Log in to search using one of your social media accounts:

 

[Editorial] Snake-bite envenoming: a priority neglected tropical disease
Last month, WHO reinstated snake-bite envenoming to its list of category A neglected tropical diseases (NTDs), which is an important milestone in disease control. NTD inclusion adds impetus to antivenom development and boosts the likelihood of investor funding for snake-bite prevention and treatment access initiatives. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Sexual health and reproductive rights at a crossroad
The untimely death of Babatunde Osotimehin, Executive Director of the UN Population Fund (UNFPA), comes at a turbulent time for sexual and reproductive health and rights. The UNFPA's mission is to deliver “a world where every pregnancy is wanted, every childbirth is safe, and every young person's potential is fulfilled”. Last week, the USA rejected part of a UN resolution designed to help female victims of violence—particularly those in conflict zones, who are at increased risk of sexual assaul t and rape—because it included a statement that women should be given the option of a safe abortion. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Viewpoint] Saving lives efficiently across sectors: the need for a Congressional cost-effectiveness committee
In the preamble of the United States Constitution, a primary goal of government was established: “to promote the general Welfare”. Upon the opening of budget deliberations for the 115th US Congressional session, we suggest an evidence-based approach for the new Congress in aligning the budget process more closely with this national goal. In particular, we underscore the efficiency of the US public health sector in promoting societal welfare, and reveal a relative underinvestment in public health compared with other sectors. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Meagan C Fitzpatrick, Burton H Singer, Peter J Hotez, Alison P Galvani Tags: Viewpoint Source Type: research

[Clinical Picture] Generalised cowpox virus infection
A 24-year-old man presented to our dermatology clinic with three haemorrhagic partially ulcerated nodules located in the right groin, surrounded by inflammation and oedema, which had evolved over the course of 1 week (figure), and fatigue. He had identical isolated skin lesions on the right shoulder, left knee, and left ankle. On examination he was febrile (temperature 38 ·5°C) and had tender generalised lymphadenopathy. He had no signs or personal history of atopy (atopic dermatitis, hay fever, asthma), although family history was positive for a sister with dermatitis. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Lisa-Lena Gr önemeyer, Anne Baltzer, Sigrid Broekaert, Livia Schrick, Lars Möller, Andreas Nitsche, Rotraut Mössner, Michael P Schön, Timo Buhl Tags: Clinical Picture Source Type: research

[World Report] US Senate unveils ACA repeal bill
June 22, the Better Care Reconciliation Act, a bill designed to replace the Affordable Care Act, was revealed, among bipartisan concern and criticism. Aaron van Dorn and Rebecca Cooney report. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Aaron van Dorn, Rebecca Cooney Tags: World Report Source Type: research

[Articles] Foley catheterisation versus oral misoprostol for induction of labour in hypertensive women in India (INFORM): a multicentre, open-label, randomised controlled trial
Oral misoprostol was more effective than transcervical Foley catheterisation for induction of labour in women with pre-eclampsia or hypertension. Future studies are required to assess whether oxytocin augmentation following misoprostol can be replaced by regular doses of oral misoprostol tablets. (Source: LANCET)
Source: LANCET - June 28, 2017 Category: General Medicine Authors: Shuchita Mundle, Hillary Bracken, Vaishali Khedikar, Jayashree Mulik, Brian Faragher, Thomas Easterling, Simon Leigh, Paul Granby, Alan Haycox, Mark A Turner, Zarko Alfirevic, Beverly Winikoff, Andrew D Weeks Tags: Articles Source Type: research

[Comment] Oral misoprostol for induction of labour in hypertensive pregnancies
Oral misoprostol is simple to use and is thus an attractive and easy option in low-resource settings where the doctor –patient ratio is suboptimum and close monitoring of intravenous drug dosage is often not possible.1 Results of the PROBAAT-II study2 in women with a wide range of indications for induction of labour at term showed oral misoprostol treatment to be non-inferior to Foley catheterisation. Now, the fi ndings of Shuchita Mundle and colleagues' INFORM study3 in The Lancet advance the role of oral misoprostol for induction of labour. (Source: LANCET)
Source: LANCET - June 28, 2017 Category: General Medicine Authors: Vanita Suri, Pooja Sikka Tags: Comment Source Type: research

[Articles] The safety, immunogenicity, and acceptability of inactivated influenza vaccine delivered by microneedle patch (TIV-MNP 2015): a randomised, partly blinded, placebo-controlled, phase 1 trial
Use of dissolvable microneedle patches for influenza vaccination was well tolerated and generated robust antibody responses. (Source: LANCET)
Source: LANCET - June 27, 2017 Category: General Medicine Authors: Nadine G Rouphael, Michele Paine, Regina Mosley, Sebastien Henry, Devin V McAllister, Haripriya Kalluri, Winston Pewin, Paula M Frew, Tianwei Yu, Natalie J Thornburg, Sarah Kabbani, Lilin Lai, Elena V Vassilieva, Ioanna Skountzou, Richard W Compans, Mark Tags: Articles Source Type: research

[Comment] Influenza vaccine: going through a sticky patch
Despite strong recommendations, influenza vaccine uptake data for the UK for 2015 –16 show that actual uptake in the population targeted lags behind the goal of the national vaccine programme,1 which aims to vaccinate 75% of people aged 65 years or older, 55% of risk groups younger than 65 years, and 75% of health-care workers (national uptake is 50·6% for front-line staff).2 A systematic review3 of available scientific literature on influenza vaccine hesitancy—mostly done in the North American and European regions—shows a lack of confidence in vaccination. (Source: LANCET)
Source: LANCET - June 27, 2017 Category: General Medicine Authors: Katja H öschler, Maria C Zambon Tags: Comment Source Type: research

[Articles] Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial
Although task shifting is an attractive solution for health-care sustainability, our results do not support investment in new stroke rehabilitation services that shift tasks to family caregivers, unless new evidence emerges. A future avenue of research should be to investigate the effects of task shifting to health-care assistants or team-based community care. (Source: LANCET)
Source: LANCET - June 27, 2017 Category: General Medicine Authors: The ATTEND Collaborative Group Tags: Articles Source Type: research

[Comment] Family-delivered rehabilitation services at home: is the glass empty?
In low-income and middle-income countries, meeting inpatient and outpatient rehabilitation needs of stroke survivors with insufficient staff and facility resources is especially challenging. Family-delivered rehabilitation services might be an innovative way to augment intensity of practice.1 The ATTEND Collaborative Group's ATTEND trial,2 published in The Lancet, is to our knowledge the first appropriately powered trial to investigate the effect of family-delivered, home-based rehabilitation intervention for patients with stroke in a low-middle-income country. (Source: LANCET)
Source: LANCET - June 27, 2017 Category: General Medicine Authors: Gert Kwakkel, Erwin E H van Wegen Tags: Comment Source Type: research

[Department of Error] Department of Error
van der Hulle T, Cheung WY, Kooij S, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet 2017; 390: 289 –297—In the author list of this Articl , the study group should have been included and read “Tom van der Hulle, Whitney Y Cheung…Menno V Huisman, for the YEARS study group*”. On page 1 of the margin information, the following text should have been included: “*YEARS study group is listed at the end of this paper”. (Source: LANCET)
Source: LANCET - June 27, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Comment] How to harness the private sector for universal health coverage
Universal health coverage (UHC) is a global goal that enjoys near universal support and is underpinned by a strong body of evidence.1,2 That battle has been won. What UHC means in reality is, however, less clear. Many countries have health systems that are fragmented and short of funds. If we are to realise the goal of delivering safe, high-quality care to as many people as possible, every available resource must be used. That includes private providers. (Source: LANCET)
Source: LANCET - June 23, 2017 Category: General Medicine Authors: Hester Wadge, Rhia Roy, Arthika Sripathy, Gianluca Fontana, Joachim Marti, Ara Darzi Tags: Comment Source Type: research

[Correspondence] Christiana Figueres joins The Lancet Countdown —delivering on the promise of Paris
The 2015 Paris Agreement on climate change marked historic progress for the planet and human health. Signatories agreed to limit global temperature rise to “well below 2°C above pre-industrial levels”; redouble a global commitment of financial flows to developing countries of US$100 billion annually by 2020; and created a mechanism to increase ambitious action.1 Although inaction threatens to undermine 50 years of progress in public health, meetin g the Paris Agreement's ambitions presents the greatest global health opportunity of this century. (Source: LANCET)
Source: LANCET - June 22, 2017 Category: General Medicine Authors: Anthony Costello, Peng Gong, Hugh Montgomery, Nick Watts, Nicola Wheeler Tags: Correspondence Source Type: research

[Seminar] Oesophageal cancer
Oesophageal cancer is a clinically challenging disease that requires a multidisciplinary approach. Extensive treatment might be associated with a considerable decline in health-related quality of life and yet still a poor prognosis. In recent decades, prognosis has gradually improved in many countries. Endoscopic procedures have increasingly been used in the treatment of premalignant and early oesophageal tumours. Neoadjuvant therapy with chemotherapy or chemoradiotherapy has supplemented surgery as standard treatment of locally advanced oesophageal cancer. (Source: LANCET)
Source: LANCET - June 22, 2017 Category: General Medicine Authors: Jesper Lagergren, Elizabeth Smyth, David Cunningham, Pernilla Lagergren Tags: Seminar Source Type: research

[Articles] Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial
GES is a safe intervention that might reduce fatigue and, to a lesser extent, physical disability for patients with chronic fatigue syndrome. These findings need confirmation and extension to other health-care settings. (Source: LANCET)
Source: LANCET - June 22, 2017 Category: General Medicine Authors: Lucy V Clark, Francesca Pesola, Janice M Thomas, Mario Vergara-Williamson, Michelle Beynon, Peter D White Tags: Articles Source Type: research

[Comment] Guided graded exercise self-help as a treatment of fatigue in chronic fatigue syndrome
In The Lancet, Lucy Clark and colleagues1 show that, in the GETSET trial (n=211), patients with chronic fatigue syndrome who were treated with a 12 week guided graded exercise self-help programme in addition to ongoing specialist medical care had significantly lower mean fatigue score (reduction by 4 ·2 points [95% CI 2·3–6·1], p (Source: LANCET)
Source: LANCET - June 22, 2017 Category: General Medicine Authors: Daniel J Clauw Tags: Comment Source Type: research

[Review] An update on Zika virus infection
The epidemic history of Zika virus began in 2007, with its emergence in Yap Island in the western Pacific, followed in 2013 –14 by a larger epidemic in French Polynesia, south Pacific, where the first severe complications and non-vector-borne transmission of the virus were reported. Zika virus emerged in Brazil in 2015 and was declared a national public health emergency after local researchers and physicians reported a n increase in microcephaly cases. In 2016, WHO declared the recent cluster of microcephaly cases and other neurological disorders reported in Brazil a global public health emergency. (Source: LANCET)
Source: LANCET - June 21, 2017 Category: General Medicine Authors: David Baud, Duane J Gubler, Bruno Schaub, Marion C Lanteri, Didier Musso Tags: Review Source Type: research

[Articles] Infection-related microcephaly after the 2015 and 2016 Zika virus outbreaks in Brazil: a surveillance-based analysis
The distribution of infection-related microcephaly after Zika virus outbreaks has varied across time and Brazilian regions. Reasons for these apparent differences remain to be elucidated. (Source: LANCET)
Source: LANCET - June 21, 2017 Category: General Medicine Authors: Wanderson Kleber de Oliveira, Giovanny Vin ícius Araújo de França, Eduardo Hage Carmo, Bruce Bartholow Duncan, Ricardo de Souza Kuchenbecker, Maria Inês Schmidt Tags: Articles Source Type: research

[Comment] Risk of Zika-related microcephaly: stable or variable?
As unexpected as the epidemic of microcephaly was, the Brazilian Government immediately set up a special notification system. By December, 2015, 3174 suspected cases of microcephaly were reported (more than 1000 in one state in northeast Brazil1). Zika spread rapidly in Latin America. We braced ourselves for a vast international epidemic of Zika-related microcephaly; but when it did not happen we asked ourselves why. Were the numbers an artifact of over reporting?2 Were they real, did cofactors modify the risk given Zika virus in pregnancy,3 or was it due to something else? (Source: LANCET)
Source: LANCET - June 21, 2017 Category: General Medicine Authors: Laura C Rodrigues, Enny S Paixao Tags: Comment Source Type: research

[Department of Error] Department of Error
Cleaver G. Access to abortion in the USA —the legal battle. Lancet 2017; 389: 2361–62—In this World Report, the following sentence should have read “Gorsuch is, as lawyer and graduate of the Yale University School of Medicine Julie Cantor says, an ‘unknown’”. This correction has been made to the online version as of June 20, 2017. (Source: LANCET)
Source: LANCET - June 20, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Comment] What are the health research needs for the Sendai Framework?
There is an important opportunity to build coherence across different policy areas with the 2015 –16 adoption of four landmark UN agreements—the Sendai Framework for Disaster Risk Reduction 2015–2030,1 the 2030 Sustainable Development Goals (SDGs), the Paris Agreement, and the New Urban Agenda (Habitat III). Ensuring that health is at the heart of the Sendai Framework is crucial. The 2030 targets of the Sendai Framework call for substantial global reductions in disaster-related mortality, number of affected people, direct economic loss, and damage to critical infrastructure (panel). (Source: LANCET)
Source: LANCET - June 19, 2017 Category: General Medicine Authors: Emily Y Y Chan, Virginia Murray Tags: Comment Source Type: research

[Articles] Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trial
A significant reduction in incidence of incisional hernia was achieved with onlay mesh reinforcement compared with sublay mesh reinforcement and primary suture only. Onlay mesh reinforcement has the potential to become the standard treatment for high-risk patients undergoing midline laparotomy. (Source: LANCET)
Source: LANCET - June 19, 2017 Category: General Medicine Authors: An P Jairam, Lucas Timmermans, Hasan H Eker, Robert E G J M Pierik, David van Klaveren, Ewout W Steyerberg, Reinier Timman, Arie C van der Ham, Imro Dawson, Jan A Charbon, Christoph Schuhmacher, Andr é Mihaljevic, Jakob R Izbicki, Panagiotis Fikatas, Phi Tags: Articles Source Type: research

[Comment] PRIMA, non nocere
Ventral incisional hernias are common, result in impairments in quality of life, and account for a heavy financial burden.1,2 Estimates suggest that for every 1% reduction in ventral hernia repairs in the USA there would be a US$32 million cost-saving.2 Thus, effective prevention of ventral incisional hernias would have a substantial effect on patient-centred outcomes and resource utilisation. (Source: LANCET)
Source: LANCET - June 19, 2017 Category: General Medicine Authors: John A Harvin, Lillian S Kao Tags: Comment Source Type: research

[Correspondence] CONACYT's freeze on postgraduate fellowships in Mexico
Although Mexico's investment in research and development is low —around 0·5% of the gross domestic product is spent on this area compared with 2–4% in countries such as the USA, South Korea, the UK, Finland, and Japan (appendix)—CONACYT, the only state agency that funds research, has officially frozen the number of postgraduate fellowships available.1 (Source: LANCET)
Source: LANCET - June 16, 2017 Category: General Medicine Authors: Interinstitutional group of Mexican postgraduate students Tags: Correspondence Source Type: research

[Correspondence] Stroke in ICD-11: the end of a long exile
In 1955, cerebrovascular diseases were reclassified as circulatory system diseases in the 7th edition of the International Classification of Diseases and Related Health Problems (ICD). WHO's idea then was that stroke is a condition affecting blood vessels. This decision to reclassify cerebrovascular diseases seemed contrary to the pathophysiology and symptoms leading to mortality and morbidity, which are those of brain dysfunction. Moreover, the decision deviated from the principle of ischaemia of other organs (such as the intestines, kidneys, and the eye), which were listed under their respective organs in ICD-7. (Source: LANCET)
Source: LANCET - June 16, 2017 Category: General Medicine Authors: Raad Shakir, Bo Norrving Tags: Correspondence Source Type: research

[Correspondence] Exposure to lead in petrol and increased incidence of dementia – Authors' reply
We appreciate the comments by Esme Fuller-Thomson and Sydney A Jopling, and Mark A S Laidlaw and colleagues on our cohort study,1 in which we investigated the association between living close to busy roadways and the incidence of dementia, Parkinson's disease, and multiple sclerosis in Ontario, Canada. Both letters hypothesised that past exposure to leaded petrol might explain, at least partly, our observed association between living near roadways and higher incidence of dementia. Their proposition is an important reminder of the potentially long-lasting negative effects of many environmental factors on human health, even ...
Source: LANCET - June 16, 2017 Category: General Medicine Authors: Hong Chen, Barry Jessiman, Ray Copes, Paul J Villeneuve, Richard T Burnett Tags: Correspondence Source Type: research

[Correspondence] Exposure to lead in petrol and increased incidence of dementia
In The Lancet, Hong Chen and colleagues1 reported that higher exposures to nitrogen dioxide (NO2) and airborne particulate matter were greatly associated with dementia. Unfortunately, Chen and colleagues1 were unable to directly measure these airborne pollutants, relying instead on the proxy measure of proximity to pollution sources, namely major roadways. (Source: LANCET)
Source: LANCET - June 16, 2017 Category: General Medicine Authors: Mark A S Laidlaw, Arthur E Poropat, Andy Ball, Howard W Mielke Tags: Correspondence Source Type: research

[Correspondence] Exposure to lead in petrol and increased incidence of dementia
We read with great interest the Article by Hong Chen and colleagues (Feb 18, p 718)1 on living near major roads and the incidence of dementia, Parkinson's disease, and multiple sclerosis. We hypothesise that the link found between residential proximity to major roads and dementia incidence might be partly due to a more distal risk factor, past exposure to leaded petrol. (Source: LANCET)
Source: LANCET - June 16, 2017 Category: General Medicine Authors: Esme Fuller-Thomson, Sydney A Jopling Tags: Correspondence Source Type: research

[Obituary] Julius Stuart Youngner
Virologist who played a key role in developing the Salk vaccine. He was born in New York, NY, USA, on Oct 24, 1920, and died in Pittsburgh, PA, USA, on April 27, 2017, aged 96 years. (Source: LANCET)
Source: LANCET - June 16, 2017 Category: General Medicine Authors: Geoff Watts Tags: Obituary Source Type: research

[Perspectives] The art of priority setting
As Rembrandt's painting The Wardens of the Amsterdam Drapers' Guild, Known as “The Syndics” reminds us, evaluation is first and foremost an art done by a group of people selected because of their expert knowledge and understanding of the task to be achieved. The painting represents a discussion between drapers who were elected to assess the quality of cloth that weavers o ffered for sale to members of their guild. One would assume that their evaluation was made on the basis of criteria decided by the group and rooted in their objectives and values, and that their decision, after careful consideration of the cha...
Source: LANCET - June 16, 2017 Category: General Medicine Authors: Mireille Goetghebeur, Hector Castro-Jaramillo, Rob Baltussen, Norman Daniels Tags: Perspectives Source Type: research

[Perspectives] The art of immunisation
Given their life-saving potential, vaccines are widely regarded as one of medicine's most groundbreaking innovations. Nevertheless, their success has done little to diminish the controversies that have marked the long history of immunisation. To this day, efforts to promote the global uptake of vaccines are hindered by issues such as vaccine hesitancy, misinformation, and localised sociocultural dynamics that continue to perplex policy makers. Such challenges are in need of creative solutions. (Source: LANCET)
Source: LANCET - June 16, 2017 Category: General Medicine Authors: James Smith Tags: Perspectives Source Type: research

[Perspectives] Where do broken hearts go?
Nick Broomfield has made many documentaries in his long career, some of the best known being Chicken Ranch (1983) and The Leader, His Driver and the Driver's Wife (1991). His latest production is Whitney Can I Be Me, a documentary about the singer Whitney Houston, who was thrust irrevocably into the spotlight in the 1980s for her beauty and amazing singing voice. She went on to dominate the pop charts for a number of years before drowning in a hotel bath in February, 2012, aged 48 years. Whitney achieved a number of recording industry firsts and bests, including seven consecutive number one hits. (Source: LANCET)
Source: LANCET - June 16, 2017 Category: General Medicine Authors: Tania Glyde Tags: Perspectives Source Type: research

[Perspectives] Hypertension
For most of its history medicine has not been a matter of numbers. Just as an early modern physician felt entirely justified in diagnosing without a fine-level grasp of anatomy, so he could confidently prognosticate and prescribe without a great deal of quantifying. Although the classical tradition took a close interest in the movement of blood, seeing it as a kind of nutritious tide originating in the liver, practitioners were more concerned with pulse rate and quality —hard, soft, languid—as markers of general health. (Source: LANCET)
Source: LANCET - June 16, 2017 Category: General Medicine Authors: Richard Barnett Tags: Perspectives Source Type: research

[World Report] Preparedness for natural disasters in Colombia
With changes in weather patterns, the risk of natural disasters such as mudslides has increased in South America. Joe Parkin Daniels reports. (Source: LANCET)
Source: LANCET - June 16, 2017 Category: General Medicine Authors: Joe Parkin Daniels Tags: World Report Source Type: research

[World Report] Access to abortion in the USA —the legal battle
While the Roe v. Wade ruling affirmed women's fundamental right to abortion, states are fighting back by drawing up laws that complicate and deter access to the procedure. Gavin Cleaver reports (Source: LANCET)
Source: LANCET - June 16, 2017 Category: General Medicine Authors: Gavin Cleaver Tags: World Report Source Type: research

[Comment] Offline: The Donald Trump Promise
Evidence-based medicine (EBM) has been a powerful influence on clinical practice. But one book should make even the most ardent EBM advocates pause. That book is How Doctors Think, by Jerome Groopman (Houghton Mifflin, 2007). Groopman, an oncologist, drew on the work of Daniel Kahneman and Amos Tversky (before both were made famous by Kahneman's own bestseller, Thinking, Fast and Slow). Groopman used his clinical experience to show how easy it was, despite the very best evidence, to be misled by multiple personal biases —most notably the bias of “availability”. (Source: LANCET)
Source: LANCET - June 16, 2017 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Comment] A global research agenda on migration, mobility, and health
With 1 billion people on the move globally —more than 244 million of whom have crossed international borders1—and a recognised need to strengthen efforts towards universal health coverage,2 developing a better understanding of how to respond to the complex interactions between migration, mobility, and health is vital. At the 2nd Global C onsultation on Migrant Health in Sri Lanka earlier this year, a group of global experts in health and migration discussed the progress and shortfalls in attaining the actions set out in the 2008 World Health Assembly (WHA) Resolution on the Health of Migrants. (Source: LANCET)
Source: LANCET - June 16, 2017 Category: General Medicine Authors: Johanna Hanefeld, Jo Vearey, Neil Lunt, Researchers on Migration, Mobility and Health Group Tags: Comment Source Type: research

[Comment] Sickle cell disease: tipping the balance of genomic research to catalyse discoveries in Africa
The completion of the Human Genome Project and the use of CRISPR/Cas9 for gene editing have begun to transform the diagnosis and management of disease. Sickle cell disease has been considered a perfect model for genomic research because it is a monogenic disease that is common and causes substantial morbidity and mortality but has no cure. The recent use of gene editing to modify disease severity1 and a case report of a patient with sickle cell disease who received successful treatment with gene therapy2 highlight the potential for translating genome-based knowledge into health benefits. (Source: LANCET)
Source: LANCET - June 16, 2017 Category: General Medicine Authors: Julie Makani, Solomon F Ofori-Acquah, Furahini Tluway, Nicola Mulder, Ambroise Wonkam Tags: Comment Source Type: research

[Editorial] Kenya's nurses strike takes its toll on health-care system
Strike action by government nurses in Kenya over poor pay and dreadful working conditions has led to the deaths of 12 patients who were not able to access vital services and care. Recent reports on Kenyan news wires described an 8-month-old child with severe malaria and anaemia not receiving the treatment he needed to survive. A critically ill elderly woman with asthma was left unattended for days. Patients with mental illness or substance addiction are being discharged or turned away, and maternity services are barely functioning. (Source: LANCET)
Source: LANCET - June 16, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Breast cancer targeted therapy: successes and challenges
This Lancet issue features a three-part Series on targeted treatment for the three most common breast cancer subtypes: oestrogen-receptor-positive (ER+), HER2-positive (HER2+), and the more heterogenous triple-negative disease. “Sometimes we have the feeling that not much has happened in everyday clinical practice” Series author Sibylle Loibl, chair of the German Breast Group says in an accompanying podcast, “but if you take a closer look then quite a bit has changed”. Indeed when the first Lancet breast cancer Ser ies was published in 2011, the focus was on gene expression profiling to inform progn...
Source: LANCET - June 16, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] What is a Global Britain?
On June 8, the UK voted in a general election called by the Conservative Prime Minister Theresa May. In an unexpected result, the Conservative Party lost its parliamentary majority, creating a hung Parliament. 21 months away from the cliff edge of Brexit, with the clock inexorably ticking, this outcome will influence the future of Brexit negotiations with the European Union, and the place of Britain on the global stage. (Source: LANCET)
Source: LANCET - June 16, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Articles] Efficacy and safety of tofacitinib monotherapy, tofacitinib with methotrexate, and adalimumab with methotrexate in patients with rheumatoid arthritis (ORAL Strategy): a phase 3b/4, double-blind, head-to-head, randomised controlled trial
Tofacitinib and methotrexate combination therapy was non-inferior to adalimumab and methotrexate combination therapy in the treatment of rheumatoid arthritis in patients with an inadequate response to methotrexate in this trial. Tofacitinib monotherapy was not shown to be non-inferior to either combination. (Source: LANCET)
Source: LANCET - June 16, 2017 Category: General Medicine Authors: Roy Fleischmann, Eduardo Mysler, Stephen Hall, Alan J Kivitz, Robert J Moots, Zhen Luo, Ryan DeMasi, Koshika Soma, Richard Zhang, Liza Takiya, Svitlana Tatulych, Christopher Mojcik, Sriram Krishnaswami, Sujatha Menon, Josef S Smolen, ORAL Strategy investi Tags: Articles Source Type: research

[Comment] Treating active rheumatoid arthritis with Janus kinase inhibitors
The ORAL Strategy trial1 by Roy Fleischmann and colleagues in The Lancet studied patients with active rheumatoid arthritis. They had all responded inadequately to methotrexate, the dominant conventional disease-modifying antirheumatic drug (DMARD). The key comparison in the trial was the effects of a combination of different treatments with methotrexate. One treatment was tofacitinib. This drug is an orally active Janus kinase (JAK) inhibitor, a relatively new type of drug for rheumatoid arthritis. (Source: LANCET)
Source: LANCET - June 16, 2017 Category: General Medicine Authors: David L Scott, Matt D Stevenson Tags: Comment Source Type: research

[Viewpoint] The need for a complex systems model of evidence for public health
Despite major investment in both research and policy, many pressing contemporary public health challenges remain. To date, the evidence underpinning responses to these challenges has largely been generated by tools and methods that were developed to answer questions about the effectiveness of clinical interventions, and as such are grounded in linear models of cause and effect. Identification, implementation, and evaluation of effective responses to major public health challenges require a wider set of approaches1,2 and a focus on complex systems. (Source: LANCET)
Source: LANCET - June 13, 2017 Category: General Medicine Authors: Harry Rutter, Natalie Savona, Ketevan Glonti, Jo Bibby, Steven Cummins, Diane T Finegood, Felix Greaves, Laura Harper, Penelope Hawe, Laurence Moore, Mark Petticrew, Eva Rehfuess, Alan Shiell, James Thomas, Martin White Tags: Viewpoint Source Type: research

[Department of Error] Department of Error
Duong TA, Valeyrie-Allanore L, Wolkenstein P, Chosidow O. Severe cutaneous adverse reactions to drugs. Lancet 2017; published online May 2. http://dx.doi.org/10.1016/S0140-6736(16)30378-6 —In this Seminar, the end of the penultimate sentence in the “Public health and drug-policy issues” section should have read: “…and (4) establishment of a safer alternative agent as first-line therapy (eg, prescription of an isoxazolyl penicillin such as cloxacillin instead of high-risk co -trimoxazole first for meticillin-susceptible Staphylococcus aureus skin infection, and clindamycin in countries with co...
Source: LANCET - June 13, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Articles] Age-specific risks, severity, time course, and outcome of bleeding on long-term antiplatelet treatment after vascular events: a population-based cohort study
In patients receiving aspirin-based antiplatelet treatment without routine PPI use, the long-term risk of major bleeding is higher and more sustained in older patients in practice than in the younger patients in previous trials, with a substantial risk of disabling or fatal upper gastrointestinal bleeding. Given that half of the major bleeds in patients aged 75 years or older were upper gastrointestinal, the estimated NNT for routine PPI use to prevent such bleeds is low, and co-prescription should be encouraged. (Source: LANCET)
Source: LANCET - June 13, 2017 Category: General Medicine Authors: Linxin Li, Olivia C Geraghty, Ziyah Mehta, Peter M Rothwell, Oxford Vascular Study Tags: Articles Source Type: research

[Comment] Preventing major gastrointestinal bleeding in elderly patients
Antiplatelet therapy is the most frequently recommended treatment to prevent recurrent ischaemic events in patients who have had an ischaemic stroke, an acute coronary syndrome, or symptomatic peripheral arterial disease. The most frequently used drugs are aspirin or clopidogrel. Most guidelines recommend lifelong intake of antiplatelet therapy. However, randomised trials that have investigated the benefit of antiplatelet therapy had an observation period of between 2 years and 4 years.1 Therefore, we lack data on the long-term benefit and risk of antiplatelet therapy across long time periods, particularly in elderly patie...
Source: LANCET - June 13, 2017 Category: General Medicine Authors: Hans-Christoph Diener Tags: Comment Source Type: research

[Articles] Brexanolone (SAGE-547 injection) in post-partum depression: a randomised controlled trial
In women with severe post-partum depression, infusion of brexanolone resulted in a significant and clinically meaningful reduction in HAM-D total score, compared with placebo. Our results support the rationale for targeting synaptic and extrasynaptic GABAA receptors in the development of therapies for patients with post-partum depression. A pivotal clinical programme for the investigation of brexanolone in patients with post-partum depression is in progress. (Source: LANCET)
Source: LANCET - June 12, 2017 Category: General Medicine Authors: Stephen Kanes, Helen Colquhoun, Handan Gunduz-Bruce, Shane Raines, Ryan Arnold, Amy Schacterle, James Doherty, C Neill Epperson, Kristina M Deligiannidis, Robert Riesenberg, Ethan Hoffmann, David Rubinow, Jeffrey Jonas, Steven Paul, Samantha Meltzer-Brody Tags: Articles Source Type: research

[Comment] Post-partum depression —a glimpse of light in the darkness?
There can be little doubt about the importance of mood episodes in pregnancy and following childbirth.1 Mood episodes are common —post-partum depression is the most common medical complication of maternity, affecting around one in ten new mothers.2 They can also be severe—episodes of post-partum psychosis represent some of the most serious episodes of illness seen in psychiatry.3 Perinatal mood episodes cause substantial impairment to women and have a wide ranging impact on their babies, families, and society. (Source: LANCET)
Source: LANCET - June 12, 2017 Category: General Medicine Authors: Ian Jones Tags: Comment Source Type: research