Papers by James Littlewood
Drugs & Therapy Perspectives, 2001
schizophrenia,l15] Now, results of small noncomparative studies have identified a potential role ... more schizophrenia,l15] Now, results of small noncomparative studies have identified a potential role for quetiapine in psychosis complicating PD. Of particular interest is the apparent efficacy of quetiapine in those patients who have not responded to other atypical antipsychotics. Elderly patients are particularly susceptible to EPS. It is, therefore, important for management of psychotic symptoms in patients with PO that any agent used does not exacerbate the risk of EPS. For this reason typical antipsychotics are not a recommended therapeutic option. Study results to date suggest that quetiapine, like clozapine, is associated with minimal risk of EPS. Although no direct comparisons have been undertaken, olanzapine and risperidone are thought to have a higher potential for EPS than quetiapine,lI,3,16] Quetiapine has the advantage over clozapine that it does not require the need for inconvenient and expensive weekly blood monitoring of granulocyte levels.[1-3] If results to date are validated in larger more robust trials, quetiapine may ultimately usurp clozapine as the atypical antipsychotic of choice for the management of psychosis in patients with PD. Until such evaluation is undertaken, however, quetiapine can only be recommended as a useful treatment alternative for difficultto-treat patients with psychosis complicating PD. References I. Juncos JL. Management of psychotic aspects of ParkInson's disease.
Archives of Disease in Childhood, 1997
Cross sectional data reporting the height, weight, and body mass index of UK patients with cystic... more Cross sectional data reporting the height, weight, and body mass index of UK patients with cystic fibrosis are presented. During the first decade of life height and weight in patients with cystic fibrosis are maintained at about 0.5 SD below those of the general population, which reflects an improvement over earlier published observations. Postpubertal stature and weight maintenance in the cystic fibrosis population still show substantial deficits which may be related to treatment.
Paediatric Respiratory Reviews, 2003
Newborn screening tests have been available for cystic fibrosis (CF) for over three decades but f... more Newborn screening tests have been available for cystic fibrosis (CF) for over three decades but few national programmes exist, most being based at a regional or local level. Reasons for this include uncertainty over the longterm benefits of implementing newborn CF screening (NCFS) and the lack of a definitive test. 1 Evidence of long-term benefit is now stronger and developments in DNA analysis have meant that a screening test with sufficient sensitivity and specificity is available when this is combined with an initial measurement of immunoreactive trypsinogen (IRT) on a heel-prick blood sample. 2 Previous papers have discussed these issues at length. The aim of this paper is to review the current situation with respect to NCFS worldwide and to assess the successes and difficulties that these schemes have encountered. Finally, we will reflect on the lessons that can be learnt from these experiences and highlight any issues or questions that remain unresolved. INTERNATIONAL EXPERIENCE To the best of our knowledge, the following section reflects the current state of NCFS around the world. We would value any further information on local screening programmes or discrepancies compared with the information provided. Australia Australia has comprehensive screening coverage. In 1998, Bridget Wilcken from Sydney reported that over 90% of Australian newborns were being screened for CF. 3 Four regions-Victoria (Melbourne), South Australia (Adelaide), New South Wales (Sydney) and Queensland-established programmes in the 1980s, initially employing an IRT/IRT protocol (P. Cooper, personal communication, 2003; T. Stewart, personal communication, 2003). 4-6 Following the identification of the cystic fibrosis transmembrane conductance regulator (CFTR) gene in 1989, all the programmes
"set about the seemingly impossible task of raising funds for research into something of which sc... more "set about the seemingly impossible task of raising funds for research into something of which scarcely anyone had heard". (Johnson, 1984). And what a success they made of it even though there were so few children with CF surviving then that very few people had even heard of the condition.
The Practitioner, Apr 1, 1980
Baillière's Clinical Gastroenterology
Coeliac disease usually presents in infancy or early childhood with diarrhoea, vomiting and inter... more Coeliac disease usually presents in infancy or early childhood with diarrhoea, vomiting and interference with weight gain and growth. Withdrawal of dietary gluten is followed by resolution of the symptoms and signs and restoration of normal weight gain and growth; the characteristic subtotal villous atrophy of the jejunal mucosa also recovers. Later re-introduction of dietary gluten will lead to a return of the jejunal mucosal abnormality in the majority and to clinical relapse in many but not all. The severity and timing of both are variable and 5% of children initially considered on clinical, biopsy and gluten response evidence to have coeliac disease appear to develop permanent tolerance to gluten, although mucosal relapse may occur years after the re-introduction of dietary gluten in a minority, emphasizing the need for long-term follow-up. Although a diagnostic and subsequent follow-up jejunal biopsy are necessary to confirm the diagnosis, anti-gliadin IgA and IgG, anti-reticulin and anti-endomysium antibodies are now almost totally reliable in identifying children who have coeliac disease and are valuable in monitoring the adequacy of gluten withdrawal. Dietary compliance is frequently poor and regular supervision by a paediatric dietitian is needed; indeed, lifelong supervision to ensure gluten withdrawal is essential to reduce the chance of developing later gastrointestinal malignancy.
Comprehensive assessment of patients attending the Regional Cystic Fibrosis Unit includes a detai... more Comprehensive assessment of patients attending the Regional Cystic Fibrosis Unit includes a detailed evaluation of their physical therapy habits and management. The following were analysed during the assessment by the physiotherapist: the frequency of patient contact with a physiotherapist, the techniques used for chest clearance, the exercise habits, the postural drainage equipment used, if any, and the frequency of respiratory cultures. The results were divided into three groups: group 1, 72 patients (66%), were first-referral patients (FR) to our cystic fibrosis unit; group 2, 26 (24%), received all their care at our unit (CFU); group 3, 10 (9%), were attending a local hospital but had had a previous assessment at our unit (PA). For all factors examined the CFU and PA patients had a more effective management than the FR patients cared for by local hospitals, with the conclusion drawn that regular contact with a physiotherapist at a cystic fibrosis unit improves the understanding, compliance, and effectiveness of the patient's treatment programme.
Pediatric Pulmonology, Feb 1, 2004
Various management strategies were introduced at the Leeds Regional Cystic Fibrosis (CF) Unit in ... more Various management strategies were introduced at the Leeds Regional Cystic Fibrosis (CF) Unit in an attempt to reduce the prevalence of chronic Pseudomonas aeruginosa respiratory infection, previously thought to be inevitable in most children with CF. These included neonatal screening (1975), regular microbiological monitoring (1975), early antibiotic treatment of first isolations of P. aeruginosa (1985), intensive intravenous antibiotic treatment where nebulized antibiotics failed to eradicate P. aeruginosa (1988), and separate clinics for patients chronically infected with P. aeruginosa and uninfected patients (1991). The aim of this study was to assess the impact of these interventions. All 232 patients receiving full-time care at the Leeds Paediatric CF Centre during the period January 1990-December 2000 were categorized into four groups: never grown P. aeruginosa; free of P. aeruginosa for at least 1 year; intermittent grower of P. aeruginosa with </=50% of months with samples positive for P. aeruginosa over the previous 12 months; and chronic P. aeruginosa infection with >50% of months with samples positive for P. aeruginosa over the previous 12 months. The yearly prevalence of patients having chronic P. aeruginosa infection fell significantly during the study, from 24.5% in 1990 to 18.1% in 2000 (P < 0.05), despite an increase in mean age of patients from 7.73 to 9.42 years. The number of patients aged less than 11 years who had chronic P. aeruginosa infection fell from 23.8% in January 1990 to only 4.3% by December 2000. The annual incidence and mean age of first acquisition of P. aeruginosa did not alter significantly. In conclusion, antipseudomonal management strategies were associated with both reduced prevalence, and an increase in the mean age of onset of chronic P. aeruginosa infection.
Human nutrition. Clinical nutrition, 1986
It has been suggested that patients with cystic fibrosis have abnormal immune responses to foods.... more It has been suggested that patients with cystic fibrosis have abnormal immune responses to foods. We have measured IgE antibodies to inhalants and foods (by RAST) in 105 patients with cystic fibrosis aged between 8 months and 28 years. Serum IgE was elevated (greater than 180 kU/l) in 21 patients. In 43, IgE antibodies were detected in serum. The majority of positive results were with house-dust mite, grass pollen or Aspergillus. Only four of the patients had a positive RAST to a food--one to milk, one to wheat and two to egg. On the basis of high serum IgE or positive RAST results, 44.8 per cent of the patients were atopic and the frequency of atopy was age-related, being higher in patients aged 4 years or more. However, the presence of food antibodies was unrelated to age. This study confirms the high prevalence of atopy in patients with cystic fibrosis but unequivocally demonstrates that the presence of IgE antibodies to foods in their serum is rare.
Journal of the Royal Society of Medicine, 1999
The small bowel is not involved * A few patients have chylous ascites.
Journal of the Royal Society of Medicine, 1986
Nutrition and health, 1987
This paper describes the clinical presentation of food allergy and/or intolerance (F.A.I.). The r... more This paper describes the clinical presentation of food allergy and/or intolerance (F.A.I.). The role of a diagnostic dietary trial is reviewed. Finally dietary management is discussed.
Clinical physics and physiological measurement : an official journal of the Hospital Physicists' Association, Deutsche Gesellschaft für Medizinische Physik and the European Federation of Organisations for Medical Physics, 1990
The operation of a commercially available nebuliser system (Medic-Aid Ltd) is reviewed and the ef... more The operation of a commercially available nebuliser system (Medic-Aid Ltd) is reviewed and the efficiency with which it produces an aerosol assessed. Defining the efficiency of nebulisation E as the fraction of the original mass of solution released as an aerosol it is found that the internal surface area, mass of solution used, the surface tension of the solution and the angle of tilt are important factors in determining E. Reducing the internal surface area of the nebuliser by means of Perspex inserts significantly increases E for 3 g of water from 49% for the unmodified system to 67% for the modified nebuliser (P less than 0.01). E increases with the mass of solution used but only exceeds 60% when 4.5 g water are used. Decreasing the surface tension of the solution from 7.2 x 10(-3) N m-1 (water) to 3.7 x 10(-3) N m-1 and 3.1 x 10(-3) N m-1 (using two different concentrations of a detergent in water) significantly increases E for 3 g solution from 49% to 65% and 69% respectively ...
Clinical physics and physiological measurement : an official journal of the Hospital Physicists' Association, Deutsche Gesellschaft für Medizinische Physik and the European Federation of Organisations for Medical Physics, 1991
A simple mathematical model describing the performance of an Acorn jet nebuliser system (Medic-Ai... more A simple mathematical model describing the performance of an Acorn jet nebuliser system (Medic-Aid Ltd) has been developed in which nebuliser efficiency E, defined as the volume fraction of solution (water) released as an aerosol or lost by evaporation, and nebulisation time T, are given as functions of the initial volume of solution. The model identifies an initial phase during which the nebuliser output is at a constant, continuous rate of 0.007 ml s-1. This is followed by an intermittent phase of operation during which output is estimated to occur for 0.25 of the total duration of the phase and results from solution deposited on the walls being recycled. The model indicates that increasing the flow of solution to the nebulisation region in the nebuliser or decreasing the fraction of aerosol intercepted by the baffle, will decrease T whilst leaving E unaffected. Two residence times tau 1, tau 2 which are a measure of the time that solution droplets adhere to the inner walls of the...
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Papers by James Littlewood