Gotowa bibliografia na temat „St. Thomas of Acon's hospital (London, England)”

Summary Leonard Craske (1878–1950), born and raised in London, England, spent two years as a medical student at St Thomas’ Hospital Medical School. Following this, he worked as an actor and studied drawing and sculpting. After emigrating to the USA and settling in Boston, he became an accomplished sculptor, creating the well-known Fishermen's Memorial in Gloucester, Massachusetts, the work for which he is best remembered.

Clinical specialist physiotherapists from the five severe respiratory failure centres in England where respiratory extracorporeal membrane oxygenation (ECMO) is practiced have established this consensus agreement for physiotherapy best practice. The severe respiratory failure centres are Wythenshawe Hospital, Manchester; Glenfield Hospital, Leicester; Papworth Hospital, Cambridge; Guy’s and St Thomas’ Hospital, London and The Royal Brompton Hospital, London. Although research into physiotherapy and ECMO is increasing, there is not a sufficient amount to write evidence-based guidelines; hence the development of a consensus document, using knowledge and experience of the specialist physiotherapists working with patients receiving ECMO. The document outlines safety aspects, practicalities and additional treatment considerations for physiotherapists conducting respiratory care and physical rehabilitation.

SummaryWe report a marked increase in the rate of notifications of tuberculosis in young adults in the London Borough of Lambeth. Analysis of notifications made to the Proper Officer over a 10-year period showed that the age specific notification rate in the cohort aged 20–44 years increased from 30/100000 in 1983 to 51/100000 in 1992. Analysis of St. Thomas' Hospital laboratory records of patients seen between 1984 and 1991 from whom Mycobacterium tuberculosis was isolated showed an increase in the number of patients of African origin from five in the first half of the study period (1984–7) to 25 in the second half (1988–91): 21 of these 25 had immigrated into England within 4 years of their illness. This finding is being further investigated in a prospective study of ethnicity, travel history and date of immigration of Lambeth residents notified with tuberculosis.

Objective: To assess the distribution of deep vein thrombosis in the calf by phlebography. Setting: Department of Vascular Radiology, St. Thomas' Hospital, London, England. Patients: Seventy patients with suspected deep vein thrombosis or pulmonary embolism were examined. Interventions: Bilateral ascending contrast phlebography was performed in all patients. Main Outcome Measures: The sites of any thrombus in the stem or muscle veins of the calf below the popliteal vein were recorded. Results: One hundred legs contained thrombus. In fifty-three legs thrombus was present solely in the calf veins below the popliteal vein. Isolated thrombus in either one or more of the three paired stem veins or the muscle veins was present in twenty-two calves. Conclusions: Because of the difficulty in visualising some calf veins by duplex ultrasound it is suggested that a detailed knowledge of the distribution of thrombus may assist ultrasonographers.

Abstract Acute Chest Syndrome (ACS) is the second most common cause of hospitalisation in patients with Sickle Cell Disease (SCD) and up to 25% of those admitted will require intensive care management. ACS is a leading cause of death in SCD. It may also play a role in the development of chronic lung disease in SCD patients and the prevalence of Asthma in SCD patients is high. The pathogenesis of ACS is complex. Previous work has suggested a relationship between asthma and higher risk of ACS in children with SCD. Data in the UK is limited. Our aim therefore was to describe the presentation, course and outcome of ACS in our local SCD pediatric population, compared with those children who had ACS with SCD and physician diagnosed Asthma (Asthma). Methods: The data collection took place at The Evelina Children’s Hospital, which is part of St Thomas’ Hospital, a large teaching hospital in Central London, England. There are over 400 children with SCD registered, and around 30 new SCD births per year. A retrospective analysis of patient hospital electronic and paper records was performed of 63 ACS presentations over a three year period from 2003 to 2006. Inclusion in the study required a new infiltrate on chest radiograph plus acute respiratory symptoms in a patient with SCD under the age of 16 years. The group included 16 (25%) presentations in children with SCD and Asthma. Results: No Known Asthma 47 Presentations; Mean age 6.2 yrs (range 1–15yrs); HbSS 87%, HbSC13%; Previous ACS 26% (n=12); Mean length of stay 5.4 days (range 1–27); Mortality 0; Mean C-Reactive protein (CRP) on admission 70 (normal <5); Mean oxygen saturations on presentation 92% in air (40% of patients presented with saturations <92% in air) Physician Diagnosed Asthma 16 Presentations; Mean age 4.6 (range 1–15yrs); HbSS 94%, HbSC 6%; Previous ACS 63% (n=10); Mean length of stay 5.4 (range 2–14); Mortality 0; Mean CRP on admission 41; Mean oxygen saturations on presentation 92% in air (50% of patients presented with saturations <92% in air) DISCUSSION: Demographics: Comparable in terms of age and haemoglobin genotype. Presentation: Patients with asthma were more likely to have had previous ACS. Children with asthma presented with a lower CRP. Treatment: The treatment in both groups including the use of blood transfusion, and need for transfer to intensive care were comparable. However there was an observed difference in the use of inhaled bronchodilators (non asthma 21% v asthma 50%). Steroids were rarely used (4%) to treat the patients who did not have a pre-existing diagnosis of asthma, however were used to treat most (94%) of those patients with asthma. Outcome: Length of stay was comparable, no deaths in either group. CONCLUSION: Although patients in our study group with asthma had a higher frequency of previous ACS episodes, we did not demonstrate that patients with asthma suffer a more severe course of illness.

AimIn March 2020, COVID-19 triggered an NHS directive to reduce face-to-face consultations and adapt to virtual clinics.1 Hospital pharmacies, each with their own model of care, quickly innovated to ensure patients received their medication safely.The aim of this study was to evaluate the provision of medications optimisation for paediatric patients following virtual outpatient consultations (VOC) and explore potential improvements for future implementations.MethodThis was a mixed method study using quantitative data; which reviewed medications sent to patients in red, amber, and green categories2 and qualitative data; using patient feedback, to evaluate the processes in three London hospitals. Pathway mapping (PM) sessions, with multidisciplinary team involvement, were conducted across these hospitals to identify areas for improvement and analyse gaps in services. Virtual PM sessions were attended by 30 representatives across the multidisciplinary team including: pharmacists, nurses, consultants, pharmacy technicians, post room attendants; and general, operational, and project managers.Semi-structured questionnaires were used to conduct one to one telephone interviews with patients’ families. A separate topic guide was used to interview General practitioners (GP) and primary care network (PCN) pharmacists. The audio recordings were transcribed as ‘intelligent verbatim’ and analysed using Nvivo. Braun and Clarke’s six phases approach was used to conduct an inductive thematic analysis.3 To improve the rigorousness of the study, more than 50% of the transcript were double coded.4As this was a service evaluation, ethics approval was not necessary. The project was registered with each hospital’s clinical audit department.ResultsThe three process maps were analysed and potential improvements for the medicines optimisation pathway were assessed by a paediatric pharmacy subgroup using ease-impact matrix. Potential improvements include: exploration and use of Electronic Prescription Service by secondary and tertiary care, improving communication through Information Technology systems between prescribers and hospital pharmacists, and the creation of a transparent standard operating procedure regarding medication supply following VOC.Seventy-one patients’ families across the sites were interviewed between January-May 2021 to reflect on their experience of receiving medications following a VOC. Four GPs and one PCN pharmacist were interviewed in May 2021 to assess on the impact of VOC on primary care.Key reflections from themes generated include the convenience of receiving medications from hospital pharmacies following VOC, satisfaction of the current process, including medicines packaging and medicines information provided to patients and their families.Other reflections included limitations of the current process and its implication on patient safety. Medicines information helplines and education provided by pharmacists were regarded by patients’ families and GPs as a valuable attribute.ConclusionPatients’ families appreciated the current model of care, however patients’ families and primary care healthcare professionals have identified both challenges and suggestions for improvement in delivering the current model. Future research should focus on a mixed mode of integrated care with green and amber medications2 prescribed directly to community pharmacies with clinical screening and counselling conducted by hospital pharmacists.ReferencesStevens S and Pritchard A. Important and urgent – next steps on NHS response to Covid-19. NHS England [Online]. 17 March 2020: Available at: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/urgent-next-steps-on-nhs-response-to-covid-19-letter-simon-stevens.pdfGuy’s and St Thomas’ NHS Foundation Trust, Kings College Hospital NHS Foundation Trust, Lewisham and Greenwich NHS Trust. South East London Joint Medicines Formulary. netFormulary. [Online]. 2020: Available at: http://www.selondonjointmedicinesformulary.nhs.uk/Braun V and Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006;3:77-101.Maher C, Hadfield M, Hutchings M, et al. Ensuring rigor in qualitative data analysis: a design research approach to coding combining NVivo with traditional material methods. International Journal of Qualitative Methods 2018;17:1-13.

The author, Derek Beatty, was diagnosed with T1D Diabetes 45 years ago when living in High Wycombe, Buckinghamshire, England. Symptoms of thirst, tiredness, difficulty in reading small print, led to GP doctor consultation with fasting blood glucose Biochemistry tests. Possible Genetic Inheritance may have contributed to reduced Immunogenic resistance to infection possibly triggered from business travel to several African Countries including Kenya, Zambia, Nigeria, Sudan, Egypt, South Africa. Add the trauma as witness to a fatal car crash in Bricket Wood, St Albans, when a driver of a Rolls Royce crashed into the rear of a lorry in the dark on an October afternoon. With a natural Adrenalin trigger to help in an emergency and First Aid training when in a Scout Group in Edinburgh, to stop and assist, comfort the car driver, shout for an ambulance when others appeared. An ambulance arrived promptly (before the era of Mobile Phones), Paramedics took over with hospital transfer. This frightening event has left a vivid memory flashback scar along with near fatal Hypoglycaemia with Neuroglycopenia scars. The Police called 3 days later and requested a witness statement. There was no hesitation to be able to help. When asked about the car driver welfare the answer was that he had suffered severe neurological injury and sadly died. What followed was a correct Fatal Accident Inquiry before a Coroner identifying Accidental Death. With courage the wife and family spoke after to thank me for doing my best to help save the driver, but sadly he had passed. We hope and pray he rests in peace. This tragic experience has left a strong sense of courage and determination in the belief that prevention is better than cure. When, and if tragedy occurs, what might have been the cause always helps in learning and education and often offers future opportunity to enable prevention. We can learn from tragedy and take steps to forensically identify cause and seek to prevent recurrence. The experience of near fatal Diabetes Hypoglycaemia and Neuroglycopenia caused by ignorance and failure to educate a family what to do in a diabetes hypoglycaemia emergency involving the Hormone Insulin with NHS GP mismanagement and Gross Negligence in Public Office cover up, when combined with an Addisonian Adrenalin Crisis, both with Neuroglycopenia and Simultaneous, has led to 30 years forensic research of the event cause with identified errors in Law justifying disclosure and loss recovery from those responsible for legal errors. Today with global interest and helpful personal clinical support from an excellent Diabetes Endocrinology Team of Clinicians and Nurses in Edinburgh and recognition with interest from many clinicians and nurses worldwide of the importance of this work has enhanced personal positivity to succeed and Win in Insulin Chicanes when at the same time treating an incurable long term health condition requiring daily injections of the hormone Insulin platformed with dose adjustment to target normoglycaemia and accommodate lifestyle while addressing insulin dose and type; exercise; diet; differences in carbohydrate and fat content in foods; interest in Keto style diet; fruit; vegetables; food sugar content; adverse stress: happiness; family and friendship encouragement and support; education of damage of excess alcohol; smoking; recreational drugs; and the link to the medical mystery. Summary review of Virological attack associated with Obesity, Overeating, Alcohol, risk of Foetal Alcohol Spectrum Disorder, Smoking, triggers for Parkinson’s Disease, Dyslexia, certain Ophthalmic conditions with possible links e.g., Nystagmus linked to Dyslexic, Genetically Inherited Addison’s Disease possibly from India after discovery by Thomas Addison in 1860 and add the Insulin Journey from discovery Banting, Best, Macleod, Collip, 1922, and the World’s First Hypoglycaemia Event with Neuroglycopenia experienced as a Clinical Event by Dr Jim Gilchrist and in L:aw recognised as Such by Banting, Best, Macleod, Collip, and Toronto Police, Canada at the time. Yes, Insulin can be used as a Poison, but it is a lifesaving Hormone for which today in 2024 all T1D Diabetes patients are exceedingly grateful for the research of over 100 years ago. One must never describe in Law Insulin as a Poison without good cause and reason. Insulin is a Hormone. This is important especially in tragic cases in pregnancy when Gestational Diabetes can occur leading to neonate and young baby infection and on occasion fatality. In 2023 I have experienced Blue Toe Syndrome associated with negative test Long COVID caused by vascular disturbance at toe extremity and Quinsi, very rare in long term Diabetes, sometimes in Tonsilitis during teenage and early adult life, but likely identified as Virological infection caused by Long COVID. Was prevention of Hypoglycaemia Unawareness in 1987–1994 possible? How do we discover? We need to research. We need social recognition and understanding in 2024 as we use this experience to better understand Clinical Hypoglycaemia and Neuroglycopenia in Law. 2023 published awareness of Hypoglycaemia, IDF INTERNATIONAL DIABETES FEDERATION with Immunogenic Issues in Diabetes and Addison’s Disease, has identified implications for COVID-19 Public Health Inquiry Investigation in Scotland. Forensic Aspects of Hypoglycaemia 4, now explores CPS Crown Prosecution Service and Court Reference Redacted in St Albans, Hertfordshire, England, to Correct Errors in Law identified from 1989 when a Law Society registered solicitor in Knutsford, Cheshire, who on the balance of probability, was aware that the Law Society in England at the time had allocated £500,000 in Public Funds to assess whether a case existed to identify Marketing and Safety adverse experience of Hypoglycaemia Unawareness? Investigation led to instances of personal injury and cases of unexplained death in bed syndrome to address a claim for damage experience against the Pharmaceutical Industry. A licence to market BHI Insulin on 26 August 1982 was given after close forensic safety consideration by application to the MHRA at the Department of Health, London. The Licence was granted with provisions that prescribing GP General Practitioner doctors reduced the Insulin dose by up to 20% when prescribed to T1D diabetes patients treated with Porcine or Beef Insulin, prescribed BG Blood Glucose monitoring medical devices to the patient, and provide clear education to the Patient and family members living with the Diabetes Patient, providing care for the patient, and knowing exactly what to do in a Diabetes Hypoglycaemia Emergency, and by default an Endocrine Red Alert Adrenalin Addisonian Crisis. On all counts the GP Practice in St Albans and Bricket Wood, Hertfordshire, failed miserably. When consulted in 1989 by the patient’s wife and sister-in-law the Knutsford solicitor firm failed to disclose known Law Society Investigation update involving Hypoglycaemia and education to the solicitor clients, the patient’s Wife and Sister-in-Law, and instead sent a libelous letter to the patient in 1989 with redisclosure in 1994. Character defamation of the patient in 1989 and 1994 is forensically identified in 2024 as clinical behavioural temporary mental health when in a state of hypoglycaemia unawareness and can be demonstrated in the animal rat model showing inferior quality Purkinje Cell Environmental Enrichment with insulin overdose or underdose leading to hyperglycaemia which when under corrected can lead to diagnose of T2D Type 2 Diabetes often associated with diet, lack of exercise, poor keto diet experience, alcohol abuse leading to obesity. In 2000, a request to the Court for medical notes disclosure was described as a ‘Fishing Trip’. Again in 2005 an Insurance Broker completely ignorant of Diabetes and Hypoglycaemia misled the court. Disclosure December 2020 by a Transaction Director, London, of the Firm EY, is identified as failure to identify and seek NHS help to address likely Genetically Inherited Addison’s Disease in an NHS patient, first suspected in 1994 when the GP Practice failed to act, then in March 1996 when the Official Solicitor was invited to investigate with referral failure. 2024 Forensic Analysis has identified opportunities to act and correct errors in law, nothing was done, why? In 2024 we investigate the cause of Suicide on 11 October 2020 in Alban Manor Nursing Home, St Albans, during COVID-19 Pandemic of Addison’s Disease Patient. Despite aged 79 her life could have been saved but alleged negligence in breach of the Mental Health Act 1983 caused the death with failure to take into account warnings from the Banting Lecture 1994 Hypoglycaemia, Real or Unreal, Lawful or Unlawful with Addison’s Disease Suicide. Under European Human Rights Law, The Human Rights Act 1998, and European Convention on Human Rights, a Public Immunity Argument exists to publish to learn from experience to prevent reoccurrence with implications to assist COVID-19 Public Health Inquiry Investigation.

Abstract Background: Secondary CNS involvement (SCNS) is a detrimental complication seen in ~5% of patients with diffuse large B-cell lymphoma (DLBCL) treated with modern immunochemotherapy. Data from older series report short survival following SCNS, typically <6 months. However, data in patients that develop SCNS following primary therapy that contains a rituximab-based-regimen as well as the impact of more intensified treatment for SCNS are limited. Aims: The aims of this study were to i) describe the natural history of SCNS in a large cohort of patients treated with immunochemotherapy, and ii) determine prognostic factors after SCNS. Patients and methods: We performed a retrospective study of patients diagnosed with SCNS during or after frontline immunochemotherapy (R-CHOP or equivalently effective regimens). SCNS was defined as new involvement of the CNS (parenchymal, leptomeningeal, and/or eye) in patients without known CNS involvement at the time of first pathologic diagnosis of DLBCL. Patients were identified from local databases and/or regional/national registries in Denmark, Canada (British Columbia), Australia, Israel, US (University of Iowa/Mayo Clinic SPORE), and England (Guy's and St. Thomas' Hospital, London). Clinico-pathologic and treatment characteristics at the time of SCNS were collected from medical records. Results: In total, 281 patients with SCNS diagnosed between 2001 and 2016 were included. Median age at SCNS was 64 (range 20-93) years and male:female ratio was 1.3. SCNS occurred as part of first relapse in 244 (87%) patients and 112 (40%) had documented concurrent systemic disease at the time of SCNS. The median time from initial DLBCL diagnosis to SCNS was 9 months, which was similar for patients treated with (N=76, 27%) or without upfront CNS prophylaxis (N=205, 73%) (10 vs 9 Mo; P=0.3). The median post-SCNS OS was 4 months (interquartile range 2-13) and the 2yr survival rate was 20% (95% CI 15-25) for the entire cohort. Associations between clinicopathologic features, management strategy, and post-SCNS survival are shown in Table 1, which excludes patients who did not receive any treatment against SCNS, patients treated with steroids alone, and a patient with unavailable treatment information (n=43, 15%). In multivariable analysis, performance status >1, concurrent leptomeningeal and parenchymal involvement, SCNS developing before completion of 1st line treatment, and combined systemic and CNS involvement by DLBCL were associated with inferior outcomes. Upfront CNS prophylaxis did not influence post-SCNS OS. High-dose methotrexate (HDMTX) and/or platinum based treatment regimens (i.e. ICE, DHAP, or GDP [+/- IT treatment and/or radiotherapy], N=163) for SCNS were associated with reduced risk of death (HR 0.45 [0.32-0.62, P<0.01]). The 2yr post-SCNS survival for patients treated with HDMTX and/or platinum-based regimens (N=163) was 29% (95% CI 22-37). For patients with isolated parenchymal SCNS, single modality treatment with radiotherapy resulted in 2-yr OS of 19% (95% CI 8-35). For the subgroup of 49 patients treated with HDMTX- and/or platinum-based regimens for isolated SCNS after 1st line DLBCL treatment and with performance status 0 or 1, the 2yr post-SCNS survival was 46% (95% CI 31-59). Overall, 9% of the patients received HDT with ASCT as part of salvage therapy at the time of SCNS. Amongst 36 SCNS patients without systemic involvement and in CR following intensive treatment (HDMTX and/or platinum-based treatments), 11 patients consolidated with HDT had similar outcomes to 25 patients treated without consolidating HDT (P=0.9, Fig 1) Conclusions: Outcomes for patients with SCNS remain poor in this large international cohort of patients from the immunochemotherapy era. Combined parenchymal and leptomeningeal disease, presence of systemic disease concurrent with SCNS, performance status >1, and SCNS developing during first line treatment were independently associated with inferior OS. However, a significant fraction of patients with isolated SCNS after first line DLBCL treatment and with good performance status may achieve long-term remissions after intensive regimens for SCNS. Disclosures El-Galaly: Roche: Consultancy, Other: travel funding. Cheah:Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees; Gilead Sciences: Membership on an entity's Board of Directors or advisory committees; Janssen-Cilag: Membership on an entity's Board of Directors or advisory committees, Other: Speaker's Bureau. Kansara:Celgene: Honoraria. Connors:Bristol Myers Squib: Research Funding; NanoString Technologies: Research Funding; F Hoffmann-La Roche: Research Funding; Millennium Takeda: Research Funding; Seattle Genetics: Research Funding. Sehn:roche/genentech: Consultancy, Honoraria; amgen: Consultancy, Honoraria; seattle genetics: Consultancy, Honoraria; abbvie: Consultancy, Honoraria; TG therapeutics: Consultancy, Honoraria; celgene: Consultancy, Honoraria; lundbeck: Consultancy, Honoraria; janssen: Consultancy, Honoraria. Opat:Roche: Consultancy, Honoraria, Other: Provision of subsidised drugs, Research Funding. Seymour:Genentech: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; AbbVie Inc.: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Villa:Celgene: Honoraria; Lundbeck: Honoraria; Roche: Honoraria, Research Funding.

John Hughlings Jackson was born into a Dissenting family in Yorkshire, England, in 1835. During a medical apprenticeship, in 1852 he entered the York Medical School, where the faculty included Thomas Laycock. Jackson studied at St. Bartholomew’s Hospital, London, 1855–1856, and then he returned to York. In 1859 he moved permanently to London, where he lived with the family of fellow Yorkshireman Jonathan Hutchinson, until he married in 1865. In 1860 Jackson acquired his M.D. by examination at the University of St. Andrews, Scotland. Also in 1860 he was persuaded to specialize in neurology by Charles-Edouard Brown-Séquard, who helped Jackson obtain his first appointment at the National Hospital, Queen Square, in 1862. In 1863 Jackson was appointed Assistant Physician to the London Hospital.