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Cox F.,Royal Brompton and Harefield NHS Trust
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2010

This two-part article, the fourth in a series on pain, explores the four main divisions of pharmacology: pharmacodynamics--what the medicine does to the body; pharmacokinetics--what the body does to the medicine; pharmacoeconomics--the cost and benefit ratio compared to other treatments; and pharmacovigilance--a medicine's safety profile. Part two, which will published next week, will explore the main categories of analgesic medicines.


Birks E.J.,Royal Brompton and Harefield NHS Trust
Heart | Year: 2010

Left ventricular assist device (LVAD) insertion in patients with advanced heart failure with deteriorating clinical status is life saving, and LVADs are now being inserted into an increasing number of patients with advanced heart failure. They were initially inserted as a bridge to transplantation, and the decreased availability of donor hearts means that an increasing number of patients are requiring LVAD support for survival when their clinical status deteriorates. There is strong evidence that with LVAD unloading, particularly when combined with pharmacological treatment, the patients' myocardial function can also recover, allowing device removal and avoiding the need for transplantation, immunosuppression and its associated complications. This indication, known as "bridge to recovery" is a newer and expanding indication. The future use of LVADs, particularly as survival continues to increase, is extending to their wider use as destination therapy, when the device is inserted lifelong as an alternative to transplantation, and this role is likely to increase further. LVAD technology is evolving quickly, survival is improving, the incidence of complications is decreasing and durability of the devices is improving.


Hallas C.N.,Royal Brompton and Harefield NHS Trust | Burke J.L.,Staffordshire University | White D.G.,Staffordshire University | Connelly D.T.,Cardiothoracic Center
Circulation: Arrhythmia and Electrophysiology | Year: 2010

Background-The testing of the implantable cardioverter-defibrillator (ICD), through the induction of repeated episodes of ventricular fibrillation, has been associated with disturbances in cerebral activity and increased levels of cytoplasmic enzymes. However, the neuropsychological outcomes of cerebral changes and their quality-of-life implications are unknown. Methods and Results-Fifty-two ICD recipients completed standardized validated neuropsychological tests 1 to 3 days before ICD surgery and then 6 weeks, 6 months, and 12 months after surgery. They also completed psychometric tests measuring anxiety, depression, and quality of life. Between 31% and 39% of patients showed a significant neuropsychological impairment from their baseline function 6 weeks, 6 months, and 12 months after surgery. Ten percent of patients had late-onset deficits at 12 months only. Frequent areas of impairment were auditory and visual memory and attention. Neuropsychological impairment was not related to mood or quality of life at follow-up, although anxiety and depression predicted reduced quality of life. Conclusions-ICD implantation is associated with neuropsychological impairment that dissipates for the majority of recipients after 12 months. Short-term memory function and attention are particularly vulnerable to changes in oxygen during ICD testing. Although anxiety and depression are prevalent, there is little evidence for the direct impact of mood on cognition, and deficits appear not to be associated with reduced quality of life. These results provide evidence for longitudinal outcomes of ICD surgery and have implications for patient rehabilitation and adjustment. © 2010 American Heart Association, Inc.


Hayward C.,Cardiovascular Biomedical Research Unit | Banner N.R.,Royal Brompton and Harefield NHS Trust | Morley-Smith A.,Cardiovascular Biomedical Research Unit | Lyon A.R.,Cardiovascular Biomedical Research Unit | Harding S.E.,Imperial College London
Human Gene Therapy | Year: 2015

Gene therapy has been applied to cardiovascular disease for over 20 years but it is the application to heart failure that has generated recent interest in clinical trials. There is laboratory and early clinical evidence that delivery of sarcoplasmic reticulum calcium ATPase 2a (SERCA2a) gene therapy is beneficial for heart failure and this therapy could become the first positive inotrope with anti-arrhythmic properties. In this review we will discuss the rationale for SERCA2a gene therapy as a viable strategy in heart failure, review the published data, and discuss the ongoing clinical trials, before concluding with comments on the future challenges and potential for this therapy. © Mary Ann Liebert, Inc.


Spiro J.R.,Royal Brompton and Harefield NHS Trust | Digby J.E.,University of Oxford | Ghimire G.,Royal Brompton and Harefield NHS Trust | Mason M.,Royal Brompton and Harefield NHS Trust | And 5 more authors.
European Heart Journal | Year: 2011

Aims The endothelium plays a role in regulating vascular tone. Acute and dynamic changes in low-flow-mediated constriction (L-FMC) and how it changes with regard to traditional flow-mediated dilatation (FMD) have not been described. We aimed to investigate the changes in brachial artery L-FMC following percutaneous coronary intervention (PCI) and during recovery from non-ST-segment elevation myocardial infarction (NSTEMI). Methods and resultsFMD was performed in accordance with a previously described technique in patients before and after PCI and in the recovery phase of NSTEMI, but in addition, L-FMC data were acquired from the last 30 s of cuff inflation. About 135 scans were performed in 96 participants (10 healthy volunteers and 86 patients). Measurement of brachial L-FMC was reproducible over hours. L-FMC was greater among patients with unstable vs. stable coronary atherosclerosis (-1.33 ±1.09 vs. -0.03 ± 1.26, P < 0.01). Following PCI, FMD reduced (4.43 ± 2.93 vs. 1.66 ± 2.16, P < 0.01) and L-FMC increased (-0.33 ± 0.76 vs. -1.63 ± 1.15, P 0.02). Furthermore, during convalescence from NSTEMI, L-FMC reduced (-1.37 ± 1.19 vs. 0.01 ± 0.82, P 0.02) in parallel with improvements in FMD (2.54 ± 2.19 vs. 5.15 ± 3.07, P < 0.01). ConclusionBrachial L-FMC can be measured reliably. Differences were observed between patients with stable and unstable coronary disease. L-FMC was acutely increased following PCI associated with reduced FMD and, in the recovery from NSTEMI, L-FMC reduced associated with increased FMD. These novel findings characterize acute and subacute variations in brachial L-FMC. The pathophysiological and clinical implications of these observations require further study. © 2011 The Author.

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