2010 Oct 27 - Paediatric mortality related to pandemic influenza A H1N1 infection in England: an observational population-based study

Nabihah Sachedina MBBS a, Prof Liam J Donaldson MD a b The Lancet, Early Online Publication, 27 October 2010doi:10.1016/S0140-6736(10)61195-6
Background
Young people (aged 0—18 years) have been disproportionately affected by pandemic influenza A H1N1 infection. We aimed to analyse paediatric mortality to inform clinical and public health policies for future influenza seasons and pandemics.

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2010 Oct - Escherichia coli O157

Prof Hugh Pennington FRCPath a. The Lancet, Volume 376, Issue 9750, Pages 1428 - 1435, 23 October 2010

Escherichia coli O157 is an uncommon but serious cause of gastroenteritis. This bacterium is noteworthy because a few, but significant, number of infected people develop the haemolytic uraemic syndrome, which is the most frequent cause of acute renal failure in children in the Americas and Europe. Many infections of E coli O157 could be prevented by the more effective application of evidence-based methods, which is especially important because once an infection has been established, no therapeutic interventions are available to lessen the risk of the development of the haemolytic uraemic syndrome.

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2010 Oct 18 - Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study

Granerod MSc a , Helen E Ambrose DPhil a, Nicholas WS Davies PhD b, Jonathan P Clewley PhD a, Amanda L Walsh MSc a, Dilys Morgan MD a, Richard Cunningham FRCPath c, Mark Zuckerman FRCPath d, Ken J Mutton MBBS e, Prof Tom Solomon FRCP f g, Katherine N Ward PhD h, Michael PT Lunn FRCP i, Sarosh R Irani MRCP j, Prof Angela Vincent FRCPath j, Prof David WG Brown FRCPath a, Natasha S Crowcroft MD a k, on behalf of the UK Health Protection Agency (HPA) Aetiology of Encephalitis Study Group. The Lancet Infectious Diseases, Early Online Publication, 18 October 2010

Background
Encephalitis has many causes, but for most patients the cause is unknown. We aimed to establish the cause and identify the clinical differences between causes in patients with encephalitis in England.

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2010 Oct 15 - Lancet Comment: Dispatcher-assisted bystander CPR: a KISS for a kiss

P Nolan a, Jasmeetx Soar b. The Lancet, Early Online Publication, 15 October 2010.

Whether cardiopulmonary resuscitation (CPR) should involve mouth-to-mouth ventilation with chest compressions or just compressions is an interesting question. Many members of the public are uncomfortable with giving rescue breaths (especially if there is vomiting) or have not been trained to give mouth-to-mouth ventilation.

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2010 Oct 15 - Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis

Michael Hüpfl MD a, Harald F Selig MD a, Dr Peter Nagele MD a b. The Lancet, Early Online Publication, 15 October 2010

Background
In out-of-hospital cardiac arrest, dispatcher-assisted chest-compression-only bystander CPR might be superior to standard bystander CPR (chest compression plus rescue ventilation), but trial findings have not shown significantly improved outcomes. We aimed to establish the association of chest-compression-only CPR with survival in patients with out-of-hospital cardiac arrest.

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2010 Oct 9 - Ethics and end-of-life care for adults in the intensive care unit

Prof J Randall Curtis MD a , Prof Jean-Louis Vincent MD b. The Lancet, Early Online Publication, 9 October 2010
The intensive care unit (ICU) is where patients are given some of the most technologically advanced life-sustaining treatments, and where difficult decisions are made about the usefulness of such treatments. The substantial regional variability in these ethical decisions is a result of many factors, including religious and cultural beliefs.

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2010 Oct 9 - Critical care and the global burden of critical illness in adults

Neill KJ Adhikari MD a, Robert A Fowler MD a, Prof Satish Bhagwanjee MBChB b, Dr, Prof Gordon D Rubenfeld MD a. The Lancet, Early Online Publication, 9 October 2010
Critical care has evolved from treatment of poliomyelitis victims with respiratory failure in an intensive care unit to treatment of severely ill patients irrespective of location or specific technology. Population-based studies in the developed world suggest that the burden of critical illness is higher than generally appreciated and will increase as the population ages.

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2010 Oct 9 - Critical care: advances and future perspectives

Prof Jean-Louis Vincent MD a , Prof Mervyn Singer FRCP b. The Lancet, Early Online Publication, 9 October 2010
Intensive care offers a standard of monitoring, intervention, and organ support that cannot be readily delivered in a general ward. Its expansion in the past few decades, including the creation of emergency and outreach teams, emphasises that intensive care has an increasingly prominent role within the hospital.

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2010 Oct 9 - Lancet Comment: Intensive care medicine: a specialty coming to LIFE

Rui Paulo Moreno a, Andrew Rhodes b. The Lancet, Early Online Publication, 9 October 2010
The Lancet today includes three papers about intensive care medicine. The papers describe the evolution of the specialty,1 the demand for and ability to supply appropriate levels of care,2 and some of the commonly faced ethical dilemmas and challenges.3 These topics are apt in this period of economic constraint.

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2010 Oct - Haemodynamic stroke: clinical features, prognosis, and management

Catharina JM Klijn MD a, L Jaap Kappelle MD a. The Lancet Neurology, Volume 9, Issue 10, Pages 1008 - 1017, October 2010
Haemodynamic stroke is a type of ischaemic stroke that is caused by hypoperfusion rather than by embolism or local vasculopathy. It can be caused by systemic diseases such as heart failure or hypotension, but also by severe obstruction of the carotid or vertebral arteries. Patients with haemodynamic stroke or transient ischaemic attack might show specific clinical features that distinguish them from patients with embolism or local small-vessel disease.

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2010 Sep 25 - Lancet Correspondence: Tranexamic acid for trauma

Biswadev Mitra a, Mark Fitzgerald a, Peter A Cameron a, Russell L Gruen a. The Lancet, Volume 376, Issue 9746, Page 1049 - 1050, 25 September 2010
The CRASH-2 trial (July 3, p 23)1 showed reduced trauma mortality through the simple and cheap intervention of tranexamic acid, placing it into a growing list of options for managing the acute coagulopathy of trauma.

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2010 Sep 6 - Antiphospholipid syndrome

Dr, Prof Guillermo Ruiz-Irastorza MD a , Prof Mark Crowther FRCPC b, Prof Ware Branch MD c, Munther A Khamashta FRCP d. The Lancet, Volume 376, Issue 9751, Pages 1498 - 1509, 30 October 2010. Published Online: 06 September 2010
The antiphospholipid syndrome causes venous, arterial, and small-vessel thrombosis; pregnancy loss; and preterm delivery for patients with severe pre-eclampsia or placental insufficiency. Other clinical manifestations are cardiac valvular disease, renal thrombotic microangiopathy, thrombocytopenia, haemolytic anaemia, and cognitive impairment.

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2010 Sep 1 - Lancet Comment: Acute coronary syndromes: finding meaning in OASIS 7

Gregg W Stone a. The Lancet, Early Online Publication, 1 September 2010doi:10.1016/S0140-6736(10)61262-7Cite or Link Using DOI
Acute coronary syndromes typically arise from rupture of a cholesterol-laden plaque with subsequent thrombotic occlusion of the coronary artery.

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2010 Sep 1 - Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial

Dr Shamir R Mehta MD a , Jean-Francois Tanguay MD b, John W Eikelboom MD a, Sanjit S Jolly MD a, Prof Campbell D Joyner MD c, Christopher B Granger MD d, Prof David P Faxon MD e, Hans-Jurgen Rupprecht MD f, Prof Andrzej Budaj MD g, Alvaro Avezum MD h, Prof Petr Widimsky MD i q, Prof Philippe Gabriel Steg MD j, Prof Jean-Pierre Bassand MD k, Gilles Montalescot MD l, Carlos Macaya MD m, Giuseppe Di Pasquale MD n, Kari Niemela MD r, Andrew E Ajani MD o, Prof Harvey D White MD p, Susan Chrolavicius BA a, Peggy Gao MSc a, Prof Keith AA Fox MBChB s, Prof Salim Yusuf MBBS a, on behalf of the CURRENT-OASIS 7 trial investigators‡. The Lancet, Early Online Publication, 1 September 2010
Background
Clopidogrel and aspirin are the most commonly used antiplatelet therapies for percutaneous coronary intervention (PCI). We assessed the effect of various clopidogrel and aspirin regimens in prevention of major cardiovascular events and stent thrombosis in patients undergoing PCI.

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2010 Aug 21 - Lancet Editorial: Pandemic influenza—(some) reasons to be cheerful?

The Lancet, Volume 376, Issue 9741, Page 565, 21 August 2010
There was no fanfare to accompany WHO's declaration on Aug 10 that the world was entering a “post-pandemic period” and that influenza A H1N1 had “largely run its course”. But the aftershocks of the pandemic might last for a long time, so this announcement should herald the start of a period of reflection.

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2010 Aug 11 - Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study

Karthikeyan K Kumarasamy MPhil a, Mark A Toleman PhD b, Prof Timothy R Walsh PhD b , Jay Bagaria MD c, Fafhana Butt MD d, Ravikumar Balakrishnan MD c, Uma Chaudhary MD e, Michel Doumith PhD c, Christian G Giske MD f, Seema Irfan MD g, Padma Krishnan PhD a, Anil V Kumar MD h, Sunil Maharjan MD c, Shazad Mushtaq MD c, Tabassum Noorie MD c, David L Paterson MD i, Andrew Pearson PhD c, Claire Perry PhD c, Rachel Pike PhD c, Bhargavi Rao MD c, Ujjwayini Ray MD j, Jayanta B Sarma MD k, Madhu Sharma MD e, Elizabeth Sheridan PhD c, Mandayam A Thirunarayan MD l, Jane Turton PhD c, Supriya Upadhyay PhD m, Marina Warner PhD c, William Welfare PhD c, David M Livermore PhD c, Neil Woodford PhD c. The Lancet Infectious Diseases, Early Online Publication, 11 August 2010
Background
Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by New Delhi metallo-β-lactamase 1 (NDM-1) are potentially a major global health problem. We investigated the prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK.

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2010 Aug 12 - Effect of specialist retrieval teams on outcomes in children admitted to paediatric intensive care units in England and Wales: a retrospective cohort study

Dr Padmanabhan Ramnarayan MD a , Krish Thiru PhD b c, Roger C Parslow PhD c d, David A Harrison PhD e, Prof Elizabeth S Draper PhD c f, Prof Kathy M Rowan PhD e. The Lancet, Early Online Publication, 12 August 2010
Background
Intensive care services for children have undergone substantial centralisation in the UK. Along with the establishment of regional paediatric intensive care units (PICUs), specialist retrieval teams were set up to transport critically ill children from other hospitals. We studied the outcome of children transferred from local hospitals to PICUs.

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2010 Aug - Effects of antihypertensive treatment after acute stroke in the Continue Or Stop post-Stroke Antihypertensives Collaborative Study (COSSACS): a prospective, randomised, open, blinded-endpoint trial

Prof Thompson G Robinson MD a , Prof John F Potter DM c, Prof Gary A Ford FRCP d, Prof Christopher J Bulpitt MD e, Julia Chernova MSc b, Prof Carol Jagger PhD b d, Martin A James MD f, Joanne Knight PhD g, Prof Hugh S Markus MD h, Amit K Mistri MD a, Prof Neil R Poulter FRCP e, on behalf of the COSSACS Investigators‡. The Lancet Neurology, Volume 9, Issue 8, Pages 767 - 775, August 2010 doi:10.1016/S1474-4422(10)70163-0Cite or Link Using DOI
Background
Up to 50% of patients with acute stroke are taking antihypertensive drugs on hospital admission. However, whether such treatment should be continued during the immediate post-stroke period is unclear. We therefore aimed to assess the efficacy and safety of continuing or stopping pre-existing antihypertensive drugs in patients who had recently had a stroke.

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2010 Jul 27 - A panoramic, practice-based view of intravenous alteplase 3—4·5 h after stroke

Scott E Kasner a, Steven R Levine b. The Lancet Neurology, Early Online Publication, 27 July 2010
Seven randomised, placebo-controlled trials combined in a recent pooled analysis 1 reported that thrombolysis with intravenous alteplase (recombinant tissue plasminogen activator; rt-PA) is efficacious in the treatment of acute ischaemic stroke.

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2010 Jul 27 - Implementation and outcome of thrombolysis with alteplase 3—4·5 h after an acute stroke: an updated analysis from SITS-ISTR

Niaz Ahmed MD a, Prof Nils Wahlgren MD a , Prof Martin Grond MD b, Prof Michael Hennerici MD c, Prof Kennedy R Lees FRCP e, Robert Mikulik MD f, Mark Parsons FRACP g, Prof Risto O Roine MD h, Prof Danilo Toni MD i, Peter Ringleb MD d, for the SITS investigators**. The Lancet Neurology, Early Online Publication, 27 July 2010
Background
In September, 2008, the European Acute Stroke Study III (ECASS III) randomised trial and the Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Registry (SITS-ISTR) observational study reported the efficacy and safety of the extension of the time window for intravenous alteplase treatment from within 3 h to within 4·5 h after stroke onset. We aimed to assess the implementation of the wider time window, its effect on the admission-to-treatment time, and safety and functional outcome in patients recorded in SITS-ISTR.

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