St Thomas and Guys Hospital

London, United Kingdom

St Thomas and Guys Hospital

London, United Kingdom
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Al Kaisy A.,St Thomas and Guys Hospital | Pang D.,St Thomas and Guys Hospital | Desai M.J.,Pain and Performance Center | Pries P.,Functional Neuromodulation | And 5 more authors.
Neurochirurgie | Year: 2015

Introduction: Failed back surgery syndrome (FBSS) results from a cascade of medical and surgical events that lead to or leave the patient with chronic back and radicular pain. This concept is extremely difficult to understand, both for the patient and for the therapist. The difficulty is related to the connotations of failure and blame directly associated with this term. The perception of the medical situation varies enormously according to the background and medical education of the clinician who manages this type of patient. Eight health system experts (2 pain physicians, 1 orthopaedic spine surgeon, 1 neuro spine surgeon, 1 functional neurosurgeon, 1 physiatrist, 1 psychologist and one health-economic expert) were asked to define and share their specialist point of view concerning the management of postoperative back and radicular pain. Ideally, it could be proposed that the patient would derive optimal benefit from systematic confrontation of these various points of view in order to propose the best treatment option at a given point in time to achieve the best possible care pathway. Conclusion: The initial pejorative connotation of FBSS suggesting failure or blame must now be replaced to direct the patient and therapists towards a temporal concept focusing on the future rather than the past. In addition to the redefinition of an optimised care pathway, a consensus based on consultation would allow redefinition and renaming of this syndrome in order to ensure a more positive approach centered on the patient. © 2014 Elsevier Masson SAS.


Adambegan M.,Medical University of Vienna | Wagner G.,Medical University of Vienna | Nader I.W.,University of Vienna | Fernandez-Aranda F.,University of Barcelona | And 2 more authors.
European Eating Disorders Review | Year: 2012

Objective We wanted to clarify whether there is any clinically relevant behavioural psychopathology in patients before onset of an eating disorder (ED) compared with their healthy sisters and if there are differences in behavioural problems between the ED subtypes anorexia nervosa-restricting type (AN-R) and EDs with bulimic behaviour. Method Behavioural psychopathology was examined by parental report using the Child Behaviour Checklist retrospectively in 83 sister pairs discordant for an ED (37 with AN-R and 46 with bulimic EDs) by means of conditional logistic regression. Results Participants who later developed an ED had significantly higher internalizing and externalizing behavioural abnormality scores before onset of the ED than their unaffected sisters. Conditional logistic regression revealed significantly higher internalizing behaviour scores in AN-R and significantly higher internalizing and externalizing scores in the bulimic disorders. Discussion Internalizing problems (anxiety, depression and somatization) preceded the development of AN, whereas both internalizing and externalizing behaviour problems (aggressive and delinquent behaviour) preceded bulimic disorders. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.


Koutroumanos N.,Moorfields Eye Hospital | Folkard A.,Birdshot Uveitis Society | Mattocks R.,Birdshot Uveitis Society | Wright J.,University of the Arts London | And 11 more authors.
British Journal of Ophthalmology | Year: 2013

Background The importance of patient and public involvement (PPI) in healthcare decisions and research is increasingly recognised. This paper describes the aims, delivery, evaluation and impact of a 'Birdshot Day' organised for patients with birdshot uveitis, their carers and healthcare professionals. Methods Delivery of this event involved the close collaboration of patients with a large number of different healthcare professionals. The event's evaluation used established social research methods including qualitative questionnaires pre, post and 6 months following the event. The results were statistically analysed. Results Results indicated that this event significantly educated both patients and professionals. The sense of isolation felt by patients was reduced and networking was developed among all attendees. Patient priorities for research were recorded and invaluable insight into patients' needs for a better quality of life was gained. Conclusions The first undertaking of this novel PPI event achieved all its aims. It became even clearer that fundamental questions remain about birdshot uveitis, including aetiology, pathogenesis, practical clinical issues and impact on quality of life. These questions can only be addressed in partnership with patients. To this end, patients and professionals came together under the banner 'Team Birdshot' and the National Birdshot Research Network was launched.


Weir M.R.,University of Maryland Baltimore County | Burgess E.D.,University of Calgary | Cooper J.E.,University of Colorado at Denver | Fenves A.Z.,Harvard University | And 6 more authors.
Journal of the American Society of Nephrology | Year: 2015

Hypertension in renal transplant recipients is common and ranges from 50% to 80% in adult recipients and from 47% to 82% in pediatric recipients. Cardiovascular morbidity and mortality and shortened allograft survival are important consequences of inadequate control of hypertension. In this review, we examine the epidemiology, pathophysiology, and management considerations of post-transplant hypertension. Donor and recipient factors, acute and chronic allograft injury, and immunosuppressive medications may each explain some of the pathophysiology of post-transplant hypertension. As observed in other patient cohorts, renal artery stenosis and adrenal causes of hypertension may be important contributing factors. Notably, BP treatment goals for renal transplant recipients remain an enigma because there are no adequate randomized controlled trials to support a benefit from targeting lower BP levels on graft and patient survival. The potential for drug-drug interactions and altered pharmacokinetics and pharmacodynamics of the different antihypertensive medications need to be carefully considered. To date, no specific antihypertensive medications have been shown to be more effective than others at improving either patient or graft survival. Identifying the underlying pathophysiology and subsequent individualization of treatment goals are important for improving long-term patient and graft outcomes in these patients. Copyright © 2015 by the American Society of Nephrology.


PubMed | St Thomas And Guys Hospital, University of Maryland Baltimore County, University of Calgary, Mayo Medical School and 6 more.
Type: Journal Article | Journal: Journal of the American Society of Nephrology : JASN | Year: 2015

Hypertension in renal transplant recipients is common and ranges from 50% to 80% in adult recipients and from 47% to 82% in pediatric recipients. Cardiovascular morbidity and mortality and shortened allograft survival are important consequences of inadequate control of hypertension. In this review, we examine the epidemiology, pathophysiology, and management considerations of post-transplant hypertension. Donor and recipient factors, acute and chronic allograft injury, and immunosuppressive medications may each explain some of the pathophysiology of post-transplant hypertension. As observed in other patient cohorts, renal artery stenosis and adrenal causes of hypertension may be important contributing factors. Notably, BP treatment goals for renal transplant recipients remain an enigma because there are no adequate randomized controlled trials to support a benefit from targeting lower BP levels on graft and patient survival. The potential for drug-drug interactions and altered pharmacokinetics and pharmacodynamics of the different antihypertensive medications need to be carefully considered. To date, no specific antihypertensive medications have been shown to be more effective than others at improving either patient or graft survival. Identifying the underlying pathophysiology and subsequent individualization of treatment goals are important for improving long-term patient and graft outcomes in these patients.

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