British medical bulletin
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The public assumes that if euthanasia and assisted suicide were to be legalized they would be carried out by physicians. ⋯ The impact of characterizing euthanasia as 'medical treatment' on physicians' professional identity and on the institutions of medicine and law should be examined in jurisdictions where assisted suicide and euthanasia have been de-criminalized.
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British medical bulletin · Jan 2013
ReviewThe neuroinflammatory response of postoperative cognitive decline.
Aseptic surgical trauma provokes a homeostatic neuroinflammatory response to promote healing and protect the organism from further injury. When this response is dysregulated, harmful consequences can follow, including postoperative cognitive decline. ⋯ The mechanisms that lead to exaggerated and persistent neuroinflammation and the best way to counteract it are still unknown. AREAS FOR DEVELOPING RESEARCH: It is imperative that we identify the underlying processes that increase the risk of cognitive decline in elderly surgical patients. In this review we explore non-resolution of inflammation as an underlying cause of developing exaggerated and persistent POCD. If interventions can be developed to promote resolution of neuroinflammation, the patient's postoperative recovery will be enhanced and long-term consequences can be prevented.
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Subclinical thyroid disease is a common finding on testing of thyroid function and its management remains controversial. ⋯ A randomized controlled trial to identify those subjects identified from screening programmes that benefit from intervention in terms of morbidity and mortality.
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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.