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Visual Function and Fitness to DriveEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: British Medical Bulletin)
Source: British Medical Bulletin - September 2, 2009 Category: Journals (General) Authors: Kotecha, A., Spratt, A., Viswanathan, A. Tags: Corrigendum Source Type: journals

Visceral pain hypersensitivity in functional gastrointestinal disordersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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, d...
Source: British Medical Bulletin - September 2, 2009 Category: Journals (General) Authors: Farmer, A. D., Aziz, Q. Tags: Gastroenterology and Hepatology Articles Source Type: journals

Sports activities after lower limb osteotomyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 tibia...
Source: British Medical Bulletin - September 2, 2009 Category: Journals (General) Authors: Gougoulias, N., Khanna, A., Maffulli, N. Tags: Sports Medicine Articles Source Type: journals

The management of Clostridium difficile infectionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 mai...
Source: British Medical Bulletin - September 2, 2009 Category: Journals (General) Authors: Williams, O. M., Spencer, R. C. Tags: Infectious Diseases Articles Source Type: journals

Open tibial fractures in the paediatric population: a systematic review of the literatureEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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’, ‘e...
Source: British Medical Bulletin - September 2, 2009 Category: Journals (General) Authors: Gougoulias, N., Khanna, A., Maffulli, N. Tags: Sports Medicine Articles Source Type: journals

Schizophrenia genetics: new insights from new approachesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 o...
Source: British Medical Bulletin - September 2, 2009 Category: Journals (General) Authors: Williams, H. J., Owen, M. J., O'Donovan, M. C. Tags: Psychiatry Articles Source Type: journals

Preventing dementia: role of vascular risk factors and cerebral emboliEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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, smo...
Source: British Medical Bulletin - September 2, 2009 Category: Journals (General) Authors: Purandare, N. Tags: Psychiatry Articles Source Type: journals

Wealth, health and equity: convergence to divergence in late 20th century globalizationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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. Area...
Source: British Medical Bulletin - September 2, 2009 Category: Journals (General) Authors: Taylor, S. Tags: Public Health Medicine Articles Source Type: journals

Global health: where are our priorities?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 WH...
Source: British Medical Bulletin - September 2, 2009 Category: Journals (General) Authors: Martin, G., Bird, P., Crichton, C. Tags: Health Policy Articles Source Type: journals

The ethics of public health practice: balancing private and public interest within tobacco policyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 crit...
Source: British Medical Bulletin - September 2, 2009 Category: Journals (General) Authors: Shickle, D. Tags: Ethics Articles Source Type: journals

Editor's ChoiceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: British Medical Bulletin)
Source: British Medical Bulletin - September 2, 2009 Category: Journals (General) Authors: Vetter, N. Tags: Articles Source Type: journals

Management of unstable slipped upper femoral epiphysis: a meta-analysisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 gav...
Source: British Medical Bulletin - June 1, 2009 Category: Journals (General) Authors: Lowndes, S., Khanna, A., Emery, D., Sim, J., Maffulli, N. Tags: Sports Medicine Articles Source Type: journals

Does exercise increase the risk of upper respiratory tract infections?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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, spo...
Source: British Medical Bulletin - June 1, 2009 Category: Journals (General) Authors: Moreira, A., Delgado, L., Moreira, P., Haahtela, T. Tags: Immunology Articles Source Type: journals

Prevention of adhesions in surgery of the flexor tendons of the hand: what is the evidence?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 a...
Source: British Medical Bulletin - June 1, 2009 Category: Journals (General) Authors: Khanna, A., Friel, M., Gougoulias, N., Longo, U. G., Maffulli, N. Tags: Sports Medicine Articles Source Type: journals

Heart rate as a treatable cardiovascular risk factorEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 res...
Source: British Medical Bulletin - June 1, 2009 Category: Journals (General) Authors: Tardif, J.-C. Tags: Cardiovascular Disease Articles Source Type: journals

From prescription-only to over-the-counter medicines ('PoM to P'): time for an intermediate categoryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 t...
Source: British Medical Bulletin - June 1, 2009 Category: Journals (General) Authors: Aronson, J. K. Tags: Psychiatry Articles Source Type: journals

Should sildenafil be available over the counter?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 t...
Source: British Medical Bulletin - June 1, 2009 Category: Journals (General) Authors: Rubin, N., Wylie, K. Tags: Psychiatry Articles Source Type: journals

Rotaviruses and rotavirus vaccinesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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, ge...
Source: British Medical Bulletin - June 1, 2009 Category: Journals (General) Authors: Desselberger, U., Manktelow, E., Li, W., Cheung, W., Iturriza-Gomara, M., Gray, J. Tags: Infectious Diseases Articles Source Type: journals

Cellular reprogramming and pluripotency inductionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 res...
Source: British Medical Bulletin - June 1, 2009 Category: Journals (General) Authors: Lensch, M. W. Tags: Genetics Articles Source Type: journals

Grand challenges in global health governanceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 t...
Source: British Medical Bulletin - June 1, 2009 Category: Journals (General) Authors: Gostin, L. O., Mok, E. A. Tags: Health Policy Articles Source Type: journals

Editor's ChoiceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: British Medical Bulletin)
Source: British Medical Bulletin - June 1, 2009 Category: Journals (General) Authors: Vetter, N. Tags: Articles Source Type: journals

Aicardi-Goutieres syndromeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 Internatio...
Source: British Medical Bulletin - March 2, 2009 Category: Journals (General) Authors: Orcesi, S., La Piana, R., Fazzi, E. Tags: Immunology Articles Source Type: journals

The effects of LIPUS on soft-tissue healing: a review of literatureEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: British Medical Bulletin - March 2, 2009 Category: Journals (General) Authors: Khanna, A., Nelmes, R. T. C., Gougoulias, N., Maffulli, N., Gray, J. Tags: Sports Medicine Articles Source Type: journals

Hepatitis C virus: the growing challengeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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, part...
Source: British Medical Bulletin - March 2, 2009 Category: Journals (General) Authors: Thomson, B. J. Tags: Infectious Diseases Articles Source Type: journals

History and evolution in total ankle arthroplastyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions Results show that ankle arthroplasty is a viable alternative for the management of ankle arthritis in selected patients. (Source: British Medical Bulletin)
Source: British Medical Bulletin - March 2, 2009 Category: Journals (General) Authors: Gougoulias, N. E., Khanna, A., Maffulli, N. Tags: Sports Medicine Articles Source Type: journals

Recent advances in the microbiology of respiratory tract infection in cystic fibrosisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 segre...
Source: British Medical Bulletin - March 2, 2009 Category: Journals (General) Authors: Foweraker, J. Tags: Infectious Diseases Articles Source Type: journals

Advanced life support updateEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: British Medical Bulletin - March 2, 2009 Category: Journals (General) Authors: Husselbee, N., Davies, R. P., Perkins, G. D. Tags: Critical Care/Intensive Care/Emergency Medicine Articles Source Type: journals

Cardiac radionuclide imaging in stable coronary artery disease and acute coronary syndromesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: British Medical Bulletin - March 2, 2009 Category: Journals (General) Authors: Stirrup, J., Wechalekar, K., Maenhout, A., Anagnostopoulos, C. Tags: Nuclear Medicine Articles Source Type: journals

Recognition and treatment of Asperger syndrome in the communityEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 c...
Source: British Medical Bulletin - March 2, 2009 Category: Journals (General) Authors: Tantam, D., Girgis, S. Tags: Psychiatry Articles Source Type: journals

The potential role and application of PARP inhibitors in cancer treatmentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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-clini...
Source: British Medical Bulletin - March 2, 2009 Category: Journals (General) Authors: Chalmers, A. J. Tags: Immunology Articles Source Type: journals

Terminal illness and access to Phase 1 experimental agents, surgeries and devices: reviewing the ethical argumentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 pos...
Source: British Medical Bulletin - March 2, 2009 Category: Journals (General) Authors: Schuklenk, U., Lowry, C. Tags: Ethics Articles Source Type: journals

Editor's ChoiceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: British Medical Bulletin)
Source: British Medical Bulletin - March 2, 2009 Category: Journals (General) Authors: Vetter, N. Tags: Articles Source Type: journals

Operative management of tennis elbow: a quantitative reviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: British Medical Bulletin - December 11, 2008 Category: Journals (General) Authors: Karkhanis, S., Frost, A., Maffulli, N. Tags: Sports Medicine Articles Source Type: journals

Coeliac diseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 pap...
Source: British Medical Bulletin - December 11, 2008 Category: Journals (General) Authors: Leeds, J. S., Hopper, A. D., Sanders, D. S. Tags: Gastroenterology and Hepatology Articles Source Type: journals

Intermittent pneumatic compression in fracture and soft-tissue injuries healingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: British Medical Bulletin - December 11, 2008 Category: Journals (General) Authors: Khanna, A., Gougoulias, N., Maffulli, N. Tags: Sports Medicine Articles Source Type: journals

The relationship between type 2 diabetes and dementiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 indiv...
Source: British Medical Bulletin - December 11, 2008 Category: Journals (General) Authors: Strachan, M. W. J., Reynolds, R. M., Frier, B. M., Mitchell, R. J., Price, J. F. Tags: Diabetes Articles Source Type: journals

The genetic basis for type 1 diabetesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 identif...
Source: British Medical Bulletin - December 11, 2008 Category: Journals (General) Authors: Mehers, K. L., Gillespie, K. M. Tags: Diabetes Articles Source Type: journals

Host-bacteria interaction in inflammatory bowel diseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 proces...
Source: British Medical Bulletin - December 11, 2008 Category: Journals (General) Authors: Knight, P., Campbell, B. J., Rhodes, J. M. Tags: Gastroenterology and Hepatology Articles Source Type: journals

Treatment of atrial fibrillationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 t...
Source: British Medical Bulletin - December 11, 2008 Category: Journals (General) Authors: Bajpai, A., Savelieva, I., Camm, A. J. Tags: Cardiovascular Disease Articles Source Type: journals

HPV vaccines: are they the answer?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Background The burden of human papillomavirus (HPV)-associated ano-genital disease is significant but the ability to generate HPV virus-like particles by the synthesis and self-assembly in vitro of the major virus coat protein L1 has transformed our prospects for preventing benign and malignant ano-genital disease caused by the common genital HPV types. Sources of data Peer reviewed journals. Areas of agreement Two HPV L1 vaccines have been developed, a quadrivalent HPV 6/11/16/18, and a bivalent HPV 16/18 product. Both vaccines are very immunogenic and well tolerated. They have been shown in the various randomized Contr...
Source: British Medical Bulletin - December 11, 2008 Category: Journals (General) Authors: Stanley, M. Tags: Public Health Medicine Articles Source Type: journals

Social cognition in schizophrenia: a review of face processingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Background People with schizophrenia have difficulties in interpreting social information. Much social information is gathered from faces, and face processing represents a well-characterized model to study the basis of social deficits in schizophrenia. Sources of data A narrative review of selected literature. Areas of agreement Individuals with schizophrenia have impairments in recognizing basic emotions and making social judgements from facial stimuli. Areas of controversy The neural basis of these abnormalities is still being determined. However, initial evidence implicates dysfunction of frontal and temporal lobe br...
Source: British Medical Bulletin - December 11, 2008 Category: Journals (General) Authors: Marwick, K., Hall, J. Tags: Psychiatry Articles Source Type: journals

A 'pain-free' deathEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Background The time around a patient's death is often filled with sadness, but good medical and nursing care can provide comfort to patients and their carers at this critical time. For many, a ‘pain-free’ death is a priority although there are other aspects to providing good care at the end of life. Honest, open discussion with patients and carers about their wishes is an essential prerequisite to individualized care. Sources of data Relevant literature was reviewed with regards to policy, education and delivery of end of life care. Areas of agreement Pain management must be tailored to the individual with du...
Source: British Medical Bulletin - December 11, 2008 Category: Journals (General) Authors: Hicks, F., Rees, E. Tags: Palliative Medicine Articles Source Type: journals

Psychological interventions following terrorist attacksEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Background Psychological reactions to terror attacks have been documented as ranging from no symptoms to transient behavioural symptoms to more serious posttraumatic stress. Sources of data A review of representative studies is presented, with a critical analysis of the salient points of the various psychological intervention strategies for terrorist attacks. Areas of agreement Common aspects of both most intervention approaches include multifaceted models that foster social support and include a preparatory phase, a phase of ‘psychological first aid’ and a follow-up phase of referral for more severe cases. ...
Source: British Medical Bulletin - December 11, 2008 Category: Journals (General) Authors: Mansdorf, I. J Tags: Psychiatry Articles Source Type: journals

Editor's ChoiceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: British Medical Bulletin)
Source: British Medical Bulletin - December 11, 2008 Category: Journals (General) Tags: Articles Source Type: journals

Current use of antiretroviral treatmentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article summarizes the current use of anti-HIV medication and the evidence behind it for the non-specialist. Areas timely for developing research New strategies for using current drugs, the best use of newly available drugs and new uses of antiretroviral drugs, such as in prevention of HIV transmission, are key areas for research. Further research addressing the question of when to start antiretrovirals and assessing their long-term effects is also needed. (Source: British Medical Bulletin)
Source: British Medical Bulletin - September 12, 2008 Category: Journals (General) Authors: Bailey, A. C., Fisher, M. Tags: HIV/AIDS Articles Source Type: journals

Visual function and fitness to driveEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Introduction Driving is recognized to be a visually intensive task and accordingly there is a legal minimum standard of vision required for all motorists. The purpose of this paper is to review the current United Kingdom (UK) visual requirements for driving and discuss the evidence base behind these legal rules. The role of newer, alternative tests of visual function that may be better indicators of driving safety will also be considered. Finally, the implications of ageing on driving ability are discussed. Sources of data A search of Medline and PubMed databases was performed using the following keywords: driving, vision...
Source: British Medical Bulletin - September 12, 2008 Category: Journals (General) Authors: Kotecha, A., Spratt, A., Viswanathan, A. Tags: Ophthalmology Articles Source Type: journals

Rating systems for evaluation of the elbowEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion Further studies are required to evaluate the reliability, validity and sensitivity of the elbow scoring systems used in the common clinical practice. (Source: British Medical Bulletin)
Source: British Medical Bulletin - September 12, 2008 Category: Journals (General) Authors: Longo, U. G., Franceschi, F., Loppini, M., Maffulli, N., Denaro, V. Tags: Sports Medicine Articles Source Type: journals

Targeted therapies for pancreatic cancerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Introduction Pancreatic cancer is a devastating malignancy and a leading cause of cancer mortality. Furthermore, early diagnosis represents a serious hurdle for clinicians, as symptoms are non-specific and usually manifest in advanced, treatment-resistant stages of the disease. Sources of data Here, we review the rationale and progress of targeted therapies currently under investigation. Areas of agreement At present, chemoradiation regimes are administered palliatively, and produce only marginal survival benefits, underscoring a desperate need for more effective treatment modalities. Areas of controversy Questions have...
Source: British Medical Bulletin - September 12, 2008 Category: Journals (General) Authors: Danovi, S. A., Wong, H. H., Lemoine, N. R. Tags: Oncology Articles Source Type: journals

Articular cartilage: structure, injuries and review of managementEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article re-visits the intricate structure of articular cartilage and reviews the different methods of regeneration described in the literature, based on evidence-based effectiveness. The methods described by their originators and their results are considered gold standards for those methods, as being the best available evidence. Areas of agreement Majority of the authors agree that cartilage injuries are complex and difficult to treat. If untreated, cartilage defects lead to early osteoarthritis. Great debate still persists about the best available treatment for symptomatic chondral or osteochondral defect(s). Areas...
Source: British Medical Bulletin - September 12, 2008 Category: Journals (General) Authors: Bhosale, A. M., Richardson, J. B. Tags: Sports Medicine Articles Source Type: journals

The social behaviours of bacterial pathogensEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Introduction The term quorum sensing (QS) is used to describe communication between bacterial cells, whereby a coordinated population response is controlled by diffusible signal molecules produced by individuals. Sources of data Studies on QS-mediated signalling processes in bacteria have revealed the existence of intricate regulatory networks to enable bacterial populations to fine tune their responses to environmental changes and increase their chances of survival, using complex signalling pathways. Areas of agreement A population of bacteria invading a host may benefit from the coordinated release of virulence determi...
Source: British Medical Bulletin - September 12, 2008 Category: Journals (General) Authors: Popat, R., Crusz, S. A., Diggle, S. P. Tags: Infectious Diseases Articles Source Type: journals