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Baldry E.L.,University of Nottingham | Leeder P.C.,Derby Hospitals NHS Foundation Trust | Idris I.R.,University of Nottingham
Obesity Surgery | Year: 2014

Background Bariatric surgery is effective at achieving weight loss in the severely obese, with the majority of procedures performed laparoscopically. A short-term pre-operative energy restrictive diet is widely adopted to enable surgery by reducing liver size and improving liver flexibility. However, the dietary approach is not standardised. This observational study reports on pre-operative restrictive diets in use across bariatric services in the UK. Methods Between September and November 2012, information was collected from bariatric services on current or past pre-operative diets, and any research providing evidence for the use or modification of their diets. Results Around one third of bariatric services (28) in the UK responded, with a total of 49 diets in current use. Types of diet include low energy, low carbohydrate and liquid, with 59 % offering low energy/low carbohydrate food-based, 21% milk/ yoghurt, 18 % meal replacement (liquid) and 2 % clear liquid. Diet duration varies between 7 and 42 days. Limited anecdotal evidence was provided by services evaluating the preoperative diet, and its alternative approaches, with dietary choice primarily clinician-led. Conclusions This study has highlighted variability and lack of consensus in the form of pre-bariatric surgery diet used across different centres. Further research comparing outcomes for alternative diets would support best practice in the future. © Springer Science+Business Media New York 2013. Source


Game F.,Derby Hospitals NHS Foundation Trust
Diabetes/Metabolism Research and Reviews | Year: 2012

Over two decades ago, the St. Vincent Declaration set a 50% reduction of lower-limb amputations as a principal target for patients with diabetes. During this time, enormous strides have been taken in our understanding of diabetic foot disease, the complexities of wound healing and the organization of care to prevent what is one of the most feared complications of the disease. Despite this, we are aware that worldwide, we have not achieved the target set in 1989, with current estimations being that a limb is lost to diabetes somewhere in the world every 30s. However, it has to be remembered that amputation is a treatment and not a disease, and it is indeed a treatment usually prescribed at the end of a long chronic illness. It is well known that patients whose disease is severe enough for amputation to be considered frequently have other complications of their diabetes, cardiovascular and peripheral vascular diseases and end-stage renal disease, in particular. The life expectancy of the patients is therefore frequently reduced, and their functional status poor even prior to the intervention of surgeons. Just as the functional status of the patients is often a contra-indication to other disease treatments, chemotherapy for some cancers, for example, then we should be considering carefully whether we should be removing limbs from patients whose functional and medical status will not improve significantly as a result. Equally, there may be patients who may benefit from an early amputation and ambulation with a prosthesis. © 2012 John Wiley & Sons, Ltd. Source


Tripathi D.,University of Birmingham | Stanley A.J.,Royal Infirmary | Hayes P.C.,Royal Infirmary | Patch D.,University College London | And 7 more authors.
Gut | Year: 2015

These updated guidelines on the management of variceal haemorrhage have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines which this document supersedes were written in 2000 and have undergone extensive revision by 13 members of the Guidelines Development Group (GDG). The GDG comprises elected members of the BSG liver section, representation from British Association for the Study of the Liver (BASL) and Liver QuEST, a nursing representative and a patient representative. The quality of evidence and grading of recommendations was appraised using the AGREE II tool. The nature of variceal haemorrhage in cirrhotic patients with its complex range of complications makes rigid guidelines inappropriate. These guidelines deal specifically with the management of varices in patients with cirrhosis under the following subheadings: (1) primary prophylaxis; (2) acute variceal haemorrhage (3) secondary prophylaxis of variceal haemorrhage and (4) gastric varices. They are not designed to deal with (1) the management of the underlying liver disease; (2) the management of variceal haemorrhage in children; or (3) variceal haemorrhage from other aetiological conditions. © 2015 BMJ Publishing Group Ltd & British Society of Gastroenterology. Source


Bajaj N.P.S.,University of Nottingham | Gontu V.,Derby Hospitals NHS Foundation Trust | Birchall J.,Foundation Medicine | Patterson J.,Institute of Neurological science | And 2 more authors.
Journal of Neurology, Neurosurgery and Psychiatry | Year: 2010

Background: This study examines the clinical accuracy of movement disorder specialists in distinguishing tremor dominant Parkinson's disease (TDPD) from other tremulous movement disorders by the use of standardised patient videos. Patients and methods: Two movement disorder specialists were asked to distinguish TDPD from patients with atypical tremor and dystonic tremor, who had no evidence of presynaptic dopaminergic deficit (subjects without evidence of dopaminergic deficit (SWEDDs)) according to 123I-N-ω-fluoro- propyl- 2β-carbomethoxy-3β-(4-iodophenyl) nortropane ([ 123I] FP-CIT) single photon emission computed tomography (SPECT), by 'blinded' video analysis in 38 patients. A diagnosis of parkinsonism was made if the step 1 criteria of the Queen Square Brain Bank criteria for Parkinson's disease were fulfilled. The reviewer diagnosis was compared with the working clinical diagnosis drawn from the medical history, SPECT scan result, long term follow-up and in some cases the known response to dopaminergic medications. This comparison allowed a calculation for false positive and false negative rate of diagnosis of PD. Results: High false positive (17.4-26.1%) and negative (6.7-20%) rates were found for the diagnosis of PD. The diagnostic distinction of TDPD from dystonic tremor was reduced by the presence of dystonic features in treated and untreated PD patients. Conclusion: Clinical distinction of TDPD from atypical tremor, monosymptomatic rest tremor and dystonic tremor can be difficult due to the presence of parkinsonian features in tremulous SWEDD patients. The diagnosis of bradykinesia was particularly challenging. This study highlights the difficulty of differentiation of some cases of SWEDD from PD. Source


Schneeweiss A.,University of Heidelberg | Chia S.,University of British Columbia | Hegg R.,Hospital Pe rola Byington | Tausch C.,Breast Center | And 6 more authors.
Breast Cancer Research | Year: 2014

Introduction: Molecular markers that predict responses to particular therapies are invaluable for optimization of patient treatment. The TRYPHAENA study showed that pertuzumab and trastuzumab with chemotherapy was an efficacious and tolerable combination for patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer in the neoadjuvant setting. We analyzed whether particular biomarkers correlated with the responses observed and therefore may predict outcomes in patients given pertuzumab plus trastuzumab.Methods: We describe the analysis of a panel of biomarkers including HER2, human epidermal growth factor receptor 3 (HER3), epidermal growth factor receptor (EGFR), phosphatase and tensin homolog (PTEN), and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) by qRT-PCR, immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), enzyme-linked immunosorbent assay (ELISA), and PCR-based mutational analyses as appropriate. For each marker analyzed, patients were categorized into 'low' (generally below median) or 'high' (generally above median) subgroups at baseline and post-treatment.Results: Correlation of marker subgroups with the achievement of a pathological complete response (pCR) (ypT0/is) was analyzed. HER2 protein and mRNA expression levels were associated with pCR rate in two of the three study arms and the pooled analyses. Correlations of biomarker status with pCR occurred in one individual arm only and the pooled analyses with EGFR and PTEN; however, interpretation of these results is limited by a strong imbalance in patient numbers between the high and low subgroups and inconsistency between arms. We also found no association between expression levels of TOP2A and pCR rate in either the anthracycline-containing or free arms of TRYPHAENA.Conclusions: According to these analyses, and in line with other analyses of pertuzumab and trastuzumab in the neoadjuvant setting, we conclude that HER2 expression remains the only marker suitable for patient selection for this regimen at present. © 2014 Schneeweiss et al.;. Source

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