A review of current ophthalmic anaesthetic practice
We present a view of contemporary ophthalmic anaesthetic practice as we see it, both from current UK clinical experience, and the available published evidence.Areas of controversyThere is an ongoing debate about the safety of sharp needle blocks (SNBs) compared to subtenons and topical techniques, but SNBs still have a role to play, both in specific cases, and in circumstances where resources are limited.Growing pointsIt remains a challenge to provide safe, cost effective anaesthesia to a growing patient base with ever increasing demands and medical comorbidities. There is a continuing trend towards replacing general with ...
Source: British Medical Bulletin - October 8, 2020 Category: General Medicine Source Type: research
Therapeutic applications of trans-splicing
AbstractBackgroundRNAtrans-splicing joins exons from different pre-mRNA transcripts to generate a chimeric product.Trans-splicing can also occur at the protein level, with split inteins mediating the ligation of separate gene products to generate a mature protein.Sources of dataComprehensive literature search of published research papers and reviews using Pubmed.Areas of agreementTrans-splicing techniques have been used to target a wide range of diseases in bothin vitro andin vivo models, resulting in RNA, protein and functional correction.Areas of controversyOff-target effects can lead to therapeutically undesirable conse...
Source: British Medical Bulletin - October 3, 2020 Category: General Medicine Source Type: research
Neurodiversity at work: a biopsychosocial model and the impact on working adults
AbstractIntroductionThe term neurodiversity is defined and discussed from the perspectives of neuroscience, psychology and campaigners with lived experience, illustrating the development of aetiological theories for included neurodevelopmental disorders. The emerging discourse is discussed with relevance to adults, social inclusion, occupational performance and the legislative obligations of organizations.Sources of dataLiterature is reviewed from medicine, psychiatry, psychology, sociology and popular press. No new data are presented in this article.Areas of agreementThere is consensus regarding some neurodevelopmental co...
Source: British Medical Bulletin - September 30, 2020 Category: General Medicine Source Type: research
Gambling in children and adolescents
AbstractIntroductionChildren are susceptible to problems with gambling because of developmental and cognitive immaturities, as well as a sensitivity to peer pressure and marketing.Sources of dataThis review uses recent UK data from the Gambling Commission and from the Avon Longitudinal Study of Parents and Children, and evidence from recent reviews of gambling in children and adolescents.Areas of agreementThe prevalence of gambling in children worldwide and in the UK is stable, having generally decreased since 2013. Online gambling is increasing in children and young people. A small minority of adolescents who gamble devel...
Source: British Medical Bulletin - September 15, 2020 Category: General Medicine Source Type: research
What prevents health policy being ‘evidence-based’? New ways to think about evidence, policy and interventions in health
AbstractBackgroundEvidence-based policy decision-making is a dominant paradigm in health but realizing this ideal has proven challenging.Sources of dataThis paper conceptually maps health policy, policy studies and social science literature critically engaged with evidence and decision-making. No new data were generated or analysed in support of this review.Areas of agreementBarriers to evidence-based policy have been documented, with efforts made to increase the uptake of evidence.Areas of controversyEvident complexities have been regarded as a problem of translation. However, this assumes that policy-making is a process ...
Source: British Medical Bulletin - September 8, 2020 Category: General Medicine Source Type: research
Cellular therapy options for genetic skin disorders with a focus on recessive dystrophic epidermolysis bullosa
AbstractIntroductionCombinatorial cell and gene therapies for life-threatening inherited skin disorders have shown tremendous potential for preclinical and clinical implementation with significant progress made for recessive dystrophic epidermolysis bullosa (RDEB). To date, various cell lineages including resident skin cells and adult stem cells have been investigated for gene and cell therapy for RDEB reaching the clinical trial stage.Sources of dataSources of data are key recent literature,ClinicalTrials.gov,Clinicaltrialsregister.eu and pharma press releases.Areas of agreementCell-based gene transfer using autologous pa...
Source: British Medical Bulletin - September 4, 2020 Category: General Medicine Source Type: research
Clozapine in the treatment of refractory schizophrenia: a practical guide for healthcare professionals
AbstractBackgroundClozapine remains the only medication licensed for treating refractory schizophrenia. However, it remains underutilized in part due to concerns regarding adverse events.Sources of dataPublished literature.Areas of agreementCommon adverse events during clozapine treatment include sedation, hypersalivation, postural hypotension, dysphagia, gastrointestinal hypomotility, weight gain, diabetes mellitus and dyslipidaemia. Rare but serious events include agranulocytosis, cardiomyopathy, myocarditis, pneumonia, paralytic ileus and seizure.Areas of controversyIt remains unclear how best to minimize clozapine-indu...
Source: British Medical Bulletin - September 4, 2020 Category: General Medicine Source Type: research
Epigenetic mechanisms in Tendon Ageing
AbstractIntroductionTendon is a composite material with a well-ordered hierarchical structure exhibiting viscoelastic properties designed to transfer force. It is recognized that the incidence of tendon injury increases with age, suggesting a deterioration in homeostatic mechanisms or reparative processes. This review summarizes epigenetic mechanisms identified in ageing healthy tendon.Sources of dataWe searched multiple databases to produce a systematic review on the role of epigenetic mechanisms in tendon ageing.Areas of agreementEpigenetic mechanisms are important in predisposing ageing tendon to injury.Areas of controv...
Source: British Medical Bulletin - August 22, 2020 Category: General Medicine Source Type: research
Covid-19 and the ‘new normal’: are remote video consultations here to stay?
AbstractIntroductionDuring the UK Covid-19 lockdown, video consultations (telemedicine) were encouraged. The extent of usage, and to which concerns to earlier implementation were set aside, is unknown; this is worthy of exploration as data becomes available.Sources of dataSources of data are as follows: published case studies, editorials, news articles and government guidance.Areas of agreementVideo can be clinically effective, especially where patients cannot attend due to illness or infection risk. Patients are positive, and they can benefit from savings in time and money. Adoption of telemedicine is hindered by a range ...
Source: British Medical Bulletin - August 22, 2020 Category: General Medicine Source Type: research
Outcome of total hip and total knee arthroplasty and vitamin D homeostasis
AbstractBackgroundLow levels of vitamin D are common in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), but it is still unclear whether the outcome of such surgery is related to vitamin D levels.Sources of dataPublicly available electronic databases were systematically reviewed to update knowledge about the role of vitamin D in THA and TKA patients, and to appraise the correlation between vitamin D levels before surgery and post-surgical outcomes. Eight studies were included in our review: six employed prospective observational designs, two reported retrospective database interrogations....
Source: British Medical Bulletin - August 10, 2020 Category: General Medicine Source Type: research
The challenges presented by haematopoietic stem cell transplantation in children with primary immunodeficiency
AbstractIntroduction or backgroundFor many primary immunodeficiencies (PIDs), haematopoietic stem cell transplantation (HSCT) offers treatment to cure disease. However, patients with PID present a unique set of challenges when considering HSCT.Sources of dataReview of recent literature.Areas of agreementThe most significant recent impact on successful outcome is introduction of newborn screening programmes for diagnosis of severe combined immunodeficiency —wider adoption of screening in an increasing number of countries will see further improvements. Other PIDs have better outcomes when treated earlier, before developmen...
Source: British Medical Bulletin - July 15, 2020 Category: General Medicine Source Type: research
Biomarkers in psychiatry: a clinician ’s viewpoint
AbstractIntroductionThe dearth of biomarkers limits the precision of our research into pathogenesis of psychiatric disorders and has slowed down the development of new drugs. In clinical practice, it undermines the validity of psychiatric diagnoses and hampers the delivery of personalized treatment.Sources of dataThe data quoted in this paper are gathered from a range of sources encompassing scientific and journalistic both in print and electronic.Areas of agreementAvailability of clinically useful biomarkers will improve the prognosis and outcome of psychiatric patients by helping in early diagnosis and delivery of indivi...
Source: British Medical Bulletin - July 15, 2020 Category: General Medicine Source Type: research
The mental health status of asylum seekers in middle to high income countries and The potential application of artificial intelligence for diagnosis and management of glaucoma in adults
These important subjects have full free online access. The Bulletin section to celebrate its amazing archive (see end of ‘In this Issue’), when covid-19 is a major threat, we celebrate the work of David Tyrrell FRS and his work at the MRC Common Cold Research Unit, including work on a corona virus, which may have caused a flu pandemic in the 1890s. The website has a fascinating section on the Nobel Prize-winners w ho wrote for the Bulletin and went on to win the accolade. This is the first volume of the British Medical Bulletin that is totally online. (Source: British Medical Bulletin)
Source: British Medical Bulletin - July 9, 2020 Category: General Medicine Source Type: research
The potential application of artificial intelligence for diagnosis and management of glaucoma in adults
AbstractBackgroundGlaucoma is the most frequent cause of irreversible blindness worldwide. There is no cure, but early detection and treatment can slow the progression and prevent loss of vision. It has been suggested that artificial intelligence (AI) has potential application for detection and management of glaucoma.Sources of dataThis literature review is based on articles published in peer-reviewed journals.Areas of agreementThere have been significant advances in both AI and imaging techniques that are able to identify the early signs of glaucomatous damage. Machine and deep learning algorithms show capabilities equiva...
Source: British Medical Bulletin - June 10, 2020 Category: General Medicine Source Type: research
Arthroscopic superior capsular reconstruction versus latissimus dorsi transfer for irreparable rotator cuff lesions: a systematic review
AbstractIntroductionThe present systematic review compared arthroscopic superior capsular reconstruction (ASCR) and latissimus dorsi transfer (ALDT) for the management of massive irreparable rotator cuff lesions.Sources of dataWe performed a systematic review searching the literature on Medline, Cochrane and Scopus databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Areas of agreementWe included a total of 20 articles, 10 on ASCR and 10 on ALDT (12 retrospective and 8 prospective studies), all published between 2013 and 2019.Areas of controversyASCR and ALDT are t...
Source: British Medical Bulletin - June 8, 2020 Category: General Medicine Source Type: research
