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Lancet 07/10/2020 13:20
Practice-based learning is the backbone of the education of physicians. Hospitals, clinics, and community services are where future doctors learn, forge professional identities, and develop an orientation to patient-focused care that shape their practice.1 The COVID-19 pandemic has had profound impacts on medical education globally. For almost all medical students clinical placements stopped as health-care settings focused on the care of patients with COVID-19 and teaching in classrooms and laboratories was cancelled, leaving students to continue their studies remotely.
Lancet 07/09/2020 18:45
Treatments for cardiovascular disease are more common in women than men in primary prevention, but the reverse is seen in secondary prevention. However, consistently better outcomes are observed in women than in men, both in those with and without previous cardiovascular disease. Improving cardiovascular disease prevention and treatment, especially in LMICs, should be vigorously pursued in both women and men.
Lancet 07/09/2020 18:45
Gerald Chi and Jolanta Marszalek raise questions about subgroup analysis and interaction terms in the THEMIS trial. Interaction terms are generally underpowered. At the same time, when several subgroups are compared, interaction terms might be positive by chance because of multiplicity of testing. These are two opposing forces in the interpretation of interaction terms that have long been appreciated in clinical trials. With respect to our work, the THEMIS trial was a positive trial in which we found significant efficacy benefit of ticagrelor in the overall population of patients with stable coronary artery disease and diabetes who were studied.
Lancet 07/09/2020 18:45
The Lancet Series on drug use1 began with a paper on global patterns of opioid dependence but insufficiently emphasised that the sequelae of these epidemics persist over decades. The risk of drug-related death increases with age in people who are opioid-dependent, and the advantage that young women users ( <35 years) have of lower drug-related mortality risk diminishes as they get older.2.
Lancet 07/09/2020 18:45
Among patients with HFrEF, the anticipated aggregate treatment effects of early comprehensive disease-modifying pharmacological therapy are substantial and support the combination use of an ARNI, β blocker, MRA, and SGLT2 inhibitor as a new therapeutic standard.
Lancet 07/09/2020 18:45
Erenumab is a CGRP receptor monoclonal antibody for the preventive treatment of migraine. It has been widely prescribed in the USA after receiving US Food and Drug Administration approval in May, 2018. An estimated 7000 prescriptions are written per week,1 which, along with postmarketing reporting, have resulted in the rapid detection of serious adverse events that were not seen during clinical trials. As a result, the product label was revised on Oct 4, 2019, to include constipation with serious complications, including cases requiring hospitalisation and surgery, with most cases reported after a single dose of erenumab.
Lancet 07/09/2020 18:45
On May 21, 2020, at a special session of the Executive Committee of the Pan American Health Organization (PAHO), WHO Regional Office for the Americas, Carissa Etienne, Regional Director, declared that due to non-payment of Member States' contributions, PAHO stands on the brink of insolvency.1 As of April 30, 2020, most of the non-payment is attributable to the USA (67%); however, late payments are outstanding from Brazil, Venezuela, Mexico, Argentina, Colombia, Chile, and others, to a total of US$164·6 million.
Lancet 07/09/2020 18:45
We read with interest the Article by Deepak L Bhatt and colleagues1 on the incremental effect of ticagrelor to aspirin for patients with diabetes and stable coronary artery disease. The THEMIS trial suggested a reduction in ischaemic events but not irreversible harms in the overall population.2 The trial also hypothesised that patients with a history of previous percutaneous coronary intervention (PCI) would show a favourable efficacy–safety tradeoff. The authors found a favourable net clinical benefit in patients with previous PCI but not in those without previous PCI (appendix).
Lancet 07/07/2020 23:29
A historic and calamitous milestone was reached this week. WHO reported more than 10 million cases of COVID-19 and over 500 000 COVID-19 deaths. The world's political leaders have been tested and they have been found wanting. It's hard to recall a more lamentable response to a global emergency. Even the climate crisis had its Kyoto and Paris agreements. But despite the urgency of this continuing human catastrophe, despite the immediacy of the economic collapse we are witnessing, there has still been no moment when nations have been convened to reflect on lessons to be learned, to coordinate actions to protect citizens, and to plan for future spikes or waves of infection.
Lancet 07/02/2020 19:59
Ambulatory management of primary spontaneous pneumothorax significantly reduced the duration of hospitalisation including re-admissions in the first 30 days, but at the expense of increased adverse events. This data suggests that primary spontaneous pneumothorax can be managed for outpatients, using ambulatory devices in those who require intervention.
Lancet 07/02/2020 19:59
The Global Burden of Disease Study (GBD) 2017 provides comprehensive assessment of population health for 195 countries and territories and subnational units for selected countries, including all province-level administrative units in China. It is important to point out that, as the GBD uses a hierarchical analytical framework, data input from all GBD 2017 analytical units, national or subnational, are integrated into a single modelling process to provide a set of estimates for all locations that are internally consistent and comparable across locations and over time.
Lancet 07/02/2020 19:59
TURP and ThuVARP were equivalent for urinary symptom improvement (IPSS) 12-months post-surgery, and TURP was superior for Qmax. Anticipated laser benefits for ThuVARP of reduced hospital stay and complications were not observed.
Lancet 07/02/2020 19:59
Zarocostas J. Plain packaging ruling hailed as a victory for tobacco control. Lancet 2020; 395: 1895—In this World Report, the 14 countries with fully implemented plain packaging should have been: Australia, Canada, France, Hungary, Ireland, Israel, New Zealand, Norway, Saudi Arabia, Slovenia, Thailand, Turkey, the UK, and Uruguay. Singapore is slated to introduce plain packaging in July. This correction has been made to the online version as of June 25, 2020.
Lancet 07/02/2020 19:59
On Feb 17, 2020, Doctors for Assange demanded an end to the torture and medical neglect of Julian Assange.1 Yet no responsible authority has acted. Nils Melzer, the UN Special Rapporteur on Torture and other Cruel, Inhuman or Degrading Treatment or Punishment, and two medical experts visited Mr Assange in prison in May, 2019, concluding that his treatment constituted psychological torture, a form of torture aimed at destroying the personality of an individual.2 The situation has deteriorated since then, with continued abuses of Mr Assange's fundamental rights and the medical risks posed by COVID-19.
Lancet 07/02/2020 19:59
The Trump administration issued the Protecting Life in Global Health Assistance policy in 2017. This policy is an expansion of the Global Gag Rule that blocks US global health assistance to foreign non-governmental organisations that provide, counsel on, refer to, or advocate for abortion services; even if they do so with their own funding and in countries where abortion is legal. Following an additional policy expansion in 2019, foreign organisations that comply with the policy must now attach it to all subgrants that they give to other foreign organisations, including those that do not involve US global health assistance.
Lancet 07/02/2020 19:59
Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery.

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