[Editorial] Brexit and the NHS
On March 14, the Office for National Statistics released the latest data on child mortality in England and Wales. After decades of progress, both infant and neonatal mortality rates rose for the second consecutive year. Furthermore, in an analysis of 15 similar countries done by the Nuffield Trust and the Royal College of Paediatrics and Child Health, the UK compares badly in seven of 16 indicators of child health. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research
[Editorial] Abortion: access and safety worldwide
44% of the world's annual 227 million pregnancies are unintended, of which 56% end in abortion, 32% in an unplanned birth, and 12% in miscarriage. These estimates —from a modelling study authored by the Guttmacher Institute and the University of Massachusetts and published by The Lancet Global Health—form the basis of a Guttmacher report on global abortion published on March 20. This analysis was last performed in 2009, since when the rate of unintended p regnancy and abortion in high-income countries has fallen significantly, concurrent with both an increase in the rate of modern contraception usage and a decrease in ...
Source: LANCET - March 23, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research
[Seminar] Multiple sclerosis
Multiple sclerosis continues to be a challenging and disabling condition but there is now greater understanding of the underlying genetic and environmental factors that drive the condition, including low vitamin D levels, cigarette smoking, and obesity. Early and accurate diagnosis is crucial and is supported by diagnostic criteria, incorporating imaging and spinal fluid abnormalities for those presenting with a clinically isolated syndrome. Importantly, there is an extensive therapeutic armamentarium, both oral and by infusion, for those with the relapsing remitting form of the disease. (Source: LANCET)
Source: LANCET - March 22, 2018 Category: General Medicine Authors: Alan J Thompson, Sergio E Baranzini, Jeroen Geurts, Bernhard Hemmer, Olga Ciccarelli Tags: Seminar Source Type: research
[Articles] Siponimod versus placebo in secondary progressive multiple sclerosis (EXPAND): a double-blind, randomised, phase 3 study
Siponimod reduced the risk of disability progression with a safety profile similar to that of other S1P modulators and is likely to be a useful treatment for SPMS. (Source: LANCET)
Source: LANCET - March 22, 2018 Category: General Medicine Authors: Ludwig Kappos, Amit Bar-Or, Bruce A C Cree, Robert J Fox, Gavin Giovannoni, Ralf Gold, Patrick Vermersch, Douglas L Arnold, Sophie Arnould, Tatiana Scherz, Christian Wolf, Erik Wallstr öm, Frank Dahlke, EXPAND Clinical Investigators Tags: Articles Source Type: research
[Comment] Effective treatment of progressive MS remains elusive
Relapsing-remitting multiple sclerosis (RRMS) has been treatable for over 20 years and increasingly effective therapies continue to be developed.1 Unfortunately, therapies that convincingly affect the progressive phase of MS have yet to be identified. The International Progressive MS Alliance was formed to combat this multifaceted problem.2 This alliance of several MS societies, scientists, foundations, pharmaceutical sponsors, and individuals has been working together since 2012 to accelerate the understanding of, develop therapies for, and undertake clinical trials in progressive MS. (Source: LANCET)
Source: LANCET - March 22, 2018 Category: General Medicine Authors: Luanne M Metz, Wei-Qiao Liu Tags: Comment Source Type: research
[Perspectives] Leo Martinez: striving to end childhood tuberculosis
Not only can Leo Martinez work opponents on the chess board —he began playing aged 8 and reached national level—he's also a talented scientist who was awarded the 2017 Stephen Lawn TB-HIV Research Leadership Prize for his contributions to reducing the burden of tuberculosis (TB) and HIV/AIDS in Africa. “Leo has done outstanding innovative research on r educing the childhood TB burden—a much needed and underappreciated area”, says Professor Heather Zar, Chair of the Department of Paediatrics and Director of the MRC Unit on Child& Adolescent Health at the University of Cape Town in South Africa. (Source: LANCET)
Source: LANCET - March 22, 2018 Category: General Medicine Authors: Rachael Davies Tags: Perspectives Source Type: research
[Department of Error] Department of Error
Thiele EA, Marsh ED, French JA, et al. Cannabidiol in patients with seizures associated with Lennox-Gastaut syndrome (GWPCARE4): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 2018; 391: 1085 –96—In this Article (published online first on Jan 24, 2018), J Sullivan should have been listed as a member of the GWPCARE4 Study Group. This correction has been made to the online version as of March 15, 2018, and the printed Article is correct. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Tags: Department of Error Source Type: research
[Correspondence] Questionable efficacy of the rVSV-ZEBOV Ebola vaccine – Authors' reply
We thank Wolfram Metzger and Sarai Vivas-Mart ínez for expressing their concern about potential sources of bias in the final analysis of our ring vaccination trial of an rVSV-vectored vaccine for Ebola virus disease (rVSV-ZEBOV).1 In that trial, the point estimate of vaccine efficacy was 100%, with no confirmed cases of Ebola virus disease det ected in vaccinated people 10 days or more after vaccination in the entire trial. We were careful to ascertain that the risk of exposure to Ebola virus and case ascertainment were low and statistically the same in the rings (clusters) that received immediate and delayed vaccination. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Ira M Longini, John-Arne R øttingen, Marie Paule Kieny, W John Edmunds, Ana Maria Henao-Restrepo Tags: Correspondence Source Type: research
[Correspondence] Questionable efficacy of the rVSV-ZEBOV Ebola vaccine
We read with great interest the final report by Ana Maria Henao-Restrepo and colleagues (Feb 4, 2017, p 505)1 on the ring vaccination trial of an rVSV-vectored vaccine for Ebola virus disease (rVSV-ZEBOV). Briefly, among 2119 people who received the vaccine immediately, no cases of Ebola virus disease were identified in a period of 11 days (10 –21 days after vaccination). By contrast, 16 cases were identified within the same time frame among 2041 people who did not receive the vaccine immediately. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Wolfram G Metzger, Sarai Vivas-Mart ínez Tags: Correspondence Source Type: research
[Correspondence] Good intentions do not replace ethical conduct in research
The Dutch disciplinary tribunal officially warned two Dutch physicians following their study with a Kenyan collaborator on the efficacy of the homeopathic substance Iquilai ( “a potentised mineral supplement”) in 228 patients with HIV/AIDS in Kenya.1–3 The case was brought forward by the Dutch Health Inspectorate that launched an investigation into the practice of the two involved physicians. The tribunal deemed the study incompatible with basic medical ethical pri nciples for research on human beings, as specified in the World Medical Association's Declaration of Helsinki: the study did not have a proper study proto...
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Joyce L Browne, Menno R Smit, Francis Angira, Rieke van der Graaf, Elizabeth A Bukusi Tags: Correspondence Source Type: research
[Obituary] Walter Werner Holland
Pioneer of UK health services research. He was born in Teplice-Sanov, Czech Republic, on March 5, 1929, and died of prostate cancer in London, UK, on Feb 9, 2017, aged 88 years. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Geoff Watts Tags: Obituary Source Type: research
[Perspectives] Giving meaning to art in hospital care
Care units are not generally noted for their visual appeal. But Garnet Ward, a dementia care unit in north London, UK, run by the Camden and Islington NHS Foundation Trust, is different. On the walls of one room, stylised paintings of exotic plants from around the world conjure up scenes of travel and exploration. Elsewhere, a landscape mural full of intrigue and wonder glows like stained glass. The wall of one little nook is a swirling wash of abstract blues, pinks, and greens that could be one of J M W Turner's skies at sunrise. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Philip Ball Tags: Perspectives Source Type: research
[Perspectives] Sadness and silencing
With the #MeToo and #blacklivesmatter campaigns, it feels as if the world is finally cracking open for human beings to speak their truths. An increasing number of people are working for and demanding change, but wider society does not always want to hear these voices. One part of the world where justice for past and present injury is sorely needed is Australia. What is widely known as Australia Day passed in January —the day in 1788 when the British first stuck a colonial flag in the soil. To many Indigenous Australians, it is known as Invasion Day or Survival Day. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Tania Glyde Tags: Perspectives Source Type: research
[Perspectives] The power of medical storytelling
Over two decades ago a surgeon told me the story of a young man with a spinal injury. The young man had a potentially catastrophic injury and either having surgery, or not, was risky. He had the surgery and recovered, but subsequently the surgeon was informed that the young man's sexual function was entirely lost. The patient fell into depression and despair. The surgeon was devastated and blamed himself. The senior ward nurse on the Nightingale ward observed all this. She listened to her patient's anguish and the surgeon's distress. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Margaret McCartney Tags: Perspectives Source Type: research
[Perspectives] Rethinking the medical record
Electronic health records (EHR) and patient portals, which epitomise the digitisation of medical care, are, ironically, major roadblocks for better health care. Much has been written about the shortcomings of EHRs, yet the unmet needs are broader and include not only the objective of control and ownership but also the capacity to search and share records by patients. The announcement earlier this year that Apple has launched a personal health record feature on its Health app that aggregates existing patient-generated data with a user's electronic medical record is a step in that direction. (Source: LANCET)
Source: LANCET - March 16, 2018 Category: General Medicine Authors: Amalio Telenti, Steven R Steinhubl, Eric J Topol Tags: Perspectives Source Type: research
