British medical bulletin最新文献

{"title":"Ligament Advanced Reinforcement System (LARS) synthetic graft for PCL reconstruction: systematic review and meta-analysis","authors":"Filippo Migliorini, Andrea Pintore, Gianluca Vecchio, Francesco Oliva, Frank Hildebrand, Nicola Maffulli","doi":"10.1093/bmb/ldac011","DOIUrl":"https://doi.org/10.1093/bmb/ldac011","url":null,"abstract":"Introduction Several strategies are available for posterior cruciate ligament (PCL) reconstruction. Source of data Recently published literature in PubMed, Google Scholar and Embase databases. Areas of agreement The Ligament Advanced Reinforcement System (LARS) is a scaffold type artificial ligament, which has been widely used for ligament reconstruction of the knee. Areas of controversy Current evidence on the reliability and feasibility of LARS for primary isolated PCL reconstruction is limited. Growing points The primary outcome of interest of the present work was to investigate the outcomes of PCL reconstruction using the LARS. The secondary outcome of interest was to compare the LARS versus four-strand hamstring tendon (4SHT) autograft for PCL reconstruction. Areas timely for developing research LARS for primary isolated PCL reconstruction seems to be effective and safe, with results comparable to the 4SHT autograft.","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"44 6","pages":""},"PeriodicalIF":6.7,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138508253","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":"Small interfering RNAs in the management of human rheumatoid arthritis","authors":"Giuseppe Gargano, Francesco Oliva, Antonio Oliviero, Nicola Maffulli","doi":"10.1093/bmb/ldac012","DOIUrl":"https://doi.org/10.1093/bmb/ldac012","url":null,"abstract":"Background Rheumatoid arthritis (RA) has unclear pathogenesis, but the molecules that feed its inflammatory state are known. Small interfering RNAs (siRNAs) are useful to identify molecular targets and evaluate the efficacy of specific drugs, and can themselves be used for therapeutic purposes. Sources of data A systematic search of different databases to March 2022 was performed to define the role of siRNAs in RA therapy. Twenty suitable studies were identified. Areas of agreement Small interfering RNAs can be useful in the study of inflammatory processes in RA, and identify possible therapeutic targets and drug therapies. Areas of controversy Many genes and cytokines participate in the inflammatory process of RA and can be regulated with siRNA. However, it is difficult to determine whether the responses to siRNAs and other drugs studied in human cells in vitro are similar to the responses in vivo. Growing points Inflammatory processes can be affected by the gene dysregulation of siRNAs on inflammatory cytokines. Areas timely for developing research To date, it is not possible to determine whether the pharmacological response of siRNAs on cells in vitro would be similar to what takes place in vivo for the diseases studied so far.","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"35 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2022-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138508222","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":"Considerations for the implementation of machine learning into acute care settings.","authors":"Andrew Bishara,&nbsp;Elijah H Maze,&nbsp;Mervyn Maze","doi":"10.1093/bmb/ldac001","DOIUrl":"https://doi.org/10.1093/bmb/ldac001","url":null,"abstract":"<p><strong>Introduction: </strong>Management of patients in the acute care setting requires accurate diagnosis and rapid initiation of validated treatments; therefore, this setting is likely to be an environment in which cognitive augmentation of the clinician's provision of care with technology rooted in artificial intelligence, such as machine learning (ML), is likely to eventuate.</p><p><strong>Sources of data: </strong>PubMed and Google Scholar with search terms that included ML, intensive/critical care unit, electronic health records (EHR), anesthesia information management systems and clinical decision support were the primary sources for this report.</p><p><strong>Areas of agreement: </strong>Different categories of learning of large clinical datasets, often contained in EHRs, are used for training in ML. Supervised learning uses algorithm-based models, including support vector machines, to pair patients' attributes with an expected outcome. Unsupervised learning uses clustering algorithms to define to which disease grouping a patient's attributes most closely approximates. Reinforcement learning algorithms use ongoing environmental feedback to deterministically pursue likely patient outcome.</p><p><strong>Areas of controversy: </strong>Application of ML can result in undesirable outcomes over concerns related to fairness, transparency, privacy and accountability. Whether these ML technologies irrevocably change the healthcare workforce remains unresolved.</p><p><strong>Growing points: </strong>Well-resourced Learning Health Systems are likely to exploit ML technology to gain the fullest benefits for their patients. How these clinical advantages can be extended to patients in health systems that are neither well-endowed, nor have the necessary data gathering technologies, needs to be urgently addressed to avoid further disparities in healthcare.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"141 1","pages":"15-32"},"PeriodicalIF":6.7,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39577520","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 WOW factors': comparing workforce organization and well-being for doctors, nurses, midwives and paramedics in England.","authors":"Cath Taylor, Karen Mattick, Daniele Carrieri, Anna Cox, Jill Maben","doi":"10.1093/bmb/ldac003","DOIUrl":"10.1093/bmb/ldac003","url":null,"abstract":"<p><strong>Background: </strong>High rates of poor mental health in healthcare staff threatens the quality and sustainability of healthcare delivery. Multi-factorial causes include the nature and structure of work. We conducted a critical review of UK NHS (England) data pertaining to: doctors, nurses, midwives and paramedics.</p><p><strong>Sources of data: </strong>Key demographic, service architecture (structural features of work) and well-being indicators were identified and reviewed by a stakeholder group. Data searching prioritized NHS whole workforce sources (focusing on hospital and community health services staff), which were rated according to strength of evidence.</p><p><strong>Findings: </strong>Key differences between professions were: (i) demographics: gender (nursing and midwifery female-dominated, doctors and paramedics more balanced); age (professions other than doctors had ageing workforces); ethnicity (greater diversity among doctors and nurses); (ii) service architecture: despite net staffing growth, turnover and retention were problematic in all professions; 41.5% doctors were consultants but smaller proportions held high grade/band roles in other professions; salaries were higher for doctors; (iii) well-being: all reported high job stress, particularly midwives and paramedics; sickness absence rates for nurses, midwives and paramedics were three times those of doctors, and presenteeism nearly double.</p><p><strong>Growing points: </strong>Sociocultural factors known to increase risk of poor mental health may explain some of the differences reported between professions. These factors and differences in service architecture are vital considerations when designing strategies to improve well-being.</p><p><strong>Areas timely for developing research: </strong>Multi-level systems approaches to well-being are required that consider intersectionality and structural differences between professions; together with inter-professional national databases to facilitate monitoring.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"141 1","pages":"60-79"},"PeriodicalIF":6.7,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8935611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60843049","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":"Ethics and antibiotic resistance.","authors":"Euzebiusz Jamrozik, George S Heriot","doi":"10.1093/bmb/ldab030","DOIUrl":"10.1093/bmb/ldab030","url":null,"abstract":"<p><strong>Introduction or background: </strong>Antibiotic resistance raises ethical issues due to the severe and inequitably distributed consequences caused by individual actions and policies.</p><p><strong>Sources of data: </strong>Synthesis of ethical, scientific and clinical literature.</p><p><strong>Areas of agreement: </strong>Ethical analyses have focused on the moral responsibilities of patients to complete antibiotic courses, resistance as a tragedy of the commons and attempts to limit use through antibiotic stewardship.</p><p><strong>Areas of controversy: </strong>Each of these analyses has significant limitations and can result in self-defeating or overly narrow implications for policy.</p><p><strong>Growing points: </strong>More complex analyses focus on ethical implications of ubiquitous asymptomatic carriage of resistant bacteria, non-linear outcomes within and between patients over time and global variation in resistant disease burdens.</p><p><strong>Areas timely for developing research: </strong>Neglected topics include the harms of antibiotic use, including off-target effects on the human microbiome, and the lack of evidence guiding most antibiotic prescription decisions.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"141 1","pages":"4-14"},"PeriodicalIF":6.7,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8935610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39901822","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":"Rotational head acceleration and traumatic brain injury in combat sports: a systematic review.","authors":"Kabir Singh Lota,&nbsp;Nikos Malliaropoulos,&nbsp;Wiesław Blach,&nbsp;Takeshi Kamitani,&nbsp;Akira Ikumi,&nbsp;Vasileios Korakakis,&nbsp;Nicola Maffulli","doi":"10.1093/bmb/ldac002","DOIUrl":"https://doi.org/10.1093/bmb/ldac002","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) in combat sports is relatively common, and rotational acceleration (RA) is a strong biomechanical predictor of TBI. This review summarizes RA values generated from head impacts in combat sport and puts them in the context of present evidence regarding TBI thresholds.</p><p><strong>Sources of data: </strong>PubMed, EMBASE, Web of Science, Cochrane Library and Scopus were searched from inception to 31st December 2021. Twenty-two studies presenting RA data from head impacts across boxing, taekwondo, judo, wrestling and MMA were included. The AXIS tool was used to assess the quality of studies.</p><p><strong>Areas of agreement: </strong>RA was greater following direct head strikes compared to being thrown or taken down. RA from throws and takedowns was mostly below reported injury thresholds. Injury thresholds must not be used in the absence of clinical assessment when TBI is suspected. Athletes displaying signs or symptoms of TBI must be removed from play and medically evaluated immediately.</p><p><strong>Areas of controversy: </strong>Methodological heterogeneity made it difficult to develop sport-specific conclusions. The role of headgear in certain striking sports remains contentious.</p><p><strong>Growing points: </strong>RA can be used to suggest and assess the effect of safety changes in combat sports. Gradual loading of training activities based on RA may be considered when planning sessions. Governing bodies must continue to work to minimize RA generated from head impacts.</p><p><strong>Areas timely for developing research: </strong>Prospective research collecting real-time RA data is required to further understanding of TBI in combat sports.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"141 1","pages":"33-46"},"PeriodicalIF":6.7,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9351374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39879935","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":"Matrix-induced autologous chondrocyte implantation (mACI) versus autologous matrix-induced chondrogenesis (AMIC) for chondral defects of the knee: a systematic review.","authors":"Filippo Migliorini,&nbsp;Jörg Eschweiler,&nbsp;Christian Götze,&nbsp;Arne Driessen,&nbsp;Markus Tingart,&nbsp;Nicola Maffulli","doi":"10.1093/bmb/ldac004","DOIUrl":"https://doi.org/10.1093/bmb/ldac004","url":null,"abstract":"<p><strong>Introduction: </strong>Chondral defects of the knee are common and their treatment is challenging.</p><p><strong>Source of data: </strong>PubMed, Google scholar, Embase and Scopus databases.</p><p><strong>Areas of agreement: </strong>Both autologous matrix-induced chondrogenesis (AMIC) and membrane-induced autologous chondrocyte implantation (mACI) have been used to manage chondral defects of the knee.</p><p><strong>Areas of controversy: </strong>It is debated whether AMIC and mACI provide equivalent outcomes for the management of chondral defects in the knee at midterm follow-up. Despite the large number of clinical studies, the optimal treatment is still controversial.</p><p><strong>Growing points: </strong>To investigate whether AMIC provide superior outcomes than mACI at midterm follow-up.</p><p><strong>Areas timely for developing research: </strong>AMIC may provide better outcomes than mACI for chondral defects of the knee. Further studies are required to verify these results in a clinical setting.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"141 1","pages":"47-59"},"PeriodicalIF":6.7,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9351375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39628532","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":"Ethics and antibiotic resistance and considerations for the implementation of machine learning into acute care settings","authors":"","doi":"10.1093/bmb/ldac006","DOIUrl":"https://doi.org/10.1093/bmb/ldac006","url":null,"abstract":"","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"1 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44050612","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":"Why are women with polycystic ovary syndrome obese?","authors":"T M Barber","doi":"10.1093/bmb/ldac007","DOIUrl":"https://doi.org/10.1093/bmb/ldac007","url":null,"abstract":"Introduction Polycystic ovary syndrome (PCOS) is a common condition characterized by reproductive, hyperandrogenic and dysmetabolic features, and often becomes clinically manifest during adolescence, particularly with weight-gain. Sources of data Pubmed search. Areas of agreement PCOS is heritable and closely associates with obesity (based on data from both epidemiological and genetic studies). Furthermore, insulin resistance forms a central cornerstone of the pathogenesis of PCOS and mediates a close association between obesity and the severity of the phenotypic features of PCOS. Areas of controversy Our understanding of the pathogenesis of PCOS remains incomplete, especially regarding its missing heritability (with only a small fraction having been identified from the genome-wide association studies reported to date), and its developmental origins. Growing points A challenge for the future is to explore a role for epigenetic modifications in the development of PCOS, and implications for the in utero environment and novel therapeutic opportunities.","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"81 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2022-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138531671","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":"Healthy, happy places-a more integrated approach to creating health and well-being through the built environment?","authors":"Rachel Turnbull","doi":"10.1093/bmb/ldab026","DOIUrl":"https://doi.org/10.1093/bmb/ldab026","url":null,"abstract":"<p><strong>Introduction: </strong>This paper explores how the built environment impacts upon health and well-being and suggests that there are opportunities for more integrated working between professionals and citizens to create healthier, happier places.</p><p><strong>Sources of data: </strong>Policy and practice guidance is presented from the urban planning and design fields. Evidence and data are presented from a range of disciplines on housing, green infrastructure and mental well-being.</p><p><strong>Areas of agreement: </strong>There is an overwhelming agreement around the principles and rationale of incorporating health in planning and design processes.</p><p><strong>Areas of controversy: </strong>These principles are not always implemented in practice. Challenges also exist around how different disciplines create and use evidence.</p><p><strong>Growing points: </strong>More innovative ways of working which incorporates health, public health, planners, designers and citizens, which responds to the needs of communities, should be tested.</p><p><strong>Areas timely for developing research: </strong>Health and public health professionals can contribute to the evidence base using objective measures to assess the impact of the built environment on mental health and well-being.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"140 1","pages":"62-75"},"PeriodicalIF":6.7,"publicationDate":"2021-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39804683","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}