St Thomas' Hospital

About: St Thomas' Hospital is a healthcare organization based out in London, United Kingdom. It is known for research contribution in the topics: Population & Pregnancy. The organization has 12105 authors who have published 15596 publications receiving 624309 citations. The organization is also known as: St Thomas's Hospital & St. Thomas's.

Fear of falling limiting activity in young-old women is associated with reduced functional mobility rather than psychological factors

Abstract: Background: many older people experience fear of falling. This is sometimes associated with activity limitation, with potential adverse health implications. The explanatory contributions of physical and psychosocial factors to this syndrome are unclear. Objectives: to examine the associations between fear of falling limiting activity (FoF-LA) among young-old women with (i) functional capacity and (ii) psychological factors. Subjects and methods: FoF-LA, functional difficulty and dependency, psychological factors, previous falls, visual and hearing handicap, memory, pain, and habitual physical activity were assessed using standard questionnaires in 713 communitydwelling London women, mean age 64.2 years. Results: 70 women (10.1%) reported FoF-LA, of whom 21 had fallen in the previous year. Women reporting FoF-LA had higher prevalence of adverse functional and clinical characteristics. Multiple logistic regression analyses showed that both mild (‘changes in the way walk half a mile’) and moderate (‘difficulty standing from armless chair’) reduction in functional capacity were independently associated with FoF-LA (odds ratios 4.02 (95% CI 1.5–10.7) and 5.07 (CI 2.0–13.0) respectively) after adjustment for age, falls and clinical factors. Psychological factors and perceived fair/poor health were bivariately but not independently associated with FoF-LA; after adjustment for them, mild and moderate reductions in functional capacity remained strongly associated with FoF-LA (OR 4.02 (CI 1.5–10.7) and 3.83 (CI 1.4–10.5) respectively), along with visual handicap and increased health service use. Conclusions: among young-old women, FoF-LA is related to early reduction of mobility function rather than psychological factors. It may identify individuals at risk of subsequent functional decline.

The delirium experience: what is the effect on patients, relatives and staff and what can be done to modify this?

Abstract: Background Delirium is a common clinical syndrome with significant associated mortality, morbidity and financial cost. Less is understood about the experience of delirium for the patient, their family and staff involved in their care. Objective This synthesis draws on qualitative and quantitative literature examining different populations (patients, relatives and staff) in different clinical settings (intensive care units, surgery and hospice care) to provide a clinical summary of the delirium experience from the perspective of patients, relatives and staff. Design A literature search was conducted in Ovid, MEDLINE, Embase, PsychINFO, British Nursing Index and Archive and PubMed between 1980 and 2011 using the terms ‘delirium’ combined with ‘distress’, ‘recall’, ‘anxiety’, ‘depression’, ‘PTSD’, ‘experience’ and ‘patient education’. Articles were restricted to English language only. Results Evidence suggests that some patients recall delirium and that recollections are generally distressing. Distress may be greater in relatives witnessing delirium and is also reported in professional staff. This distress may result in longer-term psychological sequelae. Remedial action, such as explanatory information to patients and their families, may reduce distress and psychological morbidity. Conclusions A better understanding of the experience and psychological consequences of delirium will inform the development of appropriate methods of providing support and information to those at risk of delirium and their families or carers. Copyright © 2012 John Wiley & Sons, Ltd.

αvβ6integrin promotes invasion of squamous carcinoma cells through up‐regulation of matrix metalloproteinase‐9

Abstract: The integrin alphav beta6 is a fibronectin receptor, which is not detectable on normal epithelium but is neo-expressed in oral epithelial dysplasia and oral squamous-cell carcinoma (SCC), suggesting a role in promoting malignant behaviour and tumour progression. We used transfection and retroviral infection to create a panel of SCC cell lines expressing various levels of alphav beta6 to examine this possibility. We found that increased expression of alphav beta6 in malignant keratinocytes upregulates MMP-9 and MMP-2 expression and promotes invasion in an MMP-9-dependent manner, Our results suggest a possible mechanism for the involvement of alphav beta6 in squamous carcinoma in vivo. (C) 2001 Wiley-Liss, Inc.

Long‐term efficacy and safety of cyclosporin in severe adult atopic dermatitis

Abstract: Summary A prospective, open, multicentre study was performed to investigate the efficacy and safety of longterm treatment with cyclosporin in adults with severe atopic dermatitis. Subjects were treated for a maximum of 48 weeks. For the first 8 weeks, cyclosporin was administered at 2.5 mg/kg per day. The dose was then adjusted according to response. Disease activity was monitored using the six-area. six-sign score and the proportion of skin involved. Pruritus and sleep disturbance were assessed using four-point scales. Response was further evaluated on a five-point scale. Adverse events. blood pressure and serum biochemistry were monitored. Tolerability was assessed on a five-point scale. One hundred subjects were enrolled and 65 completed 48 weeks of treatment. Withdrawals occurred due to remission (three), inadequate response (seven), protocol violations (11) and adverse events (14, of which seven were probably treatment related). Cyclosporin produced rapid and highly significant improvements in all indices of disease activity. Sixty-five subjects considered that they had shown a considerable improvement or complete clearance of disease. Most patients relapsed after cessation of treatment. but neither signs nor symptoms had returned to baseline severity 8 weeks later. Blood pressure and serum creatinine levels increased slightly. and in one subject renal impairment was a major factor contributing to withdrawal of the drug. Overall, 85 subjects rated the tolerability of cyclosporin as good or very good. The results indicate that cyclosporin has a place in the long-term treatment of severe atopic dermatitis provided that appropriate patients are selected and careful monitoring is performed.