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. Sun, 05 Feb 2012 18:43:21 +0100 http://www.medworm.com/index.php?rid=5488187&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F100%2F1%2F209%3Frss%3D1 In this study, the optimum method of cell culture and transplantation is being intensively investigated. Areas timely for developing research: Development of tissues using multiple cell types, genetic modification to treat hereditary corneal disorders and development of cell therapy for other eye diseases are future possibilities. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5488187 Thu, 08 Dec 2011 05:00:00 +0100 5488187 http://www.medworm.com/index.php?rid=5488186&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F100%2F1%2F191%3Frss%3D1 Introduction Blindness affects 50 million individuals worldwide; a significant proportion of them require a cell or tissue-based repair or replacement strategy to mend their damaged or diseased cornea. This review will focus on the epithelial stem cell (ESC) population of the cornea, where they reside, how they are identified and what alternative cells can be used as functional substitutes. Source of data Data for this review were collated after performing literature searches by inserting key words (cornea, limbal, stem cells (SCs), epithelium, stroma, and endothelium) into the search engine PubMed. Areas of agreement The prevailing notion is that corneal ESCs reside in an exclusive niche and their activation is dictated by niche-specific signals. Areas of controversy Recent studies ref... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5488186 Thu, 08 Dec 2011 05:00:00 +0100 5488186 http://www.medworm.com/index.php?rid=5488185&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F100%2F1%2F173%3Frss%3D1 Conclusion The existing data from studies of embryonic DA transplantation for advanced PD have provided valuable insights for the design of new cell-based therapies for the treatment of this and related neurodegenerative disorders. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5488185 Thu, 08 Dec 2011 05:00:00 +0100 5488185 http://www.medworm.com/index.php?rid=5488184&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F100%2F1%2F157%3Frss%3D1 Introduction Due to a lack of adequate liver donors and post-surgical complications, researchers propose that cell therapy should be an alternative treatment for patients with end-stage liver diseases. Data sources We performed a literature review on cell-based therapy for liver disorders. Areas of agreement Due to growing numbers of patients on waiting lists for liver transplantation, a substitute treatment strategy is needed for our patients. Cell therapy can save patients who are in life-threatening situations, enabling them to have more time and increase their chances of survival. Pluripotent stem cells can be a good resource for cell-based therapy after the establishment of efficient differentiation protocols in addition to the settlement of ethical and immunological issues. Cell-ba... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5488184 Thu, 08 Dec 2011 05:00:00 +0100 5488184 http://www.medworm.com/index.php?rid=5488183&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F100%2F1%2F137%3Frss%3D1 Background A novel manufacturing industry is emerging to translate unique cellular therapy bioprocesses to robust, scaled manufacturing production for successful clinical translation. Source of data This review summarizes key translational issues, and current and future perspectives to improve translation of cell-based therapy bioprocessing, based on literature search and author research. Areas of agreement It is widely recognized that cell-based therapies could revolutionize health care for a range of diseases, and that there are gaps in the overarching framework and technologies to generate clinical success. Areas of controversy There is limited understanding of how to fulfil requirements as regulatory and manufacturing guidelines are incomplete and few have achieved commercialization... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5488183 Thu, 08 Dec 2011 05:00:00 +0100 5488183 http://www.medworm.com/index.php?rid=5488182&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F100%2F1%2F123%3Frss%3D1 Background Diabetes can be treated by β-cell replacement therapy but the supply of graft material from human donors is too limited to make a significant clinical impact. Substitute β-cells generated from stem cell populations offer a potential source for the large numbers of cells required. Sources of data Primary peer-reviewed reports of experimental studies. Areas of agreement Embryonic stem cells and/or induced pluripotent stem (iPS) cells are currently the most promising starting populations from which to generate large numbers of β-cells. Differentiation protocols that recapitulate in vivo development generate insulin-expressing cells in vitro. Areas of controversy Differentiation outcomes may depend on the source of the initial pluripotent cells. The insulin-express... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5488182 Thu, 08 Dec 2011 05:00:00 +0100 5488182 http://www.medworm.com/index.php?rid=5488181&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F100%2F1%2F101%3Frss%3D1 Introduction: Suicide risk is most commonly associated with mental illness. In particular, suicide in people under mental health care presents distinct patterns of risk and opportunities for prevention due to their close proximity to specialist care. Sources of data: The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (Inquiry) is a unique UK-wide national database of all suicide cases in contact with mental health services in the 12 months preceding suicide. This review presents Inquiry findings from the beginning of the Inquiry in 1996 up to the present (2011) (15 years). Areas of agreement: Suicide varies substantially by socio-demographic (age, gender) and clinical features (e.g. diagnosis; care variables). Effective suicide prevention initiatives ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5488181 Thu, 08 Dec 2011 05:00:00 +0100 5488181 http://www.medworm.com/index.php?rid=5488180&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F100%2F1%2F73%3Frss%3D1 Background Non-surgical approaches have been developed to enhance nerve recovery, which are complementary to surgery and are an adjunct to the reinnervation process. Sources of data A search of PubMed, Medline, CINAHL, DH data and Embase databases was performed using the keywords ‘peripheral nerve injury’ and ‘treatment’. Areas of controversy Most of the conservative therapies are focused to control neuropathic pain after nerve tissue damage. Only physical therapy modalities have been studied in humans and their effectiveness is not proved. Growing points Many modalities have been experimented with to promote nerve healing and restore function in animal models and in vitro studies. Despite this, none have been actually translated into clinical practice. Areas ti... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5488180 Thu, 08 Dec 2011 05:00:00 +0100 5488180 http://www.medworm.com/index.php?rid=5488179&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F100%2F1%2F59%3Frss%3D1 Background Primary eosinophilic gastrointestinal disorders, a spectrum of inflammatory conditions, occurs when eosinophils selectively infiltrate the gut in the absence of known causes for such tissue eosinophilia. These may be classified into eosinophilic esophagitis, eosinophilic gastroenteritis and eosinophilic colitis (EC). This review focuses on EC: its pathogenesis, epidemiology, clinical presentation, diagnosis and current approach to treatment. Sources of data A literature review published in English was performed using Pubmed, Ovid, Google scholar search engines with the following keywords: eosinophilic gastrointestinal disorder, EC, eosinophils, colitis and gastrointestinal. Areas of agreement The basis for primary EC appears related to increased sensitivity to allergens, princ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5488179 Thu, 08 Dec 2011 05:00:00 +0100 5488179 http://www.medworm.com/index.php?rid=5488178&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F100%2F1%2F39%3Frss%3D1 Background Physical stimulation therapies are currently available to enhance fracture healing. Sources of data A search of PubMed, Medline, CINAHL, DH data and Embase databases was performed using the keywords ‘ultrasound’ and ‘fracture healing’. Areas of agreement The evidence in vitro and animal studies suggests that low-intensity pulsed ultrasound (LIPUS) produces significant osteoinductive effects, accelerating the healing process and improving the bone-bending strength. Areas of controversy The evidence in human trials is controversial in fresh, stress fractures and in limb lengthening. LIPUS is effective in delayed unions, in smokers and in diabetic population. Growing points LIPUS is an alternative, less invasive form of treatment for complicated fracture... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5488178 Thu, 08 Dec 2011 05:00:00 +0100 5488178 http://www.medworm.com/index.php?rid=5488177&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F100%2F1%2F23%3Frss%3D1 Introduction Inflammation plays a key role in the development of atherosclerosis and coronary heart disease (CHD). Sources of data Peer-reviewed studies published in English-language journals were reviewed with a focus on C-reactive protein (CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2). Areas of agreement Elevated levels of serum CRP and Lp-PLA2 are associated with an increased risk of incident CHD events in both primary and secondary prevention studies across a wide range of age, gender and ethnic groups. Areas of controversy The utility of inflammatory markers in predicting CHD risk when added to traditional risk factors is under debate. They are most useful in subjects in the intermediate-risk category. Growing points Treatment with a statin in subjects with elevated C... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5488177 Thu, 08 Dec 2011 05:00:00 +0100 5488177 http://www.medworm.com/index.php?rid=5488176&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F100%2F1%2F7%3Frss%3D1 Introduction or background Genetic testing for rare Mendelian disorders represents the dominant ethical paradigm in clinical and professional practice. Predictive testing for Huntington's disease is the model against which other kinds of genetic testing are evaluated, including testing for Alzheimer's disease. Sources of data This paper retraces the historical development of ethical reasoning in relation to predictive genetic testing and reviews a range of ethical, sociological and psychological literature from the 1970s to the present. Areas of agreement In the past, ethical reasoning has embodied a distinct style whereby normative principles are developed from a dominant disease exemplar. Areas of controversy This reductionist approach to formulating ethical frameworks breaks down in ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5488176 Thu, 08 Dec 2011 05:00:00 +0100 5488176 http://www.medworm.com/index.php?rid=5488175&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F100%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5488175 Thu, 08 Dec 2011 05:00:00 +0100 5488175 http://www.medworm.com/index.php?rid=5197272&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F99%2F1%2F227%3Frss%3D1 Background Stem cells are easily accessible and have great potential for healing articular cartilage defects. These features make stem cell therapy an appealing approach for treating severely impaired joint function. Sources of data Clinical and basic research articles and literature reviews. Areas of agreement Stem cells possess the potential to build articular cartilage. Malalignment and instability corrections and proper rehabilitation are crucial prerequisites for surgical procedures involving stem cell therapy. Smoking reduces the result. Areas of controversy Ethical concerns remain unresolved. No standards are established for inducing stem cell potential, optimizing culturing media or harvesting. The risk of failure has not been determined. Growing points Surgical scaffolds can i... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5197272 Sun, 04 Sep 2011 23:00:00 +0100 5197272 http://www.medworm.com/index.php?rid=5197271&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F99%2F1%2F211%3Frss%3D1 Introduction Tendons establish specific connections between muscles and the skeleton by transferring contraction forces from skeletal muscle to bone thereby allowing body movement. Tendon physiology and pathology are heavily dependent on mechanical stimuli. Tendon injuries clinically represent a serious and still unresolved problem since damaged tendon tissues heal very slowly and no surgical treatment can restore a damaged tendon to its normal structural integrity and mechanical strength. Understanding how mechanical stimuli regulate tendon tissue homeostasis and regeneration will improve the treatment of adult tendon injuries that still pose a great challenge in today's medicine. Source of data This review summarizes the current status of tendon treatment and discusses new directions fr... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5197271 Sun, 04 Sep 2011 23:00:00 +0100 5197271 http://www.medworm.com/index.php?rid=5197270&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F99%2F1%2F199%3Frss%3D1 Introduction Bone is an obvious candidate tissue for stem cell therapy. This review provides an update of existing stem cell-based clinical treatments for bone pathologies. Sources of data A systematic computerized literature search was conducted. The following databases were accessed on 10 February 2011: NIH clinical trials database, PubMed, Ovid and Cochrane Reviews. Areas of agreement Stem cell therapy offers new options for bone conditions, both acquired and inherited. Areas of controversy There is still no agreement on the exact definition of ‘mesenchymal stem cells’. Consequently, it is difficult to appreciate the effect of culture expansion and the feasibility of allogeneic transplantation. Growing points Based on the sound foundations of pre-clinical research, stem ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5197270 Sun, 04 Sep 2011 23:00:00 +0100 5197270 http://www.medworm.com/index.php?rid=5197269&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F99%2F1%2F189%3Frss%3D1 Introduction The structure of the lung is complex, it contains at least 40 different cell types. The lung interacts with the outside environment and the circulatory system. These features make the lung particularly susceptible to injury and disease. Areas of agreement Stem cells with reparative properties can be found within the lung. Also, outside sources of stem cells can contribute to the repair of the injured lung. These include multipotent stem cells from the bone marrow and pluripotent stem cells derived from the early embryo or from adult cells, which are made to reverse to a pluripotent state by the addition of viral vectors or non-viral agents. For stem cells of outside sources to have a reparative function, the cells need to reach the injured lung, either by internal mobilizatio... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5197269 Sun, 04 Sep 2011 23:00:00 +0100 5197269 http://www.medworm.com/index.php?rid=5197268&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F99%2F1%2F169%3Frss%3D1 Introduction Despite treatment advances in many diseases of the respiratory system, outcome remains poor. Sources of data This systematic review (PubMed and Ovid) ‘analyses stem cell (SC)-based therapy and regenerative medicine (RM) approaches as potential novel strategies for diseases of the respiratory system. Current preclinical research and ongoing clinical trials are presented and their potential clinical impact and routine application discussed. Areas of agreement These approaches may represent a promising alternative therapy for otherwise irreversible respiratory diseases. Several experimental and initial clinical data now exist. Areas of controversy Type of SC, limits of tissue engineering, route of delivery, cell behaviour (differentiation, growth, co-stimulation or immun... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5197268 Sun, 04 Sep 2011 23:00:00 +0100 5197268 http://www.medworm.com/index.php?rid=5197267&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F99%2F1%2F155%3Frss%3D1 Introduction Stem cells are cells with the ability to grow and differentiate into more than 200 cell types. Sources of data We review here the characteristics and potential of human embryonic stem cells (hESCs), induced pluripotent stem cells (iPSCs) and adult stem cells (ASCs). Areas of agreement The differentiation ability of all stem cell types could be stimulated to obtain specialized cells that represent renewable sources of functional cells useful for cell-based therapy. Areas of controversy The proof of functional differentiated cells needs to be investigated in more detail using both in vitro and in vivo assays including animal disease models and clinical studies. Growing points Much progress has been made in the ASCs-based therapies. Meanwhile hESCs and iPSCs have dramatically... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5197267 Sun, 04 Sep 2011 23:00:00 +0100 5197267 http://www.medworm.com/index.php?rid=5197266&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F99%2F1%2F141%3Frss%3D1 Conclusion There is a lack of scientifically based guidelines, probably a result of the relatively low levels of evidence of the studies. There is a need for adequately powered randomized clinical trials, using standard diagnostic assessment, common and validated scoring system comparing reported outcomes and duration of follow-up greater than 2 years. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5197266 Sun, 04 Sep 2011 23:00:00 +0100 5197266 http://www.medworm.com/index.php?rid=5197265&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F99%2F1%2F125%3Frss%3D1 Introduction melioidosis, an infection caused by the environmental Gram-negative bacillus Burkholderia pseudomallei, has emerged as an important cause of morbidity and mortality in Southeast Asia and northern Australia. Sources of data a review of the literature using PubMed. Areas of agreement approaches to diagnosis and antimicrobial therapy. Areas of controversy whether seroconversion signals the presence of a quiescent bacterial focus and an increase in long-term risk of melioidosis. Areas timely for developing research melioidosis is potentially preventable, but there is a striking lack of evidence on which to base an effective prevention programme. An accurate map defining the global distribution of B. pseudomallei is needed, together with studies on the relative importance of di... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5197265 Sun, 04 Sep 2011 23:00:00 +0100 5197265 http://www.medworm.com/index.php?rid=5197264&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F99%2F1%2F107%3Frss%3D1 Background Despite major advances in therapies for liver metastases, colorectal cancer remains one of the commonest causes of cancer-related deaths in the UK. Sources of data The international literature on the management of colorectal liver metastases (CLM) was reviewed. Areas of agreement Due to a combination of highly active systemic agents and low perioperative mortality achieved by high-volume centres, a growing number of patients are being offered liver resection with curative intent. Patients with bilobar and/or extrahepatic disease who would previously have received palliative treatment only, are undergoing major surgery with good results. This review focuses on preoperative evaluation, surgical planning and the role of adjuvant therapies in the management of patients with CLM. ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5197264 Sun, 04 Sep 2011 23:00:00 +0100 5197264 http://www.medworm.com/index.php?rid=5197263&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F99%2F1%2F89%3Frss%3D1 Introduction This review defines the recognized risk factors responsible for the development of knee osteoarthritis after surgical management of meniscal tears. Sources of data We performed a literature search using Medline, Ovid, Cochrane and Google Scholar using the keywords: ‘Meniscal tears’, ‘meniscectomy’, ‘osteoarthritis’, ‘complications’ and ‘risk factors’. Thirty-two published studies were identified. Areas of agreement In the long term, osteoarthritis develops in the knee of patients undergoing surgery for meniscal tears. The Coleman methodology score showed great heterogeneity in terms of patient characteristics and outcome assessment. Amount of meniscus removed, duration of pre-operative symptoms and lateral meniscect... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5197263 Sun, 04 Sep 2011 23:00:00 +0100 5197263 http://www.medworm.com/index.php?rid=5197262&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F99%2F1%2F73%3Frss%3D1 Introduction/background Type 1 diabetes is a chronic autoimmune condition characterized by destruction of insulin-producing β cells within the pancreatic islets. It is associated with considerable morbidity and mortality. Incidence levels are rising worldwide. Sources of data Pubmed search (Nov 2010) using keywords: Type 1 diabetes, prevention, trials, immunotherapy. Areas of agreement The causes of disease are multifactorial with genetic and environmental factors playing a part. There is a long pre-clinical period before the onset of overt symptoms, which may be amenable to therapeutic intervention to prevent disease. Areas of controversy The exact nature of causative environmental factors is unknown and much debated. Immunotherapeutic intervention may therefore represent the best... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5197262 Sun, 04 Sep 2011 23:00:00 +0100 5197262 http://www.medworm.com/index.php?rid=5197261&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F99%2F1%2F53%3Frss%3D1 Background Genetic testing in inherited disease has traditionally relied upon recognition of the presenting clinical syndrome and targeted analysis of genes known to be linked to that syndrome. Consequently, many patients with genetic syndromes remain without a specific diagnosis. Areas of agreement New ‘next-generation’ sequencing (NGS) techniques permit simultaneous sequencing of enormous amounts of DNA. A slew of research publications have recently demonstrated the tremendous power of these technologies in increasing understanding of human genetic disease. Areas of controversy These approaches are likely to be increasingly employed in routine diagnostic practice, but the scale of the genetic information yielded about individuals means that caution must be exercised to avoi... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5197261 Sun, 04 Sep 2011 23:00:00 +0100 5197261 http://www.medworm.com/index.php?rid=5197260&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F99%2F1%2F39%3Frss%3D1 Introduction Thyroid disorders are prevalent and their manifestations are determined by the dietary iodine availability. Sources of data Data from screening large population samples from USA and Europe. Areas of agreement The most common cause of thyroid disorders worldwide is iodine deficiency, leading to goitre formation and hypothyroidism. In iodine-replete areas, most persons with thyroid disorders have autoimmune disease. Areas of controversy Definition of thyroid disorders, selection criteria used, influence of age and sex, environmental factors and the different techniques used for assessment of thyroid function. Growing points Increasing incidence of well-differentiated thyroid cancer. Environmental iodine influences the epidemiology of non-malignant thyroid disease. Areas tim... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5197260 Sun, 04 Sep 2011 23:00:00 +0100 5197260 http://www.medworm.com/index.php?rid=5197259&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F99%2F1%2F25%3Frss%3D1 Introduction The maternal mortality ratio (MMR) is a key indicator for measurement of progress against Millennium Development Goal 5 (MDG 5). For many countries, especially those with a presumed high number of maternal deaths, only estimates are available. Sources of data Recent global estimates and the reasons for high maternal mortality are reviewed. Areas of agreement There is international consensus that efforts to reduce maternal mortality globally need to be intensified. Areas of controversy Many countries lack accurate data on number of deaths in women of reproductive age and number of births. Therefore, statistical modelling has been used to calculate estimates, which generally have wide confidence intervals and may be disputed by individual countries. Growing points There is r... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5197259 Sun, 04 Sep 2011 23:00:00 +0100 5197259 http://www.medworm.com/index.php?rid=5197258&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F99%2F1%2F7%3Frss%3D1 Background Food additives are an integral part of the modern food system, but opinion polls showing most Europeans have worries about them imply an urgent need for ethical analysis of their use. Sources of data The existing literature on food ethics, safety assessment and animal testing. Areas of agreement Food additives provide certain advantages in terms of many people's lifestyles. Areas of controversy There are disagreements about the appropriate application of the precautionary principle and of the value and ethical validity of animal tests in assessing human safety. Growing points Most consumers have a poor understanding of the relative benefits and risks of additives, but concerns over food safety and animal testing remain high. Areas timely for developing research Examining th... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5197258 Sun, 04 Sep 2011 23:00:00 +0100 5197258 http://www.medworm.com/index.php?rid=5197257&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F99%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=5197257 Sun, 04 Sep 2011 23:00:00 +0100 5197257 http://www.medworm.com/index.php?rid=4905103&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F98%2F1%2F187%3Frss%3D1 Introduction and background Peripheral vascular disease is the leading cause of limb ischemia (LI). LI is manifested by claudication, ischemic rest pain, ulcers or gangrene. It is the result of peripheral arterial disease due to atherosclerosis. Over the last decade, several centers around the world have initiated clinical trials utilizing stem cells as a treatment for this disease. Sources of data Published medical literature, clinical trials announced in clinical trials.gov and TCA cellular therapy experience. Areas of agreement There is general agreement that stem cells are useful for LI. Areas of controversy These arise from the type of cells, dose, route of administration and methods to evaluate efficacy. Growing points Growing evidence suggests that bone marrow derived-mesenchyma... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4905103 Mon, 06 Jun 2011 23:00:00 +0100 4905103 http://www.medworm.com/index.php?rid=4905102&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F98%2F1%2F161%3Frss%3D1 Introduction Stem cell therapy has emerged as a promising strategy for the treatment of ischemic cardiomyopathy. Sources of data Multiple candidate cell types have been used in preclinical animal models and in clinical trials to repair or regenerate the injured heart either directly (through formation of new transplanted tissue) or indirectly (through paracrine effects activating endogenous regeneration). Areas of agreement (i) Clinical trials examining the safety and efficacy of bone marrow derived cells in patients with heart disease are promising, but results leave much room for improvement. (ii) The safety profile has been quite favorable. (iii) Efficacy has been inconsistent and, overall, modest. (iv) Tissue retention of cells after delivery into the heart is disappointingly low. (v... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4905102 Mon, 06 Jun 2011 23:00:00 +0100 4905102 http://www.medworm.com/index.php?rid=4905101&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F98%2F1%2F143%3Frss%3D1 Background Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Despite the advances in medical and catheter-based therapy for acute myocardial infarction the 1-year mortality remains as high as 13% and the 5-year prognosis for patients with heart failure remains as high as 50%. Left ventricular systolic dysfunction, a major determinant of prognosis, is associated with significant loss of cardiomyocytes which was previously thought to be irreversible as the heart was considered a post-mitotic organ. Sources of data Review of literature published in peer reviewed journals and ClinicalTrials.Gov website. Areas of agreement There is now growing evidence that the human heart is capable of undergoing repair and in recent years there has been an increase in basic a... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4905101 Mon, 06 Jun 2011 23:00:00 +0100 4905101 http://www.medworm.com/index.php?rid=4905100&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F98%2F1%2F127%3Frss%3D1 Introduction A large number of different cells including embryonic and adult stem cells have been transplanted into animal models of spinal cord injury, and in many cases these procedures have resulted in modest sensorimotor benefits. In October 2010 the world's first clinical trial using human embryonic stem cells began, using stem cells converted into oligodendrocyte precursor cells. Sources of data In this review we examine some of the publically available preclinical evidence that some of these cell types improve outcome in animal models of spinal cord injury. Much evidence is not available for public scrutiny, however, being private commercial property of various stem cell companies. Areas of agreement Transplantation of many different types of stem and progenitor cell enhances spon... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4905100 Mon, 06 Jun 2011 23:00:00 +0100 4905100 http://www.medworm.com/index.php?rid=4905099&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F98%2F1%2F117%3Frss%3D1 Background Considerable amount of information about the potential of stem cell therapy in regenerative medicine is available today. Scientific meetings and publications in specialized journals enable experts in stem cell science and regenerative medicine to follow worldwide cutting-edge research. However, controversial information plaguing the media and the Internet lead patients to believe that stem cells are the long-awaited panacea even though there are little or no stringent factual data available yet. Sources of data PubMed database systematically searched in the period 4–6 January 2011. Areas of agreement Stem cell-based therapy is a future of regenerative medicine. Areas of controversy Based on unsubstantial claims fueled by media, patients are frequently seeking advice abo... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4905099 Mon, 06 Jun 2011 23:00:00 +0100 4905099 http://www.medworm.com/index.php?rid=4905098&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F98%2F1%2F99%3Frss%3D1 Introduction Advances in foetal medicine and neonatology have enabled increased antenatal diagnosis of life-limiting conditions and improved preterm survival, escalating the debate surrounding the ethics of neonatal end-of-life care and withholding or withdrawing intensive care. Sources of data Literature search of MEDLINE and the Cochrane library databases using the search terms [neonatal palliative care] AND [neonatal AND withdrawal of intensive care and treatment]. Review of consensus statements and guidelines. Areas of agreement UK practice is aided by Grade 3–4 evidence, consensus statements and practice frameworks. There is limited systematic evidence. Areas of controversy We illustrate UK practice with clinical cases and describe worldwide variations. Growing points Neonat... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4905098 Mon, 06 Jun 2011 23:00:00 +0100 4905098 http://www.medworm.com/index.php?rid=4905097&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F98%2F1%2F75%3Frss%3D1 Introduction Surgical techniques for the management of hallux rigidus include cheilectomy, Keller resection arthroplasty, arthrodesis, Silastic implantation, phalangeal or metatarsal osteotomy, capsular arthroplasty, partial or total joint replacement, interposition arthroplasty. However, the optimal management is controversial. Sources of data We performed a comprehensive search of CINAHL, Embase, Medline and the Cochrane Central Registry of Controlled Trials, from inception of the database to 2 November 2010. Sixty-nine articles published in peer reviewed journals were included in this comprehensive review. Areas of agreement Cheilectomy and first metatarsal or phalangeal corrective osteotomy may provide better outcome for patients with early and intermediate hallux rigidus (Stages I&n... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4905097 Mon, 06 Jun 2011 23:00:00 +0100 4905097 http://www.medworm.com/index.php?rid=4905096&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F98%2F1%2F61%3Frss%3D1 Background A new retrovirus, xenotropic murine leukaemia virus-related virus (XMRV), was identified in 2006 and an association was claimed between it and a genetic polymorphism predisposing to cancer of the prostate. In 2009 the same virus was identified in a cohort of patients with chronic fatigue syndrome (CFS). In 2010 a second related virus was identified in a separate group of CFS patients. A series of studies from disparate geographical areas have failed to substantiate this work. Most recently several papers have suggested that the detection of these viruses was explained by laboratory contamination. Sources of data All papers including the wording XMRV were abstracted from the NIH library of medicine database and included in the analysis. Areas of agreement XMRV is a newly descri... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4905096 Mon, 06 Jun 2011 23:00:00 +0100 4905096 http://www.medworm.com/index.php?rid=4905095&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F98%2F1%2F31%3Frss%3D1 Introduction Tendon injuries give rise to significant morbidity. In the last few decades, several techniques have been increasingly used to optimize tendon healing. Sources of data We performed a comprehensive search of PubMed, Medline, Cochrane, CINAHL and Embase databases using various combinations of the commercial names of each scaffold and the keywords 'tendon', 'rotator cuff', 'supraspinatus tendon', 'Achilles tendon', 'growth factors', 'cytokines', 'gene therapy', 'tissue engineering', 'mesenchymal' and 'stem cells' over the years 1966–2009. All articles relevant to the subject were retrieved, and their bibliographies were hand searched for further references in the context to tissue-engineered biological augmentation for tendon healing. Areas of agreement Several new techni... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4905095 Mon, 06 Jun 2011 23:00:00 +0100 4905095 http://www.medworm.com/index.php?rid=4905094&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F98%2F1%2F21%3Frss%3D1 Background The crisis in organ availability has triggered innovative approaches to meet a rapidly expanding worldwide demand for donor kidneys. HLA and ABO incompatibility represents one of the most significant barriers to optimizing the utilization of living donors. Kidney paired donation (KPD) allows patients with incompatible live donors to receive compatible or better-matched organs by exchanging donors. Sources of data The data presented in this review have been published and represent the most up-to-date sources of the theory and practice of KPD. Areas of Agreement there is wide agreement that in most cases the best transplant solution for a patient with an incompatible donor is to receive a compatible organ in a KPD. Areas of controversy There has been disagreement about the capa... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4905094 Mon, 06 Jun 2011 23:00:00 +0100 4905094 http://www.medworm.com/index.php?rid=4905093&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F98%2F1%2F7%3Frss%3D1 This article is based on a search and review of Chinese and English-language literature, including several very recent books in Chinese on the imbalance of the sex ratio at birth in China. It also draws on first-hand information gathered from the author's extensive fieldwork on Chinese views and experiences of abortion. Areas of agreement The current female deficit is a real and serious problem in China—not a ‘false alarm’ as earlier alleged. It is a direct consequence of the widespread practice of sex-selective abortion and is chiefly caused by the strong socio-cultural preference for sons in China. Chinese academics—demographers and medical ethicists—in general agree with the official position that sex-selective abortion is morally wrong and should be legal... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4905093 Mon, 06 Jun 2011 23:00:00 +0100 4905093 http://www.medworm.com/index.php?rid=4905092&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F98%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4905092 Mon, 06 Jun 2011 23:00:00 +0100 4905092 http://www.medworm.com/index.php?rid=4555843&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F211%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4555843 Mon, 07 Mar 2011 00:00:00 +0100 4555843 http://www.medworm.com/index.php?rid=4555842&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F197%3Frss%3D1 The valuation of health states is an integral part of economic evaluation studies. The source of these valuations (general public vs. patients) is surrounded by controversy. Health state values generated by the general public are often different compared with those of patients. General public values may not account for adaptation of the patients; patients’ values potentially incorporate self-interest. Decisions on the appropriate source of health values ultimately depend on the specific decision-making context and objectives of the evaluation. Differences in valuations and implications for decision-making should be explicitly addressed. Further research should systematically identify circumstances in which public and patients’ valuations diverge. There appears ground for develo... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4555842 Mon, 07 Mar 2011 00:00:00 +0100 4555842 http://www.medworm.com/index.php?rid=4555841&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F169%3Frss%3D1 Our population is ageing, and obesity is increasing in the elderly bringing massive and rapidly changing burdens of ill health related to increased body weights and fat as well as the main drivers of poor diet and inactivity. Overweight and obesity, and a static body mass index (BMI) commonly conceal sarcopenia (gain in body fat but loss of muscle mass and functional capacity) in older people, aggravated by inactivity. A systematic computerized literature search using an iterative manipulation process of the keywords: obesity, elderly, weight loss. The following databases were accessed on 20 October 2010: Medline, Cochrane Collaboration, Ovid and Scholar Google. A large number of clinical consequences of overweight and obesity are particularly problematic for elderly individuals, including... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4555841 Mon, 07 Mar 2011 00:00:00 +0100 4555841 http://www.medworm.com/index.php?rid=4555840&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F149%3Frss%3D1 Minimally invasive techniques for hallux valgus correction include arthroscopy, percutaneous and minimum incision surgery. In the last few decades, several techniques have been increasingly used. We performed a comprehensive search of CINAHL, Embase, Medline, HealthSTAR and the Cochrane Central Registry of Controlled Trials, from inception of the database to 4 January 2010, using various combinations of the keywords terms ‘Bosch’, ‘PDO’, ‘percutaneous distal osteotomy’, ‘SERI’, ‘percutaneous’, ‘minimal incision’, ‘minimum incision’, ‘minimally invasive’, ‘less invasive’, ‘mini-invasive’, ‘hallux valgus’, ‘bunion’, ‘surgery’, ‘arth... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4555840 Mon, 07 Mar 2011 00:00:00 +0100 4555840 http://www.medworm.com/index.php?rid=4555839&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F137%3Frss%3D1 Advances in understanding the physiology of thyroid function in normal pregnancy have highlighted the importance of the consequences of abnormal function on obstetric outcome and foetal well-being. Pubmed search was done using the terms thyroid and pregnancy. Areas of agreement are the following: gestational normative reference ranges for thyroid function tests are required for proper interpretation of any abnormalities. Measurement of thyroid-stimulating antibodies and antithyroid peroxidase antibodies is useful for diagnosis of thyroid disease in pregnancy. Treatment of Graves’ hyperthyroidism should be done with propylthiouracil for first trimester only, then carbimazole or methimazole. Patients on levothyroxine require an increase in dosage during gestation. Areas of controversy ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4555839 Mon, 07 Mar 2011 00:00:00 +0100 4555839 http://www.medworm.com/index.php?rid=4555838&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F105%3Frss%3D1 To summarize the best available evidence in the last decade for managing ankle sprains in the community, data were collected using MEDLINE database from January 2000 to December 2009. Terms utilized: ‘ankle injury primary care’ (102 articles were found), ‘ankle sprain primary care’ (34 articles), ‘ankle guidelines primary care’ (25 articles), ‘ankle pathways primary care’ (2 articles), ‘ankle sprain community’ (18 articles), ‘ankle sprain general practice’ (22 articles), ‘Cochrane review ankle’ (58 articles). Of these, only 33 satisfied the inclusion criteria. The search terms identified many of the same studies. Two independent reviewers reviewed the articles. The study results and generated conclusions we... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4555838 Mon, 07 Mar 2011 00:00:00 +0100 4555838 http://www.medworm.com/index.php?rid=4555837&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F81%3Frss%3D1 There are a number of conditions of the bladder that can lead to loss of function. Many of these require reconstructive procedures. However, current techniques may lead to a number of complications. Replacement of bladder tissues with functionally equivalent ones created in the laboratory could improve the outcome of reconstructive surgery. A review of the literature was conducted using PubMed to identify studies that provide evidence that tissue engineering techniques may be useful in the development of alternatives to current methods of bladder reconstruction. A number of animal studies and several clinical experiences show that it is possible to reconstruct the bladder using tissues and neo-organs produced in the laboratory. Materials that could be used to create functionally equivalent... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4555837 Mon, 07 Mar 2011 00:00:00 +0100 4555837 http://www.medworm.com/index.php?rid=4555836&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F47%3Frss%3D1 Injuries can counter the beneficial aspects related to sports activities if an athlete is unable to continue to participate because of residual effects of injury. We provide an updated synthesis of existing clinical evidence of long-term follow-up outcome of sports injuries. A systematic computerized literature search was conducted on following databases were accessed: PubMed, Medline, Cochrane, CINAHL and Embase databases. At a young age, injury to the physis can result in limb deformities and leg-length discrepancy. Weight-bearing joints including the hip, knee and ankle are at risk of developing osteoarthritis (OA) in former athletes, after injury or in the presence of malalignment, especially in association with high impact sport. Knee injury is a risk factor for OA. Ankle ligament inj... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4555836 Mon, 07 Mar 2011 00:00:00 +0100 4555836 http://www.medworm.com/index.php?rid=4555835&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F27%3Frss%3D1 Genome-wide association (GWA) studies search for genetic variants, across the entire genome, which display differences in frequencies between cases and controls. Studies in PubMed using the keywords ‘genomewide association’ and ‘cancer’ are reported together with selected literature. Since 2007, GWA studies have successfully yielded risk loci for most common cancers. Findings have provided insights into the biological basis of cancer susceptibility implicating previously unsuspected genes in tumourogenesis. The variants identified typically account for only a small proportion of the familial risk of cancer and thus their application for individual risk prediction is poor. Furthermore, the genotyped variants are unlikely to be directly causal and identifying the caus... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4555835 Mon, 07 Mar 2011 00:00:00 +0100 4555835 http://www.medworm.com/index.php?rid=4555834&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F17%3Frss%3D1 HMG-CoA reductase inhibitors (statins) are widely used in the therapy of hypercholesterolemia. Apart from their lipid-lowering activity, they have pleiotropic effects that are attributed to the inhibition of regulatory proteins, including Ras-homologous (Rho) GTPases. Here, we discuss the potential usefulness of statins to prevent normal tissue damage provoked by radiotherapy. Statins reduce the mRNA expression of pro-inflammatory and pro-fibrotic cytokines stimulated by ionizing radiation in vitro and alleviate IR-induced inflammation and fibrosis in vivo. The currently available data indicate that statins accelerate the rapid repair of DNA double-strand breaks and, moreover, mitigate the DNA damage response induced by IR. Furthermore, statins increase the mRNA expression of DNA repair fa... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4555834 Mon, 07 Mar 2011 00:00:00 +0100 4555834 http://www.medworm.com/index.php?rid=4555833&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F7%3Frss%3D1 This article reviews the history and evidence on impact of the previous models of GP commissioning that have been introduced in the NHS with the aim of distilling key lessons for the design, implementation and evaluation of the latest reforms. GP commissioning has the potential to generate a variety of benefits for the NHS and patients, including lowering elective and non-elective referrals, reducing waiting times, improved coordination of primary and community support services and better financial risk management. GP commissioning has also the potential to reduce patient satisfaction, increase inequalities between geographical areas and may generate substantial management and transaction costs. The GP community will need to display strong directive leadership as well as nurture a culture ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4555833 Mon, 07 Mar 2011 00:00:00 +0100 4555833 http://www.medworm.com/index.php?rid=4555832&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4555832 Mon, 07 Mar 2011 00:00:00 +0100 4555832 http://www.medworm.com/index.php?rid=4204376&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F175%3Frss%3D1 Nausea and vomiting are distinct symptoms, commonly occurring together but which should be assessed separately. Both are prevalent in patients with advanced cancer. Data are taken from The Cochrane Library (2010) and Ovid MEDLINE (1966–2010). Most current guidelines advocate an aetiology-based approach to the management of nausea and vomiting. Choice of anti-emetic is based on a clinical assessment of the likely pathophysiological component of the emetogenic pathway that is being triggered and selecting an anti-emetic drug that blocks the key receptors involved. Some authors propose a more empirical approach. The limited available evidence would suggest that both an empirical or aetiology-based approach may have similar overall efficacy. There are no published studies directly compar... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4204376 Fri, 26 Nov 2010 00:00:00 +0100 4204376 http://www.medworm.com/index.php?rid=4204375&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F159%3Frss%3D1 The number of people with dementia will rise dramatically over the next 20 years. Currently, one in three people over the age of 65 will die with dementia. A PubMed search using MeSH headings for ‘dementia’ AND ‘palliative care’ and for specific areas, i.e. enteral feeding. National reports, UK guidelines and policies were also consulted. Advanced dementia is now being perceived as a ‘terminal illness’ with a similar symptom burden and prognosis to advanced cancer. People with dementia have poor access to good quality end-of-life care. Interventions such as antibiotics, fever management policies and enteral tube feeding remain in use despite little evidence that they improve quality of life or other outcomes. Research is required on the effectiveness of ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4204375 Fri, 26 Nov 2010 00:00:00 +0100 4204375 http://www.medworm.com/index.php?rid=4204374&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F131%3Frss%3D1 Introduction The unique anatomy of the hip is challenging, and has slowed the progress of hip arthroscopy. The aim of this review is to provide an updated synthesis of existing clinical evidence on hip arthroscopy. Sources of data A systematic computerized literature search was conducted by two independent reviewers using an iterative manipulation process of the keywords used singularly or in combination. The following databases were accessed on 30th November, 2009: PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez/); Ovid (http://www.ovid.com); and Cochrane Reviews (http://www.cochrane.org/reviews/). Case reports, literature reviews, letters to editors and articles not including outcome measures were excluded. Twenty-three publications met the inclusion criteria and were included. Areas ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4204374 Fri, 26 Nov 2010 00:00:00 +0100 4204374 http://www.medworm.com/index.php?rid=4204373&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F111%3Frss%3D1 Recently there have been significant advances in rational drug design for the treatment of breast cancer, especially in the area of targeted drug therapy. These include drugs which target the HER2 receptor and angiogenesis and the novel class of drug the PARP inhibitors. Some of these agents, for example, trastuzumab used in the treatment of HER2 positive breast cancer are already established as the standard of care. However, the duration of adjuvant trastuzumab, whether to continue it beyond progression in metastatic disease and the mechanism for developing trastuzumab resistance, remain to be determined. There is also much still to be learnt regarding other targeted therapies; the efficacy of different agents, the optimal duration of use and combination of therapies. Many of these agents... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4204373 Fri, 26 Nov 2010 00:00:00 +0100 4204373 http://www.medworm.com/index.php?rid=4204372&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F93%3Frss%3D1 Our knowledge about the neuropharmacology of addiction is increasing and is leading to more informed development of pharmacotherapy. Although the dopaminergic mesolimbic system plays a central role in ‘liking’, reward and motivation, medications directly targeting it have not proved a very fruitful approach to treating addictions. A review of the literature was performed to find articles relating current and developing pharmacological treatments in the clinic and their underlying neuropharmacology. We focussed on the most common addictions for which pharmacology plays an important role. By characterizing what neurotransmitters modulate this dopaminergic pathway, new medications are now in the clinic and being successfully applied to treat a variety of addictions. In addition to... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4204372 Fri, 26 Nov 2010 00:00:00 +0100 4204372 http://www.medworm.com/index.php?rid=4204371&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F75%3Frss%3D1 Little attention has been focused on the most common risk factors for post-operative glenohumeral arthropathy in patients undergoing open and arthroscopic stabilization. We performed a literature search using Medline, Cochrane and Google Scholar using the keywords: ‘Shoulder instability surgery’ in combination with ‘glenohumeral osteoarthrosis’, ‘recurrent shoulder dislocation’ in combination with ‘surgery’ and ‘complications’. We identified 33 published studies. There is evidence of long-term postoperative glenohumeral arthropathy in patients undergoing surgical management for shoulder instability. The Coleman methodology score showed great heterogeneity in terms of study design, patient characteristics, management methods and ou... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4204371 Fri, 26 Nov 2010 00:00:00 +0100 4204371 http://www.medworm.com/index.php?rid=4204370&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F61%3Frss%3D1 Chronic cough is common, blights patients’ lives and is hard to treat. Chronic cough patients demonstrate high objective cough rates and as a group have increased cough reflex sensitivity. However, conventional cough challenge techniques show substantial overlap with normal subjects. This suggests that other important mechanisms have yet to be determined. For the last two decades, chronic cough has been considered to be caused by gastro-oesophageal reflux, post-nasal drip or Asthma. However, many patients with these conditions do not have cough, and in those with cough, the response to specific treatments is unpredictable at best. In addition, many chronic cough patients do not have an identifiable cause. This raises questions about the concept of a triad of treatable causes for chro... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4204370 Fri, 26 Nov 2010 00:00:00 +0100 4204370 http://www.medworm.com/index.php?rid=4204369&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F45%3Frss%3D1 Nontuberculous mycobacterial (NTM) infections are caused by environmental mycobacteria. Patients with pulmonary NTM disease usually have predisposing lung abnormalities. Diagnostic methods are evolving. Treatment is largely empiric. Data were extracted from peer reviewed publications, guidelines, and case series. Progressive NTM lung disease should be treated. Multidrug regimens are mostly macrolide based and are occasionally complemented by lung resection. Disease persistence and relapse are not uncommon and are a greater problem with so-called rapid-grower NTM infections. Some of the issues considered in this review are: the role of antibiotic susceptibility testing in predicting treatment effectiveness, optimal drug combinations, daily vs. intermittent dosing intervals for different NTM... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4204369 Fri, 26 Nov 2010 00:00:00 +0100 4204369 http://www.medworm.com/index.php?rid=4204368&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F23%3Frss%3D1 The objective of this paper is to address broad policy areas in respect of NCD prevention and control from a public health perspective, with a special focus on low- and middle-income countries (LMIC). The paper is a condensation of current World Health Organization (WHO) reports in this field supported by relevant literature obtained from a Medline search for the period 2000–2010. There is a strong evidence base that underpins the NCD policy agenda. National NCD policies can make a substantive impact on public health in LMIC if they are geared to addressing primary prevention and equity of health systems. National NCD policies help to catalyse, and coherently integrate regulatory, legislative and multisectoral actions across health and other health relevant sectors. Such multisectora... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4204368 Fri, 26 Nov 2010 00:00:00 +0100 4204368 http://www.medworm.com/index.php?rid=4204367&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F5%3Frss%3D1 The quality-adjusted life year (QALY) is routinely used as a summary measure of health outcome for economic evaluation, which incorporates the impact on both the quantity and quality of life. Key studies relating to the QALY and utility measurement are the sources of data. Areas of agreement include the need for a standard measure of health outcome to enable comparisons across different disease areas and populations, and the methods used for valuing health states in utility measurement. Areas of controversy include the limitation of the QALY approach in terms of the health benefits it can capture, its blindness towards equity concerns, the underlying theoretical assumptions and the most appropriate generic preference-based measure of utility. There is growing debate relating to whether a Q... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4204367 Fri, 26 Nov 2010 00:00:00 +0100 4204367 http://www.medworm.com/index.php?rid=4204366&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F96%2F1%2F1%3Frss%3D1 (No abstract is available for this citation) (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=4204366 Fri, 26 Nov 2010 00:00:00 +0100 4204366 http://www.medworm.com/index.php?rid=3905286&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F193%3Frss%3D1 Background Viral haemorrhagic fevers (VHFs) are severe infections capable of causing haemorrhagic disease and fatal multi-organ failure. Crimean-Congo, Marburg, Ebola and Lassa viruses cause both sporadic cases and large epidemics over wide endemic areas. Sources of data Original articles and reviews identified by PubMed search and personal reading; European and United States national guidance and legislation. World Health Organization information, documents and reports. VHFs cause significant morbidity and mortality in their endemic areas; they can cause healthcare-related infections, and their broad diversity and range are increasingly recognized. Areas of controversy There is uncertainty about the risks presented by VHFs in non-endemic countries, particularly in healthcare environment... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3905286 Thu, 26 Aug 2010 16:09:32 +0100 3905286 http://www.medworm.com/index.php?rid=3905285&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F175%3Frss%3D1 Occupational asthma is common, disabling and costly, and it is often difficult to diagnose. Incidence statistics are consequently unreliable, and there are formidable difficulties in recognizing and managing what should be a preventable illness. The opportunities have largely been missed. The author offers a personal view of what, ideally, should be done—recognizing that at present the ideal is not readily practical.Always consider the possibility of an occupational cause at the time adult-onset asthma is first recognized—the probability of this is of the order 9–15%. Do not prescribe treatment unless this possibility is remote or the asthma is life-threatening. If the possibility is not remote seek immediate advice from a specialized centre, without prescribing masking... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3905285 Thu, 26 Aug 2010 16:09:32 +0100 3905285 http://www.medworm.com/index.php?rid=3905284&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F161%3Frss%3D1 Introduction Dengue is a vector-borne viral infection that endangers an estimated 2.5 billion people. Disease caused by dengue ranges from a relatively minor febrile illness to a life-threatening condition characterized by extensive capillary leak. A greater understanding of dengue has the potential to improve both the clinical management of individual cases and the control of the disease. Sources of data We searched the available literature using PubMed, Embase and Web of Science for relevant articles and abstracts. Areas of agreement Addressing our gaps in the understanding of disease pathogenesis and improving our knowledge of dengue virus biology are necessary in order to develop tools to effectively control, diagnose and treat the disease. Areas of controversy The pathogenesis of d... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3905284 Thu, 26 Aug 2010 16:09:32 +0100 3905284 http://www.medworm.com/index.php?rid=3905283&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F139%3Frss%3D1 Sarcopenia reflects a progressive withdrawal of anabolism and an increased catabolism, along with a reduced muscle regeneration capacity. Muscle force and power decline more than muscle dimensions: older muscle is intrinsically weak. Sarcopenic obesity (SO) among the elderly corroborates to the loss of muscle mass increasing the risk of metabolic syndrome development. Recent studies on the musculoskeletal adaptations with ageing and key papers on the mechanisms of muscle wasting, its functional repercussions and on SO are included. Neuropathic, hormonal, immunological, nutritional and physical activity factors contribute to sarcopenia. Selective fast fibre atrophy, loss of motor units and an increase in hybrid fibres are typical findings of ageing. Satellite cell number decreases reducing ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3905283 Thu, 26 Aug 2010 16:09:32 +0100 3905283 http://www.medworm.com/index.php?rid=3905282&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F121%3Frss%3D1 The valid measurement of physical activity has the potential to be a very useful tool in countering the obesity epidemic. Previously, reviews have been carried out to investigate the validity of pedometers among adults. This paper aimed to carry out a similar review among children. A literature search was performed in PubMed, Web of Science, PsycINFO, CINAHL and SportDISCUS. Here, 25 papers investigating the validity, reliability and feasibility of pedometers for children were included in the study. Pedometers correlated highly in terms of both criterion (direct observation) and convergent validity (heart-rate monitor, accelerometer). Intra- and inter-unit reliability was also consistently high. Few studies report on feasibility issues of pedometer use in children, particularly compliance,... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3905282 Thu, 26 Aug 2010 16:09:32 +0100 3905282 http://www.medworm.com/index.php?rid=3905281&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F105%3Frss%3D1 There is ongoing debate in the UK as to the place of coercion and compulsion in community mental health care. Recent changes in service provision and amendments to the Mental Health Act in England and Wales have increased the scope for compulsion in the community. This has intensified the debate revealing fault lines in the psychiatric and legal professions. Despite powerful arguments from all sides there is little empirical evidence to inform this debate at a clinical or a theoretical level. This review utilizes evidence from articles in peer reviewed journals. Papers were identified from electronic databases, the authors' databases of relevant literature and personal correspondence with experts in the field. The evidence base is relatively small but is expanding. It has been demonstrated... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3905281 Thu, 26 Aug 2010 16:09:32 +0100 3905281 http://www.medworm.com/index.php?rid=3905280&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F79%3Frss%3D1 Multiple sclerosis (MS) is the commonest disabling neurological condition to afflict young adults and therefore has a high social burden. Over several decades, there has been a considerable progress in the understanding of the disease pathogenesis as well as in the clinical management of MS patients. The emphasis in managing MS patients has shifted to multidisciplinary teams working in specialist groups. A review of the literature was conducted using MedLine to identify recent advances in MS. The current consensus is that MS is an autoimmune disease triggered by environmental agents acting in genetically susceptible people. Based on that concept, new methods of immune intervention procedures have been introduced into clinical practice. Licensed first-line disease-modifying therapies reduce... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3905280 Thu, 26 Aug 2010 16:09:31 +0100 3905280 http://www.medworm.com/index.php?rid=3905279&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F63%3Frss%3D1 Chronic degenerative tendinopathies are frequent and difficult to treat. Tendon healing and regeneration may be improved by injecting autologous growth factors obtained from the patient's blood. Autologous growth factors can be injected with autologous whole blood or platelet-rich plasma (PRP). Electronic databases were searched for prospective clinical trials on treatment with autologous growth factors of patients with chronic tendinopathy. Chronic tendinopathy in this study included wrist extensors, flexors, plantar fasciopathy and patellar tendinopathy. Studies examining the treatment of other tendinopathies were not identified. The Physiotherapy Evidence Database score was used to examine the methodological quality of the assessment, and a qualitative analysis was performed with the le... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3905279 Thu, 26 Aug 2010 16:09:31 +0100 3905279 http://www.medworm.com/index.php?rid=3905278&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F47%3Frss%3D1 This report is a systematic review of the literature on our current understanding of lung cancer biology. Searches were carried out using PUBMED. 1990–2010. Areas of agreement A concerted effort to reduce cigarette smoking and nicotine addiction is required. A better understanding of the biology of lung cancer will lead to the identification of earlier diagnostic markers and improved therapy. Areas of controversy How chronic inflammatory disorders such as COPD and lung fibrosis contribute to lung cancer development is incompletely understood. Growing Points Developing novel biological agents to target lung cancer. New microarray-based technologies provide new methods for predicting prognosis and response to treatment. Areas timely for developing research Developing strategies to ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3905278 Thu, 26 Aug 2010 16:09:31 +0100 3905278 http://www.medworm.com/index.php?rid=3905277&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F33%3Frss%3D1 Introduction Delayed discharge from acute hospital has been a cause of concern for the last 10 years. Older people with complex health needs are particularly vulnerable to delayed discharge with negative consequences for their health and wellbeing. Source of data Review of the literature on the impact of the Community Care (Delayed Discharge) Act (2003) and subsequent policy initiatives on delayed discharges. Areas of agreement A number of cross-institutional complexities contribute to delayed discharges. Policy measures have contributed positively to reducing delayed discharges. Investment in intermediate care services has provided a range of services to promote maximum independence for older people after acute hospital admission. Joint working between health and social services is nece... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3905277 Thu, 26 Aug 2010 16:09:31 +0100 3905277 http://www.medworm.com/index.php?rid=3905276&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F7%3Frss%3D1 This synthesis seeks to assess and explain the effectiveness of policy interventions to reduce elective wait times or lists. PubMed, EMBASE, EconLit, and grey literature were systematically searched for relevant studies and reviews. Strategies with the strongest evidence base include paying for activity, buying capacity locally and setting targets with strong incentives. There is also evidence for improving the use of existing capacity. Limiting demand through rationing can reduce waits, but is ethically problematic. Short-term injections of funding, cross-border treatment schemes, unenforced targets and promotion of private health insurance had the weakest evidence. Available evidence favours options that act fairly directly on supply, demand or local organizations' behaviour, over indire... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3905276 Thu, 26 Aug 2010 16:09:31 +0100 3905276 http://www.medworm.com/index.php?rid=3905275&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F95%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3905275 Thu, 26 Aug 2010 16:09:31 +0100 3905275 http://www.medworm.com/index.php?rid=3605458&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F94%2F1%2F215%3Frss%3D1 Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has been recognized for over a decade, and usually refers to MRSA identified in previously healthy individuals with no recognized MRSA risk factors. Infections range from minor skin and soft tissue infections, through to severe pneumonia and necrotizing fasciitis. This review summarizes the current data on the epidemiology and molecular features of CA-MRSA, in addition to diagnosis and therapeutic measures. We also refer to current national guidelines for the management of these infections. Areas of agreement include the important genotypic and phenotypic differences of community MRSA strains compared with hospital strains. Areas of controversy include the precise epidemiological definition of community-acquired/ass... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3605458 Thu, 27 May 2010 16:09:49 +0100 3605458 http://www.medworm.com/index.php?rid=3605457&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F94%2F1%2F201%3Frss%3D1 Rheumatoid arthritis (RA) is the most common autoimmune inflammatory polyarthritis. Significant advances in the understanding of its pathogenesis have led in the past two decades to major advancement in its therapy. We used data from articles in Cochrane Database of Systematic Reviews on ‘rheumatoid arthritis’, meta-analyses and randomized controlled trials on adult RA (age >19 years) published in English within the past 5 years and identified in PubMed, and other key papers on management of RA. Appropriate, early and aggressive therapy is required for confirmed active cases of RA. The choice of disease-modifying drugs and different combinations, especially the newer biologic agents in regards of their early and long-term usage remains debated because of high costs and long-... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3605457 Thu, 27 May 2010 16:09:49 +0100 3605457 http://www.medworm.com/index.php?rid=3605456&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F94%2F1%2F189%3Frss%3D1 Conclusion Despite unmet goals, antihypertensive treatment has provided throughout the years successful results. Future efforts will be need to achieve a better BP control in the population and thus to obtain a greater CV protection. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3605456 Thu, 27 May 2010 16:09:49 +0100 3605456 http://www.medworm.com/index.php?rid=3605455&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F94%2F1%2F165%3Frss%3D1 Conclusion Rather than providing strong evidence for or against the use of these materials for tendon augmentation, this study instead generates potential areas for additional prospective investigation. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3605455 Thu, 27 May 2010 16:09:49 +0100 3605455 http://www.medworm.com/index.php?rid=3605454&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F94%2F1%2F145%3Frss%3D1 Introduction The incidence of type 1 diabetes (T1D) is increasing worldwide, particularly in children, and is associated with a significant burden, mainly related to the development of vascular complications. The prevention and treatment of microvascular complications, which include nephropathy, retinopathy and neuropathy, are of paramount importance to decrease the associated mortality and morbidity. Sources of data A literature search was performed on Medline and articles on microvascular complications, with particular emphasis on the increasing incidence of childhood T1D and its implications on prevention and treatment of complications, were selected. Areas of agreement The incidence of childhood T1D is increasing. Early identification of subjects at risk for long-term complications a... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3605454 Thu, 27 May 2010 16:09:49 +0100 3605454 http://www.medworm.com/index.php?rid=3605453&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F94%2F1%2F81%3Frss%3D1 Conclusion Further studies are required to evaluate the reliability, validity and sensitivity of the low back pain scoring systems used in the common clinical practice. (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3605453 Thu, 27 May 2010 16:09:48 +0100 3605453 http://www.medworm.com/index.php?rid=3605452&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F94%2F1%2F65%3Frss%3D1 Heart failure is a leading cause of morbidity and mortality worldwide. The current strategies for treatment are limited and new therapeutic approaches are needed. This review describes research performed in animal models of cardiac disease and clinical trials and discusses the mechanisms involved in possible beneficial effects of cell therapy. Cell therapy is a promising strategy to treat heart failure, as it aims to replenish the failing myocardium with contractile elements. However, cell therapy with adult progenitor cells induces a small improvement in heart function without significant cardiomyogenesis. Paracrine mechanisms are likely to be important. The most effective cell type for therapy remains unclear. Induced pluripotent stem cells have the greatest potential but more informatio... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3605452 Thu, 27 May 2010 16:09:48 +0100 3605452 http://www.medworm.com/index.php?rid=3605451&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F94%2F1%2F49%3Frss%3D1 The vast majority of cancer-related death is due to the metastatic spread of the primary tumour. Circulating tumour cells (CTC) are essential for establishing metastasis and their detection has long been considered as a possible tool to assess the aggressiveness of a given tumour and its potential of subsequent growth at distant organs. Conventional markers are not reliable in detecting occult metastasis and, for example, fail to identify ~40% of cancer patients in need of more aggressive or better adjusted therapies. Recent studies in metastatic breast cancer have shown that CTC detection can be used as a marker for overall survival and assessment of the therapeutic response. The benefits of CTC detection in early breast cancer and other solid tumours need further validation. Moreover, op... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3605451 Thu, 27 May 2010 16:09:48 +0100 3605451 http://www.medworm.com/index.php?rid=3605450&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F94%2F1%2F33%3Frss%3D1 Introduction The technique of paediatric living-donor liver transplantation (LDLT) has become standardized. In adults, however, there is scope for innovation. Unlike cadaveric whole-size liver transplantation and paediatric LDLT, size matching between the liver graft and the recipient by body weight has been a major challenge in adult LDLT because it is important to provide an adequate graft mass to the recipient while leaving a sufficient mass of remnant liver in the donor to ensure donor safety. Growing points In adult LDLT, liver grafts have been selected to meet graft-recipient size-matching requirements. In 1996, the Hong Kong group pioneered the use of the right-lobe grafts vein to overcome the volume insufficiency often encountered with the left-lobe liver grafts. Subsequently, the... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3605450 Thu, 27 May 2010 16:09:48 +0100 3605450 http://www.medworm.com/index.php?rid=3605449&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F94%2F1%2F21%3Frss%3D1 Pulmonary hypertension is an orphan disease that until recently has received limited attention within the wider medical community. This has changed distinctly in the last 10 years with the advent of new classes of therapy and a renewed interest in mechanisms of pathogenesis. This review utilized information gathered from recent conferences, and a review of the literature was conducted using MedLine and Pubmed. Accepted mechanisms of pathogenesis and currently available treatments are presented. We will discuss interesting new concepts in pathogenesis, including the importance of genetic forms of the disease and in particular the transforming growth factor receptor superfamily and the evolving evidence of the contribution of dysregulated immunity. Areas of research may yield therapeutic ben... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3605449 Thu, 27 May 2010 16:09:48 +0100 3605449 http://www.medworm.com/index.php?rid=3605448&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F94%2F1%2F7%3Frss%3D1 Introduction This paper aims to provide a concise review of the ethical issues that are commonly raised in the UK debate on non-medical sex selection. Background information on sex selection technologies is provided, as is a description of the relevant UK legislation. Arguments for and against non-medical sex selection will be explained and compared and conclusions will be drawn. It is finally suggested that the international debate on non-medical sex selection ought to be regarded as an important area of related interest. Sources of data Data were obtained from a search of existing ethics and policy literature focusing on sex selection. Areas of agreement There are very few areas of universal agreement in the debate. Areas of controversy There is much disagreement between critics over ... British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3605448 Thu, 27 May 2010 16:09:48 +0100 3605448 http://www.medworm.com/index.php?rid=3605447&cid=s_30412_22_f&fid=30412&url=http%3A%2F%2Fbmb.oxfordjournals.org%2Fcgi%2Fcontent%2Fshort%2F94%2F1%2F1%3Frss%3D1 (Source: British Medical Bulletin) British Medical Bulletin journals http://www.medworm.com/rss/comments.php?id=3605447 Thu, 27 May 2010 16:09:48 +0100 3605447 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