Haverfordwest

Researchers are evaluating a new pathway for managing diabetic maculopathy and pre-proliferative diabetic retinopathy in people with diabetes. The study aims to see if using trained opticians in community practices with OCT imaging and virtual review by hospital ophthalmologists is safe, acceptable, and efficient compared to usual hospital eye service care. This research is motivated by the growing number of people with diabetes and the need to reduce pressure on hospital eye services while improving patient experience and reducing costs and environmental impact. The study compares two approaches: the new pathway involving OCT imaging in community optometry practices with virtual ophthalmologist review, and the usual care pathway where patients are seen in hospital eye clinics. Participants will be randomly assigned to either group. The community pathway includes an appointment at a local optometrist for 3-D OCT imaging and clinical examination, with results reviewed virtually by a consultant ophthalmologist. The usual care group receives hospital-based OCT imaging and examination. Both pathways result in a management plan communicated to the patient, including discharge, monitoring, or treatment. Participants will undergo a single visit for imaging and examination, followed by completion of a patient experience questionnaire and, for some, participation in interviews about their experiences. Data collected include referral and treatment dates, clinical findings, resource use, and patient travel details. The primary outcome measured is the time from referral to treatment within six months. The study also assesses patient experience, healthcare resource use, costs, and environmental impact. Safety and confidentiality are carefully managed throughout the study, which plans to recruit 150 participants in total.

Researchers are investigating colorectal cancer (CRC) patients with newly diagnosed stage I, II, and III cancers to evaluate whether mutations in circulating tumor DNA (ctDNA) can predict disease relapse earlier than current methods. This study includes two parts: Part B focuses on analyzing tumor tissue, serial blood samples, and clinical data to detect minimal residual disease (MRD) and predict relapse, while Part C is a randomized study comparing ctDNA-guided adjuvant chemotherapy to standard care in high-risk stage II or III CRC patients post-surgery. In Part B, the study collects serial blood samples from patients who have undergone potentially curative surgery to detect and quantify ctDNA, aiming to identify MRD and predict relapse. Part C randomizes patients after surgery into two groups: one receiving standard adjuvant chemotherapy and the other receiving ctDNA-guided chemotherapy, where those testing ctDNA negative may have chemotherapy reduced. The goal is to assess if ctDNA-guided treatment can safely reduce chemotherapy use without compromising disease-free survival. Participants will undergo tumor tissue collection, blood sampling at multiple time points, and clinical assessments over several years. Researchers will monitor ctDNA levels and clinical outcomes, measuring disease-free survival up to 3 to 6 years. Safety and treatment effects will be evaluated, with follow-up visits to track relapse and treatment response. Total participation includes long-term monitoring for relapse prediction and chemotherapy guidance.