us measure brain injury and monitor stress in babies.

Genomic Imaging in Neonatal Encephalopathy

Neonatal encephalopathy is a condition related to a lack of oxygen and blood flow to a baby’s brain around the time of birth. We routinely offer cooling therapy to these babies in NHS hospitals. However, they may still have long term developmental problems, despite cooling therapy.

Recent evidence suggests that subtle genetic variations can influence how babies respond to this type of brain injury. Therefore, we need to understand the genetic variations so that in the future we can develop personalised medicines to treat babies more effectively.

Epidemiological Study Of Familial Breast Cancer

We are trying to find out more about the causes of breast, ovarian and prostate cancer in people with a family history of the disease. A small number of people have an increased risk of these cancers as a result of inheriting a mutation in specific genes, but we do not know what other genetic or lifestyle factors may be important. This study is trying to identify these other risk factors. This is a long-term study, which has and will continue to contribute to scientific papers.

Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted screening in men at higher genetic risk and controls

Recent research is beginning to suggest that men who have an alteration in one of the Mismatch Repair genes (MSH2, MSH6, MLH1), also called Lynch Syndrome, may be at a higher risk of developing prostate cancer. This study aims to look at methods of early detection of prostate cancer in men at a higher risk and compare this with a control group. You will have been invited into this study either because you have been found to have an alteration in one of the Lynch Syndrome genes after a genetic test in a genetics centre, or because you are acting as ‘a control’. Men in the control group have had a genetic test for an alteration known to be present within their family and this test has been negative. Having a control group will enable us to compare the measurements that we will take in this study in people who have an increased risk of prostate cancer (those with the genetic alteration) and those who are currently thought to have the same risk as the general population (the controls)

The Childhood Overgrowth (COG) Study

The main aims of our study are:

1. We want to identify genetic causes of conditions associated with increased or asymmetric growth in childhood.
2. We want to try to learn more about the physical and developmental problems that are sometimes associated with increased or asymmetric growth in children.
3. We want to improve the accuracy of diagnosis of conditions associated with increased or asymmetric growth in childhood and we want to develop guidelines to help clinicians manage these conditions.

We are conducting research to try to identify genetic causes for medical conditions affecting the development of the face or skull. In some cases the altered genes have been identified in the past few years, and genetic tests are now available; in others, the cause is not yet known. Sometimes altered genes may turn out not to play any role. We aim to collect samples from up to 1,750 (2,000 in total to include samples from abroad) children and adults in the United Kingdom affected with a craniofacial malformation over a 9-year period. This work is funded by the Wellcome Trust and National Institute for Health Research.

The purpose of this study is to collect blood samples from 3000 healthy individuals over a period of five years. The blood sample will allow the researchers to extract DNA from your blood which will be used to analyse the genes responsible for breaking down, and getting rid of, medicines in your body (this is called genotyping). We all vary in how we handle medicines which can result in differences in how well drugs work in different people. By understanding these differences, we may be able to develop better dosing for medicines to reduce this variability.

We would like to increase our understanding of the clinical and genetic features of rare genetic overgrowth disorders. At present we do not fully understand the genetic causes of these conditions and the medical problems that are associated with each condition. Studying the clinical features (the ‘phenotype’) of individuals with overgrowth disorders will increase our knowledge of these conditions.

Improving our understanding of these disorders will enable health care professionals to provide more accurate information and the best possible care to individuals with overgrowth conditions. Identifying the genetic causes may also help with developing treatments in the future.

Malignant bowel tumours, such as cancers, are rather common and benign bowel tumours, such as polyps are very common. Inherited factors (genes) may increase or decrease a person’s risk of bowel tumours. We are studying patients and families with a history of bowel tumours in order to identify genes that could affect the risk of developing this condition and find out why they have this effect. We are also studying patients and families who have developed tumours, such as cancers of the uterus (womb), that are potentially related to bowel cancer.

The purpose of this study is to identify and characterise new hereditary factors that may lead to the development of bowel tumours. In turn, this will increase our understanding of why bowel tumours develop

The purpose of this study is to see if it is possible to work out a category for a new mutation found in a child, by analysing a series of biological samples collected from the child’s parents. This would in turn allow geneticists to provide better estimations of risk for families.

This study is aimed at people who have been diagnosed as having Lynch syndrome (HNPCC). Liverpool Women’s is part of a national team who aim to find out the best dose of aspirin to prevent cancer. In 2011, the CAPP2 study showed that taking 600mg of aspirin daily reduced the number of cancers by more than half in people with Lynch syndrome. This cancer reduction developed about four years after starting the aspirin. Other studies have shown that lower doses of aspirin may also be effective. The plan in CAPP3 is to provide volunteers with regular aspirin at three different doses. After five years we will be able to see if lower doses are as effective.

Experiences of children with copy number variations

The purpose of this study is to try and understand about the relations between learning, behavioural and thought problems in children with genetic deletions or duplications may lead to more effective methods of treatment and prevention, thus improving the lives of children and families affected by these disorders.

The broad aims of this study are to establish:

• The frequency of the presence of learning disability, behavioural problems and thought problems in children with CNVs.
• The relationships between learning disability, behavioural problems and thought problems in children with CNVs.

This study concerns the first phase of a doctoral research study examining what helps patients make use of genetic services and possible reasons for not using these services.  It is funded by the Collaboration for Leadership in Applied Health Research and Care - North West Coast and undertaken in partnership with Liverpool Women’s NHS Foundation Trust.

Research evidence has shown that factors like ethnicity, gender and level of education can affect whether or not people attend genetic services. This study will also examine if factors such as availability of transport or living in the countryside affect whether people attend.                 

We would like to look at data from any new patients referred to the genetics service during the period 01 April 2013 to 31 March 2016.      

Permission to access this data has been approved by an NHS Ethics Committee. Only fully anonymised information will be transferred to the University secure server for further analysis.
               
Geographical Information Mapping methodology, which creates visual maps of the North West Coast area, will be used to explore if there are any relationships between, for example, availability of transport links and the pattern of referrals observed.  These relationships will be discussed with service providers in Phase 2 of the PhD study.

If you would like more information or to opt out of having the referral information the hospital holds being anonymised and included in the study, please contact  the Research and Development Department on 0151 702 4346 or research@lwh.nhs.uk