British medical bulletin
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British medical bulletin · Sep 2014
ReviewThe importance of pain management in older people with dementia.
Pain is common in people with dementia, representing a critical aspect of treatment and care. However, there remain considerable gaps in evidence to support pain assessment and treatment. ⋯ Future research should focus on developing integrated pain management approaches with optimized assessment and evidence-based treatment guidance.
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British medical bulletin · Sep 2014
ReviewMortality as a measure of quality of care in infants with congenital cardiovascular malformations following surgery.
Mortality has traditionally been perceived as a straightforward measure of outcome and has been used to evaluate surgical performance. In the rapidly developing arena of paediatric cardiac surgery, the insightful analysis of mortality figures is challenging. ⋯ As the vast majority of children undergoing cardiac surgery now survive beyond 30 days, the focus for measures of quality is shifting towards morbidity.
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British medical bulletin · Sep 2014
ReviewThe economics of medicines optimization: policy developments, remaining challenges and research priorities.
This review scopes the evidence on the effectiveness and cost-effectiveness of interventions to improve suboptimal use of medicines in order to determine the evidence gaps and help inform research priorities. ⋯ The available evidence is insufficient to assess the effectiveness and cost-effectiveness of interventions to address suboptimal medicine use in the UK NHS. Decision modelling, evidence synthesis and elicitation have the potential to address the evidence gaps and help prioritize research.
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The last two decades have seen a revolution in ophthalmic imaging. In this review we present an overview of the breadth of ophthalmic imaging modalities in use today and describe how the role of ophthalmic imaging has changed from documenting abnormalities visible on clinical examination to the detection of clinically silent abnormalities which can lead to an earlier and more precise diagnosis. ⋯ Clinical applications of new techniques and devices have yet to be determined using systematic scientific research methods.
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British medical bulletin · Sep 2014
ReviewManaging the ethical challenges of next-generation sequencing in genomic medicine.
Next-generation sequencing (NGS) is transforming the conduct of genetic research and diagnostic investigation. This creates new challenges as it generates additional information, including unsought and unwanted information. Nevertheless, this information must be deliberately managed-interpreted, disclosed and then either stored or destroyed. ⋯ Those interested in genetics, public health, bioethics and medical ethics may wish to debate these issues and influence future practice in both genetic research and genetic diagnostic services.