MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'British Medical Bulletin' source. Fri, 19 Mar 2010 15:40:44 +0100 http://www.medworm.com/index.php?rid=3344457&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F93%2F1%2F217%3Frss%3D1 This article reviews the evidence for their use and their possible benefits. Sources of data The review is based upon peer reviewed publications relating to the use of mucolytics in COPD cited in PubMed. Areas of agreement Much of the published evidence is of somewhat poor quality and many studies include patients with both chronic bronchitis and COPD. Mucolytics reduce exacerbations by up to 0.8 exacerbations per year, but have little additional benefit in those on standard maximum therapy. Areas of controversy Data that mucolytics improve symptoms, alter mucus or impact health-related quality of life in COPD patients receiving other standard therapy are unconvincing. In those on little or no other treatment, they may reduce exacerbation rate. Growing points The use of mucolytics to t... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3344457 Mon, 08 Mar 2010 15:36:35 +0100 3344457 http://www.medworm.com/index.php?rid=3344456&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F93%2F1%2F201%3Frss%3D1 Introduction The optimal management for combined anterior cruciate ligament–medial collateral ligament (ACL–MCL) injuries is controversial. Sources of data We performed a literature search using Medline, Cochrane and Google Scholar using the keywords: ‘ACL’ and ‘MCL’ in combination with ‘surgery treatment’, ‘conservative treatment’, ‘surgery management’, ‘conservative management’, ‘surgical treatment’ and ‘surgical management’. We identified 23 published studies. Areas of agreement Conservative and surgical management for combined ACL–MCL injuries resulted in different functional outcomes. The Coleman Methodology Score showed great heterogeneity in terms of study design, pati... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3344456 Mon, 08 Mar 2010 15:36:35 +0100 3344456 http://www.medworm.com/index.php?rid=3344455&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F93%2F1%2F179%3Frss%3D1 Conclusion Although there are proven strategies to control several NTDs, these diseases continue to cause a massive burden of morbidity. There is urgent need for more basic and operational research, drug and vaccine development, and greater prioritization by governments and international agencies. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3344455 Mon, 08 Mar 2010 15:36:35 +0100 3344455 http://www.medworm.com/index.php?rid=3344454&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F93%2F1%2F161%3Frss%3D1 Introduction External cardiac mechanical stimulation is one of the fastest resuscitative manoeuvres possible in the emergency setting. Precordial thump (PT), initially reported for treatment of atrio-ventricular block, has been subsequently described to cardiovert also ventricular tachycardia (VT) and fibrillation (VF). PT efficacy, mechanics and mechanisms remain poorly characterized. Sources of data Appropriate MESH and free terms were searched on PubMed, Embase and the Cochrane Library. Cross-referencing from articles and reviews, and forward search using SCOPUS and Google scholar have also been performed. Pre-set inclusion and exclusion criteria were applied to retrieved references on PT, which were then reviewed, summarized and interpreted. Areas of agreement PT is not effective in ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3344454 Mon, 08 Mar 2010 15:36:34 +0100 3344454 http://www.medworm.com/index.php?rid=3344453&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F93%2F1%2F145%3Frss%3D1 Introduction There is no curative treatment for the common motor neuron diseases, amyotrophic lateral sclerosis (ALS) and spinal muscular atrophy. Nevertheless, there is an increasing volume of published studies. This review assesses the current evidence for treatment of these conditions. Sources of data Primarily, the systematic reviews of the Cochrane Collaboration, with additional reference to other systematic reviews and online sites. Areas of agreement Riluzole remains the only medication with demonstrated efficacy and regulatory approval for the treatment of ALS. Areas of controversy, growing points and areas timely for developing research The design of clinical trials and the publication of unsatisfactory studies, in both human and animal models, continue to cause confusion in ad... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3344453 Mon, 08 Mar 2010 15:36:34 +0100 3344453 http://www.medworm.com/index.php?rid=3344452&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F93%2F1%2F125%3Frss%3D1 Introduction or background A large number of drug classes have now been reported to provoke angle closure in high-risk individuals. The mechanism of action can be generalized into three main categories: sympathomimetic, parasympatholytic and idiosyndratic reactions. Sources of data This review of the ophthalmic literature provides a clinical summary of primary angle-closure glaucoma (PACG) and its management. Areas of agreement External stimuli (pharmacological and environmental) may induce acute, and more often, asymptomatic angle closure, which carries a significant risk of glaucoma. Growing points Whenever in doubt, patients at risk of PACG who are starting on drug therapy known to provoke angle closure or aggravate the condition should be referred for detailed gonioscopic examinatio... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3344452 Mon, 08 Mar 2010 15:36:34 +0100 3344452 http://www.medworm.com/index.php?rid=3344451&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F93%2F1%2F105%3Frss%3D1 Introduction Mesothelioma is a malignant tumour of the pleura or peritoneum caused by asbestos. It is increasing in frequency and the prognosis remains grim, with average survival around 1 year. Sources of data Medical literature and personal experience. Areas of agreement Amphibole fibres are far more potent than chrysotile in causing mesothelioma. Areas of controversy A minority view suggests that mesotheliomas in those exposed to chrysotile are caused only by tremolite (an amphibole) which contaminates chrysotile. There is a hypothesis, for which evidence is weakening, that Simian virus 40 may cause mesothelioma. Growing points There is emerging evidence of genetic variation in susceptibility to fibre carcinogenesis. There are developments in treatment, particularly chemotherapy wit... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3344451 Mon, 08 Mar 2010 15:36:34 +0100 3344451 http://www.medworm.com/index.php?rid=3344450&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F93%2F1%2F85%3Frss%3D1 Introduction Haematopoietic stem cell transplantation (HSCT) is potentially curative for haematological diseases. New developments are improving its applicability and success. Sources of data A literature search was conducted on peripheral blood haematopoietic stem cell (PBHSC) mobilization, umbilical cord blood (UCB) transplantation, reduced intensity conditioning (RIC) and acute graft-versus-host disease (aGVHD). Areas of agreement PBHSC mobilization by granulocyte colony-stimulating factor and chemomobilization may fail in up to 30% of patients previously treated with extensive chemotherapy. New mobilization agents, notably the CXCR4 antagonist, have improved mobilization efficacy. UCB-HSCT is equally feasible in children and adults. RIC enables HSCT to be performed in patients who ar... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3344450 Mon, 08 Mar 2010 15:36:34 +0100 3344450 http://www.medworm.com/index.php?rid=3344449&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F93%2F1%2F69%3Frss%3D1 Background Diagnosis and treatment of latent tuberculosis infection (LTBI) is a cornerstone of tuberculosis (TB) control in the developed world. In the last century, the tuberculin skin test (TST) was the only means of diagnosing LTBI. ELISpot and whole-blood ELISA, collectively known as interferon-gamma release assays (IGRAs), are promising new tools. Areas of agreement IGRAs are more specific than TST for diagnosis of LTBI as they are not confounded by previous bacille Calmette-Guerin (BCG) vaccination. Assessing IGRA sensitivity in the absence of a gold standard for LTBI is challenging. Studies have therefore used surrogate markers such as active TB and correlation with degree of TB exposure in contact investigations. These studies suggest that sensitivity of ELISpot is higher than TST... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3344449 Mon, 08 Mar 2010 15:36:34 +0100 3344449 http://www.medworm.com/index.php?rid=3344448&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F93%2F1%2F49%3Frss%3D1 Introduction Cardiac imaging is an emerging application of multidetector computed tomography (MDCT). This review summarizes the current capabilities, possible applications, limitations and developments of cardiac CT. Sources of data Relevant publications in peer reviewed literature and national and international guidelines are used to discuss important issues in cardiac CT imaging. Areas of agreement and controversy There is broad consensus that coronary CT angiography is indicated in patients with an intermediate pre-test probability of coronary artery disease (CAD) when other non-invasive tests have been equivocal. In this context, CT can reliably exclude significant CAD. Cardiac CT also has an established role in the evaluation of bypass grafts and suspected coronary anomalies. Radiat... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3344448 Mon, 08 Mar 2010 15:36:34 +0100 3344448 http://www.medworm.com/index.php?rid=3344447&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F93%2F1%2F27%3Frss%3D1 Introduction The limit of each individual to perform a given type of exercise depends on the nature of the task, and is influenced by a variety of factors, including psychology, environment and genetic make up. Genetics provide useful insights, as sport performances can be ultimately defined as a polygenic trait. Sources of data We searched PubMed using the terms ‘sports’ and ‘genetics’ over the period 1990 to present. Areas of agreement The physical performance phenotypes for which a genetic basis can be suspected include endurance capacity, muscle performance, physiological attitude to train and ability of tendons and ligaments to withstand injury. Genetic testing in sport would permit to identify individuals with optimal physiology and morphology, and also thos... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3344447 Mon, 08 Mar 2010 15:36:34 +0100 3344447 http://www.medworm.com/index.php?rid=3344446&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F93%2F1%2F7%3Frss%3D1 This article reviews the evidence on the magnitude of socio-economic inequalities in childhood mortality within LMICs, discusses possible causes and highlights entry points for intervention. Sources of data Evidence on socio-economic inequalities in childhood mortality in LMICs is mostly based on data from household surveys and demographic surveillance sites. Areas of agreement Childhood mortality is systematically and considerably higher among lower socio-economic groups within countries. Also most proximate mortality determinants, including malnutrition, exposure to infections, maternal characteristics and health care use show worse levels among more deprived groups. The magnitude of inequality varies between countries and over time, suggesting its amenability to intervention. Reducing... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3344446 Mon, 08 Mar 2010 15:36:34 +0100 3344446 http://www.medworm.com/index.php?rid=3344445&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F93%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3344445 Mon, 08 Mar 2010 15:36:34 +0100 3344445 http://www.medworm.com/index.php?rid=3077314&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F92%2F1%2F153%3Frss%3D1 Introduction The optimal management of calcaneal fractures is controversial, as correlation between anatomical restoration and outcome has not been proven, and complications after surgery are frequent. Sources of data MEDLINE, EMBASE, CINAHL, Google scholar, the Cochrane Controlled Trials Register, and the Cochrane Musculoskeletal Injuries Group Trials Register were searched using the keywords ‘calcaneal’ and ‘fractures’, without time limits or restriction to language. Randomized and quasi-randomized trials were included. Two separate comparisons were identified in the trials: operative versus non-operative management (five studies), and impulse compression versus no impulse compression (one study). Two reviewers independently assessed trial quality, with a 12-item... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3077314 Thu, 10 Dec 2009 16:13:25 +0100 3077314 http://www.medworm.com/index.php?rid=3077313&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F92%2F1%2F135%3Frss%3D1 Introduction Age-associated cognitive decline—or normal (non-pathological, normative, usual) cognitive ageing—is an important human experience which differs in extent between individuals. The determinants of the differences in age-related cognitive decline are not fully understood. Progress in the field is taking place across many areas of biomedical and psychosocial sciences. Areas of agreement and controversy The phenotype of normal cognitive ageing is well described. Some mental capabilities are well maintained into old age. From early adulthood, there are declines in mental domains such as processing speed, reasoning, memory and executive functions, some of which is underpinned by a decline in a general cognitive factor. There are contributions to understanding individual ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3077313 Thu, 10 Dec 2009 16:13:25 +0100 3077313 http://www.medworm.com/index.php?rid=3077312&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F92%2F1%2F123%3Frss%3D1 Introduction Osteoporosis is among the chronic problems emerging as the human immunodeficiency virus (HIV)-positive population ages. Sources of data We reviewed the English language bibliography using Pubmed 2.0, Web of Science and Embase for relevant abstracts and articles. Areas of agreement The prevalence of low bone mineral density (BMD) and fracture is increased in the HIV-positive population. Areas of controversy The pathogenesis is multifactorial; there is some evidence that HIV infection is an independent risk factor and that highly active antiretroviral therapy has adverse skeletal effects. Growing points Physicians should routinely review the bone health of all HIV patients. Areas timely for developing research More studies of the mechanisms of bone loss, the skeletal effect... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3077312 Thu, 10 Dec 2009 16:13:25 +0100 3077312 http://www.medworm.com/index.php?rid=3077311&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F92%2F1%2F95%3Frss%3D1 Background Sports injuries in young athletes are a public health issue which deserves special attention. Effective prevention can be achieved with training programmes originating from the field of physical therapy and medicine. Sources of data A systematic literature search on injury prevention in youth sport was performed in the MEDLINE database. Areas of agreement For prevention programmes to reduce sports injuries, critical factors must be considered, such as training content, duration and frequency, as well as athlete compliance. Areas of controversy Home-based programmes could be inferior to supervised training, but are efficient if compliance is high. So far prevention programmes have focused on team sports and their efficiency in individual sports remains to be proven. Growing p... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3077311 Thu, 10 Dec 2009 16:13:25 +0100 3077311 http://www.medworm.com/index.php?rid=3077310&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F92%2F1%2F79%3Frss%3D1 Introduction Bile acid malabsorption (BAM) is a syndrome of chronic watery diarrhoea with excess faecal bile acids. Disruption of the enterohepatic circulation of bile acids following surgical resection is a common cause of BAM. The condition is easily diagnosed by the selenium homocholic acid taurine (SeHCAT) test and responds to bile acid sequestrants. Idiopathic BAM (IBAM, primary bile acid diarrhoea) is the condition where no definitive cause for low SeHCAT retention can be identified. Sources of data Review of PubMed and major journals. Areas of agreement Evidence is accumulating that BAM is more prevalent than first thought. Management of chronic diarrhoea involves excluding secondary causes. Treatment of the condition is with bile acid binders. Areas of controversy SeHCAT testing... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3077310 Thu, 10 Dec 2009 16:13:25 +0100 3077310 http://www.medworm.com/index.php?rid=3077309&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F92%2F1%2F61%3Frss%3D1 Introduction Anti-tumour necrosis factor (TNF) therapy is increasingly used in the management of inflammatory bowel disease; however, concerns have been raised regarding risk of infection with such drugs. Little is known about their effect upon viral infection. Sources of data A search of PubMed using the terms ‘infliximab’, ‘etanercept’, ‘adalimumab’ or ‘anti-TNF therapy’ combined with the names of specific viruses was performed. A search of cited papers was used to identify further relevant reports. Areas of agreement Numerous reports of the use of anti-TNF in patients with chronic or latent viral infection appear in the literature. Specific problems related to hepatitis B virus and varicella zoster virus may exist. The safety profile of ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3077309 Thu, 10 Dec 2009 16:13:25 +0100 3077309 http://www.medworm.com/index.php?rid=3077308&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F92%2F1%2F43%3Frss%3D1 This article describes cardiac radionuclide imaging techniques and their applications in ischaemic ventricular dysfunction. Evidence for the role of these techniques is summarized with particular reference to current guidelines. Areas of agreement Both positron emission tomography (PET) and single photon emission computed tomography (SPECT) techniques are widely validated for the detection of myocardial viability and their use is recommended in both national and international guidelines. Areas of controversy Although assessments of ventricular phase and myocardial innervation hold promise for the stratification of patients to cardiac resynchronization therapy, the poor performance of echocardiographic predictors of response in the recently published PROSPECT trial suggest that these tech... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3077308 Thu, 10 Dec 2009 16:13:25 +0100 3077308 http://www.medworm.com/index.php?rid=3077307&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F92%2F1%2F33%3Frss%3D1 Introduction Mathematical models allow us to extrapolate from current information about the state and progress of an outbreak, to predict the future and, most importantly, to quantify the uncertainty in these predictions. Here, we illustrate these principles in relation to the current H1N1 epidemic. Sources of data Many sources of data are used in mathematical modelling, with some forms of model requiring vastly more data than others. However, a good estimation of the number of cases is vitally important. Areas of agreement Mathematical models, and the statistical tools that underpin them, are now a fundamental element in planning control and mitigation measures against any future epidemic of an infectious disease. Well-parameterized mathematical models allow us to test a variety of poss... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3077307 Thu, 10 Dec 2009 16:13:25 +0100 3077307 http://www.medworm.com/index.php?rid=3077306&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F92%2F1%2F7%3Frss%3D1 Background Assessing the causes of death across all regions of the world requires a framework for integrating, and analysing, the fragmentary information that is available on numbers of deaths and their cause distributions. This paper provides an overview of the met and methods used by the World Health Organization to develop global-, regional- and country-level estimates of mortality for a comprehensive set of causes, and provides an overview of global and regional levels and patterns of causes of death for the year 2004. The paper also examines some of the data gaps, uncertainties and limitations in the resulting mortality estimates. Sources of data Deaths for 136 disease and injury causes were estimated from available death registration data (111 countries), sample death registration d... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3077306 Thu, 10 Dec 2009 16:13:25 +0100 3077306 http://www.medworm.com/index.php?rid=3077305&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F92%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3077305 Thu, 10 Dec 2009 16:13:25 +0100 3077305 http://www.medworm.com/index.php?rid=2759920&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F91%2F1%2F137%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2759920 Wed, 02 Sep 2009 23:00:00 +0100 2759920 http://www.medworm.com/index.php?rid=2759919&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F91%2F1%2F123%3Frss%3D1 We examined the most recent literature in order to concisely review the evidence for some of the most important recent advances in the putative mechanisms concerned in the pathophysiology of VPH. Areas of agreement VPH may occur due to anomalies at any level of the visceral nociceptive neuraxis. Important peripheral and central mechanisms of sensitization that have been postulated include a wide range of ion channels, neurotransmitter receptors and trophic factors. Data from functional brain imaging studies have also provided evidence for aberrant central pain processing in cortical and subcortical regions. In addition, descending modulation of visceral nociceptive pathways by the autonomic nervous system, hypothalamo–pituitary–adrenal axis and psychological factors have all b... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2759919 Wed, 02 Sep 2009 23:00:00 +0100 2759919 http://www.medworm.com/index.php?rid=2759918&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F91%2F1%2F111%3Frss%3D1 Introduction Active sports participation can be important in some patients with degenerative joint disease in the lower limb. We investigated whether this is possible after an osteotomy for osteoarthritis of the hip, knee and ankle joints. Sources of data We performed a literature search using Medline, Cochrane, CINAHL and Google Scholar with no restriction to time period or language using the keywords: ‘osteotomy and sports’. Eleven studies (all level IV evidence) satisfied our inclusion and exclusion criteria. Nine reported on high tibial osteotomies, one on periacetabular osteotomies and one on distal tibial osteotomies. The Coleman Methodology Score to assess the quality of studies showed much heterogeneity in terms of study design, patient characteristics, management meth... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2759918 Wed, 02 Sep 2009 23:00:00 +0100 2759918 http://www.medworm.com/index.php?rid=2759917&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F91%2F1%2F87%3Frss%3D1 Introduction/background Clostridium difficile is the commonest cause of nosocomial diarrhoea. The epidemiology and clinical phenotype of the disease has dramatically changed with the global emergence of a virulent strain of C. difficile. Source This review was compiled using data from individual studies and review articles identified from PubMed. The retrieved articles were also examined for additional references. Areas of agreement Appropriate and timely infection control measures are required to control C. difficile infection (CDI) in the hospital environment, and either oral metronidazole or vancomycin remains the mainstay of treatment depending on the severity of infection. Areas of controversy The optimal method for diagnosing CDI remains unclear, as does the best therapeutic strat... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2759917 Wed, 02 Sep 2009 23:00:00 +0100 2759917 http://www.medworm.com/index.php?rid=2759916&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F91%2F1%2F75%3Frss%3D1 Introduction Open tibial fractures have been studied extensively in adults, and detailed treatment strategies have been developed: wound irrigation and debridement, fracture stabilization and delayed primary wound closure or early flap coverage are basic principles of management. No clear guidelines regarding the management of open tibial fractures in children exist. Sources of data We searched Medline, Embase, Cochrane, CINAHL and Google Scholar databases using the keywords: ‘open’, ‘tibia’, ‘fracture’, ‘children’, ‘paediatric’, ‘pediatric’, ‘external fixation’, ‘nailing’. Fourteen clinical studies were included. Quality of the studies was assessed using the Coleman Methodology Score. Areas o... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2759916 Wed, 02 Sep 2009 23:00:00 +0100 2759916 http://www.medworm.com/index.php?rid=2759915&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F91%2F1%2F61%3Frss%3D1 Introduction Schizophrenia is a debilitating psychiatric disorder that imposes a considerable burden on sufferers, their families and society. The prominent involvement of genes, combined with the complexity and relative inaccessibility of the brain has led many to suggest that the identification of specific risk loci offers the best chance of understanding pathogenesis. Sources of data Recent genome-wide association studies (GWAS) and copy number variation (CNV) publications have been included in this review along with key papers from the fields of schizophrenia, functional psychoses and complex disease mapping. Areas of agreement Recent GWAS have now shown that both common alleles of small effect and rare alleles of moderate to large effect contribute to the high heritability of schizo... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2759915 Wed, 02 Sep 2009 23:00:00 +0100 2759915 http://www.medworm.com/index.php?rid=2759914&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F91%2F1%2F49%3Frss%3D1 Introduction or background Dementia, Alzheimer's disease and vascular dementia being two main causes, is major and growing health problem. Vascular risk factors are thought to be involved in the causation of both dementias. Sources of data A review of the literature was conducted using MedLine to identify current evidence for role of vascular risk factors as potential targets in preventing dementia. Cross-references were hand searched. Areas of agreement The evidence from prospective epidemiological studies suggests that optimizing the control of vascular risk factors such as hypertension, high cholesterol, diabetes, smoking and heart disease may prevent dementia. However, this has been proven in randomized placebo-controlled trials (RCT) for only hypertension. Areas of controversy Deme... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2759914 Wed, 02 Sep 2009 23:00:00 +0100 2759914 http://www.medworm.com/index.php?rid=2759913&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F91%2F1%2F29%3Frss%3D1 Introduction or background Debate over relationships between economic growth, wealth, health and health inequity is long-standing and ongoing. The main message of this paper is that economic growth, while necessary, is not a sufficient condition in itself for achieving equitable health. Sources of data This review surveys and draws on research into principal factors commonly linked with improving health—income, health care, individual behavior—suggesting, using work from the Commission on Social Determinants of Health, that these are better understood in a broader social determinants of health framework. Areas of agreement The paper acknowledges that post-war globalization has seen significant growth, poverty reduction and greater economic resources at individual and househol... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2759913 Wed, 02 Sep 2009 23:00:00 +0100 2759913 http://www.medworm.com/index.php?rid=2759912&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F91%2F1%2F23%3Frss%3D1 The subject of ‘global health’ can be considered from multiple points of view. While epidemiologists might describe global health problems in categories of pathology groups, social scientists might consider the problem from the stand point of institutional and infrastructural strengths and failings. An over-arching theme, however, is that the distribution of the burden of ill health is disproportionately carried by the poor. This paper aims to defend the idea that inequality should be considered the main priority in global ill health. Sources of data Review of the literature, personal communications and the WHO commission on the Social Determinants of Health. Areas of agreement The extent and urgency of global health problems. Areas of controversy The cause of ill health and... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2759912 Wed, 02 Sep 2009 23:00:00 +0100 2759912 http://www.medworm.com/index.php?rid=2759911&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F91%2F1%2F7%3Frss%3D1 Introduction Public health practice is characterized by measuring population health, assessing needs for health care and the provision (directly or indirectly) of services to protect and promote the public's health. It is increasingly explicitly concerned with issues of equity. Sources of data Publications discussing ethical issues in public health. Areas of agreement Unlike the duties of clinicians, professional standards for public health practice are not well defined. An ethics framework would help the development and implementation of public health policy. Areas of controversy Public health strategies have been criticized for being paternalistic and restrictive of personal choice behaviours or for being too pragmatic, and appearing to endorse illegal activities. Growing points Hist... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2759911 Wed, 02 Sep 2009 23:00:00 +0100 2759911 http://www.medworm.com/index.php?rid=2759910&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F91%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2759910 Wed, 02 Sep 2009 23:00:00 +0100 2759910 http://www.medworm.com/index.php?rid=2450230&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F90%2F1%2F133%3Frss%3D1 Introduction The management of unstable slipped upper femoral epiphysis (SUFE) is controversial, with a high risk of developing avascular necrosis (AVN). We meta-analysed two areas of concern: reduction of the slip and the timing of treatment. Methods A search of Medline, CINAHL and Embase identified only retrospectively relevant studies: four regarding the role of reduction and five regarding the timing of treatment. The incidence of AVN was compared between reduced and unreduced SUFEs, and between those treated within 24 h of symptom onset and those treated thereafter. Areas of agreement Analysis of the pooled data gave an odds ratio of 2.20 (P = 0.290) in favour of the unreduced group, who had a lower risk of developing AVN. The odds ratio was 0.50 in favour of the group treated withi... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2450230 Mon, 01 Jun 2009 04:00:00 +0100 2450230 http://www.medworm.com/index.php?rid=2450229&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F90%2F1%2F111%3Frss%3D1 Introduction or background Heavy exercise induces marked immunodepression, which is multifactorial in origin. Evidence showing clinical significance of this immunodepression is scarce. Sources of data We assessed in a systematic manner whether physical activity or intensity of exercise increase susceptibility to upper respiratory tract infections (URTI). A literature search was performed using the keywords ‘upper respiratory tract infections’, ‘athletes’, ‘exercise’ and ‘physical activity’. We considered all studies reporting of the effect of exercise, physical activity, sport and training on susceptibility to URTI. A total of 162 publications were identified and 30 studies were eligible (4 descriptive, 18 observational and 8 interventional)... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2450229 Mon, 01 Jun 2009 04:00:00 +0100 2450229 http://www.medworm.com/index.php?rid=2450228&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F90%2F1%2F85%3Frss%3D1 Introduction Despite advances in knowledge and refinements of technique, the management of flexor tendon injuries within the digital sheath continues to present a formidable challenge. This in turn has led to a massive expansion in search of modified surgical therapies and various adjuvant therapies, which could prevent adhesion formation without compromising digital function. Sources of data A search of PubMed, Medline, CINAHL and Embase databases was performed using the keywords ‘tendon adhesion prevention’, ‘tendon healing’, ‘adhesion prevention in tendons’ and ‘adjuvants for adhesion prevention’. Studies detailing the use of surgical, pharmacological and non-pharmacological agents for adhesion prevention in digital flexor tendons were id... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2450228 Mon, 01 Jun 2009 04:00:00 +0100 2450228 http://www.medworm.com/index.php?rid=2450227&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F90%2F1%2F71%3Frss%3D1 Background Although several epidemiological studies demonstrate the association between resting heart rate (HR) and cardiovascular morbidity and mortality, an elevated HR remains a neglected cardiovascular risk factor. Sources of data This review summarizes the results of published studies on the relationship between elevated HR and cardiovascular risk. Areas of agreement The role of HR in myocardial ischaemia in coronary patients is well known. Experimental data and clinical observations support the importance of HR in the pathophysiology of atherosclerosis and plaque rupture. A large body of evidence points to high resting HR as a risk factor for mortality in various populations, including coronary patients. Areas of controversy HR reduction is suggested to be a mechanism explaining t... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2450227 Mon, 01 Jun 2009 04:00:00 +0100 2450227 http://www.medworm.com/index.php?rid=2450226&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F90%2F1%2F63%3Frss%3D1 Background Increasing numbers of medicines are being made available over the counter in the UK, by purchase in a pharmacy or from other less well-regulated outlets. When this is allowed by the Licensing Authority, it is often subject to certain restrictions. However, some drugs that could usefully be converted from prescription-only medicines (PoM status) to over-the-counter sales in a pharmacy (P status) are not suitable for full over-the-counter status, even with restrictions; and in some cases restrictions vitiate the usefulness of the medicine. Areas of agreement Drugs that can acceptably be switched from PoM status to P status include those that are used in the treatment of minor ailments or injuries, for health promotion or in palliative care. Areas of controversy However, not all ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2450226 Mon, 01 Jun 2009 04:00:00 +0100 2450226 http://www.medworm.com/index.php?rid=2450225&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F90%2F1%2F53%3Frss%3D1 This article considers the process of re-classification of prescription drugs from prescription-only medications to over-the-counter (OTC) prescription drugs. Sources of data The recent change in classification for emergency contraception and simvastatin is explored in detail with similarities and differences being considered for a similar argument to be made for sildenafil. Areas of agreement The benefits for patients, physicians and other healthcare professionals are considered in detail. Areas of controversy We raise concerns about recently developed and existing patient group directions that, although extensive in their assessment, may omit to identify significant contributory factors which would necessitate appropriate medical intervention. Growing points While the decision for re... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2450225 Mon, 01 Jun 2009 04:00:00 +0100 2450225 http://www.medworm.com/index.php?rid=2450224&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F90%2F1%2F37%3Frss%3D1 Background Rotaviruses (RVs) are an important cause of acute gastroenteritis in infants and young children worldwide, resulting in more than 600 000 deaths per annum, mainly in developing countries. Since the 1980s, there has been intensive research on the development of RV vaccine candidates, and since 2006 two vaccines have been licensed in many countries. Sources of data The scientific literature since the 1970s has been consulted, and the results of original research carried out in authors' laboratories were used. Areas of agreement There are firmly established data on virus particle structure, genome composition, gene–protein assignment, protein-function assignment (incomplete), virus classification, the mechanisms of several steps of the replication cycle (adsorption, primary... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2450224 Mon, 01 Jun 2009 04:00:00 +0100 2450224 http://www.medworm.com/index.php?rid=2450223&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F90%2F1%2F19%3Frss%3D1 Introduction Cellular reprogramming is the process of directing mature cells to a primitive state of gene expression. Sources of data Medline searches using the keywords ‘pluripotency’, ‘induce’ (and derivatives), and/or ‘stem’ limited to the years 2006 to the present and other selected literature known to the author. Areas of agreement Since 2006, there has been a cavalcade of scientific works describing so-called ‘direct reprogramming’ wherein somatic cells are forced into a state of gene expression very similar to embryonic stem cells. These findings build upon prior research using nuclear transfer (cloning) and even older efforts to understand developmental processes. Areas of controversy While already of tremendous research value, it ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2450223 Mon, 01 Jun 2009 04:00:00 +0100 2450223 http://www.medworm.com/index.php?rid=2450222&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F90%2F1%2F7%3Frss%3D1 Introduction This review identifies an agenda for global health by highlighting the current ‘grand challenges’ related to governance. Sources Literature from the disciplines of health policy and medicine, conference presentations and documents, and materials from international agencies (such as the World Health Organization). Areas of agreement The present approach to global health governance has proven to be inadequate and major changes are necessary. Areas of controversy The source of problems behind the current global health governance challenges have not always been agreed upon, but this paper attempts to highlight the recurrent themes and topics of consensus that have emerged in recent years. Growing points and areas timely for developing research A solution to the &ls... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2450222 Mon, 01 Jun 2009 04:00:00 +0100 2450222 http://www.medworm.com/index.php?rid=2450221&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F90%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2450221 Mon, 01 Jun 2009 04:00:00 +0100 2450221 http://www.medworm.com/index.php?rid=2226461&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F89%2F1%2F183%3Frss%3D1 Introduction Aicardi–Goutières syndrome (AGS) is an autosomal recessive encephalopathy characterized by acquired microcephaly, cerebral calcifications, leukodystrophy, cerebral atrophy and cerebrospinal fluid findings of chronic lymphocytosis and raised interferon-alpha (INF-alpha). The main extraneurological symptoms are chilblain-like skin lesions, usually on the fingers, toes and ears. Sources of data This review is based on a search of the published literature on AGS from 1984 onwards (particularly the most recent papers) and on knowledge and experience gained through the authors' work with the International Aicardi-Goutières Syndrome Association (IAGSA). Areas of agreement It is accepted that AGS can be mistaken for a congenital infection and that the diagnostic ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2226461 Mon, 02 Mar 2009 05:00:00 +0100 2226461 http://www.medworm.com/index.php?rid=2226460&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F89%2F1%2F169%3Frss%3D1 Introduction Ultrasound is widely used for imaging purposes and as an adjunct to physiotherapy. Low-intensity pulsed ultrasound (LIPUS), having removed the thermal component found at higher intensities, is used to improve bone healing. However, its potential role in soft-tissue healing is still under investigation. Material and methods We searched on Medline using the keywords: low-intensity pulsed ultrasound, LIPUS and LIPUS and soft-tissue healing. Thirty-two suitable articles were identified. Results Research, mainly pre-clinical, so far has shown encouraging result, with LIPUS able to promote healing in various soft tissues such as cartilage, inter-vertebral disc, etc. The effect on the bone-tendon junction, however, is primarily on bone. The role of LIPUS in treating tendinopathies ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2226460 Mon, 02 Mar 2009 05:00:00 +0100 2226460 http://www.medworm.com/index.php?rid=2226459&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F89%2F1%2F153%3Frss%3D1 Background Hepatitis C virus (HCV) is a major cause of liver disease worldwide. In industrialized countries, intravenous drug users (IDUs) are the main reservoir of infection. Relatively little information is available on HCV in the developing world. Sources of data Peer reviewed publications and presentations at major academic meetings. Areas of agreement HCV-related cirrhosis and death from hepatocellular carcinoma are likely to rise dramatically in the next three decades. Urgent intervention is required both to minimize the burden of disease in those already infected and to reduce the incidence of new infections, particularly in the IDU population. Areas of controversy Current models of care and commissioning in the UK and other countries do not adequately identify or treat HCV infec... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2226459 Mon, 02 Mar 2009 05:00:00 +0100 2226459 http://www.medworm.com/index.php?rid=2226458&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F89%2F1%2F111%3Frss%3D1 Conclusions Results show that ankle arthroplasty is a viable alternative for the management of ankle arthritis in selected patients. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2226458 Mon, 02 Mar 2009 05:00:00 +0100 2226458 http://www.medworm.com/index.php?rid=2226457&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F89%2F1%2F93%3Frss%3D1 Introduction Infection is a major cause of morbidity and mortality in patients with cystic fibrosis (CF). Research on CF infection has highlighted differences from other respiratory infections—both in the range and the nature of the organisms—especially in chronic infection. This is a rapidly advancing field of microbiology and is bringing insights into the complexity and adaptations of bacteria causing chronic infection in the respiratory tract. Areas of agreement and controversy The epidemiology of some infections in CF has changed, with reduction in spread of Burkholderia cenocepacia following patient segregation. Conversely, epidemic strains of Pseudomonas aeruginosa have emerged, which spread between patients; previously, most P. aeruginosa strains were patient-specific. ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2226457 Mon, 02 Mar 2009 05:00:00 +0100 2226457 http://www.medworm.com/index.php?rid=2226456&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F89%2F1%2F79%3Frss%3D1 Conclusion Emerging evidence suggests opportunities where Resuscitation Guidelines could be strengthened by focusing on specific aspects of the chain of survival. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2226456 Mon, 02 Mar 2009 05:00:00 +0100 2226456 http://www.medworm.com/index.php?rid=2226455&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F89%2F1%2F63%3Frss%3D1 This article describes myocardial perfusion scintigraphy (MPS) and summarizes evidence for its role in stable CAD and acute coronary syndromes with particular reference to current guidelines. Areas of agreement MPS has been extensively validated for the cost-effective diagnosis and prognosis of functionally significant CAD in both the acute and chronic settings. Its use is emphasized in the current NICE, national and international guidelines. Areas of controversy Although normal MPS is associated with good outcomes, assessments of subclinical atherosclerosis such as coronary artery calcium scoring and computed tomography coronary angiography (CTA) demonstrate that non-flow-limiting CAD remains prognostically important. Growing points Technological developments, such as attenuation corre... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2226455 Mon, 02 Mar 2009 05:00:00 +0100 2226455 http://www.medworm.com/index.php?rid=2226454&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F89%2F1%2F41%3Frss%3D1 Sources of data We conducted a systematic review of the current literature for this review, but as there are many gaps in the research literature, we have supplemented this by our own clinical experience. Areas of agreement There is a general agreement that Asperger syndrome (AS) is one of the autistic spectrum disorders, that it is a developmental disorder which is either present at birth or develops shortly after and that there is a strong hereditary component. Areas of controversy The fundamental impairment of AS is in the social arena, but what causes this is disputed. We propose that it is a disorder of non-verbal communication. Another important area of controversy is the extent to which AS may remit. Growing points Many people with AS develop secondary psychiatric disorders in ad... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2226454 Mon, 02 Mar 2009 05:00:00 +0100 2226454 http://www.medworm.com/index.php?rid=2226453&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F89%2F1%2F23%3Frss%3D1 Background Since many anti-cancer agents act by inflicting DNA damage on tumour cells, there is increasing interest in the use of inhibitors of DNA repair to increase the cytotoxicity of these agents. Poly(ADP-ribose) polymerase (PARP) is an abundant nuclear enzyme that binds to sites of DNA damage and promotes repair by modifying a number of key proteins. Potent and specific inhibitors of PARP are available; these have been shown to increase the cytotoxicity of a range of anti-cancer agents including temozolomide, irinotecan and radiation. Sources of data Data from laboratory studies on human tumour cell lines, pre-clinical studies including tumour xenograft models and early phase clinical testing in human subjects are discussed. Areas of agreement Pre-clinical and early clinical testin... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2226453 Mon, 02 Mar 2009 05:00:00 +0100 2226453 http://www.medworm.com/index.php?rid=2226452&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F89%2F1%2F7%3Frss%3D1 Background The advent of AIDS brought about a group of patients unwilling to accept crucial aspects of the methodological standards for clinical research investigating Phase 1 drugs, surgeries or devices. Their arguments against placebo controls in trials, which depended—at the time—on the terminal status of patient volunteers led to a renewed discussion of the ethics of denying patients with catastrophic illnesses access to last-chance experimental drugs, surgeries or devices. Sources of data Existing ethics and health policy literature on the topic of access to experimental drugs. Areas of agreement The positions of those arguing for or against free access to experimental drugs for terminally ill patients are irreconcilable. Areas of controversy At stake are questions abou... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2226452 Mon, 02 Mar 2009 05:00:00 +0100 2226452 http://www.medworm.com/index.php?rid=2226451&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F89%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2226451 Mon, 02 Mar 2009 05:00:00 +0100 2226451 http://www.medworm.com/index.php?rid=2031975&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F88%2F1%2F171%3Frss%3D1 Conclusion We stress the need for well-designed adequately powered randomized controlled trials to be able to understand which of these operative techniques is really superior to the others. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2031975 Thu, 11 Dec 2008 05:00:00 +0100 2031975 http://www.medworm.com/index.php?rid=2031974&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F88%2F1%2F157%3Frss%3D1 Introduction Coeliac disease is a common but often under diagnosed condition with important complications. It is due to immune-mediated gluten intolerance and may present in a number of ways. It has become more frequently diagnosed due to the recognition of the atypical presentations. In recent years, more sensitive and specific serological markers have been developed but the gold standard of diagnosis remains duodenal biopsy. Compliance with a strict, lifelong gluten-free diet is the cornerstone of management, improving symptoms and reducing complications of the disease. Sources of data For this review, we focused on papers published on coeliac disease in recent years. Particular emphasis was given to clinical papers examining new methods for the diagnosis of coeliac disease or newer the... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2031974 Thu, 11 Dec 2008 05:00:00 +0100 2031974 http://www.medworm.com/index.php?rid=2031973&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F88%2F1%2F147%3Frss%3D1 Conclusions IPC appears to be an effective modality to enhance fracture and soft-tissue healing. However, the number of subjects in human studies is small, and adequately powered randomized controlled trials in humans are required to produce stronger clinically relevant evidence. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2031973 Thu, 11 Dec 2008 05:00:00 +0100 2031973 http://www.medworm.com/index.php?rid=2031972&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F88%2F1%2F131%3Frss%3D1 Introduction The prevalence of type 2 diabetes and dementia are set to rise inexorably over the next 30–40 years. There are now substantial data to suggest that type 2 diabetes is associated with an increased risk of dementia. Sources of data This is a narrative review using data from individual studies and review articles known to the authors. A Medline search was also undertaken and reference lists were reviewed to identify additional relevant studies. Areas of agreement Type 2 diabetes is associated with an increased risk of both Alzheimer's and Vascular dementia, although the reality is that many affected individuals have mixed forms of dementia. Areas of controversy The mechanisms underpinning this association remain to be clearly delineated. Type 2 diabetes is a complex diso... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2031972 Thu, 11 Dec 2008 05:00:00 +0100 2031972 http://www.medworm.com/index.php?rid=2031971&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F88%2F1%2F115%3Frss%3D1 Background Type 1 diabetes (T1D) is characterized by autoimmune destruction of insulin-producing β-cells in the pancreas resulting from the action of environmental factors on genetically predisposed individuals. The increasing incidence over recent decades remains unexplained, but the capacity of identifying infants at highest genetic risk has become an increasing requirement for potential therapeutic intervention trials. Sources of data Literature searches on T1D and genes were carried out, and key papers since the 1970s were highlighted for inclusion in this review. Areas of agreement Early genetic studies identified the most important region for genetic susceptibility to T1D—the human leukocyte antigen genes on chromosome 6; later shown to contribute approximately half of t... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2031971 Thu, 11 Dec 2008 05:00:00 +0100 2031971 http://www.medworm.com/index.php?rid=2031970&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F88%2F1%2F95%3Frss%3D1 Introduction/background Inflammatory bowel disease (IBD) results from complex interactions between: host genome, immune system, mucosa, bacteria, and environment. Sources of data Review of PubMed database using search terms ‘bacteria and inflammatory bowel disease’ and ‘genetics and inflammatory bowel disease’. PubMed ‘related reference’ feature and references from retrieved articles were examined. Areas of agreement IBD results from interaction between the microbiota of the gut and the immune system. Key gene defects associated with IBD are involved in bacterial recognition and processing. The environment at least modifies and may determine pathogenesis. Areas of controversy It has been disputed whether the primary defect in IBD is immunological or b... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2031970 Thu, 11 Dec 2008 05:00:00 +0100 2031970 http://www.medworm.com/index.php?rid=2031969&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F88%2F1%2F75%3Frss%3D1 This article provides evidence-based information on the key aspects of managing AF which is based on major guidelines, landmark clinical trials and meta-analyses. Areas of agreement It is well recognized that both rate control and rhythm control are important strategies for the management of AF, but each approach should be chosen according to individual patient circumstances. A vast majority of elderly, relatively asymptomatic patients will benefit from ventricular rate control. Embolic stroke remains a major complication of AF. Yet, anticoagulation with warfarin remains underprescribed, especially in the elderly due to the presumed risk of bleeding. The technique of catheter ablation continues to improve and is generally successful in younger patients with relatively normal hearts. Area... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2031969 Thu, 11 Dec 2008 05:00:00 +0100 2031969 http://www.medworm.com/index.php?rid=2031968&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F88%2F1%2F59%3Frss%3D1 Background The burden of human papillomavirus (HPV)-associated ano-genital disease is significant but the ability to generate HPV virus-like particles by the synthesis and self-assembly in vitro of the major virus coat protein L1 has transformed our prospects for preventing benign and malignant ano-genital disease caused by the common genital HPV types. Sources of data Peer reviewed journals. Areas of agreement Two HPV L1 vaccines have been developed, a quadrivalent HPV 6/11/16/18, and a bivalent HPV 16/18 product. Both vaccines are very immunogenic and well tolerated. They have been shown in the various randomized Control trials to be very effective at preventing infection and premalignant disease related to the vaccine HPV genotypes in women who were DNA negative and sero negative for ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2031968 Thu, 11 Dec 2008 05:00:00 +0100 2031968 http://www.medworm.com/index.php?rid=2031967&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F88%2F1%2F43%3Frss%3D1 Background People with schizophrenia have difficulties in interpreting social information. Much social information is gathered from faces, and face processing represents a well-characterized model to study the basis of social deficits in schizophrenia. Sources of data A narrative review of selected literature. Areas of agreement Individuals with schizophrenia have impairments in recognizing basic emotions and making social judgements from facial stimuli. Areas of controversy The neural basis of these abnormalities is still being determined. However, initial evidence implicates dysfunction of frontal and temporal lobe brain regions. Hyper-activation of the amygdala, a brain region involved in fear, to facial stimuli may be an important underlying neural abnormality. Growing points The p... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2031967 Thu, 11 Dec 2008 05:00:00 +0100 2031967 http://www.medworm.com/index.php?rid=2031966&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F88%2F1%2F23%3Frss%3D1 Background The time around a patient's death is often filled with sadness, but good medical and nursing care can provide comfort to patients and their carers at this critical time. For many, a ‘pain-free’ death is a priority although there are other aspects to providing good care at the end of life. Honest, open discussion with patients and carers about their wishes is an essential prerequisite to individualized care. Sources of data Relevant literature was reviewed with regards to policy, education and delivery of end of life care. Areas of agreement Pain management must be tailored to the individual with due regard to the route of analgesic administration in those unable to swallow, and consideration to the other circumstances surrounding a person's care. All staff caring f... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2031966 Thu, 11 Dec 2008 05:00:00 +0100 2031966 http://www.medworm.com/index.php?rid=2031965&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F88%2F1%2F7%3Frss%3D1 Background Psychological reactions to terror attacks have been documented as ranging from no symptoms to transient behavioural symptoms to more serious posttraumatic stress. Sources of data A review of representative studies is presented, with a critical analysis of the salient points of the various psychological intervention strategies for terrorist attacks. Areas of agreement Common aspects of both most intervention approaches include multifaceted models that foster social support and include a preparatory phase, a phase of ‘psychological first aid’ and a follow-up phase of referral for more severe cases. Areas of controversy The notion of intervention for all who may show some symptoms is not universally accepted. Where treatment or intervention is used, the debriefing as... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2031965 Thu, 11 Dec 2008 05:00:00 +0100 2031965 http://www.medworm.com/index.php?rid=2031964&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F88%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=2031964 Thu, 11 Dec 2008 05:00:00 +0100 2031964 http://www.medworm.com/index.php?rid=1787988&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F87%2F1%2F175%3Frss%3D1 This article summarizes the current use of anti-HIV medication and the evidence behind it for the non-specialist. Areas timely for developing research New strategies for using current drugs, the best use of newly available drugs and new uses of antiretroviral drugs, such as in prevention of HIV transmission, are key areas for research. Further research addressing the question of when to start antiretrovirals and assessing their long-term effects is also needed. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1787988 Fri, 12 Sep 2008 04:00:00 +0100 1787988 http://www.medworm.com/index.php?rid=1787987&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F87%2F1%2F163%3Frss%3D1 Introduction Driving is recognized to be a visually intensive task and accordingly there is a legal minimum standard of vision required for all motorists. The purpose of this paper is to review the current United Kingdom (UK) visual requirements for driving and discuss the evidence base behind these legal rules. The role of newer, alternative tests of visual function that may be better indicators of driving safety will also be considered. Finally, the implications of ageing on driving ability are discussed. Sources of data A search of Medline and PubMed databases was performed using the following keywords: driving, vision, visual function, fitness to drive and ageing. In addition, papers from the Department of Transport website and UK Royal College of Ophthalmologists guidelines were stud... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1787987 Fri, 12 Sep 2008 04:00:00 +0100 1787987 http://www.medworm.com/index.php?rid=1787986&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F87%2F1%2F131%3Frss%3D1 Conclusion Further studies are required to evaluate the reliability, validity and sensitivity of the elbow scoring systems used in the common clinical practice. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1787986 Fri, 12 Sep 2008 04:00:00 +0100 1787986 http://www.medworm.com/index.php?rid=1787985&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F87%2F1%2F97%3Frss%3D1 Introduction Pancreatic cancer is a devastating malignancy and a leading cause of cancer mortality. Furthermore, early diagnosis represents a serious hurdle for clinicians, as symptoms are non-specific and usually manifest in advanced, treatment-resistant stages of the disease. Sources of data Here, we review the rationale and progress of targeted therapies currently under investigation. Areas of agreement At present, chemoradiation regimes are administered palliatively, and produce only marginal survival benefits, underscoring a desperate need for more effective treatment modalities. Areas of controversy Questions have been raised as to whether erlotinib, the only targeted therapy to attain a statistically significant increase in median survival, is cost-effective. Growing points The ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1787985 Fri, 12 Sep 2008 04:00:00 +0100 1787985 http://www.medworm.com/index.php?rid=1787984&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F87%2F1%2F77%3Frss%3D1 This article re-visits the intricate structure of articular cartilage and reviews the different methods of regeneration described in the literature, based on evidence-based effectiveness. The methods described by their originators and their results are considered gold standards for those methods, as being the best available evidence. Areas of agreement Majority of the authors agree that cartilage injuries are complex and difficult to treat. If untreated, cartilage defects lead to early osteoarthritis. Great debate still persists about the best available treatment for symptomatic chondral or osteochondral defect(s). Areas of controversy The controversy about the management outplays its aetiological theories. Several authors have reported good results with different techniques; however non... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1787984 Fri, 12 Sep 2008 04:00:00 +0100 1787984 http://www.medworm.com/index.php?rid=1787983&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F87%2F1%2F63%3Frss%3D1 Introduction The term quorum sensing (QS) is used to describe communication between bacterial cells, whereby a coordinated population response is controlled by diffusible signal molecules produced by individuals. Sources of data Studies on QS-mediated signalling processes in bacteria have revealed the existence of intricate regulatory networks to enable bacterial populations to fine tune their responses to environmental changes and increase their chances of survival, using complex signalling pathways. Areas of agreement A population of bacteria invading a host may benefit from the coordinated release of virulence determinants and in vitro studies have shown that QS regulates virulence factor production in many species of bacteria. Areas of controversy However, the role of QS in vivo is ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1787983 Fri, 12 Sep 2008 04:00:00 +0100 1787983 http://www.medworm.com/index.php?rid=1787982&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F87%2F1%2F49%3Frss%3D1 Introduction Patients with chronic lymphocytic leukaemia (CLL) have progressive immunodeficiency and infection is the commonest cause of death. This review seeks to identify the extent of the abnormality, its cause, clinical significance and any possible remedy. Sources of data TJH has studied CLL for the past 40 years and has scanned or read every paper he could find published on the topic since 1970 and most of those of historical importance published before that date. He has read around the subject, covering relevant articles on immunology, cell biology, oncology and genetics. Furthermore, he has attended most major meetings dealing with CLL in this time and has written many reviews to update the state of knowledge about the topic. He receives weekly updates of papers published on CLL ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1787982 Fri, 12 Sep 2008 04:00:00 +0100 1787982 http://www.medworm.com/index.php?rid=1787981&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F87%2F1%2F31%3Frss%3D1 We report on the current cell types, materials and methods being investigated for developing a tissue-engineered myocardial construct. Areas of agreement Generally, there is agreement that a ‘vehicle’ is required to transport cells to the infarcted heart to help myocardial repair and regeneration. Areas of controversy Suitable cell source, biomaterials, cell environment and implantation time post-infarction remain obstacles in the field of MTE. Growing points Research is being focused on optimizing natural and synthetic biomaterials for tissue engineering. The type of cell and its origin (autologous or derived from embryonic stem cells), cell density and method of cell delivery are also being explored. Areas timely for developing research The possibility is being explored t... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1787981 Fri, 12 Sep 2008 04:00:00 +0100 1787981 http://www.medworm.com/index.php?rid=1787980&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F87%2F1%2F17%3Frss%3D1 Introduction or background It has long been recognized from epidemiological data that inflammatory bowel diseases (IBD), Crohn's disease (CD) and ulcerative colitis (UC), have a strong genetic predisposition, interacting with unknown environmental drivers to render susceptible individuals at risk for relapsing intestinal inflammation. Substantial progress has been made in the last 2 years in characterizing the susceptibility genes involved. Sources of data The recent acceleration in understanding has resulted from the use of new technologies of genome-wide association scanning in large panels of cases and controls. Areas of agreement Genome scans have robustly identified 11 susceptibility genes and loci and highlighted a number of new, previously unsuspected pathways as playing an import... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1787980 Fri, 12 Sep 2008 04:00:00 +0100 1787980 http://www.medworm.com/index.php?rid=1787979&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F87%2F1%2F7%3Frss%3D1 Introduction Progression of world records (WRs) in athletics is a reliable mean to assess the potentiality of the human body, which also reflects how society has evolved over time and will continue to evolve. We conducted a quantitative analysis of WRs in measurable Olympic events from nine representative disciplines (100, 400, 1500, 10 000 m, marathon, long jump, high jump, shot put and javelin throw) in order to identify progression and trends. Sources of data Data were gathered for the years 1900–2007 from the database of the International Olympic Committee. Areas of agreement Overall, the relative improvement of athletic performance was higher in women than in men, being nearly doubled across the different specialities. The biggest increases were observed for javelin throw and ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1787979 Fri, 12 Sep 2008 04:00:00 +0100 1787979 http://www.medworm.com/index.php?rid=1787978&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F87%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1787978 Fri, 12 Sep 2008 04:00:00 +0100 1787978 http://www.medworm.com/index.php?rid=1484723&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F86%2F1%2F129%3Frss%3D1 This article reviews the data from randomized controlled trials for the current therapeutic agents available in the UK. It also reviews new trial data for promising osteoporosis therapies, in particular Denosumab, a monoclonal antibody against RANK ligand. Areas of agreement Bisphosphonates are the current recommended first-line treatments for patients with osteoporosis. Areas of controversy/growing points There are a number of patients where bisphosphonates are contraindicated. Under these circumstances, it is important that clinicians have access to alternative treatments. The long-awaited National Institute for Health and Clinical Excellence (NICE) technology appraisals for both primary and secondary prevention and the clinical guidelines will clarify this. Treatment decisions should ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1484723 Mon, 02 Jun 2008 04:00:00 +0100 1484723 http://www.medworm.com/index.php?rid=1484722&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F86%2F1%2F109%3Frss%3D1 Introduction Parkinson's disease (PD) is one of the most common neurodegenerative disorders. Sources of data Literature search using Medline with keywords Parkinson's disease supplemented with previously published papers known to the author. Areas of agreement There have been significant recent advances in the understanding of the pathogenesis of the disease. There has also been a greater realization that the disorder may be associated with significant non-motor disturbances in addition to the more commonly recognized motor complications. Areas of controversy Although there is growing circumstantial evidence, it remains to be proven whether any of the current treatments for PD have a neuroprotective effect. Areas timely for developing research Although there is no cure, there are sever... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1484722 Mon, 02 Jun 2008 04:00:00 +0100 1484722 http://www.medworm.com/index.php?rid=1484721&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F86%2F1%2F95%3Frss%3D1 Introduction Since ancient times, competitive athletes have been familiar with the use of ergogenic aids and they will probably continue to use unfair and harmful substances in future, because their inclination to victory, along with the mirage of glory and money, will probably overcome health and legal risks. Sources of data We searched PubMed using the term doping over the period 1990 to the present day. We also included non-English journals. Areas of agreement By literature searching, it emerges that the phenomenon of doping is complex and multifaceted. It involves a number of causes and factors that do not originate solely in the athletic field, making universality its main feature. It is in fact observed in all ages and levels of competition, and it concerns all sports, even the mos... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1484721 Mon, 02 Jun 2008 04:00:00 +0100 1484721 http://www.medworm.com/index.php?rid=1484720&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F86%2F1%2F77%3Frss%3D1 Background Turner syndrome (TS) is a genetic disorder associated with abnormalities of the X chromosome, occurring in about 50 per 100 000 liveborn girls. TS is usually associated with reduced adult height, gonadal dysgenesis and thus insufficient circulating levels of female sex steroids leading to premature ovarian failure and infertility. The average intellectual performance is within the normal range. New insight into genetics, epidemiology, cardiology, endocrinology and metabolism from a number of recent studies will be included in this review. Sources of data For this review we concentrated on all papers published on TS with special emphasis on the most recent literature. Also papers relating to cardiology, especially aortic dissection, paediatrics and the effects of estradiol in ot... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1484720 Mon, 02 Jun 2008 04:00:00 +0100 1484720 http://www.medworm.com/index.php?rid=1484719&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F86%2F1%2F59%3Frss%3D1 Background The global obesity epidemic has raised concerns about the risk of a tide of Type 2 diabetes (T2DM) in childhood. This paper aims to review the recent data on the epidemiology of this problem as well as the clinical concerns. Sources of data A literature search was performed on Medline, and articles about childhood T2DM, in English and published from 2000 to 2008, were reviewed. Areas of agreement A review of 16 paediatric studies suggest that although T2DM is now more widely reported in childhood, the numbers are still reasonably small although the data do suggest that ethnicity is an important risk factor. Areas of controversy Although there are emerging data on what appears to be a significant risk of both microvascular and macrovascular complications in youth onset T2DM, t... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1484719 Mon, 02 Jun 2008 04:00:00 +0100 1484719 http://www.medworm.com/index.php?rid=1484718&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F86%2F1%2F33%3Frss%3D1 Discussion/conclusion Most injuries caused in children's sports are minor and self-limiting, suggesting that children and youth sports are safe. The training programmes should take into account their physical and psychological immaturity, so that growing athletes can adjust to the changes in their bodies. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1484718 Mon, 02 Jun 2008 04:00:00 +0100 1484718 http://www.medworm.com/index.php?rid=1484717&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F86%2F1%2F23%3Frss%3D1 Background A long-standing challenge in the treatment of depression is the development of a rapidly acting antidepressant. Conventional antidepressants typically require 2–8 weeks for clinical remission. In contrast, chronobiological interventions such as sleep deprivation treatment dramatically reduce depressive symptoms within 24–48 h in 40–60% of depressed subjects. It is hypothesized that fast-acting treatments for depression may alter circadian rhythms through chronobiological mechanisms relevant to clock gene function. Sources of data A bibliographic review using Entrez PubMed® with Boolean search terms ‘circadian’ and ‘depressive’ identified more than 1000 clinical papers published over a 40-year period (1966–present). Areas of a... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1484717 Mon, 02 Jun 2008 04:00:00 +0100 1484717 http://www.medworm.com/index.php?rid=1484716&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F86%2F1%2F7%3Frss%3D1 Background Current surgical techniques for the repair of the musculoskeletal system can be often limited by the availability, quality and quantity of materials, such as grafts to effect repair. This has led to the exploration and development of novel methods of intervention based on tissue engineering and regenerative medicine. Source of data This review summarizes the successes and investigations which are happening to date in the field of musculoskeletal tissue engineering. This is based on an extensive literature search and through basic research being performed by the authors. Areas of agreement Due to the constraints surrounding certain surgical techniques and restrictions on their use, novel procedures are required for the repair and regeneration of damaged tissues. Areas of contr... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1484716 Mon, 02 Jun 2008 04:00:00 +0100 1484716 http://www.medworm.com/index.php?rid=1484715&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F86%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1484715 Mon, 02 Jun 2008 04:00:00 +0100 1484715 http://www.medworm.com/index.php?rid=1293679&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F85%2F1%2F151%3Frss%3D1 Introduction During the past decades, health care of patients born with congenital heart disease (CHD) has improved substantially, leading to a growing population of adult survivors. Source of data Using the recently published and relevant data on adult CHD (ACHD), we reviewed the most common congenital heart defects and discussed important related issues. Areas of agreement Adults with CHD most often require specialized medical or surgical care in a tertiary centre. However, this population also need local follow-up; general practitioners and other specialists therefore have to face the complexity of their disease. Areas of controversies Management of pregnancy, non-cardiac surgery, arrhythmias and endocarditis prophylaxis may be challenging in patients with CHD and should be adapted t... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1293679 Tue, 11 Mar 2008 04:00:00 +0100 1293679 http://www.medworm.com/index.php?rid=1293678&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F85%2F1%2F127%3Frss%3D1 Conclusions There have been exciting advances in the treatment of nAMD and increased understanding of the genetics and pathogenic mechanisms involved will hopefully lead to the development of new therapies in the future. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1293678 Tue, 11 Mar 2008 04:00:00 +0100 1293678 http://www.medworm.com/index.php?rid=1293677&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F85%2F1%2F113%3Frss%3D1 Discussion With all other influences controlled, ageing does not influence quality of life negatively; rather a long period of good quality of life is possible. Therefore, the maintenance and improvement quality of life should be included among the goals of clinical management. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1293677 Tue, 11 Mar 2008 04:00:00 +0100 1293677 http://www.medworm.com/index.php?rid=1293676&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F85%2F1%2F101%3Frss%3D1 Conclusions Riders are quick to adopt safety measures. Helmet usage is now increasingly common and handlebar adaptations have been discontinued. Although the sport has a reputation for speed and risk with research and awareness, injury prevention measures are being adopted making the sport as safe as possible. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1293676 Tue, 11 Mar 2008 04:00:00 +0100 1293676 http://www.medworm.com/index.php?rid=1293675&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F85%2F1%2F87%3Frss%3D1 Conclusions Gastric cancer is now arguably one of the most understood malignancies, and real progress is being made towards eradicating this global killer. Much work still needs to be done to define the optimal approach for eradicating the causative agent, namely H. pylori infection. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1293675 Tue, 11 Mar 2008 04:00:00 +0100 1293675 http://www.medworm.com/index.php?rid=1293674&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F85%2F1%2F63%3Frss%3D1 The bicuspid aortic valve (BAV) is the most common congenital cardiac malformation. A literature search was performed using the key words ‘bicuspid aortic valve’, ‘pathophysiology’, ‘exercise’ and ‘training’. BAV is the result of a complex developmental process where several genes seem to lead to abnormal valvulogenesis. Complications associated with BAV include aortic stenosis (AS) and regurgitation, infective endocarditis and aortic dilation and dissection. Moreover, BAV may be associated with other cardiovascular anomalies, mainly aortic coarctation. There is greater awareness of BAV in the young population who practice sport, with an increasing interest on the impact of regular and competitive exercise on athletes with BAV. The early iden... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1293674 Tue, 11 Mar 2008 04:00:00 +0100 1293674 http://www.medworm.com/index.php?rid=1293673&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F85%2F1%2F47%3Frss%3D1 Background Advances in the stem cell field provide much hope for the use of these cells in the regeneration of ocular tissue damaged by diseases for which no treatments are yet available. Here, we discuss the current status and limitations on the application of stem cells to ocular therapies, and consider the future prospects for their use in the restoration of vision. Source of data The review summarizes the achievements to date and the present areas of stem cell investigations in the ophthalmic field, based on a literature search and knowledge gained by the authors' work in the subject. Areas of agreement Owing to its accessibility, the cornea constitutes an easy anatomical target for stem cell regeneration. On this basis, limbal epithelial stem transplantation is the only ocular cell-... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1293673 Tue, 11 Mar 2008 04:00:00 +0100 1293673 http://www.medworm.com/index.php?rid=1293672&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F85%2F1%2F35%3Frss%3D1 Introduction The chemical marking of the DNA and surrounding histone proteins represent some of the means by which gene expression is controlled. Many of these epigenetic modifications are pre-programmed and are an important part of the control of development. Sources of data There is an accumulating body of evidence from clinical genetics and animal work that suggests some epigenetic processes may also be labile. Areas of agreement A number of these studies have demonstrated that the epigenetic status of genes can be altered through environmental events such as in vitro culture of embryos and exposure to toxins, sometimes resulting in disease. Areas of controversy More routine variations in life events may also be encoded by changes in the epigenetic status of genes, and as such these ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1293672 Tue, 11 Mar 2008 04:00:00 +0100 1293672 http://www.medworm.com/index.php?rid=1293671&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F85%2F1%2F17%3Frss%3D1 Introduction Alkylating agents are frequently used in the chemotherapy of many types of cancer. This group of drugs mediates cell death by damaging DNA and therefore, understandably, cellular DNA repair mechanisms can influence both their antitumour efficacy and their dose-limiting toxicities. Sources of data This review focuses on the mechanism of action of the DNA repair protein, O6-methylguanine-DNA methyltransferase (MGMT) and its exploitation in cancer therapy and reviews the current literature. Areas of agreement MGMT can provide resistance to alkylating agents by DNA damage reversal. Inhibition of tumour MGMT by pseudosubstrates to overcome tumour resistance is under clinical evaluation. In addition, MGMT overexpression in haematopoietic stem cells has been shown in animal models ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1293671 Tue, 11 Mar 2008 04:00:00 +0100 1293671 http://www.medworm.com/index.php?rid=1293670&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F85%2F1%2F7%3Frss%3D1 Introduction and sources of data This paper briefly outlines the history of research on the recently dead, before critically exploring 1. In what sense can we harm the dead? 2. What are the justificatory arguments for employing family or parental consent for medical research on dead relatives? Areas of agreement, controversy, growing points of interest and areas timely for developing research The controversy surrounding harm in relation to research on dead bodies largely depends on how dead people are perceived. That is, 1. As Cadavers 2. As Ante-mortem persons 3. By Significant others Controversy over whether we need to have consent from significant others (bereaved relatives) depends on the weight we give to the bereaved and their experience of the dead. Underst... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1293670 Tue, 11 Mar 2008 04:00:00 +0100 1293670 http://www.medworm.com/index.php?rid=1293669&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F85%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1293669 Tue, 11 Mar 2008 04:00:00 +0100 1293669 http://www.medworm.com/index.php?rid=1149229&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F84%2F1%2F117%3Frss%3D1 Conclusions The concept of SLN has been well validated and is the standard of care in early breast cancer. A multidisciplinary approach and structured training is the key to the successful introduction of the technique. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1149229 Wed, 09 Jan 2008 05:00:00 +0100 1149229 http://www.medworm.com/index.php?rid=1149228&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F84%2F1%2F99%3Frss%3D1 Trachoma is the most common infectious cause of blindness worldwide. It afflicts some of the poorest regions of the globe, predominantly in Africa and Asia. The disease is initiated in early childhood by repeated infection of the ocular surface by Chlamydia trachomatis. This triggers recurrent chronic inflammatory episodes, leading to the development of conjunctival scarring. This scar tissue contracts, distorting the eyelids (entropion) causing contact between the eyelashes and the surface of the eye (trichiasis). This compromises the cornea and blinding opacification often ensues. The World Health Organization is leading a global effort to eliminate Blinding Trachoma, through the implementation of the SAFE strategy. This involves surgery for trichiasis, antibiotics for infection, facial ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1149228 Wed, 09 Jan 2008 05:00:00 +0100 1149228 http://www.medworm.com/index.php?rid=1149227&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F84%2F1%2F81%3Frss%3D1 Background Endoscopic ultrasound (EUS) represents one of the most significant developments in endoscopy over the past 20 years. It allows highly detailed assessment of the gastrointestinal wall layers as well as to visualize extraluminal structures such as the mediastium and retroperitoneum. Methods The literature was reviewed to assess the role of EUS in cancer staging. Results EUS is an integral part of the staging of many upper gastrointestinal cancers as well as rectal and lung cancer and has been shown to be cost-effective. It can be used to confirm malignancy in suspicious lesions as well as to identify and confirm nodal or metastatic spread. It has been used to re-stage cancers following chemoradiotherapy, but results are disappointing. Future developments are discussed, which may... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1149227 Wed, 09 Jan 2008 05:00:00 +0100 1149227 http://www.medworm.com/index.php?rid=1149226&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F84%2F1%2F69%3Frss%3D1 Conclusions Considered together, these studies indicate that not only are emotions engaged during moral cognition, but that emotions, particularly those mediated by VMPC, are in fact critical for human morality. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1149226 Wed, 09 Jan 2008 05:00:00 +0100 1149226 http://www.medworm.com/index.php?rid=1149225&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F84%2F1%2F49%3Frss%3D1 Background Since the advent of effective antiretroviral therapy, infection with the human immunodeficiency virus has been transformed, in the Western world, to a chronic disease associated with a variety of metabolic complications. Aims This review provides a brief summary of our current understanding of the epidemiology, clinical presentation and therapeutic approaches of what is termed ‘the HIV-associated lipodystrophy syndrome’ and of HIV-associated lipid and glucose metabolic abnormalities. Other metabolic associations including lactic acidosis, HIV-associated bone disease and the effect of the virus on other endocrine pathways are outside the scope of this article. Methods A bibliographic search was performed using Entrez Pubmed®, edition 2.0, by the National Library... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1149225 Wed, 09 Jan 2008 05:00:00 +0100 1149225 http://www.medworm.com/index.php?rid=1149224&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F84%2F1%2F37%3Frss%3D1 Conclusion At present, there is still a lack of quality evidence to advocate the expansion of MIHA. The better designed studies suggest that it should even be limited further to recognized expert centres. The complication rates and learning curve may be altered by changes in training and adapting surgical techniques. We emphasize the need for meticulous design in future studies comparing the outcomes of these two procedures. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1149224 Wed, 09 Jan 2008 05:00:00 +0100 1149224 http://www.medworm.com/index.php?rid=1149223&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F84%2F1%2F25%3Frss%3D1 Conclusion Studies reported an increase in LVEDD and LVPW, following endurance training. However, the heterogeneity of the studies and the sensitivity of echocardiography technique can be two reasons, for which the results do not allow to state unequivocally that the adaptation to endurance training of highly trained hearts stems from increments of diastolic diameter of the left ventricle and lateral wall of the left ventricle (LVPW). (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1149223 Wed, 09 Jan 2008 05:00:00 +0100 1149223 http://www.medworm.com/index.php?rid=1149222&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F84%2F1%2F5%3Frss%3D1 Conclusions Study design characteristics should also be taken into account whenever a study on MRI assessing its diagnostic performance is designed or reviewed. Level of evidence II, systematic review of level II studies. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1149222 Wed, 09 Jan 2008 05:00:00 +0100 1149222 http://www.medworm.com/index.php?rid=1149221&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F84%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1149221 Wed, 09 Jan 2008 05:00:00 +0100 1149221 http://www.medworm.com/index.php?rid=1001493&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F83%2F1%2F379%3Frss%3D1 Conclusions The biological mechanism that regulates the relationship between the thermal dose and the healing process of soft tissues with low or high water content or with low or high blood perfusion is still under study. Microwave diathermy treatment at 434 and 915 MHz can be effective in the short-term management of musculo-skeletal injuries. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1001493 Wed, 17 Oct 2007 04:00:00 +0100 1001493 http://www.medworm.com/index.php?rid=1001492&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F83%2F1%2F355%3Frss%3D1 Conclusions With current studies heterogeneous in terms of the duration of the disorder; type, frequency and total dose of SWT; period of time between SWT; type of management and control group; timing of follow-up and outcomes assessed, a pooled meta-analysis of SWT for lateral elbow tendinopathy was considered inappropriate. In a qualitative systematic per-study analysis identifying common and diverging details of 10 randomized-controlled trials, evidence was found for effectiveness of shock wave treatment for tennis elbow under well-defined, restrictive conditions only. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1001492 Wed, 17 Oct 2007 04:00:00 +0100 1001492 http://www.medworm.com/index.php?rid=1001491&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F83%2F1%2F341%3Frss%3D1 Conclusion Clearly, we have addressed the management of metastatic prostate cancer within the UK setting, though any of these government initiatives may provide a resource and framework in other countries. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1001491 Wed, 17 Oct 2007 04:00:00 +0100 1001491 http://www.medworm.com/index.php?rid=1001490&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F83%2F1%2F325%3Frss%3D1 Objective Most procedures to treat refractive error are based on laser surgery, but other techniques are available. We review the relative advantages and the risk associated with the different surgical options. Areas of agreement Laser refractive surgery is now a safe and effective alternative to glasses or contact lenses. Areas of controversy Because refractive surgery is an area of rapidly developing technology, the relative benefits of the different surgical options remain uncertain. Areas to develop research Controlled trials are needed to provide better guidance as to the relative merits of the different surgical options. Better interventions are required to minimize the biological response after laser surface treatment to eliminate the need for mechanical cutting of a flap for las... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1001490 Wed, 17 Oct 2007 04:00:00 +0100 1001490 http://www.medworm.com/index.php?rid=1001489&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F83%2F1%2F307%3Frss%3D1 Acute gastrointestinal haemorrhage is a common medical emergency that has a hospital mortality of approximately 10%. Peptic ulcer bleeding, complicating non-steroidal anti-inflammatory drugs, aspirin or Helicobacter pylori infection is the most common cause of major bleeding. Gastro-oesophageal varices are less common but managing the underlying liver disease and the severity of bleeding may be demanding. The prognosis of patients presenting with acute bleeding is dictated by the presence of medical co-morbidities and by the severity of liver disease in patients with varices. Validated prognostic scoring systems, based upon the severity of bleeding, diagnosis, endoscopic findings and extent of co-morbidities, predict mortality and have clinical utility. The treatment of non-variceal bleedi... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1001489 Wed, 17 Oct 2007 04:00:00 +0100 1001489 http://www.medworm.com/index.php?rid=1001488&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F83%2F1%2F291%3Frss%3D1 Conclusions Case identification at the earliest possible stage affords the greatest opportunity for treatment that may slow the rate of progression. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1001488 Wed, 17 Oct 2007 04:00:00 +0100 1001488 http://www.medworm.com/index.php?rid=1001487&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F83%2F1%2F275%3Frss%3D1 Conclusion The trials of the next decade will address issues such as the optimal strategies and timing for clinical use, the role of radio- and immuno-conjugates and, finally, what other potential molecules, such as those influencing cell growth and death, may be targeted. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1001487 Wed, 17 Oct 2007 04:00:00 +0100 1001487 http://www.medworm.com/index.php?rid=1001486&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F83%2F1%2F259%3Frss%3D1 Conclusions Relatively simple system changes have the potential to reduce the burden associated with medication-related adverse events in the elderly. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1001486 Wed, 17 Oct 2007 04:00:00 +0100 1001486 http://www.medworm.com/index.php?rid=1001485&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F83%2F1%2F249%3Frss%3D1 Discussion This paper suggests that policies to increase patient choice require a significant investment in terms of restructuring primary-care services to allow them to happen, as well as to present relevant information to patients, but that patients may not want to make choices about where and what type of treatment they receive for the most part, being content with having a larger say in when they are treated. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1001485 Wed, 17 Oct 2007 04:00:00 +0100 1001485 http://www.medworm.com/index.php?rid=1001484&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F83%2F1%2F235%3Frss%3D1 Conclusion It should not be assumed that the benefits of forensic databases will necessarily override the social and ethical costs, regardless of changes to the criteria for inclusion or the permitted uses of samples and profiles. The expansion of forensic databases raises issues of relevance to the medical profession. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1001484 Wed, 17 Oct 2007 04:00:00 +0100 1001484 http://www.medworm.com/index.php?rid=1001483&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F83%2F1%2F231%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=1001483 Wed, 17 Oct 2007 04:00:00 +0100 1001483 http://www.medworm.com/index.php?rid=701706&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F81-82%2F1%2F209%3Frss%3D1 Areas of general agreement Total creatine kinase (CK) levels depend on age, gender, race, muscle mass, physical activity and climatic condition. High levels of serum CK in apparently healthy subjects may be correlated with physical training status, as they depend on sarcomeric damage: strenuous exercise that damages skeletal muscle cells results in increased total serum CK. The highest post-exercise serum enzyme activities are found after prolonged exercise such as ultradistance marathon running or weight-bearing exercises and downhill running, which include eccentric muscular contractions. Total serum CK activity is markedly elevated for 24 h after the exercise bout and, when patients rest, it gradually returns to basal levels. Persistently increased serum CK levels are occasionally encou... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=701706 Thu, 28 Jun 2007 04:00:00 +0100 701706 http://www.medworm.com/index.php?rid=701705&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F81-82%2F1%2F183%3Frss%3D1 Conclusions With current studies heterogenous in terms of the duration of the disorder; type, frequency and total dose of shock wave therapy (SWT); period of time between SWT; type of management and control group; timing of follow-up and outcomes assessed, a pooled meta-analysis of SWT for chronic plantar fasciopathy was considered inappropriate. Neverhteless, there was a preponderance of well-designed studies showing favourable results. It appears that one should only consider SWT for plantar fasciopathy after more common, accepted and proven non-invasive treatments have failed. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=701705 Thu, 28 Jun 2007 04:00:00 +0100 701705 http://www.medworm.com/index.php?rid=701704&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F81-82%2F1%2F167%3Frss%3D1 Objective To review the current applications of Interventional Radiology (IR), outline newer technologies and techniques and emphasize the role of Interventional Radiologists as clinical practitioners. Background IR is a clinical modality that makes use of imaging guidance for the performance of minimally invasive treatment. The development of new imaging technologies and interventional devices has greatly increased the number of medical conditions that may now be treated by IR. Promising new treatments in cancer therapy, the treatment of fibroids, venous access and spine interventions as well as advances in non-invasive vascular imaging, pharmacological therapies and peripheral arterial and venous interventions are providing exciting opportunities for IR, attracting significant patient... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=701704 Thu, 28 Jun 2007 04:00:00 +0100 701704 http://www.medworm.com/index.php?rid=701703&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F81-82%2F1%2F149%3Frss%3D1 Discussion This review highlights the challenges of diagnosing TB in patients with HIV and the recent advances in development of commonly used and novel diagnostic tests for TB. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=701703 Thu, 28 Jun 2007 04:00:00 +0100 701703 http://www.medworm.com/index.php?rid=701702&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F81-82%2F1%2F129%3Frss%3D1 We describe the natural course of disease, some supportive therapeutic approaches already in use and those with potential based on our knowledge of molecular and cellular characteristics of this disorder. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=701702 Thu, 28 Jun 2007 04:00:00 +0100 701702 http://www.medworm.com/index.php?rid=701701&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F81-82%2F1%2F115%3Frss%3D1 The last few years have seen much progress in our understanding of, and treatments for, eosinophilic leukaemia. In preparing this review, we used Pubmed and the archives of well-known Haematology journals to search for relevant research papers and reviews published in the last 5–10 years. In this article, we review the differential diagnosis and sub-classification of eosinophilic leukaemia, and go on to discuss clinical features, investigation and treatment of these disorders. We are increasingly able to classify clonal eosinophilias based on the underlying molecular genetic abnormalities, and prognosticate and treat patients according to this. The successful treatment of certain of these patients with imatinib, followed by a greater understanding of the mechanism of this treatment, ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=701701 Thu, 28 Jun 2007 04:00:00 +0100 701701 http://www.medworm.com/index.php?rid=701700&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F81-82%2F1%2F97%3Frss%3D1 Discussion Early RA needs immediate specialist assessment and review. Early intensive therapy is effective but needs to be focussed on patients mostly at risk of severe progressive disease. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=701700 Thu, 28 Jun 2007 04:00:00 +0100 701700 http://www.medworm.com/index.php?rid=701699&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F81-82%2F1%2F81%3Frss%3D1 This article is based on a selective review of research on mental disorders in adults in LAMIC since 2001 and recent analyses of disease burden in developing countries. Mental disorders account for 11.1% of the total burden of disease in LAMIC. Unipolar depressive disorder is the single leading neuropsychiatric cause of disease burden. Alcohol use disorders account for nearly 4% of the attributable disease burden in LAMIC. Mental disorders are closely associated with other public health concerns such as maternal and child health and HIV/AIDS. Poverty, low education, social exclusion, gender disadvantage, conflict and disasters are the major social determinants of mental disorders. Clinical trials demonstrate that locally available, affordable interventions in community and primary care set... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=701699 Thu, 28 Jun 2007 04:00:00 +0100 701699 http://www.medworm.com/index.php?rid=701698&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F81-82%2F1%2F65%3Frss%3D1 Since the publication of the National Service Framework for coronary heart disease, there has been a move towards primary disease prevention with a greater focus on an individual's absolute risk. Meta-analysis and systematic reviews of the evidence for primary prevention are incomplete and the current guidelines and policy have led to considerable confusion in clinical practice. There is an increased use of risk assessment tools but no effective method of reviewing current activity with the limited integration into the existing Quality Outcome Framework. There is an inadequate evidence for some of the risk factors used to identify individuals at risk, the risk calculators used to quantify the degree of risk and the methods of communicating risk to patients are largely unproven or completel... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=701698 Thu, 28 Jun 2007 04:00:00 +0100 701698 http://www.medworm.com/index.php?rid=701697&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F81-82%2F1%2F51%3Frss%3D1 This article examines the role of National Institute of Health and Clinical Excellence (NICE) technology appraisal in detail, focussing on the process itself and the methods used to establish cost-effective practices for the National Health Service (NHS). Areas of agreement Approaches to identifying both effective and cost-effective practices have become central to rationing decisions in the NHS. The establishment of the NICE, which produces guidance on what treatments should be provided by the NHS, represents the most visible approach to introducing economic considerations into these decisions. Areas of controversy The decisions over which activities will be displaced by NICE approved treatments are made at a local level, while the cost-effectiveness threshold used to evaluate technolog... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=701697 Thu, 28 Jun 2007 04:00:00 +0100 701697 http://www.medworm.com/index.php?rid=701696&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F81-82%2F1%2F39%3Frss%3D1 This article analyses the transformation of the National Health Service (NHS) in England from a command-and-control to a mimic market model. Areas of agreement Even while introducing market incentives and encouraging private providers, the new model preserves the essential characteristics of the NHS as a universal, tax-funded service free at the point of delivery. Areas of controversy The spectacle of famine among plenty—service cutbacks at a time when the level of spending on the NHS is at a rate unprecedented in its history—raises doubts about the competence of both local managers and central policy makers. Payment by results gives providers an incentive to maximize activity so prompting questions about the future rationing of resources and the role of the medical professio... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=701696 Thu, 28 Jun 2007 04:00:00 +0100 701696 http://www.medworm.com/index.php?rid=701695&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F81-82%2F1%2F21%3Frss%3D1 Objective In this article we review different measures of socioeconomic position (SEP) and their uses in health-related research. Areas of agreement Socioeconomic circumstances influence health. Areas of controversy Generally, poorer socioeconomic circumstances lead to poorer health. This has generated a search for generic mechanisms that could explain such a general association. However, we propose that there is a greater variation in the association between SEP and health than is generally acknowledged when specific health outcomes are investigated. We propose that studying these variations provide a better understanding of the aetiological mechanisms relating specific diseases with specific exposures. Areas to develop research Using different indicators of SEP in health research can ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=701695 Thu, 28 Jun 2007 04:00:00 +0100 701695 http://www.medworm.com/index.php?rid=701694&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F81-82%2F1%2F7%3Frss%3D1 Introduction Why in particular should prophylactic mastectomy be seen more as an ethical concern than as a strictly medical question? In this article, four main explanations will be discussed. Main points First, a risky condition is not a disease and prevention does not improve well-being. The benefits are only statistical and make sense at the population level. Secondly, the cause of the risk is a genetic factor and some might argue about genetic ‘exceptionalism’. Thirdly, there is no organ as, connected to femininity, sensuality, sexuality, adulthood and motherhood as the breast. Lastly, making tough and complex choices requires assistance from ethics. Areas of agreement Among ethical principles, western countries often rely on autonomy. The physician has to deliver all the... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=701694 Thu, 28 Jun 2007 04:00:00 +0100 701694 http://www.medworm.com/index.php?rid=701693&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F81-82%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=701693 Thu, 28 Jun 2007 04:00:00 +0100 701693 http://www.medworm.com/index.php?rid=451153&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F79-80%2F1%2F245%3Frss%3D1 Conclusions Those planning community-based care for physical health problems should learn from the experience of mental health services. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=451153 Mon, 05 Mar 2007 05:00:00 +0100 451153 http://www.medworm.com/index.php?rid=451152&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F79-80%2F1%2F233%3Frss%3D1 This article sets out to guide current best practice. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=451152 Mon, 05 Mar 2007 05:00:00 +0100 451152 http://www.medworm.com/index.php?rid=451151&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F79-80%2F1%2F219%3Frss%3D1 Conclusions The available evidence indicates that pesticides are associated with PD, but further research is needed to identify long-term biomarkers of exposure, improve methods for estimating pesticide-exposure and undertake prospective cohort studies of pesticide-exposed workers. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=451151 Mon, 05 Mar 2007 05:00:00 +0100 451151 http://www.medworm.com/index.php?rid=451150&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F79-80%2F1%2F203%3Frss%3D1 Geohelminth infections and allergic disease are major public health problems and there is evidence in developing countries that they are associated. Although there is an extensive literature of the relationship between geohelminth infections and allergy, there is little consensus on whether the association is causal and if so, whether geohelminth infections may increase or decrease the risk of allergy. An explanation for the conflicting findings of epidemiological studies is that geohelminths decrease the risk of allergy in areas of high infection prevalence and increase the risk of allergy in areas of low prevalence. Chronic geohelminth infections are inversely associated with allergy and anthelmintic treatment may increase the prevalence of allergy. In this paper, we review studies that ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=451150 Mon, 05 Mar 2007 05:00:00 +0100 451150 http://www.medworm.com/index.php?rid=451149&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F79-80%2F1%2F187%3Frss%3D1 Coronary artery disease (CAD) is still an important cause of morbidity and mortality in the Western world. The gold standard for assessing significant coronary artery stenosis is invasive coronary angiography. Several disadvantages of the technique in combination with the fact that a substantial number of patients referred for conventional angiography appear free from significant stenosis have led to the pursuit of non-invasive imaging modalities for the diagnosis of CAD. The traditional modalities for this purpose are gated single-photon emission computed tomography, position emission tomography, (contrast) stress echocardiography and cardiac magnetic resonance (CMR), and these techniques can be characterized as functional imaging techniques as they detect ischaemia. Although the presence... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=451149 Mon, 05 Mar 2007 05:00:00 +0100 451149 http://www.medworm.com/index.php?rid=451148&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F79-80%2F1%2F171%3Frss%3D1 Increasing access to positron emission tomography-computed tomography (PET-CT) has resulted in a shift towards functional imaging, being the primary tool in the assessment of viable tumour in oncology patients. In this review, we discuss the basic principles of this evolving technology and the radio-isotopes it employs. The main clinical applications of PET-CT are reviewed and some of the limitations of the technique are highlighted. Finally, we offer insight into possible future developments and how these modify current practice. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=451148 Mon, 05 Mar 2007 05:00:00 +0100 451148 http://www.medworm.com/index.php?rid=451147&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F79-80%2F1%2F153%3Frss%3D1 Conclusions The increased chemical reactivity of DNA 6-thioguanine underlies its cytotoxic effects and is an important contributor to the anti-leukaemic effects of the thiopurines. The same enhanced reactivity may contribute to the increased risk of acute myeloid leukaemia and skin cancer in thiopurine-treated organ transplant patients. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=451147 Mon, 05 Mar 2007 05:00:00 +0100 451147 http://www.medworm.com/index.php?rid=451146&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F79-80%2F1%2F141%3Frss%3D1 Recent advances in determining the molecular basis for phaeochromocytoma susceptibility have revealed a much larger inherited contribution to the pathogenesis of phaeochromocytoma than had been generally recognized. The identification of individuals with phaeochromocytoma susceptibility disorders (e.g. von Hippel-Lindau disease, succinate dehydrogenase subunit mutations, multiple endocrine neoplasia type 2 and neurofibromatosis type 1) is important because of the opportunity to reduce morbidity and mortality from phaeochromocytoma and other relevant tumours in affected individuals and their at-risk relatives. Recent studies have also provided clues to the molecular pathogenesis of phaeochromocytoma development in familial cases and suggest that this differs from that seen in sporadic non-i... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=451146 Mon, 05 Mar 2007 05:00:00 +0100 451146 http://www.medworm.com/index.php?rid=451145&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F79-80%2F1%2F137%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=451145 Mon, 05 Mar 2007 05:00:00 +0100 451145 http://www.medworm.com/index.php?rid=335918&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F77-78%2F1%2F123%3Frss%3D1 The history of tobacco control in the twentieth century can be summed up by the phrase ‘too little, too late’. The century saw the proliferation of the most deadly form of tobacco use: cigarette smoking. Until the 1970s, no government took serious action to protect its citizens. In fact, probably the most effective global tobacco control ‘strategies’ to date have not been motivated by health concerns: they have been inaccessible or uneconomic markets for tobacco companies and a cultural taboo on women smoking. Economic development has led to massive increases in male cigarette smoking in developing countries but even now <10% of women in non-Western countries such as China, Russia and India smoke. With ‘westernization’, this picture is changing. Witho... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=335918 Thu, 28 Dec 2006 07:00:00 +0100 335918 http://www.medworm.com/index.php?rid=335917&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F77-78%2F1%2F103%3Frss%3D1 Leprosy is a granulomatous disease affecting the skin and nerves caused by Mycobacterium leprae. It continues to be a significant public health problem. Multidrug therapy (MDT) cures the infection, but immunological reactions may occur and neuropathy may lead to disability and deformity. It is important that the manifestations of the condition are recognized as early as possible so that early nerve damage can be identified and treated rapidly. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=335917 Thu, 28 Dec 2006 07:00:00 +0100 335917 http://www.medworm.com/index.php?rid=335916&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F77-78%2F1%2F87%3Frss%3D1 Acute stroke is a treatable condition. Over the last 10 years, the benefit of a number of acute strategies has become established and evaluation of other potentially beneficial interventions is underway. This review will discuss the evidence-based management of the acute stroke patient, consider barriers to provision of such care and update the reader on emergent strategies, which may form part of stroke management in the future. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=335916 Thu, 28 Dec 2006 07:00:00 +0100 335916 http://www.medworm.com/index.php?rid=335915&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F77-78%2F1%2F71%3Frss%3D1 Damaging DNA double-strand breaks (DNA-DSBs) following ionizing radiation (IR) exposure, potentially lead to cell death or carcinogenesis. Non-homologous end-joining (NHEJ) is the main repair pathway employed by vertebrate cells to repair such damage. Many repair pathway proteins have been identified. The creation of many diverse lymphocyte receptors to identify potential pathogens has evolved by breaking and randomly re-sorting the gene segments coding for antigen receptors. Subsequent DNA-DSB repair utilizes the NHEJ proteins. Individuals with defective repair pathways are increasingly recognized with radiosensitivity and immunodeficiency. Patients with defects in ataxia-telangiectasia mutated, nibrin, MRE11, Rad50, Artemis, DNA ligase IV and Cernunnos-XRCC4-like factor have been identif... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=335915 Thu, 28 Dec 2006 07:00:00 +0100 335915 http://www.medworm.com/index.php?rid=335914&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F77-78%2F1%2F55%3Frss%3D1 Musculoskeletal disorders are among the most common causes of sickness absence, long-term incapacity for work and ill-health retirement. The number of Incapacity Benefit (IB) recipients in the United Kingdom has trebled since 1979, despite improvement in objective measures of health. Most of the trend is in non-specific conditions (largely subjective complaints, often with little objective pathology or impairment). Understanding incapacity requires a biopsychosocial model that addresses all the physical, psychological and social factors involved in human illness and disability. Rehabilitation should be directed to overcome biopsychosocial obstacles to recovery and return to work. These principles are fundamental to better clinical and occupational management and minimizing incapacity. Sick... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=335914 Thu, 28 Dec 2006 07:00:00 +0100 335914 http://www.medworm.com/index.php?rid=335913&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F77-78%2F1%2F37%3Frss%3D1 The inherited bone marrow (BM) failure syndromes are a heterogeneous group of disorders characterized by BM failure, usually in association with one or more somatic abnormalities. The BM failure may present at birth or at a variable time thereafter including in adulthood in some cases. Over the last decade, there have been significant advances in the genetics of these syndromes particularly Fanconi’s anaemia (FA) and dyskeratosis congenita (DC). These advances are beginning to provide a better understanding of normal haemopoiesis and of the pathophysiology of some cases of idiopathic aplastic anaemia (AA). They have also provided important insights into some aspects of DNA repair (FA/BRCA pathway) and telomere maintenance (DC-related genes), two pathways critical in the maintenance o... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=335913 Thu, 28 Dec 2006 07:00:00 +0100 335913 http://www.medworm.com/index.php?rid=335912&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F77-78%2F1%2F23%3Frss%3D1 Allogeneic haematopoietic stem cell transplantation (allo-SCT) is an established treatment of haematological malignancies and other immunohaematopoietic disorders. The use of unrelated donors and cord blood (CB) grafts has increased the possibilities of finding a donor, and results are approaching those after sibling donor transplants. The use of peripheral blood stem cells (PBSCs), instead of bone marrow, results in faster engraftment and increased risk of chronic graft-versus-host disease (GVHD). High-dose myeloablative (MA) conditioning is recently challenged by reduced-intensity conditioning (RIC) for older patients and those with comorbidity. Better diagnostic tools and novel anti-microbial drugs have reduced morbidity and mortality from infections. A major problem is disease relapse.... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=335912 Thu, 28 Dec 2006 07:00:00 +0100 335912 http://www.medworm.com/index.php?rid=335911&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F77-78%2F1%2F5%3Frss%3D1 The haemolytic uraemic syndrome (HUS) is characterized by the triad of thrombocytopenia, microangiopathic haemolytic anaemia and acute renal failure. HUS may be classified as either diarrhoeal-associated or non-diarrhoeal/atypical (aHUS). aHUS has recently been shown to be a disease of complement dysregulation, with 50% of cases involving the complement regulatory genes, factor H (CFH), membrane cofactor protein (MCP; CD46), and factor I (IF). However, incomplete penetrance of mutations in each of these genes is reported. This suggests that a precipitating event or trigger is required to unmask the complement regulatory deficiency. The reported precipitating events predominantly cause endothelial injury. Discovery of these mutations has revealed important genotype–phenotype correlati... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=335911 Thu, 28 Dec 2006 07:00:00 +0100 335911 http://www.medworm.com/index.php?rid=335910&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F77-78%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=335910 Thu, 28 Dec 2006 07:00:00 +0100 335910