Lancet
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Case Reports
Interpreting survival rates for the treatment of decompensated diabetes: are we saving too many lives?
Discussion of the case of a patient admitted to hospital with decompensated diabetes revealed a conflict in attitudes to resuscitation of the patient from that disorder and from cardiac arrest. A survey was sent to 200 diabetologists and 200 cardiologists in the United Kingdom, asking about their management of diabetes and their therapeutic approaches to cardiac arrest for 3 elderly patients admitted with severe decompensated diabetes. The response rate was poor (27%) but the answers showed that all 3 patients were more likely to be resuscitated from decompensated diabetes than from cardiac arrest. Possible reasons for a different approach to the two conditions are discussed, and suggestions are put forward for a greater involvement by patients in decisions about future resuscitation.
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In 1983, a comprehensive programme was introduced to halt the spread of hepatitis B virus (HBV) infection and to reduce mortality from hepatocellular carcinoma (HCC) in Alaskan Natives, in whom the incidence of HBV infection was high. This programme includes: serological screening of all Alaskan Natives; immunisation of susceptible persons, including all newborn babies, with hepatitis B vaccine; and testing HBsAg-positive carriers twice a year for alpha-fetoprotein (AFP) to detect HCC at an early stage. ⋯ After complete immunisation of 90% of the susceptibles in the area with the highest infection rates in Alaska, the annual incidence of acute symptomatic HBV infection decreased from 215 to 14 cases per 100,000 population. After the introduction of AFP screening, the 1-year-case-fatality rate for HCC fell, from 100%, to 50%.
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Letter Randomized Controlled Trial Clinical Trial
Live attenuated oral rotavirus vaccine.