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Lancet 09/19/2019 22:16
In a provocative study titled “Does the Hippocratic Oath promote burnout?”, more than 2600 physicians were asked whether putting patient needs before their own, as required by their oath, heightened the danger of burnout. The results were mixed: roughly half believed that it did not and half were unsure or thought that it did. These findings confront one of the most cherished tenets of medicine, that doctors must put their pledge to their patients above everything else: their time, compensation, families, and even their own health and wellbeing.
Lancet 09/19/2019 21:16
For patients with migraine, preventive treatments are key. However, available drugs, including β blockers, antidepressants, antiepileptics, and botulinum toxin were licensed for other disorders and their efficacy in preventing migraine was shown more often than not through serendipity. The scarcity of novel therapeutic approaches reflects the partial and sometimes nebulous knowledge of the neurobiology of migraine. Although drug repurposing has become a widespread migraine prevention strategy, targets and mechanisms of action are not clearly defined.
Lancet 09/19/2019 20:16
Any western medical institution more than a century old and which claims to stand for peace and justice has to confront a painful truth—that its success was built on the savage legacy of colonialism. Perhaps we deal with uncomfortable pasts by burying them, excusing them, or atoning for them. The Lancet, for example, is a colonial-era institution. Its editors today must be exquisitely sensitive to the ethics of memory. How easy it is for us to pronounce on what others should do from our position of advantage.
Lancet 09/19/2019 19:16
Tess Legg and colleagues1 make unsubstantiated claims about the Foundation for a Smoke-Free World's progress and independence. They cite disclosures made in our 2018 tax return2 to suggest we are struggling.1 However, the authors’ assessment disregards the substantial progress outlined in our annual report,3 which was released alongside the tax return. The Foundation is where it was projected2 to be when we launched in 2017.4.
Lancet 09/19/2019 19:16
Hospitalised patients swap their clothes for a hospital gown and their independence for compliance with hospital routines and staff's instructions. Much of their identity and individuality can be effaced under these circumstances, especially when they are regarded as one of many clinical problems to be dealt with as efficiently as possible.1 This problem is considerably worse for the increasing population of older geriatric patients whose common multimorbidity, waning faculties, cognitive decline, dependence, and poor appearance all act to distance the health-care team from the patient as a person.
Lancet 09/19/2019 19:16
50 years after a noble but flawed attempt to eradicate malaria in the mid-20th century, the global malaria community is once again seriously considering eradication. Momentum towards eradication has been building for decades, and more than half of the world's countries are now malaria free. Since 2000, a surge of global progress has occurred, facilitated by the roll-out of new technologies and the substantial growth in political and financial commitment by countries, regions, and their global partners.
Lancet 09/19/2019 19:16
McElearney A, Murphy C, Shevlin M, Stephenson P, Monaghan M, Adamson G. A whole-school child maltreatment prevention programme in primary schools in Northern Ireland: 1 year results of Keeping Safe, a cluster-randomised controlled trial. Lancet 2018; 392: S62—In this Meeting Abstract, the first and third sentence of the Findings section should read as follows: “33 schools were allocated to the intervention (1649 children) and 31 to control (1550 children) groups… After year 1 the intervention group had 31 schools (two schools withdrew in July, 2016, after randomisation, citing changing school leadership as the reason for withdrawal) and the control group had 30 schools (one withdrew in June, 2016, citing sensitive content of questions in ou.
Lancet 09/19/2019 19:16
We commend Kim Price and Barry Godfrey1 for their thoughtful work on prison health, looking to the period since the 19th century and showing the remnants of the Victorian past in today's prison health in the UK. Particularly, we support their approach towards mental health care for prisoners. However, we would like to add two essential elements that are important for preventing infection in the prison population, both of which are unfortunately missing in prisons in the UK and many other parts of the world.
Lancet 09/19/2019 19:16
We thank John Bradley and colleagues1 for their inquiry into our results and conclusions. Our study design of a few clusters (a total of eight were randomly assigned to the control or intervention group) was necessitated by the RIMDAMAL trial being a modestly funded pilot trial on ivermectin efficacy and safety.2 Furthermore, because we hypothesised that the ivermectin treatment would most affect clinical malaria incidence in this population living in a hyperendemic area, frequent measures of malaria incidence by study nurses were required.
Lancet 09/19/2019 19:16
We read with interest the article by Foy and colleagues1 on ivermectin for malaria control and are pleased such research is being conducted. However, we have serious misgivings about their statistical methods and conclusions. It is unlikely that a trial with only four clusters per arm could reach such firm conclusions. Individual participants in cluster-randomised trials do not constitute independent observations. Analysis must account for the clustered structure of the data and we do not believe this was done.
Lancet 09/19/2019 19:16
Despite international efforts to control and eliminate malaria for the past century, the disease continues to be a public health threat, particularly in sub-Saharan Africa. In 2017, there were an estimated 200 million malaria cases and 403 000 deaths across the region, of which 61% were children younger than 5 years.1 The WHO Director-General's 1954 annual report,2 considered at the Eighth World Health Assembly, adopted malaria eradication for all endemic countries except mainland sub-Saharan Africa and Madagascar (resolution WHA8.30 [1955] and statement of Dr Williams).
Lancet 09/19/2019 19:16
All oral antihypertensives reduced blood pressure to the reference range in most women. As single drugs, nifedipine retard use resulted in a greater frequency of primary outcome attainment than labetalol or methyldopa use. All three oral drugs—methyldopa, nifedipine, and labetalol—are viable initial options for treating severe hypertension in low-resource settings.
Lancet 09/19/2019 19:16
Perioperative covert stroke is associated with an increased risk of cognitive decline 1 year after non-cardiac surgery, and perioperative covert stroke occurred in one in 14 patients aged 65 years and older undergoing non-cardiac surgery. Research is needed to establish prevention and management strategies for perioperative covert stroke.
Lancet 09/13/2019 12:13
We agree with Sachin Atre that building a tuberculosis-free world requires circumspect reflection on the failures of the past. Doing so also demands renewed ambition; only with sufficient political will and financial investments can we end the epidemic. As we underscore in the Commission,1 failure to end the epidemic is morally inexcusable and economically indefensible. We must therefore move beyond the narrow view that tuberculosis is the problem of the world's poorest societies and recognise that the disease is a universal health problem for an interdependent global population.
Lancet 09/13/2019 09:13
The burden of schizophrenia remains high, with one in 100 people affected globally over a lifetime.1 Symptoms are disabling, with auditory hallucinations, delusions, lack of motivation, cognitive impairment, and functional deficits. Despite advances in our understanding of the biological underpinnings of the illness, cure remains elusive. Antipsychotic medications are the mainstay of pharmacological treatment, but selecting the optimal medication for the individual patient is a delicate balance between efficacy and physical side-effects.
Lancet 09/13/2019 08:14
Asthma is remarkably prevalent, although most patients have mild, intermittently symptomatic disease. For these patients, as-needed short-acting β agonists (SABAs) with or without maintenance inhaled corticosteroids have formed the backbone of therapy. Yet adherence to daily maintenance regimens is often poor, especially in rarely symptomatic disease, such that alternative approaches are needed. In The Lancet, Jo Hardy and colleagues1 present the results of PRACTICAL, a study that investigated the real-world efficacy of single-inhaler reliever therapy in adults with mild to moderate asthma.

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