British medical bulletin最新文献

Introduction: The concept of consent in the pediatric setting is complex and confusing. Clinicians and researchers want to know whose consent they should obtain, when a child can provide independent consent and how that is determined. The aim of this article is to establish what produces the justification to proceed with medical or research interventions involving children and the role of consent in that. I clarify concepts such as consent, assent, capacity and competence.

Source of data: Literature review.

Areas of agreement: Engaging with children and involving them in decisions about matters that affect them is a good thing.

Areas of controversy: The role of competence or capacity and the question of when a child can provide sole consent.

Growing points: Flawed assumptions around competence/capacity.

Areas for developing research: An account of children's well-being that accommodates children's interests during the transition to adulthood.

Introduction or background: Life expectancy is an important summary measure of population health. In the absence of a significant event like war or disease outbreak, trends should, and historically have, increase over time, albeit with some fluctuations.

Sources of data: Data were extracted from the human mortality database for life expectancy at birth and age 65 years from 1980 to the latest available year for England & Wales, Scotland (Great Britain), France, Spain, Italy, the Netherlands and Germany.

Areas of agreement: It is well established that life expectancy improvements in Great Britain have stalled in recent years, and that a similar stalling was seen in other high-income countries during the mid-2010s.

Areas of controversy: The significance and causes of the slowdown in improvement in life expectancy in Britain are disputed. First, was Britain's slowdown in progress in life expectancy in the 2010s a deviation 'from' earlier sustained improvements or simply returning to normal (slower) improvement rates following faster gains in the 2000s? Second, did other European countries have slowdowns comparable to that in Britain?

Growing points: Life expectancy, as a summary measure, conceals inequalities. Other measures, such as lifespan disparity, complement it in understanding changing trends. While annual fluctuations in life expectancy are expected, continued stalls should raise concern. The three British nations examined were the only ones among these European countries to experience stalling of life expectancy gains in both sexes.

Areas timely for developing research: While it is clear that Britain is making less progress in health than similar countries, more research is needed to explain why.

Introduction: loneliness is prevalent worldwide. It is also associated with an increased risk for depression, high blood pressure, cardiovascular disease, stroke and early death. As such, loneliness is a major public health issue. This paper summarizes the salient points clinicians should know and encourages clinicians to assume an active part in the identification, mitigation and prevention of loneliness.

Sources of data: white papers, academic publications.

Areas of agreement: loneliness is a distressful subjective experience, which does not always correlate with social isolation. Both internal (personal) and external (contextual, societal) factors determine whether an individual would feel lonely in a given situation.

Areas of controversy: identifying loneliness in the clinic may be time consuming and challenging. There is a scarce robust evidence to support interventions.

Growing points: due to increased individualization and incidence of infectious diseases, loneliness is likely to become even more prevalent.

Areas timely for developing research: more research is needed to further elucidate the health impacts of loneliness as well as to find evidence-based interventions to prevent and mitigate loneliness that could then be implemented by policy-makers and clinicians.

Background: It is unclear whether femoroacetabular impingement syndrome (FAIS) affect hip range of motion (ROM).

Sources of data: We performed a systematic review with meta-analysis searching six electronic databases from inception to March 21, 2022. We included studies assessing hip ROM in FAIS, FAI morphology without symptoms (FAIm), and healthy controls. Mean differences between groups were measured in ROM degrees with 95% confidence interval (CI).

Areas of agreement: A total of 17 studies (1702 hips) were included. Comparison of FAIS patients versus healthy controls showed that hip ROM was clinically and statistically reduced in FAIS for internal rotation (90° hip flexion, -8.01°, 95% CI: -11.21, -4.90; 0° hip flexion -6.38°, 95% CI: -9.79, -2.97); adduction (90° hip flexion, -4.74°, 95% CI: -8.13, -1.34); flexion (-5.41°, 95% CI: -7.05, -3.49), abduction (0° hip flexion, -5.76°, 95% CI: -8.38, -3.23), and external rotation (90° hip flexion, -3.5°, 95% CI: -5.32, -1.67) ranging from low to high certainty of evidence. Comparison of FAIm versus healthy controls showed no statistically significant differences in any direction of movement, albeit with uncertainty of evidence.

Areas of controversy: The certainty of evidence was unclear, particularly for asymptomatic FAIm.

Growing points: Hip ROM may be reduced in all directions except extension in FAIS compared to controls. Hip ROM may not be restricted in asymptomatic FAIm.

Areas timely for developing research: Further studies are needed to resolve the uncertainty of evidence about ROM restrictions in asymptomatic FAIm compared to healthy controls.

Introduction: This systematic review aims to compare the rate and time to return to sport or work following surgical interventions for isolated scapholunate ligament (SLL) injury.

Sources of data: A PRISMA-compliant systematic search of Medline, EMBASE, Cochrane, AMED, CINAHL Plus and SPORTDiscus was performed using keywords 'scapholunate', 'scapholunate ligament', 'scaphoid lunate', 'sport', 'sport injury', 'athlete', 'athletic performance', 'elite', 'return to sport', 'training', 'work', 'activity', 'return to activity'. Adult patients with isolated SLL injury, without osteoarthritis, were included.

Areas of agreement: Fourteen papers, including six different surgical interventions, met the criteria for the final analysis. All surgical techniques demonstrated acceptable rates of return to work or sport (>80%).

Areas of controversy: The optimal surgical intervention for isolated SLL injury remains undetermined due to heterogeneity and limited sample sizes of published studies.

Growing points: This systematic review has provided clarification on the available literature on treatment modalities for isolated SLL injuries in the absence of osteoarthritis.

Areas timely for developing research: Prospective, randomized, primary studies are needed to establish optimal treatment for acute isolated SLL injuries.

Introduction: The number of cancer survivors in a working age is rising. An awareness of factors associated with adverse work outcomes, and of supportive interventions, is needed.

Sources of data: A narrative review of research obtained via several databases, including Medline and PsycINFO, was conducted.

Areas of agreement: A range of factors is associated with adverse work outcomes such as prolonged sick leave, delayed return to work, disability pension and unemployment in cancer survivors. They include the cancer type and treatment, fatigue, cognitive functioning, work factors and elements of health care systems. Effective supportive interventions encompass physical and multicomponent interventions.

Areas of controversy: The role of behaviour determinants and legislative and insurance systems is unclear. It is furthermore uncertain what the optimal timing of delivering supportive interventions is.

Growing points: Further focus on vulnerable groups, including specific cancer types and those with lower income, lower educational level and in precarious employment, is needed.

Areas timely for developing research: Recent developments are tailored and timely interventions.

Introduction: Micro RNAs (miRNAs) are short non-coding RNAs that act primarily in posttranscriptional gene silencing, and are attracting increasing interest in musculoskeletal conditions.

Source of data: Current scientific literature published in PubMed, Google Scholar, Embase and Web of Science databases.

Areas of agreement: Recently, the potential of miRNAs as biomarkers for diagnosis and treatment of meniscal injuries has been postulated.

Areas of controversy: Evaluation of the role of miRNAs in patients with meniscal tears is still controversial.

Growing points: A systematic review was conducted to investigate the potential of miRNA in the diagnosis and management of meniscal damage.

Areas timely for developing research: Intra-articular injection of microRNA-210 in vivo may represent a potential innovative methodology for the management of meniscal injuries. Characterization of the miRNAs expression in the synovial fluid could lead to the development of better early diagnosis and management strategies for meniscal tears.

Introduction: In May 2022, the World Health Organisation declared a multi-country monkeypox outbreak in non-endemic countries following cases reported from 12 member states that were not endemic for monkeypox virus.

Sources of data: Pubmed search.

Areas of agreement: The virology, epidemiology, transmission, incubation and aspects of infection control are described. Clinical features of previous and current outbreaks are described, with growing observations that the current outbreak presents with clinical features distinct from previous outbreaks.

Areas of controversy: There are variations in clinical presentations seen in the current outbreak that have not been seen in prior outbreaks. More research is needed to investigate the reasons for these differences.

Growing points: The higher numbers of HIV-positive patients in the current outbreak has allowed better description of the disease in patients co-infected with HIV and monkeypox. The absence of more severe symptoms in HIV-positive patients in the current outbreak could possibly be due to the fact that most of these patients had well-controlled HIV, although further characterization of this cohort of patients would be useful.

Areas for developing research: Current treatment and vaccination options have been extrapolated from studies of other Orthopox viruses. There remains a need for more data on the safety and efficacy of these options in the context of monkeypox infections.

Introduction: Economic evaluation has an important role to play in the demonstration of value for money of early childhood public health interventions; however, concerns have been raised regarding their consistent application and relevance to commissioners. This systematic review of the literature therefore aims to collate the breadth of the existing economic evaluation evidence of these interventions and to identify the approaches adopted in the assessment of value.

Source of data: Recently published literature in Medline, EMBASE, EconLit, Health Management Information Consortium, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Health Technology Assessment, NHS EED and Web of Science.

Areas of agreement: The importance of the early childhood period on future health and well-being as well as the potential to impact health inequalities making for a strong narrative case for expenditure in early childhood public health.

Areas of controversy: The most appropriate approaches to evaluating value for money of such preventative interventions relevant for UK decision-makers given the evident challenges.

Growing points: The presented review considered inconsistencies across methodological approaches used to demonstrate value for money. The results showed a mixed picture in terms of demonstrating value for money.

Areas timely for developing research: Future resource allocations decisions regarding early childhood public health interventions may benefit from consistency in the evaluative frameworks and health outcomes captured, as well as consistency in approaches to incorporating non-health costs and outcomes, incorporating equity concerns and the use of appropriate time horizons.

Introduction: Many children fail to receive the mental health treatments they need, despite strong evidence demonstrating efficacy of brief and low-intensity psychological interventions. This review identifies the barriers and facilitators to their implementation.

Sources of data: PsycInfo, EMBASE and Medline were searched and a systematic approach to data extraction using Normalization Process Theory highlighted key mechanisms and contextual factors.

Areas of agreement: Ten interventions from 9 papers, including 371 young people, were included. Studies identified organizational demands, lack of implementation strategy and stigma as barriers to implementation, and clear training and plans for implementation as facilitators.

Areas of controversy: No standardized implementation outcomes were used across papers so meta-analysis was not possible.

Growing points: Barriers and facilitators have been clearly identified across different settings.

Areas timely for developing research: Longitudinal studies can identify methods and processes for enhancing long-term implementation and considers ways to monitor and evaluate uptake into routine practice.