Clin Med
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Decisions about the use of therapeutic interventions, whether for individuals or entire healthcare systems, should be based on the totality of the available evidence. The notion that evidence can be reliably or usefully placed in 'hierarchies' is illusory. Rather, decision makers need to exercise judgement about whether (and when) evidence gathered from experimental or observational sources is fit for purpose.
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Neurology in England is expanding rapidly. In 2005 there were, on average, 7.2 (2.5) new and 16.8 (8.6) follow-up appointments per 1,000 population, an increase of 24% and 19% respectively since 2003. The chance of an individual being seen in this specialty varies widely according to primary care trust. This paper considers the causes and implications for neurological health, service delivery and neurology training.
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Movement impairment affects the independence and lifestyle of a significant number of people worldwide. A MDT approach towards the problem is needed for optimal restoration of mobility. ⋯ Assessment of the patient is critical to ensure successful outcomes of technological interventions. Novel technologies such as targeted reinnervation prosthesis and implantable technologies, although at a very early stage in their development, have huge potential to help people with movement impairments due to disorders of neuromuscular control or limb loss.
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Global warming is the most important science issue of the 21st century, challenging the very structure of our global society. The study of past climate has shown that the current global climate system is extremely sensitive to human-induced climate change. The burning of fossil fuels since the beginning of the industrial revolution has already caused changes with clear evidence for a 0.75 degrees C rise in global temperatures and 22 cm rise in sea level during the 20th century. ⋯ In addition, weather patterns will become less predictable and the occurrence of extreme climate events, such as storms, floods, heat waves and droughts, will increase. The potential effects of global warming on human society are devastating. We do, however, already have many of the technological solutions to cure our sick planet.