Bartholomew's Hospital Research Articles

Overall survival of black and white men with metastatic castration-resistant prostate cancer (mCRPC): a 20-year retrospective analysis in the largest healthcare trust in England.

Prostate cancer in black men is associated with poorer outcomes than their white counterparts. However, most studies reporting this disparity were conducted in localized prostate cancer and primarily in the United States. Data regarding prostate cancer incidence and mortality for East London between 2008 and 2010 were obtained from the UK National Disease Registration Service. We further evaluated survival outcomes of 425 cases of mCRPC in St Bartholomew's Hospital, East London, between 1997 and 2016, and analyzed whether ethnicity impacted on responses to different treatment types. The incidence of prostate cancer in black men was higher than white men in East London. Prostate cancer-specific mortality was proportional to incidence based on ethnic groups. In the detailed analysis of 425 patients, 103 patients (24%) were black (B), and the remainder white (W). Baseline characteristics were comparable in both groups, although black patients had a lower baseline hemoglobin (p < 0.001). Median overall survival for the total cohort was 25.5 months (B) vs 21.8 months (W) (hazard ratio (HR) = 0.81, p = 0.08). There was prolonged survival in the black population in those who only received hormone-based treatment throughout their treatment course; 39.7 months (B) vs 17.1 months (W) (HR = 0.54, p = 0.019). Black men may do better than white men with mCRPC, in the context of equal access to healthcare. The study also suggests a greater margin of benefit of hormone-based therapy in the black subpopulation.

Embedding post-doctoral clinical academic careers in practice: The St Bartholomew's Hospital model.

In order to retain and develop pre-doctoral and doctoral staff, we sought to establish and implement a model for supporting postdoctoral clinical academic careers at our hospital. Doctorally-prepared nurses can raise clinical practice standards, but there is a deficit of career opportunities and post-doctoral positions. This will inevitably impact delivering the evidence for improving patient outcomes and service delivery. It is therefore imperative that post-doctoral nursing and allied professional post-doctoral clinical academic career opportunities are developed and embedded in practice. We describe the development and implementation of a model to provide and embed post-doctoral clinical academic roles at our hospital. A multidisciplinary group devised the model which was approved by the Hospital Executive Board. The model includes having a bespoke plan for each individual, planning the post-doctoral role at time of PhD planning, providing 1 day a week protected research time for a minimum of 12 months after PhD completion, having an appropriate honorary academic contract at a partner University, and providing integrated clinical and academic supervision throughout. Other key components include senior clinical and Executive Board support and an existing vibrant research culture at our organisation. The St Bartholomew's Hospital model, focusing on individualised posts integrating clinical and academic roles to address service needs, offers a novel approach to supporting post-doctoral clinical academic careers in a clinical setting. Since doctorally-prepared nurses can raise clinical practice standards we developed a sustainable infrastructure to increase our postdoctoral nursing and allied professional workforce. This model could provide a framework for other hospitals to embed postdoctoral clinical academic careers in practice.

SARS-CoV-2 and ECMO: early results and experience.

IntroductionIn this paper, we describe our experience and early outcomes with critically unwell severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients who required extracorporeal membrane oxygenation (ECMO). We present our standard practices around ECMO decision-making, retrieval, cannulation, ventilation, anticoagulation, tracheostomy, imaging and steroids.MethodsA retrospective cohort study using data from the hospital notes on all SARS-CoV-2 patients who required extracorporeal support at St Bartholomew’s Hospital between 1 March 2020 and 31 July 2020. In total, this included 18 patients over this time period.ResultsIn total, 18 patients were managed with extracorporeal support and of these 14 survived (78%) with 4 deaths (22%). The mean duration from hospital admission to intubation was 4.1 ± 3.4 days, mean time from intubation to ECMO 2.3 ± 2 days and mean run on ECMO 17.7 ± 9.4 days. Survivor mean days from intubation to extubation was 20.6 ± 9.9 days and survivor mean days from intubation to tracheostomy decannulation 46.6 ± 15.3 days. Time from hospital admission to discharge in survivors was a mean of 57.2 ± 25.8 days. Of the patients requiring extracorporeal support, the initial mode was veno-venous (VV) in 15 (83%), veno-arterial (VA) in 2 (11%) and veno-venous-arterial (VVA) in 1 (6%). On VV extracorporeal support, 2 (11%) required additional VVA. Renal replacement therapy was required in 10 (56%) of the patients. Anticoagulation target anti-Xa of 0.2–0.4 was set, with 10 (56%) patients having a deep vein thrombosis or pulmonary embolism detected and 2 (11%) patients suffering an intracranial haemorrhage. Tracheostomy was performed in 9 (50%) of the patients and high-dose methylprednisolone was given to 7 (39%) of the patients.ConclusionIn our cohort of patients with severe SARS-CoV-2 respiratory failure, a long period of invasive ventilation and extracorporeal support was required but achieving good outcomes despite this. There was a significant burden of thromboembolic disease and renal injury. A significant proportion of patients required tracheostomy and steroids to facilitate weaning.

Intracoronary autologous bone marrow mononuclear cells for the compassionate treatment of advanced heart failure

Abstract Background Intracoronary delivery of autologous bone marrow-derived mononuclear cells (BMCs) has been shown to be beneficial in the treatment of patients with ischaemic (IHD) and non-ischaemic dilated cardiomyopathy (DCM). Given the results of phase II clinical trials in this population, our centre initiated the only programme to offer intracoronary BMCs to patients with advanced heart failure due to IHD or DCM in the UK. Clinical data and outcomes in these patients were maintained as part of a registry, the results of which are reported herein. Purpose To report outcomes of the first 20 patients with DCM treated at the compassionate stem cell unit. Methods A total of 45 patients with advanced heart failure (left ventricular ejection fraction (LVEF) at referral of ≤45%, New York Heart Association (NYHA) classification ≥2 and no secondary cause for the cardiomyopathy) despite optimal medical therapy (OMT) were accepted into the programme and received treatment with intracoronary BMCs, manufactured and supplied as Advanced Therapy Medicinal Products, with adjunctive granulocyte colony stimulating factor (G-CSF). All patients received 5 days of G-CSF followed by bone marrow aspiration and IC infusion of cells (∼10ml of BMCs) on Day 6. LVEF was assessed by cardiac CT. Results Of the 20 patients with DCM, 80% were male with a mean age of 64.6±10.6 years (range 45–81 years old). Baseline LVEF was 36.1%±10.6. Baseline NYHA class distributions were 70% NYHA class II (n=14), NYHA class III 25% (n=5), and NYHA class IV – 5% (n=1). All procedures were performed successfully with no procedural complications (100% radial). One year after treatment, 71.4% of people improved by 1 or more NYHA classes with 28.6% noting no change (1 year NYHA classes I (60%), II (27%) and III (13%)). No patients felt worse. A mean increase of 3.4% (±9.6%) was seen in LVEF at 1 year compared to baseline with a corresponding mean reduction in NT-pro-BNP of 18.9% (mean 1012pmol/l vs 1250pmol/l). In terms of clinical events, at 1 year all treated patients were alive, with no reported MACE events and no admissions for heart failure. Conclusion IC autologous BMC injections are a novel therapy for patients with advanced HF despite OMT. These data indicate this therapy is safe and results in significant improvement in symptoms of heart failure. An improvement in the LVEF is seen at levels which support initial findings of phase II clinical trials. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Heart Cell Foundation; Barts Heart Centre, St Bartholomew's Hospital

Editorial introductions

Current Opinion in Obstetrics and Gynecology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of obstetrics and gynecology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Joseph AquilinaJoseph AquilinaJoseph Aquilina, FRCOG, MFFP, is a consultant obstetrician and gynaecologist at Barts Health NHS Trust based St. Bartholomew's and the Royal London Hospitals, UK, and Honorary Senior Lecturer in Obstetrics and Gynaecology at Queen Mary University of London, UK. He is the Lead Clinician for Fetal Medicine Clinical Academic Group and runs a one-stop menstrual disorders clinic at St Bartholomew's Hospital. Mr Aquilina obtained his primary medical degree in Malta and then moved to the UK for his basic postgraduate training in Bristol, and in London at King's College and Greenwich Hospitals, UK. He subsequently undertook research and subspecialty training in feto-maternal medicine/gynaecological ultrasound as a lecturer at St.Bartholomew's and Royal London Medical School, Queen Mary Westfield College, based at Homerton Hospital, UK. He is recognised as a preceptor for training in gynaecological scanning by the Royal College of Obstetricians and Gynaecologists, UK. His special interests include polycystic ovarian syndrome, prediction of pre-eclampsia and the application of ultrasound in the diagnosis and management of benign gynaecological conditions. Ruben AlveroRuben AlveroDr Ruben Alvero is Professor of Obstetrics and Gynecology at Stanford Medical School, USA, and is the Division Director of Reproductive Endocrinology and Infertility at the Lucille Packard Children's Hospital, USA. He is Board Certified in obstetrics and gynecology, and in reproductive endocrinology and infertility. He is a fellow of the American College of Obstetrics and Gynecology and the American College of Surgeons. Following undergraduate training at Harvard College, USA (BA, Economics, 1980), Dr Alvero received his medical degree from the Uniformed Services University of the Health Sciences in Bethesda, Maryland, USA, in 1986. He completed his residency in Obstetrics and Gynecology at Walter Reed Army Medical Center, USA (1990), and a fellowship in Reproductive Endocrinology and Infertility at the National Institutes of Health, USA (NIH, 1995). Dr Alvero was the Division Director for Infertility Services at the National Naval Medical Center, Bethesda, USA, and Walter Reed Army Medical Center and faculty in the NIH-sponsored fellowship in Reproductive Endocrinology and Infertility. Dr Alvero remained a reserve Colonel in the US Army Medical Corps until 2012, and during 27 years in the Army was mobilized several times for missions around the world, including service in Iraq, Kuwait, Mongolia, Germany and various locations in the United States. Dr Alvero was Professor of Obstetrics and Gynecology and Vice Chair for Education at the University of Colorado Health Sciences Center, USA, and the Director of the Assisted Reproductive Technologies, and founding member of the Center for Surgical Innovation. Dr Alvero was Residency Program Director in Obstetrics and Gynecology at the University of Colorado, USA. He was subsequently Division and Fellowship Director at Brown University, USA. The Council in Residency Education in Obstetrics and Gynecology awarded him its National Faculty Award for Excellence three times. He has been NIH-funded, most recently as part of the Reproductive Medicine Network. Dr Alvero is currently the Vice President of the Society for Reproductive Endocrinology, the national organization of fertility specialists and will take over as President in October 2020. Dr Alvero's clinical interests include IVF, polycystic ovary syndrome, endometriosis and robotic surgery. Dr Alvero's research interests include non-invasive evaluation of embryo quality, cost-effectiveness analysis, and the role of critical thinking in medical education. A fluent Spanish-speaker, Dr Alvero is also dedicated to improving the health of the Latinx community.

Neutropenic sepsis rates in patients receiving bleomycin, etoposide and cisplatin chemotherapy using olanzapine and reduced doses of dexamethasone compared to a standard antiemetic regimen.

To investigate whether the use of a steroid-sparing antiemetic protocol (substituting dexamethasone with olanzapine) affects the incidence of neutropenia and associated hospital admissions in patients receiving bleomycin, etoposide and cisplatin (BEP) chemotherapy. Records from 108 patients who received BEP at St Bartholomew's Hospital, London were divided into two groups according to antiemetic regimen. Group 1 (treated 2008-2013) were treated with a steroid-containing antiemetic protocol and group 2 (treated 2014-2017) were treated according to a steroid-sparing protocol, i.e. using olanzapine. Outcomes included incidence of neutropenia at nadir blood count, severity of neutropenia, hospital admissions attributable to febrile neutropenia (FN) and baseline risk factors associated with FN. Statistical analyses were performed using two-sided chi-squared tests. The baseline characteristics of the two groups were balanced with regard to age, gender, histology, and proportion of patients with International Germ Cell Cancer Collaborative Group poor-risk disease. The incidence of neutropenia of any grade (group 1, 96.2%; group 2, 98.1%) was similar, although group 2 had more patients with severe neutropenia than group 2 (77.7% vs 88.8%). There was a significant difference in FN incidence (group 1, 22%; group 2 7.5%; P=0.030). Most cases of FN occurred in cycle 1. Two baseline characteristics were over-represented in patients who developed FN: female sex and age ≥50years. By comparing two cohorts who received prophylactic antibiotics, our audit suggests that rates of FN-related admissions were lower in the cohort of patients in whom we employed a steroid-sparing antiemetic protocol.

Patient and staff experience of testicular cancer support group at St Bartholomew's Hospital

Patient and staff experience of testicular cancer support group at St Bartholomew's Hospital

Editorial introductions

Current Opinion in Obstetrics and Gynecology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of obstetrics and gynecology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Joseph AquilinaJoseph AquilinaJoseph Aquilina, FRCOG, MFFP, is a consultant obstetrician and gynaecologist at Barts Health NHS Trust based St. Bartholomew's and the Royal London Hospitals, UK, and Honorary Senior Lecturer in Obstetrics and Gynaecology at Queen Mary University of London, UK. He is the Lead Clinician for Fetal Medicine Clinical Academic Group and runs a one-stop menstrual disorders clinic at St Bartholomew's Hospital. Mr Aquilina obtained his primary medical degree in Malta and then moved to the UK for his basic postgraduate training in Bristol, and in London at King's College and Greenwich Hospitals, UK. He subsequently undertook research and subspecialty training in feto-maternal medicine/gynaecological ultrasound as a lecturer at St.Bartholomew's and Royal London Medical School, Queen Mary Westfield College, based at Homerton Hospital, UK. He is recognised as a preceptor for training in gynaecological scanning by the Royal College of Obstetricians and Gynaecologists, UK. His special interests include polycystic ovarian syndrome, prediction of pre-eclampsia and the application of ultrasound in the diagnosis and management of benign gynaecological conditions. Paul D. BlumenthalPaul D. BlumenthalPaul D. Blumenthal, MD, MPH, is Professor of Obstetrics and Gynecology at Stanford University School of Medicine, USA. He directs the Stanford Gynecology Service and the Division of Family Planning Services and Research at Stanford. He also directs SPIRES, the Stanford Program for International Reproductive Education and Services, an initiative providing technical assistance and training to family planning programs in a wide variety of countries across Africa, Asia and Central America. For over 30 years, Dr Blumenthal has been an advisor to multiple international agencies such as Gynuity Health Projects, Ipas, Pathfinder, FHI360, Path, Jjpiego, the Population Council, the RCOG and the World Health Organization, and served as the Special Advisor to Minister of Health and Family Planning of the Republic of Madagascar. He currently serves as the Global Medical Director for Population Services International. Dr Blumenthal is committed to the development and implementation of innovative approaches to reproductive health issues in both the domestic and international arenas. Kavita MishraKavita MishraDr Kavita Mishra is a urogynecologist at Stanford University School of Medicine, USA, where she is an Assistant Professor of Obstetrics and Gynecology. She completed her medical degree at the University of California, San Francisco, USA, and residency training in Obstetrics and Gynecology at Brown University, USA. She subsequently completed an ABOG/ABU-approved Fellowship in female pelvic medicine and reconstructive surgery at Brown University. She has subspecialty board certification in FPMRS. She performs reconstructive surgery for pelvic organ prolapse and urinary incontinence using robotic, laparoscopic, and vaginal approaches. She currently sees patients with complex pelvic floor disorders at Stanford's multidisciplinary Pelvic Health Center with specialists from colorectal surgery, female urology and GI motility. Her research interests include epidemiology of pelvic floor disorders and mesh complications. She is involved in the Pelvic Anatomy Group of the Society of Gynecologic Surgeons.

Editorial introductions

Editorial introductions

Impact of attributed audit on procedural performance in cardiac electrophysiology catheter laboratory.

Audit has played a key role in monitoring and improving clinical practice. However, audit often fails to drive change as summative institutional data alone may be insufficient to do so. We hypothesised that the practice of attributed audit, wherein each individual's procedural performance is presented will have a greater impact on clinical practice. This hypothesis was tested in an observational study evaluating improvement in fluoroscopy times for AF ablation. Retrospective analyses of fluoroscopy times in AF ablations at the Barts Heart Centre (BHC) from 2012-2017. Fluoroscopy times were compared pre- and post- the introduction of attributed audit in 2012 at St Bartholomew's Hospital (SBH). In order to test the hypothesis, this concept was introduced to a second group of experienced operators from the Heart Hospital (HH) as part of a merger of the two institutions in 2015 and change in fluoroscopy times recorded. A significant drop in fluoroscopy times (33.3 ± 9.14 to 8.95 ± 2.50, p < 0.0001) from 2012-2014 was noted after the introduction of attributed audit. At the time of merger, a significant difference in fluoroscopy times between operators from the two centres was seen in 2015. Each operator's procedural performance was shared openly at the audit meeting. Subsequent audits showed a steady decrease in fluoroscopy times for each operator with the fluoroscopy time (min, mean±SD) decreasing from 13.29 ± 7.3 in 2015 to 8.84 ± 4.8 (p < 0.0001) in 2017 across the entire group. Systematic improvement in fluoroscopy times for AF ablation procedures was noted byevaluating individual operators' performance. Attributing data to physicians in attributed audit can promptsignificant improvement and hence should be adopted in clinical practice.

Dr Annmarie Hedges-an appreciation.

Dr Annmarie Hedges, a long-time member of the British Pharmacological Society, died peacefully on 9 August 2017. As the inaugural Press Editor of the British Journal of Clinical Pharmacology, she set the benchmark for the high production values that have characterised the Journal ever since. Born in Lewes, Sussex, on 22 May 1944, Annmarie moved with her family first to Purley and then to Bristol, where she was to finish her primary education. Having passed her 11-plus examination, she began her secondary education at Colston Girls' School, which she continued to attend when her family moved to Chew Stoke in Somerset. She obtained her tertiary education at the University of Southampton, graduating in 1965 with a BSc Hons in Biochemistry and Physiology. This was to be followed by an MSc a year later. Having joined Professor Paul Turner's Department of Clinical Pharmacology at St Bartholomew's Hospital in London, then based at 38 Little Britain, Annmarie, in conjunction with Professors Turner and Harvey, published a paper in the Journal of Clinical Pharmacology in November 1971, ‘Preliminary studies on the central effects of lorazepam, a new benzodiazapine’ 1. She continued her research at Barts, which ultimately led to a PhD thesis titled ‘The response of some human isolated smooth muscle preparations to sympathomimetic amines and to beta adrenoceptor blocking drugs’. Having moved with the Department of Clinical Pharmacology to the William Harvey Research Institute in Charterhouse Square, Annmarie devoted much of her professional career to clinical pharmacology, and her final collaborative research paper reported on a new drug for preventing mountain sickness, benzolamide 2. Annmarie was an incredibly kind and respectful person, and all who came into contact with her, clinical and nonclinical colleagues alike, benefited from her wisdom, her patience, and an almost self-effacing desire to help. This desire to help was never more evident than in her dedication to the patients who attended St Bartholomew's weekly blood pressure clinic, many of whom thought that the clinic never felt ‘quite right’ without her, and continued to ask after her long after she had retired. However, Annmarie will be best remembered for her role as the Press Editor of the British Journal of Clinical Pharmacology, a role that was especially appreciated by all those who were associated with the Journal during her tenure – authors, editors, and publisher alike. The British Pharmacological Society launched the British Journal of Clinical Pharmacology in 1974, under the inaugural editorship of Paul Turner, with Annmarie as Press Editor, a role that she would hold for the next 28 years. A painstaking and respectful Press Editor, editing and proofreading every paper before publication, Annmarie was highly respected by the academics with whom she came into contact, and many authors were grateful for her expert, but sensitive, editing of their research papers. Annmarie was equally assiduous when it came to proofreading (word-for-word against copy in those days, the typesetter having rekeyed the entire manuscript), and such was her devotion to the Journal that she would happily deal with multiple revised proofs before being satisfied that the paper could be passed on to production. As a member of the British Pharmacological Society, Annmarie regularly attended Society meetings, four a year in the early days of her role as Press Editor, and was equally painstaking when it came to editing the Clinical Section's abstracts for timely publication in the first available issue of the Journal. Away from the world of clinical pharmacology, Annmarie was a very keen gardener. Secretary of her local Allotment Society for many years, she was also a member of both the Royal Horticultural Society and the Fuchsia Society, volunteering at many highly prestigious London flower shows, including Chelsea and Hampton Court. Having joined the Knitting & Crochet Guild in 1988, Annmarie went on to become a Director, serving for 3 years from 2013 to 2016. Having reinvigorated the Central London branch in 2013, she was a regular attendee at branch meetings in South West London and helped to organise Guild stands at various yarn shows, where, as a fellow member observed, ‘she will be remembered for her calm and unflappable presence and her willingness to help and share her knowledge’. Annmarie also found time to volunteer at her local Oxfam Shop, doing two sessions a week and quickly coming to love meeting people visiting the shop. Annmarie will be greatly missed, but as one of her past colleagues so poignantly said, ‘Her soft power lives on in our culture’.

A Forgotten Contribution to Early Anaesthesia Literature

Background: Following the introduction of ether anaesthesia in London in 1846 and then the demonstration of the effectiveness of chloroform the following year, many large London Hospitals appointed an official Chloroformist to their medical staff. In 1881 Richard Gill (1856–1933) became Assistant Chloroformist to Joseph Mills at St. Bartholomew's Hospital, London and then succeeded him as Chief Chloroformist in 1893. At this time, there was considerable debate about the safety of anaesthesia and a series of investigations were instigated to try and determine which agent was the safest to use.

Harveian Oration 2017: Triumphs and challenges in a world shaped by medicine

When the president invited me to give the Harveian Oration she asked me to range widely. This comes with many hazards, including making complex issues simplistic. It is, however, in the spirit of William Harvey. Harvey took employment in St Bartholomew's Hospital explicitly to serve the poor, as well as being physician to two kings. His greatest work on circulation underpins treatment of circulatory diseases in adults and children. It combined anatomy, physiology, mathematical modelling and enlightened speculation.1 He was also a pioneer in embryology. Harvey instructed those giving the Oration to exhort the fellows and members of this College ‘to search and study out the secret of nature by way of experiment’ but also to recognise they are part of a wider medical community. Medicine is a timeless art as well as an evolving science. Many of the essential qualities of a current physician would be recognisable to Harvey and his contemporaries. Empathy, logic, dedication to the public good, diagnosis by listening and examination, and courage in the face of personal risk have not changed over time. A good example is the West African Ebola crisis 3 years ago. The initial risk of medical staff contracting Ebola was calculated at around 10% per person year, 79% of whom died. When we invited volunteers from the NHS to travel to Africa and tackle it we can be proud that there was a massive response from NHS staff, including many members and fellows of the Royal College of Physicians (RCP) going to support their Sierra Leonean colleagues.2 Turning that epidemic around required medical and nursing staff, African and international, to combine absolute discipline, courage, basic clinical skills and innovation that would have been admired by any generation of physicians. Along with these timeless elements every generation of physicians since Harvey has, through science, also changed medicine for all subsequent generations. This Oration will address two questions: what major changes in health has our generation of physicians contributed to the future? And where are we falling short? In answering these questions four issues stand out. The first is the remarkable impact of medical science on health in children globally. The second is the transformational demographic implications of these advances; medicine will in this generation leave the world a completely and permanently different shape demographically, with profound social implications. The third is the rapid advance of medical science on diseases of the middle years, especially cardiovascular disease and, increasingly, cancer. Alongside these advances however are the fourth issue: areas and challenges that we are not tackling as effectively, especially in addressing the health needs of older people with multiple conditions.

Editorial introductions

Current Opinion in Obstetrics and Gynecology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of obstetrics and gynecology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Joseph AquilinaJoseph AquilinaJoseph Aquilina, FRCOG, MFFP is a consultant obstetrician and gynaecologist at Barts Health NHS Trust based St. Bartholomew's and the Royal London Hospitals and Honorary Senior Lecturer in Obstetrics & Gynaecology at Queen Mary University of London, UK. He is the Lead Clinician for Fetal Medicine Clinical Academic Group and runs a one-stop Menstrual Disorders clinic at St Bartholomew's Hospital, London, UK. Mr Aquilina obtained his primary medical degree in Malta and then moved to the UK for his basic postgraduate training in Bristol, and in London at King's College and Greenwich Hospitals. He subsequently undertook research and subspecialty training in feto-maternal medicine/gynaecological ultrasound as a lecturer at St.Bartholomew's and Royal London Medical School, Queen Mary Westfield College, based at Homerton Hospital, UK. He is recognised as a preceptor for training in gynaecological scanning by the Royal College of Obstetricians and Gynaecologists. His special interests include polycystic ovarian syndrome, prediction of pre-eclampsia and the application of ultrasound in the diagnosis and management of benign gynaecological conditions. Paul D. BlumenthalPaul D. BlumenthalPaul D. Blumenthal, MD, MPH is Professor of obstetrics and gynecology at Stanford University School of Medicine. He directs the Stanford Gynecology Service and the Division of Family Planning Services and Research at Stanford. He also directs SPIRES, the Stanford Program for International Reproductive Education and Services, an initiative providing technical assistance and training to family planning programs in a wide variety of countries across Africa, Asia, and Central America. For over 25 years, Dr Blumenthal has been an advisor to multiple international agencies such as Gynuity Health Projects, Ipas, Pathfinder, Family Health International, Path, JHPIEGO Corporation, and the World Health Organization and served as the Special Advisor to Minister of Health and Family Planning of the Republic of Madagascar. He currently serves as the Global Medical Director for Population Services International. Dr Blumenthal is committed to the development and implementation of innovative approaches to reproductive health issues in both the domestic and international arenas.

Tasigna (nilotinib) in chronic myeloid leukemiatreatment-free remission after nearly 2years: an interview with Adam Mead.

Dr Mead earned his medical degree from the University of Oxford and trained in hematology at St Bartholomew's Hospital and University College London. In 2007, he earned his PhD at UCL, which focused on the analysis of FLT3 mutations in acute myeloid leukemia. He is now Associate Professor of Hematology and MRC Senior Clinical Fellow at the WIMM, University of Oxford. His research group focuses on myeloid diseases and normal blood stem-cell biology. Dr Mead is the lead clinician for myeloproliferative neoplasms (MPN) and chronic myeloid leukemiain the Thames Valley Strategic Clinical Network and is the chief investigator for several chronic myeloid leukemia and MPN clinical trials. Additionally, Dr Mead has helped shape the diagnostic and treatment guidelines for MPNs in the UK and serves as the chair of the MPN clinical study subgroup of the National Cancer Research Institute.

British Surgeon Frederick Salmon (1796-1868) and His "Trans-Fixing Pins and Excision" Surgical Procedure for the "Rectum Prolapsus".

Frederick Salmon was born in Bath. From his early career, he was fond of surgery, mostly interested in proctology. He had been specialized in London at St Bartholomew's Hospital. He was the founder of "The Infirmary for the Relief of the Poor Afflicted with Fistula and Other Disease of the Rectum," and the writer of one of the most important surgical treatises, the " Practical Observations on Prolapsus of the Rectum." In this book, Salmon described an innovative operation for procidentia, based on the principle "trans-fixing pins and excision." Although his work was too significant for the era, he was almost completely neglected by historians, most probably due to his clash with his fellow surgeons, who had been considered by him as scientifically inadequate in anorectal diseases.

Simple things can achieve so much.

Tonks Fawcett was one of a small number of nurses to enrol on a nursing degree in the 1970s, graduating from City University London and St Bartholomew's Hospital. She has had a long career in nurse education at the University of Edinburgh, and became professor of student learning (nurse education) in 2012. She is also associate dean for academic conduct for the college of arts, humanities and social science at the university, and in 2014 was made a principal fellow of the Higher Education Academy. She is a member of the RCNi editorial advisory board.

Dr Thomas B Boulton OBE, TD, MD, FRCA, FDSRCS, 1925–2016

Dr Thomas B Boulton OBE, TD, MD, FRCA, FDSRCS, 1925–2016

GAMEC Chemotherapy for Untreated and Relapsed Germ Cell Tumours: 15 Years of Experience with a Dose Intense Regimen at St Bartholomew's Hospital

GAMEC Chemotherapy for Untreated and Relapsed Germ Cell Tumours: 15 Years of Experience with a Dose Intense Regimen at St Bartholomew's Hospital

The Painter's Daughter and the Poor Law: Elizabeth Laroon (b. 1689 –fl.1736)

This article reconstructs the hitherto unknown life story of the only surviving daughter of the painter Marcellus Laroon the elder (c. 1648/9–1702). It begins with an updated biography of Elizabeth's father, outlines her probable financial situation at his death, and then goes on to reconstruct her catastrophic career. Elizabeth Laroon ended up as a pauper and was relieved under the Poor Law by the parish of St Martin in the Fields, Westminster for over 20 years. She spent time in the parish workhouse and experienced two stays in the Kingsland annexe of St Bartholomew's Hospital which specialized in venereal patients. Elizabeth Laroon's life history reveals much about the nature of family ties, the fragility of social position, the plight of single women, the impact of venereal disease, the identity — or perhaps more properly ‘identities’ — of ‘the poor’ and the social reach of the parish poor law in eighteenth-century London.