British Medical Bulletin (Br Med Bull )

Publisher: British Council. Medical Dept, Oxford University Press


This series of expert reviews on selected health topics in fields where significant new developments are occurring is aimed at non-specialists and postgraduate medics and serves as an invaluable reference source. It also allows those working in other specialities and younger clinicians and scientists to update their knowledge in important and well-defined subject areas. Each issue offers an authoritative and concise overview of the current state of knowledge in a specific area.

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  • Website
    British Medical Bulletin website
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  • Material type
    Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Oxford University Press

  • Pre-print
    • Author can archive a pre-print version
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    • 12 month embargo on science, technology, medicine articles
    • 24 month embargo on arts and humanities articles
    • Some titles may have different embargoes
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    • Pre-print on personal website, employer website, free public server or pre-prints in subject area
    • Post-print on Institutional or Central repositories
    • Publisher version cannot be used except for Nucleic Acids Research articles
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    • Articles in some journals can be made Open Access on payment of additional charge
    • Eligible UK authors may deposit in OpenDepot
    • Publisher will deposit on behalf of NIH funded authors to PubMed Central, Nucleic Acids Research authors must pay their fee first
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Non-communicable diseases (NCDs) such as metabolic, cardiovascular, cancers, injuries and mental health disorders are increasingly contributing to the disease burden in South Asia, in light of demographic and epidemiologic transitions in the region. Home to one-quarter of the world's population, the region is also an important priority area for meeting global health targets. In this review, we describe the current burden of and trends in four common NCDs (cardiovascular disease, diabetes, cancer and chronic obstructive pulmonary disease) in South Asia.
    British Medical Bulletin 09/2014; 111(1):31-44.
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    ABSTRACT: Injury to the tibiofibular syndesmosis often arises from external rotation force acting on the foot leading to eversion of the talus within the ankle mortise and increased dorsiflexion or plantar flexion. Such injuries can present in the absence of a fracture. Therefore, diagnosis of these injuries can be challenging, and often stress radiographs are helpful. Magnetic resonance imaging scans can be a useful adjunct in doubtful cases. The management of syndesmotic injuries remains controversial, and there is no consensus on how to optimally fix syndesmosis. This article reviews the mechanism of injury, clinical features and investigations performed for syndesmotic injuries and brings the reader up-to-date with the current evidence in terms of the controversies surrounding the management of these injuries.
    British Medical Bulletin 09/2014; 111(1):101-15.
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    ABSTRACT: Patients with myeloma develop localized and generalized bone loss leading to hypercalcaemia, accelerated osteoporosis, vertebral wedge fractures, other pathological fractures, spinal cord compression and bone pain. Bone loss is mediated by a variety of biological modifiers including osteoclast-activating factors (OAF) and osteoblast (OB) inhibitory factors produced either directly by malignant plasma cells (MPCs) or as a consequence of their interaction with the bone marrow microenvironment (BMM). Raised levels of OAFs such as receptor activator of nuclear factor-kappa B ligand (RANKL), macrophage inflammatory protein 1 alpha, tumour necrosis factor-alpha and interleukin 6 stimulate bone resorption by recruiting additional osteoclasts. Via opposing mechanisms, increases in OB inhibitory factors, such as dickkopf-1 (Dkk-1), soluble frizzled-related protein-3 and hepatocyte growth factor (HGF), suppress bone formation by inhibiting the differentiation and recruitment of OBs. These changes result in an uncoupling of physiological bone remodelling, leading to myeloma bone disease (MBD). Moreover, the altered BMM provides a fertile ground for the growth and survival of MPCs. Current clinical management of MBD is both reactive (to pain and fractures) and preventive, with bisphosphonates (BPs) being the mainstay of pharmacological treatment. However, side effects and uncertainties associated with BPs warrant the search for more targeted treatments for MBD. This review will summarize recent developments in understanding the intimate relationship between MBD and the BMM and the novel ways in which they are being therapeutically targeted.
    British Medical Bulletin 09/2014; 111(1):117-38.
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    ABSTRACT: 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.
    British Medical Bulletin 09/2014; 111(1):45-61.
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    ABSTRACT: Melanoma is a potentially curable cancer, but around 20% of patients will develop disease which is beyond surgical clearance. Rising incidence alongside breakthroughs in understanding the molecular biology of this disease identifying systemic therapies offering survival gains now demand a more proactive, integrated approach to melanoma management.
    British Medical Bulletin 09/2014; 111(1):149-62.
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    ABSTRACT: 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.
    British Medical Bulletin 08/2014;
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    ABSTRACT: 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.
    British Medical Bulletin 08/2014;
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    ABSTRACT: Genetic susceptibly to suspected chemical and environmental carcinogens may modify the response to exposure. The aim of this review was to explore the issues involved in the study of gene-environment interactions, and to consider the use of susceptibility biomarkers in cancer epidemiology, using non-Hodgkin lymphoma (NHL) as an example.
    British Medical Bulletin 08/2014;
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    ABSTRACT: 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.
    British Medical Bulletin 07/2014;
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    ABSTRACT: IntroductionDrug-resistant tuberculosis (DR-TB) is associated with increased mortality and morbidity. This is at least partly due to late diagnosis and ineffective treatment of drug-resistant status.Sources of dataSelective search of the literature on DR-TB supplemented by recent guidelines from the World Health Organization.Areas of agreementBetter and more rapid diagnosis of DR-TB by new techniques such as Xpert Mtb/RIF are likely to make a substantial impact on the disease. New therapeutics for DR-TB are entering, or about to enter the market for the first time in decades.Areas of controversyIt is not clear whether new treatments should be restricted for DR-TB or also used for drug-susceptible tuberculosis.Growing pointsWith several new agents on the horizon, there is the real possibility of an entirely new regimen for tuberculosis.Areas timely for developing researchAn inexpensive 'near-patient' diagnostic test is still needed. Optimizing new drug combination regimens in a timely manner is urgently required.
    British Medical Bulletin 05/2014;
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    ABSTRACT: Background Survival for patients with cancer varies widely across Europe. This review is an attempt to explore some of the factors that influence this variation.Sources of dataThe data on cancer survival come from EUROCARE-5 and a recent OECD report. These figures have been analysed together with data from a variety of other sources: other OECD data sets; EUROSTAT; The World Bank; Gallup and the World Health Organisation.Areas of agreementThis study confirms the importance of national socio-economic factors in influencing the outcomes for patients with cancer.Areas of controversyThe usual suspects (limited access to expensive new cancer drugs; delayed diagnosis and late presentation) may have less influence on cancer survival than is usually assumed.Growing pointsDisparities in outcomes challenge systems of health care to re-evaluate their strategies. The key point is that these new strategies need to be informed by facts, rather than suppositions.Areas timely for developing researchThe role and scope of national cancer registries should be enhanced. We need to record more detailed information on each patient with cancer and, in an era of linked data, cancer registries are ideally placed to collect and curate such information.
    British Medical Bulletin 05/2014;
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    ABSTRACT: Background Pain is common in advanced malignancy but also prevalent in other non-malignant life-limiting diseases such as advanced heart disease; end stage renal failure and multiple sclerosis. Patients with renal or liver impairment need specific consideration, as most analgesics rely on either or both for their metabolism and excretion.Sources of dataRecent evidence-based guidelines and the systematic reviews that have informed their recommendations.Areas of agreementThe principles of the WHO (World Health Organisation) analgesic ladder are commonly endorsed as a structured approach to the management of pain. For neuropathic pain, the efficacy of different agents is similar and choice of drug more guided by side effects, drug interactions and cost.Areas of controversyEvidence supporting the WHO analgesic ladder is disputed and alternatives suggested, but no overwhelming evidence for an alternative approach exists to date.Growing pointsAlternative approaches to the WHO analgesic ladder, new analgesic agents, e.g. rapid onset oral/intranasal fentanyl.
    British Medical Bulletin 05/2014;
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    ABSTRACT: IntroductionPrimary sclerosing cholangitis (PSC) is a chronic immune-mediated liver disease that results in end-stage liver disease requiring liver transplantation. PSC is closely associated with inflammatory bowel disease (IBD) with 70% of patients with PSC also suffering from IBD.Sources of dataData for this review were obtained from PubMed.Areas of agreementHistorical and genome-wide association studies have established a strong human leukocyte antigen (HLA) linkage to PSC and defined specific haplotypes associated with enhanced PSC risk. Fifteen non-HLA loci have been defined in PSC.Areas of controversyThe biological role of risk loci in PSC and their place in PSC pathogenesis remain speculative but suggest significant interactions with the host microbiome and therapeutic opportunities.Growing pointsGenetics provides a platform to systematically target emerging therapies in PSC.Areas timely for developing researchLinking PSC genotypes with biology and disease phenotypes paves the way for a personalized medicine approach to manage PSC.
    British Medical Bulletin 05/2014;
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    ABSTRACT: Background The link between asthma and inhaled workplace exposures has been long appreciated, and yet aggravation of asthma symptoms by work conditions, known as work-aggravated asthma (WAA), remains relatively common.Sources of dataA review of the literature published over the last 3 years was carried out, and additional key articles were included from outside this timeframe.AgreementWAA is commonly reported by workers with asthma. One published assessment of 12 studies identified a median prevalence of 21.5% among workers with asthma. Commonly reported causes included a variety of inhaled dusts, smoke, vapours, fumes, gases and mists, common and workplace-specific aeroallergens, physical environmental factors including temperature and humidity and physical activity at work.ControversyRemains in relation to definition, and how to distinguish WAA from occupational asthma in which there is sensitization to an agent in the workplace. Both these areas, and the development of workplace interventions to reduce WAA, are timely topics for future research.
    British Medical Bulletin 04/2014;
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    ABSTRACT: IntroductionPrecise and timely detection of human leukocyte antigen (HLA) donor-specific antibodies (DSAs) is vital for evaluating humoral immune status of patients pre- and post-transplantation.Source of dataClinically relevant articles on theory, development, methodology and application of HLA-DSA testing in kidney transplantation.Areas of agreement and controversyThe availability of solid phase HLA-antibody testing revolutionized our ability to detect HLA-DSA and to appreciate their significance in kidney transplant outcome. The best approach to determine the strength, immunogenicity and pathogenicity of HLA antibodies still remains controversial.Growing pointsAssays to identify complement-binding antibodies were developed. Their clinical utilization, pre- and post-transplantation, is currently under investigation. Appreciation of the complexity of HLA-DQ antibodies should lead to better assignment of unacceptable antibodies and cPRA calculation.Areas timely for developing researchCharacterization of HLA-antibody epitopes, and utilization of epitope matching to better define compatible donors could contribute to better transplant outcomes.
    British Medical Bulletin 04/2014;
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    ABSTRACT: Introduction/backgroundThe Argus(®) II is the first retinal prosthesis approved for the treatment of patients blind from retinitis pigmentosa (RP), receiving CE (Conformité Européenne) marking in March 2011 and FDA approval in February 2013. Alpha-IMS followed closely and obtained CE marking in July 2013. Other devices are being developed, some of which are currently in clinical trials.Sources of dataA systematic literature search was conducted on PubMED, Google Scholar and IEEExplore.Areas of agreementRetinal prostheses play a part in restoring vision in blind RP patients providing stable, safe and long-term retinal stimulation.Areas of controversyObjective improvement in visual function does not always translate into consistent improvement in the patient's quality of life. Controversy exists over the use of an external image-capturing device versus internally placed photodiode devices.Growing pointsThe alpha-IMS, a photovoltaic-based retinal prosthesis recently obtained its CE marking in July 2013.Areas timely for developing researchImprovement in retinal prosthetic vision depends on: (i) improving visual resolution, (ii) improving the visual field, (iii) developing an accurate neural code for image processing and (iv) improving the biocompatibility of the device to ensure longevity.
    British Medical Bulletin 02/2014;

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