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Cossins L.,University of Liverpool | Okell R.W.,Leighton Hospital | Cameron H.,Rehabilitation and Assessment Directorate | Simpson B.,University of Wales | And 2 more authors.
European Journal of Pain (United Kingdom) | Year: 2013

Complex regional pain syndrome (CRPS) is a disabling pain condition with sensory, motor and autonomic manifestations. Uncertainty remains about how CRPS can be effectively managed. We conducted a systematic review of randomized controlled trials (RCTs) for treatment and prophylactic interventions for CRPS published during the period 2000-2012, building on previous work by another group reviewing the period 1966-2000. Bibliographic database searches identified 173 papers which were filtered by three reviewers. This process generated 29 trials suitable for further analysis, each of which was reviewed and scored by two independent reviewers for methodological quality using a 15-item checklist. A number of novel and potentially effective treatments were investigated. Analysing the results from both review periods in combination, there was a steep rise in the number of published RCTs per review decade. There is evidence for the efficacy of 10 treatments (3× strong - bisphosphonates, repetitive transcranial magnetic stimulation and graded motor imagery, 1× moderate and 6× limited evidence), and against the efficacy of 15 treatments (1× strong, 1× moderate and ×13 limited). The heterogeneity of trialled interventions and the pilot nature of many trials militate against drawing clear conclusions about the clinical usefulness of most interventions. This and the observed phenomenon of excellent responses in CRPS subgroups would support the case for a network- and multi-centre approach in the conduct of future clinical trials. Most published trials in CRPS are small with a short follow-up period, although several novel interventions investigated from 2000 to 2012 appear promising. © 2012 European Federation of International Association for the Study of Pain Chapters. Source


Heald A.,Leighton Hospital | Montejo A.L.,University of Salamanca | Millar H.,Carseview Center | De Hert M.,University Psychiatric Center | And 2 more authors.
European Psychiatry | Year: 2010

Improved physical health care is a pressing need for patients with schizophrenia. It can be achieved by means of a multidisciplinary team led by the psychiatrist. Key priorities should include: selection of antipsychotic therapy with a low risk of weight gain and metabolic adverse effects; routine assessment, recording and longitudinal tracking of key physical health parameters, ideally by electronic spreadsheets; and intervention to control CVD risk following the same principles as for the general population. A few simple tools to assess and record key physical parameters, combined with lifestyle intervention and pharmacological treatment as indicated, could significantly improve physical outcomes. Effective implementation of strategies to optimise physical health parameters in patients with severe enduring mental illness requires engagement and communication between psychiatrists and primary care in most health settings. © 2010 Elsevier Masson SAS. Source


Wampers M.,Catholic University of Leuven | Hanssens L.,University of Liege | van Winkel R.,Catholic University of Leuven | van Winkel R.,Maastricht University | And 6 more authors.
European Neuropsychopharmacology | Year: 2012

Second-generation antipsychotics (SGA), especially clozapine and olanzapine, are associated with an increased metabolic risk. Recent research showed that plasma adiponectin levels, an adipocyte-derived hormone that increases insulin sensitivity, vary in the same way in schizophrenic patients as in the general population according to gender, adiposity and metabolic syndrome (MetS). The aim of the present study was to investigate whether different SGAs differentially affect plasma adiponectin levels independent of body mass index (BMI) and MetS status.113 patients with schizophrenia (65.5% males, 32.3. years old) who were free of antipsychotic medication were enrolled in this open-label prospective single-center study and received either risperidone (n = 54) or olanzapine (n = 59). They were followed prospectively for 12. weeks. Average daily dose was 4.4. mg/day for risperidone and 17.4. mg/day for olanzapine. Plasma adiponectin levels as well as fasting metabolic parameters were measured at baseline, 6. weeks and 12. weeks. The two groups had similar baseline demographic and metabolic characteristics. A significant increase in body weight was observed over time. This increase was significantly larger in the olanzapine group than in the risperidone group (+ 7.0 kg versus + 3.1 kg, p < 0.0002). Changes in fasting glucose and insulin levels and in HOMA-IR, an index of insulin resistance, were not significantly different in both treatment groups. MetS prevalence increased significantly more in the olanzapine group as compared to the risperidone groups where the prevalence did not change over time. We observed a significant (p = 0.0015) treatment by time interaction showing an adiponectin increase in the risperidone-treated patients (from 10,154 to 11,124. ng/ml) whereas adiponectin levels decreased in olanzapine treated patients (from 11,280 to 8988. ng/ml). This effect was independent of BMI and the presence/absence of MetS. The differential effect of antipsychotic treatment (risperidone versus olanzapine) on plasma adiponectin levels over time, independent of changes in waist circumference and antipsychotic dosing, suggests a specific effect on adipose tissues, similar to what has been observed in animal models. The observed olanzapine-associated reduction in plasma adiponectin levels may at least partially contribute to the increased metabolic risk of olanzapine compared to risperidone. © 2011 Elsevier B.V. Source


Iskander M.,Leighton Hospital
Medical Teacher | Year: 2015

Effective feedback on performance is an integral part of clinical training. It allows the trainee to critically reflect on their development, as well as enable the teacher to chart progress and detect areas for development. In order to provide effective feedback, we need to take into account the performance itself, but also the setting where feedback is offered, and the expected outcomes of the encounter. As ever, negative feedback remains more difficult to give and receive, and as such requires a greater degree of delicacy to produce a positive result. © 2015 Informa UK Ltd. All rights reserved: reproduction in whole or part not permitted. Source


Heseltine T.D.,Leighton Hospital
BMJ case reports | Year: 2014

We describe the case of a 65-year-old patient who was admitted to our tertiary centre with cardiac sounding chest pain and inferior ST elevation. Coronary angiography revealed mild plaque disease in the left anterior descending artery. The right coronary artery was smooth with no plaques with the exception of an occluded distal branch with no flow. The left ventriculogram revealed a ballooned and akinetic apex typical of Takotsubo syndrome (TS). We suspected a coronary embolus secondary to TS. A serial rise and fall in biomarkers of myocardial necrosis was noted. The patient was treated for acute coronary syndrome and discharged home 72 h from admission. Distal thromboembolism has been described in the literature before. On a search of PubMed there are no examples of coronary artery embolus in the context of TS. Source

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