A significant increase in life expectancy in successive birth cohorts of people with cystic fibrosis (CF) is a result of more effective treatment for the disease. It is also now widely recognized that outcomes for patients cared for in specialist CF Centres are better than for those who are not. Key to the effectiveness of the specialist CF Centre is the multidisciplinary team (MDT), which should include consultants, clinical nurse specialist, microbiologist, physiotherapist, dietitian, pharmacist, clinical psychologist, social worker, clinical geneticist and allied healthcare professionals, all of whom should be experienced in CF care. Members of the MDT are also expected to keep up to date with developments in CF through continued professional development, attendance at conferences, auditing and involvement in research. Specialists CF Centres should also network with other Centres both nationally and internationally, and feed Centre data to registries in order to further the understanding of the disease. This paper provides a framework for the specialist CF Centre, including the organisation of the Centre and the individual roles of MDT members, as well as highlighting the value of CF organisations and disease registries.

The 'intestinal' form of gastric cancer, which is the commonest type, develops against a background of chronic gastritis, atrophy, and intestinal metaplasia.1 2 Helicobacter pylori is the cause of (type B) chronic gastritis and has been shown in epidemiological studies to be a major risk factor for the development of gastric cancer.3-6 Increased mucosal cell proliferation increases the likelihood of the development of a neoplastic clone of epithelial cells7 where there is chronic epithelial injury associated with H pylori positive gastritis. However, little is known about cell proliferation in H pyloni associated gastritis. The aims of the study were, firstly, to compare antral mucosal cell proliferation in normal gastric mucosa with H pylori positive and negative chronic gastritis and, secondly, to determine the effect of H pylori eradication treatment on cell proliferation. MethodsPatients undergoing routine diagnostic endoscopy were recruited after informed consent. Those taking non-steroidal anti-inflammatory drugs, H2 antagonists, proton pump inhibitors, or bismuth salts, or those who had undergone gastric surgery, were excluded from the study. Using standard biopsy forceps, tissue specimens were taken from the gastric antrum (three) and corpus (two) for histological and immunohistochemical studies. The study was approved by the hospital ethical committee. HISTOLOGYTwo antral and two corpus biopsy specimens from each site were routinely processed, and stained with haematoxylin and eosin.H PYLORI H pylori status was determined using a modified Giemsa stain on the antral and corpus sections and a biopsy urease test (CLO/DeltaWest) on the third antral biopsy specimen. To establish eradication of the micro-organism, both tests had to be negative. IMMUNOHISTOCHEMISTRYTwo antral biopsy specimens for immunostaining were put immediately into RPMI (without L-Glutamine) (Gibco) containing bromodeoxyuridine (5 mg/10 ml). They were immersed in a waterbath for 60 minutes at 37°C then placed on filter paper and fixed in 346 on 10 May 2018 by guest. Protected by copyright.

There was no clear evidence that oscillation was a more or less effective intervention overall than other forms of physiotherapy; furthermore there was no evidence that one device is superior to another. The findings from one study showing an increase in frequency of exacerbations requiring antibiotics whilst using an oscillating device compared to positive expiratory pressure may have significant resource implications. More adequately-powered long-term randomised controlled trials are necessary and outcomes measured should include frequency of exacerbations, individual preference, adherence to therapy and general satisfaction with treatment. Increased adherence to therapy may then lead to improvements in other parameters, such as exercise tolerance and respiratory function. Additional evidence is needed to evaluate whether oscillating devices combined with other forms of airway clearance is efficacious in people with cystic fibrosis.There may also be a requirement to consider the cost implication of devices over other forms of equally advantageous airway clearance techniques. Using the GRADE method to assess the quality of the evidence, we judged this to be low or very low quality, which suggests that further research is very likely to have an impact on confidence in any estimate of effect generated by future interventions.