British medical bulletin
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In osteonecrosis of the femoral head (ONFH), blood supply is insufficient for the metabolic requirements of the bone. The initial management is conservative, and, in case of failure, surgery is indicated. Osteotomies aim to change the spatial position of the necrotic portion of the femoral head. This systematic review evaluates the effectiveness and safety of osteotomies for ONFH. ⋯ Randomized clinical studies should be conducted in order to define the parameters of the patient that can direct towards the most suitable osteotomic technique.
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Vaccination decisions and policies present tensions between individual rights and the moral duty to contribute to harm prevention. This article focuses on ethical issues around vaccination behaviour and policies. It will not cover ethical issues around vaccination research. ⋯ The relationship between individual, collective and institutional responsibilities to contribute to the public good of herd immunity will be a major point of discussion, particularly with regard to the COVID-19 vaccine.
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British medical bulletin · Mar 2021
ReviewDesigning delivery models of traditional and complementary medicine services: a review of international experiences.
The World Health Organization advocates integration of traditional and complementary medicine (T&CM) into the conventional health services delivery system. Integrating quality services in a patient-centred manner faces substantial challenges when T&CM is delivered within a health system dominated by conventional medicine. This review has synthesized international experiences of integration strategies across different contexts. ⋯ Research is needed on the optimal methods for financing integrated care to ensure equitable access, as well as in remuneration of T&CM practitioners working in integrative healthcare.
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Many drugs approved for other indications can control the growth of tumor cells and limit adverse events (AE). ⋯ Optimizing drug combinations, reducing cytotoxicity of chemotherapeutics and controlling associated inflammation.
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British medical bulletin · Mar 2021
Nuclear magnetic resonance spectroscopy of biofluids for osteoarthritis.
Osteoarthritis is a common degenerative musculoskeletal disease of synovial joints. It is characterized by a metabolic imbalance resulting in articular cartilage degradation, reduced elastoviscosity of synovial fluid and an altered chondrocyte phenotype. This is often associated with reduced mobility, pain and poor quality of life. Subsequently, with an ageing world population, osteoarthritis is of increasing concern to public health. Nuclear magnetic resonance (NMR) spectroscopy can be applied to characterize the metabolomes of biofluids, determining changes associated with osteoarthritis pathology, identifying potential biomarkers of disease and alterations to metabolic pathways. ⋯ Overall, this research area could be improved by the inclusion of more heterogeneous cohorts, reflecting varying osteoarthritis phenotypes, and larger group sizes ensuring studies are not underpowered. To correlate local and systemic environments, the use of blood for diagnostic purposes, over the collection of synovial fluid, requires increased attention. This will ultimately enable biomarkers of disease to be determined that may provide an earlier diagnosis, or provide potential therapeutic targets for osteoarthritis, ultimately improving patient prognosis.