Riviste scientifiche

[Editorial] Strengthening clinical research in children and young people

The Lancet - Sa, 23/05/2015 - 00:00
“The time has come to protect children and young people through research not from research”, said Bobbie Farsides, Professor of Bioethics at Brighton and Sussex Medical School and Chair of the Working Party for the Nuffield Council on Bioethics, which published its report Children and clinical research: ethical issues on May 14. “It will always be easier to say ‘no’ to research with children on the grounds that it's too difficult, but we should challenge the idea that it is acceptable to continue to offer health care to children without seeking to improve the evidence base for many of the treatments provided”, added Farsides.

[Editorial] Adolescents with diabetes

The Lancet - Sa, 23/05/2015 - 00:00
Diabetes has long been known to influence and be influenced by comorbidity. A collection of papers on diabetes and mental health, published jointly by The Lancet Diabetes & Endocrinology and The Lancet Psychiatry on May 18, shows that the diversity of interactions is far broader than once was imagined. From the family to the environment, diabetes control is subject to a myriad of stimuli. When these factors combine in adolescence, amidst the psychosocial and physiological transitions of puberty, the confluence can be problematic for glycaemic control and for relationships with health professionals.

[Editorial] The next era of disaster risk reduction

The Lancet - Sa, 23/05/2015 - 00:00
We live on a volatile planet. In May alone, Nepal has been struck by two earthquakes, tornadoes have ripped through southern America, and Typhoon Noul has lashed at the northeast of the Philippines. Natural disasters will always occur, but the extent of the devastation they cause can be reduced through better preparedness. The USA, for example, runs a national Hurricane Preparedness Week, for citizens to plan, which this year falls on May 24–30.

[Comment] Spondyloarthropathy: interleukin 23 and disease modification

The Lancet - Sa, 23/05/2015 - 00:00
Prevention of progressive loss of normal articular structure and preservation of functional capability are central goals of therapeutic discovery in rheumatology. Despite the remarkably effective inhibition of structural damage in rheumatoid arthritis that was achieved with biological agents targeting tumour necrosis factor, and the ability to reduce signs and symptoms of disease in spondyloarthropathy with the same treatments, prevention of disease progression and bone pathology in seronegative spondyloarthropathies has been immensely challenging.

[Comment] Dual RAAS blockade for kidney failure: hope for the future

The Lancet - Sa, 23/05/2015 - 00:00
Patients with diabetes and chronic kidney disease are at high risk of progression to end-stage kidney failure, requiring maintenance dialysis or transplantation.1 Presence of overt albuminuria (≥300 mg/day) further enhances the risk of kidney function decline, and is an independent risk marker for cardiovascular disease and all-cause mortality.2

[Comment] An alternative combination therapy for type 2 diabetes?

The Lancet - Sa, 23/05/2015 - 00:00
In The Lancet, Lawrence Blonde and colleagues1 present data from a randomised controlled trial of the latest glucagon-like peptide-1 (GLP-1) receptor agonist. Dulaglutide has few known discriminating features compared with the other long-acting GLP-1 receptor agonists on the market with full diurnal GLP-1 activity.2,3 Yet, in the present trial, Blonde and colleagues have turned things upside down and tested this drug as an antihyperglycaemic backbone to pre-prandial short-acting insulin and metformin treatment in patients with type 2 diabetes.

[Comment] Offline: Delivering a new future for Africa

The Lancet - Sa, 23/05/2015 - 00:00
Post-Ebola, commentators have been given permission to say in public what they have thought in private for a long time—namely, that WHO's Regional Office for Africa (AFRO) has a record and reputation for failure second to none in global health today. In advance of an unprecedented meeting convened by the new Regional Director for WHO AFRO, Dr Matshidiso Moeti, earlier this month, I asked a group of Africa health experts for their views on WHO's work on the continent. WHO AFRO does have strengths.

[World Report] India's BJP Government and health: 1 year on

The Lancet - Sa, 23/05/2015 - 00:00
1 year after the Bharatiya Janata Party Government was elected, public health experts say that it is not advancing health in India. Dinesh C Sharma reports from New Delhi.

[World Report] Russia's gaps in diabetes control

The Lancet - Sa, 23/05/2015 - 00:00
The incidence of diabetes is increasing in Russia, and problems with data collection, care, and access to educational programmes are hampering improvements. Fiona Clark reports from Moscow.

[Perspectives] Lady Mary Crawley, meet Dr Steven Corwin

The Lancet - Sa, 23/05/2015 - 00:00
What do Downton Abbey and the Metropolitan Opera have to do with New York-Presbyterian Hospital? More than you might think. In the USA, Downton Abbey is shown on television to an unprecedented number of viewers on the Public Broadcasting Service. Public television once eschewed commercials, but the recent broadcasts from New York prefaced Downton with a full minute advertisement about surgeries at the hospital. (The cancer was wrapped around my spine, but my docs aced it, and now I am the middleweight boxing champion of the world.) The back cover of the programme at the Metropolitan Opera features Gabby, diagnosed in childhood with tibial pseudarthrosis, whose leg would have been amputated by lesser docs, but now has braces only on her teeth.

[Perspectives] Finding the sweet spot in medicine

The Lancet - Sa, 23/05/2015 - 00:00
Earlier this year, the disputatious Dallas billionaire Mark Cuban stirred controversy when he called for universal quarterly blood testing “for everything available…so you have a baseline of your own personal health”. Around the same time, the US state of Arizona passed a law allowing consumers to obtain any laboratory test directly from licensed laboratories—without a physician's order. Theranos, a California company pioneering cheap, complete blood analysis with just a fingerstick, has advocated for such laws.

[Perspectives] Fergus Cameron: getting the big picture in childhood diabetes

The Lancet - Sa, 23/05/2015 - 00:00
Fergus Cameron's father encouraged him to study medicine because he thought “I'd do better in medicine rather than in business”, recalls Cameron. It turned out to be a good call. After decades as a clinician researcher, Cameron finds himself as Head of the Diabetes Services and Deputy Director of the Department of Endocrinology Unit at the Royal Children's Hospital Melbourne (RCH), as well as a diabetes research group leader at the Murdoch Children's Research Institute.

[Perspectives] The marathon of diabetes

The Lancet - Sa, 23/05/2015 - 00:00
Midway through my first year of medical school, at a moment when my medical knowledge ranged little beyond the peregrinations of the seventh cranial nerve, my classmates and I were paroled from the windowless lecture hall in which we had been interred for the past 5 months and grouped together for a “clinical session”. The adjective clinical didn't indicate the presence of actual patients, of course. Rather, it meant that we would aggregate around a stack of textbooks and attempt to communally puzzle through a printed case presentation that simulated an actual patient.

[Correspondence] Rising food insecurity in Europe

The Lancet - Sa, 23/05/2015 - 00:00
People queueing for food aid is an image reminiscent of the Great Depression in the 1930s, but one that has come to characterise many European nations in the grip of austerity today. In 2013–14, the UK's Trussell Trust, a national network of food banks, provided emergency food aid to more than 900 000 adults and children, a 163% increase from the previous year.1 Greek, Spanish, and French charities have also reported marked rises in the number of people seeking emergency food support.2 Alongside clinical evidence of rising nutritional deficiencies,2,3 these reports suggest that a problem is emerging, but to what extent is food insecurity rising across Europe?

[Correspondence] Sex and relationship education should be statutory

The Lancet - Sa, 23/05/2015 - 00:00
As members of Sexpression:UK, a network of student projects based at UK universities dedicated to providing comprehensive sex and relationship education (SRE) in schools, we are deeply concerned by the inadequacy of SRE teaching throughout the UK education system.

[Correspondence] Bivalirudin versus heparin use for patients undergoing PPCI

The Lancet - Sa, 23/05/2015 - 00:00
We congratulate Adeel Shahzad and colleagues (Nov 22, p 1849)1 on their remarkable achievement of enrolling almost 2000 patients with ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PPCI) into their trial, with minimal exclusions.

[Correspondence] Bivalirudin versus heparin use for patients undergoing PPCI

The Lancet - Sa, 23/05/2015 - 00:00
Although randomised clinical trials are the gold standard used to define treatment recommendations, beneficial effects of a drug for treatment might be obscured because of the effect of adjunctive treatment on patient outcomes. The GUSTO trial investigators1 reported that treatment of ST-segment elevation myocardial infarction (STEMI) with tissue plasminogen activator reduced mortality compared with the use of streptokinase. To show this benefit, effective adjunctive treatment with intravenous heparin was necessary.

[Correspondence] Bivalirudin versus heparin use for patients undergoing PPCI

The Lancet - Sa, 23/05/2015 - 00:00
Adeel Shahzad and colleagues1 showed that the use of heparin, compared with bivalirudin, substantially reduces the incidence of major adverse events (principally acute stent thrombosis) in patients, with no differences between the two drugs in bleeding complications. The rates of acute stent thrombosis were 3·4% in the bivalirudin group and 0·9% in the heparin group. These results should urge health-care providers to refrain from using bivalirudin in the setting of primary percutaneous coronary intervention, especially for patients with risk factors of acute stent thrombosis.

[Correspondence] Bivalirudin versus heparin use for patients undergoing PPCI

The Lancet - Sa, 23/05/2015 - 00:00
Adeel Shahzad and colleagues1 concluded that heparin, compared with bivalirudin, reduces the incidence of major adverse cardiovascular events (MACEs) in a setting of primary percutaneous coronary intervention without increasing the risk of bleeding complications. However, findings from this study1 do not accord with those from other multicentre randomised trials.2,3 In the study by Shahzad and colleagues,1 the incidence of overall MACE rates in the bivalirudin group was very high compared with other studies, but the rates reported between the other studies were comparable (table).

[Correspondence] Bivalirudin versus heparin use for patients undergoing PPCI – Authors' reply

The Lancet - Sa, 23/05/2015 - 00:00
Although the results of trials comparing heparin and bivalirudin are often portrayed as discordant and perplexing, we believe that there are some consistent messages from these and that common ground could be established to determine best practice.
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