2010 Oct 27 - Paediatric mortality related to pandemic influenza A H1N1 infection in England: an observational population-based study
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.
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.
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
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.
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.
Michael Hüpfl MD a, Harald F Selig MD a, Dr Peter Nagele MD a b. The Lancet, Early Online Publication, 15 October 2010
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.
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.
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.
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.
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.
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.
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.
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.
Acute coronary syndromes typically arise from rupture of a cholesterol-laden plaque with subsequent thrombotic occlusion of the coronary artery.
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
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.
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.
2010 Aug 11 - Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study
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.
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
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.
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
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.
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.
2010 Jul 27 - Implementation and outcome of thrombolysis with alteplase 3—4·5 h after an acute stroke: an updated analysis from SITS-ISTR
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.