-
-
![Permalink for '[This Week in Medicine] February 4–10, 2012'](/themes/lilina/web//media/mark_off.gif)
17:01
»
Lancet
Leading influenza researchers have agreed to a voluntary 60-day pause on controversial research involving mutant H5N1 virus strains that are transmissible in mammals. In an announcement on Jan 20, the scientists said the hiatus will allow time for governments, organisations, and the scientific community to discuss potential safety concerns.
-
17:01
»
Lancet
This week we publish surprising and, on the face of it, disturbing findings. According to Christopher Murray and colleagues at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle, there were 1·24 million deaths (95% uncertainty interval 0·93–1·69 million) from malaria worldwide in 2010—around twice the figure of 655 000 estimated by WHO for the same year. How should the malaria community interpret this finding? Before we answer that question, we need to look beneath the surface of this striking overall mortality figure.
-
17:01
»
Lancet
An independent advisory group has urged the UK Government to integrate genomic medicine into the National Health Service (NHS). The Human Genomics Strategy Group (HGSG), established in 2010 after a House of Lords inquiry into genomic medicine, set out their recommendations in a report published on Jan 25. First, the group proposed that the government outline a policy for expansion of genomic technology in the NHS; HGSG emphasised that commissioning of cost-effectiveness studies will be a necessary step.
-
17:01
»
Lancet
In July, 2011, the UK's medical regulator, the General Medical Council (GMC), was told by the Commons Health Select Committee to send a “clear signal” to doctors that they were failing in their duties if they did not report concerns about patients' safety. That signal has now come in Raising and acting on concerns about patient safety—new GMC guidance published on Jan 26, which advises doctors about the best ways to alert employers and health-care regulators about poor quality care.
-
17:01
»
Lancet
The National Health Service (NHS) in England has been a leading international model of tax-financed, universal health care. Legal analysis shows that the Health and Social Care Bill currently making its way through the UK Parliament would abolish that model and pave the way for the introduction of a US-style health system by eroding entitlement to equality of health-care provision. The Bill severs the duty of the Secretary of State for Health to secure comprehensive health care throughout England and introduces competitive markets and structures consistent with greater inequality of provision, mixed funding, and widespread provision by private health corporations.
-
17:01
»
Lancet
In The Lancet, the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) report meta-analyses of outcomes in 100 000 women with early breast cancer in more than 100 trials of adjuvant chemotherapy, which include the first EBCTCG meta-analyses of adjuvant taxane treatment. This study comes 35 years after the first report of the benefit of adjuvant chemotherapy, and is the 16th publication in the group's 28-year history of bringing together individual patient data from all randomised trials worldwide.
-
17:01
»
Lancet
The nature, scale, and interactions of behavioural disorders after neonatal and perinatal insults, including preterm birth and infectious diseases, are not well understood. In The Lancet, Michael Mwaniki and colleagues present a broad systematic review of the type and probability of development of a range of neurodevelopmental sequelae, in which they have included 153 research studies and 22 161 liveborn children. The authors report a very high overall prevalence of at least one deficit in any domain (median risk 39·4%, IQR 20·0–54·8%).
-
17:01
»
Lancet
“The rapid advances in cardiology during the first half of the 20th century may be fairly ascribed to the introduction of new techniques.”Paul Wood, 1951
-
17:01
»
Lancet
Antisocial behaviour in adolescence can be associated with ill health in the form of self-harm, drug abuse, and mental disorders, and may presage criminal activity later in life. This is a worldwide problem with far-reaching social and economic implications, for individuals as well as for society as a whole.
-
17:01
»
Lancet
Seen on a plate somewhere in Italy. Brains. Quite a delicacy. Not a chance.
-
17:01
»
Lancet
Scientific papers on chronic fatigue syndrome (CFS) often evoke much debate and emotional reaction, as exemplified by the recent discussions in The Lancet on the PACE trial. Also, the potential role of a retrovirus in CFS kindled a fierce controversy which has recently culminated. In 2009, in Science, Lombardi and colleagues described the occurrence of the xenotropic murine leukaemia virus (MLV)-related virus (XMRV), a gammaretrovirus, in white blood cells in 67% of patients with CFS and in 3·7% of healthy controls.
-
17:01
»
Lancet
Harm-reduction programmes are remarkably successful in controlling HIV in injecting drug users worldwide, but more effort is needed to prevent even more HIV infections in this group. Recent reviews individual behavioural approaches, and medical treatment and care. Still, little is known about evidence-based educational intervention effects of harm-reduction programmes for injecting drug users.
-
17:01
»
Lancet
Ethical violations in clinical trials in India have exposed gaping holes in the country's regulatory system, which has struggled to oversee the booming industry. Amy Yee reports from New Delhi.
-
17:01
»
Lancet
New NICE guidelines on epilepsies have come under fire by several experts who say that they do not reflect clinical experience and focus too much on drug cost effectiveness. David Holmes reports.
-
17:01
»
Lancet
Portugal's debt crisis is forcing hospital closures and hasty reform of the National Health Service, causing some observers to raise concerns about patient care. Gonçalo Figueiredo Augusto reports.
-
17:01
»
Lancet
Arriving at Washington DC's Reagan National airport last year, I, like other visitors, was greeted with large signs featuring the Statue of Liberty and the words: “Welcome to America, home to 5% of the world's people and 25% of the world's prisoners.” The posters were produced by the National Association for the Advancement of Colored People (NAACP) to help publicise their “Misplaced Priority: Over Incarcerate, Under Educate” campaign.
-
17:01
»
Lancet
[Perspectives] The sound of silence
-
17:01
»
Lancet
[Perspectives] Joseph Lau: mastering the meta-analysis
-
17:01
»
Lancet
The place that for many years served London's Middlesex Hospital as its Outpatient Department is not a beautiful building. Yet it's the oldest element of that great London hospital still standing on Cleveland Street, diagonally across from the vast field the institution used to fill, now sadly strewn with dust and broken bricks. This building has recently been the subject of a very public tussle: the owner intent on its replacement by a huge apartment block; locals and others (myself among them) equally determined to preserve it.
-
17:01
»
Lancet
[Obituary] Thomas E Bryant
-
17:01
»
Lancet
Robert Greenberg and colleagues (Aug 6, p 507) are to be commended for doing a mass screening and treatment trial for Helicobacter pylori in the general population of Latin America. There is evidence to suggest that population screening and treatment can reduce the incidence of gastric cancer and lessen the economic burden from dyspepsia. However, we are not sure that Greenberg and colleagues' conclusion that 14-day triple therapy is preferable to 5-day concomitant therapy in this setting is warranted.
-
17:01
»
Lancet
Robert Greenberg and colleagues found that, in seven Latin American sites, the probability of Helicobacter pylori eradication with triple therapy lasting 14 days (TT-14) was 82·2%, which was 8·6% higher than with concomitant therapy lasting 5 days (CT-5) and 5·6% higher than with sequential therapy (ST). However, these data deserve further analysis.
-
17:01
»
Lancet
In their multisite study, Robert Greenberg and colleagues attempted to identify a reliably effective treatment for Helicobacter pylori for use in Latin America. Each study site used locally available drugs and the regimens all contained clarithromycin or clarithromycin–metronidazole, despite the unacceptably low success of triple therapies elsewhere and a high expected prevalence of metronidazole resistance. The success of treatments for infectious diseases is mainly related to the absence of antimicrobial resistance and is predictable if one knows the pattern of resistance and the effect of resistance on the regimens tested.
-
17:01
»
Lancet
Claire Slater and Alexander Ford note that all three treatments compared in our trial achieved eradication probabilities similar to those reported from previous community-based programmes of Helicobacter pylori screening and treatment and that the less-expensive concomitant regimen might be preferable to the more effective, but more costly, triple therapy regimen in a low-resource environment. We agree with both of these points and said as much in our report. The purchase price of the three regimens varied widely between the seven study sites, with a range of US$12–120 for 14-day triple therapy, $7–56 for 10-day sequential therapy, and $6–44 for 5-day concomitant therapy.
-
17:01
»
Lancet
Sania Nishtar and Ahmed Mehboob (Aug 20, p 648) make a convincing case for retaining a federal institution to take care of national responsibilities in health in Pakistan. Despite the technical appeal of alternative options, the most striking feature of this debate is the low level of response from stakeholders to the threatened abolition of the Ministry of Health, compared with the vigorous backlash against the proposed devolution of the Higher Education Commission.
-
17:01
»
Lancet
Sania Nishtar and Ahmed Mehboob's discussion of the abolition of the Health Ministry in Pakistan raises the question of whether the health care problems in Pakistan could be solved by such a move.
-
17:01
»
Lancet
Pakistan lags far behind in meeting the Millennium Development Goals. Neonatal mortality is responsible for 57% of all deaths in children younger than 5 years in the country, and Pakistan has the highest neonatal mortality rate in the region. The under-5 mortality rate has decreased by 24% since 1990. However, both rates have remained more or less static in the poorest income quintile. With the devolution of the Ministry of Health last year, Pakistan faces the challenge of developing the much needed provincial infrastructure that would integrate the comprehensive efforts of various stakeholders in promoting better health outcomes.
-
17:01
»
Lancet
The International Food & Beverage Alliance (IFBA) includes ten global food and non-alcoholic beverage manufacturers (Coca-Cola Company, Ferrero, General Mills, Grupo Bimbo, Kellogg's, Kraft Foods, Mars, Nestlé, PepsiCo, and Unilever). Although we cannot speak for the entire food and non-alcoholic beverage industry, nor any other industry, our member companies support initiatives to address the global non-communicable disease (NCD) problem and commend the UN for bringing global attention to this issue, particularly in developing countries.
-
17:01
»
Lancet
In 2006, the Integrated Academic Training programme was initiated in the UK as a result of the Walport report on the crisis of decreasing clinical academic numbers. In Oxford, we decided that the most effective way to manage the programme would be to create a dedicated Oxford University Clinical Academic Graduate School ( OUCAGS). We wish to highlight both some advantages of this approach and challenges within the overall programme.
-
17:01
»
Lancet
Dengue fever is a mosquito-borne disease caused by dengue viruses—members of the family Flaviviridae. Severe forms of dengue infection can be fatal and are a leading cause of hospital admission in many parts of the world, placing tremendous pressure on medical resources and having a heavy economic and societal effect. There has been a 30-fold increase in the number of dengue cases over the past 50 years. Recent studies estimate 50–100 million infections each year, although, owing to under-reporting, this figure could be even higher.
-
17:01
»
Lancet
In his Correspondence (Nov 5, p 1626), Syed Wamique Yusuf reports the fact that, after acceptance and revision of the proofs, one of his case reports was deemed no longer suitable for publication when he did not comply with the obligatory subscription to the journal.
-
17:01
»
Lancet
I fully agree with Syed Wamique Yusuf that the governance of journals should be taken seriously. This is one of the functions of the Committee on Publication Ethics ( COPE). Since 2003, COPE has promoted a Code of Conduct among our members (which now number almost 7000 journal editors worldwide). If anybody feels that a member has not followed this code, they can bring a complaint against them which COPE will consider. The code states that journals should “preclude business needs from compromising intellectual standards” and goes on to state that “editors should make decisions on which articles to publish based on quality and suitability for readers rather than for immediate financial or political gain”.
-
17:01
»
Lancet
Your Editorial “Torture in Syria's hospitals” (Nov 5, p 1606) relays the allegation of Amnesty International's report that patients in state-run hospitals were being targeted and tortured by authorities to “quell dissent”. The undermining of the independence and work of medical personnel has unfortunately been a theme of recent conflicts.
-
17:01
»
Lancet
A 40-year-old woman was sent to our service for a bronchoscopy owing to multiple interstitial pulmonary infiltrates. She complained of a dry cough, dyspnoea, and wheezing of 4 months' duration. She also reported bronchospasm episodes in childhood. The patient had already been seen by three different clinicians and brought with her several test results, including a thorax CT. She had been treated with antibiotics, bronchodilators, and steroids, without improvement.
-
17:01
»
Lancet
Abraham WT, Adamson PB, Bourge RC, et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet 2011; 377: 658–66—In this Article (Feb 19), the first sentence of the fifth paragraph in the Statistical analysis section on page 661 should have started: “Prespecified supplementary analyses were heart-failure-related hospitalisations during the entire randomised follow-up (Andersen-Gill model)…” Additionally, during internal auditing of this study in preparation for data presentation to regulatory authorities, a small number of unreported events were uncovered.
-
17:01
»
Lancet
Glazener C, Boachie C, Buckley B, et al. Urinary incontinence in men after formal one-to-one pelvic-floor muscle training following radical prostatectomy or transurethral resection of the prostate (MAPS): two parallel randomised controlled trials. Lancet 2011; 378: 328–37—This Article (July 23) should have contained the following conflicts of interest statement: “BB has received travel expenses from Astellas, Medtronic, and Pfizer. All other authors declare no conflicts of interest”. This correction has been made to the online version as of Feb 3, 2012.
-
17:01
»
Lancet
Our findings show that the malaria mortality burden is larger than previously estimated, especially in adults. There has been a rapid decrease in malaria mortality in Africa because of the scaling up of control activities supported by international donors. Donor support, however, needs to be increased if malaria elimination and eradication and broader health and development goals are to be met.
-
17:01
»
Lancet
10-year gains from a one-third breast cancer mortality reduction depend on absolute risks without chemotherapy (which, for oestrogen-receptor-positive disease, are the risks remaining with appropriate endocrine therapy). Low absolute risk implies low absolute benefit, but information was lacking about tumour gene expression markers or quantitative immunohistochemistry that might help to predict risk, chemosensitivity, or both.
-
17:01
»
Lancet
Intrauterine and neonatal insults have a high risk of causing substantial long-term neurological morbidity. Comparable cohort studies in resource-poor regions should be done to properly assess the burden of these conditions, and long-term outcomes, such as chronic disease, and to inform policy and programme investments.
-
17:01
»
Lancet
CE-MARC is the largest, prospective, real world evaluation of CMR and has established CMR's high diagnostic accuracy in coronary heart disease and CMR's superiority over SPECT. It should be adopted more widely than at present for the investigation of coronary heart disease.
-
17:01
»
Lancet
Lyme borreliosis (Lyme disease) is caused by spirochaetes of the Borrelia burgdorferi sensu lato species complex, which are transmitted by ticks. The most common clinical manifestation is erythema migrans, which eventually resolves, even without antibiotic treatment. However, the infecting pathogen can spread to other tissues and organs, causing more severe manifestations that can involve a patient's skin, nervous system, joints, or heart. The incidence of this disease is increasing in many countries.
-
17:01
»
Lancet
Hereditary angio-oedema is caused by a heterozygous deficiency of C1 inhibitor. This inhibitor regulates several inflammatory pathways, and patients with hereditary angio-oedema have intermittent cutaneous or mucosal swellings because of a failure to control local production of bradykinin. Swellings typically evolve in several hours and persist for a few days. In addition to orofacial angio-oedema, painless swellings affect peripheries, which causes disfigurement or interference with work and other activities of daily living.
-
17:01
»
Lancet
Non-specific low back pain has become a major public health problem worldwide. The lifetime prevalence of low back pain is reported to be as high as 84%, and the prevalence of chronic low back pain is about 23%, with 11–12% of the population being disabled by low back pain. Mechanical factors, such as lifting and carrying, probably do not have a major pathogenic role, but genetic constitution is important. History taking and clinical examination are included in most diagnostic guidelines, but the use of clinical imaging for diagnosis should be restricted.
-
17:01
»
Lancet
In October, 2010, a 29-year-old man initially presented to a primary care clinic with fevers, sore throat, and odynophagia, and was treated with oral phenoxymethylpenicillin 250 mg four times daily for tonsillitis. He re-presented 72 h later with persisting symptoms and fever of 38·4°C, and was administered 1 000 000 units of intramuscular procaine benzylpenicillin. 4–5 min later, he collapsed with no cardiac output, and cardiopulmonary resuscitation was commenced. Paramedic staff arrived within 20 min and monitoring showed ventricular fibrillation.
-
-
17:01
»
Lancet
At the end of 2011, China's urban population overtook its rural population for the first time. The National Bureau of Statistics reports that 51·3% of the country's 1·35 billion people now live in cities. For an economy at China's stage of development, this ratio is still low, possibly due to past constraints on free movement.
-
17:01
»
Lancet
In this week's Perspectives section, Hilary and Steven Rose describe the moving film Playing Against Time. This film describes the life and music of Barbara Thompson, a jazz saxophonist, and her efforts to continue with her music despite the diagnosis of Parkinson's disease in 1996, including her struggle to obtain care and treatment. The diagnosis of a neurological disorder, such as Parkinson's disease, multiple sclerosis, or motor neuron disease, is a devastating one. Not only is there no cure—treatment will at best delay progression—there is also the predicament of a continuing decline in health, functioning, and quality of life, and a long-term reliance on professionals within the health and social care system.
-
17:01
»
Lancet
In an episode of the science fiction series Star Trek: Deep Space Nine, a trio of capitalist aliens find themselves thrown back in time to 1947. They are overjoyed to discover human beings—including medical staff—smoking tobacco. “If they'll buy poison, they'll buy anything!” cackles one of the protagonists, smelling a profit.
-
17:01
»
Lancet
“Academic publishers have become the enemies of science.” So wrote Dr Mike Taylor, a scientist at the UK's University of Bristol. He, and many scientists like him, are angry that publishers are supporting the Research Works Act (RWA), a controversial Bill before the US Congress.
-
17:01
»
Lancet
Leaders from international agencies, including WHO and the World Bank, charities, and pharmaceutical companies, together with politicians from donor and recipient countries, will meet in London on Jan 30, 2012, to pledge increased support and collaboration for the control of neglected tropical diseases (NTDs). A London Declaration from this meeting will mark an expanded vision from WHO for the elimination of some NTDs and improved implementation of control efforts for other NTDs by 2020.
-
17:01
»
Lancet
Although adjuvant therapy for gastric cancer is known to improve prognosis, controversies remain about the choice of chemotherapeutic regimens, the use of radiation therapy, and the selection of patients who are likely to benefit from different therapies. Adjuvant therapy is used to eradicate potential micrometastases after curative surgery and, therefore, therapeutic strategies vary dependent on anticipated locoregional disease control after surgery, and by institution and country. It seems reasonable to apply adjuvant chemoradiotherapy, providing a combination of radiation therapy for local control and chemotherapy to achieve systemic control and radiosensitisation, to patients with less locoregional control; and systemic adjuvant chemotherapy to those with greater local control after surgery.
-
17:01
»
Lancet
Vitamin K antagonists have been successfully used for more than 50 years as oral anticoagulant drugs in patients at risk of venous or arterial thromboembolism. Because of a narrow therapeutic window and an unpredictable dose response, regular laboratory monitoring is mandatory. A strong association exists between the intensity of anticoagulation and adverse clinical events, with an increased thrombotic risk at an international normalised ratio (INR) of less than 2·0 and an enhanced risk of bleeding when the INR exceeds 4·0.
-
17:01
»
Lancet
Lysosomal storage disorders are a diverse group of more than 50 serious, progressive diseases. Until recently, treatment was symptomatic with the expected outcomes of great disability and premature death. Improvements in bone-marrow transplantation and development of recombinant enzyme replacement therapies for some of these disorders have raised the expectation that neonatal screening could enable early treatment before irreversible damage occurs. The greatly improved early outcomes of infants treated soon after birth following identification through the Taiwanese Pompe's disease screening programme add support to this contention, but long-term data are not yet available.
-
17:01
»
Lancet
Yaws—an infectious disease caused by Treponema pallidum subsp pertenue—affects children and adults in poor rural communities in tropical countries, causing disfiguring lesions of the skin and bones. The yaws elimination programme coordinated by WHO in the 1950s and 1960s screened more than 160 million people, treated more than 50 million people with intramuscular injections of benzathine benzylpenicillin, and reduced the prevalence of yaws by more than 95%; however, yaws was not eliminated. This disease is now re-emerging (largely unnoticed) in parts of Africa, southeast Asia, and the Pacific islands.
-
17:01
»
Lancet
We invite you to submit your best research in respiratory medicine for our annual respiratory theme issue, which will be published to coincide with the 2012 European Respiratory Society (ERS) conference in Vienna, Austria on Sept 1–5.
-
17:01
»
Lancet
Every 5 years in Britain, a gargantuan exercise in judging the performance of our research-based universities takes place. The Higher Education Funding Council of England (HEFCE), for example, will spend £1·6 billion in 2011–12 on research in English universities. (A friend of mine in Italy almost choked on his cappuccino when I told him this figure.) But how should HEFCE, and similar bodies in Wales, Scotland, and Northern Ireland, judge who gets what? In the past, institutions have competed in a Research Assessment Exercise.
-
17:01
»
Lancet
While the cause of nodding syndrome in Africa continues to perplex scientists, they are hoping to soon unravel one mystery: which treatments the disease might respond to. John Donnelly reports.
-
17:01
»
Lancet
The long-running dispute over patents for the BRCA1 and BRCA2 genes granted to Myriad Genetics may finally be laid to rest by the US Supreme Court. Sharmila Devi reports.
-
17:01
»
Lancet
Safety flags for Boehringer Ingelheim's antiblood clotting agent dabigatran serve as a reminder about the risks of rapidly adopting newly approved drugs. Asher Mullard reports.
-
17:01
»
Lancet
The Greek Government's austerity drive has inadvertently triggered problems with the country's drug supply, causing shortages of hundreds of medicines. Eva Karamanoli reports from Athens.
-
17:01
»
Lancet
The Wellcome Trust has a long track record of fostering science-art collaborations, but Playing Against Time must be one of the best. It focuses on the life and music of Barbara Thompson, one of Europe's finest jazz saxophonists, who in 1996 was diagnosed with Parkinson's disease. Since then she has continued composing and performing with the constant support of her partner, jazz/rock drummer Jon Hiseman. Film maker Mike Dibb describes Playing Against Time as “a film about Parkinson's disease seen through the prism of music”, and central to his film is Barbara and Jon's collaboration as wife and husband, patient and carer, saxophonist and drummer.
-
17:01
»
Lancet
To the world at large, the late Joseph Rotblat is known as the Polish-born, British-based, scientist who worked on the Manhattan Project to build the atomic bomb, and for the rest of his life campaigned for the abolition of nuclear weapons. He, and the unofficial federation of European, American, Soviet, and other scientists that he founded, known as Pugwash, were jointly awarded the Nobel Peace Prize in 1995. To physicians, Rotblat is also known as a physicist who specialised in understanding the effects on living tissue of radiation and radioactive fallout and in developing nuclear medicine, through his long-held professorship of physics at St Bartholomew's Hospital in London.
-
17:01
»
Lancet
[Perspectives] Ndola Prata: fighting for women's reproductive health
-
17:01
»
Lancet
“O that moral science were in as fair a way of improvement, that men would cease to be wolves to one another, and that human beings would at length learn what they now improperly call humanity!”Benjamin Franklin, 1780
-
17:01
»
Lancet
Multidrug-resistant (MDR) tuberculosis and extensively drug-resistant (XDR) tuberculosis have become an important health problem in many countries of the WHO European region and currently threaten global efforts to control tuberculosis. The highest rates occur predominantly in eastern Europe; however, population movement means that drug-resistant tuberculosis is a priority public health issue for all European countries.
-
17:01
»
Lancet
Efforts to find the “real Shakespeare” are fraught with pitfalls. Although ample documentation exists about his business dealings, evidence of the man's inner psychological processes—unfiltered through plays or poetry—is non-existent. Attempts to address the private life of Shakespeare often result in the critic projecting his or her own preoccupations onto the Bard and his works. A case in point is Sigmund Freud's insistence that Hamlet represented Shakespeare's reaction to the death of his father.
-
17:01
»
Lancet
[Obituary] Robert Ader
-
17:01
»
Lancet
While WHO undergoes a wide-ranging reform sparked by a US$300 million budget shortfall, the agency is facing an exodus of qualified staff that is affecting its ability to work. The Executive Board is due to meet on Jan 16 to agree long-term principles and priorities for the organisation; it must ensure, in particular, that core functions are accorded the priority they merit. Oxfam is especially concerned that inadequate funding will severely diminish the WHO Essential Medicines Department, which for more than three decades has had an indispensable role in enabling developing countries to access affordable medicines.
-
17:01
»
Lancet
Andrew Ewer and colleagues (Aug 27, p 785) claim that their testing protocol has superior sensitivity to that advocated by de-Wahl Granelli and colleagues. This claim is incorrect for several reasons.
-
17:01
»
Lancet
The PulseOx study reports on oximetry as a screening test for critical and severe congenital heart disease. It concludes that oximetry adds value to existing screening. These results will inform decision makers about national screening recommendations.
-
17:01
»
Lancet
Although I agree that pulse oximetry is useful as an important vital sign monitor soon after birth, I have doubt in its value as a screening instrument for identifying congenital heart disease.
-
17:01
»
Lancet
Differences in results between de-Wahl Granelli and colleagues' study and ours are likely to have arisen because of antenatal screening and timing of pulse oximetry. Detection of critical congenital heart disease by antenatal ultrasound is very variable: we detected 50% of cases of critical congenital heart disease antenatally compared with only 3% in de-Wahl Granelli and colleagues' study. Detection rates of between 15% and 50% have been reported among UK health regions. We noted a lower incremental value of pulse oximetry than did de-Wahl Granelli and colleagues, almost certainly because many more cases were identified by antenatal screening in our study hospitals.
-
17:01
»
Lancet
Although of interest and hypothesis-generating, the MESA report by Michael Blaha and colleagues (Aug 20, p 684) is not a randomised trial and thus it is impossible to conclude that coronary artery calcification can be used to target patients who “derive the most and the least absolute benefit from statin therapy”.
-
17:01
»
Lancet
The paper by Michael Blaha and colleagues adds to the debate on cardiovascular risk assessment by suggesting that coronary artery calcium could (1) further risk-stratify individuals eligible for the JUPITER trial, (2) be useful to target subgroups of patients for prevention, and (3) be better than high-sensitivity C-reactive protein (hsCRP) alone. Such claims, however, can hardly be solely based on effect sizes for the association of coronary artery calcium with cardiovascular outcomes.
-
17:01
»
Lancet
Paul Ridker questions the ability of coronary artery calcium to identify appropriate patients for statin therapy. However, his implication that increased coronary artery calcium is a marker for poor response to statins is not supported by the available data.
-
17:01
»
Lancet
Intensive risk-factor control did not significantly reduce cardiovascular risk in people screened positive for diabetes in the ADDITION-Europe trial (July 9, p 156). Although the study might have been too small or too brief to show such an effect, the corollary is that absolute benefit is likely to be quite small. Were the benefit significant, it would have required screening of 1829 people, and treatment of 78 screen-positive ones, for 5·3 years to prevent one cardiovascular event.
-
17:01
»
Lancet
ADDITION-Europe is not a trial of screening for diabetes. We reviewed the evidence for screening and identified the key uncertainties: the effect of early treatment in the lead time after detection by screening and the harms associated with screening. ADDITION-Europe addressed the effect of early treatment. Inclusion of a no-screening control group in one centre enabled us to add to the growing evidence of minimal harms associated with screening. A diagnosis of diabetes certainly has adverse consequences, which are brought forward by screening.
-
17:01
»
Lancet
The need to establish quantitative and qualitative indices of scientific production by a researcher or institution is hotly debated. Worldwide, the impact factor and H-index are regarded as the best available. However, the question might arise: is an article written to be cited or to be read?
-
17:01
»
Lancet
Williams HC, Dellavalle RP, Garner S. Acne vulgaris. Lancet 2012; 379: 361–72—In this Seminar (Jan 28), an affiliation was missing for Sarah Garner. The affiliation should be “The Commonwealth Fund, New York, NY, USA”. This correction has been made to the online version as of Jan 27, 2012, and to the printed Seminar.
-
17:01
»
Lancet
The Correspondence letter by Eloi Marijon and others (Aug 20, p 662) chastises the drug regulation authorities in Europe for the slowness of their assessment processes in the approval of new antithrombotic drugs for use in atrial fibrillation. They claim that the ROCKET-AF and RE-LY studies have shown these new drugs to be superior to vitamin K antagonists. Marijon and colleagues then go on to extrapolate the claimed advantages to the European population with atrial fibrillation and calculate the number of strokes that might have been saved by earlier introduction of these drugs.
-
17:01
»
Lancet
We thank Sarah Bell and colleagues for reinforcing the point that approval processes should be optimised, in terms of delay, without decreasing the rigour of these processes.
-
17:01
»
Lancet
David Holmes's Profile (Oct 22, p 1455) quoted Steve Wesselingh, the dean of Monash University, Melbourne, VIC, Australia, as stating: “academic institutions have an enormous amount of expertise and knowledge, but rarely are they engaged in the process of health and social policy”. The inaugural Inter Academy Medical Panel (IAMP) Young Physician Leaders (YPL) programme held during the third World Health Summit in Berlin, Germany, attempted to address this deficit. IAMP sent out a global call for nominations for physicians aged 40 years or younger with demonstrated leadership skills in medicine or public health, and 22 participants were chosen, representing 18 countries—low-income, middle-income, and high-income—and diverse physician specialties.
-
17:01
»
Lancet
In your Editorial (Oct 1, p 1198), you rightly stress five reasons to ensure continued financing for the Global Fund as it undergoes necessary reforms. However, there is another compelling, often unremarked, reason to further support the Global Fund: the organisation accelerates the availability of better health products at better prices to developing countries, generating a global public good that maximises the value for money achieved by all global health donors.
-
17:01
»
Lancet
Adjuvant capecitabine plus oxaliplatin treatment after curative D2 gastrectomy should be considered as a treatment option for patients with operable gastric cancer.
-
17:01
»
Lancet
Our analysis showed that self-monitoring and self-management of oral coagulation is a safe option for suitable patients of all ages. Patients should also be offered the option to self-manage their disease with suitable health-care support as back-up.
-
17:01
»
Lancet
The combined overall proportion of infants carrying a mutation for lysosomal storage disorders was higher than expected. Neonatal screening for lysosomal storage disorders is likely to raise challenges for primary health-care providers. Furthermore, the high frequency of late-onset mutations makes lysosomal storage disorders a broad health problem beyond childhood.
-
17:01
»
Lancet
A single oral dose of azithromycin is non-inferior to benzathine benzylpenicillin and avoids the need for injection equipment and medically trained personnel. A change to the simpler azithromycin treatment regimen could enable yaws elimination through mass drug administration programmes.
-
17:01
»
Lancet
Cryoglobulins are immunoglobulins that precipitate in vitro at temperatures less than 37°C and produce organ damage through two main pathways: vascular sludging (hyperviscosity syndrome, mainly in type I cryoglobulinaemia) and immune-mediated mechanisms (principally vasculitis, in mixed cryoglobulinaemia). Cryoglobulinaemia is associated with many illnesses, which can be broadly grouped into infections, autoimmune disorders, and malignancies; the most common cause is infection with hepatitis C virus.
-
17:01
»
Lancet
Acne is a chronic inflammatory disease of the pilosebaceous unit resulting from androgen-induced increased sebum production, altered keratinisation, inflammation, and bacterial colonisation of hair follicles on the face, neck, chest, and back by Propionibacterium acnes. Although early colonisation with P acnes and family history might have important roles in the disease, exactly what triggers acne and how treatment affects the course of the disease remain unclear. Other factors such as diet have been implicated, but not proven.
-
17:01
»
Lancet
Thalassaemia is one of the most common genetic diseases worldwide, with at least 60 000 severely affected individuals born every year. Individuals originating from tropical and subtropical regions are most at risk. Disorders of haemoglobin synthesis (thalassaemia) and structure (eg, sickle-cell disease) were among the first molecular diseases to be identified, and have been investigated and characterised in detail over the past 40 years. Nevertheless, treatment of thalassaemia is still largely dependent on supportive care with blood transfusion and iron chelation.
-
17:01
»
Lancet
In October, 2010, a 55-year-old woman was admitted to our department for investigation of recurrent ascites. She had a medical history of adult polycystic kidney disease with hepatic cysts. 9 months earlier, she had started peritoneal dialysis, which was changed to haemodialysis after 5 months because of poor catheter flows and underdialysis. Subsequently, she developed ascites which required frequent drainage. The fluid was borderline for transudate or exudate with no malignant cells and was initially attributed to peritoneal irritation from her dialysis catheter.
-
-
17:01
»
Lancet
Public health professionals in the USA have called for a comprehensive investigation into the health effects of hydraulic fracturing (“fracking”) used in shale gas production. Participants at a conference on Jan 9, in Arlington, VA, expressed concern that not enough is known about the health effects of the technology, particularly with regard to possible water and air pollution.
-
17:01
»
Lancet
In 2012 there will be a major strategic shift in global health, away from development and towards sustainability. Since 2000, the Millennium Development Goals (MDGs), driven by a macroeconomic diagnosis of global poverty, have focused on investment in a small number of diseases as the most effective approach to decrease poverty. Institutions such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, Roll Back Malaria, and GAVI have been created to respond to that diagnosis.
-
17:01
»
Lancet
Last year, the UK Government decided that gently “nudging” people to change their unhealthy behaviours was the key to public health—a strategy that many public health experts and a report by the House of Lords Science and Technology Sub-Committee criticised as ineffective. Now the government is backing something that could easily be called the nag approach. According to the latest report by the NHS Future Forum, a strangely composed group that acts as a cover for the government's efforts to privatise the NHS, health service staff should “use every contact with patients and the public to help them maintain and improve their physical and mental health and wellbeing”.
-
17:01
»
Lancet
The greatest burden of surgically treatable diseases falls on people in developing countries, but the poorest third of people receive only 3·5% of operations and have the lowest numbers of surgeons per head of population. These statistics, combined with the emphasis on reducing global deaths from infectious diseases, make surgery feel like a neglected specialty in the current global health arena.
-
17:01
»
Lancet
The world faces many challenges due to limited natural resources and the environmental and political consequences of using and managing scarce resources. The human consequences of natural disasters, conflict, and climate change look set to worsen. One solution is a resource that is genuinely unlimited and renewable, if well managed: knowledge. In science and technology, knowledge is an indispensable ingredient for progress. Within health care, it is key to the challenges of minimising potential harms and costs, while improving health and wellbeing.
-
17:01
»
Lancet
In The Lancet, Fang Gao Smith and the BALTI-2 study investigators report the findings of their phase-3 randomised trial of intravenous salbutamol for acute respiratory distress syndrome (ARDS). The trial, based on reliable preclinical evidence and an encouraging phase-2 trial, was stopped early because of safety concerns.
-
17:01
»
Lancet
Results of several school-based community studies have shown that self-harm (intentional self-injury or self-poisoning) is very common in adolescents, being reported by around 10% of 15 and 16 year olds, In The Lancet Paul Moran and colleagues report a study in which they found that about 8% of adolescents in a sample of nearly 2000 Australian pupils, recruited from schools in the state of Victoria, said they had self-harmed. As in other studies, self-harm was more frequent in girls than boys (risk ratio 1·6, 95% CI 1·2–2·2), and the most common method was self-cutting, which is by stark contrast with the pattern in samples presenting to hospitals, in which overdoses predominate.
-
17:01
»
Lancet
In The Lancet, Bengt Zöller and colleagues have obtained data from the MigMed2 database (constructed from several national Swedish data registers) and report analyses to show that pulmonary embolism is a serious problem in patients with autoimmune disease. The investigators’ conclusion that autoimmune disorders should be regarded as hypercoagulable is well validated in their study.
-
17:01
»
Lancet
I was diagnosed with schizophrenia in 1991, and as such I have experienced mental health care and the challenges that come with it, from abuse—both physical and emotional—in psychiatric institutions, to inadequate mental health-care services and the detrimental effects of stigma and discrimination. I have spoken to many people with mental illnesses, which has allowed me to gain insight into the flaws and shortcomings of mental health-care services, and the needs of people using these services in South Africa.
-
17:01
»
Lancet
International Youth Day, on Aug 12, 2011, marked the end of the International Year of Youth, which the UN dedicated to the promotion of dialogue and mutual understanding between governments and young people. The occasion created an opportunity to look back and remember the value of meeting the needs of young people.
Nature (5035 unread)
Science (4262 unread)
Cell
(865 unread)Genes Development (394 unread)
Developmental Dynamics (817 unread)
Mech Dev (230 unread)
EMBO J (711 unread)
PNAS (6474 unread)
JCB (674 unread)
MCB (670 unread)
Genetics (553 unread)
Science News (1507 unread)
