Top research priorities in liver and gallbladder disorders in the UK.

OBJECTIVES: There is a mismatch between research questions considered important by patients, carers and healthcare professionals and the research performed in many fields of medicine. The non-alcohol-related liver and gallbladder disorders priority setting partnership was established to identify the top research priorities in the prevention, diagnostic and treatment of gallbladder disorders and liver disorders not covered by the James-Lind Alliance (JLA) alcohol-related liver disease priority setting partnership. DESIGN: The methods broadly followed the principles of the JLA guidebook. The one major deviation from the JLA methodology was the final step of identifying priorities: instead of prioritisation by group discussions at a consensus workshop involving stakeholders, the prioritisation was achieved by a modified Delphi consensus process. RESULTS: A total of 428 unique valid diagnostic or treatment research questions were identified. A literature review established that none of these questions were considered 'answered' that is, high-quality systematic reviews suggest that further research is not required on the topic. The Delphi panel achieved consensus (at least 80% Delphi panel members agreed) that a research question was a top research priority for six questions. Four additional research questions with highest proportion of Delphi panel members ranking the question as highly important were added to constitute the top 10 research priorities. CONCLUSIONS: A priority setting process involving patients, carers and healthcare professionals has been used to identify the top 10priority areas for research related to liver and gallbladder disorders. Basic, translational, clinical and public health research are required to address these uncertainties.

Ultrasound treatment for breast engorgement: A randomised double blind trial.

The aim of this study was to test the efficacy of thermal ultrasound therapy as a treatment for severe post partum breast engorgement. A randomised double-blind, placebo-controlled trial was conducted on 197 breasts. Two ultrasound machines of identical appearance were used. One was working normally, the other had the crystal replaced with a resistor producing surface heat only. Assessment of effectiveness was subjective, using visual analogue scales for pain and hardness, and objective, using tonometry. Results indicate that both the true and sham machines were effective in reducing subjectively perceived pain and hardness. However, the results of this study show that the effect cannot be attributed to the ultrasound component.