Morecambe Bay Medical Journal

Editorial

Shadaba Ahmed — 2024-07-01

My journey so far, and where I'm going now

Éabha Lynn — 2024-07-01

A systematic review on the efficacy of the biologic therapies Rituximab, Belimumab and Anifrolumab in Lupus Erythematosus

Juan Felipe Espitia Jaramillo — 2024-07-01

Objective: This systematic review presents the treatment efficacy of anifrolumab, belimumab and rituximab in nonrenal Systemic Lupus Erythematosus using the main endpoints.

Methods: A search was done using Embase, Medline, PubMed and Web of Science for the mentioned biologics targeting SLE after 1 Jan 2019. A manual search was done with ClinicalTrials.gov for trials, and search engines for literature reviews.

Results: For anifrolumab, all trials reached their end point except TULIP-1 (OR=1.16, [95% CI 0.77,1.76]). Meanwhile, most trials for belimumab did not reach a response, with its only randomised controlled trial (RCT) not reaching its endpoint OR=1.40 CI [0.92,2.11]. The only trial with rituximab included 125 patients; 48 achieved remission after one cycle and 61 after 2 cycles.

Conclusion: The review displays evidence on the positive efficacy of anifrolumab, a varied and safe effect for
belimumab and a good effect for rituximab. No trial revealed worsening by a biologic, which is a positive effect.

The resilient doctor: pillar of healthcare or a commodity in the marketplace?

Sophie Rosenke — 2024-07-01

Evaluating the efficacy of topiramate in the reduction of drinking behaviours amongst alcohol dependent individuals

Jack Tallentire — 2024-07-01

Alcohol dependence is a complex and multi-faceted problem, with alcohol misuse costing the NHS an estimated £3.5 billion annually. Appropriate pharmacological treatment, alongside behavioural therapy, is essential to the proper management of dependent individuals. NICE recommended pharmacotherapies are still relatively under prescribed, despite their relatively low number-needed-to-treat (NNT), perhaps owing to mixed evidence across the literature. Topiramate (currently licensed for migraine prophylaxis and epilepsy) has been proposed as one drug with potential efficacy in reducing drinking behaviours. Hence, the aim of this paper is to evaluate the efficacy of topiramate in promoting and maintaining abstinence in alcohol dependence, through a review of the current literature.
Seven papers are reported after a systematic database search (PubMed, Medline, Embase, Web of Science); statistical manipulation of results has been performed to present findings in a common format. Results were consistent and showed the effectiveness of topiramate in all outcome measures evaluated: heavy drinking days (HDDs), plasma gamma-glutamyl transferase (GGT) concentration and abstinence rate. These differences over placebo reached statistical significance in all seven studies.
This paper supports the efficacy of topiramate in treating alcohol dependence. There are several recommendations for further research, including comparisons to currently licensed alcohol dependence medications (namely naltrexone) and the pharmacogenetic influence of a GRIK1 polymorphism on the efficacy of topiramate. Further research into the tolerability of topiramate is required, although evaluation of adverse events within this paper has been positive.

Navigating the grey areas: The ethics of incidental findings in brain imaging research

Fatema Aftab — 2024-07-01

This paper explores the ethical implications of incidental findings during brain imaging research and critically
examines aspects of autonomy and distributive justice in this context. Concepts of autonomy and distributive justice must be balanced with the cost effectiveness of disclosing and further investigating all incidental findings. This paper outlines arguments for and against disclosure and recommends the use of the EUSTICE framework in ethical decision making. This existing framework can aid researchers in developing an ethical protocol to disclose pathologies that carry a serious clinical significance whilst adhering to the values of distributive justice.

Histopathology quiz 2

Phuoc-Tan Diep — 2024-07-01

Living the fall and rise of public health in the NHS: John V Dyer and community medical leadership in Lancaster, 1968-92

Michael Lambert — 2024-07-01

The recent appointment of Dr Christopher Chiswell as a public health medicine consultant in Morecambe Bay’s acute sector reflects national policy commitments around integration and population health management. His career trajectory embodies this shift, coming from a background working in specialist trusts rather than conventional bastions of public health. This shift aligns with policy debates between historical public health and new population health, and the location of medical leadership. Using the past to illuminate enduring tensions in the present, this paper considers those involved in changing community medical leadership in Lancaster between 1968 and 1992 through the career of Dr John Dyer, arguably Morecambe Bay’s first combined public health doctor.

Digital transformation across the Bay

Janet Manning — 2024-07-01

ACCS (Acute Care Common Stem) trainees at University Hospitals of Morecambe Bay

Syed Bilgrami, — 2024-07-01

New Community Diagnostic Centre providing health tests closer to home

Ingrid Kent — 2024-07-01