British medical bulletin
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The coronavirus disease 2019 pandemic has placed intensive care units (ICU) triage at the center of bioethical discussions. National and international triage guidelines emerged from professional and governmental bodies and have led to controversial discussions about which criteria-e.g. medical prognosis, age, life-expectancy or quality of life-are ethically acceptable. The paper presents the main points of agreement and disagreement in triage protocols and reviews the ethical debate surrounding them. ⋯ Examine the universality vs. context-dependence of triaging principles and criteria; empirically test the appropriateness of triaging guidelines, including impact on vulnerable groups and risk of discrimination; study the potential and challenges of AI for outcome and preference prediction and decision-support.
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This is an overall review on mindfulness-based interventions (MBIs). ⋯ More research is needed on online mindfulness trainings and interventions to improve biopsychosocial health during the COVID-19 pandemic; Deeper understanding of the mechanisms of MBIs integrating both empirical and neurophysiological findings; Long-term compliance and effects of MBIs; and development of mindfulness plus (mindfulness+) or personalized mindfulness programs to elevate the effectiveness for different purposes.
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British medical bulletin · Jun 2021
ReviewAn update on the role of anti-IL-12/IL23 agents in the management of inflammatory bowel disease.
The aim of treatment in inflammatory bowel disease (IBD) is to control symptoms and suppress gut inflammation with minimal systemic side effects. A large proportion of patients are either primary non-responders or lose response to currently licensed therapies. The development of monoclonal antibodies, blocking interleukin (IL)-12 and IL-23 pathways are a promising therapeutic advance. We review the data on IL12/23 inhibitors and emerging data on IL-23 inhibition in IBD treatment. ⋯ Head-to-head trials exploring efficacy and combination with other biologics with the potential for synergistic benefit are under investigation. Results of phase 3 trials with IL-23 inhibitors incorporating clinical, biochemical and endoscopic parameters and also exploring biomarkers as predictors of response are urgently needed.
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British medical bulletin · Jun 2021
ReviewPsychological factors associated with inflammatory bowel disease.
Both depression and anxiety are identified as significant experiences in inflammatory bowel disease (IBD); whether these are a consequence of the disease or an active contributor to the disease remains controversial. This review aimed to identify and critique recent evidence regarding mental health in IBD. ⋯ More longitudinal research may further enlighten the role of depression and anxiety in IBD. Similarly, randomized controlled trials to investigate and clarify the effect of psychiatric/psychological management on IBD outcomes.
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British medical bulletin · Jun 2021
Matrix-induced autologous chondrocyte implantation versus autologous matrix-induced chondrogenesis for chondral defects of the talus: a systematic review.
Chondral defects of the talus are common and their treatment is challenging. ⋯ AMIC exhibits similar clinical results to mACI. However, AMIC involves one single surgical procedure, no articular cartilage harvest and hence no morbidity from it, no need for chondrocyte expansion in a separate laboratory setting. For these reasons, AMIC may be preferred to mACI.