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Gaps in evidence

Fetal cell or stem cell derived treatment for Parkinson´s disease

4 Jun, 15 | by BMJ Clinical Evidence

by Arnar Astradsson and Tipu Z. Aziz

Arnar Astradsson pictureTipu Aziz.crop

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by the selective loss of nigrostriatal dopaminergic neurons which results in the cardinal symptoms of tremor, rigidity, bradykinesia and postural instability. The mainstay of therapy has been pharmacological substitution of dopamine using levodopa. However, after years of pharmacological therapy eventually the benefits may wear off and side effects such as dyskinesias may develop. Deep brain stimulation of the pallidum or subthalamic nucleus is also being used, which effectively controls the motor symptoms of Parkinson’s disease. As an alternative to pharmacological therapy or electrostimulation, cell-based therapies that reconstruct the nigrostriatal pathways have been developed with the transplantation of fetal ventral midbrain neurons into the striatum of PD patients. more…

A gap in the evidence – What is the role of surgery in the patient with severe (secondary) Raynaud’s phenomenon?

21 May, 15 | by BMJ Clinical Evidence

by Ariane Herrick and Lindsay Muir

Herrick

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People with Raynaud’s phenomenon secondary to an underlying disease or condition (the best researched one being systemic sclerosis) can progress to irreversible tissue injury with ulceration and/or critical ischaemia and gangrene. Although there has been increasing interest in recent years in identifying new drug therapies for severe Raynaud’s phenomenon with randomised controlled trials (RCTs) of, for example, phosphodiesterase inhibitors and endothelin receptor antagonists, the recent BMJ Clinical Evidence overview identified no RCTs of any of the surgical procedures that  have been advocated for advanced peripheral vascular disease. more…

Trigeminal neuralgia – gaps in evidence

14 May, 15 | by BMJ Clinical Evidence

by Joanna M. Zakrzewska and Mark E. Linskey

Trigem imageTrigeminal neuralgia is a rare condition that causes excruciating intermittent short-lasting, usually unilateral facial pain especially provoked by light touch.
Although the criteria for diagnosis appear to be clear cut, there have been no case control studies to validate them, and there is no cohort data on progression of the disorder. This is especially important as—while the disorder is generally progressive over time—in more than 50% of cases this progression is interspersed with unpredictable remissions that can last 6 months or longer. more…

Addressing gaps in evidence

9 Apr, 15 | by BMJ Clinical Evidence

?????????????????????????????????????????????????????????????????????????Evidence-based medicine (EBM) is an approach that—in addition to clinical experience and patient preferences—takes into account existing research evidence to draw conclusions on the best approach for the care of individual patients. It is a key tool for clinical decision making as the need to balance research, new tests and treatments, and available resources with clinical experience and patient requirements continues to be an important focus in healthcare. more…

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