Haverfordwest

Researchers are evaluating a new care pathway for people with diabetes suspected of having diabetic maculopathy or pre-proliferative diabetic retinopathy. The study aims to see if using opticians in community practices, combined with virtual review by hospital ophthalmologists, is safe, acceptable, and efficient compared to the current hospital-based eye service. This approach could reduce hospital clinic pressures, improve patient experience, and lower costs and environmental impact. The trial compares two groups one receiving usual care with hospital eye service assessments by ophthalmologists, and the other undergoing community-based optical coherence tomography OCT imaging by trained optometrists with virtual ophthalmologist review. Participants receive one imaging visit in either setting. The study collects data on imaging results, clinical exams, and patient experiences through questionnaires and interviews. Both pathways include follow-up plans decided by ophthalmologists based on the imaging and clinical findings. Participants will be involved in a single imaging appointment and then complete a questionnaire about their experience. Some may be invited for interviews to explore their views further. Researchers will measure the time from referral to treatment, number of appointments, travel distances, costs, and patient-reported experiences. Data collection and analysis will continue for about a year, including health economic and environmental impact assessments, to understand the feasibility and acceptability of this community-based pathway.

Researchers are studying patients with newly diagnosed stage I, II, and III colorectal cancer CRC to understand how circulating tumor DNA ctDNA in the blood can predict disease relapse. The study evaluates whether using ctDNA to guide adjuvant chemotherapy decisions after surgery is as effective as standard chemotherapy, aiming to reduce unnecessary treatments and side effects. This multi-center, prospective research includes both observational and randomized components to better manage early-stage CRC. The study has two parts Part B focuses on collecting tumor tissue, serial blood samples, and clinical data to detect minimal residual disease MRD using ctDNA after curative surgery. Part C is a randomized trial comparing ctDNA-guided adjuvant chemotherapy versus standard care in patients with high-risk stage II or III CRC. Patients are randomized post-surgery to either standard chemotherapy or a ctDNA-guided approach where those testing negative for ctDNA may receive less chemotherapy. Participants will undergo regular blood sampling and clinical assessments to monitor ctDNA levels and disease status. Researchers will measure outcomes such as 3-year disease-free survival and the relationship between ctDNA detection and treatment response over several years. The study includes follow-up periods of 4 to 8 years to evaluate long-term outcomes and safety. Participants need to consent, adhere to follow-up schedules, and be suitable for chemotherapy if randomized to Part C.