New estimates of malaria deaths: concern and opportunity.

Lancet. 2012 Feb 4;379(9814):385

Authors:

PMID: 22305210 [PubMed - in process]

Genomic medicine and the NHS: it is possible.

Lancet. 2012 Feb 4;379(9814):386

Authors:

PMID: 22305212 [PubMed - in process]

Keeping patients safe.

Lancet. 2012 Feb 4;379(9814):386

Authors:

PMID: 22305211 [PubMed - in process]

Joseph Lau: mastering the meta-analysis.

Lancet. 2012 Feb 4;379(9814):403

Authors: Kirby T

PMID: 22305215 [PubMed - in process]

Born to be wild?

Lancet. 2012 Feb 4;379(9814):395

Authors: Fletcher T

PMID: 22305213 [PubMed - in process]

Treatment of Helicobacter pylori in Latin America.

Lancet. 2012 Feb 4;379(9814):407; author reply 408-9

Authors: Slater CM, Ford AC

PMID: 22305216 [PubMed - in process]

Treatment of Helicobacter pylori in Latin America.

Lancet. 2012 Feb 4;379(9814):407-8; author reply 408-9

Authors: Gatta L, Vakil N, Vaira D

PMID: 22305217 [PubMed - in process]

Treatment of Helicobacter pylori in Latin America.

Lancet. 2012 Feb 4;379(9814):408; author reply 408-9

Authors: Graham DY, Trespalacios AA

PMID: 22305218 [PubMed - in process]

A tale of devolution, abolition, and performance.

Lancet. 2012 Feb 4;379(9814):409

Authors: Malik AU, Khalil M, Ulikpan A, Ahmad AM

PMID: 22305220 [PubMed - in process]

Improving health: can Pakistan prioritise?

Lancet. 2012 Feb 4;379(9814):410

Authors: Jalal S

PMID: 22305221 [PubMed - in process]

Non-communicable diseases and the food and beverage industry.

Lancet. 2012 Feb 4;379(9814):410-1

Authors: Voûte J, Heughan A, Casimiro J

PMID: 22305222 [PubMed - in process]

A tale of devolution, abolition, and performance.

Lancet. 2012 Feb 4;379(9814):410

Authors: Dodani S, Chotani RA

PMID: 22305223 [PubMed - in process]

The Integrated Academic Training programme at Oxford.

Lancet. 2012 Feb 4;379(9814):411

Authors: Fleming KA, Best D

PMID: 22305224 [PubMed - in process]

Global malaria mortality between 1980 and 2010: a systematic analysis.

Lancet. 2012 Feb 4;379(9814):413-31

Authors: Murray CJ, Rosenfeld LC, Lim SS, Andrews KG, Foreman KJ, Haring D, Fullman N, Naghavi M, Lozano R, Lopez AD

Abstract

BACKGROUND: During the past decade, renewed global and national efforts to combat malaria have led to ambitious goals. We aimed to provide an accurate assessment of the levels and time trends in malaria mortality to aid assessment of progress towards these goals and the focusing of future efforts.

METHODS: We systematically collected all available data for malaria mortality for the period 1980-2010, correcting for misclassification bias. We developed a range of predictive models, including ensemble models, to estimate malaria mortality with uncertainty by age, sex, country, and year. We used key predictors of malaria mortality such as Plasmodium falciparum parasite prevalence, first-line antimalarial drug resistance, and vector control. We used out-of-sample predictive validity to select the final model.

FINDINGS: Global malaria deaths increased from 995,000 (95% uncertainty interval 711,000-1,412,000) in 1980 to a peak of 1,817,000 (1,430,000-2,366,000) in 2004, decreasing to 1,238,000 (929,000-1,685,000) in 2010. In Africa, malaria deaths increased from 493,000 (290,000-747,000) in 1980 to 1,613,000 (1,243,000-2,145,000) in 2004, decreasing by about 30% to 1,133,000 (848,000-1,591,000) in 2010. Outside of Africa, malaria deaths have steadily decreased from 502,000 (322,000-833,000) in 1980 to 104,000 (45,000-191,000) in 2010. We estimated more deaths in individuals aged 5 years or older than has been estimated in previous studies: 435,000 (307,000-658,000) deaths in Africa and 89,000 (33,000-177,000) deaths outside of Africa in 2010.

INTERPRETATION: Our findings show that the malaria mortality burden is larger than previously estimated, especially in adults. There has been a rapid decrease in malaria mortality in Africa because of the scaling up of control activities supported by international donors. Donor support, however, needs to be increased if malaria elimination and eradication and broader health and development goals are to be met.

FUNDING: The Bill & Melinda Gates Foundation.

PMID: 22305225 [PubMed - in process]

Hereditary angio-oedema.

Lancet. 2012 Feb 4;379(9814):474-81

Authors: Longhurst H, Cicardi M

Abstract

Hereditary angio-oedema is caused by a heterozygous deficiency of C1 inhibitor. This inhibitor regulates several inflammatory pathways, and patients with hereditary angio-oedema have intermittent cutaneous or mucosal swellings because of a failure to control local production of bradykinin. Swellings typically evolve in several hours and persist for a few days. In addition to orofacial angio-oedema, painless swellings affect peripheries, which causes disfigurement or interference with work and other activities of daily living. Angio-oedema affecting the gastrointestinal tract or abdominal viscera causes severe pain often with vomiting due to oedematous bowel obstruction. About 2% of swellings involve the larynx and can be fatal if untreated. About 50% of patients have laryngeal swellings that are potentially fatal despite prophylaxis. In this Seminar we review the clinical features, diagnosis, and management of hereditary angio-oedema, with specific emphasis on the new treatments available for acute swellings.

PMID: 22305226 [PubMed - in process]

A lethal injection?

Lancet. 2012 Feb 4;379(9814):492

Authors: Arumugam D, Atherton JJ, Martin PT

PMID: 22305227 [PubMed - in process]

The growing threat to medical independence in conflict zones.

Lancet. 2012 Feb 4;379(9814):e31-2

Authors: Kevat D, Lander F, Loff B

PMID: 22305228 [PubMed - in process]

Editorial code of conduct.

Lancet. 2012 Feb 4;379(9814):e31

Authors: Brivet FG

PMID: 22305230 [PubMed - in process]

Editorial code of conduct.

Lancet. 2012 Feb 4;379(9814):e31

Authors: Wager E

PMID: 22305229 [PubMed - in process]

McCoy’s syndrome: a new medical entity.

Lancet. 2012 Feb 4;379(9814):e32

Authors: Martinez JB, de Padua AI

PMID: 22305231 [PubMed - in process]

The implications of PIP are more than just cosmetic.

Lancet. 2012 Feb 1;

Authors: Smith R, Lunt N, Hanefeld J

PMID: 22305764 [PubMed - as supplied by publisher]

Evidence supports the obvious: suicides need not happen.

Lancet. 2012 Feb 1;

Authors: Conwell Y, Farley-Toombs C

PMID: 22305765 [PubMed - as supplied by publisher]

Depression in adolescence.

Lancet. 2012 Feb 1;

Authors: Thapar A, Collishaw S, Pine DS, Thapar AK

Abstract

Unipolar depressive disorder in adolescence is common worldwide but often unrecognised. The incidence, notably in girls, rises sharply after puberty and, by the end of adolescence, the 1 year prevalence rate exceeds 4%. The burden is highest in low-income and middle-income countries. Depression is associated with substantial present and future morbidity, and heightens suicide risk. The strongest risk factors for depression in adolescents are a family history of depression and exposure to psychosocial stress. Inherited risks, developmental factors, sex hormones, and psychosocial adversity interact to increase risk through hormonal factors and associated perturbed neural pathways. Although many similarities between depression in adolescence and depression in adulthood exist, in adolescents the use of antidepressants is of concern and opinions about clinical management are divided. Effective treatments are available, but choices are dependent on depression severity and available resources. Prevention strategies targeted at high-risk groups are promising.

PMID: 22305766 [PubMed - as supplied by publisher]

Implementation of mental health service recommendations in England and Wales and suicide rates, 1997-2006: a cross-sectional and before-and-after observational study.

Lancet. 2012 Feb 1;

Authors: While D, Bickley H, Roscoe A, Windfuhr K, Rahman S, Shaw J, Appleby L, Kapur N

Abstract

BACKGROUND: Research investigating which aspects of mental health service provision are most effective in prevention of suicide is scarce. We aimed to examine the uptake of key mental health service recommendations over time and to investigate the association between their implementation and suicide rates. METHODS: We did a descriptive, cross-sectional, and before-and-after analysis of national suicide data in England and Wales. We collected data for individuals who died by suicide between 1997 and 2006 who were in contact with mental health services in the 12 months before death. Data were obtained as part of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. When denominator data were missing, we used information from the Mental Health Minimum Data Set. We compared suicide rates for services implementing most of the recommendations with those implementing fewer recommendations and examined rates before and after implementation. We stratified results for level of socioeconomic deprivation and size of service provider. FINDINGS: The average number of recommendations implemented increased from 0·3 per service in 1998 to 7·2 in 2006. Implementation of recommendations was associated with lower suicide rates in both cross-sectional and before-and-after analyses. The provision of 24 h crisis care was associated with the biggest fall in suicide rates: from 11·44 per 10 000 patient contacts per year (95% CI 11·12-11·77) before to 9·32 (8·99-9·67) after (p<0·0001). Local policies on patients with dual diagnosis (10·55; 10·23-10·89 before vs 9·61; 9·18-10·05 after, p=0·0007) and multidisciplinary review after suicide (11·59; 11·31-11·88 before vs 10·48; 10·13-10·84 after, p<0·0001) were also associated with falling rates. Services that did not implement recommendations had little reduction in suicide. The biggest falls in suicide seemed to be in services with the most deprived catchment areas (incidence rate ratio 0·90; 95% CI 0·88-0·92) and the most patients (0·86; 0·84-0·88). INTERPRETATION: Our findings suggest that aspects of provision of mental health services can affect suicide rates in clinical populations. Investigation of the relation between new initiatives and suicide could help to inform future suicide prevention efforts and improve safety for patients receiving mental health care. FUNDING: National Patient Safety Agency, UK.

PMID: 22305767 [PubMed - as supplied by publisher]

Do differences in blood pressure between arms matter?

Lancet. 2012 Jan 27;

Authors: McManus RJ, Mant J

PMID: 22293365 [PubMed - as supplied by publisher]

WHO’s relationship with the Stop TB Partnership.

Lancet. 2012 Jan 27;

Authors: Espinal MA

PMID: 22293366 [PubMed - as supplied by publisher]

Will increased funding for neglected tropical diseases really make poverty history?

Lancet. 2012 Jan 27;

Authors: Allen T, Parker M

PMID: 22293367 [PubMed - as supplied by publisher]

WHO’s relationship with the Stop TB Partnership.

Lancet. 2012 Jan 27;

Authors: Raviglione M, Nunn P, Floyd K, Getahun H, Grzemska M, Weil D, Weyer K

PMID: 22293368 [PubMed - as supplied by publisher]

Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis.

Lancet. 2012 Jan 27;

Authors: Clark CE, Taylor RS, Shore AC, Ukoumunne OC, Campbell JL

Abstract

BACKGROUND: Differences in systolic blood pressure (SBP) of 10 mm Hg or more or 15 mm Hg or more between arms have been associated with peripheral vascular disease and attributed to subclavian stenosis. We investigated whether an association exists between this difference and central or peripheral vascular disease, and mortality. METHODS: We searched Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane, and Medline In Process databases for studies published before July, 2011, showing differences in SBP between arms, with data for subclavian stenosis, peripheral vascular disease, cerebrovascular disease, cardiovascular disease, or survival. We used random effects meta-analysis to combine estimates of the association between differences in SBP between arms and each outcome. FINDINGS: We identified 28 eligible studies for review, 20 of which were included in our meta-analyses. In five invasive studies using angiography, mean difference in SBP between arms was 36·9 mm Hg (95% CI 35·4-38·4) for proven subclavian stenosis (>50% occlusion), and a difference of 10 mm Hg or more was strongly associated with subclavian stenosis (risk ratio [RR] 8·8, 95% CI 3·6-21·2). In non-invasive studies, pooled findings showed that a difference of 15 mm Hg or more was associated with peripheral vascular disease (nine cohorts; RR 2·5, 95% CI 1·6-3·8; sensitivity 15%, 9-23; specificity 96%, 94-98); pre-existing cerebrovascular disease (five cohorts; RR 1·6, 1·1-2·4; sensitivity 8%, 2-26; specificity 93%, 86-97); and increased cardiovascular mortality (four cohorts; hazard ratio [HR] 1·7, 95% CI 1·1-2·5) and all-cause mortality (HR 1·6, 1·1-2·3). A difference of 10 mm Hg or higher was associated with peripheral vascular disease (five studies; RR 2·4, 1·5-3·9; sensitivity 32%, 23-41; specificity 91%, 86-94). INTERPRETATION: A difference in SBP of 10 mm Hg or more, or of 15 mm Hg or more, between arms might help to identify patients who need further vascular assessment. A difference of 15 mm Hg or more could be a useful indicator of risk of vascular disease and death. FUNDING: Royal College of General Practitioners, South West GP Trust, and Peninsula Collaboration for Leadership in Applied Health Research and Care.

PMID: 22293369 [PubMed - as supplied by publisher]

Burn size and survival probability in paediatric patients in modern burn care: a prospective observational cohort study.

Lancet. 2012 Jan 30;

Authors: Kraft R, Herndon DN, Al-Mousawi AM, Williams FN, Finnerty CC, Jeschke MG

Abstract

BACKGROUND: Patient survival after severe burn injury is largely determined by burn size. Modern developments in burn care have greatly improved survival and outcomes. However, no large analysis of outcomes in paediatric burn patients with present treatment regimens exists. This study was designed to identify the burn size associated with significant increases in morbidity and mortality in paediatric patients. METHODS: We undertook a single-centre prospective observational cohort study using clinical data for paediatric patients with burns of at least 30% of their total body surface area (TBSA). Patients were stratified by burn size in 10% increments, ranging from 30% to 100% TBSA, with a secondary assignment made according to the outcome of a receiver operating characteristic (ROC) analysis. Statistical analysis was done with Student’s t test, χ(2) test, logistic regression, and ROC analysis, as appropriate, with significance set at p<0·05. FINDINGS: 952 severely burned paediatric patients were admitted to the centre between 1998 and 2008. All groups were comparable in age (mean 7·3 [SD 5·3] years, ranging from 6·1 [5·1] years in the 30-39% TBSA group to 9·6 [5·4] years in the 90-100% TBSA group) and sex distribution (628 [66%] boys, ranging from 59% [73/123] in the 60-69% TBSA group to 82% [42/51] in the 90-100% TBSA group). 123 (13%) patients died (increasing from 3% [five of 180] in the 30-39% TBSA group to 55% [28/51] in the 90-100% TBSA group; p<0·0001), 154 (16%) developed multiorgan failure (increasing from 6% [ten] in the 30-39% TBSA group to 45% [23] in the 90-100% TBSA group; p<0·0001), and 89 (9%) had sepsis (increasing from 2% [three] in the 30-39% TBSA group to 26% [13] in the 90-100% TBSA group; p<0·0001). Burn size of 62% TBSA was a crucial threshold for mortality (odds ratio 10·07, 95% CI 5·56-18·22, p<0·0001). INTERPRETATION: We established that, in a modern paediatric burn care setting, a burn size of roughly 60% TBSA is a crucial threshold for postburn morbidity and mortality. On the basis of these findings, we recommend that paediatric patients with greater than 60% TBSA burns be immediately transferred to a specialised burn centre. Furthermore, at the burn centre, patients should be treated with increased vigilance and improved therapies, in view of the increased risk of poor outcome associated with this burn size. FUNDING: Shriners Hospitals for Children, US National Institutes of Health, US National Institute on Disability and Rehabilitation Research, Institute for Translational Sciences, CFI Leaders Opportunity Fund, Physicians’ Services Incorporated Foundation.

PMID: 22296810 [PubMed - as supplied by publisher]

Survival of children with burn injuries.

Lancet. 2012 Jan 30;

Authors: Tompkins RG

PMID: 22296811 [PubMed - as supplied by publisher]

How the Health and Social Care Bill 2011 would end entitlement to comprehensive health care in England.

Lancet. 2012 Jan 25;

Authors: Pollock AM, Price D, Roderick P, Treuherz T, McCoy D, McKee M, Reynolds L

PMID: 22284434 [PubMed - as supplied by publisher]

The Research Works Act: a damaging threat to science.

Lancet. 2012 Jan 28;379(9813):288

Authors:

PMID: 22284642 [PubMed - in process]

Neurological diseases remain neglected and ignored.

Lancet. 2012 Jan 28;379(9813):287

Authors:

PMID: 22284641 [PubMed - in process]

Tobacco in the USA: smoke and mirrors.

Lancet. 2012 Jan 28;379(9813):288

Authors:

PMID: 22284643 [PubMed - in process]

Optimisation of mass chemotherapy to control soil-transmitted helminth infection.

Lancet. 2012 Jan 28;379(9813):289-90

Authors: Anderson R, Hollingsworth TD, Truscott J, Brooker S

PMID: 22284644 [PubMed - in process]

Ndola Prata: fighting for women’s reproductive health.

Lancet. 2012 Jan 28;379(9813):305

Authors: Shetty P

PMID: 22284647 [PubMed - in process]

Screening for congenital heart disease with newborn pulse oximetry.

Lancet. 2012 Jan 28;379(9813):309-10; author reply 311

Authors: Ostman-Smith I, Granelli AW

PMID: 22284648 [PubMed - in process]

Screening for congenital heart disease with newborn pulse oximetry.

Lancet. 2012 Jan 28;379(9813):310-1; author reply 311

Authors: Nirantharakumar K

PMID: 22284649 [PubMed - in process]

Screening for congenital heart disease with newborn pulse oximetry.

Lancet. 2012 Jan 28;379(9813):310; author reply 311

Authors: Macfarlane P, Talekar R

PMID: 22284650 [PubMed - in process]

Coronary artery calcium for guiding statin treatment.

Lancet. 2012 Jan 28;379(9813):311-2; author reply 312-3

Authors: Ridker PM

PMID: 22284651 [PubMed - in process]

Coronary artery calcium for guiding statin treatment.

Lancet. 2012 Jan 28;379(9813):312; author reply 312-3

Authors: Kengne AP, Echouffo-Tcheugui JB, Sobngwi E

PMID: 22284653 [PubMed - in process]

ADDITION-Europe and the case for diabetes screening.

Lancet. 2012 Jan 28;379(9813):313; author reply 313-4

Authors: Yudkin JS, Montori VM, Lipska KJ, Gale EA

PMID: 22284655 [PubMed - in process]

Cited or read?

Lancet. 2012 Jan 28;379(9813):314

Authors: Bellini C

PMID: 22284657 [PubMed - in process]

Acute dyspnoea–not always above the diaphragm.

Lancet. 2012 Jan 28;379(9813):384

Authors: Chalisey A, Shah S, Karim M

PMID: 22284658 [PubMed - in process]

New antithrombotic drugs for atrial fibrillation: caution is needed.

Lancet. 2012 Jan 28;379(9813):e24; author reply e24-5

Authors: Bell S, Nand J, Spriggs D

PMID: 22284660 [PubMed - in process]

IAMP tackles a void in medical education: leadership.

Lancet. 2012 Jan 28;379(9813):e25

Authors: Gee RE, Jarvinen T, Sultana TA, Destura R, Gjoneska B

PMID: 22284661 [PubMed - in process]

Community-based treatment of severe childhood pneumonia.

Lancet. 2012 Jan 26;

Authors: Black RE, El Arifeen S

PMID: 22285052 [PubMed - as supplied by publisher]

A practical molecular assay to predict survival in resected non-squamous, non-small-cell lung cancer: development and international validation studies.

Lancet. 2012 Jan 26;

Authors: Kratz JR, He J, Van Den Eeden SK, Zhu ZH, Gao W, Pham PT, Mulvihill MS, Ziaei F, Zhang H, Su B, Zhi X, Quesenberry CP, Habel LA, Deng Q, Wang Z, Zhou J, Li H, Huang MC, Yeh CC, Segal MR, Ray MR, Jones KD, Raz DJ, Xu Z, Jahan TM, Berryman D, He B, Mann MJ, Jablons DM

Abstract

BACKGROUND: The frequent recurrence of early-stage non-small-cell lung cancer (NSCLC) is generally attributable to metastatic disease undetected at complete resection. Management of such patients depends on prognostic staging to identify the individuals most likely to have occult disease. We aimed to develop and validate a practical, reliable assay that improves risk stratification compared with conventional staging. METHODS: A 14-gene expression assay that uses quantitative PCR, runs on formalin-fixed paraffin-embedded tissue samples, and differentiates patients with heterogeneous statistical prognoses was developed in a cohort of 361 patients with non-squamous NSCLC resected at the University of California, San Francisco. The assay was then independently validated by the Kaiser Permanente Division of Research in a masked cohort of 433 patients with stage I non-squamous NSCLC resected at Kaiser Permanente Northern California hospitals, and on a cohort of 1006 patients with stage I-III non-squamous NSCLC resected in several leading Chinese cancer centres that are part of the China Clinical Trials Consortium (CCTC). FINDINGS: Kaplan-Meier analysis of the Kaiser validation cohort showed 5 year overall survival of 71·4% (95% CI 60·5-80·0) in low-risk, 58·3% (48·9-66·6) in intermediate-risk, and 49·2% (42·2-55·8) in high-risk patients (p(trend)=0·0003). Similar analysis of the CCTC cohort indicated 5 year overall survivals of 74·1% (66·0-80·6) in low-risk, 57·4% (48·3-65·5) in intermediate-risk, and 44·6% (40·2-48·9) in high-risk patients (p(trend)<0·0001). Multivariate analysis in both cohorts indicated that no standard clinical risk factors could account for, or provide, the prognostic information derived from tumour gene expression. The assay improved prognostic accuracy beyond National Comprehensive Cancer Network criteria for stage I high-risk tumours (p<0·0001), and differentiated low-risk, intermediate-risk, and high-risk patients within all disease stages. INTERPRETATION: Our practical, quantitative-PCR-based assay reliably identified patients with early-stage non-squamous NSCLC at high risk for mortality after surgical resection. FUNDING: UCSF Thoracic Oncology Laboratory and Pinpoint Genomics.

PMID: 22285053 [PubMed - as supplied by publisher]

Device regulation in the European Union: response from MHRA.

Lancet. 2012 Jan 26;

Authors: Woods K

PMID: 22285054 [PubMed - as supplied by publisher]

Effectiveness of community case management of severe pneumonia with oral amoxicillin in children aged 2-59 months in Matiari district, rural Pakistan: a cluster-randomised controlled trial.

Lancet. 2012 Jan 26;

Authors: Soofi S, Ahmed S, Fox MP, Macleod WB, Thea DM, Qazi SA, Bhutta ZA

Abstract

BACKGROUND: Pneumonia is a leading global cause of morbidity and mortality in children younger than 5 years. In Pakistan, the proportion of deaths due to pneumonia is higher in rural areas than it is in urban areas, with a substantial proportion of individuals dying at home because referral for care is problematic in such areas. We aimed to establish whether community case identification and management of severe pneumonia by oral antibiotics delivered through community health workers has the potential to reduce the number of infants dying at home. METHODS: We did a cluster-randomised controlled trial in Matiari district of rural Sindh, Pakistan. Public-sector lady health workers (LHWs) undertook community case management of WHO-defined severe pneumonia. The children in intervention clusters with suspected pneumonia were screened by LHWs and those diagnosed with severe pneumonia were prescribed oral amoxicillin syrup (90 mg/kg per day in two doses) for 5 days at home. Children in control clusters were given one dose of oral co-trimoxazole and were referred to their nearest health facility for admission and intravenous antibiotics, as per government policy. In both groups, follow-up visits at home were done at days 2, 3, 6, and 14 by LHW. The primary outcome was treatment failure by day 6 after enrolment. We matched and randomly allocated 18 clusters (union councils, the smallest administrative unit of the district) to either intervention and control using a computer-generated randomisation scheme. Analyses were done per-protocol. This trial is registered with ClinicalTrials.gov, number NCT01192789. FINDINGS: 2341 children in intervention clusters and 2069 children in control clusters participated in the study, enrolled between Feb 13, 2008, and March 15, 2010. We recorded 187 (8%) treatment failures by day 6 in the intervention group and 273 (13%) in the control group. After adjusting for clustering, the risk difference for treatment failure was -5·2% (95% CI -13·7% to 3·3%). We recorded three deaths, two by day 6 and one between days 7 and 14. We recorded no serious adverse events. INTERPRETATION: Public sector LHWs in Pakistan were able to satisfactorily diagnose and treat severe pneumonia at home in rural Pakistan. This strategy might effectively reach children with pneumonia in settings where referral is difficult, and it could be a key component of community detection and management strategies for childhood pneumonia. FUNDING: US Agency for International Development through grants to John Snow Incorporation and Boston University, USA.

PMID: 22285055 [PubMed - as supplied by publisher]

Homozygous familial hypercholesterolaemia.

Lancet. 2012 Jan 26;

Authors: Macchiaiolo M, Gagliardi MG, Toscano A, Guccione P, Bartuli A

PMID: 22285056 [PubMed - as supplied by publisher]

BRCA patent dispute may head to US Supreme Court.

Lancet. 2012 Jan 28;379(9813):300

Authors: Devi S

PMID: 22292161 [PubMed - in process]

CDC planning trial for mysterious nodding syndrome.

Lancet. 2012 Jan 28;379(9813):299

Authors: Donnelly J

PMID: 22292160 [PubMed - in process]

Anticoagulant loses its lustre.

Lancet. 2012 Jan 28;379(9813):301

Authors: Mullard A

PMID: 22292162 [PubMed - in process]

Shakespeare under water.

Lancet. 2012 Jan 28;379(9813):306-7

Authors: Boyce N

PMID: 22292164 [PubMed - in process]

Greece’s financial crisis dries up drug supply.

Lancet. 2012 Jan 28;379(9813):302

Authors: Karamanoli E

PMID: 22292163 [PubMed - in process]

What (if anything) to do about low-risk prostate cancer.

Lancet. 2012 Jan 23;

Authors: Parker C

PMID: 22277569 [PubMed - as supplied by publisher]

Dutasteride in localised prostate cancer management: the REDEEM randomised, double-blind, placebo-controlled trial.

Lancet. 2012 Jan 23;

Authors: Fleshner NE, Lucia MS, Egerdie B, Aaron L, Eure G, Nandy I, Black L, Rittmaster RS

Abstract

BACKGROUND: We aimed to investigate the safety and efficacy of dutasteride, a 5α-reductase inhibitor, on prostate cancer progression in men with low-risk disease who chose to be followed up with active surveillance. METHODS: In our 3 year, randomised, double-blind, placebo-controlled study, undertaken at 65 academic medical centres or outpatient clinics in North America, we enrolled men aged 48-82 years who had low-volume, Gleason score 5-6 prostate cancer and had chosen to be followed up with active surveillance. We randomly allocated participants in a one-to-one ratio, stratified by site and in block sizes of four, to receive once-daily dutasteride 0·5 mg or matching placebo. Participants were followed up for 3 years, with 12-core prostate biopsy samples obtained after 18 months and 3 years. The primary endpoint was time to prostate cancer progression, defined as the number of days between the start of study treatment and the earlier of either pathological progression (in patients with ≥1 biopsy assessment after baseline) or therapeutic progression (start of medical therapy). This trial is registered with ClinicalTrials.gov, number NCT00363311. FINDINGS: Between Aug 10, 2006, and March 26, 2007, we randomly allocated 302 participants, of whom 289 (96%) had at least one biopsy procedure after baseline and were included in the primary analysis. By 3 years, 54 (38%) of 144 men in the dutasteride group and 70 (48%) of 145 controls had prostate cancer progression (pathological or therapeutic; hazard ratio 0·62, 95% CI 0·43-0·89; p=0·009). Incidence of adverse events was much the same between treatment groups. 35 (24%) men in the dutasteride group and 23 (15%) controls had sexual adverse events or breast enlargement or tenderness. Eight (5%) men in the dutasteride group and seven (5%) controls had cardiovascular adverse events, but there were no prostate cancer-related deaths or instances of metastatic disease. INTERPRETATION: Dutasteride could provide a beneficial adjunct to active surveillance for men with low-risk prostate cancer. FUNDING: GlaxoSmithKline.

PMID: 22277570 [PubMed - as supplied by publisher]

Human embryonic stem cells: early hints on safety and efficacy.

Lancet. 2012 Jan 24;

Authors: Atala A

PMID: 22281387 [PubMed - as supplied by publisher]

Embryonic stem cell trials for macular degeneration: a preliminary report.

Lancet. 2012 Jan 24;

Authors: Schwartz SD, Hubschman JP, Heilwell G, Franco-Cardenas V, Pan CK, Ostrick RM, Mickunas E, Gay R, Klimanskaya I, Lanza R

Abstract

BACKGROUND: It has been 13 years since the discovery of human embryonic stem cells (hESCs). Our report provides the first description of hESC-derived cells transplanted into human patients. METHODS: We started two prospective clinical studies to establish the safety and tolerability of subretinal transplantation of hESC-derived retinal pigment epithelium (RPE) in patients with Stargardt’s macular dystrophy and dry age-related macular degeneration-the leading cause of blindness in the developed world. Preoperative and postoperative ophthalmic examinations included visual acuity, fluorescein angiography, optical coherence tomography, and visual field testing. These studies are registered with ClinicalTrials.gov, numbers NCT01345006 and NCT01344993. FINDINGS: Controlled hESC differentiation resulted in greater than 99% pure RPE. The cells displayed typical RPE behaviour and integrated into the host RPE layer forming mature quiescent monolayers after transplantation in animals. The stage of differentiation substantially affected attachment and survival of the cells in vitro after clinical formulation. Lightly pigmented cells attached and spread in a substantially greater proportion (>90%) than more darkly pigmented cells after culture. After surgery, structural evidence confirmed cells had attached and continued to persist during our study. We did not identify signs of hyperproliferation, abnormal growth, or immune mediated transplant rejection in either patient during the first 4 months. Although there is little agreement between investigators on visual endpoints in patients with low vision, it is encouraging that during the observation period neither patient lost vision. Best corrected visual acuity improved from hand motions to 20/800 (and improved from 0 to 5 letters on the Early Treatment Diabetic Retinopathy Study [ETDRS] visual acuity chart) in the study eye of the patient with Stargardt’s macular dystrophy, and vision also seemed to improve in the patient with dry age-related macular degeneration (from 21 ETDRS letters to 28). INTERPRETATION: The hESC-derived RPE cells showed no signs of hyperproliferation, tumorigenicity, ectopic tissue formation, or apparent rejection after 4 months. The future therapeutic goal will be to treat patients earlier in the disease processes, potentially increasing the likelihood of photoreceptor and central visual rescue. FUNDING: Advanced Cell Technology.

PMID: 22281388 [PubMed - as supplied by publisher]

India reports cases of totally drug-resistant tuberculosis.

Lancet. 2012 Jan 21;379(9812):205

Authors: Loewenberg S

PMID: 22272391 [PubMed - in process]

Germany’s hospital doctors prepare to strike en masse.

Lancet. 2012 Jan 21;379(9812):206

Authors: Holt E

PMID: 22272392 [PubMed - in process]

Blunting the legacy of alcohol abuse in Western Australia.

Lancet. 2012 Jan 21;379(9812):207-8

Authors: Kirby T

PMID: 22272393 [PubMed - in process]

Victorian visions of child development.

Lancet. 2012 Jan 21;379(9812):212-3

Authors: Shuttleworth S

PMID: 22272394 [PubMed - in process]

Subclinical thyroid disease.

Lancet. 2012 Jan 20;

Authors: Cooper DS, Biondi B

Abstract

Subclinical thyroid diseases-subclinical hyperthyroidism and subclinical hypothyroidism-are common clinical entities that encompass mild degrees of thyroid dysfunction. The clinical significance of mild thyroid overactivity and underactivity is uncertain, which has led to controversy over the appropriateness of diagnostic testing and possible treatment. In this Seminar, we discuss the definition, epidemiology, differential diagnoses, risks of progression to overt thyroid disease, potential effects on various health outcomes, and management of subclinical hyperthyroidism and subclinical hypothyroidism. Treatment recommendations are based on the degree to which thyroid-stimulating hormone concentrations have deviated from normal and underlying comorbidities. Large-scale randomised trials are urgently needed to inform how to best care for individuals with subclinical thyroid disease.

PMID: 22273398 [PubMed - as supplied by publisher]

Abortion: what is the problem?

Lancet. 2012 Jan 18;

Authors: Winikoff B, Sheldon WR

PMID: 22264434 [PubMed - as supplied by publisher]

Induced abortion: incidence and trends worldwide from 1995 to 2008.

Lancet. 2012 Jan 18;

Authors: Sedgh G, Singh S, Shah IH, Ahman E, Henshaw SK, Bankole A

Abstract

BACKGROUND: Data of abortion incidence and trends are needed to monitor progress toward improvement of maternal health and access to family planning. To date, estimates of safe and unsafe abortion worldwide have only been made for 1995 and 2003. METHODS: We used the standard WHO definition of unsafe abortions. Safe abortion estimates were based largely on official statistics and nationally representative surveys. Unsafe abortion estimates were based primarily on information from published studies, hospital records, and surveys of women. We used additional sources and systematic approaches to make corrections and projections as needed where data were misreported, incomplete, or from earlier years. We assessed trends in abortion incidence using rates developed for 1995, 2003, and 2008 with the same methodology. We used linear regression models to explore the association of the legal status of abortion with the abortion rate across subregions of the world in 2008. FINDINGS: The global abortion rate was stable between 2003 and 2008, with rates of 29 and 28 abortions per 1000 women aged 15-44 years, respectively, following a period of decline from 35 abortions per 1000 women in 1995. The average annual percent change in the rate was nearly 2·4% between 1995 and 2003 and 0·3% between 2003 and 2008. Worldwide, 49% of abortions were unsafe in 2008, compared to 44% in 1995. About one in five pregnancies ended in abortion in 2008. The abortion rate was lower in subregions where more women live under liberal abortion laws (p<0·05). INTERPRETATION: The substantial decline in the abortion rate observed earlier has stalled, and the proportion of all abortions that are unsafe has increased. Restrictive abortion laws are not associated with lower abortion rates. Measures to reduce the incidence of unintended pregnancy and unsafe abortion, including investments in family planning services and safe abortion care, are crucial steps toward achieving the Millennium Development Goals. FUNDING: UK Department for International Development, Dutch Ministry of Foreign Affairs, and John D and Catherine T MacArthur Foundation.

PMID: 22264435 [PubMed - as supplied by publisher]

Global health in 2012: development to sustainability.

Lancet. 2012 Jan 21;379(9812):193

Authors:

PMID: 22265616 [PubMed - in process]

Public health in England: from nudge to nag.

Lancet. 2012 Jan 21;379(9812):194

Authors:

PMID: 22265617 [PubMed - in process]

Global surgery–the final frontier?

Lancet. 2012 Jan 21;379(9812):194

Authors:

PMID: 22265618 [PubMed - in process]

Knowledge as a key resource for health challenges.

Lancet. 2012 Jan 21;379(9812):195-6

Authors: Antes G, Clarke M

PMID: 22265619 [PubMed - in process]

Hazel Dockrell: ambassador for international health research.

Lancet. 2012 Jan 21;379(9812):211

Authors: Morris K

PMID: 22265620 [PubMed - in process]

Novel melatonin-based treatments for major depression.

Lancet. 2012 Jan 21;379(9812):215-6; author reply 217-9

Authors: Howland RH

PMID: 22265621 [PubMed - in process]

Novel melatonin-based treatments for major depression.

Lancet. 2012 Jan 21;379(9812):215; author reply 217-9

Authors: Barbui C, Cipriani A

PMID: 22265622 [PubMed - in process]

Novel melatonin-based treatments for major depression.

Lancet. 2012 Jan 21;379(9812):216-7; author reply 217-9

Authors: Jureidini J, Raven M

PMID: 22265623 [PubMed - in process]

Novel melatonin-based treatments for major depression.

Lancet. 2012 Jan 21;379(9812):216; author reply 217-9

Authors: Carroll BJ

PMID: 22265624 [PubMed - in process]

Novel melatonin-based treatments for major depression.

Lancet. 2012 Jan 21;379(9812):216; author reply 217-9

Authors: Lloret-Linares C, Bergmann JF, Mouly S

PMID: 22265625 [PubMed - in process]

Novel melatonin-based treatments for major depression.

Lancet. 2012 Jan 21;379(9812):217; author reply 217-9

Authors: Serfaty M, Raven PW

PMID: 22265626 [PubMed - in process]

Haemopoietic stem-cell transplantation for systemic sclerosis.

Lancet. 2012 Jan 21;379(9812):219; author reply 219-20

Authors: Sullivan KM, Wigley FM, Denton CP, van Laar JM, Furst DE

PMID: 22265628 [PubMed - in process]

Stay the course–is it justified?

Lancet. 2012 Jan 21;379(9812):220

Authors: Sepehry AA, Lee PE, Hsiung GY, Jacova C

PMID: 22265630 [PubMed - in process]

Is it all cerebral toxoplasmosis?

Lancet. 2012 Jan 21;379(9812):286

Authors: Mentzer A, Perry M, Fitzgerald N, Barrington S, Siddiqui A, Kulasegaram R

PMID: 22265631 [PubMed - in process]

Child mental health care in Brazil: barriers and achievements.

Lancet. 2012 Jan 21;379(9812):e16-7

Authors: Fatori D, Evans-Lacko S, Bordin IA, de Paula C

PMID: 22265632 [PubMed - in process]

Ways out of the crisis behind Bribegate for Chinese doctors.

Lancet. 2012 Jan 21;379(9812):e16

Authors: Zhang H, Wu J

PMID: 22265633 [PubMed - in process]

Ways out of the crisis behind Bribegate for Chinese doctors.

Lancet. 2012 Jan 21;379(9812):e16

Authors: Li H, Zhang H

PMID: 22265634 [PubMed - in process]

Non-communicable disease priority actions and social inclusion.

Lancet. 2012 Jan 21;379(9812):e17-8

Authors: Mannan H, Amin M, MacLachlan M,

PMID: 22265635 [PubMed - in process]

Lithium toxicity profile: a systematic review and meta-analysis.

Lancet. 2012 Jan 19;

Authors: McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR

Abstract

BACKGROUND: Lithium is a widely used and effective treatment for mood disorders. There has been concern about its safety but no adequate synthesis of the evidence for adverse effects. We aimed to undertake a clinically informative, systematic toxicity profile of lithium. METHODS: We undertook a systematic review and meta-analysis of randomised controlled trials and observational studies. We searched electronic databases, specialist journals, reference lists, textbooks, and conference abstracts. We used a hierarchy of evidence which considered randomised controlled trials, cohort studies, case-control studies, and case reports that included patients with mood disorders given lithium. Outcome measures were renal, thyroid, and parathyroid function; weight change; skin disorders; hair disorders; and teratogenicity. FINDINGS: We screened 5988 abstracts for eligibility and included 385 studies in the analysis. On average, glomerular filtration rate was reduced by -6·22 mL/min (95% CI -14·65 to 2·20, p=0·148) and urinary concentrating ability by 15% of normal maximum (weighted mean difference -158·43 mOsm/kg, 95% CI -229·78 to -87·07, p<0·0001). Lithium might increase risk of renal failure, but the absolute risk was small (18 of 3369 [0·5%] patients received renal replacement therapy). The prevalence of clinical hypothyroidism was increased in patients taking lithium compared with those given placebo (odds ratio [OR] 5·78, 95% CI 2·00-16·67; p=0·001), and thyroid stimulating hormone was increased on average by 4·00 iU/mL (95% CI 3·90-4·10, p<0·0001). Lithium treatment was associated with increased blood calcium (+0·09 mmol/L, 95% CI 0·02-0·17, p=0·009), and parathyroid hormone (+7·32 pg/mL, 3·42-11·23, p<0·0001). Patients receiving lithium gained more weight than did those receiving placebo (OR 1·89, 1·27-2·82, p=0·002), but not those receiving olanzapine (0·32, 0·21-0·49, p<0·0001). We recorded no significant increased risk of congenital malformations, alopecia, or skin disorders. INTERPRETATION: Lithium is associated with increased risk of reduced urinary concentrating ability, hypothyroidism, hyperparathyroidism, and weight gain. There is little evidence for a clinically significant reduction in renal function in most patients, and the risk of end-stage renal failure is low. The risk of congenital malformations is uncertain; the balance of risks should be considered before lithium is withdrawn during pregnancy. Because of the consistent finding of a high prevalence of hyperparathyroidism, calcium concentrations should be checked before and during treatment. FUNDING: National Institute for Health Research Programme Grant for Applied Research.

PMID: 22265699 [PubMed - as supplied by publisher]

Chronic insomnia.

Lancet. 2012 Jan 19;

Authors: Morin CM, Benca R

Abstract

Insomnia is a prevalent complaint in clinical practice that can present independently or comorbidly with another medical or psychiatric disorder. In either case, it might need treatment of its own. Of the different therapeutic options available, benzodiazepine-receptor agonists (BzRAs) and cognitive-behavioural therapy (CBT) are supported by the best empirical evidence. BzRAs are readily available and effective in the short-term management of insomnia, but evidence of long-term efficacy is scarce and most hypnotic drugs are associated with potential adverse effects. CBT is an effective alternative for chronic insomnia. Although more time consuming than drug management, CBT produces sleep improvements that are sustained over time, and this therapy is accepted by patients. Although CBT is not readily available in most clinical settings, access and delivery can be made easier through use of innovative methods such as telephone consultations, group therapy, and self-help approaches. Combined CBT and drug treatment can optimise outcomes, although evidence to guide clinical practice on the best way to integrate these approaches is scarce.

PMID: 22265700 [PubMed - as supplied by publisher]

Is the safety of lithium no longer in the balance?

Lancet. 2012 Jan 19;

Authors: Malhi GS, Berk M

PMID: 22265701 [PubMed - as supplied by publisher]

Offline: The scandal of device regulation in the UK.

Lancet. 2012 Jan 17;

Authors: Horton R

PMID: 22260986 [PubMed - as supplied by publisher]

Prevention of serogroup B meningococcal disease.

Lancet. 2012 Jan 17;

Authors: Stephens DS

PMID: 22260987 [PubMed - as supplied by publisher]

Immunogenicity and tolerability of a multicomponent meningococcal serogroup B (4CMenB) vaccine in healthy adolescents in Chile: a phase 2b/3 randomised, observer-blind, placebo-controlled study.

Lancet. 2012 Jan 17;

Authors: Santolaya ME, O’Ryan ML, Valenzuela MT, Prado V, Vergara R, Muñoz A, Toneatto D, Graña G, Wang H, Clemens R, Dull PM,

Abstract

BACKGROUND: Effective glycoconjugate vaccines against Neisseria meningitidis serogroups A, C, W-135, and Y have been developed, but serogroup B remains a major cause of severe invasive disease in infants and adolescents worldwide. We assessed immunogenicity and tolerability of a four-component vaccine (4CMenB) in adolescents. METHODS: We did a randomised, observer-blind, placebo-controlled, study at 12 sites in Santiago and Valparaíso, Chile. Adolescents aged 11-17 years received one, two, or three doses of 4CMenB at 1 month, 2 month, or 6 month intervals. Immunogenicity was assessed as serum bactericidal activity using human complement (hSBA) against three reference strains for individual vaccine antigens, and assessed by ELISA against the fourth strain. Local and systemic reactions were recorded 7 days after each vaccination, and adverse events were monitored throughout the study. Participants were initially randomised to five groups (3:3:3:3:1) during the primary phase to receive either one dose, two doses 1 or 2 months apart, or three doses of 4CMenB, or three doses of placebo, with an additional three groups generated for the booster phase. All subjects received at least one dose of 4CMenB. Geometric mean titres, proportions of participants with serum bactericidal antibody titres of 4 or more, and Clopper-Pearson 95% CIs were calculated. The study is registered with ClinicalTrials.gov, number NCT00661713. FINDINGS: Overall, 1631 adolescents (mean age 13·8 [SD 1·9] years) received at least one dose of 4CMenB. After two or three doses, 99-100% of recipients had hSBA titres of 4 or more against test strains, compared with 92-97% after one dose (p<0·0145) and 29-50% after placebo. At 6 months 91-100% of participants still had titres of 4 or more for each strain after two or three doses, but only 73-76% after one dose; seroresponse rates reached 99-100% for each strain after second or third doses at 6 months. Local and systemic reaction rates were similar after each 4CMenB injection and did not increase with subsequent doses, but remained higher than placebo. No vaccine-related serious adverse events were reported and no significant safety signals were identified. INTERPRETATION: On the basis of immunogenicity responses this study provides evidence for an adolescent 4CMenB vaccine schedule of two doses, 1-6 months apart, to provide protection against meningococcal B infection. The extent of this protection against meningococcus B variants circulating worldwide will be determined by national surveys. FUNDING: Novartis Vaccines and Diagnostics.

PMID: 22260988 [PubMed - as supplied by publisher]

Dual inhibition of HER2 in breast cancer treatment.

Lancet. 2012 Jan 16;

Authors: Gnant M, Steger GG

PMID: 22257672 [PubMed - as supplied by publisher]

Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): a randomised, open-label, multicentre, phase 3 trial.

Lancet. 2012 Jan 16;

Authors: Baselga J, Bradbury I, Eidtmann H, Di Cosimo S, de Azambuja E, Aura C, Gómez H, Dinh P, Fauria K, Van Dooren V, Aktan G, Goldhirsch A, Chang TW, Horváth Z, Coccia-Portugal M, Domont J, Tseng LM, Kunz G, Sohn JH, Semiglazov V, Lerzo G, Palacova M, Probachai V, Pusztai L, Untch M, Gelber RD, Piccart-Gebhart M,

Abstract

BACKGROUND: The anti-HER2 monoclonal antibody trastuzumab and the tyrosine kinase inhibitor lapatinib have complementary mechanisms of action and synergistic antitumour activity in models of HER2-overexpressing breast cancer. We argue that the two anti-HER2 agents given together would be better than single-agent therapy. METHODS: In this parallel groups, randomised, open-label, phase 3 study undertaken between Jan 5, 2008, and May 27, 2010, women from 23 countries with HER2-positive primary breast cancer with tumours greater than 2 cm in diameter were randomly assigned to oral lapatinib (1500 mg), intravenous trastuzumab (loading dose 4 mg/m(2), subsequent doses 2 mg/kg), or lapatinib (1000 mg) plus trastuzumab. Treatment allocation was by stratified, permuted blocks randomisation, with four stratification factors. Anti-HER2 therapy alone was given for the first 6 weeks; weekly paclitaxel (80 mg/m(2)) was then added to the regimen for a further 12 weeks, before definitive surgery was undertaken. After surgery, patients received adjuvant chemotherapy followed by the same targeted therapy as in the neoadjuvant phase to 52 weeks. The primary endpoint was the rate of pathological complete response (pCR), analysed by intention to treat. This trial is registered with ClinicalTrials.gov, NCT00553358. FINDINGS: 154 patients received lapatinib, 149 trastuzumab, and 152 the combination. pCR rate was significantly higher in the group given lapatinib and trastuzumab (78 of 152 patients [51·3%; 95% CI 43·1-59·5]) than in the group given trastuzumab alone (44 of 149 patients [29·5%; 22·4-37·5]; difference 21·1%, 9·1-34·2, p=0·0001). We recorded no significant difference in pCR between the lapatinib (38 of 154 patients [24·7%, 18·1-32·3]) and the trastuzumab (difference -4·8%, -17·6 to 8·2, p=0·34) groups. No major cardiac dysfunctions occurred. Frequency of grade 3 diarrhoea was higher with lapatinib (36 patients [23·4%]) and lapatinib plus trastuzumab (32 [21·1%]) than with trastuzumab (three [2·0%]). Similarly, grade 3 liver-enzyme alterations were more frequent with lapatinib (27 [17·5%]) and lapatinib plus trastuzumab (15 [9·9%]) than with trastuzumab (11 [7·4%]). INTERPRETATION: Dual inhibition of HER2 might be a valid approach to treatment of HER2-positive breast cancer in the neoadjuvant setting. FUNDING: GlaxoSmithKline.

PMID: 22257673 [PubMed - as supplied by publisher]

Eye can see a nest of worms!

Lancet. 2012 Jan 12;

Authors: Lin H, Liang X

PMID: 22244656 [PubMed - as supplied by publisher]

Republican presidential candidates united on health care.

Lancet. 2012 Jan 14;379(9811):107

Authors: Bristol N

PMID: 22256349 [PubMed - in process]

Grassroots project shines hope on Nairobi slum life.

Lancet. 2012 Jan 14;379(9811):108-9

Authors: Loewenberg S

PMID: 22256350 [PubMed - in process]

Pro-anorexia websites pose public health challenge.

Lancet. 2012 Jan 14;379(9811):110

Authors: Christodoulou M

PMID: 22256351 [PubMed - in process]

The short life of a race drug.

Lancet. 2012 Jan 14;379(9811):114-5

Authors: Krimsky S

PMID: 22256352 [PubMed - in process]

Effect of population-based screening on breast cancer mortality.

Lancet. 2012 Jan 10;

Authors: Gøtzsche PC, Jørgensen KJ

PMID: 22240405 [PubMed - as supplied by publisher]