British medical bulletin最新文献

{"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}

{"title":"Placing joint hypermobility in context: traits, disorders and syndromes.","authors":"Silvia Morlino, Marco Castori","doi":"10.1093/bmb/ldad013","DOIUrl":"10.1093/bmb/ldad013","url":null,"abstract":"<p><strong>Background: </strong>Joint hypermobility (JHM) is a common physical trait. It may occur alone or in combination with musculoskeletal (MSK) pain, outside or within more complex phenotypes. Hypermobility spectrum disorders (HSD) are diagnosed in individuals with JHM and related MSK pain, when an alternative diagnosis cannot be identified. Conversely, the Ehlers-Danlos syndrome (EDS) encompasses a group of rare hereditary connective tissue disorders featuring JHM along with other pleiotropic manifestations. The 2017 EDS Classification identifies 13 different subtypes. Hypermobile EDS (HEDS) is the only EDS variant still lacking a confirmatory test.</p><p><strong>Sources of data: </strong>Literature was reviewed searching for the most relevant papers related to key arguments. Particular attention was focused on papers published after the 2017 Classification.</p><p><strong>Areas of agreement: </strong>Definition, epidemiology, assessment tools and patterns of JHM are presented. The morbid nature of the 2017 EDS Classification and of the 'spectrum' is also illustrated.</p><p><strong>Areas of controversy: </strong>We discuss current limitations and disagreements concerning the 'spectrum', HSD and HEDS.</p><p><strong>Growing points: </strong>In the clinical context, elucidation of the pathophysiology of pain related to JHM should develop in parallel with the analysis of pleiotropic manifestations of syndromes with JHM.</p><p><strong>Areas timely for developing research: </strong>Future challenges concerning classification, nosology, diagnosis and management of JHM, EDS and related disorders are discussed.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"147 1","pages":"90-107"},"PeriodicalIF":6.7,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10645432","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":"Long COVID: what is known and what gaps need to be addressed.","authors":"Benjamin Krishna, Mark Wills, Nyaradzai Sithole","doi":"10.1093/bmb/ldad016","DOIUrl":"10.1093/bmb/ldad016","url":null,"abstract":"<p><strong>Introduction: </strong>Long COVID is a chronic condition that follows after acute COVID-19 and is characterized by a wide range of persistent, cyclic symptoms.</p><p><strong>Sources of data: </strong>PubMed search for publications featuring 'Long COVID' or 'post-acute sequelae of COVID-19'.</p><p><strong>Areas of agreement: </strong>Long COVID occurs frequently post-acute COVID-19, with a majority of people experiencing at least one symptom (such as cough, fatigue, myalgia, anosmia and dyspnoea) 4 weeks after infection.</p><p><strong>Areas of controversy: </strong>The specific symptoms and the minimum duration of symptoms required to be defined as Long COVID.</p><p><strong>Growing points: </strong>There is a consistent reduction in Long COVID incidence amongst vaccinated individuals, although the extent of this effect remains unclear.</p><p><strong>Areas timely for developing research: </strong>There is an urgent need to understand the causes of Long COVID, especially extreme fatigue more than 6 months after infection. We must understand who is at risk and whether reinfections similarly risk Long COVID.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"147 1","pages":"6-19"},"PeriodicalIF":6.7,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10502447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10664908","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":"Long COVID: what is known and what gaps need to be addressed and COVID-19 infection in people living with HIV","authors":"","doi":"10.1093/bmb/ldad020","DOIUrl":"https://doi.org/10.1093/bmb/ldad020","url":null,"abstract":"","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"163 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135347819","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":"From the Archive","authors":"","doi":"10.1093/bmb/ldad021","DOIUrl":"https://doi.org/10.1093/bmb/ldad021","url":null,"abstract":"","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135347818","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":"Management of complex regional pain syndrome in trauma and orthopaedic surgery-a systematic review.","authors":"Abdel Saed, Greg Neal-Smith, Scott Fernquest, Jonathan Bourget-Murray, Alexander Wood","doi":"10.1093/bmb/ldac034","DOIUrl":"10.1093/bmb/ldac034","url":null,"abstract":"<p><strong>Introduction: </strong>Complex regional pain syndrome (CRPS) is a neurological pain disorder that is challenging to diagnose and manage, resulting in increased morbidity and costs. It most commonly occurs following traumatic injury, such as a fracture, crush injury or surgery. Recent research has evaluated the efficacy of treatments which have contradicted previous hypotheses. This systematic review summarizes these findings to improve clinician's decision-making.</p><p><strong>Sources of data: </strong>A comprehensive search of PubMed, MEDLINE and Embase databases from inception through January 2021 was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers independently screened relevant articles discussing the management of CRPS in adult trauma patients. All prospective and retrospective studies, non-randomized comparison studies and case series were considered for inclusion. Data extraction was performed by populating a predefined data abstraction sheet.</p><p><strong>Areas of agreement: </strong>There is strong evidence to suggest the efficacy of prompt physiotherapy, lidocaine, ketamine, bisphosphonates, sympathectomy and brachial plexus blocks in the management of CRPS.</p><p><strong>Areas of controversy: </strong>The latest evidence suggests that vitamin C has no significant role to play in the treatment or prevention of CRPS.</p><p><strong>Growing points: </strong>A multidisciplinary team approach and early diagnosis are imperative for successful treatment of CRPS. The Budapest criteria and the British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guidelines should be used when diagnosing CRPS. There is currently no clear evidence of superiority in any treatment.</p><p><strong>Areas timely for developing research: </strong>There are few high-quality studies that inform the best treatment modalities for CRPS. Though emerging treatments show promise, further research is needed.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"146 1","pages":"27-42"},"PeriodicalIF":6.7,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9687181","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":"Stem cells and discogenic back pain.","authors":"Luca Miranda, Marco Quaranta, Francesco Oliva, Nicola Maffulli","doi":"10.1093/bmb/ldad008","DOIUrl":"10.1093/bmb/ldad008","url":null,"abstract":"<p><strong>Background: </strong>Chronic low back pain, common from the sixth decade, negatively impacts the quality of life of patients and health care systems. Recently, mesenchymal stem cells (MSCs) have been introduced in the management of degenerative discogenic pain. The present study summarizes the current knowledge on the effectiveness of MSCs in patients with discogenic back pain.</p><p><strong>Sources of data: </strong>We performed a systematic review of the literature following the PRISMA guidelines. We searched PubMed and Google Scholar database, and identified 14 articles about management of chronic low back pain with MSCs injection therapy. We recorded information on type of stem cells employed, culture medium, clinical scores and MRI outcomes.</p><p><strong>Areas of agreement: </strong>We identified a total of 303 patients. Ten studies used bone marrow stem cells. In the other four studies, different stem cells were used (of adipose, umbilical, or chondrocytic origin and a pre-packaged product). The most commonly used scores were Visual Analogue Scale and Oswestry Disability Index.</p><p><strong>Areas of controversy: </strong>There are few studies with many missing data.</p><p><strong>Growing points: </strong>The studies analysed demonstrate that intradiscal injections of MSCs are effective on discogenic low-back pain. This effect may result from inhibition of nociceptors, reduction of catabolism and repair of injured or degenerated tissues.</p><p><strong>Areas timely for developing research: </strong>Further research should define the most effective procedure, trying to standardize a single method.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"146 1","pages":"73-87"},"PeriodicalIF":6.7,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10788843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9686667","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":"Optimizing lipid management-impact of the COVID 19 pandemic upon cardiovascular risk in England.","authors":"Julia L Newton, Joseph Hamed, Helen Williams, Matt Kearney, Alison M Metcalfe, Gary A Ford","doi":"10.1093/bmb/ldad009","DOIUrl":"10.1093/bmb/ldad009","url":null,"abstract":"<p><strong>Background: </strong>We sought to understand the impact of the COVID-19 pandemic on lipid-lowering therapy prescribing as a potential cause of the excess cardiovascular mortality seen post-pandemic in England. We examined temporal changes over 3 years in the prescribing of high-intensity and non-high-intensity statin therapy and ezetimibe.</p><p><strong>Sources of data: </strong>We utilized data available via the National Health Service (NHS) Business Services Authority (NHSBSA) Information Services Data Warehouse, extracting 3 monthly data from October 2018 to December 2021 on high- and low-intensity statin and ezetimibe prescribing, (commencement, cessation or continuation) through each time period of study and those before, and after, the period of interest.</p><p><strong>Areas of agreement: </strong>Optimizing lipid management is a key component of the NHS Long Term Plan ambition to reduce deaths from cardiovascular disease, stroke and dementia.</p><p><strong>Areas of controversy: </strong>The COVID-19 pandemic and associated lockdown have seen a significant reduction in prescribing of lipid-lowering therapies. If cardiovascular risk is not to worsen in the forthcoming years, urgent action is needed to ensure that the impact of the pandemic upon optimization of cholesterol and the historical undertreatment of cholesterol is reversed and improved.</p><p><strong>Areas timely for developing research: </strong>Prescription data available via NHSBSA can support our understanding of the implications of policy and behaviour and highlight the impact of guidelines in practise.</p><p><strong>Growing points: </strong>Understanding the impact of the COVID-19 pandemic upon cholesterol management and the opportunities for newer lipid-lowering therapies delivered using a population health approach have the potential to enhance lipid-lowering and improve cardiovascular mortality and morbidity and reduce health inequalities.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"146 1","pages":"19-26"},"PeriodicalIF":6.7,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10039633","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":"Whole-body cryotherapy as a treatment for chronic medical conditions?","authors":"Hanna Tabisz, Aleksandra Modlinska, Sławomir Kujawski, Joanna Słomko, Pawel Zalewski","doi":"10.1093/bmb/ldad007","DOIUrl":"10.1093/bmb/ldad007","url":null,"abstract":"<p><strong>Introduction: </strong>Whole-body cryotherapy (WBC) is a controlled exposure of the whole body to cold to gain health benefits. In recent years, data on potential applications of WBC in multiple clinical settings have emerged.</p><p><strong>Sources of data: </strong>PubMed, EBSCO and Clinical Key search using keywords including terms 'whole body', 'cryotherapy' and 'cryostimulation'.</p><p><strong>Areas of agreement: </strong>WBC could be applied as adjuvant therapy in multiple conditions involving chronic inflammation because of its potent anti-inflammatory effects. Those might include systemic inflammation as in rheumatoid arthritis. In addition, WBC could serve as adjuvant therapy for chronic inflammation in some patients with obesity.</p><p><strong>Areas of controversy: </strong>WBC probably might be applied as an adjuvant treatment in patients with chronic brain disorders including mild cognitive impairment and general anxiety disorder and in patients with depressive episodes and neuroinflammation reduction as in multiple sclerosis. WBC effects in metabolic disorder treatment are yet to be determined. WBC presumably exerts pleiotropic effects and therefore might serve as adjuvant therapy in multi-systemic disorders, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).</p><p><strong>Growing points: </strong>The quality of studies on the effects of WBC in the clinical setting is in general low; hence, randomized controlled trials with adequate sample size and longer follow-up periods are needed.</p><p><strong>Areas are timely for developing research: </strong>Further studies should examine the mechanism underlying the clinical efficacy of WBC. Multiple conditions might involve chronic inflammation, which in turn could be a potential target of WBC. Further research on the application of WBC in neurodegenerative disorders, neuropsychiatric disorders and ME/CFS should be conducted.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"146 1","pages":"43-72"},"PeriodicalIF":6.7,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10039632","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":"Ethical challenges and principles in integrated care.","authors":"Alex McKeown","doi":"10.1093/bmb/ldac030","DOIUrl":"10.1093/bmb/ldac030","url":null,"abstract":"<p><strong>Introduction: </strong>Integrated care is an established approach to delivery in parts of the healthcare infrastructure, and an ideal which, it is claimed, should be realized system-wide. Its ethical weight derives from its defence of a view about how healthcare ought to operate. Although the goal of integration is laudable, it is ethically and practically complex, involving trade-offs.</p><p><strong>Sources of data: </strong>Considerable evidence attests to widespread enthusiasm for integration, given the need to prevent harm and extend the reach of scarce resources. Equally, evidence increasingly highlights the obstacles to successfully translating this ideal into practice.</p><p><strong>Areas of agreement: </strong>The principle that healthcare should be seamless, ensuring that patients do not come to harm through gaps in care enjoys broad agreement. There is a similar consensus that placing the patient's perspective at the centre of decision-making is vital, since this enables identification of these gaps.</p><p><strong>Areas of controversy: </strong>Integrating care by making it seamless entails blurring boundaries of care domains. This risks undermining the locus of responsibility for care decisions via confusion about who has ownership of specialist knowledge where domains overlap. There is a lack of consensus about how successful integration should be measured.</p><p><strong>Growing points: </strong>More research into the relative cost-effectiveness of upstream public health investment in preventing chronic ill-health caused by modifiable lifestyle factors vs integrating care for people already ill; further research into ethical implications of integration in practice, which can be obscured by the simplicity of the fundamental normative principle guiding integration in theory.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"146 1","pages":"4-18"},"PeriodicalIF":6.7,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10286793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9760624","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}