British medical bulletin最新文献

{"title":"Addressing the challenges facing the paramedic profession in the United Kingdom.","authors":"Georgette Eaton","doi":"10.1093/bmb/ldad024","DOIUrl":"10.1093/bmb/ldad024","url":null,"abstract":"<p><strong>Background: </strong>The paramedic profession within the United Kingdom has been evolving at pace over the last 20 years. While they are most associated with their work in ambulance services, paramedics are now found throughout a range of clinical and academic settings.</p><p><strong>Sources of data: </strong>Literature Review.</p><p><strong>Areas of agreement: </strong>Despite emergence of the paramedic across the healthcare workforce, the understanding and awareness of the professional role and capabilities is poor. This could be due to a lack of representation within senior leadership roles and within health and social care policy.</p><p><strong>Areas of controversy: </strong>Understanding of the paramedic professional identity, from a philosophical and sociological perspective, remains incomplete.</p><p><strong>Growing points: </strong>A challenge for the future is to explore how the paramedic role can continue to develop across a range of clinical settings, while retaining its sui generis professional identity.</p><p><strong>Areas timely for developing research: </strong>Research to establish perspectives of and about the paramedic profession may assist in developing an understanding of identity and its place within the wider healthcare workforce.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":" ","pages":"70-78"},"PeriodicalIF":6.7,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10724452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10238855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small interfering RNAs in the management of human osteoporosis.","authors":"Giuseppe Gargano, Giovanni Asparago, Filippo Spiezia, Francesco Oliva, Nicola Maffulli","doi":"10.1093/bmb/ldad023","DOIUrl":"10.1093/bmb/ldad023","url":null,"abstract":"<p><strong>Background: </strong>Osteoporosis results in reduced bone mass and consequent bone fragility. Small interfering RNAs (siRNAs) can be used for therapeutic purposes, as molecular targets or as useful markers to test new therapies.</p><p><strong>Sources of data: </strong>A systematic search of different databases to May 2023 was performed to define the role of siRNAs in osteoporosis therapy. Fourteen suitable studies were identified.</p><p><strong>Areas of agreement: </strong>SiRNAs may be useful in studying metabolic processes in osteoporosis and identify possible therapeutic targets for novel drug therapies.</p><p><strong>Areas of controversy: </strong>The metabolic processes of osteoporosis are regulated by many genes and cytokines that can be targeted by siRNAs. However, it is not easy to predict whether the in vitro responses of the studied siRNAs and drugs are applicable in vivo.</p><p><strong>Growing points: </strong>Metabolic processes can be affected by the effect of gene dysregulation mediated by siRNAs on various growth factors.</p><p><strong>Areas timely for developing research: </strong>Despite the predictability of pharmacological response of siRNA in vitro, similar responses cannot be expected in vivo.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":" ","pages":"58-69"},"PeriodicalIF":6.7,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10788844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10542328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing patient-centred care in dentistry: a narrative review.","authors":"Camilla Böhme Kristensen, Koula Asimakopoulou, Sasha Scambler","doi":"10.1093/bmb/ldad026","DOIUrl":"10.1093/bmb/ldad026","url":null,"abstract":"<p><strong>Introduction: </strong>Patient-centred care (PCC) is widely used within the medical setting, but there is a need for more research on PCC implementation in dentistry.</p><p><strong>Sources of data: </strong>A narrative review was conducted with literature identified from the Ovid Interface, including several databases such as Embase and Medline.</p><p><strong>Areas of agreement: </strong>PCC is associated with better health outcomes for patients, and greater work satisfaction among healthcare professionals.</p><p><strong>Areas of controversy: </strong>Efforts to implement PCC in dentistry are lacking due to several issues including non-consensus about PCC definition and lack of explicit guidelines on how to implement PCC in dentistry.</p><p><strong>Growing points and areas timely for developing research: </strong>A theory-derived model of PCC explicitly designed for the dental setting was identified. This serves as a starting point to enhance PCC in dentistry, though further research is needed to empirically test the implementation of this model.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":" ","pages":"79-88"},"PeriodicalIF":6.7,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10724466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41191931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated mortality among the second-generation (children of migrants) in Europe: what is going wrong? A review.","authors":"Matthew Wallace, Lucinda Hiam, Robert Aldridge","doi":"10.1093/bmb/ldad027","DOIUrl":"10.1093/bmb/ldad027","url":null,"abstract":"<p><strong>Introduction: </strong>The 'second-generation' (i.e. the children of migrants) represent one of the fastest growing subpopulations of the child and young adult populations in Europe today. The research so far appears to indicate that their mortality risk is elevated relative to people with non-migrant backgrounds.</p><p><strong>Sources of data: </strong>Peer-reviewed publications.</p><p><strong>Areas of agreement: </strong>Second-generation status is a clear marker of elevated mortality risk in Europe in early life (including stillbirth, perinatal, neonatal and infant mortality) and adulthood, particularly if the parent(s) were born outside of Europe. Socioeconomic inequality plays an important, albeit rarely defining, role in these elevated risks.</p><p><strong>Areas of controversy: </strong>It remains unclear what causes-of-death are driving these elevated mortality risks. The exact influence of (non-socioeconomic) explanatory factors (e.g. health care, racism & discrimination, and factors related to integration) on the elevated mortality risks of the second-generation also remains unclear.</p><p><strong>Growing points: </strong>The second-generation will continue to grow and diversify in Europe; we must intervene to address these inequalities now.</p><p><strong>Areas timely for developing research: </strong>Place more emphasis on the complexity of migration background, specific causes-of-death, and understanding the roles of explanatory factors beyond socioeconomic background.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":" ","pages":"5-21"},"PeriodicalIF":6.7,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10724460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71478262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated mortality among the second-generation (children of migrants) in Europe: what is going wrong? and interventions to tackle health inequalities in cardiovascular risks for socioeconomically disadvantaged populations","authors":"","doi":"10.1093/bmb/ldad032","DOIUrl":"https://doi.org/10.1093/bmb/ldad032","url":null,"abstract":"","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"85 9","pages":""},"PeriodicalIF":6.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138986517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RNA therapeutics for neurological diseases.","authors":"Ilaria Brentari,&nbsp;Mariia Zadorozhna,&nbsp;Michela Alessandra Denti,&nbsp;Elisa Giorgio","doi":"10.1093/bmb/ldad010","DOIUrl":"10.1093/bmb/ldad010","url":null,"abstract":"<p><strong>Introduction: </strong>Ribonucleic acid (RNA) therapeutics are a new class of drugs whose importance is highlighted by the growing number of molecules in the clinic.</p><p><strong>Sources of data: </strong>We focus on RNA therapeutics for neurogenetic disorders, which are broadly defined as diseases with a genetic background and with at least one clinical sign affecting the nervous system. A systematic search identified 14 RNA drugs approved by FDA and many others in development.</p><p><strong>Areas of agreement: </strong>The field of RNA therapeutics is changing the therapeutic scenario across many disorders.</p><p><strong>Areas of controversy: </strong>Despite its recent successes, RNA therapeutics encountered several hurdles and some clinical failures. Delivery to the brain represents the biggest challenge.</p><p><strong>Growing points: </strong>The many advantages of RNA drugs make the development of these technologies a worthwhile investment.</p><p><strong>Areas timely for developing research: </strong>Clinical failures stress the importance of implementing clinical trial design and optimizing RNA molecules to hold the promise of revolutionizing the treatment of human diseases.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"147 1","pages":"50-61"},"PeriodicalIF":6.7,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10662740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The SSS revolution in fungal diagnostics: speed, simplicity and sensitivity.","authors":"Jacob Baker,&nbsp;David W Denning","doi":"10.1093/bmb/ldad011","DOIUrl":"10.1093/bmb/ldad011","url":null,"abstract":"<p><strong>Introduction: </strong>Fungal disease has historically presented a diagnostic challenge due to its often non-specific clinical presentations, relative infrequency and reliance on insensitive and time-intensive fungal culture.</p><p><strong>Sources of data: </strong>We present the recent developments in fungal diagnostics in the fields of serological and molecular diagnosis for the most clinically relevant pathogens; developments that have the potential to revolutionize fungal diagnosis through improvements in speed, simplicity and sensitivity. We have drawn on a body of evidence including recent studies and reviews demonstrating the effectiveness of antigen and antibody detection and polymerase chain reaction (PCR) in patients with and without concurrent human immunodeficiency virus infection.</p><p><strong>Areas of agreement: </strong>This includes recently developed fungal lateral flow assays, which have a low cost and operator skill requirement that give them great applicability to low-resource settings. Antigen detection for Cryptococcus, Histoplasma and Aspergillus spp. are much more sensitive than culture. PCR for Candida spp., Aspergillus spp., Mucorales and Pneumocystis jirovecii is more sensitive than culture and usually faster.</p><p><strong>Areas of controversy: </strong>Effort must be made to utilize recent developments in fungal diagnostics in clinical settings outside of specialist centres and integrate their use into standard medical practice. Given the clinical similarities of the conditions and frequent co-infection, further study is required into the use of serological and molecular fungal tests, particularly in patients being treated for tuberculosis.</p><p><strong>Growing points: </strong>Further study is needed to clarify the utility of these tests in low-resource settings confounded by a high prevalence of tuberculosis.</p><p><strong>Areas timely for developing research: </strong>The diagnostic utility of these tests may require revision of laboratory work flows, care pathways and clinical and lab coordination, especially for any facility caring for the immunosuppressed, critically ill or those with chronic chest conditions, in whom fungal disease is common and underappreciated.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"147 1","pages":"62-78"},"PeriodicalIF":6.7,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a2/da/ldad011.PMC10502448.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10645413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mobilization-based engraftment of haematopoietic stem cells: a new perspective for chemotherapy-free gene therapy and transplantation.","authors":"Daniele Canarutto,&nbsp;Attya Omer Javed,&nbsp;Gabriele Pedrazzani,&nbsp;Samuele Ferrari,&nbsp;Luigi Naldini","doi":"10.1093/bmb/ldad017","DOIUrl":"10.1093/bmb/ldad017","url":null,"abstract":"<p><strong>Introduction: </strong>In haematopoietic stem cell transplantation (HSCT), haematopoietic stem cells (HSCs) from a healthy donor replace the patient's ones. Ex vivo HSC gene therapy (HSC-GT) is a form of HSCT in which HSCs, usually from an autologous source, are genetically modified before infusion, to generate a progeny of gene-modified cells. In HSCT and HSC-GT, chemotherapy is administered before infusion to free space in the bone marrow (BM) niche, which is required for the engraftment of infused cells. Here, we review alternative chemotherapy-free approaches to niche voidance that could replace conventional regimens and alleviate the morbidity of the procedure.</p><p><strong>Sources of data: </strong>Literature was reviewed from PubMed-listed peer-reviewed articles. No new data are presented in this article.</p><p><strong>Areas of agreement: </strong>Chemotherapy exerts short and long-term toxicity to haematopoietic and non-haematopoietic organs. Whenever chemotherapy is solely used to allow engraftment of donor HSCs, rather than eliminating malignant cells, as in the case of HSC-GT for inborn genetic diseases, non-genotoxic approaches sparing off-target tissues are highly desirable.</p><p><strong>Areas of controversy: </strong>In principle, HSCs can be temporarily moved from the BM niches using mobilizing drugs or selectively cleared with targeted antibodies or immunotoxins to make space for the infused cells. However, translation of these principles into clinically relevant settings is only at the beginning, and whether therapeutically meaningful levels of chimerism can be safely established with these approaches remains to be determined.</p><p><strong>Growing points: </strong>In pre-clinical models, mobilization of HSCs from the niche can be tailored to accommodate the exchange and engraftment of infused cells. Infused cells can be further endowed with a transient engraftment advantage.</p><p><strong>Areas timely for developing research: </strong>Inter-individual efficiency and kinetics of HSC mobilization need to be carefully assessed. Investigations in large animal models of emerging non-genotoxic approaches will further strengthen the rationale and encourage application to the treatment of selected diseases.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"147 1","pages":"108-120"},"PeriodicalIF":6.7,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c7/dc/ldad017.PMC10502445.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10646434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 infection in people living with HIV.","authors":"Jacob Brolly,&nbsp;David R Chadwick","doi":"10.1093/bmb/ldac031","DOIUrl":"10.1093/bmb/ldac031","url":null,"abstract":"<p><strong>Background: </strong>Coronavirus disease 2019 (COVID-19) and human immunodeficiency virus (HIV) are intersecting pandemics, with implications for care at an individual and global scale.</p><p><strong>Sources of data: </strong>PubMed search with relevant articles and their references reviewed.</p><p><strong>Areas of agreement: </strong>COVID-19 has changed the delivery of care to people living with HIV (PLWH). Vaccines are efficacious and safe for PLWH; patient care for symptomatic COVID-19 is similar to that of people without HIV.</p><p><strong>Areas of controversy: </strong>It remains unclear whether PLWH experience increased COVID-19-specific mortality. Treatments to reduce severity in early COVID-19 infection lack evidence in PLWH.</p><p><strong>Growing points: </strong>The effects of the COVID-19 pandemic on HIV-related morbidity and mortality are yet to be seen. COVID-19 epidemiology among PLWH is complicated by changes to the severe acute respiratory syndrome coronavirus 2, population behaviours and vaccine availability.</p><p><strong>Areas timely for developing research: </strong>Global trends in HIV-related morbidity and mortality should be monitored to appreciate the effects of the COVID-19 pandemic. The benefits of early antiviral and/or neutralizing monoclonal antibody (nMAb) treatment for PLWH and nMAb prophylaxis require investigation.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"147 1","pages":"20-30"},"PeriodicalIF":6.7,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10300678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug repurposing for COVID-19: current evidence from randomized controlled adaptive platform trials and living systematic reviews.","authors":"Yolanda Augustin, Henry M Staines, Thirumalaisamy P Velavan, Adeeba Kamarulzaman, Peter G Kremsner, Sanjeev Krishna","doi":"10.1093/bmb/ldac037","DOIUrl":"10.1093/bmb/ldac037","url":null,"abstract":"<p><strong>Introduction: </strong>The coronavirus disease 2019 (COVID-19) pandemic resulted in a race to develop effective treatments largely through drug repurposing via adaptive platform trials on a global scale. Drug repurposing trials have focused on potential antiviral therapies aimed at preventing viral replication, anti-inflammatory agents, antithrombotic agents and immune modulators through a number of adaptive platform trials. Living systematic reviews have also enabled evidence synthesis and network meta-analysis as clinical trial data emerge globally.</p><p><strong>Sources of data: </strong>Recent published literature.</p><p><strong>Areas of agreement: </strong>Corticosteroids and immunomodulators that antagonize the interleukin-6 (IL-6) receptor have been shown to play a critical role in modulating inflammation and improving clinical outcomes in hospitalized patients. Inhaled budesonide reduces the time to recovery in older patients with mild-to-moderate COVID-19 managed in the community.</p><p><strong>Areas of controversy: </strong>The clinical benefit of remdesivir remains controversial with conflicting evidence from different trials. Remdesivir led to a reduction in time to clinical recovery in the ACTT-1 trial. However, the World Health Organization SOLIDARITY and DISCOVERY trial did not find a significant benefit on 28-day mortality and clinical recovery.</p><p><strong>Growing points: </strong>Other treatments currently being investigated include antidiabetic drug empagliflozin, antimalarial drug artesunate, tyrosine kinase inhibitor imatinib, immunomodulatory drug infliximab, antiviral drug favipiravir, antiparasitic drug ivermectin and antidepressant drug fluvoxamine.</p><p><strong>Areas timely for developing research: </strong>The timing of therapeutic interventions based on postulated mechanisms of action and the selection of clinically meaningful primary end points remain important considerations in the design and implementation of COVID-19 therapeutic trials.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"147 1","pages":"31-49"},"PeriodicalIF":6.7,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10502446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10302127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}