British medical bulletin
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British medical bulletin · Jan 2005
ReviewPsychiatric genetics--the new era: genetic research and some clinical implications.
Impressive advances in the last decade have been made in the genetics and neuroscience of neuropsychiatric illness. Synergies between complex genetics, elaboration of intermediate phenotypes (Egan et al. (2004) Schizophrenia. ⋯ As the genetics and complex neurocircuits of these and disorders are being untangled, parallel applications in pharmacogenomics and gene-based drug metabolism are shaping a drive for personalized medicine. Genetic research and pharmacogenomics suggest that the subcategorization of individuals based on various sets of susceptibility alleles will make the treatment of neuropsychiatric and other illnesses more predictable and effective.
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Non-invasive ventilation (NIV) has been shown to be effective in acute respiratory failure of various aetiologies in different health care systems and ward settings. It should be seen as complementary to invasive ventilation and primarily a means of preventing some patients from deteriorating to the point at which intubation is needed. ⋯ Important benefits include the avoidance of endotracheal-tube-associated infections, which carry an important morbidity and mortality, and a reduction in health care costs. The most important ingredient for an acute NIV service is a well-trained enthusiastic ward team.
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British medical bulletin · Jan 2004
Reviewalpha2-Adrenoceptor agonists: shedding light on neuroprotection?
Although alpha(2)-adrenoceptor agonists are widely used for analgesia, anxiolysis, sedation, sympatholysis and as anaesthetic-adjuncts for many years, their potential use as neuroprotectants has so far been confined to laboratory experiments. Despite the large body of evidence from both in vivo and in vitro studies, their exact neuroprotective mechanisms remain elusive. Herein, we review the available literature pertaining to the neuroprotective effect of alpha(2)-adrenoceptor agonists and the possible biochemical and physiological cascades involved in their mechanisms of action. The remarkable safety profile of alpha(2)-adrenoceptor agonists and their high potency of neuroprotection should prompt clinical trials to evaluate their neuroprotective efficacy in humans.
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British medical bulletin · Jan 2004
ReviewComprehensive geriatric assessment for older hospital patients.
In-patient comprehensive geriatric assessment (CGA) may reduce short-term mortality, increase the chances of living at home at 1 year and improve physical and cognitive function. We systematically reviewed the literature and found 20 randomized controlled trials (10 427 participants) of in-patient CGA for a mixed elderly population. This includes seven more recent randomized controlled trials that update a previous review. ⋯ Most of the benefit was seen for ward-based management units (four patients per 100 treated, 95% CI 1-7) with little contribution from team-based care (no patients per 100, 95% CI -4 to +5). However, CGA does not reduce long-term mortality. This evidence should inform future service developments.
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British medical bulletin · Jan 2004
ReviewGenetic insights into disease mechanisms of autoimmunity.
Educating the immune system to distinguish between self and non-self is critical to ensure that an immune response is mounted against foreign antigens and not against self. A breakdown in these mechanisms can lead to the onset of autoimmune disease. Clinical and molecular data suggest that shared immunogenetic mechanisms lead to the autoimmune process. ⋯ Recent exciting results also suggest a role for the newly discovered lymphoid-specific phosphatase (LYP) protein. As well as these general mechanisms, disease-specific mechanisms are beginning to be elucidated, for example the role of autoimmune regulatory element 1 (AIRE1) in autoimmune polyendocrinopathy-candidiasis ectodermal dystrophy (APECED). Taken together, these data suggest that both general and disease-specific mechanisms lead to the clinical outcome of autoimmune disease and that increased understanding of these mechanisms will improve our knowledge of how autoimmune disease occurs, eventually leading to the development of novel therapeutic agents.