Small joints replacement for hand osteoarthritis: a systematic review
Introduction
Small joints replacement is a valid treatment for moderate to severe osteoarthritis of the hand. Several design and materials are now available for prostethic procedures with very different clinical and functional outcomes.
Sources of data
An online search was carried out using Medline, Cochrane and Google scholar online databases, searching for studies on small joints replacement in hand surgery.
Areas of agreement
Good functional and clinical outcomes can be achieved with silicone and pyrolitic carbon implants, either for trapeziometacarpal and metacarpophalangeal joints. In particular, the silicone spacer...
Source: British Medical Bulletin - December 9, 2015 Category: Journals (General) Authors: Papalia, R., Tecame, A., Torre, G., D'Adamio, S., Maffulli, N., Denaro, V. Tags: Sports Medicine Articles Source Type: research
Clinical trial transparency: many gains but access to evidence for new medicines remains imperfect
Background
Although selective and incomplete publication is widely acknowledged to be a problem, full access to clinical trial data remains illusive.
Sources of data
Authors’ personal files, key documents from Food and Drug Administration and European Medicines Agency and focussed searches of PubMed.
Areas of agreement
Existing sources of information provide an incomplete overview of scientific research.
Areas of controversy
Persistent arguments about commercial confidentiality and the potential difficulties in de-identifying raw data can block important progress. Current industry efforts are voluntary and only pa...
Source: British Medical Bulletin - December 9, 2015 Category: Journals (General) Authors: Mintzes, B., Lexchin, J., Quintano, A. d. S. Tags: Articles Source Type: research
Health, equity and the north of England: a case study on a new approach
This article describes, as a case study, a new fresh approach to tackling health inequalities, which built on a desire by local councils in the north of England to rethink approaches and collaborate on new ideas to improving health and reducing health inequalities.
Sources of data
The collaboration was supported by an independently commissioned inquiry that assessed the evidence and proposed new policy options. This article describes the context to the collaboration, called Health Equity North, findings from the independent inquiry and emerging impact. Four areas for action were recommended: linking poverty with economic ...
Source: British Medical Bulletin - December 9, 2015 Category: Journals (General) Authors: Johnstone, P. Tags: Public Health Medicine Articles Source Type: research
Human embryonic and induced pluripotent stem cells in clinical trials
Background
Human embryonic and induced pluripotent stem cells (hESC and hiPSC) have tremendous potential for clinical implementation. In spite of all hurdles and controversy, clinical trials in treatment of spinal cord injury, macular degeneration of retina, type 1 diabetes and heart failure are already ongoing.
Sources of data
ClinicalTrials.gov database, International Clinical Trials Registry Platform, PubMed and press releases and websites of companies and institutions working on hESC- and iPSC-based cellular therapy.
Areas of agreement
The initial results from multiple clinical trials demonstrate that hESC-based ther...
Source: British Medical Bulletin - December 9, 2015 Category: Journals (General) Authors: Ilic, D., Devito, L., Miere, C., Codognotto, S. Tags: Genetics Articles Source Type: research
Potential compounds for the treatment of mitochondrial disease
Introduction
Mitochondrial diseases are a group of heterogeneous disorders for which no curative therapy is currently available. Several drugs are currently being pursued as candidates to correct the underlying biochemistry that causes mitochondrial dysfunction.
Sources of data
A systematic review of pharmacological therapeutics tested using in vitro, in vivo models and clinical trials. Results presented from database searches undertaken to ascertain compounds currently being pioneered to treat mitochondrial disease.
Areas of agreement
Previous clinical research has been hindered by poorly designed trials that have shown...
Source: British Medical Bulletin - December 9, 2015 Category: Journals (General) Authors: Rai, P. K., Russell, O. M., Lightowlers, R. N., Turnbull, D. M. Tags: Genetics Articles Source Type: research
Editor's Choice, volume 116
(Source: British Medical Bulletin)
Source: British Medical Bulletin - December 9, 2015 Category: Journals (General) Authors: Vetter, N. Tags: Editor ' s Choice Source Type: research
Managing inadequate antidepressant response in depressive illness
Introduction or background
Depression frequently fails to respond to initial treatment.
Sources of data
Predominantly meta-analyses and RCTs but supplemented where necessary by additional data and the authors' clinical experience.
Areas of agreement
A systematic assessment to identify remedial causes of poor response should be followed by planned sequential treatment trials. Joint decision making by the patient and clinician is essential. Strategies with the strongest support are antidepressant augmentation with lithium or second generation antipsychotics and adding cognitive behavioural treatment. Electroconvulsive ther...
Source: British Medical Bulletin - September 8, 2015 Category: Journals (General) Authors: Haddad, P. M., Talbot, P. S., Anderson, I. M., McAllister-Williams, R. H. Tags: Psychiatry Articles Source Type: research
Social and ethical issues in mitochondrial donation
Introduction or background
The UK is at the forefront of mitochondrial science and is currently the only country in the world to legalize germ-line technologies involving mitochondrial donation. However, concerns have been raised about genetic modification and the ‘slippery slope’ to designer babies.
Sources of data
This review uses academic articles, newspaper reports and public documents.
Areas of agreement
Mitochondrial donation offers women with mitochondrial disease an opportunity to have healthy, genetically related children.
Areas of controversy
Key areas of disagreement include safety, the creation o...
Source: British Medical Bulletin - September 8, 2015 Category: Journals (General) Authors: Dimond, R. Tags: Ethics Articles Source Type: research
Management of hip fracture
Introduction
Hip fracture poses a significant global challenge both to healthcare systems and to patients themselves. We outline the management of this injury, highlight areas where the evidence is deficient and discuss research efforts towards improving the quality of the evidence base.
Sources of data
We searched MEDLINE, PubMed and the Cochrane Library, using the core search terms ‘hip fracture’ and ‘proximal femoral fracture’. In addition we reviewed national treatment guidelines for hip fracture care and references from relevant articles. Only articles published in English from inception to Ma...
Source: British Medical Bulletin - September 8, 2015 Category: Journals (General) Authors: Fernandez, M. A., Griffin, X. L., Costa, M. L. Tags: Articles Source Type: research
Advances in radionuclide imaging of cardiac sarcoidosis
This article is based on published clinical guidelines, literature review and our collective clinical experience.
Areas of agreement
Gallium-67 scintigraphy is among the diagnostic criteria for cardiac involvement in systemic sarcoidosis, and it is strongly associated with response to treatment. However, fluorine-18, 2-fluoro-deoxyglucose (FDG) positron emission tomography (PET) is now preferred both for diagnosis and for assessing prognosis.
Areas of controversy
Most data are from small observational studies that are potentially biased.
Growing points
Quantitative imaging to assess changes in disease activity in respon...
Source: British Medical Bulletin - September 8, 2015 Category: Journals (General) Authors: Kouranos, V., Wells, A. U., Sharma, R., Underwood, S. R., Wechalekar, K. Tags: Radiology Articles Source Type: research
One Chance to Get it Right: understanding the new guidance for care of the dying person
This article summarizes the background to One Chance to Get it Right and the guidance it contains.
Sources of data
One Chance to Get it Right, More Care, Less Pathway and related guidance documents.
Areas of agreement
The need to improve the standard of end-of-life care in every clinical setting.
Areas of controversy
The value of a pathway-based approach to end-of-life care in a context where well-implemented programmes of staff education in the subject are lacking.
Growing points
Public concern with, and scrutiny of, the quality of dying in the UK health-care system, particularly in hospitals but also the ability of p...
Source: British Medical Bulletin - September 8, 2015 Category: Journals (General) Authors: Sykes, N. Tags: Palliative Medicine Articles Source Type: research
Occurrence, management and outcomes of hip fractures in patients with Parkinson's disease
Introduction
Hip fractures can be debilitating, especially in patients with pre-existing Parkinson's disease; they have reportedly worse outcomes than non-Parkinson's disease patients.
Sources of data
A computerized literature search on PubMed, Medline, Embase, and CINAHL, supplemented by a manual search of related publications.
Areas of agreement
Parkinson's disease patients were found to have significantly lower bone mineral density; higher incidence of falls and hip fractures; delays to receiving their Parkinson's disease medication and surgery; higher risk of pneumonia, urinary infection, pressure sores, post-operati...
Source: British Medical Bulletin - September 8, 2015 Category: Journals (General) Authors: Critchley, R. J., Khan, S. K., Yarnall, A. J., Parker, M. J., Deehan, D. J. Tags: Geriatric Medicine Articles Source Type: research
Diagnosing orthostatic hypotension: a narrative review of the evidence
Background
Orthostatic hypotension (OH) is very common, particularly in older populations. Diagnostic criteria exist but appear to be arbitrary rather than evidence based. This review will visit the evidence for diagnostic strategies for OH.
Data sources
Medline (OvidSP), EMBASE (OvidSP), ISI Web of Science, the Health Technology Assessments Database and the Cochrane Library.
Areas of agreement
A 5-min rest is required before measuring baseline. An active stand with continuous blood pressure (BP) monitoring is preferable to a tilt test to identify initial OH in particular. At least 2 min in the upright position is requir...
Source: British Medical Bulletin - September 8, 2015 Category: Journals (General) Authors: Frith, J. Tags: Geriatric Medicine Articles Source Type: research
Is osteoarthritis a metabolic disorder?
Background
Obesity is associated with an increased risk of developing osteoarthritis (OA), even in non-weight bearing joints. High levels of adipose tissue-associated inflammation may explain this association.
Sources of data and areas of debate
Published evidence looking at the associations between components of Metabolic Syndrome (MetS) and knee, hip or hand OA and the higher mortality described with knee OA.
Emerging points
Development of MetS and OA shares a relationship with adipose tissue-associated inflammation. This review supports this inflammatory pathway being part of the shared mechanism behind obesity as a r...
Source: British Medical Bulletin - September 8, 2015 Category: Journals (General) Authors: Kluzek, S., Newton, J. L., Arden, N. K. Tags: Orthopaedic & Trauma Surgery Articles Source Type: research
Volar locking plates versus K-wire/pin fixation for the treatment of distal radial fractures: a systematic review and quantitative synthesis
Introduction
Volar locking plate and Kirschner wire/pin fixations are the most commonly used methods for surgical fixation of distal radius fractures.
Sources of data
A literature search was performed using PubMed, CINAHL, Cochrane Central and Embase Biomedical databases, selecting studies comparing two or more different surgical treatments including Kirschner wire fixation and volar locking-plate fixation. This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Methodological quality of all selected articles was assessed.
Areas of agreeme...
Source: British Medical Bulletin - September 8, 2015 Category: Journals (General) Authors: Franceschi, F., Franceschetti, E., Paciotti, M., Cancilleri, F., Maffulli, N., Denaro, V. Tags: Sports Medicine Articles Source Type: research
