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Park J.C.,Royal Infirmary | Habib N.E.,Peninsula Medical School
Canadian Journal of Ophthalmology | Year: 2015

Objective To describe a simplified tectonic lamellar keratoplasty (LK) technique, which can be used to manage full-thickness corneal perforations. Design Case series demonstrating a new surgical technique. Participants A 69-year-old female with rosacea keratitis and peripheral corneal perforation; a 49-year-old male with keratoconus, ipsilateral herpes simplex keratitis and an inferonasal corneal perforation; and a 12-year-old female with an apparently spontaneous central corneal perforation. Results These 3 patients with full-thickness corneal perforations were successfully managed with this automated tectonic LK technique. Conclusions Tectonic LK has benefits relative to tectonic penetrating keratoplasty but remains unpopular because it is technically difficult to prepare the host and donor corneas. This tectonic LK technique negates the need for challenging free-hand dissection and gives an excellent donor fit to the host bed. This provides an easier and more effective way to manage corneal perforations. © 2015 Canadian Ophthalmological Society.


Posadzki P.,Peninsula Medical School | Lizis P.,Institute of Physiotherapy | Hagner-Derengowska M.,Nicolaus Copernicus University
Complementary Therapies in Clinical Practice | Year: 2011

Objective: The aim of this paper is to systematically review all controlled clinical trials of Pilates to treat low back pain. Data sources: A systematic review of nine databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, Pedro, Rehadat, Rehab Trials) was conducted and the reference lists of all the papers were checked for further relevant publications until May 2010. Study selection: A first selection was performed by means of title and abstract. A second selection was made by means of predefined inclusion criteria: randomized controlled clinical trials testing Pilates in patients of any age or sex with low back pain. Data extraction: Data relating to changes in body function, quality of life and pain from the included studies were independently extracted by the reviewers on a standardized form. Study quality was assessed using the Oxford scale. Data synthesis: Four eligible randomized controlled clinical trials (n = 4) involving Pilates for the management of low back pain were included. The methodological quality of the RCTs was relatively low, varying from 1-4 on the Oxford scale. All studies were heterogeneous in terms of population of patients, control groups, inclusion and exclusion criteria, and outcome measures making a meta-analysis not feasible. Although there is some evidence supporting the effectiveness of Pilates in the management of low back pain, no definite conclusions can be drawn except that further research is needed with larger samples and using clearer definitions of the standard care and comparable outcome measures. Conclusions: There is a wide diversity in research investigating the clinical and cost-effectiveness of Pilates in patients with low back pain. © 2010.


Posadzki P.,Peninsula Medical School
Clinical medicine (London, England) | Year: 2013

This overview of systematic reviews (SRs) aims to evaluate critically the evidence regarding the adverse effects of herbal medicines (HMs). Five electronic databases were searched to identify all relevant SRs, with 50 SRs of 50 different HMs meeting our inclusion criteria. Most had only minor weaknesses in methods. Serious adverse effects were noted only for four HMs: Herbae pulvis standardisatus, Larrea tridentate, Piper methysticum and Cassia senna. The most severe adverse effects were liver or kidney damage, colon perforation, carcinoma, coma and death. Moderately severe adverse effects were noted for 15 HMs: Pelargonium sidoides, Perna canaliculus, Aloe vera, Mentha piperita, Medicago sativa, Cimicifuga racemosa, Caulophyllum thalictroides, Serenoa repens, Taraxacum officinale, Camellia sinensis, Commifora mukul, Hoodia gordonii, Viscum album, Trifolium pratense and Stevia rebaudiana. Minor adverse effects were noted for 31 HMs: Thymus vulgaris, Lavandula angustifolia Miller, Boswellia serrata, Calendula officinalis, Harpagophytum procumbens, Panax ginseng, Vitex agnus-castus, Crataegus spp., Cinnamomum spp., Petasites hybridus, Agave americana, Hypericum perforatum, Echinacea spp., Silybum marianum, Capsicum spp., Genus phyllanthus, Ginkgo biloba, Valeriana officinalis, Hippocastanaceae, Melissa officinalis, Trigonella foenum-graecum, Lagerstroemia speciosa, Cnicus benedictus, Salvia hispanica, Vaccinium myrtillus, Mentha spicata, Rosmarinus officinalis, Crocus sativus, Gymnema sylvestre, Morinda citrifolia and Curcuma longa. Most of the HMs evaluated in SRs were associated with only moderately severe or minor adverse effects.


Ernst E.,Peninsula Medical School | Posadzki P.,Peninsula Medical School
Clinical Medicine, Journal of the Royal College of Physicians of London | Year: 2012

Asthma patients often try some form of alternative medicine. This article questions whether this is good or bad. Systematic reviews fail to demonstrate that the treatments in question are demonstrably effective. Other data raise considerable concern over the safety of some forms of alternative medicine. Thus the risk-benefit balance fails to be positive. Patients are often mislead to believe otherwise and physicians should inform their asthma patients responsibly about the value of alternative medicine. © Royal College of Physicians, 2012. All rights reserved.


Wylde V.,University of Bristol | Palmer S.,University of the West of England | Learmonth I.D.,University of Bristol | Dieppe P.,Peninsula Medical School
Osteoarthritis and Cartilage | Year: 2011

Quantitative Sensory Testing (QST), which assesses somatosensory function by recording participant's responses to external stimuli of controlled intensity, is a useful tool to provide insight into the complex pathophysiology of osteoarthritis (OA) pain. However, QST is not commonly used in rheumatology because the test-retest reliability properties of QST in OA patients have not yet been established. This brief report presents the finding of a study which assessed the test-retest reliability of light touch thresholds, pressure pain thresholds, thermal sensation thresholds and thermal pain thresholds in 50 knee OA patients and 50 healthy participants. Pressure pain thresholds were found to be the least variable measurement, as median thresholds did not differ significantly over the 1 week period and the results were highly correlated. This provides support for the inclusion of pressure algometry in studies assessing pain perception abnormalities in OA. © 2011 Osteoarthritis Research Society International.


Qureshi N.,University of Nottingham | Armstrong S.,University of Nottingham | Dhiman P.,University of Nottingham | Saukko P.,Loughborough University | And 3 more authors.
Annals of Internal Medicine | Year: 2012

Background: Evidence of the value of systematically collecting family history in primary care is limited. Objective: To evaluate the feasibility of systematically collecting family history of coronary heart disease in primary care and the effect of incorporating these data into cardiovascular risk assessment. Design: Pragmatic, matched-pair, cluster randomized, controlled trial. (International Standardized Randomized Controlled Trial Number Register: ISRCTN 17943542). Setting: 24 family practices in the United Kingdom. Participants: 748 persons aged 30 to 65 years with no previously diagnosed cardiovascular risk, seen between July 2007 and March 2009. Intervention: Participants in control practices had the usual Framingham-based cardiovascular risk assessment with and without use of existing family history information in their medical records. Participants in intervention practices also completed a questionnaire to systematically collect their family history. All participants were informed of their risk status. Participants with high cardiovascular risk were invited for a consultation. Measurements: The primary outcome was the proportion of participants with high cardiovascular risk (10-year risk ≥20%). Other measures included questionnaire completion rate and anxiety score. Results: 98% of participants completed the family history questionnaire. The mean increase in proportion of participants classified as having high cardiovascular risk was 4.8 percentage points in the intervention practices, compared with 0.3 percentage point in control practices when family history from patient records was incorporated. The 4.5-percentage point difference between groups (95% CI, 1.7 to 7.2 percentage points) remained significant after adjustment for participant and practice characteristics (P = 0.007). Anxiety scores were similar between groups. Limitations: Relatively few participants were from ethnic minority or less-educated groups. The potential to explore behavioral change and clinical outcomes was limited. Many data were missing for anxiety scores. Conclusion: Systematically collecting family history increases the proportion of persons identified as having high cardiovascular risk for further targeted prevention and seems to have little or no effect on anxiety. Primary Funding Source: Genetics Health Services Research program of the United Kingdom Department of Health. © 2012 American College of Physicians.


Posadzki P.,Peninsula Medical School | Ernst E.,Peninsula Medical School
Clinical Rheumatology | Year: 2011

The objective of this systematic review was to assess the effectiveness of osteopathy as a treatment option for musculoskeletal pain. Six databases were searched from their inception to August 2010. Only randomized clinical trials (RCTs) were considered if they tested osteopathic manipulation/mobilization against any control intervention or no therapy in human with any musculoskeletal pain in any anatomical location, and if they assessed pain as an outcome measure. The selection of studies, data extraction, and validation were performed independently by two reviewers. Studies of chiropractic manipulations were excluded. Sixteen RCTs met the inclusion criteria. Their methodological quality ranged between 1 and 4 on the Jadad scale (max=5). Five RCTs suggested that osteopathy compared to various control interventions leads to a significantly stronger reduction of musculoskeletal pain. Eleven RCTs indicated that osteopathy compared to controls generates no change in musculoskeletal pain. Collectively, these data fail to produce compelling evidence for the effectiveness of osteopathy as a treatment of musculoskeletal pain. © Clinical Rheumatology 2010.


Jones A.G.,Peninsula Medical School | Hattersley A.T.,Peninsula Medical School
Nature Reviews Endocrinology | Year: 2010

Background. A 17-year-old female was referred for the reassessment of her type 1 diabetes mellitus, with which she had been diagnosed at the age of 15 weeks owing to symptoms of ketoacidosis. The patient had mild learning difficulties, which resulted in her requiring additional support at school. There was no family history of diabetes.Investigations. Measurements of plasma C-peptide and glutamate decarboxylase autoantibodies. Molecular genetic testing was performed.Diagnosis. Intermediate developmental delay, epilepsy and neonatal diabetes mellitus (DEND) syndrome as a result of a 59V>M Kir6.2 mutation.Management. Treatment with high-dose oral glibenclamide replaced insulin treatment. Good glycemic control was achieved with levels of HbA 1c consistently below 6.5% and no hypoglycemia. © 2010 Macmillan Publishers Limited. All rights reserved.


Perry R.,Peninsula Medical School | Terry R.,Peninsula Medical School | Ernst E.,Peninsula Medical School
Clinical Rheumatology | Year: 2010

Homoeopathy is often advocated for fibromyalgia (FM) and many FM patients use it. To critically evaluate all randomised clinical trials (RCTs) of homoeopathy as a treatment for FM, six electronic databases were searched to identify all relevant studies. Data extraction and the assessment of the methodological quality of all included studies were done by two independent reviewers. Four RCTs were found, including two feasibility studies. Three studies were placebo-controlled. None of the trials was without serious flaws. Invariably, their results suggested that homoeopathy was better than the control interventions in alleviating the symptoms of FM. Independent replications are missing. Even though all RCTs suggested results that favour homoeopathy, important caveats exist. Therefore, the effectiveness of homoeopathy as a symptomatic treatment for FM remains unproven. © 2010 Clinical Rheumatology.


Wylde V.,University of Bristol | Hewlett S.,University of the West of England | Learmonth I.D.,University of Bristol | Dieppe P.,Peninsula Medical School
Pain | Year: 2011

Persistent postsurgical pain is a prevalent but underacknowledged condition. The aim of this study was to assess the prevalence, sensory qualities, and postoperative determinants of persistent pain at 3 to 4 years after total knee replacement (TKR) and total hip replacement (THR). Patients completed a questionnaire with included the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) Pain Scale, PainDetect Questionnaire, Short-Form McGill Pain Questionnaire, and questions about general health and socioeconomic status. A total of 632 TKR patients and 662 THR patients completed a questionnaire (response rate of 73%); 44% of TKR patients and 27% of THR patients reported experiencing persistent postsurgical pain of any severity, with 15% of TKR patients and 6% of THR patients reporting severe-extreme persistent pain. The persistent pain was most commonly described as aching, tender, and tiring, and only 6% of TKR patients and 1% of THR patients reported pain that was neuropathic in nature. Major depression and the number of pain problems elsewhere were found to be significant and independent postoperative determinants of persistent postsurgical pain. In conclusion, this study found that persistent postsurgical pain is common after joint replacement, although much of the pain is mild, infrequent, or an improvement on preoperative pain. The association between the number of pain problems elsewhere and the severity of persistent postsurgical pain suggests that patients with persistent postsurgical pain may have an underlying vulnerability to pain. A small percentage of patients have severe persistent pain after joint replacement, and this is associated with depression and the number of pain problems elsewhere. © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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