British medical bulletin最新文献

Introduction: Cardiovascular disease (CVD) has shown significant health inequalities for people with low socioeconomic status associated with more risk factors. This review was to synthesize interventions that targeted CVD risks and outcomes among socioeconomically disadvantaged populations and to understand the impact associated with these interventions.

Sources of data: Cochrane CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL were searched for records published in the last decade using a systematic search strategy, complemented by screening the reference lists and citation indexes. Nineteen studies were included and a narrative synthesis with the effect direction plot was undertaken in which studies, interventions, participants and outcomes were examined according to the intervention type focusing on behaviours, lifestyle, education, medication and monitoring.

Areas of agreement: No universal definition of disadvantaged socioeconomic status was used with common factors relating to racial/ethnic minorities, low income and low or no health insurance. Mixed effects of interventions were reported on clinical outcomes including weight, body mass index, blood pressure, glycated haemoglobin and cholesterol.

Areas of controversy: Inconsistent effect was reported due to a large variety of settings, participants and intervention components although they are considered necessary to address the complex health needs of socioeconomically disadvantaged populations.

Growing points: There is inadequate evidence to determine whether any of the intervention types are effective in optimising lipids management for socioeconomically disadvantaged populations.

Areas timely for developing research: Research is needed with mixed evidence using real world evaluation and lived experience combined with health economic evaluation, on both mental and physical health outcomes.

Introduction: Participant recruitment to clinical trials is often sub-optimal. Decentralized clinical trials have the potential to address challenges in traditional site-based clinical trial recruitment.

Sources of data: This review is based on recently published literature and the experience of running a large industry-sponsored interventional trial using both traditional and decentralized methods.

Areas of agreement: Efficient delivery of clinical trials is essential to continue to provide therapeutic improvements in a timely and cost-efficient way. Clinical trial designs are constantly evolving to achieve effective trial delivery, manage the complexity of new therapeutic algorithms and conform to cultural developments.

Areas of controversy: Digitally innovative decentralized clinical trials may be a solution to improve recruitment and retention. Although many trials incorporate digital innovations to reduce patient burden, decentralized clinical trials allow remote access to clinical research, potentially enhancing geographical diversity as well as reducing participant burden.

Growing points: Areas for development currently being discussed are developing a 'recruitment platform' that exploits the reach of digital connectivity, automated identification of eligible participants from volunteers, employing technology for remote interaction and exploring the logistic process of delivering the interventions.

Areas timely for relevant research: The focus of development must ensure that the overall impact will widen participation and reduce inequalities in healthcare.

Background: 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.

Sources of data: Literature Review.

Areas of agreement: 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.

Areas of controversy: Understanding of the paramedic professional identity, from a philosophical and sociological perspective, remains incomplete.

Growing points: 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.

Areas timely for developing research: 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.

Background: 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.

Sources of data: 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.

Areas of agreement: SiRNAs may be useful in studying metabolic processes in osteoporosis and identify possible therapeutic targets for novel drug therapies.

Areas of controversy: 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.

Growing points: Metabolic processes can be affected by the effect of gene dysregulation mediated by siRNAs on various growth factors.

Areas timely for developing research: Despite the predictability of pharmacological response of siRNA in vitro, similar responses cannot be expected in vivo.

Introduction: Patient-centred care (PCC) is widely used within the medical setting, but there is a need for more research on PCC implementation in dentistry.

Sources of data: A narrative review was conducted with literature identified from the Ovid Interface, including several databases such as Embase and Medline.

Areas of agreement: PCC is associated with better health outcomes for patients, and greater work satisfaction among healthcare professionals.

Areas of controversy: 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.

Growing points and areas timely for developing research: 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.

Introduction: 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.

Sources of data: Peer-reviewed publications.

Areas of agreement: 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.

Areas of controversy: 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.

Growing points: The second-generation will continue to grow and diversify in Europe; we must intervene to address these inequalities now.

Areas timely for developing research: Place more emphasis on the complexity of migration background, specific causes-of-death, and understanding the roles of explanatory factors beyond socioeconomic background.

Introduction: Ribonucleic acid (RNA) therapeutics are a new class of drugs whose importance is highlighted by the growing number of molecules in the clinic.

Sources of data: 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.

Areas of agreement: The field of RNA therapeutics is changing the therapeutic scenario across many disorders.

Areas of controversy: Despite its recent successes, RNA therapeutics encountered several hurdles and some clinical failures. Delivery to the brain represents the biggest challenge.

Growing points: The many advantages of RNA drugs make the development of these technologies a worthwhile investment.

Areas timely for developing research: 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.