Orsett Hospital

IntroductionData on the Medicare-aged population show that older patients are major consumers of low back pain (LBP) interventions. An effective approach for patients with mechanical LBP that has been refractory to conservative management is restorative neurostimulation. The efficacy of restorative neurostimulation has been demonstrated in multiple prospective studies, with published follow-up over 4 years, showing a consistent durable effect.MethodsTo further examine the effect of restorative neurostimulation in an older demographic, data from three clinical studies were aggregated: ReActiv8-B prospectively followed 204 patients, ReActiv8-C study prospectively followed 87 patients and ReActiv8-PMCF prospectively followed 42 patients.Two hundred and sixty-one patients were identified with complete 2-year follow-up and divided into cohorts of equal size based of age quartiles.At 2 years from device activation, patients in either cohort were classified by change in disability (Oswestry Disability Index (ODI)) or change in pain score(NRS/VAS) and assessed as proportion of patients per group at each time point. Additionally, health-related quality of life (HRQoL) (EQ5D-5L) was longitudinally compared with baseline. Differences in proportions were assessed using χ2 and continuous variables by repeated measures analysis of variance.ResultsThe oldest quartile (n=65) had a median age of 60 (56–82) years compared with the entire population (n=261) who had a median age of 49 (22–82) years. The completer analysis on patients with 2 years of continuous data showed improvement of a 50% in pain was achieved by 62% and 65% and a 15-point ODI improvement in 48% and 60% in the oldest quartile and entire population, respectively. HRQoL (EuroQol 5-Dimension) improved from baselines of 0.568 and 0.544 to 0.763 and 0.769 in the oldest quartile and entire population respectively. All age quartiles improved statistically and clinically over baseline.ConclusionsThis aggregate analysis of three independent studies provides insight into the performance of restorative neurostimulation in an older population. Patients derived significant and clinically meaningful benefit in disability, pain and HRQoL. When compared with a similarly indicated cohort of younger patients, there were no statistically or clinically significant differences.

The advances in knowledge in the field of pain medicine in the last half century have recently been reported from both the scientific and the social points of view [...].

To assess the effects of a multi-modal resilience program, the Stress Management and Resiliency Training (SMART) Program, on healthcare professional well-being and job satisfaction. This pilot, mixed-methods, quality improvement, cohort study assessed perceived stress, physical and mental health, job satisfaction, burnout, and value of the curriculum to attendees. Participants experienced a significant reduction in perceived stress (P < 0.001) and significant improvements in global mental health (P = 0.001), physical health (P = 0.045), and job satisfaction (P = 0.047). There was no significant improvement in burnout. Qualitative analysis of free text responses revealed appreciation for the skills taught, increased resiliency, and a positive impact on relationships. Delivering the SMART Program to healthcare professionals is feasible and may serve as a useful tool for reducing stress and increasing resilience.

Giuliano Lo Bianco, 1&amp;amp;ndash;3 Simon Thomson, 3 Simone Vigneri, 4 Hannah Shapiro, 5 Michael E Schatman 6, 7 1Universit&amp;amp;agrave; di Catania, Dipartimento di Scienze Biomediche e Biotecnologiche (BIOMETEC), Catania, Italy; 2I.R.C.C.S. CROB Centro di Riferimento Oncologico Basilicata, Rionero in Vulture, Potenza, Italy; 3Basildon and Thurrock University Hospitals NHSFT, Orsett Hospital, Pain Management and Neuromodulation, London, Essex, UK; 4Pain Medicine Department, Santa Maria Maddalena Hospital, Occhiobello, Rovigo, Italy; 5Department of Biopsychology, Tufts University, Medford, MA, USA; 6Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; 7Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USACorrespondence: Michael E Schatman Tel +1425647-4880Email Michael.Schatman@tufts.edu\nAbdominal pain is a nonspecific symptom which can be caused by myriad pathologies,&amp;amp;nbsp;resulting in frequent misdiagnosis. 1 Some pathological conditions can cause&amp;amp;nbsp;paroxysmal gastrointestinal symptoms, such as&amp;amp;nbsp; porphyria, cyclical vomiting, intestinal&amp;amp;nbsp;malrotation, peritoneal bands, and abdominal migraine. 2 Furthermore, emotional&amp;amp;nbsp;and psychological factors may also play an important role in the presentation&amp;amp;nbsp;of certain patients with gastrointestinal disorders, and accurate diagnosis can be&amp;amp;nbsp;confounded by these. An accurate diagnosis may be delayed or even abandoned due&amp;amp;nbsp;to the attribution of &amp;amp;ldquo;functional&amp;amp;rdquo; or &amp;amp;ldquo;psychogenic&amp;amp;rdquo;&amp;amp;nbsp; causality. 3 Physicians in numerous&amp;amp;nbsp;fields of practice too often respond in such a fashion when the more common&amp;amp;nbsp;causes of pain conditions are ruled out, 4 which potentially puts patients with rare&amp;amp;nbsp;pain disorders that are challenging to diagnose at considerable risk for needless,&amp;amp;nbsp;prolonged suffering. Further, the stigma associated with being diagnosed with&amp;amp;nbsp;a Somatoform Disorder or a Medically Unexplained Symptom (MUS) should not&amp;amp;nbsp;be understated. 5

EID use and normal 7-day PFIs first emerged in the 50-100 g pill era! Indeed, in the Mayo Clinic-based collected series, 7 16/25 women who, despite allegedly good pill-taking, conceived on enzyme-inducers were taking 50 g pills; and the remaining nine were taking 100 g pills (with mestranol)!

Kumar, Manoj M.S., M.Ch.(Plast.Surg.), F.R.C.S.; Rao, G. S. M.S., F.R.C.S.(Plast.) Edin. Author Information

We report the incidental finding at surgery for retroperitoneal fibrosis of a carcinoid tumour causing complete right ureteric obstruction. Retroperitoneal fibrosis is an uncommon inflammatory disease that leads to extensive fibrosis throughout the retroperitoneum. It can occur at any age, peak incidence being in patients between 40 and 60 years of age. Carcinoid tumours arise from enterochromaffin or amine precursor uptake and decarboxylation cells that occur in gastrointestinal tract. Carcinoid tumours are an uncommon clinical entity and incidence varies with gender and age. No association between retroperitoneal fibrosis and carcinoid tumour has been previously reported in the English literature, although one case has been reported in a French journal.

Academic unemployment: a personal view Get access C S Rogers, BSc, MSc, PhD, MIBiol C S Rogers, BSc, MSc, PhD, MIBiol 162A Heath Road, Orsett Heath, Grays, Essex, RM16 3AL,UK The author traces his academic progress to un-employment with observations on the academic, industrial and governmental systems which to some extent have made his problem for him.1969–1971, Insect pest infestation Officer, Ministry of Agriculture. 1971–76, Technician and subsequently Senior Technician in charge of Research and Teaching Laboratories, North East London Polytechnic. 1976–79, Research Assistant at same. Graduated BSc General Honours (Internal London), Northern Polytechnic, 1965. MSc (CNAA) at NELP, 1975; project on the CNS actions of Disulphuram, Pyrazole, Antipyrene, and Ethanol. His PhD (CNAA) was for research on the gastrointestinal absorption of enkephalin fragments in the rat, a project done also at NELP. Search for other works by this author on: Oxford Academic Google Scholar Science and Public Policy, Volume 8, Issue 6, December 1981, Pages 458–464, https://doi.org/10.1093/spp/8.6.458 Published: 01 December 1981