Faecal transplantation for IBD management —pitfalls and promises
AbstractBackgroundFaecal microbiota transplantation (FMT) as a potential treatment for inflammatory bowel disease (IBD) is an area of active current research, having been stimulated by the remarkable efficacy of FMT in treatment ofClostridium difficile-associated colitis.Sources of dataThis review is based on data from numerous case series on FMT in IBD since 1989 and results of four RCTs in ulcerative colitis (UC); three fully published.Areas of agreementEarly signals of short to medium-term efficacy of FMT for UC are promisingAreas of controversyMethodology, underlying mechanisms and questions regarding safety of FMT rem...
Source: British Medical Bulletin - November 13, 2017 Category: General Medicine Source Type: research
Perioperative management of the obese surgical patient
AbstractIntroductionThe escalation in the prevalence of obesity throughout the world has led to an upsurge in the number of obese surgical patients to whom perioperative care needs to be delivered.Sources of dataAfter determining the scope of the review, the authors used PubMed with select phrases encompassing the words in the scope. Both preclinical and clinical reports were considered.Areas of agreementThere were no controversies regarding preoperative management and the intraoperative care of the obese surgical patient.Areas of controversyIs there a healthy obese state that gives rise to the obesity paradox regarding po...
Source: British Medical Bulletin - November 13, 2017 Category: General Medicine Source Type: research
Retraction
(Source: British Medical Bulletin)
Source: British Medical Bulletin - October 31, 2017 Category: General Medicine Source Type: research
The rise and potential fall of pancreas transplantation
AbstractBackgroundThe aim of this review is to bring pancreatic transplantation out of the specialist realm, informing practitioners about this important procedure, so that they feel better equipped to refer suitable patients for transplantation and manage, counsel and support when encountering them within their own speciality.Sources of dataNarrative review conducted in May 2017. OVID interface searching EMBASE and MEDLINE databases, using Timeframe: Inception to June 1, 2017. Articles were assessed for clinical relevance and most up to date content with articles written in english as the only inclusion criteria. Other so...
Source: British Medical Bulletin - October 27, 2017 Category: General Medicine Source Type: research
Friedreich ’s ataxia: clinical features, pathogenesis and management
AbstractIntroductionFriedreich ’s ataxia is the most common inherited ataxia.Sources of dataLiterature search using PubMed with keywords Friedreich ’s ataxia together with published papers known to the authors.Areas of agreementThe last decade has seen important advances in our understanding of the pathogenesis of disease. In particular, the genetic and epigenetic mechanisms underlying the disease now offer promising novel therapeutic targets.Areas of controversyThe search for effective disease-modifying agents continues. It remains to be determined whether the most effective approach to treatment lies with increasing ...
Source: British Medical Bulletin - October 25, 2017 Category: General Medicine Source Type: research
Sustainable Development Goals (SDGs), and their implementationA national global framework for health, development and equity needs a systems approach at every level
AbstractIntroductionThe Sustainable Development Goals (SDGs) are a set of global goals for fair and sustainable health at every level: from planetary biosphere to local community. The aim is to end poverty, protect the planet and ensure that all people enjoy peace and prosperity, now and in the future.Sources of dataThe UN has established web-sites to inform the implementation of the SDGs and an Inter-Agency and Expert Group on an Indicator Framework. We have searched for independent commentaries and analysis.Areas of agreementThe goals represent a framework that is scientifically robust, and widely intuitive intended to b...
Source: British Medical Bulletin - October 24, 2017 Category: General Medicine Source Type: research
The role of complement inhibition in kidney transplantation
AbstractIntroduction and backgroundThe complement system which belongs to the innate immune system acts both as a first line of defence against various pathogens and as a guardian of host homeostasis. The role of complement has been recently highlighted in several aspects of kidney transplantation: ischaemia-reperfusion, antibody-mediated rejection and native kidney disease recurrence.Sources of dataExperimental data, availability of complement-blocking molecules (mainly the anti-C5 monoclonal antibody, eculizumab) and several trials in human kidney transplant recipients has led to some areas of agreement and some disappoi...
Source: British Medical Bulletin - October 21, 2017 Category: General Medicine Source Type: research
Who bears the cost of NICE public health recommendations?
AbstractBackgroundIn the UK, NICE issues guidance on public health initiatives. Failure to report which sectors of the economy are affected by their implementation precludes the appropriate accounting for the full opportunity costs, and has the potential to result in erroneous decision making and inefficient budgetary planning.Sources of dataWe reviewed all NICE public health guidances available at the time of research, categorizing the sector on which the cost burden of the public health initiatives fall and the extent to which this burden was estimated.Areas of agreementThe majority of guidances were determined to be ass...
Source: British Medical Bulletin - October 19, 2017 Category: General Medicine Source Type: research
Pharmacogenetics: a general review on progress to date
AbstractBackgroundPharmacogenetics is not a new subject area but its relevance to drug prescribing has become clearer in recent years due to developments in gene cloning and DNA genotyping and sequencing.Sources of dataThere is a very extensive published literature concerned with a variety of different genes and drugs.Areas of agreementThere is general agreement that pharmacogenetic testing is essential for the safe use of drugs such as the thiopurines and abacavir.Areas of controversyWhether pharmacogenetic testing should be applied more widely including to the prescription of certain drugs such as warfarin and clopidogre...
Source: British Medical Bulletin - October 11, 2017 Category: General Medicine Source Type: research
Immunology of cystic echinococcosis (hydatid disease)
AbstractBackgroundThe neglected disease cystic echinococcosis is caused by larvalEchinococcus granulosus flatworms, which form bladder-like hydatid cysts in liver, lungs, and other organs.Sources of dataPublished literature.Areas of agreementEstablishing larvae are susceptible to antibody-dependent killing, as attested by successful animal vaccination, whereas once established they are partially protected by the so-called laminated layer. Host responses are Th2 dominated, with a Th1 component. Diagnostic antigens from cyst fluid are known, but responses appear absent in one-fifth of patients.Areas of controversyIs evasion ...
Source: British Medical Bulletin - October 7, 2017 Category: General Medicine Source Type: research
Management of chronic pain through pain management programmes
AbstractIntroductionChronic pain carries significant impact and is difficult to treat with limited success. Pain management programmes (PMPs) use cognitive behavioural therapy (CBT)-based multidisciplinary rehabilitative approaches to drive functional improvement.Sources of dataA search was conducted using Medline and the Cochrane Library to identify published literature about PMPs or CBT to treat chronic pain.Areas of agreementPMPs have significant benefit on functioning for some patients but relatively little impact on the pain. Not all patients, nor pain types, benefit. Around a third of patients show improvement, with ...
Source: British Medical Bulletin - September 13, 2017 Category: General Medicine Source Type: research
Think adult – think child! Why should staff caring for dying adults ask what the death means for children in the family? and Transtendon repair in partial articular supraspinatus tendon tear
(Source: British Medical Bulletin)
Source: British Medical Bulletin - September 7, 2017 Category: General Medicine Source Type: research
Think adult – think child! Why should staff caring for dying adults ask what the death means for children in the family? and Transtendon repair in partial articular supraspinatus tendon tear
(Source: British Medical Bulletin)
Source: British Medical Bulletin - September 7, 2017 Category: General Medicine Source Type: research
Abnormal uterine bleeding
AbstractIntroductionIt is not uncommon for a woman to suffer from abnormal uterine bleeding (AUB) or heavy menstrual bleeding (HMB) at some point during her lifetime. Once pathology is excluded, in practice, management needs to be individualised, taking into account the improvement of the woman's symptoms and quality of life.Sources of dataPeer-reviewed journals, governmental and professional society publications.Areas of agreementThere is now agreement on a structured, universal approach to the diagnosis of AUB, with the aide memoirs PALM (polyps, adenomyosis, leiomyoma, malignancy) and COEIN (coagulopathies, ovulatory dy...
Source: British Medical Bulletin - August 28, 2017 Category: General Medicine Source Type: research
