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[Editorial] Dangerous words
Medicine is underpinned by both art and science. Art that relies upon strong therapeutic relationships with patients and populations. And science that brings statistical rigour to clinical and public health practice. If allegations reported in The Washington Post on Dec 15 are credible, the Trump administration has seriously undermined both foundations by banning the words “vulnerable”, “entitlement”, “diversity”, “transgender”, “fetus”, “evidence-based”, and “science-based” from government documents for the US$7 billion budget discussions ...
Source: LANCET - December 22, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Our responsibility to protect the Rohingya
Much has been made of the Rohingya being stateless. But how they are being treated is utterly heartless. The almost 1 million Rohingya Muslims displaced from Myanmar's Rakhine State to Bangladesh are housed in squalid camps quickly becoming reservoirs of disease and despair. A new outbreak of diphtheria comes on the heels of cholera and measles outbreaks. Insufficient food, shelter, health care, and hope add to the almost unimaginable suffering of these most disenfranchised refugees. (Source: LANCET)
Source: LANCET - December 22, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Artificial intelligence in health care: within touching distance
Replacing the doctor with an intelligent medical robot is a recurring theme in science fiction, but the idea of individualised medical advice from digital assistants like Alexa or Siri, supported by self-surveillance smartphone data, no longer seems implausible. A scenario in which medical information, gathered at the point of care, is analysed using sophisticated machine algorithms to provide real-time actionable analytics seems to be within touching distance. The creation of data-driven predictions underpins personalised medicine and precision public health. (Source: LANCET)
Source: LANCET - December 22, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Department of Error] Department of Error
Connolly SJ, Eikelboom JW, Bosch J, et al. Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 2017; 391: 205 –18—In this Article (published online first on Nov 10, 2017) the TIMI score was calculated incorrectly, without the use of all nine factors that made up the score, which resulted in changes to the composite primary outcome described in the text and shown in figure 4. There were also a few GUSTO bleeds that qualified in one of the categories, which resulted in changes to table 3. (Source: LANCET)
Source: LANCET - December 21, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Editorial] Personalised medicine in the UK
The future of personalised and genomic medicine in the UK was debated on Dec 14 in a seminar organised by the Westminster Health Forum. (Source: LANCET)
Source: LANCET - December 21, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Articles] Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial
Among patients with recent cerebral ischaemia, intensive antiplatelet therapy did not reduce the incidence and severity of recurrent stroke or TIA, but did significantly increase the risk of major bleeding. Triple antiplatelet therapy should not be used in routine clinical practice. (Source: LANCET)
Source: LANCET - December 20, 2017 Category: General Medicine Authors: Philip M Bath, Lisa J Woodhouse, Jason P Appleton, Maia Beridze, Hanne Christensen, Robert A Dineen, Lelia Duley, Timothy J England, Katie Flaherty, Diane Havard, Stan Heptinstall, Marilyn James, Kailash Krishnan, Hugh S Markus, Alan A Montgomery, Stuart Tags: Articles Source Type: research

[Comment] Learning from TARDIS: time for more focused trials in stroke prevention
Antithrombotic therapy immediately following stroke is important to minimise the risk of recurrence, but the optimum choice and number of drugs to use are unclear, and efficacy in preventing thrombosis needs to be weighed against bleeding risk. In The Lancet, the TARDIS investigators report findings from a randomised trial1 that tested intensive antiplatelet therapy with three agents (aspirin, clopidogrel, and dipyridamole) against therapy based on current UK guidelines2 (either clopidogrel, or aspirin plus dipyridamole) for 30 days in patients with transient ischaemic attack (TIA) or ischaemic stroke. (Source: LANCET)
Source: LANCET - December 20, 2017 Category: General Medicine Authors: Pierre Amarenco Tags: Comment Source Type: research

[Correspondence] Timely sensory stimulation and early childhood development
The Review by Wilson and colleagues (Dec 2, 2017)1 provides useful insights on the plight of people with or at risk of hearing loss globally, and outlines a comprehensive blueprint for intervention, especially in low-income and middle-income countries. The timing is auspicious because, in May, the World Health Assembly renewed the 1995 resolution on the prevention of hearing impairment, urging member states and the director-general of WHO to take specific steps to curtail the disease burden.2 However, we wish to draw attention to the implications of this Review for the prevailing disability-inclusive Sustainable Developmen...
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Bolajoko O Olusanya, Tony Sirimanna, Bradley McPherson Tags: Correspondence Source Type: research

[Correspondence] Targeted-release budesonide therapy for IgA nephropathy – Authors' reply
Kenji Tsuda and colleagues correctly report that the NEFIGAN study1 investigated the use of corticosteroid therapy outside of the current guidelines,2 which endorse the use of systemic corticosteroids in patients with urinary protein excretion of more than 1 g/day. However, the NEFIGAN study was not a trial of systemic corticosteroids but rather a trial of steroid therapy that targeted the intestinal mucosal immune system, with minimal systemic effects, in patients with optimised RAS blockade. We were conducting a proof-of-concept study; thus the choice of reduction in proteinuria rather than the proportion of patients ent...
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Bengt Fellstr öm, Jonathan Barratt, Jürgen Flöge, Alan Jardine Tags: Correspondence Source Type: research

[Correspondence] Targeted-release budesonide therapy for IgA nephropathy
Bengt Fellstr öm and colleagues (May 27, p 2117)1 report that the addition of a targeted-release formulation of budesonide (TRF-budesonide) to an optimised renin-angiotensin system (RAS) blockade reduced proteinuria in patients with IgA nephropathy. However, whether patients with proteinuria of 0·5–1·0 g/day , as were enrolled in this study, need further treatments in addition to RAS blockade therapy remains debatable.2,3 The 2012 Kidney Disease Improving Global Outcome guidelines4 suggest giving corticosteroids to patients with persistent proteinuria of more than 1 g/day who do not respond to opti...
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Kenji Tsuda, Tetsuya Tanimoto, Jinichi Mori, Kazuhiro Kosugi, Tsunehiko Komatsu Tags: Correspondence Source Type: research

[Correspondence] Time for WHO to renew its commitment to health research
WHO's global Advisory Committee on Health Research (ACHR) —established in 1959 in Geneva, Switzerland, as the Advisory Committee on Medical Research (ACMR) and renamed ACHR in 1986—is one of the oldest institutions in the organisation. After establishment of the global committee, ACHRs were established in all of WHO's regional offices. As it approaches its 60th anniversary, the global ACHR can be proud of its many achievements. However, the committee has not convened in the past 7 years, with the last full meeting held in 2010. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Tikki Pang, Mahmoud Fathalla, Judith Whitworth, Luis-Gabriel Cuervo Tags: Correspondence Source Type: research

[Correspondence] A call to reinstate Pakistan's death penalty moratorium
The death penalty remains a subject of contention in the public forum, and most countries have chosen to abolish it. However, Pakistan is one of 58 countries to continue to practise the death penalty, with an estimated 6000 –8000 prisoners on death row in 2015.1 In 2008, a moratorium was declared against the death penalty by the new Pakistani Government. However, after the devastating attack on an Army Public School on Dec 17, 2014, the moratorium was lifted for terrorism cases, and for all cases the following year, with the number of executions increasing steadily since. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Syed Ibaad Ali, Ariba Khan, Huda Fatima, Syed Ather Hussain Tags: Correspondence Source Type: research

[Obituary] Joan Bicknell
Pioneering psychiatrist in learning disability. She was born in Isleworth, UK, on April 10, 1939, and died of cancer in Stalbridge, UK, on June 12, 2017, aged 78 years. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Geoff Watts Tags: Obituary Source Type: research

[Perspectives] The disaster artists
In Case of Emergency is a timely exhibition on natural disasters and their human antecedents and consequences. Antibiotic resistance, global warming, and post-extinction revival are all covered in this exhibition at the Science Gallery, Trinity College Dublin, Ireland. The gallery is a bright and dynamic space now firmly established as a leading element in the cultural and intellectual life of the city. Compact in size and smart in design, the gallery has woven a unique and original spell with the Irish public and international visitors since opening in 2008. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Desmond O'Neill Tags: Perspectives Source Type: research

[Perspectives] They died as they walked
Edwin Landseer's Man Proposes, God Disposes, first shown in 1864, now hangs in the Picture Gallery at Royal Holloway, University of London. Against a sublime and stormy Arctic landscape two monstrous polar bears root through the wreckage of an expedition, one of them devouring a human ribcage. Student folklore claims the picture has driven viewers mad, and when exams are held in the Picture Gallery it is covered with a Union Jack. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Richard Barnett Tags: Perspectives Source Type: research

[Perspectives] Elizabeth Garrett Anderson: early pioneer of women in medicine
Today, about 55% of medical students in the UK are women. While change is needed to address issues such as the representation of women in leadership positions in medicine, career progression, and gender differences in pay and grant funding, women are now entering medicine in increasing numbers. Given the important role of women in the medical profession, it might be easy to forget the struggles experienced by early women doctors in trying to attain medical qualifications. Elizabeth Garrett Anderson, who died on Dec 17, 1917, was one of these early pioneers. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Laura Kelly Tags: Perspectives Source Type: research

[World Report] The cost of mass-casualty attacks
Mass-casualty attacks incur heavy human costs and impact on weakened health systems. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: John Zarocostas Tags: World Report Source Type: research

[Comment] Public availability of trial protocols
The Lancet has improved efforts to reduce research waste and increase the importance of scientific contributions through the Reward Campaign. One of the targets of this campaign is to make the methods of studies more accessible, which could be accomplished by increasing the public availability of research protocols. A protocol is a document that describes the aims, interventions, outcomes, statistical procedures, ethical considerations, and planned use and dissemination of data before the start of a clinical trial. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Morgan Lucey, Jocalyn Clark, Paul Glasziou Tags: Comment Source Type: research

[Comment] Offline: The unspoken dangers facing UK medical science
Hope. Clarity. Certainty. Reassurance. Don't be fooled. Brexit is not over yet. The hard part is yet to come. And many medical scientists remain anxious. A professor at one of the UK's top universities frowned. He was born in Germany and moved to Britain (soon after receiving his PhD) where his field of research was thriving. He had recently offered a senior leadership role in his institution to another German scientist. She had declined his offer based on the worry that her team would not wish to move to a country that was exiting the European Union (EU). (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Editorial] The balancing act of orphan drug pricing
In the past year, the high price tag of orphan drugs has come under severe scrutiny. Global industry players have used incentive schemes such as the USA's Orphan Drug Act (which offers a 50% tax rebate to help cover research and development costs and 7 years of marketing exclusivity from approval), and the EU Regulation on orphan medicinal products (which offers exclusive access to market for 10 years when approved) to drive up profits in the sector. Health-care systems, under increasing pressure from under-resourcing, ageing populations, and high-price biomedical advances, can be tempted to reduce costly orphan drug progr...
Source: LANCET - December 15, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Dementia burden coming into focus
WHO announced the launch of the Global Dementia Observatory (GDO) on Dec 7. This new internet-focused platform aims to provide a constant monitoring service for data relating to dementia planning around the world. The GDO currently features data from 21 countries, with the aim to expand monitoring to 50 countries by the end of 2018. Important data, such as government policy, treatment and care infrastructure, and disease burden, will be accessible online and kept constantly updated. The first sets of data are positive: 81% of the participating countries have a dementia awareness campaign, and 71% provide support and traini...
Source: LANCET - December 15, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Achieving sustainable solidarity development goals
The meaning of social security varies nationally. In the USA, it might bring to mind the eponymous agency that administers social insurance providing benefits for retired individuals and those living with disability. In 1934, in the wake of the Great Depression when as many as 25% of Americans were unemployed, President Franklin D Roosevelt announced his plans to create a social security programme for the nation to “encourage a greater security for each individual who composes it”. He proclaimed: “This seeking for a greater measure of welfare and happiness does not indicate a change in values. (Source: LANCET)
Source: LANCET - December 15, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Articles] Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial
Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. (Source: LANCET)
Source: LANCET - December 14, 2017 Category: General Medicine Authors: Guy E Thwaites, Matthew Scarborough, Alexander Szubert, Emmanuel Nsutebu, Robert Tilley, Julia Greig, Sarah A Wyllie, Peter Wilson, Cressida Auckland, Janet Cairns, Denise Ward, Pankaj Lal, Achyut Guleri, Neil Jenkins, Julian Sutton, Martin Wiselka, Gonza Tags: Articles Source Type: research

[Comment] Rifampicin for Staphylococcus aureus bacteraemia: give it ARREST
Although Staphylococcus aureus bacteraemia is both common and potentially lethal, clinical decisions involving its treatment remain largely unencumbered by high-quality data.1 With the ARREST multicentre, randomised, double-blind, placebo-controlled trial, Guy Thwaites and colleagues2 have contributed high-quality evidence and addressed an unresolved question involving the role of adjunctive rifampicin in treatment regimens for patients with S aureus bacteraemia. (Source: LANCET)
Source: LANCET - December 14, 2017 Category: General Medicine Authors: Thomas L Holland, Vance G Fowler Tags: Comment Source Type: research

[Articles] Estimates of global seasonal influenza-associated respiratory mortality: a modelling study
These global influenza-associated respiratory mortality estimates are higher than previously reported, suggesting that previous estimates might have underestimated disease burden. The contribution of non-respiratory causes of death to global influenza-associated mortality should be investigated. (Source: LANCET)
Source: LANCET - December 13, 2017 Category: General Medicine Authors: A Danielle Iuliano, Katherine M Roguski, Howard H Chang, David J Muscatello, Rakhee Palekar, Stefano Tempia, Cheryl Cohen, Jon Michael Gran, Dena Schanzer, Benjamin J Cowling, Peng Wu, Jan Kyncl, Li Wei Ang, Minah Park, Monika Redlberger-Fritz, Hongjie Yu Tags: Articles Source Type: research

[Comment] Challenges in reducing influenza-associated mortality
This study provides a much needed update to the often cited but unsubstantiated WHO-attributed estimate of 250  000–500 000 annual influenza deaths. The authors used country-specific, influenza-associated excess respiratory mortality estimates from 1999 to 2015, to calculate a new estimate of 291 243–645 832 seasonal influenza-associated respiratory deaths per year (4·0–8·8 per 100 000 indi viduals). (Source: LANCET)
Source: LANCET - December 13, 2017 Category: General Medicine Authors: Sheena Sullivan Tags: Comment Source Type: research

[Perspectives] Tony Capon: the world's first professor of planetary health
Speaking to The Lancet from the University of Sydney, where he is the world's first Professor of Planetary Health, Tony Capon says: “Planetary health is about safeguarding the health and wellbeing of current and future generations through good stewardship of Earth's natural systems and by rethinking the way we feed, move, house, power, and care for the world.” Capon hopes his new team in Sydney can make a real difference. (Source: LANCET)
Source: LANCET - December 12, 2017 Category: General Medicine Authors: Tony Kirby Tags: Perspectives Source Type: research

[Articles] Acalabrutinib in relapsed or refractory mantle cell lymphoma (ACE-LY-004): a single-arm, multicentre, phase 2 trial
Acalabrutinib treatment provided a high rate of durable responses and a favourable safety profile in patients with relapsed or refractory mantle cell lymphoma. These findings suggest an important role for acalabrutinib in the treatment of this disease population. (Source: LANCET)
Source: LANCET - December 11, 2017 Category: General Medicine Authors: Michael Wang, Simon Rule, Pier Luigi Zinzani, Andre Goy, Olivier Casasnovas, Stephen D Smith, Gandhi Damaj, Jeanette Doorduijn, Thierry Lamy, Franck Morschhauser, Carlos Panizo, Bijal Shah, Andrew Davies, Richard Eek, Jehan Dupuis, Eric Jacobsen, Arnon P Tags: Articles Source Type: research

[Comment] Acalabrutinib in mantle cell lymphoma
Mantle cell lymphoma is a rare, distinct subtype of non-Hodgkin lymphoma, with a disparate clinical course that varies from indolent at times to frequently aggressive. No standard of care exists; most patients relapse and ultimately die as a result of their disease. Notable strides in the past few years, however, have ushered an era of unprecedented progress, with swift approval of new therapies from a variety of drug classes. One such drug that has catapulted to prominence is ibrutinib, the first-in-class, irreversible inhibitor of Bruton tyrosine kinase (BTK), a crucial component of the B-cell-receptor signalling pathway...
Source: LANCET - December 11, 2017 Category: General Medicine Authors: Prashant Kapoor, Stephen M Ansell Tags: Comment Source Type: research

[Review] China's Silk Road and global health
In 2013, China proposed its Belt and Road Initiative to promote trade, infrastructure, and commercial associations with 65 countries in Asia, Africa, and Europe. This initiative contains important health components. Simultaneously, China launched an unprecedented overseas intervention against Ebola virus in west Africa, dispatching 1200 workers, including Chinese military personnel. The overseas development assistance provided by China has been increasing by 25% annually, reaching US$7 billion in 2013. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Kun Tang, Zhihui Li, Wenkai Li, Lincoln Chen Tags: Review Source Type: research

[Review] The primary health-care system in China
China has made remarkable progress in strengthening its primary health-care system. Nevertheless, the system still faces challenges in structural characteristics, incentives and policies, and quality of care, all of which diminish its preparedness to care for a fifth of the world's population, which is ageing and which has a growing prevalence of chronic non-communicable disease. These challenges include inadequate education and qualifications of its workforce, ageing and turnover of village doctors, fragmented health information technology systems, a paucity of digital data on everyday clinical practice, financial subsidi...
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Xi Li, Jiapeng Lu, Shuang Hu, KK Cheng, Jan De Maeseneer, Qingyue Meng, Elias Mossialos, Dong Roman Xu, Winnie Yip, Hongzhao Zhang, Harlan M Krumholz, Lixin Jiang, Shengshou Hu Tags: Review Source Type: research

[Department of Error] Department of Error
Pearson M, Metcalfe C, Jayamanne S, et al. Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial. Lancet 2017; 390: 1863 –72—In this Article (published online first on Aug 11, 2017), Martin Wilks (Swiss Centre for Applied Human Toxicology, University of Basel, Switzerland) should have been cited in the Data Monitoring Committee. This correction has been made to the online version as of Dec 7, 2017. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Correspondence] Antiplatelet cessation to manage bleeding events in elderly people – Authors' reply
We agree with Cody Magnusson that little evidence exists to suggest that long-term use of aspirin in primary prevention of vascular events is effective in people older than 70 years. Indeed, we previously suggested that aspirin might be used for primary prevention of vascular events and cancer in people who are middle-aged,1,2 but should then be gradually withdrawn because of the high risk of bleeding at older ages. We await the results of the ASPREE trial,3 which should provide definitive evidence of the short-term benefits and harms of aspirin use in people older than 70 years. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Linxin Li, Peter M Rothwell Tags: Correspondence Source Type: research

[Correspondence] Antiplatelet cessation to manage bleeding events in elderly people
In their Article in The Lancet, Linxin Li and colleagues (June 13, p 490)1 postulated that the increased risk of bleeding events with antiplatelet therapy in patients older than 75 years is sufficient to routinely prescribe proton-pump inhibitors (PPIs) in this group. This assumption is based on extrapolation from data showing the efficacy of PPIs in prevention of upper gastrointestinal bleeding in a younger population (mean age 68 ·4 years).2 What the authors do not consider is the opposite solution: cessation of antiplatelet therapy. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Cody Magnusson Tags: Correspondence Source Type: research

[Correspondence] Overestimation of cardiovascular outcome incidence – Authors' reply
We thank Yuanzi Ye and Ricardo Fonseca for their interest in our Article.1 We agree that the cumulative incidence of each outcome is slightly overestimated when the simple technique for calculating Kaplan-Meier curves is used instead of a more sophisticated method accounting for competing risks. However, the effect of overestimation is modest and, because it affects all strata simultaneously, the hazard ratios (HRs) between strata are nearly unchanged. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Helmut Schumacher, Felix Mahfoud, Michael B öhm Tags: Correspondence Source Type: research

[Correspondence] Overestimation of cardiovascular outcome incidence
We read with interest the study by Michael B öhm and colleagues (June 3, p 2226),1 in which they investigated the associations between blood pressure and cardiovascular outcomes and suggested that the lowest blood pressure possible is not the best goal for high-risk patients. Böhm and colleagues1 used Kaplan-Meier curves and Cox regression f or the outcomes, stratified by different values of systolic blood pressure and diastolic blood pressure. However, because this study1 regards prediction of cardiovascular outcomes for patients, we caution about overestimation of the cumulative incidence of each outcome in the...
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Yuanzi Ye, Ricardo Fonseca Tags: Correspondence Source Type: research

[Correspondence] Anonymity in HIV testing: implications for public health
To end the HIV epidemic, UNAIDS has set an ambitious target: by 2020, 90% of the people living with HIV will be diagnosed, 90% of those diagnosed will receive antiretroviral therapy (ART), and 90% of those receiving ART will be virally suppressed.1 The test and treat strategy will ensure care and treatment for almost 36 ·7 million people living with HIV, potentially saving millions of lives; however, the implementation of the strategy comes with multiple programmatic challenges. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Edson Luis Bernardo, Laura Fuente-Soro, Elisa Lopez-Varela, Denise Naniche Tags: Correspondence Source Type: research

[Correspondence] Political determinants of Sustainable Development Goals
We read with interest the article by the GBD 2016 SDG Collaborators1 (Sept 16, p 1423), which presents a comprehensive analysis of the potential gaps and gains in the health-related Sustainable Development Goals by 2030. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Camila Gianella, Marta Rodriguez de Assis Machado, Siri Gloppen Tags: Correspondence Source Type: research

[Correspondence] Health-care delivery for long-term survivors of childhood cancer
In their Article in The Lancet (Dec 9, p 2569),1 Bhakta and colleagues provide compelling data and novel statistical analysis to quantify the overwhelming lifetime cumulative burden of chronic health conditions caused by curative paediatric cancer therapies. As a 27-year survivor of Hodgkin's lymphoma, I applaud the authors' suggestion that it might be time to rethink the methods by which we provide care for long-term childhood cancer survivors. As a patient, I have had numerous encounters over the past three decades that have left me frustrated by the scarcity of easy access to coordinated comprehensive care for survivors. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Gregory J Aune Tags: Correspondence Source Type: research

[Perspectives] Icarus
When did the Middle Ages end? A traditional date is 1453, the fall of Byzantium. Another candidate is 1610, when Galileo reported that Jupiter had moons. But if a defining feature of the Middle Ages was transcendence —the belief that human beings are ultimately spiritual and that life on earth is a shadow of the heavenly life—then for some people, the Middle Ages ended with the collapse of great theocratic empires (Russia, China, the Ottoman Empire) and the advancement of secular politics. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Athar Yawar Tags: Perspectives Source Type: research

[Perspectives] Hospital histories
We never quite know what goes on behind closed doors. Hospitals are incubators for the most vital and vivid of human interactions. Much of these are secret and enclosed, sealed against the outside world. We are stripped down, as patients, wheeled on a trolley for surgery, our flawed and faulty bodies all we are left with. We become reliant on others to fulfil our basic bodily functions. Often dependant and frightened, patients are ministered to by staff, who also come with their own needs, anxieties, and dysfunctions. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Margaret McCartney Tags: Perspectives Source Type: research

[Perspectives] Qimin Zhan: driving medical research for better health in China
“Clinical medicine + X”—the idea of integrating medicine with other disciplines—is at the heart of Qimin Zhan's vision for better health in China. As President of Peking University Health Science Centre (PUHSC) and Vice Chancellor of Peking University, he oversees five medical colleges, ten affiliated hospitals, and 14 teaching hospitals, and is committed to making this health system one of the world's leading medical centres. “We want to integrate medicine with disciplines like engineering, bioinformatics, nanotechnology, and big data to speed up the development of medical science” , sa...
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Rachael Davies Tags: Perspectives Source Type: research

[World Report] Millions in need of humanitarian assistance in Yemen
The situation in Yemen —one of the world's worse humanitarian crises—risks deteriorating further. The death of Ali Abdullah Saleh might accelerate conflict. Sharmila Devi reports. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Sharmila Devi Tags: World Report Source Type: research

[World Report] Phage therapy: revival of the bygone antimicrobial
The idea of using bacteriophages as vectors for antimicrobial therapy has existed for decades, but development towards clinical application still lags behind. Geoff Watts reports. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Geoff Watts Tags: World Report Source Type: research

[Comment] Offline: The tasks facing Dr Tedros
Uncertainty is good. The fluidity that doubt brings can stimulate fresh thinking. Old assumptions discarded, orthodoxies dissolved, shibboleths erased. Unpredictability can be provocatively energising. WHO is currently undergoing such a period of creative instability. The draft 13th General Programme of Work (GPW) for 2019 –23, presented to a Special Session of the Executive Board last month, was welcomed by member states as an ambitious new vision for the agency. But it also opened up a disruptive conversation about WHO's role and purpose. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Editorial] When a hospital becomes a prison
Imprisonment for debt has a long history. In England during the 18th and 19th centuries, for instance, thousands of people were detained in debtors' prisons for failure to pay debts. Although such institutions no longer exist, in many parts of the world detention for unpaid debts is still a well known occurrence. Less recognised, however, is hospital detention —the practice of holding people in hospital against their will, not because their condition requires it, but because they have outstanding health-care bills. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Family planning: accelerating the way ahead
The latest figures and progress of the Family Planning 2020 (FP2020) global partnership were released in its annual report on Dec 5. FP2020 The Way Ahead, together with a related research paper by Niamh Cahill and colleagues published online in The Lancet, paint a mixed picture. By July, 2017, more than 309 million women and girls of reproductive age in the 69 FP2020 focus (the world's poorest) countries are using modern methods of contraception. That figure is 38 ·8 million more than at the start of the FP2020 initiative in 2012. (Source: LANCET)
Source: LANCET - December 8, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Perspectives] Osman Sankoh: better data for better health
Data are to health planning what pills are to pharmacy: a lack of the one impedes the effective practice of the other. And such a lack has long been one of the problems of health planners working in many African countries, says Professor Osman Sankoh of the INDEPTH Network, a non-governmental organisation based in Ghana. “Many people would come from overseas and collect cross-sectional data, and then they would go back and write it up”, he says. “But they would not be able to talk about how things change over time or what might be the cause of a health problem.” A snapshot of how things are at one m...
Source: LANCET - December 8, 2017 Category: General Medicine Authors: Geoff Watts Tags: Perspectives Source Type: research

[Department of Error] Department of Error
Williams R, Alexander G, Armstrong I, et al. Disease burden and costs from excess alcohol consumption, obesity, and viral hepatitis: fourth report of the Lancet Standing Commission on Liver Disease in the UK. Lancet 2018; 391: 1097 –107—In this Health Policy (published online first on Nov 29, 2017), the first sentence in the legend of figure 4 should read “Data are from references 31 and 32 and were categorised into 5 year bands.” This correction has been made to the online version as of Dec 7, 2017, and the printed He alth Policy is correct. (Source: LANCET)
Source: LANCET - December 7, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Articles] Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data
Traditionally, efforts to improve mental health outcomes have largely focused on the development of new and more effective treatments. Our analyses show that the way psychological therapy services are implemented could be similarly important. Mental health services elsewhere in the UK and in other countries might benefit from adopting IAPT's approach to recording and publicly reporting clinical outcomes. (Source: LANCET)
Source: LANCET - December 7, 2017 Category: General Medicine Authors: David M Clark, Lauren Canvin, John Green, Richard Layard, Stephen Pilling, Magdalena Janecka Tags: Articles Source Type: research