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Braganza J.M.,Royal Infirmary | Lee S.H.,Royal Infirmary | McCloy R.F.,Lancashire Teaching Hospitals | McMahon M.J.,University of Leeds
The Lancet | Year: 2011

Chronic pancreatitis is a progressive fibroinflammatory disease that exists in large-duct (often with intraductal calculi) or small-duct form. In many patients this disease results from a complex mix of environmental (eg, alcohol, cigarettes, and occupational chemicals) and genetic factors (eg, mutation in a trypsin-controlling gene or the cystic fibrosis transmembrane conductance regulator); a few patients have hereditary or autoimmune disease. Pain in the form of recurrent attacks of pancreatitis (representing paralysis of apical exocytosis in acinar cells) or constant and disabling pain is usually the main symptom. Management of the pain is mainly empirical, involving potent analgesics, duct drainage by endoscopic or surgical means, and partial or total pancreatectomy. However, steroids rapidly reduce symptoms in patients with autoimmune pancreatitis, and micronutrient therapy to correct electrophilic stress is emerging as a promising treatment in the other patients. Steatorrhoea, diabetes, local complications, and psychosocial issues associated with the disease are additional therapeutic challenges. © 2011 Elsevier Ltd. Source


Reddy S.,Lancashire Teaching Hospitals
Anaesthesia and Intensive Care Medicine | Year: 2010

The aims of premedication are anxiolysis, analgesia and reduction of perioperative risk (specific to each patient and type of surgery). With the advent of modern anaesthetic agents and day-case surgery the use of sedative premedication has declined. The preoperative visit is used to alleviate anxiety and to decide which of the patient's current medication should be given preoperatively, and also to consider other risk-reduction strategies. Benzodiazepines are the most commonly used anxiolytic agents. Analgesia (e.g. paracetamol and non-steroidal anti-inflammatory drugs) is sometimes prescribed as it can help to reduce postoperative opiate requirements, useful in the day-case setting. Antacids (e.g. H 2 receptor antagonists and proton-pump inhibitors) should be prescribed to patients at risk of aspiration of gastric contents. Antisialogogues e.g. glycopyrronium, may be indicated to reduce airway secretions prior to awake fibreoptic intubation. Other risk-reduction measures include reducing the risk of venous thromboembolism. © 2010 Elsevier Ltd. All rights reserved. Source


Bhalme M.,St Jamess Hospital | Sharma A.,Lancashire Teaching Hospitals | Keld R.,Wrightington Wigan | Willert R.,University of Manchester | Campbell S.,University of Manchester
European Journal of Gastroenterology and Hepatology | Year: 2013

BACKGROUND: Adalimumab (ADA) is a subcutaneous anti-tumour necrosis factor (anti-TNF) agent, effective in inducing and maintaining remission in Crohn's disease (CD). Unlike Infliximab (IFX), ADA dosing is not weight adjusted and dose frequency is based on clinical response. AIM: To determine whether obesity is a risk factor for early loss of response (LOR) to anti-TNF treatment and whether weight-adjusted anti-TNF treatment is favourable. MATERIALS AND METHODS: A hospital database of CD patients receiving anti-TNF treatment was analyzed retrospectively. The relationship between time to LOR and BMI was examined by Kaplan-Meier (KM) survival curves and a Cox proportional hazards model. RESULTS: ADA patients: Of the 54 patients (46 BMI<30 and 8 BMI≥30), KM estimation indicated a significantly shorter time to dose escalation in the BMI of at least 30 (χ=6.117, P=0.01). The Cox proportional hazards model showed that an increased hazard of LOR to ADA is related to increases in BMI (P=0.04). IFX patients: Of the 76 patients (62 BMI<30 and 14 BMI≥30), KM estimation showed that the differences in survival curves were not significant (χ=1.933, P=0.16) for the BMI groups. This was supported by the Cox proportional hazard model (P=0.36). CONCLUSION: BMI appears to be important in predicting ADA efficacy (LOR) in CD. IFX appears to overcome this reduction of efficacy in obese patients. A prospective study evaluating the effect of weight on anti-TNF drug response and serum drug levels is warranted. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source


Nwosu A.C.,University of Liverpool | Debattista M.,Lancashire Teaching Hospitals | Rooney C.,The Christie NHS Foundation Trust | Mason S.,University of Liverpool
BMJ Supportive and Palliative Care | Year: 2015

Background: Social media describes technological applications which are used to exchange information in a virtual environment. The use of social media is increasing, in professional and social contexts, on a variety of platforms such as Twitter; however, the scope and breadth of its use to discuss end-of-life care has not previously been reported. Aims: To determine the frequency, sentiment and trend of Twitter 'tweets' containing palliative care-related identifiers (hashtags) and/or phrases sent by users over a 2-year period. Methods: A 2-year retrospective analysis of Twitter posts (tweets), between the 1 August 2011 to 31 July 2013, using a social media analytics tool: TopsyPro. Thirteen search terms were identified and analysed for tweet volume, frequency, sentiment and acceleration. Results: A total of 683.5K tweets containing a combination of 13 palliative care terms were analysed. The tweet volume for all terms increased by 62.3%between 2011-2012 (262.5K) and 2012-2013 (421K). The most popular terms include 'end-of-life' (210K), #hpm (114K) and 'palliative care' (93.8K). Sentiment was high with 89%of tweets rated more positive than all other tweets sent on Twitter during this period. The term 'Liverpool Care Pathway' experienced the highest percentage increase in tweets (55% increase) reaching a peak in July 2013. Conclusions: A lot of discussion about palliative care is taking place on Twitter, and the majority of this is positive. Social media presents a novel opportunity for engagement and ongoing dialogue with public and professional groups. Source


McKenzie L.H.,Lancaster University | Simpson J.,Lancaster University | Stewart M.,Lancashire Teaching Hospitals
Psychology, Health and Medicine | Year: 2010

In addition to the physical benefits, another important objective of coronary artery bypass graft (CABG) surgery is improvement of health-related quality of life. The aim of this systematic review is to provide an overview of the literature relating to the pre-operative prediction of post-operative depression and anxiety in individuals who have undergone CABG surgery. Forty-six studies were identified through a literature search of electronic databases conducted using explicit inclusion and exclusion criteria. The study characteristics, methodological features, and psychometric and clinical outcomes were summarised in a systematic manner. Collective appraisal of the studies indicated that symptoms of depression and anxiety exhibited after CABG surgery are best predicted by pre-operative measures of functioning in that area. Papers were inconclusive with respect to the predictive qualities of gender and age. Further research is required to clarify the predictive values of these and other factors, including pre-morbid ill health and socio-economic status. The findings of this review indicate a range of pre-operative predictors of post-operative depression and anxiety in patients with CABG. Chief among these are pre-operative depression and anxiety. These findings have clinical implications concerning the importance of pre and post-operative psychological assessment and intervention for individuals at risk of poor psychological recovery. Source

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