Lancet
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Letter Randomized Controlled Trial Clinical Trial
Should we treat acute respiratory distress syndrome with inhaled nitric oxide?
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The provision of intensive care is a perplexing issue for clinicians and the public. Concerns about the apparent lack of beds and the appropriateness of the patients admitted are tempered by the high cost of providing this service. As part of a study commissioned by the UK Department of Health, we tested the hypothesis that there is excess mortality among patients who are refused admission to intensive-care units. ⋯ Although this study is observational and case-mix adjustment is incomplete, we found a higher rate of attributable mortality in patients who were refused intensive care, particularly for emergency cases. We question whether the provision of more beds alone would be a solution and conclude that there is an urgent need for more appropriate admission and discharge criteria.
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In 1995, the World Bank launched an African Programme for Onchocerciasis Control to eliminate Onchocerca volvulus disease from 19 African countries by means of community-based ivermectin treatment (CBIT). Several cases of encephalopathy have been reported after ivermectin in people heavily infected with microfilariae of Loa loa (loiasis). We assessed the incidence of serious events in an area where onchocerciasis and loiasis are both endemic. ⋯ Epidemiological surveys aimed at assessing the intensity of infection with L loa microfilariae should be done before ivermectin is distributed for onchocerciasis control in areas where loiasis is endemic. In communities at risk, monitoring procedures should be established and adhered to during CBIT so that people developing serious reactions may receive appropriate treatment.