British medical bulletin最新文献

Introduction: This article reviews the ethical issues surrounding obesity in public health and clinical contexts. We examine how obesity intersects with medical and social norms that raise questions of liberty, fairness, safety, and effectiveness or consequences.

Sources of data: PubMed, Cochrane Library, and Google Scholar.

Areas of agreement: We identify three main areas of agreement that are pertinent to ethical analysis of obesity: stigma is considered harmful, there needs to be a more-than personal responsibility approach, and a general acceptance of a global rise in body weight.

Areas of controversy: There are many areas of controversy, we limit our focus to four: conflicts of interest in the creation of guidelines and policies, mortality rates, whether weight is a meaningful proxy for health, and how to treat childhood obesity.

Areas timely for developing research: Post-genomic explanations, such as exposure to endocrine disrupting toxins, and development of epigenomics and microbiomics in the form of personalized nutrition are two developing areas we identify.

Introduction: Anterior cruciate ligament (ACL) injuries in children and adolescents with open physes are common.

Areas of agreement: Evidence of ACL reconstruction using allografts in children with open physes is limited.

Areas of controversy: Whether the outcomes of ACL allograft reconstruction in children and adolescents with open physes are superior to autograft ACL reconstruction is unclear, with contrasting evidence.

Source of data: In October 2024, the Web of Science, PubMed, and Embase were accessed with no additional filters. Only clinical investigations evaluating ACL reconstruction in children or adolescents with open physes were eligible. Only studies reporting a minimum length of 24 months of follow-up were included.

Areas timely for developing research: Children who undergo allograft ACL reconstruction demonstrate similar functional outcomes to those who undergo autograft ACL reconstruction. Although allografts allow a faster return to sport, the greater laxity, the reduced activity level, and the higher failure and reoperation rates make their use dubious as a first-choice option for ACL reconstruction in skeletally immature patients.

Purpose: The present prospective comparative study included patients with acute Achilles tendon rupture (ATR) who underwent percutaneous repair with one knot compared to percutaneous repair with two knots.

Methods: All patients underwent the procedure under local anesthesia. A total of 29 patients underwent percutaneous repair with two knots (Group A), and 33 patients underwent percutaneous repair with one knot (Group B). All patients were treated by a single surgeon between 2019 and 2021 and were followed prospectively for 24 months.

Results: Patients' characteristics at baseline were similar between the two groups, except for age [38.0(15.0) vs 32.0(15.0) years, P = 0.028]. The procedure took longer for the two knots technique [19.0(4.0) vs 13.0(3.0) min, P < 0.001]. The Achilles tendon total rupture score was not different between the two techniques (90.7 ± 3.26 vs 90.5 ± 2.18, P = 0.737), as was the elongation of the gastrosoleus-Achilles tendon complex measured by the Achilles tendon resting angle [-1.0(2.0) vs - 1.0(2.0), P < 0.380]. The calf circumference of the injured and non-injured leg did not differ between the groups. Plantarflexion strength of the operated leg was significantly weaker than the non-operated leg in both groups. The European Foot and Ankle Society and patient reported outcome measures score by Piedade et al. scores were not statistically significant different between the two groups. No patient experienced a re-rupture, a venous thrombo-embolism episode, or injury to the sural nerve.

Conclusion: The modified technique offered similar objective and subjective outcome measures, in addition to reduced operative time.

Introduction: Knee osteoarthritis (OA) is a common degenerative joint condition and a major cause of disability in the general population.

Source of data: Recent published literature identified from PubMed, EMBASE, Google Scholar, and Scopus.

Areas of agreement: Orthobiological therapies try to regenerate articular cartilage and stop the progression of the degenerative lesion. Intra-articular injections of biological derivates have been increasingly used in the last decade.

Areas of controversy: The indications for the use of bone marrow aspirate concentrate (BMAC) are still unclear.

Growing points: We systematically reviewed the current literature on BMAC in the management of knee OA, giving an update on the current indications for the selection of the ideal patient and the preparations and efficacy of BMAC compared to other biological alternatives.

Areas timely for developing research: BMAC is a valuable source of mesenchymal stem cells, offering potential benefits in attenuating the inflammatory pathway associated with knee OA. Intra-articular injection of BMAC has shown effectiveness in clinical trials improving functional outcomes of knee OA patients. The superiority of BMAC over other orthobiological treatments cannot be assessed because of conflicting results.

Introduction: Long COVID (LC) occurs when people experience symptoms for weeks, months or even years after a COVID-19 infection. This review looks at research exploring the LC definitions, prevalence, symptoms, risk factors, and associated impacts in research on healthcare workers (HCWs).

Data sources: We systematically searched five electronic databases (CINAHL, EMBASE, Medline, PsycInfo and PubMed) and compiled a narrative literature review based on 56 relevant studies.

Areas of agreement: LC is prevalent among HCWs who become infected by COVID-19. Many of the most frequent symptoms associated with LC in the general population are also reported among HCWs. Some risk factors for LC are also similar to those in the general population, such as female sex, older age, and having a pre-existing respiratory illness.

Areas of controversy: The mechanism(s) responsible for LC remains unknown. A variety of terms, timeframes and symptoms are used to define LC, creating difficulties in comparing results across studies. Much of the research is cross-sectional and fails to explore the impacts that prolonged symptoms have on HCWs' personal and professional lives.

Growing points: The need to support HCWs with LC is clear. Identifying the mechanism(s) responsible for LC is a key priority, as this will inform treatments.

Areas for developing research: Future research should move towards a standard definition for LC. Greater attention should be paid to longitudinal and qualitative studies, which could give insights into prognosis, lived experience and work participation. Finally, studies evaluating treatments suitable for people with LC are timely.

Background: Acute severe ulcerative colitis (ASUC) is a potentially life-threatening medical emergency that occurs in up to 25% of patients with ulcerative colitis. Although intravenous corticosteroids remain the cornerstone of therapy, 30-40% of patients will not respond and need timely consideration of rescue therapy with (currently) either infliximab or ciclosporin or indeed colectomy, underscoring the importance of multidisciplinary care to ensure favourable outcomes for patients. We discuss the current evidence and present an approach to the management of ASUC for general and specialist clinicians caring for patients with ASUC.

Sources of data: The information in this review is derived from data published in peer- reviewed academic journals and registered clinical trials.

Areas of agreement: Management of acute severe colitis requires a multidisciplinary approach with early initiation with steroids and timely escalation of treatment to either medical rescue therapy or surgery.

Areas of controversy: Balancing the risks of delayed surgery vs. optimizing medical therapy, including accelerated dosing schedules for biologics, remains ambiguous.

Growing points: The position on newer molecules like Janus Kinase inhibitors, such as tofacitinib, is a growing area with early real-world data showing promise for steroid refractory ASUC.

Areas timely for developing research: Developing predictive biomarkers and clinical risk scores for personalized rescue therapy selection is an evolving area of research.

Introduction: Spinal cord injury (SCI) may bring lifelong consequences for affected patients and a high financial burden to the health care system.

Source of data: Published peer-reviewed scientific articles identified from EMBASE, Google Scholar, PubMed and Scopus.

Areas of agreement: Surgery and blood pressure management are the main targets in acute SCI to avoid secondary damage.

Areas of controversy: The management of secondary chronic SCI is challenging, with unpredictable outcomes.

Growing points: Given the lack of consensus on pharmacological therapy for acute and secondary chronic SCI, the present study analyses the currently available drugs and treatment options to manage secondary chronic SCI.

Areas timely for developing research: Different approaches exist for the pharmacological management of secondary chronic SCI. One of the most investigated drugs, 4-aminopyridine, improves central motor conduction and shows improvement in neurological signs. Positive results in different areas have been observed in patients receiving the anti-spastic drugs tizanidine and baclofen or Granulocyte colony-stimulating factor. Growth hormone showed only minimal or no significant effects, and the therapy of secondary chronic SCI with riluzole has been poorly researched to date.

Introduction: Chronic pain affects over a quarter of the workforce with high economic burden for individuals, employers and healthcare services. Access to work-related advice for people with chronic pain is variable. This systematic review aims to explore the effectiveness of workplace-delivered digital interventions for the self-management of chronic pain.

Source of data: MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library, JBI, Open Science Framework, Epistemonikos and Google Scholar. Articles published between January 2001 and December 2023 were included. Searches were conducted between October 2023 and December 2023.

Areas of agreement: Workplace-delivered digital interventions to support self-management of chronic pain at work may improve pain and health-related quality of life in vocationally active adults. Delivering interventions outside of clinical services, through the workplace setting, may help to reduce inequity in access to work-related advice for people with chronic pain, and ultimately reduce the burden on individuals, employers and healthcare services. Interventions include mobile apps and web-based programmes.

Areas of controversy: Studies were moderate-to-low quality. Most studies focused on exercise, few considered other aspects of pain self-management. Given the limited evidence in the current literature, consensus on best intervention format and delivery is lacking.

Growing points: More high-quality studies are needed given the heterogeneity in study design, interventions and outcome measures.

Areas timely for developing research: No interventions included advice on work-related adjustments or support. Few studies included work-related outcomes, despite the known impact of pain on work and work on health.

Background: The National Health Service (NHS) in England is facing a workforce crisis. A new Long Term Workforce Plan (LTWP) seeks to address this, setting out ambitious proposals to expand and reform domestic medical education and training in England. However, there are concerns about their feasibility.

Sources of data: In September 2023, over 60 individuals representing medical education and training in the UK participated in an exercise run by UK Medical Schools Council by using systems theory to identify risks.

Areas of agreement: The UK does need more 'home grown' doctors, but the LTWP has important gaps, including lack of attention to postgraduate training, absence of reference to the need for more educators and capital investment and risk of inadequate clinical placement capacity, particularly in primary care settings.

Areas of controversy: There are unresolved differences in the understanding of a proposed medical apprenticeship model and no scheme has, as yet, been approved by the General Medical Council. Participants were unable to determine who the beneficiaries of this scheme will be (apart from the apprentices themselves).

Growing points: While the LTWP represents a welcome, although overdue, commitment to address the NHS workforce crisis, we identified significant gaps that must be resolved.

Areas timely for developing research: First, the development of the LTWP provides a case study that adds to literature on policymaking in the UK. Second, while we only examined the expansion of medical training, the method could be applied to other parts of the LTWP. Third, a prospective evaluation of its implementation is necessary.