British medical bulletin
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British medical bulletin · Sep 2015
ReviewCommissioning for equity in the NHS: rhetoric and practice.
This paper reviews evidence on equity as a policy goal of resource allocation in the English NHS, focussing on the role of clinical commissioning groups (CCGs) as purchasers of health services since 2013 and their capacity to achieve equity through the process of commissioning. ⋯ Additional assessments of structural capacity should be complemented by further development of indicators of equity of access and studies that quantify inequities. Research should also explore how an equity principle can be embedded in commissioning, which currently revolves around cost containment and efficiency.
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British medical bulletin · Sep 2015
ReviewMesenchymal stem cells for therapeutic applications in pulmonary medicine.
Mesenchymal stem cells (MSCs) of different biological sources are in Phase 1 clinical trials and are being considered for Phase 2 therapy of lung disorders, and lung (progenitor) cells derived from pluripotent stem cells (SCs) are under development in preclinical animal models. ⋯ Although safety of MSC-based cell therapy was proved in Phase 1, efficacy, long-term survival and preservation of lung respiratory function need to be further evaluated, cautioning against hastily translating SCs therapy from animal models of lung injury to clinical trials of patients with lung disorders.
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Streptococci are a genus of Gram-positive bacteria which cause diverse human diseases. Many of these species have the potential to cause invasive infection resulting from the presence of bacteria in a normally sterile site. ⋯ Studies of invasive streptococcal disease are challenging to undertake, not least because individual hospitals treat relatively few confirmed cases. Instead clinicians and scientists must work together to build national and international networks with the aim of developing a more complete evidence base for the treatment and prevention of these devastating infections.
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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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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.