2011 Jan 18 - Neurological complications of acute ischaemic stroke

Joyce S Balami MRCP a ‡, Ruo-Li Chen PhD b ‡, Iris Q Grunwald PhD c, Prof Alastair M Buchan FMedSci c d. The Lancet Neurology, Early Online Publication, 18 January 2011
Complications after ischaemic stroke, including both neurological and medical complications, are a major cause of morbidity and mortality. Neurological complications, such as brain oedema or haemorrhagic transformation, occur earlier than do medical complications and can affect outcomes with potential serious short-term and long-term consequences.

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2011 Jan 20 - Nosocomial pneumonia: de-escalation is what matters

Santiago Ewig a. The Lancet Infectious Diseases, Early Online Publication, 20 January 2011
The American Thoracic Society guideline 1 for management of hospital-acquired, ventilator-associated, and health-care associated pneumonia in adults is probably one of the most authoritative document for clinicians caring for patients with nosocomial pneumonia worldwide. This authority stems from the interpretation of available data for a complex issue provided by an experienced group of clinical scientists, resulting in a seemingly very differentiated and balanced set of useful recommendations. N ...

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2011 Jan 20 - Implementation of guidelines for management of possible multidrug-resistant pneumonia in intensive care: an observational, multicentre cohort study

Prof Daniel H Kett MD a , Ennie Cano PharmD a, Andrew A Quartin MD a, Prof Julie E Mangino MD b, Prof Marcus J Zervos MD c, Paula Peyrani MD d, Cynthia M Cely MD a, Kimbal D Ford PharmD e, Ernesto G Scerpella MD e, Prof Julio A Ramirez MD d, the Improving Medicine through Pathway Assessment of Critical Therapy of Hospital-Acquired Pneumonia (IMPACT-HAP) Investigators‡ The Lancet Infectious Diseases, Early Online Publication, 20 January 2011
Background
The American Thoracic Society and Infectious Diseases Society of America provide guidelines for management of hospital-acquired, ventilator-associated, and health-care-associated pneumonias, consisting of empirical antibiotic regimens for patients at risk for multidrug-resistant pathogens. We aimed to improve compliance with these guidelines and assess outcomes.

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2011 Jan 18 - Neurological complications of acute ischaemic stroke

Joyce S Balami MRCP a ‡, Ruo-Li Chen PhD b ‡, Iris Q Grunwald PhD c, Prof Alastair M Buchan FMedSci c d. The Lancet Neurology, Early Online Publication, 18 January 2011
Complications after ischaemic stroke, including both neurological and medical complications, are a major cause of morbidity and mortality. Neurological complications, such as brain oedema or haemorrhagic transformation, occur earlier than do medical complications and can affect outcomes with potential serious short-term and long-term consequences.

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2011 Jan - Clinical outcomes of health-care-associated infections and antimicrobial resistance in patients admitted to European intensive-care units: a cohort study

Original TextDr Marie-Laurence Lambert MD a , Carl Suetens MD b, Anne Savey MD c, Mercedes Palomar MD d, Prof Michael Hiesmayr MD e, Ingrid Morales MD a, Prof Antonella Agodi PhD f, Prof Uwe Frank MD g, Karl Mertens MSc a, Prof Martin Schumacher PhD h, Martin Wolkewitz PhD i. The Lancet Infectious Diseases, Volume 11, Issue 1, Pages 30 - 38, January 2011. Published Online: 01 December 2010
Background
Patients admitted to intensive-care units are at high risk of health-care-associated infections, and many are caused by antimicrobial-resistant pathogens. We aimed to assess excess mortality and length of stay in intensive-care units from bloodstream infections and pneumonia.

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2011 Jan 19 - Augmented CPR: rescue after the ResQ trial

Peter Nagele a. The Lancet, Early Online Publication, 19 January 2011doi:10.1016/S0140-6736(10)62309-4
Out-of-hospital cardiac arrest remains a grim situation. Without cardiopulmonary resuscitation (CPR), cardiac arrest is invariably fatal, and even under the best possible circumstances survival rates often do not exceed 10%.

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2011 Jan 19 - Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial

Tom P Aufderheide MD a , Ralph J Frascone MD b, Marvin A Wayne MD c, Brian D Mahoney MD d, Prof Robert A Swor DO e, Robert M Domeier MD f, Prof Michael L Olinger MD g, Richard G Holcomb PhD h, Prof David E Tupper PhD i, Demetris Yannopoulos MD i, Prof Keith G Lurie MD d i. The Lancet, Early Online Publication, 19 January 2011
Background
Active compression-decompression cardiopulmonary resuscitation (CPR) with decreased intrathoracic pressure in the decompression phase can lead to improved haemodynamics compared with standard CPR. We aimed to assess effectiveness and safety of this intervention on survival with favourable neurological function after out-of-hospital cardiac arrest.

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2011 Jan 20 - Implementation of guidelines for management of possible multidrug-resistant pneumonia in intensive care: an observational, multicentre cohort study

Daniel H Kett MD a , Ennie Cano PharmD a, Andrew A Quartin MD a, Prof Julie E Mangino MD b, Prof Marcus J Zervos MD c, Paula Peyrani MD d, Cynthia M Cely MD a, Kimbal D Ford PharmD e, Ernesto G Scerpella MD e, Prof Julio A Ramirez MD d, the Improving Medicine through Pathway Assessment of Critical Therapy of Hospital-Acquired Pneumonia (IMPACT-HAP) Investigators‡. The Lancet Infectious Diseases, Early Online Publication, 20 January 2011doi:10.1016/S1473-3099(10)70314-5
Background
The American Thoracic Society and Infectious Diseases Society of America provide guidelines for management of hospital-acquired, ventilator-associated, and health-care-associated pneumonias, consisting of empirical antibiotic regimens for patients at risk for multidrug-resistant pathogens. We aimed to improve compliance with these guidelines and assess outcomes.

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2011 Jan 8 - Decompression illness

Dr Richard D Vann PhD a , Frank K Butler MD b, Simon J Mitchell FANZCA c, Prof Richard E Moon MD a. The Lancet, Volume 377, Issue 9760, Pages 153 - 164, 8 January 2011
Decompression illness is caused by intravascular or extravascular bubbles that are formed as a result of reduction in environmental pressure (decompression). The term covers both arterial gas embolism, in which alveolar gas or venous gas emboli (via cardiac shunts or via pulmonary vessels) are introduced into the arterial circulation, and decompression sickness, which is caused by in-situ bubble formation from dissolved inert gas.

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2010 Dec 25 - Lancet Comment - The PIERS trial: hope for averting deaths from pre-eclampsia

Katherine C Teela a, Rebecca M Ferguson a, France A Donnay a, Gary L Darmstadt a. The Lancet, Early Online Publication, 25 December 2010
Maternal and neonatal deaths are decreasing worldwide, 1 , 2 but we are still far from achieving Millennium Development Goals 4 on child health and 5 on maternal health. Between 10% and 15% of maternal deaths are thought to be associated with hypertensive disorders of pregnancy, with 5—10% associated specifically with pre-eclampsia and eclampsia. 3 In about 30% of patients with pre-eclampsia, placental insufficiency or reduced placental blood flow causes intrauterine growth restriction or fetal death. ...

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2010 Dec 25 - Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model

Dr Peter von Dadelszen MBChB a b e , Beth Payne BSc a e, Jing Li MSS a e, J Mark Ansermino MBBCh d e, Prof Fiona Broughton Pipkin Dphil m, Anne-Marie Côté MD g, M Joanne Douglas MD d, Andrée Gruslin MD f, Jennifer A Hutcheon PhD a e, Prof KS Joseph MD a b e, Prof Phillipa M Kyle MBChB k, Tang Lee MSc a e, Pamela Loughna MBChB m, Jennifer M Menzies MSc a e, Mario Merialdi MD p, Alexandra L Millman BSc a, M Peter Moore MBChB l, Prof Jean-Marie Moutquin MD h, Annie B Ouellet MD h, Prof Graeme N Smith MD i, Prof James J Walker MBChB n, Prof Keith R Walley MD c, Barry N Walters MBChB o, Mariana Widmer MSc p, Prof Shoo K Lee MBBS j, Prof James A Russell MD c, Laura A Magee MD a b c e, for the PIERS Study Group. The Lancet, Early Online Publication, 25 December 2010
Background
Pre-eclampsia is a leading cause of maternal deaths. These deaths mainly result from eclampsia, uncontrolled hypertension, or systemic inflammation. We developed and validated the fullPIERS model with the aim of identifying the risk of fatal or life-threatening complications in women with pre-eclampsia within 48 h of hospital admission for the disorder.

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2010 Dec 20 - Very early hypothermia induction in patients with severe brain injury (the National Acute Brain Injury Study: Hypothermia II): a randomised trial

Prof Guy L Clifton MD a , Alex Valadka MD a b, David Zygun MD c, Prof Christopher S Coffey PhD e f, Pamala Drever RN a, Sierra Fourwinds g, L Scott Janis PhD h, Elizabeth Wilde PhD i, Pauline Taylor RN c, Kathy Harshman RN j, Adam Conley MD a, Ava Puccio RN j, Prof Harvey S Levin PhD i, Stephen R McCauley PhD i, Prof Richard D Bucholz MD k, Prof Kenneth R Smith MD k, John H Schmidt MD l, James N Scott MD d, Prof Howard Yonas MD m, Prof David O Okonkwo MD jThe Lancet Neurology, Early Online Publication, 20 December 2010
Background
The inconsistent effect of hypothermia treatment on severe brain injury in previous trials might be because hypothermia was induced too late after injury. We aimed to assess whether very early induction of hypothermia improves outcome in patients with severe brain injury.

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2010 Dec 1 - Does microbial resistance matter?

Jean-Louis Vincent. The Lancet Infectious Diseases, Early Online Publication, 1 December 2010
Infections caused by multidrug-resistant bacteria (MRB) are undoubtedly associated with higher morbidity and mortality and greater costs than are other infections. 1—4 Patients with MRB infections are more seriously ill than are patients infected with antibiotic-susceptible bacteria, and have higher severity scores and longer hospital stays. These patients typically have also received recent antibiotic therapy and many have some degree of immunosuppression. Therefore, that infection related to MRB ...

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2010 Dec 1 - Clinical outcomes of health-care-associated infections and antimicrobial resistance in patients admitted to European intensive-care units: a cohort study

Dr Marie-Laurence Lambert MD a , Carl Suetens MD b, Anne Savey MD c, Mercedes Palomar MD d, Prof Michael Hiesmayr MD e, Ingrid Morales MD a, Prof Antonella Agodi PhD f, Prof Uwe Frank MD g, Karl Mertens MSc a, Prof Martin Schumacher PhD h, Martin Wolkewitz PhD i. The Lancet Infectious Diseases, Early Online Publication, 1 December 2010
Background
Patients admitted to intensive-care units are at high risk of health-care-associated infections, and many are caused by antimicrobial-resistant pathogens. We aimed to assess excess mortality and length of stay in intensive-care units from bloodstream infections and pneumonia.

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2010 Nov 27 - Lancet Comment: Delirium treatment: an unmet challenge

Yoanna Skrobik. The Lancet, Volume 376, Issue 9755, Pages 1805 - 1807, 27 November 2010
Rivastigmine, a cholinesterase inhibitor, has been used to treat delirium in elderly patients with stroke. 1 A biologically plausible premise—that impaired cholinergic transmission might either cause or worsen delirium—led to a randomised, placebo-controlled, double-blind trial by Maarten van Eijk and colleagues 2 in The Lancet in which they added rivastigmine or placebo to usual treatment of patients in intensive care.

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2010 Nov 16 - Clostridium difficile infection in Europe: a hospital-based survey

Dr Martijn P Bauer MD a b , Daan W Notermans PhD a, Birgit HB van Benthem PhD a, Jon S Brazier PhD c, Prof Mark H Wilcox MD d, Prof Maja Rupnik PhD e, Dominique L Monnet PhD f, Prof Jaap T van Dissel PhD b, Ed J Kuijper PhD b, for the ECDIS Study Group‡. The Lancet, Early Online Publication, 16 November 2010
Background
Little is known about the extent of Clostridium difficile infection in Europe. Our aim was to obtain a more complete overview of C difficile infection in Europe and build capacity for diagnosis and surveillance.

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2010 Nov 5 - Lancet Comment: Delirium treatment: an unmet challenge

Yoanna Skrobik aThe Lancet, Early Online Publication, 5 November 2010
Rivastigmine, a cholinesterase inhibitor, has been used to treat delirium in elderly patients with stroke.1 A biologically plausible premise—that impaired cholinergic transmission might either cause or worsen delirium—led to a randomised, placebo-controlled, double-blind trial by Maarten van Eijk and colleagues2 in The Lancet in which they added rivastigmine or placebo to usual treatment of patients in intensive care.

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2010 Nov 5 - Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomised trial

Maarten MJ van Eijk MD a, Prof Kit CB Roes PhD b, Marina LH Honing MD c, Michael A Kuiper MD d, Attila Karakus MD e, Mathieu van der Jagt MD f, Peter E Spronk MD g, Prof Willem A van Gool MD h, Prof Roos C van der Mast MD i, Prof Jozef Kesecioglu MD a, Dr Arjen JC. The Lancet, Early Online Publication, 5 November 2010
Background
Delirium is frequently diagnosed in critically ill patients and is associated with adverse outcome. Impaired cholinergic neurotransmission seems to have an important role in the development of delirium. We aimed to establish the effect of the cholinesterase inhibitor rivastigmine on the duration of delirium in critically ill patients.

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2010 Nov 8 - Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial

P. falciparum ring form

Arjen M Dondorp MD l, Caterina I Fanello PhD l, Ilse CE Hendriksen MD l, Ermelinda Gomes MD a, Amir Seni MD a, Kajal D Chhaganlal MD a, Kalifa Bojang FRCP b, Rasaq Olaosebikan FWACP b, Nkechinyere Anunobi FMCpaed b, Prof Kathryn Maitland PhD d, Esther Kivaya MSc d, Prof Tsiri Agbenyega PhD c, Samuel Blay Nguah FWACPCH c, Jennifer Evans MRCPCH c, Samwel Gesase MD e, Catherine Kahabuka MD e, George Mtove MD g, Behzad Nadjm MD f, Jacqueline Deen MD f, Juliet Mwanga-Amumpaire MD j, Margaret Nansumba MD j, Corine Karema MD h, Noella Umulisa MD h, Aline Uwimana MD h, Olugbenga A Mokuolu FWACP i, Olanrewaju T Adedoyin FWACP i, Prof Wahab BR Johnson FWACP i, Prof Antoinette K Tshefu MD k, Marie A Onyamboko MB k, Tharisara Sakulthaew BNS l, Wirichada Pan Ngum PhD l, Kamolrat Silamut PhD l, Kasia Stepniewska PhD l, Charles J Woodrow MRCP l, Delia Bethell MRCPCH m, Bridget Wills FRCPCH o, Martina Oneko MD p, Prof Tim E Peto FRCP m, Lorenz von Seidlein PhD n, Prof Nicholas PJ Day FRCP l, Prof Nicholas J White FRS l , for the AQUAMAT group‡. The Lancet, Early Online Publication, 8 November 2010doi:10.1016/S0140-6736(10)61924-1Cite or Link Using DOI

Background
Severe malaria is a major cause of childhood death and often the main reason for paediatric hospital admission in sub-Saharan Africa. Quinine is still the established treatment of choice, although evidence from Asia suggests that artesunate is associated with a lower mortality. We compared parenteral treatment with either artesunate or quinine in African children with severe malaria.

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2010 Oct 27 - Paediatric mortality related to H1N1 infection in England

Robert A Fowler a, Philippe Jouvet b. The Lancet, Early Online Publication, 27 October 2010
In The Lancet Nabihah Sachedina and Liam Donaldson1 analyse paediatric mortality related to pandemic influenza A H1N1 in England. The investigators used sensitive case-finding procedures and follow-up ascertainment of H1N1 status to determine population mortality rates for children of different ages and at various pre-existing states of health.

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