British medical bulletin
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Varicella zoster virus infection (VZV) is widespread and clinically important as the cause of varicella pneumonitis and meningoencephalitis (a complication of primary infection/zoster) and post-herpetic neuralgia (a complication of zoster/secondary infection). The use of live-attenuated varicella vaccine to reduce the burden of these diseases has been established in many countries for a number of years. ⋯ No international consensus exists: measurement of VZV immunity or cost-effectiveness of introducing VZV vaccination to a country. Decisive factors will include the pre-vaccination burden of VZV-associated disease.
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British medical bulletin · Sep 2012
ReviewHealth economic decision-making: a comparison between UK and Spain.
This review examines the impact of economic evaluation in informing national or local policies within both jurisdictions. We focus on the factors that have made the economic evaluation evolves differently in both settings. ⋯ Cost-effectiveness approach is based on the assumption of health maximization subject to a budget constraint. Decision-makers are not only interested in health maximization alone. This may result in policy-makers failing to consider economic evaluations into their allocation decisions. AREAS TO DEVELOP RESEARCH: Methods that incorporate wider decision-makers goals (mainly local) and research to study the real impact of economic evaluation in terms of improved efficiency and equity are particularly required.
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British medical bulletin · Sep 2012
ReviewSoothing suffering swimmers: a systematic review of the epidemiology, diagnosis, treatment and rehabilitation of musculoskeletal injuries in competitive swimmers.
This review details the examination, diagnosis, treatment and management of injuries encountered by competitive swimmers. Primarily, these involve the shoulder, however, the spine, knee and hip can be involved. Using the Coleman methodology score, we show that the methods used in obtaining and reporting clinical findings and intervention results could be improved. Where possible, we suggest improvements. ⋯ Clinical findings and rehabilitation methods should be reported using a more structured method possibly based on the Coleman methodological scoring system.
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The prevalence of knee osteoarthritis (OA) is rising and the search for interventions to mitigate risk is intensifying. This review considers the contribution of occupational activities to disease occurrence and the lessons for prevention. ⋯ Reasonably good evidence exists that physical work activities (especially kneeling, squatting, lifting and climbing) can cause and/or aggravate knee OA. These exposures should be reduced where possible. Obese workers with such exposures are at additional risk of knee OA and should therefore particularly be encouraged to lose weight. AREAS OF UNCERTAINTY/RESEARCH NEED: Workplace interventions and policies to prevent knee OA have seldom been evaluated. Moreover, their implementation can be problematic. However, the need for research to optimize the design of work in relation to knee OA is pressing, given population trends towards extended working life.
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British medical bulletin · Jan 2012
ReviewOverview of anesthetic considerations for Cesarean delivery.
Physiologic changes of pregnancy uniquely influence anesthesia for Cesarean delivery. Included is a review of current obstetrical anesthesia considerations for Cesarean delivery and recent changes improving maternal care and outcome. ⋯ Obstetric anesthesia advances have improved maternal outcomes. Current areas of needed obstetric anesthesia research include improved obese patient care, the impact of anticoagulation on neuraxial techniques in pregnancy, long-term neurocognitive effects of neonatal exposure to anesthesia and postoperative pain management.