Page V.J.,Watford General Hospital |
Page V.J.,Imperial College London |
Davis D.,University of Cambridge |
Davis D.,University of Edinburgh |
And 7 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2014
Rationale: Delirium is common in intensive care unit (ICU) patients and is a predictor of worse outcomes and neuroinflammation is a possible mechanism. The antiinflammatory actions of statins may reduce delirium. Objectives: To determine whether critically ill patients receiving statin therapy had a reduced risk of delirium than those not on statins. Methods: A prospective cohort analysis of data from consecutive ICU patients admitted to a UK mixed medical and surgical critical care unit between August 2011 and February 2012; the Confusion Assessment Method for ICU was used to determine the days each patient was assessed as being free of delirium during ICU admission. Measurements and Main Results: Delirium-free days, daily administration of statins, and serum C-reactive protein (CRP) were recorded. Four hundred and seventy consecutive critical care patients were followed, of whom 151 patients received statins. Using randomeffects multivariable logistic regression, statin administration the previous evening was associated with the patient being assessed as free of delirium (odds ratio, 2.28; confidence interval, 1.01-5.13; P , 0.05) and with lower CRP (b = 20.52; P , 0.01) the following day. When the association between statin and being assessed as free of delirium was controlled for CRP, the effect size became nonsignificant (odds ratio, 1.56; confidence interval, 0.64-3.79; P = 0.32). Conclusions: Ongoing statin therapy is associated with a lower daily risk of delirium in critically ill patients. An ongoing clinical trial, informed by this study, is investigating if statins are a potential therapy for delirium in the critically ill.Copyright © 2014 by the American Thoracic Society.
Galazis N.,Whittington Hospital |
Docheva N.,University of Nottingham |
Simillis C.,Ealing Hospital |
Nicolaides K.H.,King's College London
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2014
Background: Obese women are at increased risk for many pregnancy complications, and bariatric surgery (BS) before pregnancy has shown to improve some of these.Objectives: To review the current literature and quantitatively assess the obstetric and neonatal outcomes in pregnant women who have undergone BS.Search strategy: MEDLINE, EMBASE and Cochrane databases were searched using relevant keywords to identify studies that reported on pregnancy outcomes after BS. Selection criteria: Pregnancy outcome in firstly, women after BS compared to obese or BMI-matched women with no BS and secondly, women after BS compared to the same or different women before BS. Only observational studies were included.Data collection and analysis: Two investigators independently collected data on study characteristics and outcome measures of interest. These were analysed using the random effects model. Heterogeneity was assessed and sensitivity analysis was performed to account for publication bias.Main results: The entry criteria were fulfilled by 17 non-randomised cohort or case-control studies, including seven with high methodological quality scores. In the BS group, compared to controls, there was a lower incidence of preeclampsia (OR 0.45, 95% CI 0.25-0.80; P = 0.007), GDM (OR 0.47, 95% CI 0.40- 0.56; P < 0.001) and large neonates (OR 0.46, 95% CI 0.34-0.62; P < 0.001) and a higher incidence of small neonates (OR 1.93, 95% CI 1.52-2.44; P < 0.001), preterm birth (OR 1.31, 95% CI 1.08-1.58; P = 0.006), admission for neonatal intensive care (OR 1.33, 95% CI 1.02-1.72; P = 0.03) and maternal anaemia (OR 3.41, 95% CI 1.56-7.44, P = 0.002).Conclusions: BS as a whole improves some pregnancy outcomes. Laparoscopic adjustable gastric banding does not appear to increase the rate of small neonates that was seen with other BS procedures. Obese women of childbearing age undergoing BS need to be aware of these outcomes. © 2014 Elsevier Ireland Ltd. All rights reserved.
Wagg A.,University of Alberta |
Cardozo L.,King's College London |
Nitti V.W.,NYU Langone Medical Center |
Castro-Diaz D.,University Hospital of the Canary Islands |
And 4 more authors.
Age and Ageing | Year: 2014
Introduction: mirabegron is a β3-adrenoceptor agonist developed for the treatment of symptoms of overactive bladder (OAB). As the prevalence of OAB increases with age, a prospective subanalysis of individual and pooled efficacy and tolerability data from three 12-week, randomised, Phase III trials, and of tolerability data from a 1-year safety trial were conducted in order to evaluate the efficacy and tolerability of mirabegron in subgroups of patients aged ≥65 and ≥75 years. Methods: primary efficacy outcomes were change from baseline to final visit in the mean number of incontinence episodes/24 h and the mean number of micturitions/24 h. Tolerability was assessed by the incidence of treatment-emergent adverse events (TEAEs). Results: over 12 weeks mirabegron 25 mg and 50 mg once-daily reduced the mean numbers of incontinence episodes and micturitions/24 h from baseline to final visit in patients aged ≥65 and ≥75 years. Mirabegron was well tolerated: in both age groups, hypertension and urinary tract infection were among the most common TEAEs over 12 weeks and 1 year. The incidence of dry mouth, a typical anticholinergic TEAE, was up to sixfold higher among the older patients randomised to tolterodine than any dose of mirabegron. Conclusions: these analyses have demonstrated the efficacy of mirabegron over 12 weeks and the tolerability of mirabegron over 12 weeks and 1 year in OAB patients aged ≥65 and ≥75 years, supporting mirabegron as a therapeutic option in older patients with OAB. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.
Maman K.,Creativ Ceutical SARL |
Aballea S.,Creativ Ceutical SARL |
Nazir J.,Astellas Pharma Europe |
Desroziers K.,Creativ Ceutical SARL |
And 5 more authors.
European Urology | Year: 2014
Context Overactive bladder (OAB) treatment guidelines recommend antimuscarinics as first-line pharmacologic therapy. Mirabegron is a first-in-class β3-adrenoceptor agonist licensed for the treatment of OAB and has shown to be well tolerated and effective in the treatment of OAB symptoms. Objective To assess the relative efficacy and tolerability of OAB medications, specifically mirabegron 50 mg versus antimuscarinics in patients with OAB. Evidence acquisition A systematic literature search was performed on published peer-reviewed articles from 2000 to 2013. This review included randomised controlled trials (RCTs) studying changes in symptoms (micturition frequency, incontinence, and urgency urinary incontinence [UUI] episodes) and incidence of the most frequently reported adverse events (dry mouth, constipation) associated with current OAB medications. The following drugs were considered in addition to mirabegron: darifenacin, tolterodine immediate release (IR) and extended release (ER), oxybutynin IR/ER, trospium, solifenacin, and fesoterodine. Bayesian mixed treatment comparisons (MTCs) were performed for efficacy (micturition, incontinence, UUI) and tolerability (dry mouth, constipation, blurred vision). Evidence synthesis Overall, 44 RCTs involving 27 309 patients were included. The MTCs showed that mirabegron 50 mg was as efficacious as antimuscarinics in reducing the frequency of micturition incontinence and UUI episodes, with the exception of solifenacin 10 mg that was more efficacious than mirabegron 50 mg in improving micturition frequency and frequency of UUI. Mirabegron 50 mg had an incidence of dry mouth similar to placebo and significantly lower than all included antimuscarinics. Conclusions Mirabegron 50 mg had similar efficacy to most antimuscarinics and lower incidence of dry mouth, the most common adverse event reported with antimuscarinics and one of the main causes of discontinuation of treatment. Despite being a powerful tool for evidence-based health care evaluation, the Bayesian MTC method has limitations. Further head-to-head comparisons between mirabegron and antimuscarinics should be conducted to confirm our results. © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Rivers L.,Ealing Hospital |
Gaspar H.B.,University College London
Archives of Disease in Childhood | Year: 2015
Severe combined immunodeficiency (SCID) is a rare but important condition. Affected infants are born with profound abnormalities of immune cell function that lead to severe and recurrent infection that are almost always fatal in the first year of life without treatment. Infants with SCID are often initially seen by general paediatricians in the hospital care setting, and the recognition of the cardinal features of the disease and alertness to specific laboratory parameters are important in making an early diagnosis. There is also increasing interest in newborn screening for SCID, which has the potential to significantly improve outcome through early diagnosis and implementation of prophylactic medications. Definitive treatments such as haematopoietic stem cell transplantation and gene therapy have also made major advances over the last decade and again promise to improve the overall outcome for SCID with reduced long-term toxicities. In this review, we highlight some of the major advances in diagnosis and management of the disease, but we also want to emphasise the important role of the general paediatrician in making an early diagnosis and in ongoing management. © 2015, BMJ Publishing Group. All rights reserved.
Lattimer C.R.,Ealing Hospital |
Kalodiki E.,Ealing Hospital |
Azzam M.,Ealing Hospital |
Geroulakos G.,Ealing Hospital
European Journal of Vascular and Endovascular Surgery | Year: 2012
Objectives: To evaluate a duplex-derived score for varicose vein treatments using numerical values of haemodynamic effectiveness. Design: The saphenous treatment score (STS) was developed prospectively to compare the effect of endovenous treatments on reflux within saphenous segments. Patients: Sixty-six patients were randomised to endovenous laser ablation (EVLA) or ultrasound-guided foam sclerotherapy (UGFS) to the great saphenous vein (GSV). Methods: Assessments included the Aberdeen varicose vein severity score (AVVSS), the venous clinical severity score (VCSS), the venous filling index (VFI) and the STS. Results: A mean STS of 5.70 decreased to 3.30, P < .0005, post-treatment. The median (IQR) AVVSS, VCSS and VFI (ml/sec) decreased from 21.52(15.48) to 18.86(11.27), P = .14, from 6(4) to 3(4), P < .0005 and from 7.1(6.9) to 1.9(.9) P < .0005, respectively. In 15 patients requiring additional UGFS the mean STS values decreased from 5.8 to 4.13 and then to 2.6 P < .0005, respectively. The individual above and below knee mean treatment differences in STS on 38 EVLA and 28 UGFS patients were 1.92 and.87 (EVLA) compared to 1.57and.29 (UGFS) P = .001, respectively. Conclusions: The STS has been shown to grade the haemodynamic effects of different treatments as well as ongoing treatments on the GSV. © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
McGinley E.,Ealing Hospital
Journal of Community Nursing | Year: 2015
This article examines and summarises the role of nutrition and the dietitian in the final stages of palliative care. The recent publication of One chance to get it right (NHS England, 2014), highlighted the need for a change in the approach to food and drink, especially when caring for those patients who are at the end of life. There is a clear need for documentation and formulation of clear, patient-centred and effective care plans, as it is vital that food and drink are offered, as long as it remains safe and is not harmful to the patient.
Hirt L.S.,Ealing Hospital
Stroke | Year: 2014
Background and Purpose-Progression of asymptomatic carotid stenoses with >50% luminal narrowing is associated with an increased risk of stroke. The significance of the progression rate in these patients is unknown. The main aim of this study was to evaluate the rate of change of carotid luminal narrowing over 1 year, as a risk factor for ipsilateral ischemic events, in patients with a >50% asymptomatic carotid stenosis. Secondary aims were to establish the incidence of changes in carotid luminal narrowing and establish additional risk factors for ipsilateral neurological events. Methods- A retrospective analysis was conducted of data derived from the deferred endarterectomy arm of the Asymptomatic Carotid Surgery Trial. Patients were followed up for 5 years with serial carotid duplex examinations. Data were derived from information obtained at randomization and annual follow-up visits with carotid duplex examination. Potential risk factors for ipsilateral neurological events were analyzed in Poisson regression models. Results-Data from 1469 patients were included. Two hundred forty-four had ipsilateral events; 240 had ipsilateral carotid surgery; 370 died from nonstroke causes; and 82 had an asymptomatic carotid occlusion. The annual incidence of progression in the cohort as a whole was 5.2%. Ipsilateral events occurred in 17% of patients. Diabetes and previous contralateral symptoms showed a significant independent association with ipsilateral neurological events. Ipsilateral events were associated with high rates of progression over 1 year but not with low progression rates or regression. Conclusions-Fast rates of progression of carotid luminal narrowing should be interpreted as a sign of significantly increased risk of future ipsilateral neurological events.
Jawad M.,Imperial College London |
Abass J.,Freelance Researcher |
Hariri A.,Imperial College London |
Rajasooriar K.G.,Imperial College London |
And 3 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2013
Although waterpipe smoking is growing in popularity worldwide, its epidemiology remains poorly understood. The purpose of this study was to determine the prevalence and attitudes of waterpipe smoking among 489 medical students (54.6% female; mean age 20.4 ±2.0 years) in the United Kingdom by conducting a cross-sectional survey. Waterpipe smoking was more common than cigarette smoking (current 11.0% vs. 6.3%, ever 51.7% vs. 16.8%). Mean age at waterpipe smoking initiation was 16.1 ± 2.6 years. Sex, ethnicity and sociodemographic factors did not predict current/ever waterpipe smoking. Tobacco control efforts need to consider waterpipe smoking in the light of this high prevalence. © 2013 The Union.
Michie C.A.,Ealing Hospital |
Sanchez N.,Ealing Hospital
Early Human Development | Year: 2011
Neonatologists and paediatricians have a crucial role working with mothers at the most nutritionally challenged point in their lives and that of their infants. This position of responsibility is particularly important in tackling the re-emerging problem of hypovitaminosis D. In this overview the role of vitamin D, its contribution to pathology in those to whom we provide a service and possible actions will be considered. © 2011 Elsevier Ltd.