British medical bulletin
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British medical bulletin · Sep 2015
ReviewDiagnosing orthostatic hypotension: a narrative review of the evidence.
Orthostatic hypotension (OH) is very common, particularly in older populations. Diagnostic criteria exist but appear to be arbitrary rather than evidence based. This review will visit the evidence for diagnostic strategies for OH. ⋯ Establishing the long-term clinical outcomes for transient drops in BP detected on continuous, non-invasive monitoring. Evaluating the different patterns of BP drop to aid diagnosis and direct treatment.
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The UK is at the forefront of mitochondrial science and is currently the only country in the world to legalize germ-line technologies involving mitochondrial donation. However, concerns have been raised about genetic modification and the 'slippery slope' to designer babies. ⋯ It is expected that the first cohort of 'three parent' babies will be born in the UK in 2016. Their health and progress will be closely monitored.
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Hip fracture poses a significant global challenge both to healthcare systems and to patients themselves. We outline the management of this injury, highlight areas where the evidence is deficient and discuss research efforts towards improving the quality of the evidence base. ⋯ Strategies to improve postoperative mobility, postoperative nutrition and the role of home-based rehabilitation. There is a need to identify the optimum analgesic regimes and assessment tools for hip fracture patients with cognitive impairment.
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Obesity is associated with an increased risk of developing osteoarthritis (OA), even in non-weight bearing joints. High levels of adipose tissue-associated inflammation may explain this association. ⋯ In an era of an obesity epidemic, this review identifies a need for well-designed cohort studies assessing early metabolic changes in populations at high risk of OA and MetS, and to identify risk factors for increased mortality in patients with OA.
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Crowdsourced R&D, a research methodology increasingly applied to medical research, has properties well suited to large-scale medical data collection and analysis, as well as enabling rapid research responses to crises such as disease outbreaks. ⋯ Further research in areas such as artificial intelligence may allow better coordination and management of the high volumes of medical data and problem-solving inputs generated by the crowdsourced R&D process.