Riviste scientifiche

People are hacking antidepressant doses to avoid withdrawal

New Scientist - Ma, 11/07/2017 - 13:00
A patient-led movement is helping people taking psychiatric medicines to hack their dosing regimens, but regulatory agencies advise against self-medication

It’s time we all burst our carbon bubbles

New Scientist - Ma, 11/07/2017 - 11:00
Distant financial elites aren't the only ones with investments in the fossil fuel industry – most people with a private pension or savings account do too

Meningitis B vaccines may fight the rise of super-gonorrhoea

New Scientist - Ma, 11/07/2017 - 01:30
Antibiotic-resistant gonorrhoea has spread worldwide. Now there’s hope that existing vaccines for meningitis could control gonorrhoea before it becomes unbeatable

Cancer trials in sub-Saharan Africa: Aligning research and care

PLoS Medicine - Lu, 10/07/2017 - 23:00

by Satish Gopal

Satish Gopal discusses the challenges of deliverable cancer care and cancer trials in sub-Saharan Africa as well as a potential framework for overcoming these challenges.

Patient-reported outcomes and survival in multiple sclerosis: A 10-year retrospective cohort study using the Multiple Sclerosis Impact Scale–29

PLoS Medicine - Lu, 10/07/2017 - 23:00

by Joel Raffel, Alison Wallace, Djordje Gveric, Richard Reynolds, Tim Friede, Richard Nicholas

Background

There is increasing emphasis on using patient-reported outcomes (PROs) to complement traditional clinical outcomes in medical research, including in multiple sclerosis (MS). Research, particularly in oncology and heart failure, has shown that PROs can be prognostic of hard clinical endpoints such as survival time (time from study entry until death). However, unlike in oncology or cardiology, it is unknown whether PROs are associated with survival time in neurological diseases. The Multiple Sclerosis Impact Scale–29 (MSIS-29) is a PRO sensitive to short-term change in MS, with questions covering both physical and psychological quality of life. This study aimed to investigate whether MSIS-29 scores can be prognostic for survival time in MS, using a large observational cohort of people with MS.

Methods and findings

From 15 July 2004 onwards, MSIS-29 questionnaires were completed by people with MS registered with the MS Society Tissue Bank (n = 2,126, repeated 1 year later with n = 872 of the original respondents). By 2014, 264 participants (12.4%) had died. Higher baseline MSIS-29 physical (MSIS-29-PHYS) score was associated with reduced survival time (subgroup with highest scores versus subgroup with lowest scores: hazard ratio [HR] 5.7, 95% CI 3.1–10.5, p < 0.001). Higher baseline MSIS-29 psychological score was also associated with reduced survival time (subgroup with highest scores versus subgroup with lowest scores: HR 2.8, 95% CI 1.8–4.4, p < 0.001). In those with high baseline MSIS-29 scores, mortality risk was even greater if the MSIS-29 score worsened over 1 year (HR 2.3, 95% CI 1.2–4.4, p = 0.02). MSIS-29-PHYS scores were associated with survival time independent of age, sex, and patient-reported Expanded Disability Status Scale score in a Cox regression analysis (per 1-SD increase in MSIS-29-PHYS score: HR 1.8, 95% CI 1.1–2.9, p = 0.03). A limitation of the study is that this cohort had high baseline age and disability levels; the prognostic value of MSIS-29 for survival time at earlier disease stages requires further investigation.

Conclusions

This study reports that PROs can be prognostic for hard clinical outcomes in neurological disease, and supports PROs as a meaningful clinical outcome for use in research and clinical settings.

Risk of surgical site infection, acute kidney injury, and <i>Clostridium difficile</i> infection following antibiotic prophylaxis with vancomycin plus a beta-lactam versus either drug alone: A national propensity-score-adjusted retrospective cohort study

PLoS Medicine - Lu, 10/07/2017 - 23:00

by Westyn Branch-Elliman, John E. Ripollone, William J. O’Brien, Kamal M. F. Itani, Marin L. Schweizer, Eli Perencevich, Judith Strymish, Kalpana Gupta

Background

The optimal regimen for perioperative antimicrobial prophylaxis is controversial. Use of combination prophylaxis with a beta-lactam plus vancomycin is increasing; however, the relative risks and benefits associated with this strategy are unknown. Thus, we sought to compare postoperative outcomes following administration of 2 antimicrobials versus a single agent for the prevention of surgical site infections (SSIs). Potential harms associated with combination regimens, including acute kidney injury (AKI) and Clostridium difficile infection (CDI), were also considered.

Methods and findings

Using a multicenter, national Veterans Affairs (VA) cohort, all patients who underwent cardiac, orthopedic joint replacement, vascular, colorectal, and hysterectomy procedures during the period from 1 October 2008 to 30 September 2013 and who received planned manual review of perioperative antimicrobial prophylaxis regimen and manual review for the 30-day incidence of SSI were included. Using a propensity-adjusted log-binomial regression model stratified by type of surgical procedure, the association between receipt of 2 antimicrobials (vancomycin plus a beta-lactam) versus either single agent alone (vancomycin or a beta-lactam) and SSI was evaluated. Measures of association were adjusted for age, diabetes, smoking, American Society of Anesthesiologists score, preoperative methicillin-resistant Staphylococcus aureus (MRSA) status, and receipt of mupirocin. The 7-day incidence of postoperative AKI and 90-day incidence of CDI were also measured. In all, 70,101 procedures (52,504 beta-lactam only, 5,089 vancomycin only, and 12,508 combination) with 2,466 (3.5%) SSIs from 109 medical centers were included. Among cardiac surgery patients, combination prophylaxis was associated with a lower incidence of SSI (66/6,953, 0.95%) than single-agent prophylaxis (190/12,834, 1.48%; crude risk ratio [RR] 0.64, 95% CI 0.49, 0.85; adjusted RR 0.61, 95% CI 0.46, 0.83). After adjusting for SSI risk, no association between receipt of combination prophylaxis and SSI was found for the other types of surgeries evaluated, including orthopedic joint replacement procedures. In MRSA-colonized patients undergoing cardiac surgery, SSI occurred in 8/346 (2.3%) patients who received combination prophylaxis versus 4/100 (4.0%) patients who received vancomycin alone (crude RR 0.58, 95% CI 0.18, 1.88). Among MRSA-negative and -unknown cardiac surgery patients, SSIs occurred in 58/6,607 (0.9%) patients receiving combination prophylaxis versus 146/10,215 (1.4%) patients who received a beta-lactam alone (crude RR 0.61, 95% CI 0.45, 0.83). Based on these associations, the number needed to treat to prevent 1 SSI in MRSA-colonized patients is estimated to be 53, compared to 176 in non-MRSA patients. CDI incidence was similar in both exposure groups. Across all types of surgical procedures, risk of AKI was increased in the combination antimicrobial prophylaxis group (2,971/12,508 [23.8%] receiving combination versus 1,058/5,089 [20.8%] receiving vancomycin alone versus 7,314/52,504 [13.9%] receiving beta-lactam alone). We found a significant association between absolute risk of AKI and receipt of combination regimens across all types of procedures. If the observed association is causal, the number needed to harm for severe AKI following cardiac surgery would be 167. The major limitation of our investigation is that it is an observational study in a predominantly male population, which may limit generalizability and lead to unmeasured confounding.

Conclusions

There are benefits but also unintended consequences of antimicrobial and infection prevention strategies aimed at “getting to zero” healthcare-associated infections. In our study, combination prophylaxis was associated with both benefits (reduction in SSIs following cardiac surgical procedures) and harms (increase in postoperative AKI). In cardiac surgery patients, the difference in risk–benefit profile by MRSA status suggests that MRSA-screening-directed prophylaxis may optimize benefits while minimizing harms in this selected population. More information about long-term outcomes and patient and societal preferences regarding risk of SSI versus risk of AKI is needed to improve clinical decision-making.

Sunflowers work together to avoid overcrowding and soak up rays

New Scientist - Lu, 10/07/2017 - 22:00
In very dense fields, sunflowers self-organise into an alternating-tilt pattern that maximises exposure to sunlight

Brain-training game fails test against regular computer games

New Scientist - Lu, 10/07/2017 - 20:00
A study that pitted the Lumosity brain-training program against other computer games suggests it’s no better than them at improving your cognitive abilities

Quantum cheques could be a forgery-free way to move money

New Scientist - Lu, 10/07/2017 - 19:34
Using IBM’s cloud-based quantum computer, researchers have shown that it’s possible to create ultra-secure cheques with quantum technology

Mike Pence says he touched NASA equipment on a dare

New Scientist - Lu, 10/07/2017 - 18:10
The US Vice President placed his hands on a piece of the Orion spacecraft while on a tour at NASA’s Kennedy Space Center, despite a sign that forbade it

Climate change lets invaders beat Alpine plants in mountain race

New Scientist - Lu, 10/07/2017 - 18:00
Rising temperatures and mountain roads are helping invasive weeds to overwhelm native Alpine flowers

Titan’s conditions could be just right to power US-sized colony

New Scientist - Lu, 10/07/2017 - 17:15
Saturn’s largest moon may be able to provide enough wind, solar or tidal power to make human life there a possibility – if we can build the tech to exploit it

Spiders lure bees for dinner by making flowers look flashier

New Scientist - Lu, 10/07/2017 - 13:54
Crab spiders that sit on flowers and reflect UV light could be attracting bees, making them easier prey

Nice science, but don’t forget about the ethics

New Scientist - Lu, 10/07/2017 - 12:00
The march of science is giving us new powers, but also creating new ethical dilemmas. We must trust in public engagement to try to seek consensus

[Correspondence] Open letter to the UN's new health chief from “Alternative Nobel Prize” laureates

The Lancet - Sa, 08/07/2017 - 00:30
We congratulate Tedros Adhanom Ghebreyesus on his election as Director-General of WHO—a job that literally makes the difference between life and death for millions of people around the world.

[Editorial] Addressing the vulnerability of the global food system

The Lancet - Sa, 08/07/2017 - 00:00
Nearly 1 billion people depend on international trade to sustain their food requirements, making the global food system a vital component of food security. On June 27, Chatham House published Chokepoints and Vulnerabilities in Global Food Trade. This report shows that the global food system is reliant upon highly delicate trade routes, which navigate through 14 so-called chokepoints—such as the Suez Canal, Black Sea ports, and Brazil's road network—where food trade is vulnerable to interruptions or disruptions.

[Editorial] An African-driven health agenda

The Lancet - Sa, 08/07/2017 - 00:00
The first WHO Africa health forum closed on June 28 in Kigali, Rwanda, with commitments from governments to ensure universal health coverage. 700 delegates attended the forum organised by the WHO regional office for Africa to review progress towards the health-related sustainable development goals. The promises of universal health coverage chime well with the instalment of Dr Tedros as WHO's 9th director-general on July 1. He has said “all roads should lead to universal health coverage”. Being the first African director-general, and having transformed Ethiopia's health system, Dr Tedros' leadership bodes well for Africa's visibility on the international health stage and may translate into needed health gains.

[Editorial] Where next for UK tobacco control?

The Lancet - Sa, 08/07/2017 - 00:00
July 1, 2017, marked the tenth anniversary of the entire UK becoming smoke free in indoor public places, an opportune moment for Cancer Research UK (CRUK) to provide an update on UK smoking prevalence. Compared with 2007, there are 1·9 million fewer smokers, a reduction from 21% to 16%. Smoking prevalence has never been so low, although there remain 8 million smokers in the UK. Importantly, the latest data show that the largest reduction occurred in the 16–24 year age group, although this could reflect a lifestyle switch from tobacco to the £1 billion UK e-cigarette industry among younger people.

[Comment] What is the impact of treatment for hepatitis C virus infection?

The Lancet - Sa, 08/07/2017 - 00:00
The introduction of direct-acting antiviral (DAA) medicines in 2013 revolutionised the treatment of chronic hepatitis C virus (HCV) infection. The efficacy of DAA therapy is impressive—in many clinical trials HCV cannot be detected by sensitive laboratory assays in more than 90% of people who complete DAA therapy, and observational studies have documented similar results.1,2 High efficacy combined with low rates of adverse events have led WHO to include DAAs in the WHO Model List of Essential Medicines.

[Comment] Retraction and republication—Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of osteoarthritis pain: a network meta-analysis

The Lancet - Sa, 08/07/2017 - 00:00
On March 17, 2016, The Lancet published online a network meta-analysis of the effectiveness of non-steroidal anti-inflammatory drugs for pain in knee and hip osteoarthritis, and the Article was published in print on May 21, 2016.1 On July 6, 2016, the authors drew our attention to two missed trials2,3 and a duplicate publication.4,5 Lancet editors discussed the corrections that were needed in the paper, and decided, in accordance with the Committee on Publication Ethics' guidelines, that because of the extent of the changes necessary, the previous version of the Article should be retracted and a corrected version republished after reanalysis and rereview.
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