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 & Randomized controlled trial. 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.

BTS guidelines for home oxygen in children

Abstract: > “… as we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns – the ones we don’t know we don’t know.” D Rumsfeld, 2002 ### 1.1 Aims and target audience The aims of these guidelines are to present the evidence base for the practice of administering supplemental oxygen to children outside hospital and to make recommendations for best practice. For many aspects high-quality evidence is lacking, and suggestions are made based on clinical experience. It is hoped the guideline will highlight areas where research is needed to further inform clinicians. The target audience is clinicians who prescribe home oxygen for children, principally those in hospital practice. It is also intended for other professionals involved with the whole process, which may include community paediatricians, paediatric neurodisability specialists, nurse specialists, school nurses, occupational therapists and physiotherapists; this is reflected by the multidisciplinary nature of the guideline committee (section 13). ### 1.2 Methodology for generation of the guidelines The initial literature search was carried out by the Centre for Reviews and Dissemination at the University of York. Further searches were then carried out by members of the working group who concentrated on their own topics. Details of the search strategy are given in Appendix 1 available online. Each section of the guideline was researched and drafted by a subgroup of the Paediatric Section of the British Thoracic Society (BTS) Home Oxygen Guideline Development Group (itself a subcommittee of the BTS Standards of Care Committee). Publications were rated according to the SIGN 50 criteria for the calibre of the methodology of the research to give levels of evidence (see box 1). Once all parts were merged into one document, the whole group then met to discuss the first …

Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): a randomised controlled trial

Abstract: Summary Background Hot flushes and night sweats (HFNS) affect 65–85% of women after breast cancer treatment; they are distressing, causing sleep problems and decreased quality of life. Hormone replacement therapy is often either undesirable or contraindicated. Safe, effective non-hormonal treatments are needed. We investigated whether cognitive behavioural therapy (CBT) can help breast cancer survivors to effectively manage HFNS. Methods In this randomised controlled trial, we recruited women from breast clinics in London, UK, who had problematic HFNS (minimum ten problematic episodes a week) after breast-cancer treatment. Participants were randomly allocated to receive either usual care or usual care plus group CBT (1:1). Randomisation was done in blocks of 12–20 participants, stratifying by age (younger than 50 years, 50 years or older), and was done with a computer-generated sequence. The trial statistician and researchers collecting outcome measures were masked to group allocation. Group CBT comprised one 90 min session a week for 6 weeks, and included psycho-education, paced breathing, and cognitive and behavioural strategies to manage HFNS. Assessments were done at baseline, 9 weeks, and 26 weeks after randomisation. The primary outcome was the adjusted mean difference in HFNS problem rating (1–10) between CBT and usual care groups at 9 weeks after randomisation. Analysis of the primary endpoint was done by modified intention to treat. The trial is registered, ISRCTN13771934, and was closed March 15, 2011. Findings Between May 5, 2009, and Aug 27, 2010, 96 women were randomly allocated to group CBT (n=47) or usual care (n=49). Group CBT significantly reduced HFNS problem rating at 9 weeks after randomisation compared with usual care (mean difference −1·67, 95% CI −2·43 to −0·91; p Interpretation Group CBT seems to be a safe and effective treatment for women who have problematic HFNS after breast cancer treatment with additional benefits to mood, sleep, and quality of life. The treatment could be incorporated into breast cancer survivorship programmes and delivered by trained breast cancer nurses. Funding Cancer Research UK.

Inter-study reproducibility of cardiovascular magnetic resonance myocardial feature tracking

Abstract: Background: Cardiovascular magnetic resonance myocardial feature tracking (CMR-FT) is a recently described method of post processing routine cine acquisitions which aims to provide quantitative measurements of circumferentially and radially directed ventricular wall strain. Inter-study reproducibility is important for serial assessments however has not been defined for CMR-FT. Methods: 16 healthy volunteers were imaged 3 times within a single day. The first examination was performed at 0900 after fasting and was immediately followed by the second. The third, non-fasting scan, was performed at 1400. CMR-FT measures of segmental and global strain parameters were calculated. Left ventricular (LV) circumferential and radial strain were determined in the short axis orientation (EccSAX and ErrSAX respectively). LV and right ventricular longitudinal strain and LV radial strain were determined from the 4-chamber orientation (EllLV, EllRV, and ErrLAX respectively). LV volumes and function were also analysed. Inter-study reproducibility and study sample sizes required to demonstrate 5% changes in absolute strain were determined by comparison of the first and second exams. The third exam was used to determine whether diurnal variation affected reproducibility. Results: CMR-FT strain analysis inter-study reproducibility was variable. Global strain assessment was more reproducible than segmental analysis. Overall EccSAX was the most reproducible measure of strain: coefficient of variation (CV) 38% and 20.3% and intraclass correlation coefficient (ICC) 0.68 (0.55-0.78) and 0.7 (0.32-0.89) for segmental and global analysis respectively. The least reproducible segmental measure was EllRV: CV 60% and ICC 0.56 (0.41-0.69) whilst the least reproducible global measure was ErrLAX: CV 33.3% and ICC 0.44 (0–0.77). Variable reproducibility was also reflected in the calculated sample sizes, which ranged from 11 (global EccSAX) to 156 subjects (segmental EllRV). The reproducibility of LV volumes and function was excellent. There was no diurnal variation in global strain or LV volumetric measurements. Conclusions: Inter-study reproducibility of CMR-FT varied between different parameters, as summarized above and was better for global rather than segmental analysis. It was not measurably affected by diurnal variation. CMR-FT may have potential for quantitative wall motion analysis with applications in patient management and clinical trials. However, inter-study reproducibility was relatively poor for segmental and long axis analyses of strain, which have yet to be validated, and may benefit from further development.

TLRs to cytokines: Mechanistic insights from the imiquimod mouse model of psoriasis

Abstract: Psoriasis is an inflammatory disease of the skin affecting 2-3% of the population, characterized by a thickening of the epidermis and immune infiltrates throughout the dermis and epidermis, causing skin lesions that can seriously affect quality of life. The study of psoriasis has historically been hampered by the lack of good animal models. Various genetically induced models exist, which have provided some information about possible mechanisms of disease, but these models rely mostly on intrinsic imbalances of homeostasis. However, a mouse model of psoriasiform dermatitis caused by the repeated topical application of Aldara™ containing 5% imiquimod was described in 2009. The mechanisms of action of Aldara™ are complex. Imiquimod is an effective ligand for TLR7 (and TLR8 in humans) and also interferes with adenosine receptor signaling. In addition, isostearic acid present in the Aldara™ vehicle has been shown to be biologically active and of importance for activating the inflammasome. Interestingly, the repetitive application of Aldara™ reveals a complex aetiology involving multiple cell types, cytokines, and inflammatory pathways. In this review, we will dissect the findings of the imiquimod model to date and ask how this model can inform us about the immunological aspects of human disease.