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Airdrie, United Kingdom

Pearsall R.,Monklands Hospital | Hughes S.,Tulare Community Health Clinic | Geddes J.,University of Oxford | Pelosi A.,Regional Eating Disorders Unit
BMC Psychiatry | Year: 2014

Background: People with serious mental illness are at an increased risk of physical ill health. Mortality rates are around twice those of the general population with higher levels of cardiovascular disease, metabolic disease, diabetes, and respiratory illness. Although genetics may have a role in the physical health problems of these patients, lifestyle and environmental factors such as smoking, obesity, poor diet, and low levels of physical activity play a prominent part.Methods: A qualitative grounded theory approach was used to understand the problems experienced by these individuals when asked to attend a healthy living programme. Three main areas were explored: the influence of potential barriers, health problems, and general attitudes towards healthy living.Results: Thirteen patients were interviewed during the study. Many did not recall receiving an initial invitation letter to the programme. Several believed that there was no necessity to attend as they had already had recent routine health checks by their general practitioner. The patients' current level of mental and physical health was important with symptoms such as depression, anxiety or arthritis affecting interest in the programme. Patients described that they found smoking enjoyable or calming in its effect. Dietary intake was determined by taste or gaining pleasure in eating certain types of food. Several lessons were learnt during this research that may aid future research and practice. Participation seemed to be better if the approach was first made by the patient's own community keyworker. This contact may have provided a greater opportunity to explain the purpose and importance of the programme. Alternative appointments should be considered when certain patients are in better physical and mental health. Healthy living programmes need to be flexible and adaptive to individual patient needs. Assistance from their community worker may help engagement. Simple measures may improve participation and reduce potential barriers.Conclusion: These findings highlighted some of the problems encountered by patients when attempting to participate in a healthy living programme. These results may be useful when implementing future healthy living interventions for patients with serious mental disorders. © 2014 Pearsall et al.; licensee BioMed Central Ltd. Source


Kelly R.J.,BexleyWing | Hill A.,BexleyWing | Arnold L.M.,BexleyWing | Brooksbank G.L.,BexleyWing | And 6 more authors.
Blood | Year: 2011

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal hematopoietic disorder with increased mortality and morbidity resulting from intravascular hemolysis. Eculizumab, a monoclonal antibody against the complement protein 5, stops the intravascular hemolysis in PNH. We evaluated 79 consecutive patients treated with eculizumab in Leeds between May 2002 and July 2010. The survival of patients treated with eculizumab was not different from age- and sexmatched normal controls (P = .46) but was significantly better than 30 similar patients managed before eculizumab (P = .030). Three patients on eculizumab, all over 50 years old, died of causes unrelated to PNH. Twenty-one patients (27%) had a thrombosis before starting eculizumab (5.6 events per 100 patientyears) compared with 2 thromboses on eculizumab (0.8 events per 100 patientyears; P < .001). Twenty-one patients with no previous thrombosis discontinued warfarin on eculizumab with no thrombotic sequelae. Forty of 61 (66%) patients on eculizumab for more than 12 months achieved transfusion independence. The 12-month mean transfusion requirement reduced from 19.3 units before eculizumab to 5.0 units in the most recent 12 months on eculizumab (P < .001). Eculizumab dramatically alters the natural course of PNH, reducing symptoms and disease complications as well as improving survival to a similar level to that of the general population. © 2011 by The American Society of Hematology. Source


Gupta G.,Monklands Hospital
Journal of the European Academy of Dermatology and Venereology | Year: 2015

Background Lmax, the maximum lesion count during treatment, is a new concept for evaluating the efficacy of field-directed treatments for actinic keratosis (AK) against clinical and subclinical lesions. Imiquimod 3.75% is a field-directed AK treatment, which can detect and clear clinical and subclinical lesions across an entire sun-exposed field such as the full face or balding scalp.Objectives To evaluate the importance of integrating Lmax into daily clinical practice by describing the clinical features and outcomes obtained in the first 10 patients who were treated with imiquimod 3.75% in a UK dermatology department.Methods Ten AK patients were treated with imiquimod 3.75% in two 2-week treatment cycles separated by a 2-week treatment-free interval. Lesions were counted before, during and 2 months after treatment was completed. Patients compared the imiquimod 3.75% regimen with their previous AK therapies in terms of treatment duration and side-effect profile.Conclusions Imiquimod 3.75% in daily clinical practice enables dermatologists to detect and clear clinical and subclinical AK lesions across a large sun-exposed area. Patients generally find imiquimod 3.75% easy-to-use with a better side-effect profile than other AK treatments.Results All 10 patients in this cohort had used two or more prior AK treatments including 5-flurouracil, diclofenac, imiquimod 5% and photodynamic therapy. The patients had a median of 10 AK lesions on clinical presentation and a median Lmax of 14. The median lesion count was zero 2 months after treatment was completed. All patients thought that imiquimod 3.75% was easy-to-use and that the duration of treatment was better than that of previous AK therapies. Seven of the patients considered the side-effect profile of imiquimod 3.75% to be better than that of their prior AK treatments. © 2014 European Academy of Dermatology and Venereology. Source


Ritchie N.D.,University of Glasgow | Baggott A.V.,Monklands Hospital | Andrew Todd W.T.,Travel Clinic
Journal of Travel Medicine | Year: 2012

Background Acetazolamide has been reported to be effective in the prevention of acute mountain sickness (AMS). Our aim was to conduct a systematic review of randomized, placebo-controlled trials of acetazolamide in the prevention of AMS. Methods Studies were identified by searching the MEDLINE, Embase, Cochrane Clinical Trials Register, and ClinicalTrials.gov databases. Primary end point was difference in incidence of AMS between acetazolamide and placebo groups. Results Acetazolamide prophylaxis was associated with a 48% relative-risk reduction compared to placebo. There was no evidence of an association between efficacy and dose of acetazolamide. Adverse effects were often not systematically reported but appeared to be common but generally mild. One study found that adverse effects of acetazolamide were dose related. Conclusions Acetazolamide is effective prophylaxis for the prevention of symptoms of AMS in those going to high altitude. A dose of 250 mg/day has similar efficacy to higher doses and may have a favorable side-effect profile. © 2012 International Society of Travel Medicine. Source


Pearsall R.,Monklands Hospital | Smith D.J.,University of Glasgow | Pelosi A.,Regional Eating Disorders Unit | Geddes J.,University of Oxford
BMC Psychiatry | Year: 2014

Background: Individuals with serious mental illness are at a higher risk of physical ill health. Mortality rates are at least twice those of the general population with higher levels of cardiovascular disease, metabolic disease, diabetes, and respiratory illness. Although genetics may have a role in the physical health problems of these patients, lifestyle and environmental factors such as levels of smoking, obesity, poor diet, and low levels of physical activity also play a prominent part.Methods: We conducted a systematic review and meta-analysis of randomised controlled trials comparing the effect of exercise interventions on individuals with serious mental illness.Searches were made in Ovid MEDLINE, Embase, CINAHL, PsycINFO, Biological Abstracts on Ovid, and The Cochrane Library (January 2009, repeated January 2013) through to February 2013.Results: Eight RCTs were identified in the systematic search. Six compared exercise versus usual care. One study assessed the effect of a cycling programme versus muscle strengthening and toning exercises. The final study compared the effect of adding specific exercise advice and motivational skills to a simple walking programme. The review found that exercise improved levels of exercise activity (n = 13, standard mean difference [SMD] 1.81, CI 0.44 to 3.18, p = 0.01). No beneficial effect was found on negative (n = 84, SMD = -0.54, CI -1.79 to 0.71, p = 0.40) or positive symptoms of schizophrenia (n = 84, SMD = -1.66, CI -3.78 to 0.45, p = 0.12). No change was found on body mass index compared with usual care (n = 151, SMD = -0.24, CI -0.56 to 0.08, p = 0.14), or body weight (n = 77, SMD = 0.13, CI -0.32 to 0.58, p = 0.57). No beneficial effect was found on anxiety and depressive symptoms (n = 94, SMD = -0.26, CI -0.91 to 0.39, p = 0.43), or quality of life in respect of physical and mental domains.Conclusions: This systematic review showed that exercise therapies can lead to a modest increase in levels of exercise activity but overall there was no noticeable change for symptoms of mental health, body mass index, and body weight. © 2014 Pearsall et al.; licensee BioMed Central Ltd. Source

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