Hot off the presses! Nov 12 LANCET

The Nov 12 issue of the LANCET is now up on Pubget (About LANCET): if you're at a subscribing institution, just click the link in the latest link at the home page. (Note you'll only be able to get all the PDFs in the issue if your institution subscribes to Pubget.)

Latest Articles Include:

• The day of diabetes: coming soon to a person near you
  - LANCET 376(9752):1513 (2010)
  
• Trick or treat or UNICEF Canada
  - LANCET 376(9752):1514 (2010)
  
• Addressing mental health in the UK
  - LANCET 376(9752):1514 (2010)
  
• Malaria elimination: worthy, challenging, and just possible
  - LANCET 376(9752):1515-1517 (2010)
  
• Call to action: priorities for malaria elimination
  - LANCET 376(9752):1517-1521 (2010)
  
• Into the light? Diabetic nephropathy and vitamin D
  - LANCET 376(9752):1521-1522 (2010)
  
• Dispatcher-assisted bystander CPR: a KISS for a kiss
  - LANCET 376(9752):1522-1524 (2010)
  
• Ranking of drugs: a more balanced risk-assessment
  - LANCET 376(9752):1524-1525 (2010)
  
• Offline: Danger in Scotland
  - LANCET 376(9752):1526 (2010)
  
• Healing the scars of torture
  - LANCET 376(9752):1527-1528 (2010)
  
• Grasping the nettle of mental illness in prisons
  - LANCET 376(9752):1529-1530 (2010)
  
• Tracking the fever trail of malaria
  - LANCET 376(9752):1531-1532 (2010)
  
• A distorting take on DDT
  - LANCET 376(9752):1532 (2010)
  
• Richard Feachem—scaling the heights of global health leadership
  - LANCET 376(9752):1533 (2010)
  
• Experimenting with fire: giving malaria
  - LANCET 376(9752):1534-1535 (2010)
  
• Nicholas Cohen
  - LANCET 376(9752):1536 (2010)
  
• Mephedrone: still available and twice the price
  - LANCET 376(9752):1537 (2010)
  
• The twilight of dementia
  - LANCET 376(9752):1537 (2010)
  
• The twilight of dementia
  - LANCET 376(9752):1537-1538 (2010)
  
• The twilight of dementia – Author's reply
  - LANCET 376(9752):1538 (2010)
  
• How generalisable is INTERSTROKE?
  - LANCET 376(9752):1538-1539 (2010)
  
• How generalisable is INTERSTROKE? – Authors' reply
  - LANCET 376(9752):1539 (2010)
  
• Biomarkers and diagnostics for tuberculosis
  - LANCET 376(9752):1539-1540 (2010)
  
• Biomarkers and diagnostics for tuberculosis – Authors' reply
  - LANCET 376(9752):1540 (2010)
  
• Family physicians in Iran: success despite challenges
  - LANCET 376(9752):1540-1541 (2010)
  
• Family physicians in Iran: success despite challenges
  - LANCET 376(9752):1541 (2010)
  
• Membership exams overseas in light of new global code of practice
  - LANCET 376(9752):1541-1542 (2010)
  
• Science as superstition
  - LANCET 376(9752):1542 (2010)
  
• Department of Error
  - LANCET 376(9752):1542 (2010)
  
• Department of Error
  - LANCET 376(9752):1542 (2010)
  
• Selective vitamin D receptor activation with paricalcitol for reduction of albuminuria in patients with type 2 diabetes (VITAL study): a randomised controlled trial
  - LANCET 376(9752):1543-1551 (2010)
  Background Despite treatment with renin–angiotensin–aldosterone system (RAAS) inhibitors, patients with diabetes have increased risk of progressive renal failure that correlates with albuminuria. We aimed to assess whether paricalcitol could be used to reduce albuminuria in patients with diabetic nephropathy. Methods In this multinational, placebo-controlled, double-blind trial, we enrolled patients with type 2 diabetes and albuminuria who were receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Patients were assigned (1:1:1) by computer-generated randomisation sequence to receive 24 weeks' treatment with placebo, 1 μg/day paricalcitol, or 2 μg/day paricalcitol. The primary endpoint was the percentage change in geometric mean urinary albumin-to-creatinine ratio (UACR) from baseline to last measurement during treatment for the combined paricalcitol groups versus the placebo group. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00421733. Findings Between February, 2007, and October, 2008, 281 patients were enrolled and assigned to receive placebo (n=93), 1 μg paricalcitol (n=93), or 2 μg paricalcitol (n=95); 88 patients on placebo, 92 on 1 μg paricalcitol, and 92 on 2 μg paricalcitol received at least one dose of study drug, and had UACR data at baseline and at least one timepoint during treatment, and so were included in the primary analysis. Change in UACR was: −3% (from 61 to 60 mg/mmol; 95% CI −16 to 13) in the placebo group; −16% (from 62 to 51 mg/mmol; −24 to −9) in the combined paricalcitol groups, with a between-group difference versus placebo of −15% (95% CI −28 to 1; p=0·071); −14% (from 63 to 54 mg/mmol; −24 to −1) in the 1 μg paricalcitol group, with a between-group difference versus placebo of −11% (95% CI −27 to 8; p=0·23); and −20% (from 61 to 49 mg/mmol; −30 to −8) in the 2 μg paricalcitol group, with a between-group difference versus placebo of −18% (95% CI −! 32 to 0; p=0·053). Patients on 2 μg paricalcitol showed an early, sustained reduction in UACR, ranging from −18% to −28% (p=0·014 vs placebo). Incidence of hypercalcaemia, adverse events, and serious adverse events was similar between groups receiving paricalcitol versus placebo. Interpretation Addition of 2 μg/day paricalcitol to RAAS inhibition safely lowers residual albuminuria in patients with diabetic nephropathy, and could be a novel approach to lower residual renal risk in diabetes. Funding Abbott.
• Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis
  - LANCET 376(9752):1552-1557 (2010)
  Background 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. Methods Medline and Embase were systematically reviewed for studies published between January, 1985, and August, 2010, in which chest-compression-only bystander CPR was compared with standard bystander CPR for adult patients with out-of-hospital cardiac arrest. In the primary meta-analysis, we included trials in which patients were randomly allocated to receive one of the two CPR techniques, according to dispatcher instructions; and in the secondary meta-analysis, we included observational cohort studies of chest-compression-only CPR. All studies had to supply survival data. The primary outcome was survival to hospital discharge. A fixed-effects model was used for both meta-analyses because of an absence of heterogeneity among the studies (I2=0%). Findings In the primary meta-analysis, pooled data from three randomised trials showed that chest-compression-only CPR was associated with improved chance of survival compared with standard CPR (14% [211/1500] vs 12% [178/1531]; risk ratio 1·22, 95% CI 1·01–1·46). The absolute increase in survival was 2·4% (95% CI 0·1–4·9), and the number needed to treat was 41 (95% CI 20–1250). In the secondary meta-analysis of seven observational cohort studies, no difference was recorded between the two CPR techniques (8% [223/2731] vs 8% [863/11 152]; risk ratio 0·96, 95% CI 0·83–1·11). Interpretation For adults with out-of-hospital cardiac arrest, instructions to bystanders from emergency medical services dispatch should focus on chest-compression-only CPR. Funding US National Institutes of Health and American Heart Association.
• Drug harms in the UK: a multicriteria decision analysis
  - LANCET 376(9752):1558-1565 (2010)
  Background Proper assessment of the harms caused by the misuse of drugs can inform policy makers in health, policing, and social care. We aimed to apply multicriteria decision analysis (MCDA) modelling to a range of drug harms in the UK. Methods Members of the Independent Scientific Committee on Drugs, including two invited specialists, met in a 1-day interactive workshop to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance. Findings MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places. Interpretation These findings lend support to previous work assessing drug harms, and show how the improved scoring and weighting approach of MCDA increases the differentiation between the most and least harmful drugs. However, the findings correlate poorly with present UK drug classification, which is not based simply on considerations of harm. Funding Centre for Crime and Justice Studies (UK).
• Shrinking the malaria map: progress and prospects
  - LANCET 376(9752):1566-1578 (2010)
  In the past 150 years, roughly half of the countries in the world eliminated malaria. Nowadays, there are 99 endemic countries—67 are controlling malaria and 32 are pursuing an elimination strategy. This four-part Series presents evidence about the technical, operational, and financial dimensions of malaria elimination. The first paper in this Series reviews definitions of elimination and the state that precedes it: controlled low-endemic malaria. Feasibility assessments are described as a crucial step for a country transitioning from controlled low-endemic malaria to elimination. Characteristics of the 32 malaria-eliminating countries are presented, and contrasted with countries that pursued elimination in the past. Challenges and risks of elimination are presented, including Plasmodium vivax, resistance in the parasite and mosquito populations, and potential resurgence if investment and vigilance decrease. The benefits of elimination are outlined, specifically elim! ination as a regional and global public good. Priorities for the next decade are described.
• Ranking of elimination feasibility between malaria-endemic countries
  - LANCET 376(9752):1579-1591 (2010)
  Experience gained from the Global Malaria Eradication Program (1955–72) identified a set of shared technical and operational factors that enabled some countries to successfully eliminate malaria. Spatial data for these factors were assembled for all malaria-endemic countries and combined to provide an objective, relative ranking of countries by technical, operational, and combined elimination feasibility. The analysis was done separately for Plasmodium falciparum and Plasmodium vivax, and the limitations of the approach were discussed. The relative rankings suggested that malaria elimination would be most feasible in countries in the Americas and Asia, and least feasible in countries in central and west Africa. The results differed when feasibility was measured by technical or operational factors, highlighting the different types of challenge faced by each country. The results are not intended to be prescriptive, predictive, or to provide absolute assessments of feas! ibility, but they do show that spatial information is available to facilitate evidence-based assessments of the relative feasibility of malaria elimination by country that can be rapidly updated.
• Operational strategies to achieve and maintain malaria elimination
  - LANCET 376(9752):1592-1603 (2010)
  Present elimination strategies are based on recommendations derived during the Global Malaria Eradication Program of the 1960s. However, many countries considering elimination nowadays have high intrinsic transmission potential and, without the support of a regional campaign, have to deal with the constant threat of imported cases of the disease, emphasising the need to revisit the strategies on which contemporary elimination programmes are based. To eliminate malaria, programmes need to concentrate on identification and elimination of foci of infections through both passive and active methods of case detection. This approach needs appropriate treatment of both clinical cases and asymptomatic infections, combined with targeted vector control. Draining of infectious pools entirely will not be sufficient since they could be replenished by imported malaria. Elimination will thus additionally need identification and treatment of incoming infections before they lead to tran! smission, or, more realistically, embarking on regional initiatives to dry up importation at its source.
• Costs and financial feasibility of malaria elimination
  - LANCET 376(9752):1604-1615 (2010)
  The marginal costs and benefits of converting malaria programmes from a control to an elimination goal are central to strategic decisions, but empirical evidence is scarce. We present a conceptual framework to assess the economics of elimination and analyse a central component of that framework—potential short-term to medium-term financial savings. After a review that showed a dearth of existing evidence, the net present value of elimination in five sites was calculated and compared with effective control. The probability that elimination would be cost-saving over 50 years ranged from 0% to 42%, with only one site achieving cost-savings in the base case. These findings show that financial savings should not be a primary rationale for elimination, but that elimination might still be a worthy investment if total benefits are sufficient to outweigh marginal costs. Robust research into these elimination benefits is urgently needed.
• Flowers of evil
  - LANCET 376(9752):1616 (2010)