Prolonged benefit in post-polio syndrome from comprehensive rehabilitation: a pilot study.

PURPOSE: To report physical, psychological and functional outcomes from a pilot study of a multi-disciplinary rehabilitation programme for post-polio syndrome (PPS). METHOD: Twenty-seven participants completed the nine-day programme and were available for re-assessment at three and six months. Physical outcome measures were muscle strength and endurance; psychological outcomes included illness perceptions (IPQ), depression and anxiety (HADS); functional outcomes were fatigue (HFS) and client-centred occupational performance and satisfaction (COPM). RESULTS: There was no significant change at six months for muscle strength or anxiety. Significant improvements were recorded for exercise endurance, depression and levels of fatigue. A shift towards an endorsement that the patient's own behaviour could be important in symptom severity of PPS was seen. Five out of 24 participants demonstrated significant clinical changes in occupational performance and satisfaction on the COPM. CONCLUSIONS: Prolonged benefits were found for physical, psychological and functional outcomes. A qualitative study is planned to investigate the patient-reported benefits of attending the programme such as the support gained interacting with others with similar disability and in lifestyle adjustment such as pacing of physical activities.

A prospective observational study of on-treatment plasma homocysteine levels as a biomarker of toxicity, depression and vitamin supplementation lead-in time pre pemetrexed, in patients with non-small cell lung cancer and malignant mesothelioma.

OBJECTIVES: Vitamin supplementation reduces pemetrexed toxicity. Raised plasma homocysteine reflects deficiency in vitamin B12 and folate, and is suppressed by supplementation. This observational study of 112 patients receiving pemetrexed-based chemotherapy assessed homocysteine levels after 3 weeks of vitamin supplementation, hypothesising high levels would correlate with ongoing deficiency, thus increased toxicity. MATERIAL AND METHODS: Primary endpoint was the composite of proportion of patients with treatment delay/ dose reduction/ drug change or hospitalisation during the first six weeks of chemotherapy, comparing those with normal plasma homocysteine (successfully supplemented, SS) and those with high homocysteine (unsuccessfully supplemented, USS). Secondary endpoints included toxicity and analyses for depression. Post-hoc analysis examined correlation between interval of vitamin and folate supplementation and pemetrexed on primary endpoint and grade 3-4 toxicities. RESULTS: Eighty-four patients (84%) were successfully supplemented (SS group). The proportion of patients undergoing a treatment delay/ dose reduction/ drug change or hospitalisation in SS group was 44.0% (95% confidence interval [CI] 33.2%-55.3%) and in USS group was 18.8% (95% CI 4.0%-45.6%) (p = 0.09). Twelve percent of patients gave a past history of depression however 66% of patients had an on study Hospital Anxiety and Depression (HAD) score of >7. Supplementation status was not associated with depression. The median overall survival (OS) was 11.8 months (95% CI 8.6-16.5) in the SS group and 8.8 months (95% CI 6.6-16.2) in the US group (p = 0.5). The number of days (<7 or ≥ 7 days) between vitamin B12 and folate initiation and pemetrexed administration, had no effect on the primary endpoint and grade 3-4 toxicities. CONCLUSION: On-treatment homocysteine levels were not a biomarker of toxicity or depression. Standard vitamin supplementation is adequate in the majority of patients receiving pemetrexed. High HAD score were noted in this population giving an opportunity for mental health intervention. The lead-in time for vitamin supplementation can be short.

Quality of psychiatric care in the general hospital: referrer perceptions of an inpatient liaison psychiatry service.

AIMS: To explore the experience of senior staff on acute medical wards using an established inpatient liaison psychiatry service and obtain their views on clinically relevant performance measures. METHODS: Semistructured face-to-face interviews with consultants and senior nurses were taped, transcribed and analyzed manually using the framework method of analysis. RESULTS: Twenty-five referrers were interviewed. Four key themes were identified - benefits of the liaison service, potential areas of improvement, indices of service performance such as speed and quality of response and expanded substance misuse service. Respondents felt the liaison service benefited patients, staff and service delivery in the general hospital. Medical consultants wanted stepped management plans devised by consultant liaison psychiatrists. Senior nurses, who perceived themselves as frontline crisis managers, valued on-the-spot input on patient management. CONCLUSIONS: Consultants and senior nurses differed in their expectations of liaison psychiatry. Referrers valued speed of response and regarded time from referral to definitive management plan as a key performance indicator for benchmarking services.

HIV, thrombotic thrombocytopaenic purpura and rituximab in a violent noncompliant patient.

HIV is an increasingly common cause of thrombotic thrombocytopaenic purpura in the United Kingdom. We report a patient with both conditions who presented major therapeutic and ethical challenges. Furthermore, he was recalcitrant to all established therapies, and was, therefore, the first reported HIV patient with thrombotic thrombocytopaenic purpura to receive rituximab.

An audit of pregnant women with severe mental illness referred during the first 2 years of a new perinatal mental health service.

The importance of identifying pregnant women at high risk of postpartum psychotic illness has been highlighted by recent enquiries and guidelines. It has been recommended that these women are referred to perinatal mental health services, and that individualised care plans are made prior to delivery. This audit describes a cohort of 45 women, referred to a new perinatal mental health service, with a history of psychotic illness or at risk of developing a postpartum psychotic episode. It describes the characteristics of this group, and the outcomes in terms of relapse and whether their children remained in their care. Thirty-nine women (87%) were seen for assessment. Sixty-seven per cent were under the care of a community mental health team. Twenty-one (53.8%) were well at the time of referral. Planned pregnancies were uncommon (15%). All women seen antenatally had care plans written to address the high risk of postpartum relapse. Ten (26%) women had psychiatric admissions during pregnancy. Fifteen (38%) relapsed or had admissions during the first postpartum year. At 1 year postpartum, 74% women had care of their children; 18% children had been adopted or were in foster care; and the outcome was unknown for 8%.