Guy's and St Thomas' NHS Foundation Trust

About: Guy's and St Thomas' NHS Foundation Trust is a healthcare organization based out in London, United Kingdom. It is known for research contribution in the topics: Population & Medicine. The organization has 7686 authors who have published 9631 publications receiving 399353 citations. The organization is also known as: Guy's and St Thomas' National Health Service Foundation Trust & Guy's and St Thomas' National Health Service Trust.

A Comprehensive Examination of Changes in Psychological Flexibility Following Acceptance and Commitment Therapy for Chronic Pain.

Abstract: Acceptance and commitment therapy (ACT) for chronic pain aims to improve patient functioning by fostering greater psychological flexibility. While promising, ACT treatment process research in the context of chronic pain so far has only focused on a few of the processes of psychological flexibility. Therefore, this study aimed to more comprehensively examine changes in processes of psychological flexibility following an ACT-based treatment for chronic pain, and to examine change in these processes in relation to improvements in patient functioning. Individuals with chronic pain attending an interdisciplinary ACT-based rehabilitation program completed measures of pain, functioning, depression, pain acceptance, cognitive fusion, decentering, and committed action at pre- and post-treatment and during a nine-month follow-up. Significant improvements were observed from pre- to post-treatment and pre-treatment to follow-up on each of the treatment outcome and process variables. Regression analyses indicated that change in psychological flexibility processes cumulatively explained 6–27 % of the variance in changes in functioning and depression over both assessment periods, even after controlling for changes in pain intensity. Further research is needed to maximize the effectiveness of ACT for chronic pain, and to determine whether larger improvements in the processes of psychological flexibility under study will produce better patient outcomes, as predicted by the psychological flexibility model.

Autonomic status epilepticus in panayiotopoulos syndrome and other childhood and adult epilepsies: A consensus view

Abstract: Summary: Purpose: To discuss and propose a definition of autonomic status epilepticus (SE), describe its clinical and EEG features, and review what is known about its epidemiology, pathophysiology, differential diagnosis, and management. Methods: An international consortium of established researchers in the field was identified from their published work, agreed the purpose of the project, searched the literature, and, by use of e-mail communication, agreed the consensus document. Results: Autonomic SE is a condition lasting at least 30 min and characterized by epileptic activity causing altered autonomic function of any type at seizure onset or in which manifestations consistent with altered autonomic function are prominent (quantitatively dominant or clinically important) even if not present at seizure onset. It is best described, and probably most commonly encountered in children, with Panayiotopoulos syndrome. However, it also occurs in children with symptomatic epilepsies and, exceptionally, in adults. Its pathogenesis and most appropriate management are poorly understood Conclusions: It is hoped that this document will help clinical recognition of Autonomic SE, reduce misdiagnosis, and promote further interest and studies into what has been a relatively neglected area. Key Words: Epileptic seizures— Epilepsy—Status epilepticus—Autonomic nervous system— Consensus statement.

The impact and prognosis for dystonia in childhood including dystonic cerebral palsy: a clinical and demographic tertiary cohort study

Abstract: Introduction and methods The impact of dystonia in childhood is poorly understood We report our experience of referrals between 2005 and 2012 Results Of 294/315 assessable children, 15/294 had pure spasticity, leaving 279/294 with dystonia classified as primary (30/279: 107%); primary-plus (19/279: 68%) and secondary (230/279: 824%) dystonia, including heredodegenerative dystonia (29/279: 103%); 150/279 (537%) with cerebral palsy and 51/279 (182%) acquired brain injury Definitive diagnoses were available in 222/294 (796%), but lower in primary/primary-plus compared with secondary groups (11/49 vs 211/230: Fisher9s exact test p Median age (interquartile years) at referral was 975 (658–13), not significantly differing by aetiology (Kruskal–Wallis test p>005); dystonia-onset age was 3 (05–70) for primary/primary-plus and 025 (008–08) in the secondary/CP groups Dystonia duration at referral was 475 years (30–1033) for primary/primary-plus groups and 783 (54–11) in the secondary group The mean (interquartile range) proportion of life lived with dystonia, derived as dystonia duration normalised to age was 068 (031–096); 059 (035–08); 075 (062–095)and 09 (092–099) for primary, primary-plus, heredodegenerative and secondary-static dystonias respectively Only 91/279 (326%) experienced a period of normal motor development Carers perceived dystonia deterioration in 168/279 (602%), stabilisation in 88/279 (315%) and improvement in 23/279 (82%) Dystonia occurred in 26/225 (116%) siblings: 14/26 secondary and 5/26 heredodegenerative dystonia Comorbidities were identified in 176/279 (631%) cases Gross Motor Function Classification System (GMFCS) levels I–III were commoner in primary/primary-plus (37/49: 75%) compared with secondary/CP (29/230: 13%) cases, χ 2 p Discussion In this selective cohort, childhood dystonia is severe, presenting early before worsening without remission Secondary dystonias spend a higher proportion of life living with dystonia and lower functional capacity Despite referral bias, services offering neurosurgical interventions and health service planning agencies should understand the context and predicament of life with childhood dystonia