Hardman T.C.,NICHE |
Dubrey S.W.,Hillingdon Hospital
Diabetes Therapy | Year: 2011
There is a recognized need for new treatment options for type 2 diabetes mellitus (T2DM). Recovery of glucose from the glomerular filtrate represents an important mechanism in maintaining glucose homeostasis and represents a novel target for the management of T2DM. Recovery of glucose from the glomerular filtrate is executed principally by the type 2 sodium-glucose cotransporter (SGLT2). Inhibition of SGLT2 promotes glucose excretion and normalizes glycemia in animal models. First reports of specifically designed SGLT2 inhibitors began to appear in the second half of the 1990s. Several candidate SGLT2 inhibitors are currently under development, with four in the later stages of clinical testing. The safety profile of SGLT2 inhibitors is expected to be good, as their target is a highly specific membrane transporter expressed almost exclusively within the renal tubules. One safety concern is that of glycosuria, which could predispose patients to increased urinary tract infections. So far the reported safety profile of SGLT2 inhibitors in clinical studies appears to confirm that the class is well tolerated. Where SGLT2 inhibitors will fit in the current cascade of treatments for T2DM has yet to be established. The expected favorable safety profile and insulin-independent mechanism of action appear to support their use in combination with other antidiabetic drugs. Promotion of glucose excretion introduces the opportunity to clear calories (80-90 g [300-400 calories] of glucose per day) in patients that are generally overweight, and is expected to work synergistically with weight reduction programs. Experience will most likely lead to better understanding of which patients are likely to respond best to SGLT2 inhibitors, and under what circumstances. © The Author(s) 2011.
Lucas D.N.,Northwick Park Hospital |
Robinson P.N.,Northwick Park Hospital |
Nel M.R.,Hillingdon Hospital
International Journal of Obstetric Anesthesia | Year: 2012
Sepsis in pregnancy and the puerperium remains a significant cause of maternal mortality and morbidity worldwide. Major morbidity arising as a result of obstetric sepsis includes fetal demise, organ failure, chronic pelvic inflammatory disease, chronic pelvic pain, bilateral tubal occlusion and infertility. Early recognition and timely response are key to ensuring good outcome. This review examines the clinical problem of sepsis in obstetrics and the role of the anaesthetist in the management of this condition. © 2011 Elsevier Ltd. All rights reserved.
Forbes A.E.,Hillingdon Hospital |
Zochowski W.J.,County Hospital |
Dubrey S.W.,Hillingdon Hospital |
Sivaprakasam V.,County Hospital
QJM | Year: 2012
The recent high-profile death of a British Olympic rower from leptospirosis has raised awareness to this uncommon but potentially fatal disease. The re-emergence of the disease abroad is well documented in the literature, but less is known about cases in the UK. The increase in participation in water sports, foreign travel and often a combination of the two, has increased the exposure of tourists subsequently returning to the UK from areas of high prevalence. Leptospirosis is a zoonotic infection. The bacteria are shed in the urine of animals to the environment from where humans are infected by incidental hosts. There is a wide spectrum of severity of symptoms, from a self-limiting febrile illness to fatal pulmonary haemorrhage, renal or liver failure. It is thought that cases remain unrecognized every year in the UK, largely due to the mild nature of symptoms and the wide differential for febrile illness and partly due to lack of awareness among clinicians. This review examines the epidemiology of leptospirosis in the UK, over the period 2006-10, the clinical features, diagnostic techniques and treatment. © The Author 2012. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.
Stiles E.,Hillingdon Hospital
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2011
Diabetes mellitus is a complex long-term condition. To achieve best outcomes, patients must have a good understanding of the condition and should adopt a vigilant self-care approach. However, this may be difficult for patients with low health literacy because they may struggle with obtaining, understanding and applying health information. Health literacy encompasses factors such as culture, empowerment, motivation and the quality of the individual's exchanges with the health system. Nurses' understanding of health literacy as a concept is key to helping patients achieve self-management of long-term conditions. Health literacy strategies should focus on improving communication between healthcare providers and people with diabetes, providing information in a variety of formats and seeking to improve access to healthcare services. This article suggests how nurses can help people with diabetes improve their health literacy.
Entabi M.,Hillingdon Hospital |
Harman F.,Queen Victoria Hospital NHS Trust |
Lee N.,Hillingdon Hospital |
Bloom P.A.,Hillingdon Hospital
Journal of Cataract and Refractive Surgery | Year: 2011
Purpose: To evaluate the efficacy and rotational stability of an injectable 1-piece hydrophilic acrylic toric intraocular lens (IOL). Setting: Department of Ophthalmology, Hillingdon Hospital, Uxbridge, Middlesex, United Kingdom. Design: Cohort study. Methods: This study enrolled consecutive patients who had 2.00 diopters (D) or more of preexisting corneal astigmatism. Patients had phacoemulsification with implantation of a T-flex 623T toric IOL through a 2.8 mm astigmatically neutral incision. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities (logMAR), refraction, keratometry, and the cylinder axis of the toric IOL were measured. Results: Thirty-three eyes of 25 patients were evaluated. The mean preoperative refractive astigmatism was 3.35 D ± 1.20 (SD) and the mean keratometric astigmatism, 3.98 ± 1.89 D, respectively. Four months postoperatively, the mean UDVA was 0.28 ± 0.23 D logMAR, improving to 0.19 ± 0.23 D logMAR CDVA. The mean refractive astigmatism was 0.95 D ± 0.66 D; vector analysis using the Holladay-Cravy-Koch method showed that the mean reduction in refractive astigmatism was 2.94 ± 0.89 D. The mean difference between the intended and the actual final IOL cylinder axis was 3.44 degrees (range 0 to 12). Conclusions: The toric IOL reduced visually significant keratometric astigmatism and increased spectacle independence after cataract surgery. There were no cases of significant IOL rotation in the capsular bag 4 months postoperatively. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. © 2011 ASCRS and ESCRS.
'The COPD breathlessness manual': A randomised controlled trial to test a cognitive-behavioural manual versus information booklets on health service use, mood and health status, in patients with chronic obstructive pulmonary disease
Howard C.,Hillingdon Hospital |
Dupont S.,Hillingdon Hospital
npj Primary Care Respiratory Medicine | Year: 2014
Background:Chronic obstructive pulmonary disease (COPD) is a costly long-term condition associated with frequent Accident and Emergency (A&E) and hospital admissions. Psychological difficulties and inadequate self-management can amplify this picture.Aims:To compare a cognitive-behavioural manual versus information booklets (IB) on health service use, mood and health status.Methods:Two hundred and twenty-two COPD patients were randomly allocated to receive either the COPD breathlessness manual (CM) or IB. They were instructed to work through their programme at home, over 5 weeks. Guidance from a facilitator was provided at an initial home visit plus two telephone call follow-ups.Results:After 12 months, total A&E visits had reduced by 42% in the CM group, compared with a 16% rise in the IB group. The odds of people in the IB group attending A&E 12 months post-intervention was 1.9 times higher than for the CM group (CI 1.05-3.53). Reduction in hospital admissions and bed days were greatest in the CM group. At 6 months, there were significantly greater improvements in anxiety (F (2,198)=5.612, P=0.004), depression (F (1.8,176.1)=10.697, P≤ 0.001) and dyspnoea (F (2,198)=18.170, P≤0.001) in the CM group. Estimated savings at 12 months were greatest in the CM group, amounting to £30k or £270 per participant.Conclusion:The COPD manual, which addresses physical and mental health, is a straightforward cost-effective intervention that is worth offering to COPD patients within primary or secondary care. © 2014 Primary Care Respiratory Society UK/Macmillan Publishers Limited.
Selby J.,Hillingdon Hospital |
Prabhudesai A.,Hillingdon Hospital
International Journal of Colorectal Disease | Year: 2014
Aims: To explore if post-operative day 3 C-reactive protein (CRP), the ratio of pre-operative to day 3 white cell count (WCC) and platelet count can be used to predict the risk of post-operative complication and stratify the severity of complications as defined by the Clavien-Dindo classification. Methods: Data was obtained retrospectively on 127 patients who had elective bowel resection for malignancy between 2011 and 2013. Baseline demographics and clinical details were obtained including pre-operative and day 3 WCC and platelets and day 3 CRP. Ratio of pre-operative to day 3 WCC and platelets was calculated. Outcome measures were if a complication occurred (death included) and complication as defined by the Clavien-Dindo clasification. Mann-Whitney U test and Kruskal-Wallis were used to test for significance. Results: Of 127 patients, 57 % (n = 73) were male with a total median age of 72 and the commonest histology result T3N0 (40.6 %, n = 52). CRP was found to predict a complication (p < 0.0005) and the severity of complication as per the Clavien-Dindo classification (p < 0.0005). Day 3 CRP over 285 suggested a life-threatening complication (Clavien-Dindo score 4). There was no statistical significance between the ratio of WCC and platelets to any of the outcome measures. Conclusions: WCC, platelets and CRP are routinely performed in the post-operative period. Previous research has shown CRP to be a good predictor of a complication. This paper has shown that day 3 CRP can not only predict but can also stratify the severity of post-operative complications. © 2014, Springer-Verlag Berlin Heidelberg.
Dubrey S.W.,Hillingdon Hospital
Postgraduate Medical Journal | Year: 2012
Heart involvement by amyloid deposition remains the most challenging of all organ sytems that may become involved, in what is generally a systemic disease. The correct diagnosis of amyloid type is critical to selection of the appropriate and wide range of therapies. The treatment of amyloid heart disease comprises two strategies: conventional management of a restrictive cardiomyopathy, and varied therapies aimed at the underlying amyloidogenic process. In light chain (AL) amyloidosis, many of the most efficacious therapies involve chemotherapeutic agents with their own inherent toxicities to the heart and bone marrow. In the case of the hereditary amyloidosis, major surgery in the form of liver transplantation is usually required. Moreover, consideration should be given to screening of family members for a potentially hereditary disease. Several types of amyloidosis may require one or more, of heart, liver and/or kidney transplantation, sometimes in addition to high-dose chemotherapy. The objective is to provide a schematic overview of available therapies in the management of AL, hereditary, senile systemic, isolated atrial and secondary forms of amyloidosis.
Stiles E.,Hillingdon Hospital
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2013
This literature review investigates nurses' attitudes towards providing artificial nutrition and hydration (ANH) in the palliative care setting. Various factors that influence nurses' attitudes are examined. While some of the findings have limited generalisability because of the dearth of evidence originating from the UK, United States and western Europe, the issues should still be considered. It is recommended that more research is carried out examining nurses' attitudes towards providing ANH in palliative care in the UK, to gain a better understanding of the factors that may influence decision making.
Dubrey S.W.,Hillingdon Hospital |
Comenzo R.L.,Tufts Medical Center
QJM | Year: 2012
Amyloid diseases in man are caused by as many as 23 different pre-cursor proteins already described. Cardiologists predominantly encounter three main types of amyloidosis that affect the heart: light chain (AL) amyloidosis, senile systemic amyloidosis (SSA) and hereditary amyloidosis, most commonly caused by a mutant form of transthyretin. In the third world, secondary amyloid (AA) is more prevalent, due to chronic infections and inadequately treated inflammatory conditions. Much less common, are the non-transthyretin variants, including mutations of fibrinogen, the apolipoproteins apoA1 and apoA2 and gelsolin. These rarer types do not usually cause significant cardiac compromise. Occurring worldwide, later in life and of less clinical significance, isolated atrial amyloid (IAA) also involves the heart. Heart involvement by amyloid often has devastating consequences. Clinical outcome depends on amyloid type, the extent of systemic involvement and the treatment options available. An exact determination of amyloid type is critical to appropriate therapy. In this review we describe the different approaches required to treat this spectrum of amyloid cardiomyopathies. © The Author 2012. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.