Evolution of arthroscopy: from a technique to a subspecialty

The arthroscope was first introduced to orthopaedics as a diagnostic instrument by Tagaki in 1918. A high degree of clinical accuracy, combined with low morbidity, has encouraged the use of arthroscopy to assist in diagnosis, to determine prognosis and often to provide treatment. Arthroscopy has dramatically changed the orthopaedic surgeons＇ approach to the diagnosis and treatment of a variety of joint ailments. Moreover, arthroscopists have specialised in sport medicine and this field was one of the most popular fellowship choices among graduating orthopaedic residents. Arthroscopy has already evolved to an important subspecialty of orthopaedics.     

Blinkered objections to bioethics: a response to Benatar

In a recent commentary, S R Benatar criticised the debates over organ donation and kidney selling for being located within a "narrow and inadequate framework". Benatar levels four charges against those who engage in the current organs debate: that they myopically focus on saving lives; that they accept the dominance of market orientated approaches to health care; that they reify individualism, and that they engage in limited moral arguments. Given the importance of the organs debate it is imperative that the misunderstandings of it on which Benatar's criticisms are based are dispelled. Accordingly, I will consider and reject each of his objections in turn.     

Leatherwork: a possible hazard to reproduction

A retrospective study was carried out aimed at eliciting the causes of perinatal death in Leicestershire between 1976 and 1982. Case notes were reviewed and the mothers interviewed in over 1000 cases. An analysis of maternal occupations showed that leatherworkers were at increased risk of having a perinatal death, particularly from congenital malformations and macerated stillbirths, even when compared with other manual workers in the same social class. The excess risk occurred in all towns of the county where leatherwork was undertaken. Further investigation is needed of the materials used in the leather industry in order to ensure that risks are minimised. Fecund women working in the industry should be informed of any residual risk if these findings are confirmed.     

From genomic databases to translation: a call to action

The rapid rise of international collaborative science has enabled access to genomic data. In this article, it is argued that to move beyond mapping genomic variation to understanding its role in complex disease aetiology and treatment will require extending data sharing for the purposes of clinical research translation and implementation.     

Granulomatous prostatitis: a reminder to clinicians

Granulomatous Prostatitis (GnP) is a heterogenous entity classified into specific infections, non-specific infections, post surgical i.e. post-transurethral resection of prostate (TURP) and rare secondary (systemic) causes. A total of 1388 reports of prostatic biopsy and prostatic chips from TURP were reviewed from 1995 and 2007. The results which showed granulomatous prostatitis were analyzed and retrospective data collected from the patient's records. A total of 9 cases with granulomatous prostatitis were identified. There are 3 types of entities which are the non-specific (NSGnP), post-TURP and the specific type. The incidence of GnP in our center is lower than reported by Stillwell et al. The majority of the patients were Malays.     

Not a NICE fallacy: a reply to Dr Quigley

A repudiation of Muireann Quigley's argument that the National Institute for Health and Clinical Excellence (NICE) values and assesses the worth of people's lives; together with an alternative account of what it appears that NICE actually does, why these procedures are not unreasonable and some of the unresolved problems, especially when making interpersonal comparisons of health, which remain for NICE or, indeed, anyone seeking to determine the contents of the benefits bundles of a public health insurance programme such as the NHS. Some other ethically dubious propositions by Dr Quigley are also rejected.     

Effectiveness of a strategy to improve adherence to tuberculosis treatment in a resource-poor setting: a cluster randomized controlled trial

Context  Poor adherence to treatment remains a major obstacle to efficient tuberculosis (TB) control in developing countries. Innovative strategies to improve access and adherence to treatment are needed. Objectives  To assess the effectiveness of a contextualized intervention strategy aimed at improving patients' adherence to treatment and to evaluate its impact on TB control in a resource-poor country in Africa with prevalent TB infection. Design, Setting, and Patients  A cluster randomized controlled trial, conducted between June 2003 and January 2005, at 16 government district health centers in Senegal. Patients older than 15 years with newly diagnosed sputum smear–positive pulmonary TB were randomly assigned to the intervention or control group. Intervention  The intervention strategy included reinforced counseling through improved communication between health personnel and patients, decentralization of treatment, choice of directly observed therapy (DOT) supporter by the patient, and reinforcement of supervision activities. In the control group, the usual TB control program procedures remained unchanged. Main Outcome Measure  Proportion of patients successfully completing the 8-month course of treatment and the proportion of patients defaulting from treatment. Results  A total of 1522 patients were recruited into the study. Treatment was successful for 682 (88%) of 778 patients recruited in the intervention group, and for 563 (76%) of 744 patients recruited in the control group (adjusted risk ratio [RR], 1.18; 95% confidence interval [CI], 1.03-1.34). The proportion of patients defaulting was reduced in the intervention group to 5.5% (n = 43) compared with 16.8% (n = 125) in the control group (adjusted RR, 0.43; 95% CI, 0.21-0.89). Conclusion  The intervention package based on improved patients counseling and communication, decentralization of treatment, patient choice of DOT supporter, and reinforcement of supervision activities led to improvement in patient outcomes compared with the usual TB control procedures. This approach may be generalized in the context of TB control programs in resource-poor countries. Trial Registration  clinicaltrials.gov Identifier: NCT00412009