Riviste scientifiche

[Editorial] Is digital medicine different?

The Lancet - Sa, 14/07/2018 - 00:00
To coincide with the 70th anniversary of the National Health Service (NHS) on July 5, a new NHS app enabling patients to make appointments, order repeat prescriptions, access their general practitioner (GP) records, and make urgent medical queries was announced by Jeremy Hunt, then UK Secretary for Health and Social Care. The app, developed by NHS England and NHS Digital, will be freely available from December, 2018. Hunt acknowledged that while technology has transformed many sectors, the health sector has remained comparatively unchanged.

[Editorial] Food security in the Middle East and north Africa

The Lancet - Sa, 14/07/2018 - 00:00
Early civilisations emerged in conjunction with agriculture and the food security that crops provided. In Mesopotamia (now Iraq), agriculture and science flourished symbiotically. But the agriculture of Iraq that once nourished thinkers who shaped the ancient world is no longer able to feed the population. Agricultural Outlook 2018–2027, published on July 3 by the OECD and the UN Food and Agriculture Organization, explains why. The report focuses on the Middle East and north Africa, where unsustainable farming practices are widespread.

[Editorial] Indonesia disavows “unity in diversity”

The Lancet - Sa, 14/07/2018 - 00:00
A new report by Human Rights Watch, published on July 1, lays bare Indonesia's “crackdown” on the rights of lesbian, gay, bisexual, and transgender (LGBT) people to live free from intimidation and discrimination. Indonesia is a largely Muslim democracy where LGBT people face widespread stigma and discrimination—one 2018 survey found that among Indonesians who knew what LGBT was, 79·1% would object to having an LGBT person as a neighbour. Intolerance and the behaviour of the country's police force have exacerbated an existing HIV crisis.

[Comment] How Montgomery is reconfiguring consent in the UK

The Lancet - Sa, 14/07/2018 - 00:00
How should consent be measured? The answer to that question will depend on where in the world you practise medicine or receive treatment—whether it be in a patient-centred health-care service like in Australia or a more consumer-driven system such as in the USA. In the UK, the validity of consent was until recently based on whether a reasonable body of medical opinion would agree with it—a principle widely known as the Bolam test.1 However, in a 2015 ruling involving a case of birth complicated by shoulder dystocia that resulted in a child being born with cerebral palsy (Montgomery v Lanarkshire Health Board 2015),2 the UK Supreme Court declared the Bolam test to be an outdated instance of medical paternalism.

[Comment] Denicotinised cigarettes

The Lancet - Sa, 14/07/2018 - 00:00
Preventing smoking is crucial to public health. Countries that implement the WHO Framework Convention on Tobacco Control MPOWER tobacco control policies, which include high taxes, marketing prohibitions, smoke-free policies, media campaigns, and treatment for addicted smokers,1 can substantially reduce smoking prevalence. Such efforts are likely to be enhanced by the availability of consumer nicotine products, such as e-cigarettes, for use as smoking substitutes.2 However, since millions of smokers continue to die prematurely every year, and these deaths are avoidable, new policies to accelerate progress towards a world free from smoking are needed.

[Comment] Offline: The UK's child health emergency

The Lancet - Sa, 14/07/2018 - 00:00
Last week, Britain celebrated the 70th anniversary of the National Health Service (NHS). It was hard to understand why. Some of the most reliable assessments of health systems come from the Institute for Health Metrics and Evaluation, based at the University of Washington in Seattle. Its Universal Health Coverage Index, which measures nine tracer interventions, together with risk-standardised death rates for 32 causes of death, last year placed the UK 19th out of 22 countries in western Europe. The health systems of Finland, Iceland, Switzerland, Norway, Sweden, Luxembourg, Spain, the Netherlands, Austria, Andorra, Italy, France, Ireland, Belgium, Denmark, Germany, Greece, and Cyprus all outperformed the UK.

[World Report] Prospects for health in Mexico after the presidential election

The Lancet - Sa, 14/07/2018 - 00:00
The country's President-elect faces a tough challenge to redress the health system, but his tough stance on corruption might help. Stephen Woodman reports from Mexico City.

[World Report] Proposed regulation of oxytocin in India causes concern

The Lancet - Sa, 14/07/2018 - 00:00
Misuse of the synthetic hormone has prompted the government to propose strict regulations, but some worry about potential consequences on women's health. Sophie Cousins reports.

[World Report] African Union launches a pan-African anti-malaria campaign

The Lancet - Sa, 14/07/2018 - 00:00
African leaders launch a continent-wide Zero Malaria Starts with Me campaign to spur response in the face of a setback in progress in the fight against the disease. John Zarocostas reports.

[World Report] Devastation in Yemen ongoing

The Lancet - Sa, 14/07/2018 - 00:00
Agencies warn against the looming threat of military action to retake the central port of Hudaydah which is already exacerbating the crisis on the ground. Sharmila Devi reports.

[Perspectives] A fellowship of error

The Lancet - Sa, 14/07/2018 - 00:00
Like all health professionals, I've made a lot of mistakes. Many of these were clinical—through inexperience or lack of knowledge, through making poor decisions when I should have known better, through exhaustion, or sheer bad luck. But some of the most powerful were not clinical at all.

[Perspectives] Trepanned cranium

The Lancet - Sa, 14/07/2018 - 00:00
Trepanned skulls and crania have long appalled and fascinated their observers. Some skulls with multiple trepan sites, performed over a period of time and showing long-term wound healing, pose intriguing questions. These can be hard to answer when the human remains date from a time or culture about which little can be known directly of medical practices, ideas of disease, or social structures of care. Trepanation has a notable history in the western medical tradition, hallowed by Hippocratic and Galenic textual discussions and Roman instruments.

[Perspectives] Ahmed Salim Saif Al-Mandhari: bridge-builder from Oman

The Lancet - Sa, 14/07/2018 - 00:00
“I am a family physician, I am a human being. These two concepts are my main driving force towards whatever I do at all levels as a leader of an organisation”, says Ahmed Al-Mandhari, who became Regional Director of the WHO Regional Office for the Eastern Mediterranean (EMRO) on June 1, 2018. Taking the helm at WHO EMRO, he says, “is a big shift and a major decision in my life”. The post had been vacant since the sudden death of Mahmoud Fikri, a United Arab Emirates national, in October, 2017. During the campaign for WHO EMRO Regional Director, Al-Mandhari set out the challenges ahead: “Our region is really passing through a very critical era, marked by increasingly expanded natural and man-made crises and characterised by severe socio-political and economic instability, weak health systems, insufficient financial resources, unbalanced workforce, an upsurge of old and new communicable diseases, and increasing burden of non-communicable diseases.” In his acceptance speech, he emphasised that every effort must be made to find appropriate solutions to these challenges, particularly for displaced populations and refugees.

[Perspectives] Defiant gardens: from Helmand to Headley Court

The Lancet - Sa, 14/07/2018 - 00:00
There were gardens at Camp Bastion, so many of them that anyone flying in to the British base of operations during the UK's involvement in the war in Afghanistan from 2001 to 2014 would have been astounded. The best way to see all these little patches of green in the dry dust of the desert behind miles and miles of barbed wire fence was from a helicopter, but if you flew or travelled in one of the Apaches or Chinooks that bumped down every hour at one of Bastion's landing sites, you had other things to worry about.

[Perspectives] A woman revolts

The Lancet - Sa, 14/07/2018 - 00:00
Women's rights have regained attention with the 2017 and 2018 Women's Marches, and the #MeToo and Time's Up movements. Thus, it is surprising to discover an evocative portrait of a woman ill at ease with patriarchal society that feels entirely modern but was written in 1928. Sophie Treadwell wrote her masterpiece Machinal—one of the finest examples of American expressionism—almost a century ago, taking inspiration from the case of Ruth Snyder, the first woman in New York state to die in the electric chair after having been condemned for the murder of her husband.

[Obituary] Ogobara Doumbo

The Lancet - Sa, 14/07/2018 - 00:00
Leading malaria researcher. Born in the Dogon region of Mali, Africa, on Jan 1, 1956, he died after complications from surgery in Marseille, France, on June 9, 2018, aged 62 years.

[Correspondence] Should hydroxyethyl starch be banned?

The Lancet - Sa, 14/07/2018 - 00:00
In their Correspondence in The Lancet, Ian Roberts and colleagues (Feb 12, p 736)1 ask the director general of WHO to ban the use of hydroxyethyl starch (HES) solutions worldwide “to protect patients”. Several clarifications and corrections are needed to place the authors' arguments into proper perspective.

[Correspondence] Should hydroxyethyl starch be banned?

The Lancet - Sa, 14/07/2018 - 00:00
Roberts and colleagues'1 Correspondence in The Lancet asking WHO to support a ban on the use of hydroxyethyl starch (HES) deserves clarification. First, registration of HES is not yet suspended; a legally binding decision by the European Commission is still pending. Second, Roberts and colleagues claim that HES was used to treat postpartum haemorrhage in the WOMAN trial.2 In fact, the publication doesn't provide any information about HES treatment or its related adverse events. Third, the authors refer to their own studies as examples of high-quality trials, but these have been publicly criticised for methodological deficiencies and severe limitations.

[Correspondence] Should hydroxyethyl starch be banned?

The Lancet - Sa, 14/07/2018 - 00:00
Two recent letters in The Lancet regarding the Pharmacovigilance Risk Assessment Committee (PRAC) recommendation to suspend the marketing of hydroxyethyl starch (HES) could hardly be more different, yet both raise highly pertinent points. Djillali Annane and colleagues1 emphasise that the PRAC decision was far from unanimous, and that the European Medicines Agency's own selected panel of experts advised PRAC against this decision. The authors further emphasised the problems that can arise in resuscitation in cases “when crystalloids alone are not sufficient”.

[Correspondence] Should hydroxyethyl starch be banned? – Authors' reply

The Lancet - Sa, 14/07/2018 - 00:00
Medicines should be licensed for use when there is reliable evidence that patients benefit from them. In their Correspondences, Michael Frank James and colleagues and Hans-Joachim Priebe overlook this crucial point. Instead, they cast doubt on the high-quality randomised trials that question the safety of hydroxyethyl starch (HES), or claim that future studies might show some benefit for its use. They wrongly assert that CHEST trial data are being withheld when these are probably the only fluid trial data that have been independently reanalysed (confirming the integrity of the analysis and conclusions), and which remain available for further analysis in accordance with the sponsor's open data policy.
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