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Welton, United Kingdom

Clark A.L.,Castle Hill Hospital | Anker S.D.,Charite - Medical University of Berlin
Journal of Heart and Lung Transplantation | Year: 2010

Cardiac cachexia, associated with excessive activation of the sympathetic nervous system together with immune activation, is an important prognostic indicator in heart failure. Anecdotally, the prevalence of cardiac cachexia appears to be falling, perhaps due to the increased use of beta-blockers. However, chronic heart failure is so common that many patients continue to lose weight and continue to deteriorate to a point where transplantation or mechanical support is considered. The origin of cachexia remains elusive and further research is needed to explore the relation between weight, sympathetic activation, and the response to cardiac surgery or transplantation. © 2010 International Society for Heart and Lung Transplantation. Source

Sathyapalan T.,University of Hull | Dixit S.,Castle Hill Hospital
Expert Review of Anticancer Therapy | Year: 2012

Hypopituitarism is a disorder caused by impaired hormonal secretions from the hypothalamic-pituitary axis. Radiotherapy is the most common cause of iatrogenic hypopituitarism. The hypothalamic-pituitary axis inadvertently gets irradiated in patients receiving prophylactic cranial radiotherapy for leukemia, total body irradiation and radiotherapy for intracranial, base skull, sinonasal and nasopharyngeal tumors. Radiation-induced hypopituitarism (RIH) is insidious, progressive and largely nonreversible. Mostly, RIH involves one hypothalamic-pituitary axis; however, multiple hormonal axes deficiency starts developing at higher doses. Although the clinical effects of the hypopituitarism are more profound in children and young adults, its implications in older adults are being increasingly recognized. The risk continues to persist or increase up to 10 years following radiation exposure. The clinical management of hypopituitarism is challenging both for the patients and healthcare providers. Here we have reviewed the scale of the problem, the risk factors and the management of RIH. © 2012 Expert Reviews Ltd. Source

Background: We report on the outcomes of patients with metastatic oesophago-gastric (OG) cancer progressing after first-line platinum-based chemotherapy (PBCT) who received a re-challenge schedule of PBCT (r-PBCT) as second-line therapy. Patients and Methods: Patients with metastatic OG cancer treated with first-line PBCT (n = 138) between January 2009 and June 2013 were selected for the purpose of the study. Treatment-related outcomes were assessed including response rates, progression-free survival (PFS) and overall survival (OS). Results: 43 (32%) patients progressed (group A: platinum resistant (PR)) and 95 (68%) patients showed a response (group B: platinum sensitive (PS)) or had stable disease after first-line PBCT. Approximately 20% (9/43) of the patients in group A received second-line chemotherapy compared to 50% (38/80) in group B. Most patients (39/47) received r-PBCT, and the remaining patients (8/47) were treated with irinotecan-based chemotherapy. More than 50% (20/39) of the patients achieved disease control, with median PFS and OS of 3 months (95% confidence interval (CI) = 2.0-4.0 months) and 5.7 months (95% CI = 4.7-6.7 months) after commencement of r-PBCT. The actuarial median OS of patients responding to second-line or second and third lines of r-PBCT was 26.7 and 30.1 months, respectively. Conclusion: In platinum responders, r-PBCT appears to be an appropriate second-line option with survival outcomes comparable to those of other agents. © 2015 S. Karger GmbH, Freiburg Copyright © 2015, S. Karger Verlag für Medizin und Naturwissenschaften GmbH. All rights reserved. Source

Atkin P.,Castle Hill Hospital
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2012

Telemonitoring involves remotely monitoring patients' vital signs. It is an innovative and promising development in the care of people with heart failure that may reduce hospital admissions and the burden on the NHS, as well as improve patients' quality of life and clinical outcomes. This article describes what telemonitoring is and explores the evidence base for its use. The role of the nurse in telemonitoring is also discussed, with particular reference to dealing with and responding to alerts. The development and implementation of new technology is essential to improve the delivery of healthcare and optimise patient outcomes, and telemonitoring may play an important role in the future of heart failure services. Source

Sylvester D.C.,Royal Infirmary | Carr S.,Castle Hill Hospital | Nix P.,Leeds General Infirmary
International Forum of Allergy and Rhinology | Year: 2013

Background: The management of chronic rhinosinusitis is based on a trial of "maximal medical therapy" before surgery is considered. Ear-Nose-Throat (ENT) UK consultant members were surveyed to determine the role and variability of UK-wide practices. Methods: A survey was posted to all ENT UK consultant members (n = 603). This assessed the frequency of prescription, duration, and type of oral antibiotics, steroids, and antihistamines for chronic rhinosinusitis. Results: A total of 158 questionnaires (26.3%) were returned. Of these, 61% were primarily rhinologists. The use of decongestants, antifungals, and immunotherapy was generally limited. Oral antibiotics were often used, with clarithromycin of <5 weeks duration being the preferred choice. Sixty-one percent of consultants always prescribe a steroid spray, most commonly mometasone furoate (75%). Conclusion: Although most respondents use triple therapy of oral antibiotics, steroid nasal spray, and saline douching to some extent, "maximal medical therapy" for chronic rhinosinusitis seems to vary greatly among consultants and frequently does not reflect recent guidelines. © 2013 ARS-AAOA, LLC. Source

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